For nearly a year now, the phrase fully vaccinated has carried a cachet that it never did before. Being fully vaccinated against COVID-19 is a ticket for a slate of liberties—a pass to travel without testing and skip post-exposure quarantine, per the CDC, and in many parts of the country, a license to enter restaurants, gyms, and bars. For many employees, full vaccination is now a requirement to work; for many individuals, it’s a must for any socialization at all. Sometime in the very, very near future, that status—and the perks that come with it—could evaporate in an instant for millions of Americans. Medical experts and public-health officials have for weeks been calling for the CDC to alter the definition of fully vaccinated to include another dose. Countries such as Israel have already done it; Anthony Fauci has been gunning for the switch. As he told me this summer, “I bet you any amount of whatever” that three shots, spread out over several months, will ultimately be the “standard regimen for an mRNA vaccine.” Even the CDC told me this week that it “may change [the] definition in the future”—a line it’s never used with me before. For a cautious government agency, that’s kind of a gargantuan leap. A new floor for full vaccination, one that firmly requires what we’re now calling booster shots, is starting to look like a matter of when, not if. The CDC has already ballooned its pool of booster-eligible people to include nearly every American who was fully vaccinated by the end of spring (or later, if they got Johnson & Johnson)—an urgent push to seriously, get boosted n-o-w, but short of an order that says “Actually, you must, or suffer the consequences.” Now might be the time to turn stern urging into a legitimate stick, as the United States collides with Omicron amid an ongoing Delta surge. (To be fair, the CDC offers no carrots to the boosted, either.) Nearly 150 million fully vaccinated Americans, 20 million of them over the age of 65, have yet to nab a booster—and they are heading into the winter with far fewer infection-fighting antibodies than they had in the spring. [Read: Fully vaccinated is suddenly a much less useful phrase] A change in definition would almost certainly spur some individual action in the short term; it’s maybe the closest the CDC can get to mandating boosters without, you know, mandating boosters. But it would also invite a whole lot of mess. Millions of people would be bumped back into “partially vaccinated” purgatory. Unvaccinated people would have one more hurdle to clear to achieve CDC-sanctioned status; some could be further disincentivized from getting the necessary shots. If Fauci is correct, the amendment is inevitable, and the risks of a logistics and communications tangle are worth taking now. But some other experts aren’t so sure. “We still don’t know what the optimal vaccination schedule is,” Boghuma Kabisen Titanji, an infectious-disease physician at Emory University, told me. And there’s still no consensus on what our COVID-19 vaccines are supposed to accomplish in the short or long term. Stamp out severe disease? Aggressively tamp down all infections, so that we can squelch viral spread? In deciding what fully vaccinated means, it would help to know “what outcomes we’re trying to prevent, and why,” Céline Gounder, an infectious-disease physician at Bellevue Hospital Center, in New York, told me. That would dictate our dosing strategies—the what, the when, the how many. Already, in the year since our shots first rolled out and full vaccination against COVID-19 was first defined, the pandemic landscape has shifted. And in this long fight against a fast-moving, fast-morphing virus, we may never actually, truly be fully vaccinated at all. Updating the definition of fully vaccinated is a strong move—hence the push for it at all. But it’s also a reminder of the power of waiting until we’re more sure of what we want our shots to do. None of this waffling is, to be clear, an indictment of boosters. By this point in the pandemic, it’s quite clear that adding on more shots can come with big benefits, especially now. Months have passed since many people got their shots, leaving antibody levels relatively low. And the heavily mutated Omicron can hopscotch over several of the antibodies that are left, taking hold more easily in vaccinated bodies compared with its predecessors, and perhaps transmitting more rapidly out of them. But a booster’s bump can skyrocket both the quantity and quality of frontline immune defenses, and restore much of the body’s ability to pin the coronavirus in place. Early data suggest that while two doses of an mRNA vaccine deliver kind of meh protection against Omicron infection, tacking on another dose brings the body back to a Delta-like benchmark. Omicron will still spread within vaccinated bodies, and among them. But it will do so less often with a booster. At this point, “I don’t think we can meaningfully interrupt transmission without three doses,” Saad Omer, a Yale epidemiologist, told me. Our viral opponent has clearly upped its offense, and boosters—a bolstering of defense—have never made more sense. Looping boosters into “full vaccination,” then, could clinch the importance of these shots. “We’ve hit a tipping point,” Jason Schwartz, a vaccine-policy expert at Yale, told me. It’s become essential to “encourage and promote boosters,” and sticking stubbornly to a now-obsolete definition of fully vaccinated could undermine that effort. A modification wouldn’t be without precedent. The measles/mumps/rubella vaccine first debuted as a single shot, but it became a double-doser in 1989 to better contain outbreaks; the chicken-pox vaccine underwent a similar tweak in 2006. But those decisions were made with years of data to back them up. With the COVID-19 vaccines, we are still figuring out how long we can expect the benefits of additional shots to last—whether they offer only a temporary return to the early defenses that the first doses conferred, or launch people to a higher, more durable level of protection. Vaccinologists typically draw a distinction between these two outcomes: Crudely, the doses in a primary series generate new immune protection, while boosters restore those defenses once they’ve started to fade. It’s not totally clear what purpose a third mRNA dose, for instance, might serve. [Read: A better name for booster shots] This is a sticking point for Paul Offit, a pediatrician and vaccine expert at the Children’s Hospital of Philadelphia, who’s long said that the main goal of COVID vaccines should be to stave off serious illness, protection he is “certain” manifests durably after two doses. (J&J, he and others told me, should also be considered a two-dose vaccine, because the second injection adds on protection that wasn’t there before.) Offit could be swayed toward updating the definition of full vaccination, he said, if clear, consistent data show that a two-dose regimen isn’t holding its ground on the severe-disease front. Not everyone agrees. Non-severe disease can still be very debilitating, especially for those with long COVID. We’d make massive, pandemic-ending inroads if we were able to sustainably ratchet down milder infections and transmission. More doses do seem to curb those outcomes, largely by lifting antibody levels back up. If those safeguards persist at a protective level, a third vaccine dose for the mRNAs, for instance, could be the last one we get for years. In that case, making fully vaccinated synonymous with three shots makes sense. If defenses drop quickly again, though, the United States could be saddled with a fresh slate of post-vaccination infections in a few months’ time, spurring people to line up for another round of shots. While durable protection’s possible, if the point is to keep all infections at a minimum, we almost certainly will need to dose more often than if we’re drawing the line at severe disease. Eventually the new fully vaccinated would become obsolete too. “What’s to say that in three months we won’t be in a situation where we think about changing it again?” Titanji said. Yet another round of revisions would further erode public trust. A definitional conversion for fully vaccinated would also create logistical nightmares for freshly instated mandates that rely on the current definition—one dose of J&J, two of mRNA. In practice, an update to fully vaccinated could completely rejigger who is and isn’t compliant; workers who only just met a two-dose mandate would have to await a third shot at the six-month mark. “You already have a lot of resistance,” Gounder said. Faced with new requirements, some employers might try to do away with mandates entirely; employees might choose to call it quits. [Read: You’re boosted! Now what?] The prospect of three required doses could also raise a barrier for people still trying to decide whether they want to get any COVID-19 shots at all. Right now, a one- or two-dose shot means waiting two to six weeks to hit full vaccination. A three-doser could balloon that to eight months, with potentially three rounds of side effects. One of the best ways to protect the world is for unvaccinated people to get vaccinated; we could quickly find ourselves in trouble if third doses get pushed at the cost of firsts. Ideally, we’d bring the entire world to three injections—perhaps more if needed. But partial vaccination is still better than none. And the more doses we buy up and urge onto the residents of wealthier countries, the harder it becomes for people around the world to get their initial series, giving the virus more places and chances to transform itself into something even more troublesome. With all of these factors at play, experts like Grace Lee, a Stanford pediatrician and the chair of the CDC’s Advisory Committee on Immunization Practices, thinks we might be better off shifting the conversation entirely—asking whether people are “up-to-date” on their shots, rather than whether they’re fully vaccinated. Whereas fully vaccinated implies a sort of finality, and has, to some, even become shorthand for fully protected, up-to-date is more flexible and forgiving. The phrase, which is already used among health professionals when discussing vaccines, might leave more room for individual tailoring, and it accommodates the unpredictability of our circumstances. Up-to-date is also a little more agnostic on the primary-versus-booster distinction. And asking “Did you get your shot this year?” rather than “Are you fully vaccinated?” could be an especially useful framework, Lee told me, if we end up having to retool and readminister our vaccines somewhat regularly, much like we do with vaccines for the seasonal flu. Titanji is also in favor of focusing on increments rather than end points. She gave the example of polio-eradication campaigns in sub-Saharan Africa that billed vaccines as “additional doses” in order to help people keep pace with what was happening in their communities and the environment. Relying too heavily on who’s fully vaccinated, she said, could inadvertently imply that people’s initial doses “just didn’t count,” when it’s more that “the situation has changed.” [Read: Omicron has created a whole new booster logic] Millions of us have been lumped into a single “fully vaccinated” category for months, based only on the number of doses we’ve received. But the fully vaccinated are not a monolith. Some are weeks out from their shots; others, many months. Some are triply dosed, others singly. Some are older, and their immune system sleepier. And to label someone “fully vaccinated” at all invites questions about what, exactly, we are fully vaccinating them against. What counts as fully vaccinated during a lull in a Delta wave might be insufficient to fend off an Omicron surge. Jettisoning the singular “fully vaccinated” category, then, could open up room for dosing recommendations pegged to age or immune-system status, which is already done with other vaccines. People over 65 get a higher dose of the annual flu shot; the age at which someone starts their HPV vaccination series dictates whether they get two primary doses or three. With COVID-19, older individuals might need more vaccines, while younger men might need fewer, to balance the risks of a very rare heart-inflammation side effect that’s been linked to the mRNA vaccines. And some immunocompromised people need to repeat vaccines that don’t take the first time, something physicians, including Titanji, are already asking certain patients to do by getting third and fourth COVID shots. Guidelines could still shift over time too, as both host immunity and pathogen genetics continue to evolve. In this period where the long-term outlook for our shots is fuzzy, organizations and communities can still push strongly for boosters without “making this a three-dose vaccine,” Gounder pointed out. Several sports leagues and universities, as well as New Mexico’s Department of Health, which runs the state’s vaccine-mandate program, have already started requiring additional vaccine doses—and they’re still calling them boosters. And while a change in definition might invite behavior to follow, there’s an argument for reminding ourselves of the original goals we laid out. First doses remain essential; the unvaccinated are still the ones who are most at risk. There will be nothing to boost at all if no protective foundation has yet been laid. from https://ift.tt/3scPgTH Check out http://natthash.tumblr.com
