Daily Archives: February 17, 2022

In the ongoing struggle of SARS-CoV-2s genes versus our wits, the virus that causes Covid-19 relentlessly probes human defenses with new genetic gambits. New variants of this coronavirus with increasing transmissibility have sprung up every few months, a scenario that is likely to continue.

Some experts believe that the pandemic appears to be on an evolutionary slide toward becoming endemic, a new normal in which humans and the virus co-exist, as we currently do with influenza. But coronaviruses are clever. While an endemic resolution may be in sight, SARS-CoV-2 could still shock the human species with a devastating evolutionary leap.

Here are four possible scenarios, each taken directly from the known evolutionary playbook of coronaviruses.

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Epidemic means upon the people (epi + demos); endemic means within the people (en + demos). The hope is that Covid-19 will morph from the former to the latter.

Humans currently coexist with four known endemic coronaviruses. Their scientific designations sound like technical code: 229E, OC43, NL63, and HKU1. Almost every person on earth becomes infected with all four of these viruses during childhood. These infections tend to be mild, causing only transient upper respiratory infections, hence the convenient shorthand name of common cold coronaviruses (CCC) for this gang of four. Because immunity to these coronaviruses wanes with time, infections can recur throughout the human lifespan.

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When the CCCs emerged and from where are hazy, but genetic analyses suggest they probably originated in various animal species before crossing into humans hundreds of years ago. The likely ancestral origin of OC43 is a bovine coronavirus; the nearest neighbor for 229E is a llama coronavirus; and the others probably arose as inter-species jumps from the vast global reservoir of bat coronaviruses.

If the common cold coronaviruses did originally emerge from cross-species jumps of animal viruses into humans before germ theory and the modern science of microbiology, they would probably have been mistaken for influenza and not recognized as new diseases. As these species-jumping coronaviruses adapted to humans, there would have been selective pressure for more efficient transmission. When a virus adapts to a new host, it accrues no survival advantages by debilitating or killing its host. Just the opposite: a respiratory-borne virus is more easily transmitted by an ambulatory, socially interactive host.

Just as the four common cold coronaviruses likely started out as novel epidemic viruses that evolved toward endemicity, SARS-CoV-2 may well follow the same path and become the fifth CCC.

In this scenario, SARS-CoV-2 evolves to infect new cell types in the human body, changing from predominantly infecting and affecting the respiratory system to infecting and affecting other organ systems. This scenario could lead to a better outcome or a worse one, depending on the organs damaged and the extent of it.

Most animal coronaviruses, including SARS-CoV-2, infect cells that line the gastrointestinal tract as well as those in the respiratory tract. Mutations can switch the ability of viruses to grow in the cells of one organ system to the cells of another. Among swine, a major shift occurred in 1984 when the transmissible gastroenteritis virus mutated to become the porcine respiratory virus. Among chickens, all strains of the infectious bronchitis virus affect the trachea, but some mutant strains have emerged that damage the kidneys.

In humans, SARS-CoV-2 has been found in the intestine, kidney, and central nervous system. A new SARS-CoV-2 variant with redirected preference for new organs (organ tropism) could produce new Covid-19 signs and symptoms.

Viruses like influenza, HIV, and coronaviruses routinely swap genetic material between strains. If the genetic material of the human SARS-CoV-2 were to be combined with the genetic material of an existing animal coronavirus such as a virus endemic in fowl, swine, rodents, or even dogs and cats it could create a hybrid that spawns a new pandemic, just as the occasional hybridization of human and bird influenza viruses is known to give rise to human influenza pandemics. When an animal cell happens to be co-infected with two different coronaviruses, recombination between two parental strands can occur, giving rise to a novel hybrid genome that just might be better at replication than its parents.

There is already evidence that SARS-CoV-2 strains are recombining with other SARS-CoV-2 strains. Fowl coronaviruses and swine coronaviruses are widespread problems in commercial animal husbandry, and mouse hepatitis virus has been a common nuisance infection in laboratory mouse colonies. SARS-CoV-2-infected individuals who have close contact with coronavirus-infected animals could easily serve as hosts for the generation of recombinant viruses.

Given the huge number of SARS-CoV-2 infected humans, the chances are good that someone somewhere on earth might be simultaneously infected with SARS-CoV-2 and an animal coronavirus and some of their cells infected with both giving rise to novel hybrid virus recombinants.

And given the high counts of SARS-CoV-2 genomes in human sewage systems, it is possible that a coronavirus-infected rodent or bird could encounter human SARS-CoV-2 through contact with human waste.

