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3 COVID Scenarios That Could Cause Trouble in the Fall

3 COVID Scenarios That Could Cause Trouble in the Fall


Editor’s Note: See Medscape’s latest COVID-19 news and guidance. coronavirus resource center.

As the US enters its third fall with COVID-19, the virus appears to be gone for many. But for those keeping an eye on it, it’s not being forgotten, as the number of deaths and infections continues to rise at a declining but steady pace.

What does this mean for the coming months? Experts are predicting a range of scenarios, some more dire than others, and some more encouraging.

In the United States, more than 300 people die every day According to the Centers for Disease Control and Prevention (CDC), more than 44,000 new cases are reported every day from COVID.

But progress is undeniable. The grim daily death toll for 2020 has plummeted.Vaccines and treatments have dramatically reduced the number of serious illnesses and the need for masks has largely disappeared. personal preference.

Epidemiologists and other medical experts have applauded this progress, but the maps and numbers point to several scenarios ahead, some of which, combined with weakened immunity, lead to more resistant disease. One mutation, the possibility of a “storm”, etc. indicates that a wave of diseases is coming. “Influenza/COVID onslaught and inadequate use of life-saving vaccines and treatments.

Looming Variants/Weakened Immunity

Omicron variant BA.5 still accounts for approximately 80% of infections in the United States. BA4.6, According to the CDCbut other subvariants have emerged and are showing signs of resistance to current antiviral treatments.

Eric Topol, M.D., Founder and Director of the Scripps Research Translational Institute and Editor-in-Chief of Medscape, said about COVID this fall:

He said the subvariants XBB and BQ.1.1 “have extreme levels of immune evasion and both can cause problems”, explaining that XBB is more likely to cause problems than BQ.1.1. Did.

Topol points to new research on these variants in a preprint posted in . bioRxiv server. AUTHORS’ CONCLUSIONS: “These results suggest that current herd immunity and BA.5 vaccine boosters may not provide sufficient broad protection against infection.”

Dr. Michael Sweat

Another variant of note, according to some experts, is the Omicron variant BA.2.75.2. Resistance to antiviral therapy. And it’s growing at a pretty alarming rate, says Dr. Michael Sweat, director of the MUSC (Medical College of South Carolina) Global Health Center in Charleston. accounts for less than Spread across at least 55 countries and 43 US states rear First appeared at the end of last year Globally, in the US in mid-June.

No peer review Last month’s preprint study Swedish researchers found that variants in blood samples were neutralized on average with “about 6.5 times the potency of BA.5, with BA.2.75.2 being the most neutralized.” [neutralization-resistant] Variants evaluated to date. ”

Caitlin Jetelina, Ph.D., assistant professor in the Department of Epidemiology, University of Texas Health Science Center, said: Medscape Medical News US waves often follow European waves, and Europe recent spikes Cases and hospitalization No It’s related to the Omicron subspecies, but it’s associated with weather changes, reduced immunity, and behavioral changes, she said.

who report on wednesday While cases have fallen in all other parts of the world, Europe stands out, with an 8% increase in cases from the previous week.

Jetelina cites events such as Germany’s Oktoberfest, which ended last week, drawing nearly six million people in two weeks, as potential contributors, and people heading indoors as weather patterns change in Europe. rice field.

Dr. Ali Mokhdad

Dr. Ali Mokdad, chief strategy officer for population health at the University of Washington in Seattle, said: Medscape Medical News He’s less concerned about the possibility that new immune escape mutants will still emerge than the documented mutants we know of.

“Now we know that the Chinese are preparing to open up their country. We expect many infections of Omicron to spread in China because they have low immunity and are less likely to be infected.” This may be due to the number of infections in which variants can be seen.”

Mokhdad said weakened immunity could also make populations more vulnerable to mutations.

“Even if you do get it, you’re likely to get it again after about five months. Remember, most of the infections from Omicron happened in January or February of this year, followed by two waves.” he said.

Mokdad said a new bivalent vaccine fine-tuned to target some Omicron subspecies would help, but said “people are very reluctant to take it.” .

Jennifer Nuzzo, Ph.D., professor of epidemiology at Brown University’s School of Public Health in Providence, Rhode Island, and director of the Pandemic Center, said the U.S. will cut back on funding for test kits this year, reducing its ability to track variants. I am concerned that test site. Most people are testing at home, which isn’t showing up in the numbers, but the US is relying more on data from other countries to spot trends.

“I think it will only reduce visibility into the circulation of this virus,” she said. Medscape Medical News.

Twindemic: COVID and Influenza

Dr. Caitlin Jetelina

Jetelina noted that Australia and New Zealand have just finished their flu season and have returned to normal after a steep decline in flu numbers over the past two years, with North America typically following suit.

“We expect a flu outbreak here in the United States, possibly at pre-pandemic levels. Everyone is holding their breath. We haven’t really experienced that yet,” she said.

However, there is some disagreement about the possibility of a so-called “twindemic”. influenza And COVID.

Dr. Richard Webby, an infectious disease specialist at St. Jude Children’s Research Hospital in Memphis, Tennessee, said: Medscape Medical News He thinks it’s unlikely that both viruses will surge at the same time.

“That doesn’t mean there won’t be flu and COVID activity in the same winter, but I think it’s unlikely that both will be rampant at the same time,” he explained.

As an indicator, influenza activity began to recover at the beginning of last year’s flu season in the northern hemisphere, but when Omicron variants emerged, “flu could not compete in the same environment, and flu numbers could quickly drop.” It has decreased.” Previous literature suggests that when one virus surges, it is difficult for another respiratory virus to take hold.

Vaccines, treatments not used

Jennifer Nuzzo, DrPH

Another threat is the vaccines, boosters, and treatments on the shelf.

MUSC’s Sweat noted dissatisfaction with vaccine uptake that seemed “frozen to amber.”

As of October 4th, Only 5.3% of people In the US, it was for eligible users who received an updated booster that launched in early September.

Nuzzo says a booster for people at least 65 years old will be key to the severity of COVID this season.

“I think that’s probably the biggest factor heading into fall and winter,” she said.

38% of those aged 50 and over and only 45% of those aged 65 and over got a second booster As of early October.

“If nothing else is done, the group will have to increase its booster intake,” Nuzzo said.

She treats nirmatrelvir/Ritonavir (pax robid, Pfizer) is very underutilized to treat mild to moderate COVID-19 in patients at high risk of severe disease. I’m worried about that “rebound” effect.

Nuzzo encouraged more drug use and education Methods of managing drug interactions.

“We have very strong data that it helps keep people out of the hospital. Sure, there may be a rebound, but it pales in comparison to the risk of being hospitalized.” she said.

Mild COVID season?

Not all predictions are dire. According to Sweat, there’s another less-talked-about scenario. That means the COVID season could be mild.

Omicron blew up with such strength, he notes, and may have left wide immunity in its wake. There is a possibility.

“If the next subspecies is descended from the Omicron line, I suspect that all those who have just been infected have considerable, if not complete, protection,” Swett said.

Topol, Nuzzo, Sweat, Webby, Mokudad, Jetelina No related financial relationships have been reported.

Marcia Frellick is a freelance journalist based in Chicago. She has contributed to the Chicago She’s Tribune, Science She’s News, and, and has been editor at the Chicago She’s the Sun Times, Cincinnati She’s the Enquirer, and the St. She’s the Cloud (Minnesota) Times. Follow her on her Twitter. @mfrellick

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