A COVID Recap from Dr Topol

At Ground Truths, Dr Eric Topol has a new column titled Covid, 4 years on.

Here are some excerpts, minus the charts and graphs, which I've never been able to figure out how to insert, so click here to read the entire article.

Impact: The global excess mortality has reached about 30 million lost lives attributable to Covid, and the Global Burden of Disease published a major paper this week in The Lancet on the toll it has taken for reducing life expectancy in 204 countries summarized as "The COVID-19 pandemic caused the most severe drops in life expectancy seen in 50+ years." The study did not address disability among survivors, with multiple concurrent studies reinforcing the prevalence of Long Covid in tens of millions of people.

Evolution of the Virus:  The JN.1 variant took over globally and a number of subvariants (JN.1.11.1, JN.1.18, JN.1.13, JN.1.18) are showing up with added spike mutations such as R346T and F456L, but without signs of wastewater levels on the rise or other concerning metrics.

But BA.2.87.1, as mapped below, is the major “Omicron-like” event out there that has been the subject of 5 recent papers/preprints (here, here, here, here and here). That, in itself, should tell you it’s a variant of interest. It’s chock full of new mutations compared with the variants that came long previously, and many of these are deletions

In itself, it is not a threat as there’s no sign it is more immunoevasive or transmissible. In fact, the consensus it that it’s less evasive of our immune response, the current booster works to achieve good levels of neutralizing antibodies, and some of the monoclonal antibodies that were previously found to be resistant to earlier variants my be effective again. That’s great news. But as Yunlong Cao and his team appropriately warned us, “BA.2.87.1 may not become widespread until it acquires multiple [receptor binding domain] RBD mutations to achieve sufficient immune evasion comparable to that of JN.1.”

It’s much too early to know whether (and when) this will take place, but after 4 years if there’s anything to predict, it is that the virus will find its way (through selection) to infect more hosts and repeat human hosts. 

One More Thing: I remain very disappointed and surprised by the recent change (1 March) of CDC policy towards isolation, without regard to using rapid antigen tests. Their own data shows that at least 1 in 3 people will still be infectious at 5 days after symptom onset! That’s by culturable virus, the gold standard, which tracks very closely with the rapid tests. To reduce infecting others, especially high risk vulnerable individuals, no less adding to the toll of Long Covid, rapid tests should be used before people circulate.