The best thing you can do to quash a deadly Covid-19 surge this winter

Redesigned Covid-19 vaccines could save thousands of lives, but few are getting them.

By Umair Irfan  Oct 13, 2022, 2:15pm EDT

https://www.vox.com/science-and-health/23393321/covid-vaccine-bivalent-booster-pfizer-moderna

People wait in line for a Covid-19 test at the beginning of the coronavirus pandemic in the Bronx, New York, in April 2020.

 Timothy A. Clary/AFP via Getty Images

Another winter, another wave.

With the leaves changing color, temperatures dropping, and people spending more time indoors, health officials are warning of a spike not just in Covid-19 cases but other infections as well.

“The challenge with holiday seasons every year is it’s also a time where contagious respiratory viruses — like influenza, RSV, and, again this year, Covid — spread much more quickly,” said Ashish Jha, the White House Covid-19 response coordinator, during a press conference on Tuesday.

Covid-19 cases are already rising in Europe, a trend that has preceded waves of infection in the US in the past. The key question: Just how deadly will Covid-19 be this winter?

Jha said that Covid-19 is not the same disruptive threat it was in the past two years. It’s likely that cases will increase again, but that they won’t cause the towering spike of hospitalizations and deaths experienced last winter, which were fueled by the omicron variant of the SARS-CoV-2 virus that causes Covid-19. In January, more than 2,000 people per day died from Covid-19. Currently, about 300 people are dying every day in the US from the disease.

What’s changed is that far more people have been vaccinated and exposed to Covid-19 by now, so “basically, no one is seeing this virus for the first time at this point,” said Justin Lessler, a professor of epidemiology at the University of North Carolina who develops Covid-19 models. That means most people now have some degree of protection against the disease, which lowers the likelihood of dying from it.

But that’s not enough to absorb another wave of misery. Protection from Covid-19 exposure or vaccination fades over time. Some groups, like older adults and immunocompromised people, remain at higher risk of severe illness and death from Covid-19 even with vaccines. The virus itself is continuing to change in ways that make it easier to spread and harder to counter. And while most US adults have received at least one dose of a Covid-19 vaccine, only a tiny fraction are up to date on their boosters.

RELATED

Why Covid-19 death rates remain stubbornly flat

Treatments for those infected with the virus also have caveats: Not everyone is getting this care after they’re infected. And some therapies, like monoclonal antibodies, which counter the virus in early stages of the disease, are becoming less effective against the new variants.

What’s clear is that Covid-19 can continue to surprise, confound, and frustrate, but our actions now can limit much of its potential harm.

“What happens in the weeks and months ahead will have a large impact on how the winter goes,” Jha said. “And really what happens in this winter is largely up to us, as the American people.”

One of the biggest factors shaping the course of Covid-19 is within our control

The Centers for Disease Control and Prevention now recommends that all people over the age of 5 get a booster dose of a bivalent Covid-19 vaccine after completing their initial vaccine regimen. These reformulated mRNA vaccines — from Moderna and Pfizer/BioNTech — are optimized to target the original version of the SARS-CoV-2 virus, as well as some of the newer omicron subvariants.

Boosters ramp up immune protection and reduce the likelihood of severe Covid-19 cases. The problem is that few people are getting boosted. Almost 80 percent of the US population has had at least one Covid-19 vaccine dose. Yet since regulators gave bivalent boosters the green light last month, less than 4 percent of eligible Americans have received the new shots. Even among people over the age of 65, one of the highest-risk groups for severe Covid-19, less than one-third have gotten the bivalent booster.

If rates remain this low, that could lead to more hospitalizations and deaths this winter. The Commonwealth Fund, a nonprofit health research group, mapped out different scenarios for booster uptake. At current vaccination rates, they estimated the US could see upward of 1,200 deaths from Covid-19 per day by this coming March.

However, if Covid-19 bivalent booster rates matched that of the influenza vaccine last year — about 50 percent uptake — daily deaths would continue declining, reaching around 200 per day. By spring 2023, the reformulated vaccines would avert 75,000 deaths. If 80 percent of eligible people get their bivalent shots by the end of the year, deaths would decline even further, saving 90,000 lives by the spring.

Thousands of deaths could be avoided if more people received Covid-19 vaccine boosters.

 Commonwealth Fund

The key is to get as many people boosted as possible now, though the benefits may take a while to manifest in lower cases and deaths.

“Today’s boosters won’t necessarily cause or not cause a surge tomorrow, but this slow buildup of immunity in the population will affect what happens two, three, four months from now,” said Lauren Ancel Myers, director of the Covid-19 Modeling Consortium at the University of Texas in Austin, who was not involved with the Commonwealth Fund study.