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In late May of 2020, the U.S. hit one of what has become so many grim pandemic milestones: our first 100,000 dead from COVID-19. I remember how heartbroken I was then—and how frustrated. The novel coronavirus, a stealthy pathogen, was bound to take a toll no matter how perfect Americans’ response was to the crisis. But Americans’ response was far from perfect. I was frustrated by people who refused to wear a mask. It made me feel like the lives of my patients—and my own life, as a health-care worker—were disposable. I was frustrated that patients weren’t getting the treatments they needed—like care for heart attacks and strokes—because hospitals across the country were overrun. And I was frustrated by the basic needs going unmet: food, housing, and paid leave so people with COVID could isolate, as well as a safety net for those who’d lost their livelihoods to the pandemic. What made all this frustration even more painful was the clear picture forming of who would suffer the most. Our essential workers—caregivers, domestic workers, agricultural workers, restaurant workers—are disproportionately immigrants and people of color, and they were given a false choice between going to work, thus risking their health, and staying home but not being able to feed their families. Other race-related health disparities, such as access to COVID testing, were beginning to emerge. The virus was spreading out of the big cities, including New York and Seattle, which were hit hard early on, into rural areas, which weren’t prepared to handle so many and such sick patients. Indigenous communities, which have suffered from centuries of disempowerment and disinvestment, sustained some of the highest COVID death tolls. COVID-19 was following the well-trodden path of other infectious diseases—at first a threat to the general population, but then concentrating among vulnerable populations—such as tuberculosis, HIV/AIDS, and others before it. We know where that path has led us. Today, more than 800,000 Americans are dead. It’s an enormous, hard-to-fathom number. Americans seem to have become numb to this scale of loss. But one thing that’s especially easy to overlook is who these deaths are. COVID-19 has been especially deadly for the elderly in the U.S. and around the world. About 75 percent of COVID deaths in the U.S.—600,000 lost lives—have been among people ages 65 and older. Latino, Black, and Indigenous people are twice as likely to have died from COVID as their white counterparts. America has made meaningful progress against the virus over the past year, and certainly vaccination efforts among vulnerable communities have saved many lives. At the same time, these deaths speak for themselves, again and again, every time we march by yet another horrible marker. We do not value the elderly. We do not value Black and brown Americans. Where there is structural violence and systemic racism, infectious diseases will flourish. We did not need COVID-19 to teach us that the elderly are more vulnerable to disease. We’ve had the tools to help protect them since the early days of the pandemic. Even before we had vaccines, we had masks. We could open doors and windows. We have HEPA air-filtration units for homes and businesses (though they don’t come cheap). By definition, elder caregiving is infrastructure—that which is needed to support social and economic functions. America needs to offer affordable, reliable care options, and while paying our caregivers living wages and providing them with safe working conditions. Instead, the country’s long-term-care system was broken long before the pandemic even started. A staggeringly small percentage of older Americans receive care at home compared with their counterparts in other developed countries. Instead, we ask a workforce of mostly poor women of color to shoulder this burden in nursing homes and other long-term-care facilities. We hide away disease, disability, and death. Societies more known for valuing their elders, as is the case in many East Asian countries such as Singapore, South Korea, China, and Japan, have fared much better than the U.S. throughout the pandemic, with fewer cases and deaths from COVID and some of the highest COVID vaccination rates. In the U.S., we value individualism, self-reliance, and productivity. We derive our status and identity from our work. When people stop working and become dependent and unproductive, they can be seen as disposable. The tension in this kind of thinking is obvious. The American population is graying, with 16 percent of Americans now age 65 or older. The burden of caring for our elders weighs more heavily than ever before. Parents find themselves spread thin between caring for their children and for their own aging parents. Caregiving has traditionally fallen to women, which means that it’s often unpaid, unsupported, and unvalued. And with elders living longer, their needs are only becoming more complicated. COVID-19 also did not have to teach us that communities of color are at greater risk. It was no surprise to me that the U.S. hit 100,000 deaths from COVID at the same time that George Floyd’s murder was so widely broadcast. Americans have stood by watching as people of color die over and over again during the course of the pandemic. Many have watched at a distance, in the news headlines and in the stats, but not up close. It’s not the people they know, because America is as segregated as it’s been in decades. We are segregated in our housing, in our schools, in our work, and in our health. Black and brown communities are more likely to live in dense, multigenerational homes. Their neighborhoods are underserved by health-care facilities and pharmacies. Many schools serving majority Black or Latino student populations have health and safety problems such as poor indoor ventilation, facilitating transmission of SARS-CoV-2. Essential workers remain excluded from New Deal–era federal laws and do not enjoy adequate health and safety protections on the job, or decent wages. Earlier this week, the journalist Matthew Walther argued in The Atlantic that many Americans do not care about COVID. This, sadly, is true. But it’s also callous. What it really means is that many Americans don’t care about the people who have died from COVID, and who will keep dying of COVID. To those who do not care, I say: COVID not only is worth fighting, it’s something we have to fight, whether we all want to or not. Even if you don’t care about dying strangers, those deaths—and all the complications that come with rampant disease spread—take a toll on all of us. A total of 7 million Americans are currently unemployed. According to a U.S. Census Bureau survey of American households this fall, almost 4 million Americans said they weren’t working because they were caring for someone or sick themselves with COVID symptoms; almost 2.5 million, because they were concerned about getting or spreading SARS-CoV-2; about 4.5 million, because they’d been laid off or furloughed due to the pandemic; and more than 3.2 million, because their employer had closed temporarily or permanently due to the pandemic. Employers are anxious to get people back to work and back in the office. But any argument that everyone merely should throw up their arms and learn to live with COVID as we continue down our path toward endemicity dismisses very real fears. People will resume their lives when they feel safe. Right now, more than 1,000 Americans are dying from COVID per day, and as people gather for the holidays and the Omicron variant spreads, those numbers will trend up in the coming weeks. To communities where people are dying, these are not acceptable losses. They should be scared of dying from COVID, especially when they know their lives aren’t valued. from https://ift.tt/3m6G2EL Check out http://natthash.tumblr.com America was not prepared for COVID-19 when it arrived. It was not prepared for last winter’s surge. It was not prepared for Delta’s arrival in the summer or its current winter assault. More than 1,000 Americans are still dying of COVID every day, and more have died this year than last. Hospitalizations are rising in 42 states. The University of Nebraska Medical Center in Omaha, which entered the pandemic as arguably the best-prepared hospital in the country, recently went from 70 COVID patients to 120 in four days, leaving its staff “grasping for resolve,” the virologist John Lowe told me. And now comes Omicron. Will the new and rapidly spreading variant overwhelm the U.S. health-care system? The question is moot because the system is already overwhelmed, in a way that is affecting all patients, COVID or otherwise. “The level of care that we’ve come to expect in our hospitals no longer exists,” Lowe said. The real unknown is what an Omicron cross will do when it follows a Delta jab. Given what scientists have learned in the three weeks since Omicron’s discovery, “some of the absolute worst-case scenarios that were possible when we saw its genome are off the table, but so are some of the most hopeful scenarios,” Dylan Morris, an evolutionary biologist at UCLA, told me. In any case, America is not prepared for Omicron. The variant’s threat is far greater at the societal level than at the personal one, and policy makers have already cut themselves off from the tools needed to protect the populations they serve. Like the variants that preceded it, Omicron requires individuals to think and act for the collective good—which is to say, it poses a heightened version of the same challenge that the U.S. has failed for two straight years, in bipartisan fashion. The coronavirus is a microscopic ball studded with specially shaped spikes that it uses to recognize and infect our cells. Antibodies can thwart such infections by glomming onto the spikes, like gum messing up a key. But Omicron has a crucial advantage: 30-plus mutations that change the shape of its spike and disable many antibodies that would have stuck to other variants. One early study suggests that antibodies in vaccinated people are about 40 times worse at neutralizing Omicron than the original virus, and the experts I talked with expect that, as more data arrive, that number will stay in the same range. The implications of that decline are still uncertain, but three simple principles should likely hold. First, the bad news: In terms of catching the virus, everyone should assume that they are less protected than they were two months ago. As a crude shorthand, assume that Omicron negates one previous immunizing event—either an infection or a vaccine dose. Someone who considered themselves fully vaccinated in September would be just partially vaccinated now (and the official definition may change imminently). But someone who’s been boosted has the same ballpark level of protection against Omicron infection as a vaccinated-but-unboosted person did against Delta. The extra dose not only raises a recipient’s level of antibodies but also broadens their range, giving them better odds of recognizing the shape of even Omicron’s altered spike. In a small British study, a booster effectively doubled the level of protection that two Pfizer doses provided against Omicron infection. Second, some worse news: Boosting isn’t a foolproof shield against Omicron. In South Africa, the variant managed to infect a cluster of seven people who were all boosted. And according to a CDC report, boosted Americans made up a third of the first known Omicron cases in the U.S. “People who thought that they wouldn’t have to worry about infection this winter if they had their booster do still have to worry about infection with Omicron,” Trevor Bedford, a virologist at Fred Hutchinson Cancer Research Center, told me. “I’ve been going to restaurants and movies, and now with Omicron, that will change.” Third, some better news: Even if Omicron has an easier time infecting vaccinated individuals, it should still have more trouble causing severe disease. The vaccines were always intended to disconnect infection from dangerous illness, turning a life-threatening event into something closer to a cold. Whether they’ll fulfill that promise for Omicron is a major uncertainty, but we can reasonably expect that they will. The variant might sneak past the initial antibody blockade, but slower-acting branches of the immune system (such as T cells) should eventually mobilize to clear it before it wreaks too much havoc. To see how these principles play out in practice, Dylan Morris suggests watching highly boosted places, such as Israel, and countries where severe epidemics and successful vaccination campaigns have given people layers of immunity, such as Brazil and Chile. In the meantime, it’s reasonable to treat Omicron as a setback but not a catastrophe for most vaccinated people. It will evade some of our hard-won immune defenses, without obliterating them entirely. “It was better than I expected, given the mutational profile,” Alex Sigal of the Africa Health Research Institute, who led the South African antibody study, told me. “It’s not going to be a common cold, but neither do I think it will be a tremendous monster.” That’s for individuals, though. At a societal level, the outlook is bleaker. Omicron’s main threat is its shocking speed, as my colleague Sarah Zhang has reported. In South Africa, every infected person has been passing the virus on to 3–3.5 other people—at least twice the pace at which Delta spread in the summer. Similarly, British data suggest that Omicron is twice as good at spreading within households as Delta. That might be because the new variant is inherently more transmissible than its predecessors, or because it is specifically better at moving through vaccinated populations. Either way, it has already overtaken