Bits of good news about Covid

We’re talking about Covid again, so let’s grab some shreds of good news and pile them up like hamster bedding–only (if I remember my brother’s hamster correctly) not as stale smelling.

 

Shred number one

A study involving older, high-risk adults showed that nasal irrigation reduced the risk of hospitalization and death from Covid and helped people recover faster. 

What does “older” mean if we don’t have a comparison group? C’mon, we all know that in our culture it’s not nice to say someone’s old. They’re trying to be polite. My best guess is, older than the researchers.

Next question: What’s nasal irrigation? An inexpensive and low-tech way of clearing out your sinuses. You squirt a mild sterile saline solution up one nostril, tipping your head so it dribbles helplessly out the other, having found its way via satellite navigation. As the solution falls into the sink, you’ll hear a small voice saying, “You have reached your destination.” 

Irrelevant photo: It must be time for another cat photo. This is Fast Eddie, who doesn’t look like he was assembled correctly but was. Really.

Okay, I asked Lord Google what it involves, and I even tried doing it. It’s mildly off-putting but I’ve done worse things in the name of health. It’s entirely survivable.

But let’s go back to the study: Only 1.3% of the subjects were hospitalized, and none died. Compare that to the control group, where 9.47% were hospitalized and 1.5% died. Group one also got better faster and had fewer symptoms hanging on at the end of two weeks. 

The inspiration behind the study was 1) that saline decreases Covid’s ability to attach to cells–to the ACE2 receptor, in case you’re taking notes and 2) that the larger a person’s viral load is, the sicker they’re likely to be, so if within 24 hours of testing positive (the study’s designers reasonsed) some of the virus was rinsed out, that might reduce Covid’s damage. 

Nasal irrigation is a common practice in Southeast Asia, and interestingly enough death rates from Covid were lower there. That’s not definitive proof, but it’s intriguing enough to make a person design a study around it–if the aforesaid person happens to be in the right line of work, of course. 

Irrigation also helps with colds, postnasal drip,  sinus headaches, and all sorts of fun stuff. It’s said to improve people’s sense of taste and smell and the quality of their sleep. 

I’m starting to sound like a true believer, aren’t I? Sorry. I’ll recover in a minute or two, as soon as I stop this saline solution dribbling out of my left nostril. In the meantime, I can balance things out by admitting that it won’t make you taller or reverse aging.

 

Shred number two

A small study hints that vaccination may be decreasing the number of people who come down with long Covid. The study comes from the long Covid clinic at the Cambridge University Teaching Hospital, which treats people on the severe end of the spectrum. Between August 2021 and June 2022, it saw a 79% drop in referrals compared to August 2020 and July 2021.

That’s not proof that vaccination’s the cause–it’s only correlation–but it does suggest it.

Other studies also show a decrease, although the numbers have been all over the map. One showed a 15% reduction and another 50%. A third showed “eight of the ten most-commonly reported symptoms were reported between 50 and 80% less often.” I’d translate that into a format that parallels the other studies but somebody glued the pieces in place and I can’t. 

The reason the numbers vary so much is that the studies weren’t defining long Covid the same way or following people for the same length of time. 

So does catching Covid multiple times increase your odds of getting long Covid? The assumption has been that with each infection, you roll the dice again, taking the same risk each time. But one author of the study expects that previous infections will have more or less the same impact as vaccination and the risk will turn out to diminish after the first infection.

Probably.

 

Shred number three

The omicron variant may be 20% to 50% less likely to turn into long Covid than the delta variant, depending on a person’s age and how much time has passed since they were last vaccinated. 

But–and isn’t there always a but?–because more people caught the omicron variant than the delta, the absolute number of people in the UK who came down with long Covid as a result was higher. 

Sorry. That second paragraph was as welcome as a thorny old blackberry cane sneaking into the hamster bedding.

 

Shred number four

Allergies might offer some protection against Covid. Do you have hay fever, allergic rhinitis, eczema, dermatitis? Be grateful for your bad luck, because you may be 23% less likely to get infected . Got one of those plus asthma? Be grateful twice: It may have down by 38%. 

That’s not proof, but it’s an interesting possibility.

 

Shred number five

A study estimates that in the first year Covid vaccines were available, they prevented 19.8 million deaths worldwide. Unfortunately, though, because of how unevenly they were distributed, the advantage was heavily skewed toward the richest countries.

