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The Pandemic Isn't Over. Here's How to Stay Safe
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science
May 2023
After more than three years, over 6 million hospitalizations, and 1.1 million American deaths, the Biden Administration has officially declared an end to the federal Covid-19 public health emergency as of May 11, 2023.
In a fact sheet summarizing the decision, the US Department of Health and Human Services stated that since January 2021, Covid-19-related hospitalizations and deaths have declined by 91 percent and 95 percent, respectively.
With the World Health Organization also declaring earlier this month that Covid-19 is now merely a global health threat, rather than an "emergency of international concern," May 2023 marks a watershed in the pandemic.
However, some experts fear that such declarations can be misleading. "When the government sends the messaging that Covid-19 is largely over, I don't think it's helpful," says Harvard University epidemiologist William Hanage. "I would argue that the ongoing cost of Covid should be less than we are tolerating. People are still dying, and the frustrating thing is that many of these deaths are preventable."
While the significant spikes in hospitalizations and deaths that characterized so much of 2020 and 2021 are long gone, due to the efficacy of the global vaccination rollout, Covid-19 is still taking an ongoing death toll.
According to the Centers for Disease Control and Prevention (CDC), more than 1,000 Americans are still dying from causes related to the SARS-CoV-2 virus each week. This continuous line of fatalities can add up to a surprisingly large number over the course of weeks and months. Based on the CDC's figures, some 42,924 Americans died from Covid-19 between December 28 and May 3.
"It's a slow burn, but it's a steady burn," says Denis Nash, an epidemiologist at the City University of New York. "When you start to look at this data across time, it really is scary and insidious how many deaths are still happening. I think when people see it tallied that way, they begin to really appreciate how this is not over in the way that we hear a lot of our elected leaders, politicians, and other talking heads discussing it."
The elderly and people with underlying health conditions remain the most vulnerable to the virus. In particular, the 7 million Americans who are immunocompromised remain at risk from the virus because key monoclonal antibody treatments are now ineffective against the newer variants.
Cutbacks in data collection have meant that it's hard for scientists to understand which sectors of the population are being hospitalized and dying from Covid-19. The CDC has announced it's now shutting down some of its Covid data tracking efforts, including tracking and reporting new infections.
"You've got some people who have received vaccines and so doctors assume that they're not vulnerable anymore, but their immunity isn't that strong because of their age or health conditions, and these are the people who are slipping through the cracks," says Nash.
According to William Schaffner, professor of infectious diseases at Vanderbilt University Medical Centre in Nashville, Tennessee, the majority of people now being hospitalized are typically vaccinated but fall into certain high-risk groups. "These are people who are older, frail, or younger patients who have underlying illnesses like heart or lung disease, or diabetes," he says.
New variants of the SARS-CoV-2 virus continue to emerge and become dominant in various parts of the world, often subtly changing the symptomatology of Covid in the process.
As an example, the latest Omicron subvariant, XBB.1.16, nicknamed Arcturus, contains an additional mutation in the spike protein that makes it more contagious than Omicron. First discovered in India, it was detected in 30 countries by early May.
While the Arcturus variant does not seem to cause more severe disease compared to other variants, it yields an inflammatory response in the body that tends to result in a high fever. In contrast, people infected with Omicron rarely expressed fever-like symptoms. In addition, Arcturus appears to cause conjunctivitis or inflammation of the outside of the eye, particularly in children.
There is currently no sign that SARS-CoV-2 will become more virulent, but scientists remain wary of how it might adapt in the future, particularly with the reduction in PCR tests impacting the amount of data available on Covid variants.
Young, otherwise healthy people can still be at risk of developing long Covid from contracting the virus. A review paper in January 2023 estimated that approximately 10 percent of those infected go on to develop this condition. Through these estimates, it suggested that long Covid has impacted at least 65 million people worldwide since the beginning of the pandemic.
Studies on the disease have identified more than 200 different symptoms, with impacts on multiple organ systems.
The paper also estimated that the vast majority of long Covid cases are in people who initially reported a mild, acute illness. However, hospitalized patients have a greater probability of suffering from long-term symptoms, with 50-70 percent of those people going on to develop long Covid.
Vaccination appears to have a protective effect against long Covid, but 10-12 percent of vaccinated individuals still develop the condition. People aged 36 to 50 appear to be most vulnerable.
There are still no broadly effective treatments for the condition, but studies have shown that certain therapies can work well on specific symptoms. For example, beta blockers have been shown to help postural tachycardia syndrome (POTS)--the abnormal increase in heart rate after sitting or standing up reported by many patients--and low-dose naltrexone has been used to treat the neuroinflammation behind persistent headaches and brain fog. Non-pharmaceutical options, such as boosting salt intake for POTS and cognitive pacing techniques for brain fog have also been found useful. Investigations into a range of other potential treatments are ongoing, including antihistamines, anticoagulant regimens, and a drug called BC007 that may be able to tackle possible autoimmune causes of the condition.
Shoshanah Jacobs, a biologist at the University of Guelph, says anyone concerned about the threat of Covid-19 can take simple precautions, such as wearing a mask in public, keeping their home well ventilated, and meeting outdoors for social events. Schaffner still advises older individuals, who may have weaker immune systems, to avoid going to indoor gatherings with large numbers of people.
"In our family, our children wear masks to school, we filter our home air, and when we meet up with folks who are outside our little social unit, we usually meet outside," says Jacobs. "For things like traveling on airplanes, a good-fitting mask that can keep out as much of the different viral particles as possible is important to reduce the risk of getting Covid."
The other major step is simply remaining up-to-date with booster vaccines. According to the CDC, just 16.9 percent of the American population have received their latest booster, a lapse that can cost lives, particularly for older individuals. "I know people who died, unaware that they were eligible for boosters that would have likely saved their lives," says Hanage.
The vaccine landscape is about to change significantly in the US as the health insurance system takes over from the federal government. To receive a booster, patients will have to get a prescription and perhaps cover a copayment. But for the time being, boosters will remain free for practically everyone, including the uninsured, through the Affordable Care Act.
Scientists see a grave need for more investment in a wider range of antivirals that can protect immunocompromised people from the virus.
At the moment, health care systems rely heavily on the oral antiviral Paxlovid, which can reduce the severity of Covid-19. But should future variants render it ineffective, there is currently no alternative.
"A lot of people don't think about the immunocompromised," says Hanage. "But the lack of options for them is something which is genuinely worthy of concern."