Delta as the dominant variant in South Africa. Soon, it will likely do the same in Scotland and Denmark. Even the U.S., which has much poorer genomic surveillance than those other countries, has detected Omicron in 35 states. “I think that a large Omicron wave is baked in,” Bedford told me. “That’s going to happen.” More positively, Omicron cases have thus far been relatively mild. This pattern has fueled the widespread claim that the variant might be less severe, or even that its rapid spread could be a welcome development. “People are saying ‘Let it rip’ and ‘It’ll help us build more immunity,’ that this is the exit wave and everything’s going to be fine and rosy after,” Richard Lessells, an infectious-disease physician at the University of KwaZulu-Natal, in South Africa, told me. “I have no confidence in that.” To begin with, as he and others told me, that argument overlooks a key dynamic: Omicron might not actually be intrinsically milder. In South Africa and the United Kingdom, it has mostly infected younger people, whose bouts of COVID-19 tend to be less severe. And in places with lots of prior immunity, it might have caused few hospitalizations or deaths simply because it has mostly infected hosts with some protection, as Natalie Dean, a biostatistician at Emory University, explained in a Twitter thread. That pattern could change once it reaches more vulnerable communities. (The widespread notion that viruses naturally evolve to become less virulent is mistaken, as the virologist Andrew Pekosz of Johns Hopkins University clarified in The New York Times.) Also, deaths and hospitalizations are not the only fates that matter. Supposedly “mild” bouts of COVID-19 have led to cases of long COVID, in which people struggle with debilitating symptoms for months (or even years), while struggling to get care or disability benefits. And even if Omicron is milder, greater transmissibility will likely trump that reduced virulence. Omicron is spreading so quickly that a small proportion of severe cases could still flood hospitals. To avert that scenario, the variant would need to be substantially milder than Delta—especially because hospitals are already at a breaking point. Two years of trauma have pushed droves of health-care workers, including many of the most experienced and committed, to quit their job. The remaining staff is ever more exhausted and demoralized, and “exceptionally high numbers” can’t work because they got breakthrough Delta infections and had to be separated from vulnerable patients, John Lowe told me. This pattern will only worsen as Omicron spreads, if the large clusters among South African health-care workers are any indication. “In the West, we’ve painted ourselves into a corner because most countries have huge Delta waves and most of them are stretched to the limit of their health-care systems,” Emma Hodcroft, an epidemiologist at the University of Bern, in Switzerland, told me. “What happens if those waves get even bigger with Omicron?” The Omicron wave won’t completely topple America’s wall of immunity but will seep into its many cracks and weaknesses. It will find the 39 percent of Americans who are still not fully vaccinated (including 28 percent of adults and 13 percent of over-65s). It will find other biologically vulnerable people, including elderly and immunocompromised individuals whose immune systems weren’t sufficiently girded by the vaccines. It will find the socially vulnerable people who face repeated exposures, either because their “essential” jobs leave them with no choice or because they live in epidemic-prone settings, such as prisons and nursing homes. Omicron is poised to speedily recap all the inequities that the U.S. has experienced in the pandemic thus far. Here, then, is the problem: People who are unlikely to be hospitalized by Omicron might still feel reasonably protected, but they can spread the virus to those who are more vulnerable, quickly enough to seriously batter an already collapsing health-care system that will then struggle to care for anyone—vaccinated, boosted, or otherwise. The collective threat is substantially greater than the individual one. And the U.S. is ill-poised to meet it. America’s policy choices have left it with few tangible options for averting an Omicron wave. Boosters can still offer decent protection against infection, but just 17 percent of Americans have had those shots. Many are now struggling to make appointments, and people from rural, low-income, and minority communities will likely experience the greatest delays, “mirroring the inequities we saw with the first two shots,” Arrianna Marie Planey, a medical geographer at the University of North Carolina at Chapel Hill, told me. With a little time, the mRNA vaccines from Pfizer and Moderna could be updated, but “my suspicion is that once we have an Omicron-specific booster, the wave will be past,” Trevor Bedford, the virologist, said. Two antiviral drugs now exist that could effectively keep people out of the hospital, but neither has been authorized and both are expensive. Both must also be administered within five days of the first symptoms, which means that people need to realize they’re sick and swiftly confirm as much with a test. But instead of distributing rapid tests en masse, the Biden administration opted to merely make them reimbursable through health insurance. “That doesn’t address the need where it is greatest,” Planey told me. Low-wage workers, who face high risk of infection, “are the least able to afford tests up front and the least likely to have insurance,” she said. And testing, rapid or otherwise, is about to get harder, as Omicron’s global spread strains both the supply of reagents and the capacity of laboratories. Omicron may also be especially difficult to catch before it spreads to others, because its incubation period—the window between infection and symptoms—seems to be very short. At an Oslo Christmas party, almost three-quarters of attendees were infected even though all reported a negative test result one to three days before. That will make Omicron “harder to contain,” Lowe told me. “It’s really going to put a lot of pressure on the prevention measures that are still in place—or rather, the complete lack of prevention that’s still in place.” The various measures that controlled the spread of other variants—masks, better ventilation, contact tracing, quarantine, and restrictions on gatherings—should all theoretically work for Omicron too. But the U.S. has either failed to invest in these tools or has actively made it harder to use them. Republican legislators in at least 26 states have passed laws that curtail the very possibility of quarantines and mask mandates. In September, Alexandra Phelan of Georgetown University told me that when the next variant comes, such measures could create “the worst of all worlds” by “removing emergency actions, without the preventive care that would allow people to protect their own health.” Omicron will test her prediction in the coming weeks. The longer-term future is uncertain. After Delta’s emergence, it became clear that the coronavirus was too transmissible to fully eradicate. Omicron could potentially shunt us more quickly toward a different endgame--endemicity, the point when humanity has gained enough immunity to hold the virus in a tenuous stalemate—albeit at significant cost. But more complicated futures are also plausible. For example, if Omicron and Delta are so different that each can escape the immunity that the other induces, the two variants could co-circulate. (That’s what happened with the viruses behind polio and influenza B.) Omicron also reminds us that more variants can still arise—and stranger ones than we might expect. Most scientists I talked with figured the next one to emerge would be a descendant of Delta, featuring a few more mutational bells and whistles. Omicron, however, is “dramatically different,” Shane Crotty, from the La Jolla Institute for Immunology, told me. “It showed a lot more evolutionary potential than I or others had hoped for.” It evolved not from Delta but from older lineages of SARS-CoV-2, and seems to have acquired its smorgasbord of mutations in some hidden setting: perhaps a part of the world that does very little sequencing, or an animal species that was infected by humans and then transmitted the virus back to us, or the body of an immunocompromised patient who was chronically infected with the virus. All of these options are possible, but the people I spoke with felt that the third—the chronically ill patient—was most likely. And if that’s the case, with millions of immunocompromised people in the U.S. alone, many of whom feel overlooked in the vaccine era, will more weird variants keep arising? Omicron “doesn’t look like the end of it,” Crotty told me. One cause for concern: For all the mutations in Omicron’s spike, it actually has fewer mutations in the rest of its proteins than Delta did. The virus might still have many new forms to take. Vaccinating the world can curtail those possibilities, and is now an even greater matter of moral urgency, given Omicron’s speed. And yet, people in rich countries are getting their booster six times faster than those in low-income countries are getting their first shot. Unless the former seriously commits to vaccinating the world—not just donating doses, but allowing other countries to manufacture and disseminate their own supplies—“it’s going to be a very expensive wild-goose chase until the next variant,” Planey said. Vaccines can’t be the only strategy, either. The rest of the pandemic playbook remains unchanged and necessary: paid sick leave and other policies that protect essential workers, better masks, improved ventilation, rapid tests, places where sick people can easily isolate, social distancing, a stronger public-health system, and ways of retaining the frayed health-care workforce. The U.S. has consistently dropped the ball on many of these, betting that vaccines alone could get us out of the pandemic. Rather than trying to beat the coronavirus one booster at a time, the country needs to do what it has always needed to do—build systems and enact policies that protect the health of entire communities, especially the most vulnerable ones. Individualism couldn’t beat Delta, it won’t beat Omicron, and it won’t beat the rest of the Greek alphabet to come. Self-interest is self-defeating, and as long as its hosts ignore that lesson, the virus will keep teaching it. from https://ift.tt/3E1qxnx Check out http://natthash.tumblr.com My breakthrough infection started with a scratchy throat just a few days before Thanksgiving. Because I’m vaccinated, and had just tested negative for COVID-19 two days earlier, I initially brushed off the symptoms as merely a cold. Just to be sure, I got checked again a few days later. Positive. The result felt like a betrayal after 18 months of reporting on the pandemic. And as I walked home from the testing center, I realized that I had no clue what to do next. I had so many questions: How would I isolate myself in a shared apartment? And why for 10 days, like the doctor at the testing site had advised? Should I get tested again? Following the doctor’s orders, my partner—who had tested negative—dragged a sleeping bag to the couch. Masks came on, windows went up, and flights were canceled. I ate flavorless dinners on my side of the apartment. One by one, the symptoms I knew so well on paper made their real-life debut: cough, fever, fatigue, and a loss of smell so severe, I couldn’t detect my dog’s habitually fishy breath. Turns out I wasn’t the only one feeling baffled about what to do. “Oh yeah, people are very confused about breakthrough cases,” Peter Chin-Hong, an expert on infectious diseases at UC San Francisco, told me. Now that the Omicron variant is here, many more Americans may soon have to deal with breakthrough confusion. There’s a lot we don’t know about the new variant, but it’s spreading fast. Although the unvaccinated remain most at risk, vaccinated America isn’t in the clear: While the shots still seem effective at preventing hospitalization and death, early reports suggest that they are less effective against milder cases. So if you do get a breakthrough infection right now, what should you do? [Read: The pandemic of the vaccinated is here] At least for now, Omicron shouldn’t change how Americans act when they get a breakthrough infection. “All of the same things stand, whether it’s Delta, Omicron, or any other Greek letter or non-Greek letter of SARS-CoV-2,” says Stephen Kissler, an epidemiologist at Harvard. “Once you know you’re infected, hang tight, limit your encounters with other people, and just take care of yourself.” If only the official guidance were this straightforward. Rebecca Wurtz, an infectious-disease expert at the University of Minnesota, told me that people are perplexed “partly because, I think, the guidance is confusing.” The CDC’s guidelines are limited: Isolate if you’ve either tested positive in the past 10 days or are experiencing symptoms, and end your isolation after 10 days only if you’ve gone 24 hours with no fever (without the use of Tylenol or other anti-fever drugs) and your other symptoms are improving—not counting the loss of taste and smell, which could take a couple of weeks to return. “They’re unclear as they’re stated, and they’re a little too complicated in any case,” Wurtz said. (When I reached out to the CDC for comment on its guidance on breakthroughs, a spokesperson pointed me back to the recommendations on the agency’s website.) If you start feeling anything that resembles COVID