Sunday, March 7, 2021

Covid-19: Good News, Bad News

                                                                                             written 28 February 2021

                                                                                               published 7 March 2021



            There is good news about Covid-19.  On February 28th, daily US cases had dropped from the January 8th third wave peak of 396,176, to 53,480, and daily deaths dropped from 6,421 on February 12th, to 1,318.  California and Mendocino County numbers are showing similar trends.  The US has administered over 50 million doses of vaccine and rates are increasing weekly.  Prioritizing vaccination of older people has diminished new cases and deaths in elder care facilities. 

            A third vaccine, this by Johnson and Johnson, was approved by the FDA, and millions of doses are being shipped.  Unlike the first two, this is a single dose vaccine, and doesn't need extreme refrigeration.  The Federal government is now giving coherent and consistent messaging, with regular press briefings by actual medical experts, coordinating with State and local governments.  Another large Covid-19 economic relief bill has passed the House, and should clear the Senate, despite complete lack of Republican support.

            The bad news is the totals are grim.  At the end of February, reported the US was still number one, with 29,235,040 Covid-19 cases (1/4 of the global total and almost three times number two India), and 525,578 deaths (more than twice number two Brazil). 

            The facts about Covid-19 are still polarized for crass political gain by Republicans, and the third peak was created by ill-considered social gatherings around Christmas, New Year, and the super bowl.  The current low daily new case and death rates are higher than the second wave peak in July, indicating a pandemic still raging out of control.  Almost 200 countries lost fewer of their citizens during the entire year of pandemic than America did just last week.

            There is increasing concern about the rise of virus variants.  Most life forms have their genetic information stored as double strand DNA, a stable configuration that reduces copying errors during replication.  Covid-19, is a simple RNA virus, which has a single stand of genetic material, prone to replication errors.  Increased copying errors helps the virus move into new species by rapidly creating new genetic possibilities.  Most are not viable, or of no help, but a few allow for greater infection rates and transmissibility.  Whenever there is a large pocket of infection, the possible emergence of more potent variants increases. 

            Public health researchers keeping track of genetic structures have reported the emergence of hundreds of variants, mostly with no effect.  The variant that first infected the west coast of America was similar to the "original" found in China.  But the strain that infected the east coast, and then the rest of the country, was a somewhat more transmissible version that caused havoc in Italy.  Seven variants have been identified arising in the US alone, which is no surprise given our large infected population.  However, researchers are intently monitoring three different variants first identified in the UK, South Africa, and Brazil, each with as much as 70 percent greater transmissibility, with some indications of increased lethality as well.  

            Dr. Peter Hotez of Baylor College of Medicine, said that the current decline in cases is like being in the eye of a hurricane, and the next big surge will be caused by the spread of the variants.  The more transmissible UK variant is doubling in the US every ten days, and is expected to dominate across the US by the end of March.  While genetic sequencing can identify different variants, the quantity of this kind of testing is currently very limited, so we are still flying blind with this pandemic.

            So far, all the approved vaccines show good results against the known variants.  There is indication that prevention from getting the disease is somewhat reduced, particularly the South African strain, but the excellent protection from serious illness, hospitalization, or death, seems unaffected.  Since all the current vaccines focus on targeting proteins comprising the spikes on the surface of the Covid-19 virus, if a significant enough variation occurs in the genetics for these proteins, the virus could escape control, and run rampant through the population.  It is expected that some form of booster shot, a modification of the current vaccines, may be required. 

            One year in, we are more prepared to deal with Covid-19, with better hospital procedures, several therapeutics, and some very effective vaccines, but we are still a long way from "normal".