Nearly four years since the implementation of worldwide lockdowns amid the emergence and extensive spread of coronavirus disease 2019 (COVID-19), new cases of the disease — and of deaths caused by it — persist. In the twenty-eight-day period between December 11, 2023, and January 7, 2024, for instance, over one million new cases and nearly nine thousand fatalities were recorded by the World Health Organization. These reports represent the largest wave of infections since the Omicron surge of early 2022. But with public health responses having faded and discussion of the disease all but vanishing in news media and public discourse, questions remain. What variant are we on now? What prevention and treatment options are available, and how effective are they? And what’s long COVID?!
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, is notoriously mutable. Mutations in SARS-CoV-2, particularly in its spike glycoprotein, lead to new viral variants which can often evade the host’s immune system. Since vaccines against the coronavirus largely target that spike glycoprotein, genetic mutation within it can reduce vaccines’ effectiveness and lead to infection in those otherwise inoculated or who have previously had the disease. The aforementioned 2022 wave was caused by such a phenomenon, alongside dwindling public health recommendations. The B.1.1.529 variant — dubbed Omicron — was found to evade “the protection rendered by vaccine-induced antibodies and natural infection, as well as overpower[ing] antibody-based immunotherapies” and required pharmaceutical manufacturers to produce updated vaccines to catch up with the virus. Omicron remains the dominant variant of the virus, with its subvariant JN.1 (officially BA.2.86.1.1) currently on the rise. In the United States, JN.1 is estimated to be responsible for approximately 86 percent of COVID-19 cases between January 7 and 20, 2024.
Despite rapid mutation, updated vaccines appear to provide strong protection against COVID-19, especially against severe illness, hospitalization, and death caused by the disease; these vaccines are projected to continue doing so against JN.1. Rather than being “boosters” — designed to re-expose the body to a pathogen its immunological memory may have forgotten, so to speak — these vaccines are “updated,” exposing the body to new (sub)variants and providing more specific protection against them. Health agencies thus recommend updated vaccination to reduce the spread of new forms of SARS-CoV-2. (Readers in the United States can visit Vaccines.gov or call 1-800-232-0233 to learn more about receiving an updated vaccine.) Several treatments, too, are authorized for individuals at high risk of severe illness upon COVID-19 infection. These antiviral treatments — known by brand names Paxlovid, Veklury, and Lagevrio — have been shown to reduce hospitalizations and deaths in high-risk individuals. COVID convalescent plasma (CCP) therapy has also been found to be effective at preventing severe disease when administered early to immunocompromised patients. (See my “All in Vein” for a discussion of blood donation, like that necessary for CCP administration, and the need to make donor eligibility more equitable.)
The patient-coined term “long COVID” has loomed since the onset of the pandemic, used by numerous individuals who had been infected, and had ostensibly recovered, but who were experiencing newfound medical problems. These patients report a wide range of symptoms, including increased fatigue, weakness, impaired concentration and memory (“brain fog”) and difficulty breathing, among others. Despite these symptoms affecting an estimated ten to twenty percent of people who have had COVID-19, there are no certain answers as to the causes of long COVID and therefore few solutions to treat patients suffering with it. Research is ongoing, however, with possible causal mechanisms including persistence of SARS-CoV-2 in bodily tissues, viral reactivation, issues with blood clotting pathways, and neurological damage by the virus. So too is research into long COVID treatment ongoing, such as in recent large-scale studies across the United States investigating the efficacies of the abovementioned antiviral Paxlovid (a combination of nirmatrelvir and ritonavir), the wakefulness-promoting agents Sunosi and Provigil (solriamfetol and modafinil, respectively), and the heart medication Procoralan (ivabradine). These prospective treatments target possibilities of viral persistence, brain fog, and nervous system damage by the virus, respectively. With eighty thousand participants expected to enroll in addition to the study of sixty million electronic health records, this and other efforts will hopefully produce helpful results to ameliorate patient care for those experiencing long COVID symptoms.
Far from being a relic of the epidemiological past, COVID-19 remains a threat to populations’ health and well-being worldwide. As governments and populations leave what was once deemed the “new normal” behind, global health organizations and researchers must take COVID-19 seriously and continue efforts to combat the disease and improve treatment for those suffering with it and its apparent consequences.