The trouble is that many people in the US don’t grasp the stakes of the current rounds of vaccination. A poll last month from the Kaiser Family Foundation showed that half of Americans had heard little or nothing about bivalent Covid-19 vaccines. Only one-third of adults said they had received the new booster or were planning to get it as soon as possible.

So before shots can go into arms, health officials will have to raise the dismal levels of awareness of the new vaccines.

Treatments and testing remain critical as well

One of the biggest uncertainties this winter is how the virus itself will change. “What the virus does and how it evolves is very key to what’s going to happen in the next few months,” Myers said.

Already, SARS-CoV-2 has mutated in ways that frustrate the response to it. The latest major variant, omicron, has spawned its own subvariants. Right now, about 80 percent of Covid-19 cases in the US are caused by the BA.5 subvariant, but another subvariant, BA.4.6, is gaining ground. Early reports show that BA.4.6, a descendant of BA.4, is even better at evading the immune system than BA.5. It also appears to reproduce faster.

While the bivalent vaccine boosters target BA.4 and BA.5, the virus could mutate further and render the vaccines less effective. Mutations can also undermine treatments like monoclonal antibodies, which are designed to attach to specific parts of the virus. If those regions change, the antibodies are less effective at slowing infections.

White House Covid-19 Response Coordinator Ashish Jha emphasized bivalent Covid-19 vaccine booster doses could prevent thousands of deaths.

 Kevin Dietsch/Getty Images

There are emerging complications with other treatments as well. Antiviral drugs like Paxlovid are less affected by changes in the virus, but they have to be administered early in the course of a Covid-19 infection. That’s getting tougher to do as testing rates drop off and people have a harder time finding infections before they show symptoms. Such therapies have been an important tool to decouple Covid-19 cases from deaths, helping more people who were infected survive. But Covid-19 drugs only work if people know about them and can get them in time.

Changes in Covid-19 testing are also making it harder to get a handle on how the disease is spreading. Many Covid-19 tests are administered at home these days, and most aren’t monitored by health officials. Among the tests that are tracked, states are reporting them less frequently. The CDC has switched from daily to weekly Covid-19 data reports.

For researchers, that’s making it harder to track the ebb and flow of the disease, and some are looking at other metrics. “I have switched my focus from cases to hospitalization,” Lessler said. Scientists are also monitoring wastewater to anticipate new spikes in cases. Virus levels in wastewater are on the rise in some parts of the US now, like the Midwest and Northeast.

Covid-19 is confounding, but how we react still matters

Even though it’s hard to predict exactly where Covid-19 will go, the models and forecasts show that “how we respond will impact the severity, the timing, the size of that new wave,” Myers said.

Getting booster rates up is likely the most impactful tactic. However, there is little political appetite for vaccine mandates, and a number of states are proposing preemptive legislation to prevent vaccines from being required.

Besides vaccines, getting infected people treatments for Covid-19 is crucial. Preventing infections in the first place with social distancing and wearing face masks remains effective as well, but the will to do these things is all but gone. That’s one of the biggest changes this winter compared to the last one. Myers said it would be useful to develop guidelines and trigger points for masking, testing, and isolation recommendations, depending on factors like hospitalization rates.

And Covid-19 isn’t the only bug in the air. As people travel for the holidays and as the few restrictions left continue to be relaxed, other infections like influenza could also take advantage of the season. Hospitals are facing staffing shortages after two exhausting years of the pandemic. The workers who remain will likely have their hands full, so keeping people out of beds remains critical to avoid overwhelming the health care system.

There may still be more surprises in store when it comes to Covid-19, but depending on how we respond, this winter doesn’t have to be so grim.

https://www.vox.com/science-and-health/23393321/covid-vaccine-bivalent-booster-pfizer-moderna

With a sniff or a swallow, new vaccines aim to put the brakes on Covid-19 spread

 By Brenda Goodman, CNN

Updated 1426 GMT (2226 HKT) July 22, 2022

https://edition.cnn.com/2022/07/18/health/mucosal-immunity-covid-19/index.html?

(CNN)Injected vaccines against the coronavirus that causes Covid-19 have been hugely successful, saving nearly 20 million lives globally in their first year of use and slashing the pandemic's death toll by an estimated 63%, according to a recent study. Yet good as these shots are, they have not stopped the virus from spreading from person to person.

