Daily Archives: August 18, 2021

In the 1980s, doctors at an English hospital deliberately tried to infect 15 volunteers with a coronavirus. COVID-19 did not yet existwhat interested those doctors was a coronavirus in the same family called 229E, which causes the common cold. 229E is both ubiquitous and obscure. Most of us have had it, probably first as children, but the resulting colds were so mild as to be unremarkable. And indeed, of the 15 adult volunteers who got 229E misted up their nose, only 10 became infected, and of those, only eight actually developed cold symptoms.

The following year, the doctors repeated their experiment. They tracked down all but one of the original volunteers and sprayed 229E up their nose again. Six of the previously infected became reinfected, but the second time, none developed symptoms. From this, the doctors surmised that immunity against coronavirus infection wanes quickly and reinfections are common. But subsequent infections are mildereven asymptomatic. Not only have most of us likely been infected with 229E before, but weve probably been infected more than once.

This tiny study made little impression at the time. In the 80s and 90s, coronaviruses still belonged to the backwater of viral research, because the colds they caused seemed trivial in the grand scheme of human health. Then, in the spring of 2020, scientists urgently searching for clues to immunity against a novel coronavirus rediscovered this decades-old research. Before the emergence of SARS-CoV-2, which causes COVID-19, only four known coronaviruses were circulating among humans, including 229E. All four of these coronaviruses cause common colds, and in the most optimistic scenario, experts have told me, our newest coronavirus will end up as the fifth. In that case, COVID-19 might look a lot like a cold from 229Erecurrent but largely unremarkable.

That future may be hard to imagine with intensive-care units filling up yet again during this Delta surge. But the pandemic will end. One way or another, it will end. The current spikes in cases and deaths are the result of a novel coronavirus meeting naive immune systems. When enough people have gained some immunity through either vaccination or infectionpreferably vaccinationthe coronavirus will transition to what epidemiologists call endemic. It wont be eliminated, but it wont upend our lives anymore.

With that blanket of initial immunity laid down, there will be fewer hospitalizations and fewer deaths from COVID-19. Boosters can periodically re-up immunity too. Cases may continue to rise and fall in this scenario, perhaps seasonally, but the worst outcomes will be avoided.

We dont know exactly how the four common-cold coronaviruses first came to infect humans, but some have speculated that at least one also began with a pandemic. If immunity to the new coronavirus wanes like it does with these others, then it will keep causing reinfections and breakthrough infections, more and more of them over time, but still mild enough. Well have to adjust our thinking about COVID-19 too. The coronavirus is not something we can avoid forever; we have to prepare for the possibility that we will all get exposed one way or another. This is something were going to have to live with, says Richard Webby, an infectious-disease researcher at St. Jude. And so long as its not impacting health care as a whole, then I think we can. The coronavirus will no longer be novelto our immune systems or our society.

Endemicity as the COVID-19 endgame seems quite clear, but how we get there is less so. In part, that is because the path depends on us. As my colleague Ed Yong has written, the eventuality of endemic COVID-19 does not mean we should drop all precautions. The more we can flatten the curve now, the less hospitals will become overwhelmed and the more time we buy to vaccinate the unvaccinated, including children. Letting the virus rip through unvaccinated people may get us to endemicity quickest, but it will also kill the most people along the way.

The path to endemic COVID-19 will also depend on how much the virus itself continues to mutate. Delta has already derailed summer reopening plans in the U.S. And with so much of the world still vulnerable to infection, the virus has many, many opportunities to luck into new variants that may yet enhance its ability to spread and reinfect. The good news is this virus is unlikely to evolve so much that it sets our immunity back to zero. Our immune responses are so complex, its basically impossible for a virus to escape them all, says Sarah Cobey, an evolutionary biologist at the University of Chicago. For example, levels of antibodies that quickly neutralize SARS-CoV-2 do indeed drop over time, as happens against most pathogens, but reserves of B cells and T cells that also recognize the virus lie in wait. This means that immunity against infection may wane first, but the protection against severe illness and death are much more durable.

