Health care

Pandemic Update – January 12, 2022

<h3>What&rsquo;s after Omicron?</h3><p>The Omicron variant continues to shatter records in the U.S. Yesterday, the country recorded a staggering 885,000 cases, and experts say the peak is still weeks away.</p><div class="slate-resizable-image-embed slate-image-embed__resize-left"><img src=";v=beta&amp;t=6wGxnw-Zpxlmb8ZEQ-MZv82fx8BHMRIyWR6bXbMFqqg" alt="No alt text provided for this image" data-media-urn="" data-li-src=";v=beta&amp;t=6wGxnw-Zpxlmb8ZEQ-MZv82fx8BHMRIyWR6bXbMFqqg" /></div><p>We&rsquo;re learning more about the new variant, and, so far, it seems to spread faster but cause less severe illness than previous variants; it also leads to fewer hospitalizations and deaths. Last week,&nbsp;Carl Zimmer reported&nbsp;that an Omicron infection may protect against later infections with the Delta variant.</p><p>Those qualities have led to a lot of speculation about the Omicron surge and its aftermath. To help us answer these questions, and for a look at how 2022 might unfold.</p><p><strong>Omicron is so infectious it has led to some speculation that it may help us reach herd immunity. Could it?</strong></p><p>Nobody should think that Omicron is going to make Covid magically disappear. Herd immunity is the idea of a virus just disappearing on its own because it can&rsquo;t find enough hosts to keep itself going. And that is not going to happen. It&rsquo;s too widespread. It&rsquo;s too well adapted to us.&nbsp;SARS-CoV-2 is in animals. I mean, it&rsquo;s just not going away.</p><p>But we could be in a situation by some time in 2022 where it could be a much more manageable situation, where vaccines help to keep it in check &mdash;&nbsp;but it&rsquo;s not disappearing.</p><p><strong>People sometimes talk about the possibility that Covid becomes endemic. What does that look like?</strong></p><p>When a virus is endemic, the number of infections every year is at a constant baseline level. Like chickenpox. People get chickenpox at a pretty steady rate year in, year out. But right now, Covid is not endemic. So the question is, is it going to eventually settle down to a steady, much lower background rate?</p><p><strong>What&rsquo;s the latest thinking on that?</strong></p><p>One possibility that epidemiologists are thinking is that there will be future waves, but they will be smaller waves. New variants will evolve, but there will already be so much immunity &mdash; people will have already been infected with the coronavirus or will have been vaccinated &mdash; and so it&rsquo;ll just be harder for new variants to find a lot of vulnerable hosts.</p><p><strong>So will Omicron help us reach endemicity?</strong></p><p>We don&rsquo;t know. Something becoming endemic is a long, complex process, and it&rsquo;s not like we can recognize in the middle of a new surge whether something is going to lead to endemicity. Epidemiologists aren&rsquo;t trying to make that claim now. All they&rsquo;re saying right now, in a very guarded way, is that maybe after this big surge over the next month or two, that if there are more surges later in the year, they will be smaller.</p><p><strong>So are there any upsides to Omicron, a variant that is milder but spreads faster?</strong></p><p>Framing it as a possible benefit is not really the right way to think about it. I mean, it&rsquo;s better to be dealing with a variant that causes less severe disease. But if it&rsquo;s much more transmissible, then you&rsquo;re going to have a lot more seriously ill people in hospitals. So you can&rsquo;t just look at one side of Omicron and ignore the other side.</p><p>A lot of people, especially unvaccinated people, are going to get seriously sick from Omicron. And after the surge is done, there could be a lot of immunity to Omicron and perhaps to other variants. But it&rsquo;s a very high price to pay for that. We should be trying to keep infections down. We should be protecting the most vulnerable among us. We should be thinking in those terms, not just asking, &ldquo;Oh, what&rsquo;s the upside of this?&rdquo;</p><p><strong>How are you personally feeling about the state of the pandemic in the U.S.?