Regardless of where and how novel recombinant descendants of SARS-CoV-2 might arise, the new virus could evade SARS-CoV-2 immunity and could even have different disease manifestations than what has been seen with Covid-19.

In this worrisome scenario, SARS-CoV-2 evolves to not only evade its human hosts immune response but to actively exploit it. The successive major variants of SARS-CoV-2 so far Alpha through Omicron show that the relentless evolution of the virus helps evade the immune system. But some coronaviruses, like the feline infectious peritonitis virus, take evasion to the next level: exploitation.

When a person or in this case a cat encounters a virus or receives a vaccine, immune cells begin making antibodies. These proteins bind to the virus and disable it. Paradoxically, antibodies against feline infectious peritonitis virus that are infused into non-immune cats render the animals more susceptible to peritonitis and severe disease than cats that have not been infused with anti-feline infectious peritonitis virus antibodies.

A similar perverse exploitation of the immune system can occur when humans are infected with dengue virus, which is not a coronavirus. A first infection with a dengue-type virus typically produces a self-limited, week-long illness with high fever and muscle and joint pain. The antibody immune response to that first infection renders a person immune to future exposures with that same type of dengue virus. But if the individual later becomes exposed to a dengue virus of a different type, the first infection increases the risk of severe disease instead of providing protection against it. How? In the human body, some cells have receptors for dengue viruses on their surface, while other cells have receptors for antibodies. Antibodies that bind to viruses normally prevent the virus from attaching to cells with dengue receptors. But these antibody-coated viruses can instead bind to, enter, and grow in the cells with antibody receptors on their surfaces. This process is called antibody dependent enhancement of virus growth.

Other coronaviruses that infect humans, such as SARS-CoV-1 and MERS-CoV, have been shown in laboratory studies to be able to exploit bound antibodies as a way to attach to cells and begin to replicate in them. SARS-CoV-2 viruses can also use antibody dependent enhancement to bind to cells with antibody receptors, with the virus having been shown to enter cells and begin to replicate. But in experiments so far, the full viral replication cycle wasnt completed in test cells.

The worry here is that if SARS-CoV-2 evolves to use antibody dependent enhancement to increase virus growth and transmission, the new variant could explosively retrace its spread through immune populations.

Im not confident about how the pandemic endgame will play out. While I do think the most likely future scenario for SARS-CoV-2 is that it will become endemic, the other more worrisome scenarios I describe here are within the realm of possibility: a mutant that produces a different disease, a new recombinant virus, or a variant that exploits immunity. And these scenarios are not mutually exclusive. A new SARS-CoV-2 recombinant virus containing animal coronavirus genes might well cause altered disease.

Some other scenarios I havent discussed are also worth thinking about, like ongoing back-and-forth spillover from humans to animals and back to humans, or increased transmissibility from chronically infected people with long Covid.

None of these epidemic scenarios is a fantasy. All are variations of the known evolution of real-world coronaviruses. A new viral variant can emerge anywhere on Earth to cover the globe in a matter of weeks, as SAR-CoV-2 did. Indeed, somewhere on Earth SARS-CoV-2 strains may have already evolved in one of more of the directions I describe here but have not yet been detected.

The world cannot afford to be blindsided again. Pandemic planners from the U.S., the World Health Organization, and other countries and organizations need to develop formal risk assessments and contingency plans for a wide range of possible pandemic futures.

Viral evolution requires ongoing viral transmission and replication. The more new viral particles generated, the greater the chance that new viral mutants and recombinants could emerge. Preventing disease and death is, of course, the main goal around the world. But countering the evolution of new variant viruses is another important mission. Doing this requires controlling SARS-CoV-2 replication by quenching person-to-person virus transmission. And this must happen everywhere on the planet, not just in the U.S.

Technical and financial assistance for bringing transmission-blocking vaccines to low- and middle-income countries is not just an act of charity; it is an expression of enlightened national self-interest. The national security of the U.S. and every other country depends on winning this global viral war.

Donald S. Burke is a professor of infectious disease epidemiology at the Graduate School of Public Health at the University of Pittsburgh, where he previously served as dean.

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4 evolutionary scenarios for the coronavirus that causes Covid-19 - STAT - STAT

By the end of next year, COVID-19s economic sting is likely to be an ugly but fading memory for the worlds wealthiest economies: Their GDP levels are forecast to be somewhat higher than pre-pandemic projections indicated they would be by 2023. Not so for most emerging market and developing economies (EMDEs), which will remain debilitated well into this decade.