Read: Your vaccinated immune system is ready for breakthroughs

Protection against severe illness and death was, in fact, the original goal of vaccines. When I spoke with vaccine experts as the trials were under way last summer, they universally told me to temper expectations. Vaccines against respiratory viruses rarely protect against full infection because they are better at inducing immunity in the lungs than in the nose, where respiratory viruses gain their first foothold. (Consider: The flu shot is 10 to 60 percent effective depending on the year.) But the extraordinary efficacy from the initial clinical trials raised expectations, Ruth Karron, the director of the Center for Immunization Research at Johns Hopkins University, told me. With the Pfizer and Moderna vaccines 95 percent effective against symptomatic infection, eliminating COVID-19 locally, like measles or mumps in the U.S., suddenly seemed possible.

Then came the less pleasant surprise: new variants, like Beta, Gamma, and now Delta, that erode some protection from vaccines. We now are where we thought we would be a year ago, Karron said. The vaccines still protect against serious illness very well, as expected, but herd immunity again seems out of reach. The virus will continue to circulate, but fewer people will get sick enough to be hospitalized or die. Highly publicized outbreaks among vaccinated people, such as in Provincetown, Massachusetts, already show this pattern playing out. And entire countries with high vaccination rates, such as the U.K., Iceland, and Israel, are also seeing spikes with only a fraction of their pre-vaccine deaths.

The timing and severity of reinfections and breakthrough infections once COVID-19 becomes endemic depend on how quickly the protective effects of immunity against the virus wanes. And that, in turn, depends on a combination of two factors: first, how quickly our immune systems get rusty against SARS-CoV-2, and second, how quickly this coronavirus evolves to disguise itself. The immunological machinery is simply harder to rouse against an old enemy. But a reinfection or breakthrough infection does reinvigorate the immune response. A breakthrough case acts like a booster for the vaccine, as Laura Su, an immunologist at the University of Pennsylvania, told my colleague Katherine J. Wu. In the 229E study, the doctors also found that the volunteers who did not get infected the first time were more likely to be infected when exposed a year later, compared with volunteers who got sick the first timesuggesting that more recent illness is more protective.

The virus itself will also change with time. As more people gain immunity via either infection or vaccination, the coronavirus will try to find ways to evade that immunity too. This is a natural consequence of living with a circulating virus; the flu also mutates every year in response to existing immunity. But in the endemic scenario, where many people have some immunity, the coronavirus will not be able to infect as many people nor replicate as many times in each person it infects. Im very confident that the rate of adaptation is going to be set by the prevalence of SARS-CoV-2 in the world, Cobey says. You might think of viral replication as buying lottery tickets, in which the virus accumulates random mutations that very occasionally help it spread. And the fewer lottery tickets the virus has, the less likely it is to hit the mutation jackpot. The appearance of troubling new variants may slow down.

Reinfections with the four common coronaviruses are likely driven by a combination of our immunity fading and the viruses themselves evolving. Putting together everything we do know, a pattern starts to emerge: We are likely first exposed to these common coronaviruses as children, when the resulting disease tends to be mild; our immune systems get rusty; the virus changes; we get reinfected; the immune response is updated; the immune system gets rusty again; the virus changes again; we get infected. And so on.

In the best case, COVID-19 will follow the same pattern, with subsequent infections being mild, says Stephen Morse, an epidemiologist at Columbia University. If the burden of disease is not high, we take [the virus] very much for granted, he says. Still, these colds are not completely benign; one of the common-cold coronaviruses has caused deadly outbreaks in nursing homes before. In a less good scenario, COVID-19 looks like the flu, which kills 12,000 to 61,000 Americans a year, depending on the seasons severity. But deaths alone do not capture the full impact of COVID-19. A big question mark there is long COVID, says Yonatan Grad, an immunologist and infectious-disease researcher at Harvard. There are still no data to prove how well the vaccines prevent long COVID, but experts generally agree that a vaccinated immune system is better prepared to fight off the virus without doing collateral damage.