</strong></p><p>It&rsquo;s striking that we are not better able to deal with a new surge two years into the pandemic. Scientists have been warning that this virus, like all viruses, would mutate, so we needed to be ready for change. We had Alpha and then we had Delta, so we&rsquo;ve been through this before. And yet, in the U.S., we&rsquo;re in this latest surge without a strong testing capacity to deal with it, without a system to get people good masks, which we know can help. And so there&rsquo;s just chaos.</p><p>The Biden administration is now saying it&rsquo;s going to give out 500 million tests. Those tests aren&rsquo;t going to be coming in for at least a couple of more weeks &mdash; deep into this surge. And it&rsquo;s not enough. It&rsquo;s basically like waiting until half the house is burned down before you send in the firefighters &mdash; and you send one small fire engine.</p><p><strong>What do you see for the U.S.?</strong></p><p>We are going to go through a big surge. We&rsquo;re going to go through a surge of cases over the next month, maybe more. We don&rsquo;t know how much hospitalization that&rsquo;s going to lead to, but it&rsquo;s going to be a lot. And then it&rsquo;s going to go down just like it&rsquo;s gone down in the past.</p><p>And so the question then is, what&rsquo;s it like for the rest of 2022? Epidemiologists I talked to say it is possible that we may not have to deal with another giant surge later in the year just because there&rsquo;ll be so much immunity once we get through this. But a lot of people are going to die. Tens of thousands or hundreds of thousands of people are going to die in the surge.</p><p><strong>Should the fact that Omicron is milder change our behavior?</strong></p><p>I haven&rsquo;t had Omicron myself, but I certainly know some people who have. Fortunately, none of them ended up in the hospital, but they&rsquo;ve had a range of symptoms. Some of them have felt like they&rsquo;ve just had a stuffy nose and others have been in bed for a few days. If you&rsquo;re vaccinated, you could still be looking at being physically knocked out for a few days.</p><p>But just as important, if you just walk around and say, &ldquo;Well, you know, I&rsquo;m not going to care about this virus,&rdquo; you could then become the source of infection for other people &mdash; maybe people who are much more vulnerable. We&rsquo;re still in the middle of a public health crisis, and it&rsquo;s not just about ourselves as individuals.</p><h3><strong>Reason for hope</strong></h3><p>As a new year begins, we want to look back on the first two years of the pandemic in the U.S. &mdash; and look ahead to what 2022 may bring.</p><p>Covid-19 is so named because it began spreading in China in late 2019. In the U.S., doctors first detected a case in Washington State in January 2020. Both cases and deaths then surged:</p><div class="slate-resizable-image-embed slate-image-embed__resize-right"><img src=";v=beta&amp;t=L5E3VWcztpAecOALx1-ItpYN91xG5tMWNL8NUwOOj7Q" alt="No alt text provided for this image" data-media-urn="" data-li-src=";v=beta&amp;t=L5E3VWcztpAecOALx1-ItpYN91xG5tMWNL8NUwOOj7Q" /></div><p>2021 began with a hopeful turning point: the ramping up of a mass vaccination campaign.</p><p>By February, new cases were plummeting, and by spring, the virus seemed as if it might be in permanent retreat, at least in highly vaccinated countries. On June 2, President Biden gave a speech looking ahead to &ldquo;a summer of freedom, a summer of joy.&rdquo;</p><p>Then came a second, much grimmer turning point: the emergence of the Delta variant, in late spring. It caused many more infections among the vaccinated than earlier variants, but the overwhelming majority of these breakthrough infections&nbsp;were mild.