Coronavirus Updates July 2022

[missy]

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Novavax is here! Just not the silver bullet we need​

Jul 20

Yesterday, ACIP—CDC’s external scientific advisory board—unanimously voted to authorize the Novavax vaccine (called NVX-CoV2373) in the U.S. This was big news for the small, underdog Maryland company who had a long road to authorization.
After rigorous clinical trials, FDA and CDC scientific meetings, and more than 1 million vaccines already rolled out across the globe, it’s clear this vaccine is safe and effective. There are two ways this vaccine could potentially help us in the U.S.:

1. Vaccinating the unvaccinated
2. Broadening protection through multiple vaccine platforms (e.g., mRNA primary series + Novavax booster)

Unfortunately, I’m not optimistic for either. I don’t think Novavax is the silver bullet we need in the U.S. to close out our fight against SARS-CoV-2.

Vaccine for the unvaccinated​

Novavax was authorized as a primary series. In other words, this is intended for those who are still unvaccinated. There is still a significant need and opportunity to improve COVID-19 vaccination rates in the U.S. Around 26-37 million (10-14%) of adults have not received a COVID-19 vaccine. The majority of these folks are multiple races (30%) or non-Hispanic White (22%), living in rural areas (22%), below poverty (19%), and/or uninsured (31%).
Novavax uses a different vaccine platform than current COVID-19 vaccines do. A diverse portfolio is important for many reasons, like freeing up supply bottlenecks and providing options for those allergic to vaccines ingredients. The Novavax vaccine also may reduce vaccine hesitancy because it uses a more traditional biotechnology. Its method has a much longer track record than the newer approaches, as it’s used for some flu and HPV vaccines.
The CDC conducted a poll with unvaccinated people in the beginning of the year and found 16% of the unvaccinated would “probably” or “definitely” get the Novavax vaccine. Given pandemic fatigue and lots of infections since, it’s not surprising that this number is lower now: a more recent poll (June 2022) found only about 10% of unvaccinated people will line up for this vaccine.
Among unvaccinated people who do not want Novavax, top concernsinclude “concern about side effects,” “worried the vaccine moved through clinical trials too fast,” “don’t think the vaccine will be effective,” and “don’t trust the company making the vaccine.” Moving the dial is going to be difficult because it requires building trust. This isn’t done overnight with a new vaccine release.

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(CDC)

Boosting with Novavax​

The other potential is for the larger population vaccinated with mRNA vaccines to use Novavax as a booster. I was most excited about this. Originally, we hypothesized combining vaccines from different platforms would broaden protection, as the body was exposed to the virus in different ways, potentially giving it more tools. While boosting with Novavax has been shown to be safe, preliminary effectiveness of this approach is underwhelming. (To be clear, the current authorization does not “allow” Novavax boosting yet.)
One study published in Lancet assessed the effectiveness of vaccinating with one dose of mRNA with a second dose of Novavax. The figure below (left panel) shows antibodies after Pfizer+Novavax (purple) wasn’t as high as the two mRNA vaccines (orange and yellow). The same pattern was found for T-cell protection (right panel below).

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Figure from Stuart et al., 2022, Lancet.
Another study in Science compared three mRNA doses with two Novavax plus one mRNA dose. The antibody response was about the same, even against some of the newer Omicron subvariants, like BA.4/5.

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Figure from Bowen et al., 2022, Science.
If we switch the series order (2 mRNA+1 Novavax), the story doesn’t change. A randomized control trial published in Lancet found Novavax did boost immunity, but not significantly more than other combinations. Interestingly, T-cell-boosting effects of Novavax were lower in people who had received two mRNA vaccines compared to those who received two doses of the Oxford’s Adnovirus vaccine. This study shows that combining can be advantageous for certain vaccines, but that doesn’t seem to be the case for mRNA and Novavax.
One thing we don’t know is the durability of combining mRNA with Novavax. Although antibodies may be the same, the combination could theoretically slow the rapid waning we see with the mRNA series. I’ll be anxiously awaiting the data.

Bottom line​

Novavax is a great vaccine for the unvaccinated, and it will save millions of lives. It can eventually be used as a booster, but the effect will not be as impactful as I would have hoped. For now, I don’t recommend using Novavax off-label as a booster or, worse, waiting for a booster because Novavax is coming.
It’s abundantly clear that first generation vaccines, like Novavax, are not the silver bullet we need to close out this pandemic. We desperately need the funding and the drive for second generation vaccines, like pan-coronavirus vaccines (variant proof) or nasal vaccines (future post to come), to finally get ahead of this virus.

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[Karl_K]

Novavax is to little to late, what we need is a new booster targeting the variants out there now.

 

[missy]

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COVID State of Affairs: July 25​

Katelyn Jetelina

As Omicron subvariants sweep the globe, the international death toll started rising for the first time in seven months. Although deaths still remain low, a 39% increase in death toll is noticeable. This increase is mainly driven by Southeast Asia (+20%), followed by the Eastern Mediterranean (+15%) and Americas (+7%).
Hospitalizations have doubled in Europe and no peaks have been seen yet for countries like France, U.K., Greece, or Italy, although hospitalizations do look to be slowing down. Notably, Australia has surpassed their previous Omicron peak for hospitalizations, and many systems are reaching capacity. Japan hospitalizations are also on the rise, which is not a surprise given that they just reported 152,538 new coronavirus cases—the biggest one-day increase on record.