symptoms or learn that you’ve been exposed to someone who has tested positive, some experts told me, the first thing to do is to get tested. “If you’re not sure, you have to get tested,” Chin-Hong said. That’s especially true now that we’re heading into the winter, when all sorts of non-COVID illnesses are also circulating. It can be impossible to differentiate between the early symptoms of a cold, the flu, and COVID, and getting tested is the only way to confirm a breakthrough infection. The bottom line is that knowing whether you’re positive is important not just for you, but also for anyone who you’ve been in contact with recently—especially those who are unvaccinated or immunocompromised. PCR tests are still considered to be the gold standard, but they take much longer to generate results than rapid tests, which you can buy at a pharmacy and take at home. A test is merely a snapshot in time, and because Omicron appears to have a shorter incubation period than past variants, a result from a few days ago may not mean much. More than 60 fully vaccinated people tested positive for Omicron after an office holiday party in Norway, and all had gotten negative rapid-test results just a day earlier. [Read: Omicron’s explosive growth is a warning sign] Wurtz said that if you start to feel sick but haven’t been in contact with anyone and don’t plan to be, the best recourse is to stay home, minimize exposure to other people, and rest. “This may seem a little radical,” she said, “but I don’t think there’s a need in that context to be tested at all, period.” Again, the thing to consider is whether you’ve put anyone around you at risk of infection. If you do test positive, you should alert your local public-health authority so they can initiate contact tracing, Chin-Hong said. Many testing sites do this automatically, but at-home tests of course do not. The CDC advises that after confirming your infection, you should start isolating right away, but unless you are asymptomatic, the first day of symptoms is technically what counts as the start of your 10 days of isolation. I learned the hard way that you aren’t supposed to “test out” of isolation, when a physician’s assistant yelled at me for getting tested after feeling better on day seven. She said I was putting others at risk, although the CDC guidance didn’t specifically say not to get tested. Explaining that I would have to isolate regardless of the outcome, she never told me my result. Isolating can be especially tricky if, like many Americans, you don’t get paid sick leave, or if you live with people who have tested negative. That’s a common situation with breakthrough infections: While a positive test in a household full of unvaccinated people may soon lead everyone to test positive, that’s not necessarily the case in a home where everyone is vaccinated. “At the minimum, don’t be in the same room,” Javaid said. “If you have to interact with each other, you should always wear masks.” Considering Omicron’s contagiousness, it’s worth wearing more protective masks, such as N95s or KN95s, in lieu of the cloth masks that are common across the U.S. And even if it’s cold, opening windows four to six inches, Kissler said, can help with ventilation. If people you live with start having symptoms, the same guidelines apply: They too should self-isolate, and test if they’re going to see others. But as The Atlantic’s Katherine Wu has written, not all public-health experts agree that those with breakthrough infections really need to isolate for 10 days, given recent research suggesting that they clear the virus more quickly than the unvaccinated, for whom the 10-day window was designed. Wurtz said that the 10-day isolation period is “somewhat arbitrary,” but she acknowledged that the cautiousness can be reassuring with a new, less understood variant. Thankfully, most breakthrough infections tend to be mild cases, and that seems likely to hold true with Omicron too (especially for those with booster shots). If you’re feeling unwell, the usual treatment for respiratory infections—cold-and-flu medications, anti-fever drugs, liquids, and rest—are sufficient for most people with breakthrough COVID, Wurtz said. Although monoclonal antibodies are effective at treating COVID, Chin-Hong said he offers them only to people who are older or immunocompromised, because they are the most vulnerable, even after getting vaccinated. (Soon, we’ll have yet another treatment option: antiviral pills.) Breakthrough infections are unlikely to lead to hospitalization for most people, but you should seek emergency care if you develop any severe symptoms, such as trouble breathing, persistent pain or pressure in the chest, or confusion. [Read: Timing is everything for Merck’s COVID pill] At some point, as we learn more about Omicron, the guidance regarding what to do after getting a breakthrough infection could change. “I think it’s important with the new variant that we’re seeing right now to consider getting the boosters as soon as possible,” Javaid said. But aside from that, the best thing vaccinated people can do is make sure they’re ready for a breakthrough infection before it strikes. Stock up on rapid tests so you’re not in a bind if any COVID symptoms suddenly appear. Talk to your family or roommates about where the best place to isolate is in your home. Be prepared to miss 10 days of work if you’re in person. Thankfully, I’m fully recovered from my breakthrough infection, except for the ongoing inability to smell my dog’s breath. For now, what makes breakthroughs like mine so confusing is that the U.S. is in an “awkward transition phase,” Wurtz said, between following somewhat random rules—such as isolating for 10 days—and more deeply understanding what COVID-19 does to our bodies. I’ve since gotten a booster, and accepted that I’ll probably get sick with COVID again, maybe many times. COVID will someday turn endemic, and having it may become more like having a cold or a bout of flu: a normal, albeit exasperating, part of everyday life for most people (though not everyone). Eventually, even with Omicron, breakthroughs will become a lot less stressful. “I do think it is time to start normalizing breakthrough infections,” Wurtz added. “We have to learn to live with them.” from https://ift.tt/3dWILfA Check out http://natthash.tumblr.com This time last year, health officials were advising Americans to stay home for the holidays. The CDC cautioned against travel; Anthony Fauci announced that he would be spending Christmas apart from his children for the first time in 30 years. But that grim advice was accompanied by hope for a normal 2021 holiday season: Pfizer’s COVID-19 vaccine was authorized for emergency use in adults on December 11, 2020, with Moderna’s following close behind. Now 61 percent of Americans are fully vaccinated, and more than 70 percent have received at least one dose of a vaccine. These numbers mean that millions of American families can feel a whole lot safer than they did last year about gathering for the holidays. But U.S. vaccination rates still leave a lot of room for unprotected family members or friends at celebrations, unwrapping gifts or ringing in the new year together—including children under 5, who still aren’t eligible for any COVID-19 vaccine. While vaccinated people tend to live with other vaccinated people, and unvaccinated people with other unvaccinated people, “I think once you start adding in extended families … mixed vaccination status would become pretty common,” Jennifer Beam Dowd, a demography and population-health professor at the University of Oxford, told us. [Read: America is getting unvaccinated people all wrong] Those families will have to face the tough question of how normal their gathering can really be if some attendees are not vaccinated. We spoke with Dowd and several other experts about how to weigh the risks of getting together with unvaccinated loved ones and make the holidays as safe as possible. The safest holiday table this year will be the one where everyone present is fully vaccinated and, if eligible, boosted. If that’s the case, and no one at your gathering is at high risk of severe illness from COVID-19, everyone can remove their mask and celebrate with cautious optimism, Rachael Piltch-Loeb, a researcher at the Harvard T. H. Chan School of Public Health, told us via email. Anyone at this hypothetical party still has a chance of contracting a breakthrough infection. How big that chance is will depend in part on whether the Omicron variant is circulating in your area. The variant has been shown to be more transmissible than Delta, and the risk of getting a breakthrough infection is higher. The good news is, booster shots seem to help stave off Omicron infections. COVID-19 cases among the vaccinated have been overwhelmingly mild, but we don’t yet know whether that will be true in the long run for Omicron, and the logistical headache of a positive test is still worth considering before you sit down for an unmasked, indoor meal. [Read: Omicron’s explosive growth is a warning sign] For many Americans, being in a room with unvaccinated loved ones while case numbers are high and a new variant looms constitutes unacceptable risk. “I personally am not comfortable gathering with unvaccinated adults,” Joshua Barocas, an infectious-disease researcher at the University of Colorado School of Medicine, told us. But if you’ve thought about the risk that such a gathering poses to yourself and others, and decided that you’re willing to go anyway, know that not all mixed-vaccination-status gatherings are created equal. To help you better understand the risks associated with various scenarios, we’ve broken down the chances of transmission at a gathering with one unvaccinated adult, multiple unvaccinated adults, and unvaccinated or semi-vaccinated kids, who add another layer of complexity to already tricky situations. If your gathering includes only one unvaccinated adult—say, Cousin Paula—she is roughly three times more likely to become infected than anyone else. Paula’s exact risk of infection depends on how widely the coronavirus is circulating in her community, the possibility that the vaccinated people present could be experiencing breakthrough infections, whether everyone wears a mask indoors, and what the ventilation situation is like, Barocas said. And if she does catch the virus, Paula’s risk of hospitalization is roughly twice as high, and her risk of death seven times as high, as if she were vaccinated. According to Piltch-Loeb, exactly how much of a threat Cousin Paula poses to her vaccinated friends and family depends on a few factors: her behavior prior to attending the event, the precautions that the entire group takes, and where she’s coming from. (The CDC still recommends that unvaccinated Americans not travel until they are fully vaccinated.) If Paula has tested negative before the gathering and lives in a community with relatively low transmission, the other attendees won’t be as significant, Piltch-Loeb said. But keep in mind that the CDC currently classifies transmission as substantial or high in more than 90 percent of U.S. counties. [Read: We’re not at endemicity yet] If Paula isn’t the only unvaccinated adult coming over for Christmas, the riskiness of your gathering will be higher, and more complicated to assess. Dowd said the chance of COVID exposure is additive: If about one in 100 people in your community is testing positive each day, then one unvaccinated guest would mean a 1 percent risk of exposure, two unvaccinated guests would mean a 2 percent risk, and so on. In other words, when caseloads are high, each unvaccinated person at a gathering raises everyone’s risk by a greater factor than when caseloads are low. Children add yet another layer of complexity. Kids 12 and older have been eligible for vaccination since May, but the 5-to-11 group was given the green light only at the end of October. Only those who got their first shot within the first two weeks of eligibility stand a chance of being fully vaccinated by Christmas Eve. Meanwhile, the nation’s 23 million or so under-5-year-olds still don’t have access to vaccination. And no one under 16 is eligible for a booster shot. That means plenty of American children going through the holidays without the full protection of vaccination. Kids are not likely to become severely ill or die if they do get infected with the coronavirus, but more than 600 children have died of COVID-19 in the United States so far, and this summer’s Delta wave led to huge numbers of kids being hospitalized. Even in the best-case scenario, testing positive can wreak havoc on a household. “There are life events that go with quarantining: missed school, missed work. It's a tough choice for parents,” says Larry Corey, a virologist at Seattle’s Fred Hutchinson Cancer Research Center. [Read: COVID parenting is reaching a breaking point] To protect unvaccinated and half-vaccinated kids during the holidays, Barocas recommends keeping them away from unvaccinated adults, especially in areas with high transmission. The safest gathering for kids, he said, is one where all adults present are vaccinated. We don’t yet know for sure how Omicron changes the risk landscape for children. The number of young patients testing positive for the coronavirus in South African hospitals has increased over the past few weeks, but doctors there told The New York Times last week that they have not seen a spike in kids being hospitalized for COVID and that few children have required oxygen. Even if they’re relatively safe in a room full of vaccinated grown-ups, unvaccinated