As we head into the third summer of the COVID-19 pandemic, you would notice that so much has changed.
We no longer need to wipe down items we bought from the grocery store. We know that the new subvariants are airborne and highly infectious with close contact in closed spaces or in places with poor ventilation. Also, access to vaccination and various therapy outcomes have already clearly improved.
However, we are fatigued by this constant vigilance to avoid a COVID-19 infection and it is taking its toll. Everyone wants to move on. So how do we continue to stay focused and make every effort to stay safe and to not get infected?
With the introduction of home COVID-19 testing and results not being collected centrally, accurate tracking of community infections has become much more difficult.
In an email to the L.A.Times, Chair of UC San Francisco's Department of Medicine Dr. Robert Wachter said that "home testing leads to marked underestimates of case numbers. Clearly, many hundreds of thousands of people are now diagnosing themselves with positive home tests (generally plus symptoms, and these are not reported."
It is estimated that the level of infections is 5-6 times higher than the official tallies indicated by the Centers for Disease Control and Prevention's (CDC) COVID Data Tracker.
While the new variants are much more infectious, they are less dangerous medically. Statistically speaking, due to fewer hospitalizations and deaths, many mild infections often go unrecorded.
1. Wastewater Testing: An Early Warning System
Over the past year or so, wastewater testing has emerged as an important new tool in assessing both the number and types of COVID-19 infections.
Wastewater surveillance data from the CDC and Biobot Analytics (the current vendor for the CDC’s NWSS COVID-19 wastewater testing contract) revealed the presence of the new and more infectious BA.4 and BA.5 omicron subvariants some months ago, before case rates began to increase dramatically in the community. Now, the results indicate the dominance of the BA.5 strain, which is causing current surges across the US and in countries around the world.
New findings from the Bay Area in California revealed the presence of yet another new omicron subvariant in the wastewater: the BA 2.75 subvariant.
Currently dominant in India, BA.2.75 is now beginning to spread rapidly. The pattern of diseases is yet still unclear.
In a report from NBC Chicago, Director of Clinical Virology Matthew Binnicker at the Mayo Clinic in Rochester, MN said that “it’s still really early on to draw too many conclusions” about BA.2.75 “but it does look like, especially in India, the rates of transmission are showing kind of that exponential increase.” Whether BA.2.75 will outcompete BA.5 remains to be seen, NBC further states.
2. Sources of Subvariants
Whenever COVID-19 becomes widespread, the chances of having new variants increases because the virus constantly changes through mutation—resulting in the formation of new variants.
China’s recent COVID-19 surge brought about the detection of a new variant, BA.5.2.1. According to Zhao Dandan, vice-director of the Shanghai’s health commission, the case was found on July 8th at the financial district of Pudong, as Reuters reported.
The BA.4 and BA.5 subvariants came from South Africa when a COVID-19 spread occurred among poor communities, where acquired immunodeficiency syndrome (AIDS) is prevalent.
Meanwhile, the BA 2.75 subvariant came about after a rapid and wide spread of COVID-19 infections in India.
Global strategies are required to tackle this problem. However, currently, no comprehensive planning is even at the discussion phase. Within each country, the financial costs of the pandemic have soared. Bringing together additional resources is extremely challenging, especially with an ongoing crisis involving food shortages, climate change, and general financial instability.
Must-Do List for Myeloma Patients in this New Era of COVID-19
1. Avoid getting infected as much as you can!
Despite the fatigue of a lengthy pandemic and the likelihood of ongoing, new and more transmissible subvariants it is important to avoid a COVID-19 infection as much as possible.
Infections, although potentially mild, can result in chronic symptoms such as long COVID. These long-term consequences are more likely when immunity is low and with re-infections occurring with BA.5, for example. Please do not give up on staying healthy!
2. Get vaccinated and boosted.
Current COVID-19 vaccines still provide considerable protection against severe disease. I highly recommend getting that 2nd booster (even a 3rd one, if it’s been 4 months since you received the 2nd booster shot.)
There will likely be better boosters available later in the Fall — you should be prepared to schedule for that, as soon as they become available.
A new COVID-19 vaccine from Novavax has been cleared by the CDC and has been issued an emergency use authorization by the FDA.
This protein-based vaccine uses traditional technology and may be attractive to patients who are reluctant to get the newer mRNA-based vaccines, such as the Pfizer and Moderna vaccines.
“Protein subunit vaccines package harmless proteins of the COVID-19 virus alongside another ingredient called an adjuvant that helps the immune system respond to the virus in the future. Vaccines using protein subunits have been used for more than 30 years in the United States, beginning with the first licensed hepatitis B vaccine. Other protein subunit vaccines used in the United States today include those to protect against influenza and whooping cough (acellular pertussis),” CDC states in its press release.
