Thursday, March 10, 2022

Ok, How did we do? Omicron and the End of the Pandemic

It's clear I didn't have the time to post as much as I planned! This first half of the semester was busier than I expected. So what's happened since I wrote about Omicron at the end of December...? 

So far, WHO hasn't officially posted any new variants of concern. The CDC has eased recommendations for masking. Case counts in Pennsylvania are declining, and hospitalizations/ICU admissions are decreasing. So far, biology is performing as I expected. Even with immunization rates in some areas below those considered ideal, the population seems to be more resilient to the virus, as repeated exposures reinforce newly acquired immunity.

From Politico 

Interestingly, In some jurisdictions worldwide, we're seeing the spread of Omicron among populations that applied very strong "zero tolerance" measures of quarantine and isolation, such as Hong Kong (with a 68% vaccination rate) and New Zealand (with a 78% rate). It may be that people getting sick did help some with getting society at large more immune to SARS-CoV-2, as discussed by Stefan Pilz and colleagues at the Medical University of Graz and Stanford University. Allesandro Sette and Shane Crotty note that useful immunity to SARS-CoV-1--which was responsible for Severe Acute Respiratory Syndrome nearly 20 years ago--could be detected up to 17 years after that infection. They suggest that we might find similar results over time with the closely related SARS-CoV-2, which causes COVID-19.

So we are pretty much where I expected us to be at this moment. I'll emphasize that new tricks could be forthcoming from this coronavirus..., but I don't expect it for the near future. It's possible that we'll get something newer and weirder next winter, but we might not. Along those lines, a lot of authorities are announcing a transition from "pandemic" to a world where SARS-CoV-2 is endemic--part of our usual array of "background hazards" like influenza, bacterial pneumonia, and sexually transmitted diseases.

Here's what I'm seeing in my practice:

  • Fewer cases of acute covid. In fact I haven't had one in over two weeks.
  • A few cases of prolonged covid recovery. This isn't so-called "long-Covid." Rather it's people who are recovering slowly and require multiple remedies to get them back to normal over a period of 3-6 weeks.
  • A few cases of long-Covid, months after the original infection. Treatment of these has been going slowly.
  • Several cases of vaccine injury or what homeopaths call "vaccinosis." In some cases these have been after the second shot, not the first. Treating these has been going a bit more briskly, so that's good. 
Of everyone in my practice, I can say that vaccinosis is a minority, but has happened more often than I expected, so maybe 4-8% of vaccinated persons I've seen over the past year. However I suspect it's lower in the general population, given the fact that some folks self-select for homeopathic care. But maybe that's not true, either, since vaccinosis is a poorly defined term, and reporting on it varies by official sources. I tend to assign the diagnosis if a patient has developed a new medical problem since their immunization for covid. Common examples have been asthma, fatigue, and mental status changes involving memory and attention--coincidentally common symptoms of covid!

I found an interesting article from the University of Montreal by Alexandra Tauzin and colleagues that discusses an experiment that showed that shorter intervals between vaccine doses--as we have been doing so far--and shorter periods between having covid and then getting vaccinated--provides no significant improvement in the duration of immunity. 

They suggest that these findings mean we might apply existing vaccines more flexibly. Basically we might not have to try to space shots 1 and 2 so closely together, which would make vaccine administration easier. For me, given the extent to which patients are reporting more--and more intense--symptoms after the second dose of the 2-dose vaccines, or when the first dose is given too close to a case of covid infection, it means maybe we should be a bit more trusting of immunity after covid infection, and maybe we shouldn't be hammering people with vaccine doses and booster shots so close together.

From Nature Medicine A year ago, this graph speculated about the unknowns.

Ah, well, when all you have is a hammer, everything looks like a nail!

The vaccine is our every time something goes a little sideways with the current pandemic, we hit at it with our hammer. But is this wise?

  • Continually revaccinating may lead to more, and enduring, vaccinosis--my practice experience suggests this, but that experience isn't conclusive proof. Current research shows that reimmunizations raise circulating antibodies, but only to a point, as an Israeli study showed that even four shots didn't provide more protection against the Omicron variant. Moreover, circulating antibodies may not be the most useful benchmark. The study by Sette and Shane suggest that using T-memory cell activity may be a better way to understand our risks with respect to new covid variants and the potential for future surges of infection.
  • A French study did find that people who had covid had more side effects after the first dose of the vaccine. Looking through the research, I didn't find much to suggest that looking at timing versus response has been closely explored, excepting the study by Tauzin I mentioned above--and they were only suggesting that maybe we can give vaccines farther apart; they didn't look at whether people had fewer or less intense side effects as a result. The risk of studying that relationship is that if it shows that spacing shots farther apart, or that covid illness confers adequate immunity to a second episode of severe disease, might reduce public willingness to get vaccinated. The simple public health message is currently" "vaccinate, vaccinate, and vaccinate some more! Get your booster!" Is the world ready for a more subtle message?
  • It has been argued that much of the world is still unvaccinated. Does it really make sense to focus on repeatedly immunizing the citizens of wealthy nations, while those in poorer countries stand by waiting for even their first dose of a covid vaccine? Omicron emerged in southern Africa, where only a third of people have even gotten their first dose of any vaccine for covid. Such an approach, it seems, is neither moral nor practical, since as we have seen, new variants tend to come from virus-/vaccine-naive populations.
So the question one might ask me: "Will you get your booster shot?"

For now, my answer is "No."

My experience with HIV has shown me that once we get through the "OMG-so-many-people-are-dying" phase of an epidemic, we begin to accrue more thoughtful study, and with a longer view. The current research suggests that I am immune to severe disease, and likely to not be very susceptible to mild disease. This may not be everybody's story--so check with your own doctor! My clinical experience suggests that, mostly, these vaccines don't cause too much harm to too many folks...but I don't want to keep playing around with it. All things in moderation!

So I think I've had about as much of this vaccine as I need for now.
Be well!

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