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GUEST ESSAY: The present and future of COVID-19 | Columnists

Somehow the mood has changed over the past few weeks. I cannot share any science behind this statement. Except that fewer and fewer people ask me questions like: Will I get it? Will I get it again? Am I going to have a long COVID? Should I have a second reminder? How long will this pandemic last?

Maybe people are tired of my sometimes vague best guesses. Yet it seems more than that. People are so tired of living in the shadows, hiding, even talking about this damn virus.

I say. But the sad truths must be repeated:

  • The omicron BA.5 variant of SARS-CoV-2 is the most contagious to date, among the most contagious viruses of all time. It is also adept at evading our immune defenses.
  • In the United States, we are currently reporting a daily average of approximately 85,000 new cases of COVID-19. Reported cases… but in reality most cases go unreported; the actual number may be 10 times greater. So 850,000 a day? OMG, such a number would have caused panic last year.
  • COVID-19 has now caused life expectancy in the United States to plummet for a second year.
  • One in five of us who are infected may develop long COVID. A few will develop COVID-related heart disease.

People also read…

If you just yawned, please consider this: The SARS-CoV-2 pandemic is one of the most fascinating chapters in the long history of infectious diseases that have plagued humans. Looking at it that way helps me withstand COVID fatigue. Maybe you do too. So …

The epic struggle

It’s an epic fight between us and the virus. We humans are the most dominant animals in history. SARS-CoV-2 is one of the most effective viruses in history. Unfortunately, while he is truly successful in this struggle – success is like continuously reproducing to preserve his life force – we become a little or a lot sick, or even die. Not good for the imperative of preserving our race.

Actual status

We are certainly not winning this battle. It’s a back and forth tug of war. You can see nicely presented in the Warren County data that our reported cases have bounced between mid-teens and low-40s every day since the June BA.5 flair ended. See their COVID-19 information webpage: https://warren-county-ny-covid-19-warrencountyny.hub.arcgis.com/pages/warren-county-covid-19-information.

But remember: the actual number of infections is higher than reported. Putting a point on this, the analysis shows far greater amounts of virus in Glens Falls sewage than reported cases are expected to produce.

The stability of the standoff between us and SARS-CoV-2 has lulled us into mindless apathy. But we must be on our guard: with the virus constantly producing countless new copies of itself, there is a good chance that it will develop another successful mutation, perhaps this fall.

During this time, many of us in the United States have been infected with SARS-CoV-2 (some say 60% of us) and many of us have received two doses of the vaccine (about 68%) . There’s a lot of immunity trying to protect us, but not enough. And only a few of us are still trying to do distancing and hiding.

A closer look at SARS-CoV-2

Many viruses are wonderful at changing their genetics, using processes like mutation and recombination. I will not explain these processes — too complicated. But let’s get to the important point: the modification of viral genetics, also called evolution, leads to changes in the behavioral characteristics of the virus. Here, “behaviour” means how a virus works – how it spreads through its host, how it causes disease, and how it evades counterattacking immune system defenses.

Some viruses evolve better than others. Viruses whose genetics consist of double-stranded DNA are not so good. Examples are varicella zoster, the causative agent of chickenpox and shingles, and smallpox, the causative agent of smallpox. And the monkeypox virus. These cause nasty infections with awesome viral magic, but they don’t tend to vary their genetics very much – they don’t develop many variants.

However, single-stranded RNA viruses tend to change genetics frequently, as the structure of RNA is unstable.

Coronaviruses use RNA. And they are all-time champions of evolution. This is why SARS-CoV-2 was able to jump from bats, its original host species, to humans. It’s also why we experience wave after wave of variants, with each new one spreading more easily or better evading our established immune defenses.

Keep in mind that the more an RNA virus replicates, the more likely it is to evolve. This is why it is frightening to consider the amount of SARS-CoV-2 in our wastewater, therefore among us: the risk of it evolving is high. If so, we can pay.

Take a closer look at us

Our immune systems are amazing and incredibly complicated – again, too complicated to describe in detail. But special mention should be made of the wonderful lymphocytes called CD4+ T cells. Upon coming into contact with a virus or with a vaccine specific to the virus, CD4+ T cells develop instructions and then cause other cells called B cells to make new, specially designed antibodies against that virus. Similarly, they cause CD8+ T cells to destroy virus-infected whole cells. They are the strong men on our side in the showdown.

We have another most important advantage in our struggle: our brains. Brains have led us to develop these vaccines that prime T cells to defend us, dramatically reducing the likelihood that we will get seriously ill or die from COVID-19. And after Labor Day, a smart new development will be rolled out that I think could give us some important new immune muscle: our vaccines have been reformulated to cover the currently active omicron variants. Our CD4+ T cells are waiting impatiently.

It’s disheartening that our brains aren’t telling us all to get vaccinated, that vaccines alone aren’t enough to quell this pandemic, and that we still have to use those annoying social distancing and masking measures. Why don’t we think better? Unfortunately, we are on the wrong side of a two-century-old delusion that, being masters of the planet, we can easily control germs. Isn’t it obvious? Germs are much better at persevering in this world…even if we stop degrading the climate to the point that we can no longer live in it.

Where are things going?

Things could get better: for example, if new vaccines work as hoped… and if we take them. Or worse: if a new variant evolves that can evade the defenses of our immune system, can spread better and is more deadly.

Until such changes occur, we will continue the standoff: the virus will not go away, there will be small waves of new variants, we will remain in our state of apathy, and this fight will continue on and on. .

More bad news: With the growing pressures humans are placing on the world, it’s increasingly likely that another deadly virus is around the corner. What virus? Influenza viruses use single-stranded RNA and are also champions of evolution. Do you remember the Spanish Flu of 1918? It killed maybe 40 million people around the world. COVID-19 has “only” killed 6.5 million people. The best bet: a newly evolved flu will come our way. Or a new coronavirus.

Last words

Hoping that I have re-interested you, but knowing that you may feel even more tired from COVID, or worse, that you are now so depressed that you are ready to catch COVID-19 and be done with it, I urge you to do your best to protect yourself. Look, you don’t want to risk an infection. It could be next to nothing, but it could make you very sick or even die. And an infection can leave you with COVID-related heart disease or long COVID. Please protect yourself.

Beyond that, come on, you don’t want COVID-19 spreading its damage to your neighborhood, your family. Put yourself in their shoes and treat their interests as your own – the golden rule. Protecting yourself protects them. If we all did our best, we would turn the balance of the fight in our favor.

Need details? Check here to see what the CDC advises: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html.

And as fall approaches, think about both the flu and COVID-19. Viruses work the same way; countermeasures as well. Get your flu shot as well as a COVID booster. Use ventilation, social distancing, and masks to your advantage against both.

I do hope you are doing well.

Richard Leach, MD, is a retired internist, infectious disease consultant, and travel and tropical medicine specialist. He practiced in Glens Falls for 35 years, as an infection control officer and hospital epidemiologist at Glens Falls Hospital.


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