At some point around the new year I switched from obsessively checking my curated COVID experts Twitter list to obsessively checking my two newly curated Ukraine crisis Twitter lists (Ukraine Crisis and Ukraine military experts). Such is life.
This morning I was browsing through the COVID list and I found my way to this post by Eric Topol. Topol is a physician generalist who heads up a biomedical institute at the Scripps Research Center in California. He’s not an epidemiologist or virologist. But COVID has been his focus since the beginning of the pandemic. The post is entitled The Covid Capitulation. And it is part of that genre of COVID writing in which a COVID expert bemoans the fact that the whole country has decided the epidemic is over when in fact it’s clearly not.
I have an ambivalent response to these pieces. On the one hand I agree to a significant extent. (I’m that guy who is still wearing a medical grade mask in indoor public spaces. I don’t mind it and I’d prefer not to get COVID.) And yet, it’s all so much water under the bridge. Spitting into the wind. You might as well be holding out for a Beatles reunion. The particular issue Topol focuses on is the continuing evolution of Omicron. For a while we were in a cycle of novel variants and surges. But Omicron is different. It has kept evolving on its own trajectory, at a faster rate and its new subvariants seem to have much less immune crossover.
When I say that Omicron keeps evolving, some of that is just naming conventions. The WHO could have given the current subvariant BA.2.12.1 a new Greek letter. But it’s not just that. There does seem to be a consistent evolutionary path as opposed to seeing new evolutionary branches suddenly popping up out of the blue, as was the case with most of the earlier variants. But the key is that it’s evolving quickly and each new version seems to hold a good chance of reinfecting you.
We’ve known reinfection was possible since early in the pandemic. But it wasn’t common. The new trajectory of Omicron seems to be one in which it will be quite possible to get COVID 2 or 3 times in a single year.
Bummer.
In any case, none of this is what made me want to share the post with you. As I said, I read these things and think “yep, good point but it doesn’t matter.” But there is a point that Topol focuses on which I think does matter and which I think there’s at least a good shot at there being political will to act on.
There’s zero public appetite for masks or really any restrictions on public life. But I think there still can be a lot of public support for medicines. Antibodies treatments don’t work as well with Omicron. There are now issues of COVID rebounding with the main antiviral treatment. The course of taking it might need to be longer, at least for some people. But there are a lot of other treatments in the pipeline and they would benefit a lot from government support. We can get them to market quicker.
This seems like a no-brainer. Two years is enough for just about everyone having restrictions on their lives. But I think most normal people are pretty cool with having treatments available if they get sick.
Here’s one paragraph …
We’re not just looking at running out of vaccines and antiviral medications. Congress should immediately allocate for an Operation Warp Speed (OWS)-like initiative to bring nasal vaccines over the goal line. Three of these are in late stage clinical trials and success of any would markedly ameliorate our problems of transmission, no less the alluring aspect of achieving mucosal immunity and being variant-proof. That brings us to catalyzing the efforts for a pan-β-coronavirus vaccine, previously reviewed, now that we have discovered tens of broad neutralizing antibodies but have limited traction of these in the form of advanced clinical trials. Our backstop to infections in people at increased risk has turned to Paxlovid, which is increasingly being recognized to have a liability of rebound with infectiousness in many people after the 5-day blister pill pack. Not only does this unanticipated problem urgently need to be sorted out, but we may confront mounting resistance to Paxlovid in the months ahead as its continues to gain wide scale use, and that phenomena that has already been recognized in selected cases after remdesivir treatment. Look at how the evolution of the virus has blown through most of the monoclonal antibodies that were previously highly effective. We urgently need more safe and effective medications, preferably pills, easily administered shots (subcutaneously, not intravenous or intramuscular), or inhalation treatments. There are so many promising ones in the pipeline, yet little to no support to accelerate their progress. Ignoring all these vital needs surely represents Covid capitulation.
The nasal vaccines are a potentially a very big deal because that puts the immunity directly at the primary point of entry into the body. To a significant degree the current vaccines really go to work after the COVID has gotten a foothold in your nasal passages and is trying to move into the rest of your body, especially your lungs. That’s the basis of a lot of comparatively mild breakthrough infections. These nasal vaccines can potentially block COVID at the doorstep of the body. This isn’t just another vaccine that’s a bit easier to administer. They likely offer a different level or kind of immunity.
The point is simple. People are done with COVID. There’s high resistance to even minimal impacts on people’s daily activities. But outside of a core of delusional anti-vax types and ivermectin freaks, there’s no similar resistance to investing in treatments. We should get on this. Comparative small investments of public money could have a big impact.
