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Four years after the emergence of SARS-CoV-2, experts know more about strain mutation, vaccine effectiveness, and the long duration of COVID-19. Here's what it means for you.
More than four years after the emergence of SARS-CoV-2, most people are eager to leave COVID-19 in the rearview mirror.
Unfortunately, the virus is far from having disappeared.
During the last week of December 2023 and the first weeks of January 2024, the United States experienced a surge in COVID-19 infections and hospitalizations, according to the Centers for Disease Control and Prevention (CDC) COVID Data Tracker . Deaths from the virus have hovered around 1,400 per week since September 2023 and peaked at 2,029 in early January , bringing the total number of COVID-19 deaths in the United States to 1.17 million by the end of January 2024.
These figures are far lower than the hospitalizations and deaths at the height of the pandemic, when more than 25,000 people died in the United States in a single week in January 2021. According to infectious disease experts, this is because the virus has mutated and now causes less severe illness, and most people have some form of immunity from previous infections and the protection offered by vaccines.
Nevertheless, while hundreds of millions of people continue to be infected with the virus and at least 20 million Americans have been diagnosed with long COVID, infectious disease experts are warning the public not to let their guard down .
“There’s a bit of complacency among people who think, ‘ Now that COVID-19 is over, I don’t need to worry anymore ,’” says Alessandro Sette, PhD, co-director of the Institute for Research on Infectious Diseases (IRM), co-director of the La Jolla Institute Center for Vaccine Innovation, and assistant professor at the University of California, School of Medicine, La Jolla Institute for Immunology. “ That’s not the case. We’re in a new phase .”
AAMCNews spoke with experts from academic medical institutions specializing in immunology, vaccinology, epidemiology, and critical care to answer the most common questions about COVID-19 in 2024.
How is the JN.1 variant different from previous strains?
The JN.1 variant, which is a sub-variant of omicron , accounted for 83% to 88% of all SARS-CoV-2 variants currently circulating as of January 19, according to the CDC . This sub-variant is known to virologists as the " hypermutated variant ," explains Mr. Sette.
" This variant is potentially concerning because it is associated with the possibility of escaping the neutralizing antibody response ," notes Mr. Sette.
This could explain the increase in the number of people experiencing symptomatic illness, even after having been vaccinated or previously infected. However, the data suggest that this variant does not cause more severe illness than other variants . Furthermore, T cells, the body's second line of defense against foreign pathogens at the cellular level, continue to respond well to JN.1 infections, as found by Dr. Sette and a cohort of Swedish scientists in a recent study . Another study, currently in preprint, showed that the body's immune system can adapt to recognize the virus, even in the presence of various mutations.
" This therefore represents enormous potential ," explains Mr. Sette. " The immune system can indeed keep pace with the mutations of the virus ."
This is good news for people with healthy immune systems, and especially for those who get vaccinated, because it means they will likely be able to fight the virus more easily .
How long does immunity against a COVID-19 infection last?
The immune response to a COVID-19 infection typically fades after 3 to 4 months , explains Dr. Kawsar Talaat, a vaccinologist and associate professor in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health and Johns Hopkins School of Medicine in Baltimore, Maryland.
If a person was infected during this latest wave and has not received the latest COVID-19 vaccine, Mr. Talaat recommends getting vaccinated three to four months after recovering from the illness in order to maximize protection.
While COVID-19 rates tend to rise during the winter months in the United States, the virus has not yet entered a predictable seasonal pattern, with occasional regional surges throughout the year. For now, Mr. Talaat recommends following the CDC's vaccination guidelines . Individuals at higher risk of complications from the virus may need to be vaccinated more frequently , as advised by their doctor.
" I often hear people say , ' COVID isn't that bad anymore, why should I keep getting vaccinated?' " Talaat said. "Actually, COVID isn't that bad if you're young, healthy, and have a normal immune system . People with risk factors continue to get sick, be hospitalized, and, sadly, die."
Can I contract COVID-19 even if my vaccinations are up to date?
Yes . Ms. Talaat notes that currently available vaccines do not provide complete protection against infection and mild symptoms, which explains why some people become ill even after being vaccinated, but that the vaccines are effective in preventing severe illness. Because vaccination prepares the immune system for the virus, vaccinated individuals and those who have already been infected are likely to have a faster and stronger immune response, which can reduce the viral load in the body and alleviate symptoms .
People who received the updated vaccines in 2023 are more likely to avoid infections than those who did not . The CDC found that recent vaccination with the updated vaccine reduced symptomatic infections by 54% compared to people whose immunity was waning due to an expired vaccination status.
What treatment is available for COVID?
For most patients, symptomatic treatment is sufficient. Paracetamol remains the first-line treatment for pain and fever, and the usual contraindications for NSAIDs still apply.
The following guidelines were written by scientific societies and can be used as a guide. L'Univers Masqué is not responsible for updating them.
- For patients outpatient:
- at risk of severe COVID-19: guidelines for early outpatient treatment of patients with non-severe SARS-CoV-2 infection
- who require hospitalization but are offered intensive outpatient care (patient choice or hospital saturation)
- For some patients, the use of anticoagulants is recommended (Belgian Society of Thrombosis and Haemostasis)
- for patients who still require supplemental oxygen after being discharged from the hospital: guidelines for the correct use of oxygen
If you are staying home due to respiratory symptoms, contact your doctor:
- if symptoms worsen;
- if new symptoms appear;
- at the end of the period of incapacity for work if symptoms persist.
