How will the virus evolve in 2022?

This week of April 3, 2022, we look at three possible scenarios for the virus’ future, what scientists learned about the course of a COVID-19 infection, and the latest on ivermectin trials

MANILA, Philippines – Coronavirus cases continue their decline in the Philippines, with nationwide infections averaging 364 cases per day. That’s 24% lower than the previous week. Meanwhile, roughly 16% of COVID-19-dedicated hospital beds are currently filled.

About 60% of all Filipinos have been fully vaccinated as of April 1, 2022. Of the 46.1 million individuals eligible to get boosted at this point, some 12 million have gotten an additional dose.

Here’s what we’re watching this week of April 3, 2022:

COVID-19’s next move

The World Health Organization (WHO) recently released an updated plan for COVID-19 that laid our three possible scenarios for how the virus may evolve in the coming year. The most likely scenario sees the virus continue to evolve, but with incision decreasing over time, said Director-General Tedros Adhanom Ghebreyesus.

  • The likely scenario is owing to increased immunity due to vaccination and infection. But this won’t preclude from the possibility that periodic boosting may be needed for vulnerable populations as immunity wanes, which, in turn, could lead to spikes in cases and deaths.
  • Still, this is just one of three possible outcomes. Countries need to stay prepared for two other potential situations:
    • The best case scenario – less variants will emerge so boosters or new vaccine formulas will be unnecessary.
    • The worst case scenario – A more virulent and highly transmissible variant emerges and peoples’ protection from prior vaccination or infection will wane rapidly. This situation would require altering current vaccines and making sure reformulated ones get to the most vulnerable to severe disease.
  • The WHO’s third Strategic Preparedness, Readiness and Response Plan for COVID-19 advises countries how to prepare for all events by setting out adjustments in five components to decrease transmission, lessen the impact of the virus, and end the emergency phase of the pandemic.
  • “We have all the tools we need to bring this pandemic under control: we can prevent transmission with masks, distancing, hand hygiene and ventilation; And we can save lives by ensuring everyone has access to tests, treatments, and vaccines. Equitable vaccination remains the single most powerful tool we have to save lives,” Tedros said in a press conference.
PROTECTION. Parishioners at the Minor Basilica of the Black Nazarene in Quiapo Manila avail themselves of COVID-19 vaccine booster shots at Plaza Miranda on March 11, 2022.
Understanding a COVID-19 infection

Back in March 2021, scientists in the United Kingdom seek to understand the course of a COVID-19 infection by a “human challenge” model. Carefully-screened volunteers were given a small amount of virus to see how it would progress. Results from that study were recently published in the science journal Naturesharing valuable insights on how the sickness plays out:

  • A total of 36 volunteers between the ages of 18 and 29 were given a tiny drop of fluid containing the original strain of COVID-19 through a thin tube inserted into their nose.
    • Volunteers could take part in the study if they did not have risk factors for severe disease, including comorbidities, low or high body mass index, abnormal blood or heart problems, and reduced kidney or liver functions, among others.
  • Among trial participants, 18 eventually got infected. Viral shedding began within two days of exposure, with viral load peaking at five days after inoculation with the virus.
    • It only takes tiny amounts of the virus to make someone sick. Volunteers received a dose “roughly equivalent to the amount of virus in a single droplet of nasal fluid,” Nature reported.
    • The virus could be detected at the back throat earlier than the nose. Scientists found it took 40 hours for the virus to be detectable through PCR testing via the throat. It took 58 hours for the nose, where it eventually grew and persisted for an average of 10 days.
    • On average, volunteers shed virus for six and a half days, but some had shed virus for 12 days.
    • Of those who were infected, two never developed symptoms, but had as much virus in their upper airways as did those who were symptomatic. Infections lasted just as long too.
    • For those that did show symptoms, mild symptoms included runny noses, sneezing, and sore throats. Viral load was likewise not correlated with symptoms.
    • Loss of smell was common and occurred later than other symptoms. Most of those infected lost their sense of smell to a certain degree, with nine unable to smell at all. For those who lost their sense smell completely, improvements were seen before day 28 of the virus. Six months after the study, one participant’s smell isn’t back to normal yet, but is improving.
  • These findings confirm what we know about COVID-19 and also underscore why experts say it is so important to the mask (which covers one’s nose and mouth) to avoid infection.
  • Such studies also offer insight into how infection plays out in our bodies, which doctors may otherwise be unable to see in other settings because patients tend to seek help at a later time.
  • The study poses some other questions worth pursuing, like why some people don’t get sick and what personal factors might be at play to reduce the risk of illness.
  • Dr. Christopher Chiu, lead author of the study, said his team plans to study this and conduct similar studies in the future. One possibility is looking at how the virus may play out in vaccinated people infected with Delta. Chiu is an infectious disease specialist and immunologist at Imperial College London.
Ivermectin does not alleviate COVID-19

Results from a large-scale clinical trial showed that the controversial anti-parisitic drug ivermectin showed no signs of reducing the risk of hospitalization due to COVID-19. The drug soared in popularity over the pandemic, embodying the desperation and fear some people felt toward the virus despite trials showing the drug was not effective in treating COVID-19.

  • In a study published in the New England Journal of Medicine, researchers compared more than 1,300 patients infected with the virus in Brazil. Half received ivermectin and the other half received a placebo.
  • “Treatment with ivermectin did not result in a lower incidence of medical admission to a hospital due to progression of Covid-19 or of prolonged emergency department observation among outpatients with an early diagnosis of Covid-19,” said the study’s authors.
  • The New York Times reported that researchers also looked at different groups of volunteers to see if some benefits were experienced or if factors like taking ivermectin early on in an infection mattered. “But volunteers who took ivermectin in the first three days after a positive coronavirus test turned out to have worse outcomes than did those in the placebo group,” the Times said.
  • Ivermectin’s effects on COVID-19 have largely been spotty.
    • Back in December 2020, virologist Andrew Hill of the University of Liverpool conducted a review of 23 small trails on ivermectin and concluded that the drug appeared to lower the risk of death from COVID-19. But after reports surfaced that many of the major studies on the drug were flawed, and in some cases fraudulent, Hill’s second review focusing on the least likely to be biased found that the drug’s benefits against COVID-19 were absent.
    • A third review, which included results from the Brazil trial, saw no benefit from ivermectin again. Hill’s latest analysis covered trials that included a total of over 5,000 people.
  • With more data from controlled, well-conducted trials available, experts hope that doctors may steer patients toward other treatments.
  • More randomized trials on ivermectin, which include thousands of volunteers, are underway, but experts say it would be rare to find something different from the Brazil trial, which was large enough and carefully designed.
  • Dr. Paul Sax, a renowned infectious disease expert, told the Times“I welcome the results of the other clinical trials and will view them with an open mind, but at some point it will become a waste of resources to continue studying an unpromising approach.”

News you can use: With COVID-19 cases falling around the Philippines, the education sector is gearing up for a return to face-to-face classes. First to go back to school will be college students in Alert Level 1 areas.

But before campuses reopen, the government requires students to have medical insurance. Here’s how to get that through the Philippine Health Insurance Corporation:

Here's how students can get PhilHealth insurance for face-to-face classes

– Rappler.com

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