7 October 2023
The changing leaves of fall mark the country’s fourth autumn with COVID-19. Although most reporting is anecdotal, new variants have caused case counts to rise. The number of new cases in the country was recently the highest since last winter but still far below case totals during the last three autumns.
The reporting of hospitalizations and deaths is more accurate than that of case counts, and the news is optimistic. While hospitalizations have risen significantly, paralleling cases, the numbers are proportionately fewer than in previous years. Deaths are rising but not significantly, and overall mortality from COVID-19 is dropping, slowly but steadily. This is probably the result of a combination of acquired population immunity (vaccination and previous infection) and reduced severity of the current variants.
A dramatic uptick in COVID-19 cases or an emerging, more lethal variant could leave the country in the lurch, especially in light of the questionable decision by public health entities to cut back on case reporting. In light of this lack of knowledge, what can the public do?
The response should be to demand better reporting by physicians, public health officials and science journalists. Here are six topics we should know more about.
Current COVID-19 trends
Tracking COVID-19 cases and trends has become more difficult, in part because of home testing. Public health officials have largely abandoned anything other than wastewater virus surveillance. “We have essentially given up on other types of surveillance,” said Bill Hanage, an associate director at the Center for Communicable Disease Dynamics at Harvard University. “People are testing at home. … The only way we really have of keeping hold of what pandemic activity is going on is through stuff like wastewater. … That’s about as close as we can (get) to forecasting.”
We can still appreciate large shifts in COVID-19 trends by measuring wastewater, hospitalizations and deaths, but more sensitive surveillance methods are still necessary. There is a need for innovative ideas, perhaps a trial of QR codes on home test kits to allow “citizen surveillance” reporting and/or tracking pharmacy prescriptions for the COVID-19-specific medication Paxlovid.
Vaccines
As COVID-19 evolves with emerging variants, every new booster is unique. Boosters must be developed rapidly in preparation for new outbreaks; therefore, much of the data on effectiveness comes from testing immune responses in animals. It takes time to obtain real-world results in adults. The public needs up-to-date information on how the new generations of vaccines actually perform in patients, along with potential side effects incurred. The information should be readily accessible and easily understandable to lay readers.
Long COVID-19
Long COVID-19 — persistent, lingering symptoms from previous COVID-19 infection — is a potential problem for millions of Americans. Yet estimates of the number of patients affected vary significantly because there are no agreed-on definitions of what constitutes long COVID-19. Moreover, adequate control groups are important because many symptoms seen in people with past COVID-19 infection are also seen in patients who have not had COVID-19. How big a problem do we face, and how do we know?
COVID-19 and obesity
Obesity is a major risk factor, possibly the major risk factor, for death from COVID-19. The U.S. obesity epidemic is one explanation as to why the U.S. has more than 1 million COVID-19 deaths, far more than any other country. New research and recent treatments have brought a revolution in the care of obesity. This raises the questions of whether vaccines and treatment work as well in obese patients and whether healthy eating campaigns and the obesity medications recently approved by the Food and Drug Administration could be targeted at patients at especially high risk for COVID-19.
COVID-19 social isolation
This year, the U.S. surgeon general released an advisory about the public health crisis of loneliness and social isolation in the country. This was aggravated by lockdowns during the COVID-19 epidemic, and this continues to be a problem that has likely aggravated the distressing suicide rate in the country. Last year, nearly 50,000 people died by suicide, according to the Centers for Disease Control and Prevention. We should direct more effort to combating personal isolation and maintaining family and social connections.
COVID-19 genetics
Genetics plays an important role in COVID-19 infections, and it has become clear that certain genes are associated with stronger clinical and immunologic responses to COVID-19. This is one explanation for why some COVID-19 patients get life-threatening infections while others get the sniffles. It has been recognized since early in the pandemic that when domestic partners are infected simultaneously, one may get much sicker than the other (and it is not unusual for one partner to stay uninfected while the other gets sick). Certain areas of the world, such as Singapore and central Africa, have exceedingly low COVID-19 mortality rates that may be related to genetics. This aspect of COVID-19 should be a much bigger story than it is currently, and has implications in the future for COVID-19 and personalized medicine.
Rising numbers of cases and hospitalizations have peaked for now, but there is still consternation about COVID-19 misinformation. Yet the larger threat to the public is the lack of information in so many spheres.
Ben Hogan, one of the 20th century’s greatest golfers, once said, “The average golfer’s problem is not so much the lack of ability as it is lack of knowledge about what he should be doing.” In that respect, COVID-19 is a lot like golf.
Dr. Cory Franklin is a retired intensive care physician. Dr. Robert Weinstein is an infectious disease specialist at Rush University Medical Center. They wrote this column for the Chicago Tribune.
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