kids might pose some danger to those around them: Studies have shown that children can infect others in their household, as well as in schools and other group settings. For this reason, Dowd recommends limiting the amount of time that unvaccinated kids spend in close proximity to their more vulnerable loved ones, such as their grandparents. [Read: Why are we microdosing vaccines for kids?] Vaccination remains the best way to protect yourself and the people around you from the coronavirus, but it’s not the only way. If you decide to attend a holiday gathering of people with mixed vaccination statuses, Barocas recommends that everyone, even if they’re vaccinated, gets a rapid test the day they plan to get together. Cousin Paula should take a (slower, more reliable) PCR test too, Corey adds. If you can’t find enough rapid tests to cover everyone, Dowd recommends prioritizing unvaccinated folks, then people who work in high-risk industries, such as health care and food services, and anyone with a known recent exposure. As our colleague Katherine J. Wu has reported, rapid tests are most likely to catch you when you are infectious—they aren’t very good at ruling out infection in an asymptomatic person. It’s a tricky distinction, Barocas said: “A negative test says that you could still be infected but, as best we can tell, you’re unlikely at that particular moment to transmit the virus to another person—you’re not so infectious.” A positive rapid test, whether you’re vaccinated or unvaccinated, symptomatic or asymptomatic, indicates that you’re most likely infected and infectious. If you do test positive on a rapid test, Barocas said, you should get a PCR test to confirm, skip any gatherings, and self-isolate. [Read: The wrong way to test yourself for the coronavirus] In addition to testing, Dowd recommends being extra careful about possible exposure in the week prior to the holidays by avoiding large gatherings and crowded indoor spaces and wearing a mask if you can’t avoid them. The more layers of risk involved in your holiday plans—in the form of unvaccinated attendees or possible prior exposure—the more layers of protection you should add. Though they might not make for the carefree holiday of your dreams, additional safety measures such as opening windows and doors for ventilation, dining outside if the weather permits, and masking while you’re not eating can reduce, though not erase, the risk of mixed-vaccination gatherings. Of course, all of this advice is useful only if you know whether your friends and family are fully vaccinated. Tara Kirk Sell, a senior scholar at the Johns Hopkins Center for Health Security, told us that before you initiate that conversation with a loved one, you should know what level of risk you’re willing to accept. “It’s good to figure out first what your ground rules are before you start trying to find information,” she said. Then explain why you’re so interested in knowing their vaccination status: Maybe you have an unvaccinated child at home; maybe you’re concerned about your life being disrupted by a breakthrough infection. [Read: Getting back to normal is only possible until you test positive] Lizzie Post, a co-president of the Emily Post Institute and a co-host of the Awesome Etiquette podcast, suggests another option if asking for someone’s vaccination status directly could cause conflict. You can let your loved one know your COVID safety measures—such as requiring everyone opening presents on Christmas morning to be vaccinated—and ask whether they’re able to accommodate that. If they say they can’t, Post says, you can offer an alternative, such as joining via Zoom, wearing a mask, or gathering outside. If the conversion gets heated, Amanda Craig, a licensed marriage and family therapist practicing in New York City and Connecticut, recommends letting your family member or friend know that you appreciate where they’re coming from, but you won’t back down on your own safety. The ability to express ourselves, especially to our loved ones, is crucial for our health too, Craig told us. Family are the people who are supposed to care about us. “If we can’t be honest with them,” she said, “that’s a whole different problem.” from https://ift.tt/3q2aGjx Check out http://natthash.tumblr.com “Today was great!” my 7-year-old exclaimed recently when I came home from work. By cosmic standards, her day wasn’t that special. She went to the playground, where she finally mastered the monkey bars. She visited the history museum—or at least its gift shop. She got “really big” nachos. She went to the kids’ art studio. Two years ago, visiting a museum and a nacho joint was so common, it wouldn’t even have registered. What did you do today? Oh, nothing. But our standards are no longer cosmic. “Today was great,” she said, and my wife’s eyes welled up at her enthusiasm. So much had been missed already—a quarter of our daughter’s life lived in shadow. She learned to read and ride a bike. She ceased to be a little kid and became just a kid—in appearance, ability, and aspiration. And as of the end of November, she’s “fully” vaccinated. It happened just in time for another version of the virus, the one with more mutations: Omicron. Today was great. One can feel only despair about this latest shift. The Greek-letter naming convention, wisely adopted to avoid stigmatizing places, was already dour, as if each new variant were scripted as an enemy in science fiction. Omicron seems even worse—quicker to spread than the more transmissible strain of an already-transmissible virus. What are we supposed to do now? What were we supposed to do before? Just hold out for the hospitals, we heard in spring 2020. Just wear masks, we heard that summer. Hold off on travel, the winter said. Test often, warned the spring. Just wait for the vaccines to be deemed safe for kids, entreated early fall. Now it’s winter again, and even with vaccines, next year feels no more encouraging than this one. Just more of the same. This calamity has been foreseen, over and over again. Everyone knew that absent global vaccinations, the virus would mutate, and that it could also hide in wildlife and remerge, maybe stronger and more dangerous. Delta proved the point, and yet nothing changed. Now that Omicron is here, and apparently worse, it’s easy to conclude that nothing ever will. This is the moment in a piece about the pandemic when I acknowledge that I have been lucky. Not everyone can work from home and educate their kids. The elderly, and then the working poor and people of color, have always been at much greater risk of dying from COVID-19 than me or my immediate family. The developing world had it worse and still does. Medical professionals, already having attended so much death, are long past their breaking point. For a while, the more fortunate could sail the big ocean that was the pandemic, with enough cargo to address their basic needs. We thought if we could make it through those first weeks, or months, or until vaccines, then we’d arrive at some new shore. Things did get better, of course, but landfall never really came. That disappointment offered another source of gloom. The new despair wells up from the gap between what we knew and what we did, like sulfur seeping from deep-sea vents. Having had the chance to tame the virus and failed to do so, and then fallen prey to exactly the risks that we foresaw—this is a new burden. Omicron might not be worse when measured in human lives: The pile of 800,000 bodies in the U.S. doesn’t have to double, yet again, in size. But it is a different burden. The holidays only deepen the lows. This is a time of joy and warmth and cold and excess. Even if few will (or should) change their holiday plans this month, we have all been forced to ponder the matter. Two weeks’ worth of news took us from It’s finally safe to have Grandma in the house with the kids to Is it even safe for Grandma to leave her house? No matter what you do, it comes topped with a thick head of new emotional terror. People hoped that visits would be free of stress this year, compared with last. But underneath that hope was another, equally important one: that this relief would feel more permanent. That we would feel as if we had made some progress. We took precautions, at times too many of them, and thought we were acting for the greater good. But it could never be enough—masking up at Trader Joe’s doesn’t vaccinate the global South. The failure of this righteousness only adds more gloom. Why did we even bother? And why keep at it now? I am vaccinated, Gen Z says, so I’m just gonna, like, do me. Quitting has been on the agenda. The “Great Resignation” suggested that COVID-19 might open a wormhole to better lives. But the emotional bills for those moves are now coming due. I quit my professorship at Georgia Tech this year in part because I despaired of fighting a state government that refused to take precautions in the face of all the other reasons for despair. Staring down the sorrow of giving up a home and life at an already fragile moment, I moved to Washington University in St. Louis, which had imposed a mask and vaccine mandate, like most private universities. I spent the fall in the classroom, in person, with members of Generation C—that’s C for COVID. As the term wore on and the leaves ruddied and Thanksgiving loomed, normalcy of a sort set in. Some students started bringing water or coffee to class again, carefully lowering their masks to take sips. In such moments, I’d catch uncanny glimpses of their faces—their entire faces—and find myself amid familiar strangers. The unexpected shape of a student’s chin could open up a world of mysteries. What else had I been missing? What would I never know I’d missed, because widespread and effective control of the virus never really came? Those losses have been accruing, and nobody has had time to grieve them. Omicron issued a margin call on all that grief. The Omicron variant’s infections may yet prove to be mild. That outcome would be better than the alternative, but it still can manufacture dread. For one part, the public is now accustomed to medical professionals’ perverse understanding of “mild,” namely: It probably won’t put you in the hospital or kill you; as for long COVID, who even knows? For another, the uncertainty surrounding Omicron’s virulence, mated to the scientific bureaucracy’s reliance on “too early to tell” messaging, makes the mere contemplation of the new strain deeply unsettling. And for yet a third, all that uncertainty has produced a new deluge of coronavirus content, this article included. That coverage may be justified—the public ought to be informed—but a surfeit of information also ratchets up anxiety. Even if this strain is less bad than it might have been, only dumb luck will have made it so. That’s neither victory nor a sign that the emergency is over. The coronavirus was once “novel” because it was new. Now it feels both ancient and eternal. Having endured the emergence of two major strains even since the rollout of vaccines, a difficult thought is planted in my head: What if the pandemic never ends? The scientists tell me that “endemicity” is now the goal: COVID-19 will never go away, but eventually we will be able to control it. That sounds good, but we have just spent a year proving that we cannot control it, even when the tools for control appear to be at hand. “Now is the time to overreact,” I wrote in The Atlantic in March 2020, a few days after the global pandemic received its formal declaration. I hoped that a feeling of dread might spur excessive action—lockdowns or rent cancellation or border closings—whatever might have brought the virus to heel. But we have overreacted less and less with each cycle of outbreak, and watched new setbacks follow every victory. That gloomy slog has begotten new generations of dread. Having lived through the past two years on Earth, one should be allowed to wonder if our present circumstances might persist endlessly. Perhaps as superstition, to ward off its arrival through voodoo. Perhaps as hostility toward the too-early-to-tell recklessness of bureaucratic scientism. Perhaps as sensation, to let despair’s heat burn off any useless hope or fear that still remains. Perhaps as practice, to gird ourselves for the worst-case scenario. What if it never ends? Back at the start of the pandemic, when my youngest was 5 and we lived in another house in a different state, and I worked a different job, she used to talk about what we’d do “after coronavirus.” So many plans. Museums and dining out. Seeing family and going to Disney World. Maybe visiting one of those children’s amusement centers full of inflatable play structures that seemed like a disease vector even before things got weird, and which she has now outgrown anyway. Everyone knows the past is gone, but now the past’s future feels lost too. I hope it’s not, but I can’t shake the feeling. from https://ift.tt/3oWUnpb Check out http://natthash.tumblr.com Killer T cells, as their name might imply, are not known for their mercy. When these immunological assassins happen upon a cell that’s been hijacked by a virus, their first instinct is to butcher. The killer T punches holes in the compromised cell and pumps in toxins to destroy it from the inside out. The cell shrinks and collapses; its perforated surface erupts in bubbles and boils, which slough away until little is left but fragmentary mush. The cell dies spectacularly, horrifically—but so, too, do the virus particles inside, and the killer T moves on, eager to murder again. It’s all a bit ruthless, but the killer T does not care. It is merely adhering