You knew it wouldn’t all be good news here, didn’t you? 

During the first Covid wave, before vaccines were available, shutting schools cut daily deaths by 1.23 per million over 24 days and shutting workplaces cut daily deaths by 0.26 per million over 24 days. (Kids were less likely to get sick but they’re generous little creatures and they do like to share their germs.) For a population of 67 million (which just happens to be Britain’s population), that translates to roughly 82 deaths avoided every 24 days by shutting schools and 17 by shutting workplaces.

Lockdowns and restrictions on public transportation didn’t have as significant an impact. The difference is at least partially attributable to vulnerable people not being able to avoid workplaces and schools.  

 

Shred number six

India and China have approved inhalable vaccines, and many medical manufacturers are chasing their own inhalable versions. Injected vaccines concentrate antibodies in our muscles, which is useful, but we catch Covid by inhaling it, so the theory goes that loading the nose and mouth with antibodies could potentially keep us from spreading it. In other words, it really could end the pandemic.

Potentially. I don’t think the data on either of the new vaccines have been made public yet, so keep watching.

 

And now your weekly quota of bad-to-ambiguous news

Tedros Adhanom Ghebreyesus, head of the World Health Organization, said, “Last week, one person died with Covid-19 every 44 seconds. Most of those deaths are avoidable.”

That quote’s from early September .

“You might be tired of hearing me say the pandemic is not over. But I will keep saying it until it is.”

A week later, he said “We have never been in a better position to end the pandemic. We are not there yet, but the end is in sight.”

However, “If we don’t take this opportunity now, we run the risk of more variants, more deaths, more disruption, and more uncertainty.”

WHO is urging countries to continue testing for the virus, to continue sequencing it, and to vaccinate 100% of the most at-risk groups, including health workers and the elderly.

Is the pandemic over?

Can I be the bearer of bad news? 

You’re not here to answer and the news won’t surprise you anyway, so I’ll just go ahead: The World Health Organization tells us that the pandemic’s not over. 

How do I know? Because Tedros Adhanom Ghebreyesus, WHO’s director general said, “This pandemic is nowhere near over.”

That’s a subtle way of putting it, but if you pay close attention you can tease out the message.

He also said, “Omicron may be less severe, on average, but the narrative that it is a mild disease is misleading. Make no mistake: Omicron is causing hospitalisations and deaths, and even the less severe cases are inundating health facilities.”

And if that’s not enough, “While Omicron causes less severe disease than Delta, it remains a dangerous virus—particularly for those who are unvaccinated. We mustn’t allow this virus a free ride or wave the white flag, especially when so many people around the world remain unvaccinated.”

The “overwhelming majority” of people admitted to hospitals are unvaccinated, he said.

 

Irrelevant photo: The first daffodils are out.

Has Covid gone endemic?

But what about the idea that Covid’s changing from a pandemic to an endemic disease and that we need to stop whining and learn to live with it? 

Let’s start by figuring out what that means: An endemic disease is “consistently present but limited to a particular region. This makes the disease spread and rates predictable.” 

Sorry, but I need to step in here. That last sentence doesn’t mean that being consistently present and limited to one region makes the disease spread. It means those things make the disease’s spread predictable.

Which was probably already clear, but I couldn’t help myself. I used to misunderstand people for a living, and old habits are hard to break.

So how do we measure up to that definition? We’ve blown it on the “limited to a particular region” part, but let’s not be fussy. Are the spread and rate predictable? 

Nope. Not only do we have sharp spikes, we have no idea when a new variant will come along or how dangerous or benign it’ll be. We do know that the climate’s right for creating new variants.

Another defines an endemic disease as constantly present but not causing the upheaval or massive number of infections that an epidemic does. Covid hasn’t become endemic by that definition either.

But again, let’s not be fussy. Even if Covid doesn’t fit either definition, couldn’t we pretend it does, get over our fear, and learn to live with it?

Well, it depends on how we want to live. Or die. Being endemic doesn’t mean it’s no threat. Before penicillin, tuberculosis was endemic. [Late correction: Penicillin has nothing to do with tuberculosis. See the comments below. It’s the things you think you know that trip you up.] So was syphilis. They wrecked a lot of lives. They killed a lot of people. People learned to live with them because they had no choice, but I wouldn’t make a virtue of it. 