The transition to endemic COVID-19 is also a psychological one. When everyone has some immunity, a COVID-19 diagnosis becomes as routine as diagnosis of strep or flunot good news, but not a reason for particular fear or worry or embarrassment either. That means unlearning a year of messaging that said COVID-19 was not just a flu. If the confusion around the CDC dropping mask recommendations for the vaccinated earlier this summer is any indication, this transition to endemicity might be psychologically rocky. Reopening felt too fast for some, too slow for others. People are having a hard time understanding one anothers risk tolerance, says Julie Downs, a psychologist who studies health decisions at Carnegie Mellon University.

With the flu, we as a society generally agree on the risk we were willing to tolerate. With COVID-19, we do not yet agree. Realistically, the risk will be much smaller than it is right now amid a Delta wave, but it will never be gone. We need to prepare people that its not going to come down to zero. Its going to come down to some level we find acceptable, Downs says. Better vaccines and better treatments might reduce the risk of COVID-19 even further. The experience may also prompt people to take all respiratory viruses more seriously, leading to lasting changes in mask wearing and ventilation. Endemic COVID-19 means finding a new, tolerable way to live with this virus. It will feel strange for a while and then it will not. It will be normal.

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How We Live With the Coronavirus Forever - The Atlantic

Texas Gov. Greg Abbott, pictured here in July, is not experiencing any symptoms, his office said Tuesday. Tamir Kalifa/Getty Images hide caption

Texas Gov. Greg Abbott, pictured here in July, is not experiencing any symptoms, his office said Tuesday.

Texas Gov. Greg Abbott, who has been fully vaccinated, has tested positive for the coronavirus, his office announced Tuesday. Abbott has opposed mask mandates, and his orders have drawn legal challenges.

The Republican governor is experiencing no symptoms and "has been testing daily, and today was the first positive test result," his office said.

Abbott "will isolate in the Governor's Mansion and continue to test daily. Governor Abbott is receiving Regeneron's monoclonal antibody treatment," the statement said.

Texas first lady Cecilia Abbott tested negative.

With more than 16,000 new daily cases, Texas is one of the states with the highest risk of COVID-19.

Last week, Abbott directed state officials to use staffing agencies to find additional medical personnel from outside Texas as the state's resources became overwhelmed. He also asked hospitals to postpone all elective medical procedures voluntarily.

The Biden administration is suing the state of Texas to block Abbott's order for state troopers to stop vehicles carrying migrants on grounds that the migrants may spread COVID-19. But medical experts say migrants are no more likely to have the coronavirus than any other travelers who are crossing the border, or anyone living in U.S. COVID-19 hot spots.

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Texas Gov. Greg Abbott Tests Positive For The Coronavirus - NPR

In the state of Maharashtra, one of the first places struck by Indias devastating second wave of Covid-19 earlier this year, scientists are anxiously looking for signs of a third.

New laboratories in the financial capital, Mumbai, and in the city of Pune are searching for dangerous new variants. They have stepped up testing, to over 3,600 samples per month from 134 in December last year, as they search for mutations that could make the virus even harder to stop.

India is still far short of its goal to increase genome sequencing nationwide. While Covid-19 cases and deaths have plunged, according to official numbers, the virus is continuing to spread in some parts of the country. A low vaccination rate and other factors have left India especially vulnerable to variants like Delta, the strain that helped power Indias second wave this past spring.

We need to track new variants to prepare ourselves for the next wave because waves will keep happening, much like the flu or common cold, which keep recurring because the virus mutates or recombines, said Dr. Vinod Scaria, the principal scientist at the Institute of Genomics and Integrative Biology in New Delhi. You cant really prevent that. But you can always be prepared for it.

The second wave, which exploded across the country in April and May, exposed both the Delta variants increased communicability and Indias inability to cope. Official figures show that about 430,000 people have died since the virus hit early last year, though the numbers are widely considered unreliable and experts say the true toll may be in the millions. The second wave pushed the countrys medical system past its limits and led to anger over the governments inability to handle the crisis.

