For many months, I’ve been writing—and warning—about COVID. Now, I’m warning you about what I call Re-COVID—what the medical community calls re-infection. But so much of our understanding of COVID, the extent of infections; the dangers or what some argue is an exaggerated, even hysterical danger; and how best to deal with it, is fraught with great controversy. There seem to be two different realities when it comes to COVID.
The Washington Post put it quite succinctly: “America has decided the pandemic is over. The coronavirus has other ideas. The latest omicron offshoot, BA.5, has quickly become dominant in the United States, and thanks to its elusiveness when encountering the human immune system, is driving a wave of cases across the country.”
I’m with those medical experts arguing for renewed caution and more vigorous intervention, especially given COVID’s rapid evolution and adaption and the puzzling and stubborn refusal of so many to more adequately protect themselves and others in the community. The Post quotes Eric Topol, an expert in the behavior of pandemics at Scripps Research, who warns that variant BA.5 is not only “the worst version of the virus that we’ve seen,” but seems able to evade antibodies from vaccination and bouts with previous strains of COVID.
To balance Topol’s assessment, the Post writes: “Other experts point out that, despite being hit by multiple rounds of ever-more-contagious omicron subvariants, the country has not yet seen a dramatic spike in hospitalizations. About 38,000 people were hospitalized nationally with COVID as of Friday, according to data compiled by The Washington Post. That figure has been steadily rising since early March, but remains far below the record 162,000 patients hospitalized with COVID in mid-January. The average daily death toll on Friday stood at 329 and has not changed significantly over the past two months.”
As always, there are multiple ways to see and analyze statistics. So, yes, the Post is accurate when it reports that, today, COVID hospitalizations are far lower than they were in mid-January, but take a look at recent trends. On April 4, 2022, there were 590 COVID deaths. A few days ago, on July 7, 2022 there were 1,111 deaths. On April 4, 2022, there were 14, 915 hospitalizations. By July 7, 2022 hospitalizations were up to 38, 439.
Thanks to the UK Financial Times, we can see the trajectory in cumulative COVID cases and deaths in the country since the onset of the epidemic:
Simply put, these are not the trajectories of an epidemic that is done with us, but, rather, one that is in progress. So, let’s look at what’s happening now and some of what we’ve recently been learning about COVID.
While many of those who have made it through their first mild case of COVID seem to act as if COVID is no big deal, convinced that they’ve now added a certain kind of invincibility, for many the opposite is true.
A recent study of more than five and a half million patients, entitled “Outcomes of SARS-CoV-2 Reinfection,” utilized the extensive medicals records of U.S. veterans. Led by Dr. Ziyad Al-Aly, a clinical epidemiologist at Washington University in St. Louis, the results have alerted us to the very real dangers of re-infection.
Here’s how CNN puts it: “Repeatedly catching Covid-19 appears to increase the chances that a person will face new and sometimes lasting health problems after their infection, according to the first study on the health risks of reinfection.” (Emphasis added.)
This is what Dr. Ziyad Al-Aly told CNN about his study: “If you asked me about reinfection maybe a year and a half ago, I would tell you that maybe I have a patient here or there, but it’s really, really rare,” Al-Aly said. “That’s not true anymore, though. So we asked a simple question that if you got Covid before and now you’re on your second infection, does this really add risk? And the simple answer is that it does.”
Of that very large group of veterans, 5,396,855 hadn’t been infected; 257,427 had been infected for the first time; and 38,926 had been infected two or more times. The conclusions should provoke a national conversation about whether or not we are adequately protecting the public from the health and safety risks we’re currently facing. And whether or not the decisions to resume a more normal life, while certainly understandable, are the result of politically and economically motivated impulses more than our latest, best understanding of the science of this pandemic. And are they really appropriate in this period of the heightened risks of re-infection, and the recent surge of the variant BA.5:
“We show that compared to people with first infection, reinfection contributes additional risks of all-cause mortality, hospitalization, and adverse health outcomes in the pulmonary and several extrapulmonary organ systems (cardiovascular disorders, coagulation and hematologic disorders, diabetes, fatigue, gastrointestinal disorders, kidney disorders, mental health disorders, musculoskeletal disorders, and neurologic disorders) …” (Emphasis added.)
Unfortunately, as regards to vaccination: “the risks were evident in those who were unvaccinated, had 1 shot, or 2 or more shots prior to the second infection; the risks were most pronounced in the acute phase, but persisted in the post-acute phase of reinfection, and most were still evident at 6 months after reinfection. Compared to non-infected controls,assessment of the cumulative risks of repeated infection showed that the risk and burden increased in a graded fashion according to the number of infections. The constellation of findings show that reinfection adds non-trivial risks of all-cause mortality, hospitalization, and adverse health outcomes in the acute and post-acute phase of the reinfection. Reducing overall burden of death and disease due to SARS-CoV-2 will require strategies for reinfection prevention.” (Emphasis added.)