3. Wear best-quality masks.
Current vaccines do NOT protect against COVID-19 infections, they can only prevent you from having severe symptoms and help you avoid the worst consequences.
Wearing best-quality masks (such as N95 and KN95 masks) offers the best protection against an infection. I strongly advise wearing a mask in all situations where exposure to the COVID-19 virus is likely, especially indoors, situations where close contact is unavoidable, and in closed spaces with poor ventilation.
Be aware that during early infection, a rapid home test can show a negative result during the initial infectious phase. Thus, someone who has recently traveled and has been exposed to COVID-19 may test negative but may still be highly infectious. Be especially cautious around individuals with unknown COVID-19 status, even if they are asymptomatic.
4. Get tested when symptoms emerge.
Early treatment improves outcomes. If you’re exhibiting symptoms, get tested right away to know if further action is required.
By now, you must have heard that President Joe Biden tested positive for COVID-19. The good news is, the President is only experiencing mild symptoms and is currently working in isolation at the White House.
After testing positive for COVID-19 and experiencing the following symptoms on Wednesday evening: “a runny nose, fatigue, and an occasional dry cough,” as reported by CNN, 79-year-old Pres. Biden began taking the antiviral drug, Paxlovid™.
Pres. Biden’s physician Dr. Kevin O’Connor “noted that the President met the FDA’s criteria for use of the antiviral Paxlovid” adding that he anticipates the President to “respond favorably, as most maximally protected patients do,” CNN further states.
Because of his age, the President “is at an increased risk for a more severe case of COVID-19, although the CDC says older adults being fully vaccinated and boosted significantly reduces their risk of hospitalization and death,” said CNN.
CNN noted that the President received the 2-dose Pfizer/BioNTech COVID-19 vaccine prior to his inauguration in January 2021, a first booster shot in September 2021, and a second booster shot on March 30 this year.
Paxlovid is important to consider as an early intervention. However, there are many potential drug interactions, side effects, and even a possibility of a “COVID-19 rebound” so this must be discussed carefully with your doctor.
I recommend having a prescription on hand ahead of time but be aware that this is not an automatic panacea—the use of Paxlovid is a carefully balanced decision.
The rebound of infection and symptoms a few days after stopping the use of Paxlovid has become particularly troubling and warrants caution.
5. Work carefully to achieve response or maintain remission.
COVID-19 is most dangerous if myeloma is active or complex, or if aggressive therapies are making the patient more vulnerable. Thus, simplifying care and keeping myeloma in check are top priorities to minimize periods of increased risk.
Maintaining a stable remission may be more important than pushing harder to get a deeper response. If an excellent response (for example, being MRD-negative) has been achieved, perhaps an autologous stem cell transplant (ASCT) can be deferred, based upon the equivalence of overall survival noted in the recent DETERMINATION Trial, with or without early ASCT.
Greater cautions are a priority in this new era of the COVID pandemic.
The Importance of a Positive Attitude
Despite many challenges, it is possible to stay healthy and safe. It is not always going to be easy and relying on some of principles of resilience will definitely help.
Have your family and close friends support you in whatever is most pressing— whether making appointments, transportation, best options, or just getting through a rough day.
Inspiration from the Past
A new book, Elusive by Frank Close, was just published. The book tells the story of Scotland-based scientist Peter Higgs who lives in Edinburgh (where I attended Medical School) and the Nobel Prize he received for his work in theoretical physics.
He faced many challenges in his life and work but three weeks in the summer of 1964, he came up with a theory which would change the way we understand the universe.
He described what came to be called as Higgs boson— a heavy particle which gives mass to the universe and explains the invisible particulate web which holds our universe together. The existence of Higgs boson was confirmed by studies at the Large Hadron Collider — a multi-billion-dollar piece of equipment in Switzerland.
A broad conclusion from this work is that space is NOT EMPTY but filled with what we used to call ether and we are like fish swimming in an unseen ocean. Connecting the real world that we are experiencing with this unseen field is truly tantalizing.
Important takeaway messages from the book include resilience, staying focused and that offering simple answers to fundamental questions pay off.
Just like how Higgs boson was elusive in earlier research, the scientist himself is also evasive and reclusive—not wanting public attention nor notoriety.
For Peter, it seems that putting the boson building block into the framework of the universe is rewarding enough; acknowledging that he is an unassuming “giant” in the field provides a stepping time for those who follow to uncover the workings of the world around us beyond Higgs boson—which many have described as the “God particle.”
The Bottom Line
For me, it is reassuring that constant new knowledge can reveal new and better answers. Let’s hope that new advances both in COVID-19 and myeloma will allow us to better manage these diseases and that prevention strategies and a cure for myeloma will no longer be elusive in the near future.