RUNNELS COUNTY – For the past few weeks we have been examining important health problems, to see what can be done at the local level to reduce the impact of those problems. Last week I ended with this, “Having made a good start toward answering, ‘What are the most important problems?’ next week we will begin to look at some of the things that can be done.” We will indeed do so. However, this article is one which is very different from the one I had expected to write this week. Today I am writing – yet again – on the subject of COVID 19. I do so not only because it was the leading cause of death in Runnels County last year, but also because there have been some new developments in the past several days which will impact our health THIS year.
The phrase ‘arms race’ is one that is commonly used to describe the ways that germs and people interact over time. In the case of COVID-19, for example, the first steps that public health officials advocated were aimed at creating a perimeter defense by using masks, handwashing and social distancing. These were part of the planned response for the next flu pandemic. As it turns out, they worked really well against the flu, and we had almost no influenza in our County or anywhere in the entire country during 2020 and 2021. Extending the combat metaphor, we were very well prepared to fight the last war. No doubt these perimeter defenses did help, but they were entirely inadequate to protect us from COVID-19 for two reasons. First, flu spreads mostly by droplets, and these don’t travel very far before falling to the floor or another surface. COVID, on the other hand, is spread mostly by aerosol. In this case, tiny droplets containing the infectious particles evaporate, leaving the virus suspended in the air for a considerable period of time. The second reason is that COVID spreads more easily than flu, due in part to reason number one.
The arms race between respiratory viruses and human beings has been going on for much longer than we have had public health officials, and the human body has a number of defenses against these germs. The system known as “acquired immunity’ depends on a type of intelligence gathering in order to provide a targeted and coordinated counter attack when the body is invaded.
One of the reasons that COVID cases were so mild in most children is that the virus which causes COVID is related to a handful of coronaviruses that cause the common cold. Kids catch a whole lot of colds, and their bodies are in great shape to mount a defense. However, if a person was infected with COVID and did not mount a rapid and strong defense, the virus penetrated deep into brain and lung tissue, where it rapidly divided and killed cells. This in turn triggered another type of immune response, a more general system called innate immunity, that is heavily dependent on inflammation to overcome the invader. Unfortunately, this is a weapon system with very poor targeting capabilities, and there can be a lot of casualties due to ‘friendly fire’.
Most of the people who died of COVID actually died as a result of this type of overly active inflammatory response. The first treatment that was proven to be effective in reducing the mortality of COVID was dexamethasone, which works by reducing the bodies inflammatory response. Two other things of note: I said that COVID invades brain tissue, and we know that it commonly does so because the sense of smell actually relies on brain tissue that is very close to the air coming into the body, and the loss of smell in COVID is due to the destruction of this brain tissue. There may or may not be destruction of other brain tissue; it varies from person to person. Also, the term “acquired immunity” is so named because it depends on the human body’s immune system acquiring a sort of an image of the invader, that is then literally remembered by the immune system and passed on to various cells that then function in harmony to target anything that displays that image.
One of the main ways that this system works is through the production of antibodies that adhere to molecules or cells displaying that image. This ‘paints’ the target, and then other cells destroy the target. This process typically takes a couple of weeks before it is functional, so it is of limited usefulness against an overwhelming initial attack.
In humanity’s battle against COVID, after perimeter defense and the suppression of friendly fire, the next major tactical advance in weaponry for team human was development of the first monoclonal antibody (bamlanivimab) that could be given IV to treat the disease. Bamlanivimab – ‘bam’, as it came to be known – was the first of many manufactured molecules engineered to paint the COVID target, just like the body’s own antibodies would do, if they had the opportunity. This was a huge breakthrough, but it didn’t take long before variants arose that could ‘defeat’ or ‘escape’ this weapon. By combining two different monoclonal antibodies, the effectiveness was greatly enhanced. However, no advantage is permanent in an arms race.