For now, the disaster appears to have ebbed. Indias daily official caseload has fallen to about 40,000, compared with the more than 300,000 it saw during the worst of the crisis. The hardest-hit urban centers like New Delhi, Mumbai and Pune have had a dramatic decline in cases. Covid-19 wards in many major cities have emptied.

Some hope that the sheer contagiousness of the Delta variant means that many people have already caught it and developed a measure of protection. A recent survey by the Indian Council of Medical Research, a government agency that funds and evaluates studies, found that two-thirds of blood samples surveyed had coronavirus antibodies, compared with about one-quarter in December and January. In some states, as many as three-quarters of samples surveyed carried antibodies.

But scientists cautioned that the survey, with a small sample size of 36,000, shouldnt be read as an indication that India is out of the woods. Such tests can be prone to false positives. Also, the survey doesnt represent all areas, said Giridhara Babu, professor of epidemiology at the government-affiliated Public Health Foundation of India, though it could help Indian officials better target areas for testing and vaccinations.

Even if the numbers are accurate, they suggest that 400 million people in India remain vulnerable to Covid-19.

What is going to happen now is that areas with low sero prevalence and low vaccination will have more number of cases and more people getting hospitalized and higher deaths, Dr. Babu said, referring to serology, or antibody, testing.

The potential for new variants complicates the picture even further. Places like India with low vaccination rates and other risk factors are particularly vulnerable to new strains.

Aug. 18, 2021, 7:10 a.m. ET

After a chaotic and slow start, India has intensified its inoculation drive, regularly delivering five million doses per day. About half a billion doses have been administered so far, and more than 100 million citizens are now fully vaccinated. Indian medical experts hope the increased vaccinations will help blunt the impact of a third wave because even one shot can reduce the severity of infection.

Still, only 8.5 percent of the population is fully vaccinated. It remains to be seen whether the country can reach its goal of vaccinating all the adult population of roughly 900 million by the end of the year.

Low testing rates are another factor. India now administers an average of about 1.2 tests per thousand people per day, according to the Our World in Data project at Oxford University, well above levels at the beginning of the year. But its rate is still well below those of richer countries, coming in at a bit more than half of the level of the United States, for example.

Those low test rates make charting the course of the virus difficult. Currently, a large number of positive tests are coming from southern states like Kerala, which in general conduct more tests than in other parts of the country. That state accounts for nearly half of the total active cases. Infections in areas with lower testing rates would be hard to detect.

Understandthe State of Vaccine and Mask Mandates in the U.S.

Researchers are particularly watching Kerala, which was hit later by the second wave than other parts of the country. A better-prepared health infrastructure helped reduce fatalities. But the circulation of the virus has been so steady that it gives opportunity for mutation.

It is cause for satisfaction, in a way, that the mortality is not high, said Dr. V.K. Paul, who leads the Indian governments Covid-19 task force. But when there is so much of virus replication, there are problems variants can emerge, other areas can get infected, and vulnerable population in any part of the country remains susceptible.

Kerala increased its genome sampling early, testing about 1,400 per month since December. Proactive genome sequencing has helped Kerala and Maharashtra in recent months to identify districts where a variant known as Delta Plus has emerged and immediately respond to contain the spread.

But broadly, Indias sampling effort is lagging. Under an initiative organized by the Indian SARS-CoV-2 Genomics Consortium, or Insacog, a group of national laboratories, each state was initially supposed to test 3 percent to 5 percent of samples. Currently, the country is sampling only about 0.1 percent of Covid-19 tests.

Should a third wave emerge, Indian officials say they have not let down a guard raised during the second wave. In New Delhi, which was the epicenter of the second wave, more than 95 percent of regular Covid beds as well as intensive care unit beds remain available. The states chief minister said that 27 oxygen plants had been added, and that tankers were being acquired, to avoid the oxygen shortage of the last wave. In Mumbai, about 85 percent of the regular Covid beds and nearly 70 percent of I.C.U. beds remain vacant. The number of vacant beds in Pune remains at about 77 percent.