Some patients may experience COVID-19 symptoms for several weeks or months. KCE summarizes the most important information on its website to help patients with long COVID.
If I have COVID, should I take Paxlovid?
The Food and Drug Administration has approved the prescription of the oral antiviral drug Paxlovid for patients with mild to moderate COVID-19 symptoms who have at least one risk factor for severe illness , such as being over 50 years of age, having a chronic illness, or having a weakened immune system. For it to be fully effective, the drug must be taken within five days of the onset of symptoms. Studies have shown the drug to be very effective in reducing the risk of hospitalization and death .
Some people have reported a "rebound" after taking Paxlovid, meaning they appear to get better, then test positive again or symptoms reappear after a few days. However, according to an article published by Yale Medicine , doctors believe the drug is still useful for people at risk of severe illness, especially since there is no evidence that Paxlovid is less effective in treating the most serious consequences in these cases .
Paxlovid could also reduce the risk of developing long COVID , explains Ziyad Al-Aly, MD, FASN, chief of research and development at Veterans Affairs St. Louis Health Care System and clinical epidemiologist at the University of Washington at St. Louis.
What are the risks of long COVID? Are there any treatments?
Al-Aly, who is one of the leading experts studying long COVID, explains that specialists tend to divide long COVID patients into two camps: those whose main symptoms are brain fog, fatigue, dysautonomia (dysfunction of the autonomic nervous system) and post-exercise malaise , and those whose main symptoms result from organic damage .
" Long COVID can affect almost every organ system ," explains Al-Aly. " It can affect almost anyone... throughout their life, in all demographic groups... It is a very heterogeneous disease ."
The risk of developing long COVID also appears to increase with each infection.
We clearly see people saying, " I had COVID three years ago, I got through it fine. I had it a second time and I got through it fine ," before succumbing to long COVID after a third infection , he adds.
When policymakers and the public only measure the impact of COVID-19 by counting deaths and hospitalizations, they fail to account for the approximately 20 million people in the country who have long COVID, including about 4 million who are unable to work due to long COVID symptoms, explains Mr. Al-Aly.
And although Al-Aly and other specialists have conducted important research on long COVID over the past four years, they are still unable to fully explain its cause or offer a cure or treatment other than symptom relief.
Many patients presenting at Northwestern Medicine's Comprehensive COVID-19 Center (CCC) in Chicago suffer from a variety of unexplained symptoms and lack a diagnosis , adds Dr. Marc Sala, a pulmonologist and critical care physician and co-director of the CCC. The CCC brings together a multidisciplinary team including specialists in neurology, pulmonology, cardiology, otolaryngology, and other specialties to study and treat the diverse symptoms of long COVID.
" Some symptoms are not specific, such as fatigue and shortness of breath, brain fog, and cough 90 days after a COVID infection ," explains Dr. Sala. " We conduct a thorough medical workup to rule out causes unrelated to COVID, and then we end up with a diagnosis of exclusion [because] there is no biomarker for this disease ."
Sala explains that one of the leading hypotheses about the cause of long COVID is that the virus hides in the body and continues to stimulate the host's immune response over time . Because the body is unable to completely eliminate the virus, patients with long COVID remain in a prolonged inflammatory state. With more research and clinical trials, he hopes progress will be made in developing treatments.
However, Mr. Sala fears that the public has grown tired of COVID-19 and that interest - and funding - are shifting to other issues, despite the importance of this disease .
" Even if the number of long COVID cases decreases, it is useful to study this type of post-viral condition ," explains Mr. Sala. " I don't think this is the last virus of this nature that we will see ."
Are the vaccines effective against the latest variants?
Experts were unanimous on the question of the value of vaccines: they are underestimated .
In the United States, only 21.8% of adults and 11% of children had received the updated COVID-19 vaccine as of January 26, 2024, while nearly half of adults and children are vaccinated against the flu .
" I can't tell you how amazing and unexpected it is that we almost hit a home run with the first [mRNA] vaccines ," says Mr. Talaat. " They are incredibly effective at saving lives and preventing hospitalizations. "
She notes that current vaccines do not prevent infection, but there are new vaccines in clinical trials that could be administered nasally and could stop a COVID-19 infection before it starts .
In the meantime, existing vaccines can make a huge difference to public health .
" You should get vaccinated to protect yourself, and if you think you are healthy, consider getting vaccinated to protect your loved ones who are at higher risk of contracting a serious illness ," says Mr. Talaat. " None of us live in a bubble; we live in a community. "
Al-Aly goes further by encouraging people to " strategically mask themselves ," for example on public transport, and by pressuring policymakers to adopt measures such as installing air filtration systems in buildings that reduce the circulation of infectious particles in the air.
" We need a sustained research effort ," says Mr. Al-Aly. " Pandemics cause disabilities and illnesses; we must study how to treat them, not only for the benefit of those who are sick today, but also for the benefit of our children and grandchildren who will experience pandemics in the future. "
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