COVID 2023: The future remains uncertain
It's that time of year when scientists, clinicians and public health experts are asked to become oracles forecasting what awaits us in the new year. Many of us feel like Cassandra, the Trojan princess in Greek mythology whose prophecies, often of gloom, are ignored.
As respiratory viruses such as influenza, Respiratory Syncytial Virus (RSV) and SARS-COV-2 rage through communities, resulting in increasing infections, hospitalizations and over 300 deaths per day just due to COVID-19, questions arise to what awaits us in 2023.
It appears that we are living in a Greek tragedy with well over 1 million deaths since the start of the pandemic, more than 235,000 people dying in 2022 and millions now suffering from Long COVID in the United States alone. Mitigation efforts largely disappeared in 2022, when mask and vaccine mandates were deemed illegal and the public was encouraged to resume their pre-pandemic lives.
COVID-19 first appeared in China, which was at the eye of the hurricane coming, into 2020. In 2023, China is again front and center in this torrential storm.
After maintaining a draconian "zero COVID" policy for three years, a public uproar in late November led to their reversal by early December. The infection rate soared to over 250 million cases in just 3 weeks and an estimated 9,000 deaths per day by the end of 2022.
Experts predict that China's basic reproduction number for how many people are infected by one person is on the same level as measles - one of the most contagious viruses on the planet. Additionally, as the virus replicates, it mutates. What happens in China has a profound impact on global health and the economy.
Because China is not transparent with its data and has stopped official testing, several nations, including the United States, have implemented testing requirements for flights arriving from China in 2023. There are questions on how useful this approach may be; however, it can be a more effective surveillance tool if followed up with additional testing, including genomic sequencing to detect new mutations.
By early 2022, the omicron variant was starting to ravage the United States and its health care workforce. During the year, clinicians continued to leave practices resulting in staff shortages. This year, it is imperative that support services be provided to all clinicians and front-line employees, and programs such as physician and nursing reentry are implemented to ensure that health systems can be sustained to handle pandemic-related issues as well as other health concerns.
In response to the surge, in January 2022, the Centers for Disease Control and Prevention (CDC) updated its mask guidelines to recommend N95 respirators, leading to a nationwide effort to distribute 400 million free respirators from the National Stockpile. Unfortunately, N95s only successfully fit 85 percent of women.
In 2022, the National Institute for Occupational Safety and Health in conjunction with the Biomedical Advanced Research and Development Authority announced the winners of its Mask Innovation Challenge and said during a November workshop it has plans for future challenges this year. It's an important step toward ensuring that everyone can live and work well and safely in any environment.
To stave off omicron, updated vaccines were authorized in 2022, but by December, only 15.1 percent of eligible individuals had received the newest bivalent vaccine booster. Last year, it became apparent that vaccines did not prevent COVID transmission or infection, but could still prevent serious illness and hospitalization for those at high risk. However, there is concern that the omicron subvariants such as XBB.1.5 could be even more immune evasive and these vaccines may be less effective.
Additionally, in 2022, enhanced concern over the development of rare side effects of myocarditis with mRNA vaccines, especially in young men, and blood clots in premenopausal women with the Johnson and Johnson vaccine, elevated the urgency to examine the impact of subpopulation demographics and the role of precision medicine in order to tailor the dose and type of vaccine to the population being treated.
Seeking solutions, the White House hosted conferences to address the need for new types of vaccines, including mucosal and intradermal, which may provide greater protection. One challenge is that the duration and durability of immunity due to natural infection and vaccinations are still unknown and constantly changing as the virus evolves.
Furthermore, there is an increased need for the use of therapeutics beyond monoclonal antibodies because some of the current crops are no longer effective against new subvariants.
‘‘This year, it is imperative that support services be provided to all clinicians and front-line employees, and programs such as physician and nursing reentry are implemented to ensure that health systems can be sustained to handle pandemic-related issues as well as other health concerns.”