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United States
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BA.5 was slower to claim dominance in the U.S., but now accounts for 78%of cases. And, like clockwork, once it claimed dominance, wastewater trends went upwards in all regions of the U.S. Interestingly, this uptick may be short lived as wastewater recently slowed and even reversed in some places. Case trends continue to give all sorts of weird signals, but test positivity rates seem to have peaked, too. This could be the top of the wave, which would be a surprising but welcome reprieve.

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Wastewater trends and case trends throughout the entire pandemic. Source: Biobot Analytics

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Regional wastewater trends in past 6 months. Purple= Midwest; Orange= Northeast; Pink=South; Green=West. Source: Biobot Analytics
My eyes have been specifically on the pink line above—the South. With the combination of low booster rates, a heatwave (i.e. people headed inside), little BA.2.12.2 wave, low Paxlovid uptake, and little-to-no testing, severe disease may sneak up, just like we saw with Delta last summer.
On a national level, hospitalization trends continue to steadily increase. And this will continue as hospitalizations lag case trends. More than 43,000 people are in hospitals with COVID-19 on an average day. Notably, many of the acceleration leaders for hospitalizations are in the South: Arkansas, Louisiana, West Virginia, Kentucky, and Georgia.
Although hospitalizations are increasing, we are clearly in a different phase of the pandemic in regards to severe disease:

• Case hospitalization rate continues to decrease over time, especially given dramatic underreporting.
• ICU admissions—one proxy of severe COVID-19—remains relatively steady, regardless of an increase in hospitalizations overall and a highly transmissible virus sweeping the community.

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(NYT)

• “For” COVID-19: We do not have a great picture of hospitalizations “with” vs. “for” COVID-19, but some jurisdictions, like Massachusetts, have been tracking this since January 2022. Today, of all COVID-related hospitalizations, about 30% are “for” COVID, and the percentage has steadily declined since January 2022 (when they started tracking this).
  

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  It’s important to note that this doesn’t mean the 70% “with” COVID-19 hospitalizations are irrelevant to the pandemic. COVID-19 could be complicating health issues, causing people to be in the hospital. Also, people bring COVID-19 to the hospital; hospital-acquired COVID continues to be steady.
• Vaccination status. The vast majority of people in hospitals are older and unvaccinated or not up-to-date with their vaccines. Below are the current hospitalization rates in Los Angeles county.
  

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  (County of Los Angeles Public Health; Source Here)

The national picture mirrors that of LA: The rise in hospitalizations is driven by 70+ year olds (see figure below). The hospitalization gap between this group and other age categories continues to widen, too. Unfortunately, even some fully vaccinated groups remain at risk for hospitalization. These groups will continue to remain at high risk until transmission calms down.
On the other side of the spectrum, pediatric hospitalizations remain relatively low compared to adults. But their hospitalization rate just passed the Delta peak, while other age groups are still far below it. This is likely explained by low vaccination rates among children.

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(CDC)
Unfortunately, more than 400 people are still dying each day from COVID-19. After a few weeks of reprieve, excess death started to creep up again as BA.2.12.2 took hold in mid-May. Excess mortality data is delayed, so it will be important to continue to track this. With a new virus in our repertoire, an “acceptable” level of death is still a national conversation we need to have.

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(CDC)

Bottom line
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We are in the middle of a wave, and the world is feeling it. There are signs that BA.5 cases peaked in the U.S., but we need to ensure this trend solidifies. The story of severe COVID-19 continues to change for the better. If you don’t want to get sick or want to protect the vulnerable around you even if they are vaccinated, like grandparents, you need to continue to ride this wave responsibly.

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[House Cat]

I have covid. I have a cough, fatigue, and loss of smell and taste. For me, it’s mild. I just sleep all day and night. The weirdest thing is that I’m losing hair. I read that can be a thing. Hopefully, i don’t lose too much!

 

[chrono]

I hope you feel better soon @House Cat

 

[junebug17]

I have covid. I have a cough, fatigue, and loss of smell and taste. For me, it’s mild. I just sleep all day and night. The weirdest thing is that I’m losing hair. I read that can be a thing. Hopefully, i don’t lose too much!

Take care of yourself and feel better soon @House Cat <3

 

[autumngems]

I have covid. I have a cough, fatigue, and loss of smell and taste. For me, it’s mild. I just sleep all day and night. The weirdest thing is that I’m losing hair. I read that can be a thing. Hopefully, i don’t lose too much!

I hope you feel better soon, a co-worker who had it also lost some hair and says her became dry/brittle.

 

[missy]

I am sorry to hear this @House Cat wishing you a speedy and full recovery and your hair will grow back. It’s a Covid side effect but it should grow back. Sending you bucketloads of healing vibes and gentle hugs

 

[Arcadian]

Feel better @House Cat . August marks the end of a very long study for me that wasn't very fun but hopefully they got some good data!

Covid is pretty hot and heavy in my area. I'm doing all I can to mitigate though I'm now back in the gym. Folks are not being as nasty as they were precovid at least.

I'm going to wait to get my booster in October with my flu shot.

 

[MamaBee]

I hope you get better quickly @House Cat..I think your hair will grow back when you get well. Any stress on the body can make your hair fall out temporarily. Sleep is the best medicine..

 

[House Cat]

Thanks for the well wishes everyone.