to its creed: Virus-infected cells must die so that the rest have a better shot at living. The cold-blooded slaughter can “make the difference between someone having a mild infection and a severe one,” Azza Gadir, an immunologist and scientific advisor at the microbial sciences company Seed Health, told me. And that’s exactly what experts now hope is happening in vaccinated people whose antibodies might be faltering against Omicron, the new coronavirus variant that’s sweeping across the globe. T cells can’t totally forestall infection on their own, so we still need the other strategies we use to keep the virus at bay. But prepped by shots or past infection, these elite killers could help hold the line against hospitalizations and deaths, and offer a safety net that could spare us some of the coronavirus’s worst effects. Enough preliminary data have been gathered to show that Omicron can undermine some of the defenses that immunized bodies have built. The variant’s spike protein—the molecular key that the virus uses to unlock cells, and the centerpiece of most of the world’s COVID-19 shots—sports more than 30 mutations compared with the original SARS-CoV-2. Last week, several teams of scientists, as well as Pfizer, released early laboratory data suggesting that these tweaks might make the variant up to 41 times better at sidestepping the neutralizing antibodies roused by vaccines. In an actual body, that could make it easier for Omicron to kick-start an infection. [Read: Our first preview of how vaccines will fare against Omicron] But infection doesn’t always guarantee serious disease. And neutralizing antibodies are not the only defense that the immune system can muster. Immune responses are layered and redundant; where one squadron falters, another can swoop in to help. Killer Ts represent one such layer, and their violent modus operandi comes with serious perks: They home in on different aspects of the virus than antibodies do, and they are much harder to stump with mutations. Against Omicron, T-cell protection might drop slightly, Tao Dong, an immunologist at Oxford University, told me. “But it is not something we should be really worried about.” Antibodies are powerful but simple sentinels. Squeezed out by B cells, they spend their days wandering the body, trying to glom on to a super-specific anatomical sliver on a pathogen. When they manage the feat, some of them—the neutralizers—can cling on so tightly that a virus becomes unable to interact with and enter cells. “That’s why we care so much about antibodies,” Andrew Redd, an immunologist at the National Institute of Allergy and Infectious Diseases, told me. They can block infection solo; the rest of the immune system never has to get involved. That perfect scenario doesn’t always play out, though. After vaccination or infection, antibody levels skyrocket—then, slowly but surely, they start to tick down, giving pathogens more opportunities to sneak by. Neutralizing antibodies are also easily duped by mutations that even slightly rejigger a microbe’s superficial features. Where they once clung on tight, they’ll simply slip off. Viruses, then, have both time and mutations on their side: Infections become easier as antibodies disappear and microbes metamorphose. And once a pathogen has foisted its way inside a cell, it becomes “inaccessible to [neutralizing] antibodies,” Alessandro Sette, of the La Jolla Institute for Immunology, told me. The relevant bits of the bug are no longer visible to them, so they just whiz on by. [Read: Show your immune system some love] But where antibodies stumble, killer Ts shine. Their entire raison d’être is rooting out infected cells—not free-floating viruses—and they manage that feat through an affinity for gore. As a signal of distress, infected cells can chop up some of the viruses they’re being forced to produce and display the mangled pieces on their outside. “They say, ‘Look, I’m infected with something,’” Avery August, an immunologist at Cornell University, told me. The dismembered bits are gross but effective: Nothing makes killer Ts go wild more than a hunk of mutilated virus splattered onto the surface of an infected cell. While neutralizing antibodies pinpoint viruses by their external traits, the microbe equivalent of hair and skin, killer Ts can also identify them via their innards—the blood, muscle, and bone underneath. And because the virus is pretty mashed up at this point, T cells aren’t always as flummoxed by mutations as are antibodies, which care intimately about shape. “That all makes it much more difficult for the virus to evade T-cell responses,” Gadir, of Seed Health, said. SARS-CoV-2 would have to alter a lot more of its physiology to successfully disguise itself—revamping its outsides with plastic surgery, and reshuffling its internal organs with transplants—something the virus might not be able to accomplish without compromising its ability to hack into our cells. Even if the coronavirus somehow managed a major makeover, it would still have to outsmart another trick: Thanks to a genetic quirk, different people’s infected cells will parade different bits of the virus in front of killer Ts—a hand and a liver in you, an ear and a kidney in me. Which means that a version of the virus that manages to elude T cells in one person might still be completely trounced in the next. “That really protects us on a population level,” August said. T cells, in this way, can hamper the spread of infection both within bodies and among them. [Read: COVID-19 vaccine makers are looking beyond the spike protein] All of this coalesces into a not-totally-catastrophic forecast as to where the immunized could be headed with Omicron. Some T cells might waver—but a hefty contingent should still rush in to fight when the variant invades, as long as a vaccine or prior infection has already wised them up. We don’t, to be fair, have the full picture on Omicron yet; more data are still on their way. What’s known so far, though, looks promising. New data gathered by teams led by Sette and Redd show that most of the viral bits that trained T cells tend to recognize, including those within the spike protein, are still pristinely preserved on Omicron, with only a few exceptions. In previously infected people, for instance, Sette’s team predicted that some 95 percent of spike-specific killer Ts should still hit their mark; in the vaccinated, it was 86 percent. Similar data from Pfizer, as well as the biotech company Adaptive, clock in closer to 80 percent for the inoculated. (T cells sampled from vaccinated individuals fixate on the spike—the only thing shots showed them—but T cells in previously infected individuals would be able to home in on other parts of the coronavirus’s anatomy as well.) So there’s probably a dip in how well T cells can suss out Omicron, but not a massive one. And it’s in line with what researchers have observed with other SARS-CoV-2 variants with a wonky-looking spike: T cells consistently pummeled them, because they hadn’t switched up most of the snippets that made them vulnerable to detection, and our vaccines still worked. Omicron, admittedly, is more deviant, and scientists still need to test how well T cells perform against chunks of the variant—something Sette’s group is working on now. But Sette stressed that the important takeaway is that a lot of the T-cell response should still be effective--which means that “the capacity of the immune system to limit the spread of the virus … would still be preserved.” T cells “become even more important if antibodies are not working well,” Dong said. Cellular infections might start to roll out at a rapid clip, but T cells can swoop in to help corral the pathogen in place, typically within a couple of days. This rapid walling-off can halt the progression of disease, and maybe even curb transmission; it also buys the rest of the immune system time to gather its wits. B cells, reawakened from their slumber, will start to churn out more antibodies to replace the ones that have faded; another group of T cells, nicknamed the helpers, will arrive to help coordinate the rest of the immune response. Getting a booster, too, could jump-start this process ahead of infection, coaxing out extra antibodies and possibly tickling more T cells into joining the fray. [Read: Omicron won’t ruin your booster] All of this is likely to mean that more vaccinated people could get infected by Omicron—a new and unfortunate hurdle, as the world continues its struggle to contain the super-transmissible Delta. But the immunized will probably still be at much lower risk of getting seriously sick than their unvaccinated peers, a pattern that early studies out of South Africa seem to fit. That’s in keeping with the stepwise fashion in which immune protection tends to ebb: The safeguards against infection—mostly neutralizing antibodies—fall first. But protection against severe disease and death is the last to go; to engineer those very serious outcomes, viruses have to linger in the body, repeatedly thwarting the many defenders that the immune system tosses their way. But our shot-trained T cells can’t be expected to stand their ground forever. Too many people around the world remain unvaccinated, offering the virus many more chances to splinter into new, troublesome lineages. The quicker the virus moves to colonize us, the more likely it is to outpace our defenses. SARS-CoV-2 could eventually learn to hopscotch more killer Ts, too—a risk we run when we force our bodies to repeatedly tussle with this fast-changing foe. from https://ift.tt/31WSyzo Check out http://natthash.tumblr.com Even before the arrival of Omicron, the winter months were going to be tough for parts of the United States. While COVID transmission rates in the South caught fire over the summer, the Northeast and Great Plains states were largely spared thanks to cyclical factors and high vaccination rates. But weather and the patterns of human life were bound to shift the disease burden northward for the holidays—and that was just with Delta. Enter a new variant that appears better able to evade immunity, and that seasonal wave could end up a tsunami. Back in July, CDC Director Rochelle Walensky announced that COVID had become “a pandemic of the unvaccinated,” an unfortunate turn of phrase that was soon picked up by the president. Now the flaws in its logic are about to be exposed on what could be a terrifying scale. Unvaccinated Americans will certainly pay the steepest price in the months to come, but the risks appear to have grown for everyone. The pandemic of the vaccinated can no longer be denied. The 60 percent of Americans who are fully vaccinated could soon find their lives looking very different. For much of the summer and fall, those who had received two Pfizer or Moderna doses or one Johnson & Johnson shot were told that they were essentially bulletproof, especially if they were young and healthy. But preliminary data from South Africa and Europe now suggest that two vaccine doses alone might still allow for frequent breakthrough infections and rapid spread of the disease—even if hospitalization and death remain unlikely. Getting three shots, or two shots plus a previous bout of COVID, seems to offer more protection. For Saad Omer, the director of the Yale Institute for Global Health, that’s enough evidence to justify changing the CDC’s definition of full vaccination. “With Omicron and the data emerging, I think there is no reason why we shouldn’t have a pretty strong push for everyone to have boosters,” he told me. [Read: Stop calling it a ‘pandemic of the unvaccinated’] At this point, the CDC has recorded that less than a quarter of adults who are fully vaccinated under the existing definition have gotten a third shot. That leaves about 150 million people who are vaccinated but unboosted. Given that the people in this group are less protected against infection, they’re at greater risk of passing on the disease to unvaccinated or partially vaccinated kids, as well as to unvaccinated or immunologically vulnerable adults. They will also pass the coronavirus more readily among themselves. Settings that might have previously seemed safe for vaccinated folks—say, a restaurant or performance venue that strictly checks vaccination status—could become fertile ground for transmission, because the people inside them are more likely to catch and spread the virus. Indeed, anecdotal reports already suggest that large indoor gatherings of fully vaccinated people can become super-spreader events in the age of Omicron. Population-level immunity could suffer in another way too, Omer said: People who were previously protected because of a prior infection could now be quite vulnerable to getting reinfected and passing on the disease. In fact, it’s possible the only parts of the country where community transmission might be blunted are those that faced devastating early waves of the virus and subsequently had strong vaccination rates—mostly a handful of areas in the Northeast. “It’s really very, very challenging to consider how those differences might play out,” Joshua Schiffer, a disease-modeling expert at the Fred Hutchinson Cancer Research Center, told me. Here’s the upshot: Each fully vaccinated person might still be at minimal risk of getting seriously ill or dying from COVID this winter, but the vestiges of normalcy around them could start to buckle or even break. In the worst-case scenario, highly vaccinated areas could also see “the kind of overwhelmed hospital systems that we saw back in 2020 with the early phase in Boston and New York City,” Samuel Scarpino, a network scientist