</p><div class="slate-resizable-image-embed slate-image-embed__resize-middle"><img src=";v=beta&amp;t=jfoa-FHNk1mqcONh4h_4bSDL4HfxiS98AMCyrqSsfWw" alt="No alt text provided for this image" data-media-urn="" data-li-src=";v=beta&amp;t=jfoa-FHNk1mqcONh4h_4bSDL4HfxiS98AMCyrqSsfWw" /></div><p>As a result, communities with high vaccination rates were mostly protected from the worst outcomes:</p><div class="slate-resizable-image-embed slate-image-embed__resize-middle"><img src=";v=beta&amp;t=xcVTDrpbwh3Dm5Zcvx6R4V4tf9_wkwgI43L0p4UW8qc" alt="No alt text provided for this image" data-media-urn="" data-li-src=";v=beta&amp;t=xcVTDrpbwh3Dm5Zcvx6R4V4tf9_wkwgI43L0p4UW8qc" /></div><p>Still, the emergence of Delta meant that 2021 often felt like a frustrating year of pandemic purgatory. In addition to the direct damage from Covid, the disruptions to daily life &mdash; intended to slow the spread of the virus &mdash; have brought their own costs.</p><p>Children have fallen behind in school, and many are experiencing&nbsp;mental health problems&nbsp;brought on by isolation. Americans&rsquo; blood pressure has risen, and&nbsp;drug overdoses have soared.</p><div class="slate-resizable-image-embed slate-image-embed__resize-middle"><img src=";v=beta&amp;t=xE7I-ytIGz4zQ6MaQgyfb5huD3-bN9CBHOq_jM0eKKo" alt="No alt text provided for this image" data-media-urn="" data-li-src=";v=beta&amp;t=xE7I-ytIGz4zQ6MaQgyfb5huD3-bN9CBHOq_jM0eKKo" /></div><p>Even people who have avoided the worst of the pandemic&rsquo;s damage often feel fed up. And now the latest variant, Omicron,&nbsp;has sent cases soaring&nbsp;to their highest level yet, and raised the prospect that 2022 will be another year of pandemic purgatory.</p><div class="slate-resizable-image-embed slate-image-embed__resize-right"><img src=";v=beta&amp;t=HDlNbP8CnLx6MpRdxMZ1a6AD7iX_iv6aADneoyyXdPQ" alt="No alt text provided for this image" data-media-urn="" data-li-src=";v=beta&amp;t=HDlNbP8CnLx6MpRdxMZ1a6AD7iX_iv6aADneoyyXdPQ" /></div><p>The emerging evidence suggests that Omicron&nbsp;really is milder&nbsp;than earlier versions of this coronavirus (either because of intrinsic biological reasons or because of higher levels of population immunity). In South Africa and England, as well as New York, San Francisco and other parts of the U.S., hospitalization numbers are lower than doctors had feared.</p><p>Omicron will still do terrible damage among the unvaccinated in both the U.S. and worldwide. Many hospitals face the risk of being overwhelmed in coming weeks.</p><p>Yet when the current surge begins receding, it will likely have left a couple of silver linings: Omicron is so contagious that it will have infected a meaningful share of the population, increasing the amount of Covid immunity and helping defang the virus. Omicron has also helped focus Americans on the importance of&nbsp;booster shots, further increasing immunity.</p><p>As important, the world has more powerful weapons to fight Covid than it did only a few weeks ago:&nbsp;two new post-infection treatments, one from Merck and a more powerful one from Pfizer, that lower the risk of hospitalization and death. With Pfizer&rsquo;s treatment, the reduction is by almost 90 percent, according to early research trials.</p><p>All of which suggests that the U.S. could emerge from the Omicron wave significantly closer to the only plausible long-term future for Covid &mdash; one in which it becomes an endemic disease and a more normal part of daily life. It will still cause illness and death; a typical flu season kills more than 30,000 Americans, most of them elderly. For the foreseeable future, battling Covid &mdash; through vaccination, treatment and research &mdash; will remain important.</p><p>But endemic disease does not need to dominate life the way a pandemic does. It does not need to cause the sort of social isolation and public-health problems that Covid has over the past two years. If the U.S. reaches that point in 2022 &mdash; as appears likely &mdash; the next New Year will feel a lot more satisfying than this one.</p><h3>&lsquo;Not the same&rsquo; Omicron is milder</h3><p>The details of the Omicron variant are becoming clearer, and they are encouraging.</p><p>They&rsquo;re not entirely encouraging, and I will get into some detail about one of the biggest problems &mdash; the stress on hospitals, which are facing huge numbers of moderately ill Covid-19 patients. But regular readers of this newsletter know that I try to avoid&nbsp;the bad-news bias&nbsp;that often infects journalism. (We journalists tend to be comfortable delivering bad news straight up but uncomfortable reporting good news without extensive caveats.)