The emergence of a third wave or another variant will ultimately depend on human behavior, said Dr. Scaria, of the Institute of Genomics and Integrative Biology. Testing may find the variant too late, as it did in the second wave, when the spread of the Delta variant did not become apparent in the countrys limited genome testing until April. Masks, vaccinations, social distancing and other precautions will be crucial to stopping new variants from emerging.

A variant by itself cannot cause a wave, because variants can be tackled if you have the information in advance, Dr. Scaria said. Human behavior is as important, if not more, in creating a wave. If the right variant reaches the right population, it will create a wave.

Hari Kumar contributed reporting.

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Indias Covid-19 Numbers Have Fallen. A Third Wave Still Looms. - The New York Times

In most cases, they found, the chain of transmission stopped with the infected child, but in 27.3 percent of households, children passed the virus along to at least one other resident.

Aug. 18, 2021, 7:10 a.m. ET

Adolescents were most likely to bring the virus into the home: Children from 14 to 17 made up 38 percent of all the index cases. Children who were 3 or younger were the first to get sick in just 12 percent of households but they were the most likely to spread the virus to others in their homes. The odds of household transmission were roughly 40 percent higher when the infected child was 3 or younger than when they were between 14 and 17.

The findings may be the result of behavioral differences between toddlers and teenagers, medical experts said.

When we think about whats teen social behavior outside of the house, theyre spending a lot of time together, theyre often in quite close quarters, theyre often touching or sharing a drink, said Dr. Susan E. Coffin, an infectious disease specialist at Childrens Hospital of Philadelphia, who was not involved in the study.

Those behaviors could make teens more likely to contract the virus and bring it home, she said.

On the other hand, while very young children probably have less social interaction outside the home, they tend to be in close physical contact with others in their households, in addition to frequently putting their hands and other objects in their mouths, which could help spread the virus. Once they bring it into the household, it can be spread easily, Dr. Coffin said.

It is also possible that the youngest children may carry higher levels of virus, or have higher rates of viral shedding, than teenagers, the researchers noted. Some studies have found that even though young children rarely get seriously ill, they may carry similar, or even higher, levels of virus than adults do. Although viral load is not a perfect predictor of infectiousness, the data suggest that children could potentially be as contagious as adults.

But the dynamics of disease transmission are complicated, and the precise role that children play in spreading the virus remains uncertain.

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Babies and Toddlers Spread Coronavirus in Homes More Easily Than Teens, Study Finds - The New York Times

The Philadelphia region except for Delaware County was seeing high coronavirus transmission rates as of Tuesday, according to the CDC, and local health officials said they are continuing to watch rising hospitalizations, particularly among the unvaccinated.

Throughout the pandemic, rising case counts have precipitated an increase in hospitalizations. This summer, the spread of the highly transmissible delta variant has not deviated from the sobering trend, with most patients being unvaccinated.

In Philadelphia and South Jersey, coronavirus hospitalizations have tripled since last month, spokespeople for the city and Camden County said. In the western suburbs, Bryn Mawr, Paoli, and Riddle Hospitals and Lankenau Medical Center were treating more than 50 patients for virus-related complications as of Monday, up from zero patients on July 4, said Jonathan Stallkamp, interim chief medical officer for Main Line Health.

Were definitely not at the peak of this next wave, said Stallkamp, a physician, adding that Main Line patients include seriously ill young people without preexisting conditions. Its sad to watch.

As long as the vaccination rate doesnt see a massive and sudden increase, and delta remains dominant, the virus appears primed to keep spreading across the region, erasing any early-summer hopes of the pandemic retreating, health officials warn.

Nationwide, new case counts are the highest theyve been in six months, with hospitals overwhelmed in some states. In Pennsylvania, case counts have doubled over the last two weeks, according to the New York Times, with hospitalizations increasing, too, but at a slower rate. Both metrics are rising in New Jersey, too, though less rapidly.

