redsturgeon wrote:It is impossible to be sure one way or another but the situation as I see it now is different to the early days.
- We now have the Omicron variant that is less virulent than earlier variants.
- Almost everyone has some level of immunity either natural, vaccine induced or both.
- treatments are more effective
Omicron is causes somewhat less acute disease - but not by much. You'll often hear it compared to delta, which it's about half has virulent as - but delta was a "nasty" one, somewhat more virulent than the original strain.
Omicron is still very capable of causing nasty disease, and in particular it still seems to be pretty good at causing long Covid. And since the omicron family tends to be quite immune-escapy, you may find the "less virulent" omicron causing more disease than the "more virulent" delta, just because of the immune escape thing. For instance,
in the latest variant briefing :
Oxford University report neutralisation studies on serum collected 28 days following a third dose of Pfizer BNT162b2 vaccine, and in vaccinated cases infected with BA.1, BA.2 and BA.4/5. Data show significant reductions in neutralisation titres against BA.2.75.2, BA.2.3.20 and BJ.1, compared to BA.2 and BA.4/5, which may suggest they have been selected to escape pre-existing immunity to earlier waves of Omicron infection.I wouldn't get too complacent about treatments continuing to work either, especially the antibody-based ones, for instance :
https://www.biorxiv.org/content/10.1101 ... 787v4.fullCOV2-2196+COV2-2130 (Evusheld) 26,29 is vulnerable to F486, R346, and K444-G446 mutations, evaded or highly impaired by BJ.1 (R346T), XBB (R346T+V445P+F486S), BA.2.75.2/CA.1/BM.1.1/BM.1.1.1/CH.1.1 (R346T+F486S), CJ.1 (R346T+F486P), BR.2 (R346T+F486I), BA.4.6.1 (R346T+F486V), BA.5.6.2/BQ.1 (K444T+F486V), BU.1 (K444M+F486V), and BQ.1.1 (R346T+K444T+F486V).
LY-CoV1404 (Bebtelovimab) remains potent against BF.16 (K444R) and BA.5.5.1 (N450D) and shows reduced potency against BA.5.1.12 (V445A) 27 (Extended Data Fig. 1a). However, LY-CoV1404 was escaped by BJ.1, XBB, BR.1, CH.1.1, BA.4.6.3 and BQ.1.1 while exhibiting strongly reduced activity against BA.2.38.1, BA.5.6.2, and BQ.1 due to K444N/T mutations and the combination of K444M/G446S or V445P/G446SBA.1/2/4/5 are the current UK official variants of concern, the designated variants (generally the up and coming ones) are the B.1.617.2 lineage from the delta family and from the omicron family XE, BA.2.12.1, BA.2.75, BA.4.6, BQ.1 and XBB. A month ago it was 87% BA.5 with BA.2.75 and BA.4.6 bubbling under, but lab studies suggest that the BQ.1 group has a significant growth advantage and it looks like it will be the next "big one" by Christmas.
And immunity to this thing falls away pretty quickly :
https://www.nature.com/articles/s41564-022-01163-3 Between 3 and 20 weeks after the second vaccine dose [of Pfizer]
, neutralizing antibody titres [to the original Wuhan strain]
fell 4.9-fold to a median titre of 21.3 (neutralization dose 80%), with 21.6% of individuals having no detectable neutralizing antibodies at the later time point.They then looked at responses to different spike proteins, and found "substantial antigenic escape" especially for omicron and delta among others.
Nineteen sera from the same individuals boosted with a third dose of BNT162b2 contained higher neutralizing antibody titres, providing cross-protection against Omicron BA.1 and BA.2. Despite SARS-CoV-2 immunity waning over time in older adults, booster vaccines can elicit broad neutralizing antibodies against a large number of SARS-CoV-2 variants in this clinically vulnerable cohort.Boosters work, and just because you've had two jabs doesn't mean you have much residual immunity left, particularly to immune-escaping variants like omicron.
And we seem to be losing some treatments altogether, for instance MSD's molnupiravir (Lagevrio) was approved by the UK a year ago based on an interim analysis of 762 patients and we bought a billion quid's worth of it. The European Medicines Agency still hasn't approved it. and a bigger trial suggests that it's no better than placebo :
https://www.bmj.com/content/379/bmj.o2441The Panoramic study, sponsored by the University of Oxford, found that 0.8% of patients in the molnupiravir group (103 of 12 516) and 0.8% in the usual care group (96 of 12 484) were admitted to hospital or died in the first 28 days (adjusted odds ratio 1.061 (95% bayesian credible interval 0.80 to 1.40)).Preprint :
https://papers.ssrn.com/sol3/papers.cfm ... id=4237902Also the latest from NICE :
https://www.nice.org.uk/guidance/gid-ta ... uments/129https://www.bmj.com/content/379/bmj.o2759NICE has recommended three drugs—nirmatrelvir plus ritonavir (Paxlovid), tocilizumab (RoActemra), and baricitinib (Olumiant)—for the treatment of covid-19 in adults, as part of draft guidance.1
NICE has not recommended other covid-19 treatments, including casirivimab plus imdevimab (Ronapreve), molnupiravir (Lagevrio), remdesivir (Veklury), sotrovimab (Xevudy), and tixagevimab plus cilgavimab (Evusheld).
NICE said that while there was evidence suggesting molnupiravir and remdesivir were effective, the current pricing means they are not likely to be a cost effective use of NHS resources.
In the case of casirivimab plus imdevimab, sotrovimab, and tixagevimab plus cilgavimab, the committee said it was highly uncertain whether these treatments were effective against the omicron variant and that they were not a cost effective use of resources.And just to hammer home the point that "less virulent than delta" does not mean "avirulent", an epidemiologist in charge of infection control at a major hospital felt
driven to say this:
Some perspective for those who still don't get it:
If I were forced to be infected by either HIV or COVID, I would choose HIV without hesitation.He goes on to explain himself thus :
COVID can cause many chronic diseases, data suggests that telomere damage ages the body by about 5 years, and it causes damage to the immune system.
HIV mostly just damages the immune system and is easily treated.
Finally, we don't know what else COVID might cause over time.Now it's fair to say that this is an extreme view, but I can see the point he's trying to make as someone whose daily life involves managing the risks from infectious disease. HIV is really bad, but at least we know its limits, but we still don't know what we don't know about Covid, and we don't have any treatments for long Covid. That's two things to scare the bejeesus out of someone in risk management.
I must admit as someone with mild long Covid, it's really not been much fun lately - I dread to think what it would be like to get it "properly".