at the Rockefeller Foundation’s Pandemic Prevention Institute, told me. If only a small percentage of Omicron infections lead to hospitalization, the variant is still spreading with such ferocity that millions of people could need a bed. Such a scenario would be especially dangerous if those millions of people all needed a bed at the same time. Omicron is so transmissible that cases could peak across the country more or less in tandem, Schiffer and Scarpino both said, which would make it harder for the U.S. to shuffle personnel and ventilators to particularly hard-hit regions. ICU capacities in some states are already stretched thin and health-care workers are resigning en masse, so the harms could be even worse. “If we don’t get serious, if we don’t get the masks on, if we don’t get testing up, we’re going to be back into lockdown again because people will be dying in the hallways of hospitals,” Scarpino said. The prospect of such a surge in hospitalizations is “keeping me up nights, to be honest,” Schiffer told me. This all would be mitigated if Omicron turns out to cause significantly milder disease than Delta—still a possibility, but far from confirmed—and if the vaccines’ protection against severe disease holds strong. But even in that sunnier version of the future, cases are almost certain to increase in highly vaccinated areas and undervaccinated ones alike, and bring with them a host of disruptions to daily life. Schiffer suggested that in areas with sufficient political will—mostly highly vaccinated ones—high case rates could spur local leaders to institute new shutdowns. In any event, fully vaccinated people are still required to isolate for at least 10 days after a positive test, and anyone they’ve been in contact with might have to stay home from school or work. A positive test in a classroom could send dozens of kids into quarantine, and keep their parents out of work to care for them. Jon Zelner, an epidemiologist at the University of Michigan, told me that massive disruptions caused by surging Omicron cases this winter could force Americans to reconsider these sorts of procedures. [Read: The new pandemic division tearing Europe apart] Whatever the effects on vaccinated Americans, the Omicron fallout is going to be much more severe for everyone else. In places with low vaccine coverage and strong anti-shutdown politics, inconvenience could be replaced by mass death and even greater grief. And the devastation will almost certainly be greater, on average, in rural communities, poor communities, and communities of color. “It’s unvaccinated people who are going to be at the worst risk for the worst outcomes. And it’s also going to be the folks who don’t have the ability or the luxury to quarantine or just kind of hide out when it looks like the numbers are getting too high,” Zelner said. People working multiple jobs might not have time to get a booster or sick days to use while recovering from side effects. People who live in areas that are underserved by hospital systems will have more trouble finding a bed and receive worse care if they do get sick. None of these futures are yet written in stone. The scope of the coming hardship will depend on how capable Omicron is of causing severe disease and death. And though Omicron seems likely to overtake Delta, “cases are still low enough with Omicron that we can have a big effect if [we] act early,” Scarpino said—though “acting early was last week.” A month ago, one could still pretend that burden fell on those who lived in some other place, far away from vaccinated people in vaccinated communities. Now that delusion looks shakier than ever. from https://ift.tt/31PjuBb Check out http://natthash.tumblr.com A lot is still unknown around Omicron, but a worrying trend has become clear: This variant sure is spreading fast. In South Africa, the U.K., and Denmark—countries with the best variant surveillance and high immunity against COVID—Omicron cases are growing exponentially. The variant has outcompeted the already highly transmissible Delta in South Africa and may soon do the same elsewhere. According to preliminary estimates, every person with Omicron is infecting 3–3.5 others, which is roughly on par with how fast the coronavirus spread when it first went global in early 2020. In other words, Omicron is spreading in highly immune populations as quickly as the original virus did in populations with no immunity at all. If this holds and is left uncontrolled, a big Omicron wave lies ahead—bigger than we would have expected with Delta. Cases were already surging ahead of winter. The U.S. already had a too-low vaccination rate. And now Omicron threatens to eat away at the immunity we thought we had. To be clear, this does not mean the pandemic clock has reset to early 2020. Vaccines and previous infections can blunt the virus’s worst effects. Even if protection against infection is eroded, which experts expect, given Omicron’s heavily mutated spike protein, protection against severe disease and death should be more durable. Hospitalizations, rather than cases, might be a better measure of the virus’s impact, as I and others have argued. But if cases balloon dramatically, even a tiny percentage of patients becoming seriously ill can turn into too many hospitalizations all at once. Therein lies the danger possible with Omicron. “That small proportion of severe disease, if it’s multiplied by millions of cases, that will be bad,” says Jeffrey Barrett, the director of the COVID-19 Genomics Initiative at the Wellcome Sanger Institute. “I’m pretty worried.” This is the simple math we have to keep in mind: A tiny percent of a huge number is still a big number. A largely mild but uncontrolled Omicron wave could cause a lot of pain, hospitalizations, and death across a country. The ultimate impact of Omicron will depend on how tiny that tiny percent is and how huge that huge number is. We can’t say for sure, but we have some hints. Given the early trends out of South Africa, the U.K., and Denmark, a large Omicron wave is very possible, though not guaranteed. If we wanted to reassure ourselves, we could note that the absolute numbers of Omicron cases detected so far are so small, they may be skewed by chance, and we could be overestimating the variant’s growth by specifically searching for it. But Omicron is consistently increasing in the three countries looking hardest for it and therefore likely increasing quietly everywhere else. At the same time, Omicron doesn’t appear terribly virulent so far—but this observation comes with even bigger caveats. Doctors in South Africa, where Omicron is already dominant, have not seen as many severe cases as previous waves. Other countries with small numbers of Omicron haven’t found many very sick patients either. But there are several reasons to believe that the news on severity could turn out less rosy than it currently appears. First of all, it’s early. Infections take weeks to progress to severe infections and eventually to death. Back in 2020, the first COVID case in the U.S. was confirmed on January 20, 2020; the first official COVID death was not reported until February 29. The picture may change with time. The early severity data are also confounded by who is getting sick. People who catch the virus early in a wave may be disproportionately young and healthy. “They’re probably taking fewer precautions than an elderly person or someone who’s immunocompromised,” says Vineet Menachery, a virologist at the University of Texas Medical Branch. South Africa’s population is itself fairly young, with a median age of 28, compared with the U.S.’s 38.5. And although vaccination rates are low in South Africa, where less than a quarter are fully inoculated, immunity from previous infection is very high, with one estimate suggesting 62 percent. A good number of Omicron cases are likely to be reinfections. Cases in people who are young or have been previously infected or both should be largely mild. If Omicron cases in this population were mostly severe, that would be a catastrophic sign. The fact that they’re not right now is merely a not-bad one. Scientists are now working furiously to understand Omicron’s effect on vaccinated people. Even if most breakthrough cases continue to be mild in the vaccinated, a small uptick in how many are not mild can still impact hospitalizations by the “tiny percent of a huge number” rule. Protection against infection after two doses is not looking very good. “Omicron was a huge jump in evolution,” says Jesse Bloom, an evolutionary virologist at the Fred Hutchinson Cancer Research Center, in Seattle. In what seems to be just a few months, the virus has changed as much as Bloom says he and many researchers expected it to change “over the span of four or five years.” In a slew of recent lab studies, the potency of antibodies that can neutralize the virus dropped anywhere from five- to sevenfold against “pseudoviruses” that have been engineered to carry Omicron’s spike mutations to 41-fold in a study with live Omicron viruses, which is the gold standard. (In the Beta and Delta variants, we saw drops of about six- and threefold compared with the original virus, respectively.) A 41-fold drop in neutralizing antibody activity after two doses does not mean a 41-fold drop in vaccine effectiveness. The real-world impact is hard to predict, but the effect is big enough that protection against infection might be quite low, says Florian Krammer, a virologist at Mount Sinai’s Icahn School of Medicine. “I think you’re dealing with a variant that has no problem infecting vaccinated individuals,” he says. Not all is lost, because protection against severe disease is likely to hold up much better against Omicron. The first glimmers of real-world data will probably come from the U.K., which is closely tracking Omicron’s spread. Protection against severe disease generally tends to be more durable because of how the immune system works. The first-line defenses of neutralizing antibodies might wane, but other, slower parts of the immune system, such as T cells, can still hold against severe disease. A booster can also strengthen the immune response, says Ali Ellebedy, an immunologist at Washington University in St. Louis. The preliminary data so far bear that out: Two doses plus infection or three doses get people to a higher baseline of neutralizing antibodies, which can better withstand the erosion from Omicron. Currently, however, fewer than half of Americans over 65 have gotten a booster shot, even though they were prioritized because the elderly tend to mount weaker vaccine responses. And 13 percent are still not fully vaccinated. The early glimpses of severity Omicron data cannot tell us how the variant affects an older and unvaccinated group, but everything about our experience so far with COVID suggests that there’s an extreme age skew to risk. Hospitalization trends this winter will likely track with how many older people remain unvaccinated. And the size of this group is another “small percent of a big number” problem: 13 percent of the 54 million Americans over the age of 65 translates to 7 million people at risk for requiring hospitalization if they get COVID. The unvaccinated population remains vulnerable to Omicron, as do immunocompromised people who don’t mount a good response to the vaccine. “Once you have spread, then you start bringing in all those populations that are inherently more susceptible, and that’s a problem,” Ellebedy says. Omicron is also arriving on the cusp of the holiday season, when Americans are gearing up for holiday parties and travel. “It’s an especially bad time for a new variant,” says Matthew Ferrari, who studies infectious-disease dynamics at Penn State. “People are already going to be hanging out. They already have plans. It’s going to be hard to disrupt those plans.” He points out that other seasonal respiratory illnesses such as the flu, which can also burden hospitals, are rising too. Nearly two years of pandemic have left many hospitals understaffed and backlogged. Health-care workers are quitting in droves. The level of tolerable COVID hospitalizations in a potential Omicron wave depends on the capacity of our health-care system to absorb them, and hospitals are already running with little slack. This “tiny percent of a huge number” problem has been with us since the very beginning of the pandemic. The coronavirus is much less deadly than other emerging viruses that have rung alarm bells in the past—SARS, MERS, or Ebola—but it is a whole lot more transmissible. Across the population, this has still added up to so many severe cases, it overwhelmed our health-care system. COVID patients got worse care, as did anyone unlucky enough to get sick or injured during these big surges. We don’t want to get close to this point again. But we aren’t in the same position as in early 2020 because we now have the tools to control Omicron. And thanks to the scientists in South Africa who saw the risk of this variant very early, we have time to put them in place. Vaccines will likely keep protecting against severe infections, and a third shot is likely to boost that protection. Manufacturers are working on an Omicron-specific booster. We better understand the virus’s airborne transmission and how to stop it with masks and ventilation. We have antivirals on the horizon. We have rapid tests, though they should be easier to get. We know social distancing has curbed the virus before. Omicron is spreading fast, but we know how to slow it down. from https://ift.tt/33cZ8m2 Check out http://natthash.tumblr.com And there it is, the first trickle of