As the SARS-CoV-2 virus spreads, it changes. That's helped it get past our firewalls, the immunity created by vaccines or left behind after we recover from an infection. Which is why, well into the third year of the pandemic, we're in the midst of another wave of Covid-19 caused by the most immune-evasive variant yet, BA.5. And more variants are coming.

Even as vaccine manufacturers race to update the first-generation shots in the hopes of patching up our protection for the fall, other scientists are taking a different approach, making vaccines delivered via nasal sprays or tablets that would deploy more immune defenders to the body's front lines: the lining of the mouth, nose and throat.

Why the Omicron offshoot BA.5 is a big deal

"The hope is to shore up the defenses right there in the nose so that the virus can't even replicate in the nose," said Dr. Ellen Foxman, an immunobiologist at the Yale School of Medicine. "And then someone who has a really effective mucosal vaccination can't even really support viral replication or make viruses that can infect other people.

"That would be like the holy grail," said Foxman, who helped plan the International Congress of Mucosal Immunology meeting this week in Seattle, which is sponsored by pharmaceutical companies Pfizer, Janssen and Merck.

If it works, there's hope that mucosal immunity could slow the development of new coronavirus variants and finally bring the Covid-19 pandemic under control.

There's a long way to go before that happens, however, and many scientists say the approach needs an injection of funding to accelerate the pace of development, much in the same way the billions of dollars doled out by Operation Warp Speed delivered the first generation of Covid-19 vaccines in record time.

An old approach meets new technology

The idea behind vaccinating the mucosa -- the lining of "the tube" (as mucosal immunologists refer to it) that runs from our nose and mouths to our lungs and guts -- isn't new. There are nine existing vaccines that work this way, including oral drops that protect against polio, cholera, salmonella and rotavirus, and a nasal spray, FluMist, that inoculates against the flu.

The quest for longer-lasting Covid-19 vaccines

Most are based on the oldest types of vaccine technologies, using killed or weakened versions of a virus or bacteria to teach the body how to recognize it and fight it off when a real infection gets underway.

Because of those actual pathogens, some people can't use these kind of vaccines. It's risky to expose certain groups -- including pregnant women and those with weakened immune systems -- to even weakened viruses.

None has achieved the goal of blocking the transmission of an infection, but that may be because they haven't gotten the same kind of investment as injectable vaccines, says Ed Lavelle, an immunologist at Trinity College in Dublin.

"What hasn't really happened with mucosal vaccines is kind of huge advances in technology that have happened with injectable vaccines, even before Covid," Lavelle said.

That may be about to change, however.

Can nasal spray vaccines put the brakes on new variants?

More than a dozen nasal spray vaccines against Covid-19 are being tested around the world. Many use new kinds of technologies, like delivering instructions for making the spike protein of the coronavirus through harmless Trojan horse viruses. Others aim to deploy the mRNA technology that was so successful in the injectable vaccines in the form of a nasal spray.

One company, Vaxart, has even made a tablet that delivers instructions for making parts of the new coronavirus to the gut, which then builds immunity in "the tube."

In animal tests, hamsters vaccinated in the nose or mouth have been less likely to spread a SARS-CoV-2 infection to uninfected animals that are in separate cages but share the same air.

"What we found is that if you did an oral immunization, you inhibited the ability for that breakthrough to infect other animals," said Sean Tucker, chief scientific officer for Vaxart.

The Vaxart tablet, which is about the size and shape of an aspirin, uses an adenovirus -- the same delivery system utilized by the Johnson & Johnson and AstraZeneca Covid vaccines -- to ferry instructions for making parts of the SARS-CoV-2 spike protein into cells in the gut, which stimulates the release of antibodies in the nose and mouth.

Now proven against coronavirus, mRNA can do so much more

In an early trial that included 35 participants, 46% had an increase of antibodies in their nose after taking the tablet vaccine. Those who did seemed to create a broad spectrum of immunity to a number of types of coronaviruses, and they appeared to hold on to that protection for about a year. That may be a bit longer than injectable vaccines, though more research is needed to confirm those results.

Tucker is presenting these early results Monday at the Seattle conference. He says they'll also be published as a preprint study in the coming days.

A phase 2 trial of a tablet with a slightly different formulation, involving almost 900 participants, is also underway, Tucker says. It is scheduled to be completed next summer.

Most of the mucosal vaccines under development are designed to be delivered as a squirt of liquid or mist up the nose, and many are intended to be used as boosters in people who've had a complete primary series of Covid-19 vaccines.

"I don't think of them as nasal vaccines. I think of them as nasal boosts," said Jennifer Gommerman, an immunologist at the University of Toronto who specializes in tissue-specific immunity.