It would be interesting to look at how much resistance measures to control their spread met. But that’s another post.

Learning to live with Covid is one of those phrases that, when you look at it, means nothing. Does it mean we tear off our masks, join a germ exchange, and relearn the lyrics to that Country Joe and the Fish song with the line “Whoopee, we’re all going to die”? Or does it mean we wear masks religiously, invest in some serious ventilation, and pass vaccine mandates? They’re both ways of living with a virus.

Does it mean learning to live with a constant threat, not just of death but of disability from long Covid–a threat that no one’s been able to quantify yet? If so, how will we decide to live with it?

Michael Ryan, the head of emergencies at WHO, said, “Endemic malaria kills hundreds of thousands of people; endemic HIV; endemic violence in our inner cities. Endemic in itself does not mean good. Endemic just means it’s here forever.”

Okay, he skipped the predictable part, but we did say we weren’t going to be fussy.

“What we need to do is get to low levels of disease incidence with maximum vaccination of our populations, so nobody has to die,” Ryan said. “The issue is: It’s the death. It’s the hospitalizations. It’s the disruption of our social, economic, political systems that’s caused the tragedy—not the virus.”

And in case you’re betting on the next variant being milder than Omicron, mutation isn’t a one-way street. The direction of travel is random. 

 

Could you scrape up some good news, please?

Possibly, but let’s whisper so we don’t spook it: Some experts say that once the Omicron wave recedes we may get a period of quiet. The theory is that we’ve built up widespread immunity that could keep future waves from hitting as hard as they have in the past. 

Do waves hit? Is that a mixed metaphor? Do we care?

Probably, but let’s focus on the important stuff.

That’s not a unanimous opinion and other experts are more cautious, reminding us that it’s not clear how long Omicron immunity will last or whether a new variant will evade it. Omicron has demonstrated that even a relatively mild version of Covid can put a huge strain on health systems–and on the people who work in them. 

And as Boghuma Titanji, a virologist at Emory University School of Medicine, put it, “Wealthy countries moving on, I fear, will push the issues of access to vaccines and therapeutics access down the global priority list.” Which would mean not only more deaths in poor countries but (self-interest alert here) more variants loose in the world.

On the other hand, data suggests that the human immune response becomes better and broader every time it’s exposed to Covid’s spike protein. 

On the third hand, however, Leif Erik Sander, an immunologist at the Charité University Hospital, says that Omicron’s spike is so different from the spike in earlier variants that it’s not clear just how much immunity the Omicron wave will leave us with.

At which point we’re out of hands and it’s time to talk about what the next variant might look like. One possibility is that Delta could stage a comeback tour. Omicron was able to spread so quickly in part because the earlier versions hadn’t left us immune to it. Once that advantage fades, it may die back, leaving Delta room to work. Or they could work out their disagreements, move in together, and have babies, which could easily be uglier than either parent.

And, since a handful of antibodies does not an immune system make, what happens if a new variant evades not just our antibodies but our T cell response? (Reminder: T cells are an essential part of your immune system. Don’t leave home without them.) Well, if that happens “we’re dealing with another pandemic,” Shabir Madhi, a vaccinologist at the University of the Witwatersrand, said. But “the likelihood of that happening, I believe, is quite slim.”

 

Let’s try that good news thing again . . .

. . . because my last try didn’t go well.

Researchers in Finland are working on something they call a biological mask–a spray that could (assuming the tests go well) protect a person against Covid for 8 hours. 

It’s not meant to replace vaccines but to supplement them. If a person’s immune system doesn’t respond well to the vaccines, this spray is their friend. Or if they’re faced with a combination of a vaccine-evading variant and too many human beings in a risky setting, then ditto. 

The active molecule in the spray is called TriSb92, a name I forgot as soon as I got past the comma. Never mind. It’s a clever little beast that targets a part of Covid’s spike protein that’s common to all variants–at least so far–and once it makes contact it keeps the virus from going to work. You know what that’s like. It calls in sick and loses its job because spike proteins have no union and therefore no sick leave and no job security. 

If it was anything other than the Covid virus I’d feel bad about that, but it’s got it in for us. Have no mercy.

The developers think the spray might also be effective against new coronaviruses that emerge. Keep your fingers crossed. This sounds promising.