</p><p>To be clear: The latest evidence about Covid is largely positive. A few weeks ago, many experts and journalists were warning that&nbsp;the initial evidence&nbsp;from South Africa &mdash; suggesting that Omicron was milder than other variants &mdash; might turn out to be a mirage. It has turned out to be real.</p><p>&ldquo;In hospitals around the country, doctors are taking notice,&rdquo;&nbsp;my colleagues Emily Anthes and Azeen Ghorayshi write. &ldquo;This wave of Covid seems different from the last one.&rdquo;</p><p>There are at least three main ways that Omicron looks substantially milder than other versions of the virus:</p><p><strong>1. Less hospitalization</strong></p><p>Somebody infected with Omicron is less likely to need hospital treatment than somebody infected with an earlier version of Covid.</p><p>An analysis of patients in Houston, for example, found that Omicron patients were only about one-third as likely to need hospitalization as Delta patients. In Britain, people with Omicron were about half as likely to require hospital care, the government reported. The pattern looks similar in Canada, Emily and Azeen note.</p><p>Hospitalizations are nonetheless rising in the U.S., because Omicron is so contagious that it has led to&nbsp;an explosion of cases. Many hospitals are running short of beds and staff, partly because of Covid-related absences. In Maryland, more people are hospitalized with Covid than ever.</p><p>&ldquo;Thankfully the Covid patients aren&rsquo;t as sick. But there&rsquo;s so many of them,&rdquo; Craig Spencer, an emergency room doctor in New York, tweeted on Monday, after a long shift. &ldquo;The next few weeks will be really, really tough for us.&rdquo;</p><p>The biggest potential problem is that overwhelmed hospitals will not be able to provide patients &mdash; whether they have Covid or other conditions &mdash; with straightforward but needed care. Some may die as a result. That possibility explains why many epidemiologists still urge people to take measures to reduce Covid&rsquo;s spread during the Omicron surge. It&rsquo;s likely to last at least a couple more weeks in the U.S.</p><p><strong>2. Milder hospitalization</strong></p><p>Omicron is not just less likely to send somebody to the hospital. Even among people who need hospital care, symptoms are milder on average than among people who were hospitalized in previous waves.</p><p>A crucial reason appears to be that Omicron&nbsp;does not attack the lungs&nbsp;as earlier versions of Covid did. Omicron instead tends to be focused in the nose and throat, causing fewer patients to have breathing problems or need a ventilator.</p><p>As Dr. Rahul Sharma of NewYork-Presbyterian/Weill Cornell told The Times, &ldquo;We&rsquo;re not sending as many patients to the I.C.U., we&rsquo;re not intubating as many patients, and actually, most of our patients that are coming to the emergency department that do test positive are actually being discharged.&rdquo;</p><p>In London, the number of patients on ventilators has remained roughly constant in recent weeks, even as the number of cases has soared, John Burn-Murdoch of The Financial Times&nbsp;noted.</p><p><strong>3. And deaths?</strong></p><p>In the U.S., mortality trends typically trail case trends by about three weeks &mdash; which means the Omicron surge, which began more than a month ago, should be visible in the death counts. It isn&rsquo;t yet:</p><div class="slate-resizable-image-embed slate-image-embed__resize-middle"><img src=";v=beta&amp;t=gwet7k52bXuBhtzLTN4ohehTtpol6zYz08AHcaAqvVM" alt="No alt text provided for this image" data-media-urn="" data-li-src=";v=beta&amp;t=gwet7k52bXuBhtzLTN4ohehTtpol6zYz08AHcaAqvVM" /></div><p>Covid deaths will still probably rise in the U.S. in coming days or weeks, many experts say. For one thing, data can be delayed around major holidays. For another, millions of adults remain unvaccinated and vulnerable.