Covid-19 has been pushed off front pages by falling case counts and other news stories, though the pandemic’s threat hasn’t really changed — we’re just in the trough of the last wave. Nonetheless, it was strange to hear President Joe Biden talk in his State of the Union address as if the pandemic were just another item on a laundry list of issues from the inflation to infrastructure.
Biden’s most notable comment on the virus was the promise to make testing widely available at pharmacies and allow those who test positive to get free access to antiviral pills. That makes sense because in clinical trials, Pfizer’s drug Paxlovid showed close to 90% efficacy at reducing hospitalizations when given to people who test positive for Covid-19 within five days of reporting symptoms.
But giving away Paxlovid isn’t quite that simple, because the drug interferes with the absorption of other drugs. Many people who are vulnerable enough to be good candidates for Paxlovid are going to be on multiple other drugs and would need a doctor’s supervision to take the five-day course of pills safely.
And that five-day window is important — so testing would have to be easily available not only at pharmacies but at home. The vaccination campaign showed many Americans who have a high risk of severe disease didn’t have a car or other means to get to testing or vaccination centers, and might not be able to get to a pharmacy to get the necessary tests and the drug. He promised more free at-home tests, and that’s a good start.
Beyond that, if another surge flares up, testing facilities could again become swamped if we don’t prepare now, and push for more backup supplies of at-home rapid tests. Ongoing research could also improve the accuracy of these tests.
The president also promised that it would be possible to deploy a new vaccine within 100 days of a new variant’s emergence, but that’s highly misleading. Scientists did develop an omicron-specific vaccine, but it was ready too late — and turned out to be no more effective than a booster of one of the original vaccines.
Dan Barouch of Harvard and Beth Israel Deaconess Medical Center told me in an interview that such “variant chasing” might never be productive. What’s needed is continued funding for basic experiments in immunology — ones that are mapping out how vaccines and natural immunity work against new variants such as the currently circulating sub-variant called BA.2. Also critical is a vaccine that is effective against more parts of the vaccine than just the spike protein, making it more likely to work against new variants.
Biden did mention the need for vigilance against new variants. One way to do this would be wastewater sampling, which can pick up surges before positive tests start to increase. Random testing for surveillance studies could help us stay ahead of a new wave as well.
Biden didn’t mention long Covid, but he should have. There are concerning results that the virus can traverse the whole body and persist long after an apparent recovery, and that it can have long-term damaging effects on the brain and the heart. The fact that some people have had long Covid since early 2020 suggest the condition could be permanently disabling. Research into long Covid might yield new ways to treat or prevent other observed long-term effects of viral infections.
And while few attendees at the speech wore masks, we do need more research on what kinds of masking works to protect others, the wearer, both or neither. CDC is recommending that people who test positive, have Covid symptoms or live in a designated high-risk area wear a mask rather than stay home. But without clear evidence that cloth masks — which many Americans continue to use — prevent transmission, it would be safer to ask people experiencing symptoms to self-isolate.
One of the biggest challenges for political leaders — and the news media — is the illusion that humans have control over the way the virus rises or falls. The language we use suggests that when waves ebb, we’re “succeeding in the fight” or “getting the virus under control,” when it’s clear at that scientists don’t understand why cases rise when and where they do, or why they tend to peak and fall so precipitously. That’s another area where scientists need to do more research. Once scientists figure out what causes waves to decline, maybe our political leaders could harness that to actually gain some control.
The US wasted weeks in early 2020 when we could have better prepared for what was very likely coming. If the virus does give us a few weeks of reprieve now, it would be wise not to waste the time again.
Bloomberg