Michael Levy, an associate professor of epidemiology at the University of Pennsylvania, said he looks at that momentum and worries that the number of infections will continue to rise, especially as students return to their classrooms and college campuses this fall.

Dont think its not going to happen here, Levy said. We saw delta go through India, go through Britain [where 61% of the population is fully vaccinated]. I think we should be worried.

Places that have vaccination rates as high as Philly are getting hit, he added. About half of the citys total population, including children not yet eligible for shots, are fully vaccinated.

Most people getting sick and the vast majority of those being hospitalized have not had their shots, officials and physicians say, providing further evidence that vaccines are working.

Across the Philadelphia region, public health leaders said they hope enough people are vaccinated to prevent a repeat of the surge last winter, before the shots were widely available.

READ MORE: Some peoples minds are changing about the coronavirus vaccine. Heres how doctors persuade them.

If weve learned anything from this pandemic, its to not expect anything, Philadelphia spokesperson James Garrow said. Its our hope that our high vaccine rate, coupled with masking, will help flatten the curve of new cases, and keep our hospitals from being overwhelmed.

In Bucks County, where 29 people were hospitalized with the virus as of Tuesday, officials said they were heartened to see that neither hospitalizations nor deaths have increased in proportion to the increase in cases.

While we may see an increase as the weather turns colder, we do not anticipate anything on the scale of last winter, county officials said, nor do we expect to see the level of hospitalizations and deaths that we encountered a year ago.

Chester Countys vaccination rate, the regions highest, should help it weather a surge, said county health director Jeanne Franklin. As of Tuesday, it was the only county in the region not seeing high transmission.

If a surge increases excluding the introduction of another variant we anticipate [the surge] to last for a shorter time, Franklin said in a statement. But really the crystal ball is still nowhere to be found!

About 54% of Pennsylvanians, including children under 12 who arent yet eligible for shots, are fully vaccinated, according to the New York Times, as are 60% of New Jerseyans. In Philadelphia and its collar counties, the rate ranges from about 50% in the city to 63% in Chester County, according to state and city data.

READ MORE: Swag bags and a coronavirus Cupid: How the region hopes to persuade millennials to get their shots

Even more people have received one dose of a two-dose vaccine, and the number of first doses has recently ticked up in some places. But experts say both shots are needed for the most protection.

Health experts say this is especially important in the face of the delta variant, which is more transmissible than earlier forms of the virus, and it sometimes spreads through vaccinated people, even if they dont feel sick, and can occasionally make the immunized mildly ill.

Its rise has led to a bevy of new mitigation measures: Days after Philadelphia brought back its indoor mask mandate, Montgomery County on Monday formally recommended that people mask up indoors. The move echoed the Centers for Disease and Control and Preventions universal masking recommendation for any counties experiencing high or substantial spread, which was announced last month.

Because of the delta variant, Montgomery County has seen increases in our key COVID-19 indicators for the past several weeks. However, I want to be very clear that the vast majority of the new cases are occurring in unvaccinated individuals, Montgomery County Commissioner Chair Val Arkoosh said Monday at a briefing. The quickest way to get this pandemic under control is to get vaccinated.

READ MORE: Pa., N.J., and Del. leaders weigh vaccine-verification options, but largely hold off on mandates

As it sees a growing proportion of cases in children and teenagers, Camden County is focusing on increasing vaccinations among those age groups before the school year starts.

Vaccinations and social behavior will dictate what this winter looks like, said county spokesperson Dan Keashen. It will be incumbent upon us to do everything we can to avoid another surge like we had last winter.

Levy, the Penn epidemiologist, said any increase in vaccinations would be hugely important, and hed like to see an even greater, on-the-ground push at this critical juncture.

While its unclear whether vaccines can stop the spread of delta, vaccines slow the spread, he said. And that means everything because this thing is just [about] momentum. Everything we can do to slow it down is going to lead to fewer people getting infected before they get protected. "

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Coronavirus spread is high and hospitalizations are rising across the Philadelphia region - The Philadelphia Inquirer