</p><p>But the increase in deaths is unlikely to be anywhere near as large as the increase last summer, during the Delta wave. Look at the data from South Africa, where the Omicron wave is already receding:</p><div class="slate-resizable-image-embed slate-image-embed__resize-middle"><img src=";v=beta&amp;t=eZXPMcRiK-ZVZFAQbNeY0bxVMTRQiYeY27c8q-ovRb0" alt="No alt text provided for this image" data-media-urn="" data-li-src=";v=beta&amp;t=eZXPMcRiK-ZVZFAQbNeY0bxVMTRQiYeY27c8q-ovRb0" /></div><h3>The bottom line</h3><p>Given the combination of surging cases and milder disease, how should people respond?</p><p>Dr. Leana Wen, Baltimore&rsquo;s former health commissioner, wrote&nbsp;a helpful Washington Post article&nbsp;in which she urged a middle path between reinstituting lockdowns and allowing Omicron to spread unchecked.</p><p>&ldquo;It&rsquo;s unreasonable to ask vaccinated people to refrain from pre-pandemic activities,&rdquo; Wen said. &ldquo;After all, the individual risk to them is low, and there is a steep price to keeping students out of school, shuttering restaurants and retail shops and stopping travel and commerce.&rdquo;</p><p>But she urged people to get booster shots, recommended that they wear&nbsp;KN95 or N95 masks&nbsp;and encouraged governments and businesses to&nbsp;mandate vaccination. All of those measures can reduce the spread of Covid and, by extension, hospital crowding and death.</p><p>What about elderly or immunocompromised people, who have been at&nbsp;some risk of major Covid illness&nbsp;even if they&rsquo;re vaccinated?</p><p>Different people will make different decisions, and that&rsquo;s OK. Severely immunocompromised people &mdash; like those who have received organ transplants or are actively receiving cancer treatment &mdash; have reason to be extra cautious. For otherwise healthy older people, on the other hand, the latest data may be encouraging enough to affect their behavior.</p><p>Consider this: Before Omicron, a typical vaccinated 75-year-old who contracted Covid had a roughly similar risk of death &mdash; around 1 in 200 &mdash; as a typical 75-year-old who contracted the flu.&nbsp;</p><p>Omicron has changed the calculation. Because it is milder than earlier versions of the virus, Covid now appears to present less threat to most vaccinated elderly people than the annual flu does.</p><p>The flu, of course, does present risk for the elderly. And the sheer size of the Omicron surge may argue for caution over the next few weeks. But the combination of vaccines and Omicron&rsquo;s apparent mildness means that, for an individual, Covid increasingly resembles the kind of health risk that people accept every day.</p><h3>What doctors are telling us about Omicron</h3><p>We&rsquo;re getting more data on Omicron&rsquo;s effects on patients, this time from inside U.S. hospitals. From medical centers across the country, doctors are telling our reporters the same thing: This Covid wave seems different from the last one.</p><p>In Omicron hot spots from New York to Florida to Texas, a smaller share of patients are landing in the intensive care units or requiring mechanical ventilation, my colleagues Azeen Ghorayshi and Emily Anthes report. They tend to stay in the hospital for fewer days and many patients show up at the hospital for other ailments and incidentally test positive for the coronavirus.</p><p>&ldquo;We are seeing an increase in the number of hospitalizations,&rdquo; said Rahul Sharma, emergency physician-in-chief for NewYork-Presbyterian/Weill Cornell hospital. But the severity of the disease looks different this time, he said. &ldquo;Most of our patients that are coming to the emergency department that do test positive are actually being discharged.&rdquo;</p><p>The shift in hospitals fits with emerging data that Omicron may be a variant with inherently milder effects than those that have come before. But another explanation for the less severe cases is that Omicron is infecting more people who have some prior immunity, whether through vaccination or prior infection. Doctors said that a vast majority of Omicron patients in I.C.U.s are unvaccinated or have severely compromised immune systems.</p><p>A new report from Houston suggests a similar pattern. Researchers at the Houston Methodist health care system compared 1,313 symptomatic patients infected with Omicron to patients who had been infected with the Delta or Alpha variants.