The World Banks latest Global Economic Prospects report forecasts that by 2023, just one EMDE regionEurope and Central Asiawill come anywhere close to regaining the GDP level that had been expected before the pandemic (Figure 1). In Latin America and the Caribbean, the Middle East and North Africa, and sub-Saharan Africa, the gap with the pre-pandemic projection is expected to be 4 percent or more. South Asia will be the farthest behind, with its GDP level nearly 8 percent below where it might have been but for COVID-19.

Each of these regions has been hit in ways that warrant customized responses. Four factors make these six regions different, and also provide the clues for quicker recovery and convergence.

For many countries, vaccine delays are prolonging the pandemic and forestalling a full economic recovery. In all regions except one, large gaps persist between the quantities of vaccine doses contracted and the amounts delivered. The exception is East Asia and the Pacificand even there, the gap remains large in many countries other than China.

In sub-Saharan Africa, only about 7 percent of the population was fully vaccinated in early Februarycompared to more than 50 percent of the population of all EMDEs (Figure 2). That reflects delivery delays and financial constraints, predominantly, but also in-country logistical challenges such as insufficient vaccine storage and vaccine sites and difficulties distributing vaccines to rural populations.

For all EMDE regions, the top priority must be to overcome vaccine challengesquickly. Success will depend on greater global cooperation, including a swift expansion of vaccine donations by nations that enjoy a vaccine surplus. Wealthy countries should also channel additional financial resourcesthrough international financial institutions and regional development banksto help poor countries improve their access to vaccines.

By the end of 2021, GDP-weighted total debt in EMDEs was more than 200 percent of GDP, a 50-year record. The uptick in debt during the pandemic follows a decadelong wave of debt accumulation. In East Asia and the Pacific, business and household debt are at record levels, as is the volume of nonperforming loans held by banks. In Latin America and the Caribbean, South Asia, and sub-Saharan Africa, the largest debt-related risks are in the public sector (Figure 3).

Growing indebtedness means that debt-service burdens in some economies are rising rapidly. At the same time, inflation spiked in 2021 in many EMDEs as energy and food prices rose, demand rebounded along with easing pandemic-related restrictions, and global supply-chain challenges continued. Already, about 40 percent of EMDEs have increased policy interest rates in response. In the near term, central banks in major advanced economies are on the verge of raising interest rates and unwinding exceptional monetary policy support extended during the pandemic. This combination of record-high debt and tightening global financial conditions is perilous, as it makes EMDEs vulnerable to a sudden change in risk sentiment in markets.

Under the circumstances, EMDEs need to carefully formulate their fiscal and monetary policies, focus on rebuilding foreign exchange reserves, keep a close eye on currency risks, and strengthen macroprudential policies. They should also step up efforts to mobilize domestic resources and broaden their tax base.

Two-thirds of EMDEs rely on commodity exports for growth and development. These countriesconcentrated in Europe and Central Asia, Latin America, the Middle East and North Africa, and sub-Saharan Africaare regularly buffeted by boom-and-bust cycles, the causes of which are typically beyond their control. More than half the worlds extreme poor live in some of these commodity-exporting countries. After a sharp decline during the early stages of the pandemic, commodity prices have soared (Figure 4).

COVID-19 brought an end to a remarkable era of shared prosperity that started in the 1990s: when the income of the poorest nations began to catch up with those of the wealthiest. Today, inequality in incomes between countries is at levels not seen in a decade. Within-country inequality, which was already higher in EMDEs than in wealthy ones before the pandemic, has also risen. That reflects severe job and income losses, especially among vulnerable groups, including low-income people, youth, women, and informal workers. Latin America and the Caribbean and Sub-Saharan Africa face particularly elevated levels of within-country inequality.

Rising inequality should worry us all. Widening income gaps pose risks to social and political stability. Addressing inequality is all the more important when considering that some regions such as Sub-Saharan Africa have made little progress over the past two decades on catching up to advanced-economy levels of income, while the gains in others (Latin America and Middle East and North Africa) have been partly reversed (Figure 6).

Overcoming the detrimental economic effects of the pandemic will not be easy. But it can be doneand the restoration must start now. Some of these challenges underscore the importance of strengthening global cooperation to foster rapid and equitable vaccine distribution, support health and economic policies, enhance debt sustainability in the poorest countries, and tackle the mounting costs of climate change.

National policymakers can achieve much by prioritizing investment in health and education, and by introducing policies that reduce the number of school dropouts and facilitate the reentry into the workforce for those who lost jobs because of the pandemic. Careful calibration of monetary and fiscal policy given the global financial landscape, as well as quick reactions in the case of financial market stress, could help prevent debt crises. Policy efforts that will pay off in the long termthose encouraging diversification and inclusionmust not be laid aside despite the host of near-term challenges.