data to confirm it. In the eyes of vaccinated immune systems, Omicron looks like a big old weirdo—but also, a kind of familiar one. That’s the verdict served up by several preliminary studies and press releases out this week, describing how well antibodies, isolated from the blood of vaccinated people, recognize and sequester the new variant in a lab. The news is … well, pretty much the middling outcome that experts have been anticipating for weeks: a blunting of a certain type of immune protection, but not an obliteration. Omicron harbors more than 30 mutations in its spike protein, the primary target of most of the world’s COVID-19 shots. And it’s certainly dodging some of the antibodies that vaccines goad our bodies into producing—more so, it appears, than the variants that have come before it. But the variant isn’t stealthy enough to elude the gaze of all antibodies we throw its way. Which likely means that a decent degree of vaccine-induced protection, especially against severe disease, will probably be preserved. This is, in other words, “not great, but not the worst-case scenario either,” Vineet Menachery, a coronaviroloigst at the University of Texas Medical Branch, told me. Omicron’s likely to cause some degree of inoculation chaos in the coming months—more vaccinated people will probably contract the variant and, even, get sick. But Omicron hasn’t rewound our immunological clocks to the beginning of the pandemic. Menachery and other experts remain hopeful that there’s a path forward. If immunity is, in part, a numbers game, then boosters—and the additional antibodies they coax out—may help cushion the Omicron blow, at least for a time. A press release from Pfizer this morning seems to point to this possibility, though the company has yet to release its data to the public. [Read: Omicron has created a whole new booster logic] These new studies, which haven’t yet been published in scientific journals, are merely the beginning of a long and complicated conversation. In the coming days, the world will be inundated by a flood of similar laboratory data; nearly all of the findings will show a notable drop-off in antibody potency against Omicron, compared with the variants that came before. But the magnitude of the blunting will vary from study to study—as already seems to be happening—and it’ll take time to reach consensus. It’s way too early to actually, qualitatively assess how much Omicron will chip away at vaccine effectiveness, which encapsulates a lot more than what antibodies alone have to offer, and hinges on how well immunized people actually fare against the variant. Immune systems are complex; so is the real world. Even so, these early reports mark our first concrete indications that Omicron is rejiggering the risk landscape for the vaccinated. It’s not because the shots themselves have changed, or even the immunity they’ve left behind. It’s because we’ve yet again allowed our foe to morph into something more formidable. To find our footing with this new glut of evidence, it’s worth taking a step back to understand how the data came about—and what they can and cannot tell us. The results we’re seeing now are primarily the product of neutralization assays, laboratory-based experiments that slurry together Omicron (or an artificial look-alike) with antibodies sampled from the blood of people who have been vaccinated or infected, and see if the molecules can block, or neutralize, the pathogen before it infiltrates cells. What researchers observe with these studies isn’t an exact approximation of what goes on in a complex human body. But when they need answers fast, a neutralization assay can serve as a decent bellwether for whether our bodies’ frontline immune protection might hold up, Lisa Gralinski, a coronavirologist at the University of North Carolina at Chapel Hill, told me. A neutralization assay was the driving force behind a widely discussed study posted online this week, led by the virologist Alex Sigal of the Africa Health Research Institute, in South Africa, one of the first countries to detect and report Omicron’s existence. The researchers gathered blood plasma from 12 people who’d received Pfizer’s vaccine, six of whom had also previously been infected by an older SARS-CoV-2 variant, a near-perfect match for the version of the virus that the shot had been modeled upon. The antibodies, on average, neutralized the older variant about 41 times better than they neutralized Omicron. The researchers didn’t do a head-to-head comparison between Omicron and other variants of concern, but similar studies have found that vaccine-elicited antibodies are roughly three to 15 times worse at neutralizing Beta, another coronavirus variety with a wonky-looking spike, than the original SARS-CoV-2. The outlook on Omicron, then, can seem bleak: It is trickier for antibodies to glom on to and quell this virus, compared with the variants that preceded it. But the case on Omicron immunity isn’t closed yet. For one, 41 might not be the be all and end all, though it may be quite close, based on other data now being shared. Other researchers, collecting blood from other populations with diverse infection histories or ages, or who received other vaccine brands at different points in time, might see somewhat disparate numbers. Omicron is still relatively scarce in most parts of the world; scientists need time to track it down, then grow it. In the meantime, some might try a workaround: cobbling together a fake Omicron pseudovirus that’s been harmlessly engineered to display the variant’s version of the spike protein. Another research group at the Karolinska Institute, in Sweden, has already done this and posted its own preliminary results, which also surveyed a small group of people, some of whom had been both infected and vaccinated. The Swedish team’s estimates for the drop in neutralization weren’t nearly as drastic--about five- to sevenfold lower for Omicron. But a lot of their participants were health-care workers who had been repeatedly exposed to the virus; some had been boosted. And other experts advised a little more caution when interpreting studies that used faux-Omicron copycats, which might not always behave like the real thing. Pfizer’s preliminary studies, too, have relied on pseudovirus; the company today reported an average of a 25-fold drop in neutralization in 20 people who’d received two doses, according to company spokesperson Jerica Pitts. Experts told me they were more inclined to stick with the 40-ish number until we know more. That drop may sound dire, but “it’s not a complete wipeout,” Penny Moore, a virologist at the University of the Witwatersrand, in South Africa, who worked with Sigal on his study, told me. Most people should still have some vaccine-trained antibodies around that can cling to the parts of the spike that Omicron didn’t modify. [Read: Omicron won’t ruin your booster] The laboratory data also represent a single snapshot in time—the moment when blood was taken out of a vaccinated person. But the antibodies in our blood currently aren’t the ones we’re stuck with forever. The point of a shot isn’t to keep bodies flush with gobs of antibodies in perpetuity; it’s to endow them with the ability to produce more of them when they’re needed. It’s why antibody levels naturally drop after immunization, and why they rocket back up when people get infected. Within days of exposure to Omicron, Menachery told me, “we’ll be talking orders of magnitude more protection.” The capacity to churn out antibodies, in particular, is holstered in B cells, which seem to stick around in droves after vaccination, and continue to sharpen their responses to spike for months. (It’d be a different story if there was no preexisting antibody pool to amplify—which is not the case among people who have been vaccinated.) Neutralization assays also can’t capture the performance of other immune defenders. Some antibodies can’t neutralize viruses on their own, but can still detain them with the help of other immune fighters—a tag-team approach that a neutralization assay won’t capture. Also essential to most antiviral responses are T cells, calculating mercenaries that help B cells pump out antibodies, or blow up virus-infected cells. T cells can’t prevent infections on their own, but their power is in their flexibility. Variant mutations that would totally bamboozle antibodies can’t always fool T cells, which means a lot more of them will be fairly Omicron-proof, Gralinski told me. Pfizer’s press release tentatively confirms this. All of this means that a 40-fold drop in neutralization wouldn’t suddenly make our COVID-19 vaccines perform 40 times worse, especially against the most serious outcomes. Again, we still don’t have solid data on vaccine effectiveness. When the shots’ protection ebbs, it tends to do so stepwise: first, against infection, then transmission and symptoms, and finally against severe disease. High antibody levels are generally a good sign; when the body’s chock-full of the molecules, they form a blazing frontline defense, sometimes capable of blocking infection entirely. But having diminished antibody levels isn’t all that telling, because other immune fighters might jump in to compensate when a virus invades. Even in a worst-case scenario, where protections against infection and mild illness substantially fray, Deepta Bhattacharya, an immunologist at the University of Arizona, told me that vaccine effectiveness against severe disease probably wouldn’t suffer more than “a small drop.” Right now, the road ahead is muddy. For weeks, vaccine makers have already been gearing up to revamp their recipes to better accommodate Omicron; Pfizer, for instance, expects it could have an Omi-vax available by March. But experts aren’t yet ready to take this week’s data as a surefire sign that we’ll need to go down that path—just that it remains wise to prepare. Over the next few weeks, they’ll be monitoring not just how Omicron interacts with antibodies but also how deadly the virus is, and whether it seems poised to usurp Delta’s global throne. If Omicron fizzles out on its own, or doesn’t land tons of people in the hospital, another vaccine formulation might not be necessary, even if our current shots aren’t its exact Achilles’ heel. In the meantime, a viable, if imperfect, stopgap is available to millions of people, at least in well-resourced countries, where supplies of COVID vaccines abound—booster shots. Pfizer’s press release pointed to a pattern that researchers have been hoping to see for weeks: Some vaccine-trained antibodies are clearly bad at sticking to Omicron’s outsides, but if there are enough of them around, they can still collectively bring the virus to heel. The antibodies the researchers pulled out of people doubly dosed with Pfizer were, on average, 25 times less able to neutralize an Omicron look-alike in the lab. But the company also found that a third dose rocketed Omicron neutralization levels up by a factor of 25, suggesting that quantity might at least partially patch holes in quality. A huge caveat: The jury’s still out on how long that antibody bump lasts. But the results are an encouraging echo of past data that have shown that boosters increase people’s ability to fight off all sorts of variants, not just the ones in the original-recipe shots. [Read: Omicron’s best- and worst-case scenarios] The company’s report seems to match up well with the data out of South Africa. People who had been infected by SARS-CoV-2, then vaccinated, had far more neutralizing antibodies at baseline—an observation that’s been made before, and termed a sort of super-powerful “hybrid immunity.” Those sky-high levels provided a buffer against Omicron’s stealth: There was still a big drop in the antibodies’ ability to neutralize the variant, compared with the earlier strain. But where they landed wasn’t all that bad. “The higher you start, the better off you are,” Moore said. “And there are many ways to get there.” That said, boosters are no panacea. They can’t be expected to fully erase Omicron’s setbacks, and the new variant will still evade booster-borne antibodies better than its predecessors did, as evidenced by a study out of Germany. We could still end up needing a bespoke Omicron shot, or something much like it. That might be wise even if Omicron doesn’t turn out to be a significantly worse threat, considering that the variant the vaccines were modeled on was displaced long, long ago by its more transmissible successors. That said, making something hyper-specific to Omicron might not be a perfect solution. We’d have to make sure it still worked well against other variants, including, for the foreseeable future, Delta, which is still the globe’s dominant variant. Boosting with the shots we already have, then, feels more urgent now than ever. That’s a problem, unfortunately, in a world where vaccine distribution has been patchwork at best, leaving billions without first doses while those in wealthier countries help themselves to thirds. “Right now we should be prioritizing getting people some immunity,” Stacey Schultz-Cherry, a virologist at St. Jude Children’s Research Hospital in Memphis, told me. Initial inoculations remain essential to ensuring that people around the world have a baseline immune response to build on, and won’t be facing off with Omicron entirely unguarded. Where we fail to vaccinate widely, the virus will find more inroads; where the virus finds more inroads, more variants will certainly arise. from https://ift.tt/3pze5X0 Check out http://natthash.tumblr.com |
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