That's important, Gommerman says, because nasal vaccines -- like FluMist -- haven't really worked all that well.

The next generation of inoculations will be something different, she says. They will build on the body-wide immunity that was created by shots; they'll just redeploy it to the nose and throat where it is needed most, she says.

Here's a look at how the different coronavirus vaccines work

"But here, we're actually talking about something else, where we're talking about building on the systemic immunity that was induced by a vaccine to a three shots of mRNA and then training that systemic immunity to go to the upper respiratory tract by boosting through the nose," Gommerman says.

One such approach was recently tested by Akiko Iwasaki, an immunobiologist at Yale University. According to their preprint study, Iwasaki and her team inoculated mice with a low dose of Pfizer's Comirnaty mRNA vaccine and followed up two weeks later with a boost of mRNA vaccine delivered via a nasal spray. The low dose of the injected vaccine was meant to simulate waning immunity. Other groups of mice got only an injection or only a dose of vaccine in the nose.

Only the group that got the injection followed by the nasal spray developed robust immunity against the Covid-19 virus.

"That approach we have shown in the mouse model to be 100% protective against lethal dose of SARS-CoV-2 infection, and it dramatically reduces the viral load in the nose and in the lung," Iwasaki said.

Going for IgA antibodies

Mucosal vaccines also target a slightly different part of the immune system than shots.

Injections trigger the body to make antibodies against the virus that causes Covid-19. Most of these are Y-shaped proteins called IgG antibodies that are programmed to recognized and block specific parts of the SARS-CoV-2 virus along its spikes, the parts of the virus that latch onto and infect our cells.

A much smaller portion of these are IgA antibodies, and they look like two Ys joined together at their tails and turned sideways so it looks more like a dog bone, Gommerman says.

Like bouncers at a bar, IgA antibodies are the primary immune molecules on guard in the mucosa.

New coronavirus subvariants escape antibodies from vaccination and prior Omicron infection, studies suggest

These molecules are beefier than IgG antibodies. They have four arms instead of two, and they're special because they're less picky about what they grab onto than IgG antibodies.

"They might be a little more promiscuous in the way they recognize different variants. And that's obviously a plus," Gommerman said.

Shots increase IgA antibodies in the nose for a short time, but the hope is that mucosal vaccines will really ramp up the population of these sentries and help them stay active for longer.

"Whether they'll be able to confer complete sterilizing immunity, that's a very tall order," Gommerman said. "But we should be now working on ways to slow down person-to-person transmission, because this virus continues to mutate and then fools our immune system and gets past that mucosal layer.

Get CNN Health's weekly newsletter

Sign up here to get The Results Are In with Dr. Sanjay Gupta every Tuesday from the CNN Health team.

"This is now a very contagious virus," she said.

Iwasaki says she would love to move her vaccine out of animal studies and into clinical trials in people.

"We're still at the stage where we're kind of struggling to raise money, even make the vaccine for human use, because it takes millions of dollars, and we are not sitting on that kind of money for research lab," she said, "so not yet."

https://edition.cnn.com/2022/07/18/health/mucosal-immunity-covid-19/index.html?

BBC: UK's decision to ban flights was 'rushed'

 

Live Reporting

Summary

• The UK imposes travel restrictions on six African countries over a new coronavirus variant
• The variant is highly mutated and there are concerns vaccines could be less effective against it
• A top UK health official called it "the most significant variant we have encountered to date"
• Uncertainty over the new variant has hit Asian stock markets
• Several European countries are considering new restrictions amid a fourth wave of cases
• Belgium's PM says the increase in cases has been worse than expected

Edited by Yvette Tan   BBC

Get involved

• Send an email to haveyoursay@bbc.co.uk

1. 
   

2. Posted at 15:1607:16   26 November 2021

   UK's decision to ban flights was 'rushed'

   

   Getty ImagesCopyright: Getty Images

   Cape Town in South Africa is a popular destination for British touristsImage caption: Cape Town in South Africa is a popular destination for British tourists

   The UK health secretary's decision to ban flights from South Africa over concerns of a new variant detected there "seems to have been rushed", South Africa's foreign ministry says.

   "Our immediate concern is the damage that this decision will cause to both the tourism industries and businesses of both countries," Naledi Pandor said in a statement.

   He said the move had come before the World Health Organization (WHO) had issued any guidance on the matter, and that his country would work with the UK authorities to try to get the ban lifted as soon as possible.

   The UK is South Africa's largest source for tourists outside of the continent, with more than 400,000 visitors arriving there per year before the pandemic.

3. SOURCE