The next development that is widely held to be an advance was the wide-spread distribution of vaccines. These worked by teaching the body to make its own monoclonal antibodies, to paint the COVID invaders for targeting by the body’s immune system. The intention was to inoculate people who had not had COVID, and prevent them from becoming ill with the disease. The initial reports were terrific! The people who were vaccinated had a 90+% decrease in their risk of becoming ill with COVID. However, the virus mutated so fast that by the time these vaccines were widely distributed they were not nearly that effective at preventing disease. The vaccines did, however, prepare the human body to mount a better defense, and greatly reduced the likelihood of death due to the friendly fire of uncontrolled inflammatory response.
Then there was Omicron. Omicron was different from previous variants in many ways. For one thing, it almost completely escaped or defeated every prior targeted response, including the monoclonal antibodies as well as immunity acquired from infection by a previous variant or by vaccination. Also, Omicron acts more like the coronaviruses that cause the common cold as it does not have as strong tendency to invade deeply into brain or lung tissue, as did prior COVID variants. Omicron has virtually replaced all other variants, because it replicates and spreads so quickly, and also because so many of the cases are completely asymptomatic. However, there are still more variants. They arise because they have some advantage in terms of the arms race.
What we called Omicron when it tore through our County in January, is now called BA1. The next variant to arise was known as BA2, and it evidently spread even more quickly, but people who had had BA1 were still very unlikely to get sick if exposed to BA1 or BA2. However, there is a new variant, BA2.12.1 that has escaped or defeated the immunity derived from having BA1 or BA2, or from vaccines (apart from the few weeks following vaccination, when the body is in a state of high inflammation and immune hypervigilance). BA2.12.1 is responsible for the new rise in cases in Europe and the Northeastern US. In addition to this one there are two other variants that are on the rise in other countries, BA4 and BA5, which are able to completely defeat the immunity conferred by vaccination or infection with BA2 or prior strains. Also, it appears that one advantage that BA4 and BA5 have over previous variants is that they appear to be more easily spread through contact with contaminated surfaces. Perhaps the virus is more stable in the environment.
So, now what? Hand washing, disinfecting of surfaces and other basic sanitation measures are practices that we should maintain. Be sure to take advantage of all of the federal government’s offers of free test kits and free masks. (See https://www.covid.gov/tests.) The at-home COVID tests are likely to maintain their current sensitivity (about 90%) so keep some on hand, and if you think that you may have COVID stay home until you have tested negative on two different days, then you can be fairly certain you don’t have COVID. If you do test positive, and begin to feel short of breath or are at high risk for severe disease, make a telemedicine visit to see if you should be treated.
The new oral medications Paxlovid and molnupiravir are effective against all known variants. If you must go out without being tested, wear a surgical mask as that makes it much less likely that you will spread the disease to others, by catching the microscopic, virus-containing droplets in your breath. If you ae not sick and want to stay that way, consider wearing a respirator such as the N-95 if you are at high risk, either because of underlying health conditions or if (like yours truly) you are around a lot of people who are sick with unknown ailments.
In addition to these things that we can do individually, please consider some of the important ways that an organization such as the Health and Wellness Coalition for Runnels County (HAWC) might benefit the people you know. Such an organization could be a repository for donated masks and testing supplies, which could then be given to or delivered to individuals and families on an as-needed basis. Trained volunteers or Community Health Workers (CHWs) could facilitate telemedicine visits, assist in distributing masks and test kits and also respond to requests for thermometers and pulse oximeters. Such items were available for distribution at various times when COVID was peaking, because it was a way of keeping people out of hospital. Also, the CHWs could answer questions as to location and availability of additional information and services. These are but a few of the possibilities.
Finally, remember that there is more to life than avoiding disease. We do not know whether Omicron and its variants will cause as much persistent disease, or long-COVID, as the previous variants. There is reason to believe that it will not. In any case, do not let your life be dominated by fear. I promise, if you will keep reading each week, I will let you know if there comes a time to panic.
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Originally Appeared Here