COVID at 2 Years: Preparing for a Different ‘Normal’

Two years into the COVID-19 pandemic, the United States is still breaking records for hospital overcrowding and new cases.

The US is logging nearly 800,000 cases a day, hospitals are starting to fray, and deaths in the US have topped 850,000. Schools oscillate from remote to in-person learning, polarizing communities.

The vaccines are lifesaving for many, yet frustration mounts as the number of unvaccinated people in this country stays relatively stagnant (63% in the US are fully vaccinated) and other parts of the world have seen hardly a single dose. Africa has the slowest vaccination rate among continents, with only 14% of the population receiving one shot, according to The New York Times tracker.

Yet there is good reason for optimism among leading US experts because of how far science and medicine have come since the World Health Organization first acknowledged person-to-person transmission of the virus in January 2020.

Effective vaccines and treatments that can keep people out of the hospital were developed at an astounding pace, and advances in tracking and testing — in both access and effectiveness — are starting to pay off.

Some experts see the possibility that the raging Omicron surge will slow, possibly by late spring, providing some relief and possibly shifting the pandemic to a slower-burning endemic.

But other experts caution to keep our guard up, saying it’s time to settle into a “new normal” and upend the strategy for fighting COVID-19.

Time to Change COVID Thinking

Three former members of the Biden-Harris Transition COVID-19 Advisory Board wrote recently in the Journal of the American Medical Association that COVID-19 has now become one of the many viral respiratory diseases providers and patients will manage each year.

The group of experts from the University of Pennsylvania, University of Minnesota, and New York University write that “many of the measures to reduce transmission of SARS-CoV-2 (eg, ventilation) will also reduce transmission of other respiratory viruses. Thus, policy makers should retire previous public health categorizations, including deaths from pneumonia and influenza or pneumonia, influenza, and COVID-19, and focus on a new category: the aggregate risk of all respiratory virus infections.”

Dr Amesh Adalja

Other experts, including Amesh Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security in Baltimore, Maryland, have said that it’s been clear since the early days of SARS-CoV-2 that we must learn to live with the virus because it  “will be ever present for the remaining history of our species.”

But that doesn’t mean the virus will always have the upper hand. Although the US has been reaching record numbers of hospitalizations in January, these hospitalizations differ from those of last year — marked by fewer extreme life-saving measures, fewer deaths, and shorter hospital stays — due in part to medical and therapeutic advances and in part to the nature of the Omicron variant itself.

One sign of progress, Adalja said, will be the widespread decoupling of cases from hospitalizations, something that has already happened in countries such as the United Kingdom.

“That’s a reflection of how well they have vaccinated their high-risk population and how poorly we have vaccinated our high-risk population,” he said.

Omicron Will Bump Up Natural Immunity

Adalja said though the numbers of unvaccinated in the US appear stuck, Omicron’s sweep will make the difference, leaving behind more natural immunity in the population.

Currently, hospitals are struggling with staffing concerns as a “direct result” of too many unvaccinated people, he said.

Dr Andrew Badley

Andrew Badley, MD, an infectious diseases specialist at Mayo Clinic in Rochester, Minnesota, and director of the clinic’s COVID-19 Task Force, said the good news with Omicron is that nearly all people it infects will recover. Over time when the body sees foreign antigens repeatedly, the quantity and quality of the antibodies the immune system produces increase and the body becomes more efficient at fighting disease.

Therefore, “a large amount of the population will have recovered and have a degree of immunity,” Badley said.

His optimism is tempered by his belief that “it’s going to get worse before it gets better.”

But Badley still predicts a turnaround. “We’ll see a downturn in COVID in late spring or early summer where well into the second quarter of 2022 “we’ll see a reemergence of control.”

Right now, with Omicron, one infected person is infecting three to five others, he said. The hope is that it will eventually reach one to one endemic levels.

As for the threat of new variants, Badley said, “It’s not predictable whether they will be stronger or weaker.”

Masks May Be Around for Years

Many experts predict that masks will continue to be part of the national wardrobe for the foreseeable future.

“We will continue to see new cases for years and years to come. Some will respond to that with masks in public places for a very long time. I personally will do so.”

Two Mindsets: Inside/Outside the Hospital

Emily Landon, MD, an infectious disease physician and the executive medical director of Infection Prevention and Control at University of Chicago Medicine, told Medscape Medical News she views the pandemic from two different vantage points.

As a healthcare provider, she sees her hospital, like others worldwide, overwhelmed. Supplies of a major weapon to help prevent hospitalization, the monoclonal antibody sotrovimab, are running out. Landon said she has been calling other hospitals to see if they have supplies and, if so, whether Omicron patients can transfer there.

https://www.medscape.com/viewarticle/966877?src=soc_fb_220122_mscpedt_news_mdscp_covid&faf=1#vp_2

Créditos: Comité científico Covid