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Getting out of the coronavirus economic contraction - Brookings Institution

The leading US health officials said on Wednesday that the nation is moving closer to the point that Covid-19 is no longer a constant crisis as more cities, businesses and sports venues began lifting pandemic restrictions around the country.

Centers for Disease Control and Prevention (CDC) director Rochelle Walensky said during a White House briefing that the government is contemplating a change to its mask guidance in the coming weeks.

Noting recent declines in Covid-19 cases, hospital admissions and deaths, she acknowledged people are so eager for health officials to ease masking rules and other measures designed to stop the spread of the coronavirus.

We all share the same goal to get to a point where Covid-19 is no longer disrupting our daily lives, a time when it wont be a constant crisis rather something we can prevent, protect against, and treat, Walensky said.

With the Omicron variant waning and Americans eager to move beyond the virus, government and business leaders have been out ahead of the CDC in ending virus measures in the last week, including ordering workers back to offices, eliminating mask mandates and no longer requiring proof of vaccine to get into restaurants, bars and sports and entertainment arenas.

The efforts have been gaining more steam each day.

Philadelphia officials on Wednesday said the citys vaccine mandate for restaurants was immediately lifted, though indoor mask mandates remain in place for now.

At Disney World, vaccinated guests will no longer have to wear masks at the Florida theme park starting Thursday.

Professional sports teams including the Utah Jazz and Washington Wizards and Capitols have stopped requiring proof of vaccine for fans.

Health commissioner Cheryl Bettigole said Philadelphias average daily case count had dropped to 189 cases a day in the city of more than 1.5 million people.

Bettigole said the plunge in infections has been steeper in Philadelphia than elsewhere in the state or the country, making it easier to lift the vaccine mandate for restaurants and other businesses announced in mid-December and that fully went into effect just this month.

Our goal has always been to be the least restrictive as possible while ensuring safety, she said.

She added that the vaccine mandate helped spur a very large increase in pediatric vaccinations, pushing the city way ahead of the national average for first doses among kids ages five to 11. More than 53% of Philadelphia residents in that age group have received a first dose, compared with closer to 30% nationally, she said.

In Provincetown, Massachusetts, a seaside town that became a coronavirus hot spot with an early outbreak of the Delta variant last summer, officials on Tuesday lifted a mask mandate and vaccine requirement for indoor spaces like restaurants and bars.

Town manager Alex Morse said the community of about 3,000 recorded zero active cases last week among Provincetown residents something that hasnt happened since the surge following last years July 4 celebrations.

We are learning to live with, and mitigate, the impact of the virus on our community, Morse said.

Covid-19 infections and hospitalizations have fallen sharply in the US, with the seven-day rolling average for daily new cases dropping from about 453,000 two weeks ago to about 136,000 as of Tuesday, according to data from Johns Hopkins University.

Hospitalizations are at levels similar to September, when the US was emerging from the Delta variant surge. Almost 65% of Americans are fully vaccinated.

As a result of all this progress and the tools we now have, we are moving to a time where Covid isnt a crisis but is something we can protect against and treat, said Jeff Zients, the White House coronavirus response coordinator.

Walensky said the CDC will soon put guidance in place that is relevant and encourages prevention measures when they are most needed to protect public health and our hospitals.

She suggested any changes will take into account measures of community transmission, as well as hospitalization rates or other gauges of whether infected people are becoming severely ill. They also would consider available bed space in hospitals.

Several states with indoor mask mandates announced last week they would be lifted in coming weeks, also citing promising numbers.

Two music festivals that draw thousands of people to the California desert town of Indio in April and May, Coachella and Stagecoach, also said this week there will be no vaccination, masking or testing mandates, in accordance with local guidelines.

Walensky said the CDC wants to give most people a break from things like mask-wearing when circumstances improve, though be able to mask up again if things worsen.

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CDC contemplating change to mask guidance in coming weeks - The Guardian

The head of the World Health Organization said conditions are ideal for more variants to emerge.

ATLANTA The declining number of COVID cases nationwide is generating optimism, but health professionals are busy explaining why the situation makes us vulnerable for new variants.

We are still in a very intense period and should not be lulled into a false sense of security, said Dr. Jayne Morgan, Clinical Director of the COVID Task Force at Piedmont Healthcare.

Delta and omicron have been the most noteworthy variants of the coronavirus pandemic. Both have proven to be far more contagious than the original strain.

Tedros Adhanom Ghebreyesus, the head of the World Health Organization, warned the world is ripe for new variants of the coronavirus.

There are different scenarios for how the pandemic could play out and how the acute phase could end, said Ghebreyesus. But its dangerous to assume that omicron will be the last variant or that we are in the endgame. Globally, the conditions are ideal for more variants to emerge.