Al-Aly also told WebMD that there are additional health concerns for those who were first infected: “It is also possible that the first infection may have weakened some organ systems and made people more vulnerable to health risks when they get a second or a third infection … There are a lot of variables at play, but it is clear that reinfections contribute additional risks and they should be avoided.”
Dr. Katelyn Jetelina, MPH PhD, is an epidemiologist and biostatistician, who publishes the newsletter “Your Local Epidemiologist (YLE)” to make public health issues more comprehensible to folks like us. She recently tackled the “Epidemiology of reinfections.”
While we in the U.S. don’t track national reinfection statistics, Dr. Jetelina reminds us, luckily the United Kingdom does: “Before Omicron, reinfections were rare. In the U.K., reinfections comprised around 1 percent of cases in April 2021. With the introduction of Omicron, reinfection rates quickly increased to 11 percent of all infections. Right now, reinfections make up about 25-27 percent of cases in the U.K.” (Emphasis added.)
Bill Comeau is a retired Ontario, Canada professor and statistician now focused on creating charts and visual tools for better understanding COVID-19. He recently created an illustration that charts the trajectory of COVID reinfections in England.
Dr. Jetelina explains that we can get reinfected in several ways:
“The virus mutates to skirt around our first line of defense—called neutralizing antibodies. Omicron keeps mutating to do this better and better. But importantly, Omicron can’t fully escape. This is why immunity can still prevent infection for some.
“Antibodies wane over time, so our first wall of defense gets shorter and shorter.
“Some people don’t mount an immune response after a primary, and typically mild, infection.
“So unfortunately, with more transmission, a rapidly evolving virus, and a virus that recently mutated to become less severe, we can expect SARS-CoV-2 reinfections.” (Emphasis added.)
This CDC chart reveals how this year BA.5 has gained prominence over other Covid variants, and is now responsible for more than 53 percent of cases:
Back to the Washington Post and Eric Topol, BA.5 “‘is the worst version of the virus that we’ve seen.’ He adds, ‘It takes immune escape, already extensive, to the next level, and, as a function of that, enhanced transmissibility,’ well beyond earlier versions of omicron. There has not been a marked increase in hospitalizations and deaths, he reports, because there is so much immunity built up from the winter omicron wave. But there are aspects of this new variant very much worth keeping an eye on as the United States remains stuck at an uncomfortably high plateau of pandemic misery. And the new variants are driving a case surge in Europe.” (Emphasis added.)
So here is a look at the latest upturn in COVID hospitalizations in a range of other nations:
Eric Topol explains: “‘At the core of the BA.5 difference is its biology. Evolution has given it more fitness, a term that incorporates its ability to transmit, grow and evade immunity; the variant shows ‘marked difference from all prior variants.’ One way it does so is by evading the body’s immune system, and BA.4 and BA.5 together are ‘the most immune-evasive variants’ seen in multiple studies to date.”
Unfortunately, many Americans seem unaware of the COVID warnings that researchers and frontline medical practitioners are issuing. Few of their recent studies or current hospital experiences make it to the public square with any detailed analysis. Many people are convinced we are making steady progress in the battle against COVID. School boards and airlines and restaurants and stadiums and arenas are increasingly relaxing mask mandates. Television viewers routinely see scenes of large unmasked crowds, making it easy to believe that COVID is mostly behind us. It was almost shocking to see a packed soccer stadium in South Korea filled with mask-wearing fans.
Sometimes it helps to look elsewhere, to another place, to put aside one’s own biases and political inclinations, and hopefully we can see more clearly a problem not all that different than the one we’re confronting. Let’s look for a moment to the north, to Ontario, Canada. There, health care workers, researchers, and epidemiologists are frustrated by the hesitancy of their government’s health agencies to acknowledge the slow but steady increase of COVID cases and deaths. With one distinguished Canadian author now calling COVID the forever plague.
Andrew Nikiforuk writes: “While Omicron’s subvariants find new ways to evade vaccines and destabilize immune systems, another pandemic has overwhelmed officials who are supposed to be in charge of public health. Let’s call it a plague of willful incompetence or an outbreak of epidemiological stupidity … In any case, COVID, a novel virus that can wreak havoc with any organ in the body, continues to evolve at a furious pace. In response officials have largely abandoned any coherent response, including masking, testing, tracing and even basic data collection. Yes, the people have been abandoned. So don’t expect ‘normal’ to return to your hospital, your airport, your nation, your community or your life anytime soon.” (Emphasis added.)
Nikiforuk and others are particularly concerned that officials at Health Canada have taken steps to relax previous protections, including scrapping a nation-wide smartphone app, a warning system that informed people they might have been exposed. A June 17, 2022 COVID advisory for Canada declared: “More than 6.9 million people living in Canada successfully downloaded the app and did their part to help prevent the spread of COVID-19. And over 57,000 users who tested positive for COVID-19 notified others of a possible exposure.
