The infectious disease specialist shares views on viruses, vaccines and treatments

More than two years since the onset of the global COVID-19 pandemic, the SARS-CoV-2 virus continues to rage through rapidly evolving mutations and gaps in population immunity. But the prospects for combating COVID-19 are brighter than in those first dark days of 2020, according to Infectious Diseases Specialist Richard T. Allison III, MD, professor of medicine and hospital epidemiologist at UMass Memorial Medical Center.

“We are in a very good situation because most people in the United States have now been vaccinated or may have actually had COVID before, so there is a great deal of immunity to serious diseases,” Dr. Allison said.

“Having said that, it’s a virus that’s spread all over the world. Some people have suppressed immunity or them immune system not as strong and they can have an infection for long periods of time. And it allows the virus to change and mutate. Not many people get sick, but the virus continues to develop into variants that are very, very easily spread. ”

At least two options appeared around the world after the Omicron strain switched from the delta in December.

Hospitalizations have shrunk

According to Allison, the number of people in the hospital locally and especially in the intensive care unit who fell ill with COVID-19 has decreased compared to previous jumps. And about half of the people hospitalized with COVID-19 were admitted for another reason, such as kidney stones or a heart attack. Hospital staff should take all precautions to prevent the spread of infection among patients and staff, regardless of when the infection was detected prior to admission.

– So the hospital needs to be very careful and still requires everyone to wear masks, gowns and gloves – personal protective equipment that was not enough two years ago, “said Allison. Goggles, which are associated with a lower risk of transmission, have become standard.

Even more difficult, many doctors and nurses are absent from work because they contracted COVID-19 in the community, such as at a family gathering or at a restaurant, which, according to Allison, affects hospital care.

Therapeutic agents and “Paxlovid rebound”

Therapeutic agents, including the antiviral drug Paxlovid and monoclonal antibodiesAllison said it “really changes value” in reducing symptoms and keeping people from going to the hospital. He urged people who are 65 years of age or older, or who have health problems, to contact a doctor as soon as they receive a positive result to begin treatment.

Recent media attention has focused on some people whose infection went into remission after five days of Paxlovid treatment, even showing negative test results, but then symptoms returned after treatment, a situation called “Paxlovid rebound”.

Allison said a small number of people experienced recurrent symptoms during clinical trials of the drug, but overall: “Paxlovid is excellent at helping many people recover and certainly prevents people from being hospitalized. intensive care unit and preventing people’s deaths. ”Five days of treatment may not be enough to completely eradicate the virus in some people, so they have symptoms a second time, he said.

Reinforcing arrows

The U.S. Food and Drug Administration has allowed a second Pfizer-BioNTech and Moderna vaccine in the spring for those 50 years of age and older, or 12 years of age or older with certain types of impaired immunity, and who have received the first regulatory vaccination at least four months earlier.

Allison said that because these populations are facing reduced immunity, a second booster is “definitely worth it”. But for the younger, generally healthier population, “the relative risks and benefits of a second booster vaccine don’t really mean that everyone needs it.” He stressed the importance of the first revaccination for all who have been vaccinated.

While some people are wondering whether they will have to be vaccinated every few months to keep up with new strains of viruses, Alison said success is already on the horizon.

The phase II / III clinical trials currently underway, including for Moderna under the direction of Jennifer Van, MD, professor of medicine, are investigating different configurations of a divalent vaccine covering the original spike protein and the beta variant of the adhesion protein. Researchers hope that these recycled vaccines will become a broader shield against new mutations.

Allison said scientists are working to develop a single vaccine that would protect against influenza and SARS-CoV-2 so people can receive an annual combination vaccine instead of individual vaccinations.

Recommendations for isolation, testing and masks

Meanwhile, policy recommendations evolved as to how humans can stop the spread of COVID-19. The CDC recommends that people with confirmed or suspected COVID-19 are isolated for at least five full days. After five days and 24 hours without a fever without the use of antipyretic drugs, a person who has been ill may end the isolation but still have to wear a mask next to others and watch for symptoms for at least 10 days.

If 10 days after the first positive test or the appearance of symptoms, the infected person gives a positive result of the antigen test, he should still take precautions. “There is a close link between a positive antigen test and the release of an infectious virus, so on a practical basis everyone who gets a positive result antigen test can infect other people, ”Allison said.