As long as the virus continues to spread there is the risk of another prominent variant, Morgan said.

You have to look at the pandemic as a worldwide problem and consider vaccine access.

We still have 86 countries that havent met the minimum criteria set by the World Health Organization, said Morgan. We have Africa that has 85% of the entire continent that is yet to receive a first dose, so the World Health Organization is right to be concerned.

According to the CDC, the omicron variant was first detected in South Africa in November. By early December it was spreading in the U.S.

We are all interconnected, Morgan said. We cannot have countries and continents that are unvaccinated and then declare ourselves out of the pandemic. It doesnt work that way.

Some parts of the world, like Germany and Brazil, have seen cases climb in recent weeks, according to data gathered by the New York Times.

All of those infections provide opportunities for this virus to replicate and then form mutations and for these mutations to form other variants, Morgan said. Millions of opportunities.

Morgan said while scientists are working to identify new variants, one can develop and spread for days or weeks before it is discovered.

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Why are we vulnerable to new variants of the coronavirus? - 11Alive.com WXIA

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Active coronavirus cases in Wyoming increase by 54 on Wednesday - Wyoming Tribune

Confirmed cases of COVID-19 have passed 418 million globally, according to Johns Hopkins University. The number of confirmed deaths has now passed 5.85 million. More than 10.42 billion vaccination doses have been administered globally, according to Our World in Data.

Hong Kong SAR's coronavirus battle intensified on Thursday as authorities reported new cases had multiplied by 60 times so far this month. Hospitals are overwhelmed with some patients being treated on beds in the open air.

New COVID-19 infections have continued to decline across the Americas region. They were down by 31% in the last week but deaths rose by 5.6%, the Pan American Health Organization said on Wednesday. Half of the region's 34,000 deaths were reported in the United States.

Top US infectious disease expert Dr Anthony Fauci said on Wednesday it is time for the United States to start inching back towards normality, despite remaining risks from COVID-19. Fauci said US states face tough choices in balancing the need to protect citizens and the growing fatigue with the pandemic.

Germany will ease COVID-19 restrictions as a wave of infections from the Omicron coronavirus variant seems to have passed its peak, Chancellor Olaf Scholz said on Wednesday, but he warned that the pandemic was not over yet.

Switzerland has lifted almost all its coronavirus pandemic restrictions as fears wane that a spike in infections fuelled by the Omicron variant would overwhelm the healthcare system.

A drop in COVID-19 testing rates is likely contributing to a decline in reported cases even as deaths are rising, the World Health Organization's technical lead on COVID-19 Maria Van Kerkhove said on Wednesday. The WHO earlier this week urged governments to improve vaccination rates and rapid testing.

Daily new confirmed COVID-19 cases per million people in selected countries

Image: Our World in Data

Germany's BioNTech has developed a vaccine factory made from shipping containers that it plans to ship to Africa as assembly kits to ease what the World Health Organization has described as huge disparities in global COVID-19 vaccine access.

The factory prototype will be instrumental in helping the biotech firm deliver on a pledge made last year to Rwanda, South Africa, Senegal and the African Union to secure mRNA vaccine production on the continent, where inoculation rates are far behind other parts of the world.

Work on the first mRNA manufacturing facility in the African Union is due to begin in mid-2022 and the first container module is expected to arrive on the continent in the second half of the year, BioNTech said in a statement.

The factory, housed in two groups of six 40-foot-containers, should kick off vaccine production about 12 months after the delivery of the assembly kit.

BioNTech on Wednesday presented a prototype of one six-container module to the presidents of Senegal, Ghana and Rwanda, and other dignitaries including the WHO's director general and the German development minister, at its main vaccine production site in Marburg, Germany.

Efforts to strengthen global health security in a future health crisis will only succeed if the role of the World Health Organization is also enhanced, WHO Director-General Tedros Adhanom Ghebreyesus said on Thursday.

Speaking via a video link at a G20 meeting of finance leaders in the Indonesian capital, Tedros was responding to proposals to establish a separate global health fund tasked with delivering emergency funds, vaccines and other medical needs.

"It's clear that at the centre of this architecture, the world needs a strong and sustainably financed WHO ... with its unique mandate, unique technical expertise and unique global legitimacy," Tedros told a panel discussion at the meeting.

"Any efforts to enhance the governance, systems and financing of global health security can only succeed if they also enhance WHO's role," he said.

The views expressed in this article are those of the author alone and not the World Economic Forum.

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COVID-19: What you need to know about the coronavirus pandemic on 17 February - World Economic Forum