“While the pandemic is not over, the decision to decommission COVID Alert comes after careful consideration following discussions with provinces and territories on the ongoing evolution of public health programming that varies in each jurisdiction … The public health situation in Canada has improved. Case counts have fallen, and hospitalization and deaths are decreasing across the country. Following a successful vaccination campaign, 32 million (or nearly 90 per cent) of people living in Canada over the age of 12 have been vaccinated against COVID-19 with two doses. Canada also has one of the highest rates of vaccination in the world. We are now better equipped to manage the COVID-19 pandemic and reduce pressure on the health care system.” (Emphasis added.)
Bill Comeau, the retired Ontario statistician, recently created a series of illustrations that offer a far different picture of what’s happening in Canada:
He then added a look of at how Canada’s COVID death rates compare to rates in other nations over the last three years:
Clearly, based on the COVID deaths recorded thus far in 2022 compared to 2021 in Canada, there’s little reason to believe things are better. And Bill Comeau recently commented on the ongoing tension between those who are acknowledging the new Covid surge versus the public officials who are trying to reassure the public:
Again, this is what Canadian authorities are telling its citizens: “The public health situation in Canada has improved. Case counts have fallen, and hospitalization and deaths are decreasing across the country.”
“Merlin Wear an N95” has tweeted a simple comparison of COVID deaths, showing the increase from last year to this. Yet one more vivid indication that the reality on the ground is vastly different than the impression the authorities are offering the public:
In an effort to better prepare ourselves, it’s worth taking a look at what is happening right now in Australia and India, harbingers of what might be coming our way. Mike Honey is a Data Visualisation and Data Integration specialist living in Melbourne, Australia:
And now, several experts are warning about a new variation of BA.2, named “Centaurus” or BA.2.75:
Times News Now reported on July 11, 2022 that “The BA.2.75 subvariant of the Omicron COVID-19 strain has scientists worried. With COVID-19 cases rising across the world, including in India and the United States, scientists have started to look at the subvariant as a super contagious mutation.
“They believe the BA.2.75 mutant may have the capability to spread rapidly and escape immunity both from vaccines and from previous infections. However, it has not yet been established that BA.2.75 causes more serious disease than other Omicron subvariants. It is thought that the BA.2.75 subvariant may be more contagious than the current prevalent BA.5 subvariant.”
As William Haseltine notes in Forbes Magazine, “Far from concluding, the Covid pandemic seems to be picking up speed with new variants. The BA.5 variant is spreading rapidly in Europe and North America, potentially infecting as many or more people as the original Omicron virus from which it is derived. A second variant, BA.2.75, has been detected in India and is rising quickly…
“BA.2.75 is still very new. It was recently discovered in India, followed by ten countries soon after. The World Health Organization has already warned about BA.2.75 and continues to monitor the variant as it spreads to more regions of the globe. While confirmed cases due to BA.2.75 are relatively low, numbers are expected to increase in the coming weeks.” (Emphasis added.)
As for those of us in Berkshire County, for the moment we’ve got BA.5 to worry about. I’m guessing you’re a lot more likely to listen to Your Local Epidemiologist than me, your intrepid purveyor of opinion. On July 13, 2022, Dr. Jetelina warned: “BA.5 has arrived. An estimated 10-15 percent of Americans will be infected. Unfortunately, hospitalizations and death will follow, albeit at lower rates than we’ve seen before.”
She reminds us that “there are many reasons to avoid an infection (can’t miss work; don’t want to feel crappy for a week or two; risks of long COVID; high risk for severe disease; live with vulnerable people …”
Now, think Ontario. And ask yourself: will you be satisfied with a warning wrapped in reassurance? The New York Times reports on the latest pronouncement of the White House Coronavirus Task Force: “President Biden’s coronavirus response team warned Americans on Tuesday that they must do more to protect themselves against Covid-19, as the highly transmissible Omicron subvariant known as BA.5 fuels a new wave of infections, re-infections and hospitalizations across the country.
“But their new strategy to combat the threat sounded a lot like the old one, couched as advice that they hope more people will follow: Get vaccinated or boosted even if you have already been infected; test if you feel sick; seek out therapeutics if you test positive and wear masks in crowded indoor spaces.
“‘Variants will continue to emerge if the virus circulates globally and in this country,’ Dr. Anthony S. Fauci, Mr. Biden’s chief medical adviser for the pandemic, said at a White House news briefing. ‘We should not let it disrupt our lives. But we cannot deny that it is a reality that we need to deal with.’”
When a virus lays you low, keeps you from work, from seeing your friends and loved ones, or puts you in a hospital, or in the ICU, how exactly do you keep it from disrupting your life?
Since I don’t know the answer, and you might not, please be careful.
