From early on, we pointed out that the officialdom in the US was wagering heavily on magic Covid vaccines as the solution to the pandemic. They made that position explicit when the CDC went into “Mission Accomplished” mode and gave the public license to stop wearing masks if they were fully vaccinated. Not only was that decision risky given the proportion of the population that had gotten the needed jabs was under 50%, but it also gave the refusniks, as the wags on Twitter put it, to declare that they identified as vaccinated.
Our Covid brain trust continues to be of the view that combatting Covid will require a multi-pronged approach, including treatments like antivirals. By contrast, the vaccine boosters argue that mRNA vaccines can be developed so rapidly, in a week, that it will be easy to fire up new versions to beat back new variants. But even so, approval, manufacture, distribution and persuading people to get another shot all take time, as in months.
GM has sounded some cautionary notes, such as the vaccines being less effective on the immuocompromised and the elderly. For instance, from the abstract of this paper:
Here we assessed humoral and cellular immune responses following vaccination with mRNA vaccine BNT162b22 in elderly participants prospectively recruited from the community and younger health care workers. Median age was 72 years and 51% were females amongst 140 participants. Neutralising antibody responses after the first vaccine dose diminished with increasing age, with a marked drop in participants over 80 years old. Sera from participants below and above 80 showed significantly lower neutralisation potency against B.1.1.7, B.1.351 and P.1. variants of concern as compared to wild type. Those over 80 were more likely to lack any neutralisation against VOC compared to younger participants following first dose. The adjusted odds ratio for inadequate neutralisation activity against the B.1.1.7, P.1 and B.1.351 variants in the older versus younger age group was 4.3 (95% CI 2.0-9.3, p<0.001), 6.7 (95% CI 1.7- 26.3, p=0.008) and 1.7 (95% CI 0.5-5.7, p=0.41). Binding IgG and IgA antibodies were lower in the elderly, and frequency of SARS-CoV-2 Spike specific B-memory cells was higher in elderly responders versus non-responders. We observed a trend towards lower somatic hypermutation in participants with suboptimal neutralisation, and elderly participants demonstrated clear reduction in somatic hypermutation of class switched cells, particularly in the IgA1/2 isotype.
GM also pointed out:
We have historically never had much of success with viruses. Treatment is symptomatic.
We can keep you alive with the more recently developed antivirals if you have HIV, but not cure you.
And we’ve had fairly good proper cure success with antivirals for hepatitis C.
And that’s about it.
Antibiotics are (though that is to change to “were”) truly miraculous, because with those you could target broadly conserved key cellular mechanisms that are unique to prokaryote biology. Viruses by their very nature are not as susceptible because they hijack our own cellular machinery to replicate, so any drug that hits them hard at the level of replication will have serious side effects on our own cells at way too high doses. Meanwhile the battle is against runaway exponential replication and it can easily be lost if treatment has not started early on. That leaves various mechanisms specific to each virus (if there are such mechanisms, which may not be the case) but that means slow and arduous development of specific drugs for each virus. Which has been tried for the most important ones and success has been meager.
COVID’s pathology is such that I would not expect any proper treatment any time soon, if ever.
Much of the damage is done by your own immune system 1-2 weeks after infection has started, not by the virus itself. And for that we have the immunosuppressants that are already being used, and they do lower mortality, but are no miracle, and once you are at that stage, there will probably be lasting damage.
The hyperactivation of the immune system is driven by the runaway replication of the virus, but the problem is that the virus has a laundry list of mechanisms for silencing and hiding from the immune system. The result is that much of that replication happens unnoticed, until it’s too late.
If there is ever an effective antiviral, it will be effective only during that early state of replication, the problem with which should be obvious — it happens while people are hardly aware of it or they still have minor symptoms. If everyone gets tested daily so that all cases are caught early and treated on time, then we might be able to treat them effectively. But that is in no way a “return to normal”, nor is it really logistically possible.
Having said that, there is an intranasal vaccine under development, described in May in MedicalXpress that seems particularly promising. but even if all goes well, it’s not likely to be launched until late 2022, which is a way away. GM again:
This will likely work — the Novavax vaccine is not all that different, and it does work. There was also another paper in Science earlier this year using a conceptually similar approach.
It is also very nice they tried it intranasal — we have to stop transmission, and intranasal vaccines will do that.
The problem is it will not get us out of the yearly to biannual booster cycle — it will probably still wear off within that time frame and require boosters. Anything intranasal will probably wear off quickly.
In other words, advanced economies are hardly in a position to declare victory, yet that’s what we’ve done. Maginot Line, anyone? The extent of magical thinking and class loyalty is remarkable. I’m insulated from it by not getting out much, but reports from many quarters confirm that if you are a right-thinking person, and particularly a right-thinking medical person, you are all in for the vaccines.
As KLG put it:
What I hear, both from clinicians at work and my friends on the street and the golf course (there are three Lefty walking golfers in the US, but I haven’t yet met the other two), is that vaccination is the true, final, and only answer to COVID-19. The non-scientist tends to view all vaccines through the lens of Jonas Salk/Albert Sabin: get vaccinated and never worry about polio or whatever particular affliction again. Those of us with a scientific or medical background have no excuse. Which reminds me that medical education, which is a large part of my day job, really and truly has a rickety scientific foundation these days. This has not always been true. We generally just tell ’em what they need to know, preparing them to listen raptly as Pfizer tells ’em what they will need to know in 6-8 years. I fight this, but at some point after I am told for the hundredth time that I am a “facilitator” (i.e., one who makes something easy) rather than a scientist/tutor/teacher/mentor with long and relevant experience who makes this possible, I will just STFU.
I’ve also noticed how people here [elite institution you have heard of], even though if there is anyone with the capacity to understand the pathogenesis of the disease and the course of its evolution, it is them (many work on the immune system daily and have done so for years) who show exactly zero interest in doing so. We are talking about people who have published dozens cutting-edge immunology papers, including on topics directly relevant to the intrcicacies of COVID pathogenesis, and some of them work on those in the context of COVID right now. And yet…
And they have apparently checked out many months ago, some never checked in to begin with — I had many baffling conversations with people I highly respect for their scientific capabilities all throughout 2020 that showed very weird lack of knowledge of the problem.
But it is really bad now — all the cognitive biases are on full display. “Science” has saved the day and “we”, as in “scientists”, i.e. our perceived in-group, have triumphed, so what could be wrong and how could there be a problem?
And then there is the class conflict aspect of it — most “scientists” right now are perfect examples of the PMC type, and this “solution” to the problem suits them very well — last year around that time everyone was in panic, stock markets were down, university endowments were in free fall, tuition money had stopped flowing in, etc. Now the stock market is up, endowments have recovered, students will be herded back to campuses in the Fall, and even if they have to be sent back in November, tuition will have been collected by then, so everything is good, right? Who dares spoil the party with objections and bleak progonostications about the long-term future?
I’ve literally had people say to me “I don’t want to listen about any doom and gloom”…
I’m also not keen about the pre-positioning of blame if things go pear shaped on states with low vaccination rates. Here in supposed dirtbag Alabama, the Covid test positivity rate in Jefferson County, the most populous county, is 1%.
By contrast, the better off are in a position to do much more traveling and frequenting of bars and restaurants on average than lower income cohorts. And even though international travel is very much dampened down due to many destinations having strict quarantines) I have already heard of one vacationer who went abroad coming back with a not horribly symptomatic case….which was enough to infect members of his work group). A real test coming soon is the resumption of Caribbean cruises.
As I too often say, it would be better if I were wrong. But continuing to wear KN/N95 masks seems like a cheap hedge.