</p><p>Fewer than 15 percent of the Omicron patients were hospitalized, compared with 43 percent of the Delta patients and 55 percent of the Alpha patients, the study found. Among those who were admitted, Omicron patients were also less likely to need ventilators and had shorter hospital stays.</p><p>Despite the shift in illness severity among patients, hospitals are under enormous strain. Experts warned that the number of I.C.U. patients &mdash; a lagging indicator &mdash; is likely to rise in the coming weeks. Hospitals also face challenges with staffing and contagion as employees fall ill, doctors said. And the new wave is arriving as some hospitals continue to struggle under the crush of patients from Delta.</p><p>It&rsquo;s also early days. Although the initial accounts are encouraging, there is not yet enough detailed data to draw firm conclusions about Omicron&rsquo;s inherent severity, said Natalie Dean, a biostatistician at Emory University in Atlanta.</p><p>&ldquo;There hasn&rsquo;t been really quite enough time,&rdquo; Dean said. It took months for numerous large studies of Delta&rsquo;s hospitalization risks to appear.</p><h3>Updating the booster calendar</h3><p>The C.D.C. recommends that Americans who received two doses of the Pfizer vaccine&nbsp;get a booster shot five months after the second shot, and not wait six months, as earlier guidance had said.</p><p>The agency also recommended that some immunocompromised children ages 5 to 11 receive an additional primary vaccine shot 28 days after the second shot, matching the guidance for people 12 and older with such conditions. (Pfizer&rsquo;s vaccine is the only one authorized for pediatric use in the U.S.)</p><p>The moves come at a time when the fast-spreading Omicron variant is infecting record numbers of people in the U.S. each day. The endorsements also&nbsp;mirror guidance&nbsp;from the F.D.A. announced yesterday.</p><p>The F.D.A. also cleared 12- to 15-year-olds to receive boosters of the Pfizer vaccine. The C.D.C.&rsquo;s vaccine advisory committee will meet tomorrow to discuss whether to recommend that step.</p><p>The guidance has not changed for when to seek booster shots after receiving the Moderna vaccine (6 months after the second shot) or the Johnson &amp; Johnson vaccine (2 months after the single shot).</p><h3>CDC tweaks vaccine advice, primary care braces for Omicron, and what should we be counting?</h3><p>Stratospheric Covid case numbers are spurring this question: Should we be counting hospital admissions instead? They rose 63% last week from the<strong>&nbsp;</strong>prior week, but still fall short of the pre-vaccine high of 16,500 per day set a year ago, the Associated Press notes Also:</p><ul><li>Primary care offices are bracing to meet an onslaught of milder Omicron cases with more staffers out sick, AP&nbsp;reports.</li><li>The CDC&nbsp;shortened the time&nbsp;between a second dose of Pfizer vaccine and booster to five months (no change for J&amp;J or Moderna shots). And the agency said some immunocompromised kids ages 5 to 11 may receive an additional primary vaccine shot 28 days after the second shot, in line with the&nbsp;guidance&nbsp;for similar people 12 and up.</li></ul><ol><li>And President Biden talked about testing&nbsp;yesterday: &ldquo;Believe me it's frustrating to me, but we're making improvements,&rdquo; he said.</li></ol><h3>Will we need yet another booster shot?</h3><p><em>In this week's edition&nbsp;of Bloomberg&rsquo;s Covid Q&amp;A, we look at additional booster doses.&nbsp;In&nbsp;hopes of making this very confusing time just a little less so, each week Bloomberg Prognosis is&nbsp;picking one question sent in by readers and putting it to&nbsp;experts in the field. This week's question comes to us from&nbsp;Ren&eacute;e in Potomac, Maryland.&nbsp;Ren&eacute;e is worried about immunity waning in the face of omicron&mdash;even after a booster.&nbsp;Ren&eacute;e asks:</em></p><blockquote>Will a fourth dose be approved in the U.S?</blockquote><p>Breakthrough Covid-19 infections are everywhere these days, even among the boosted,&nbsp;so it&rsquo;s&nbsp;natural to question whether we might need another dose to ward off the hyper-contagious omicron variant.</p><p>Israel has begun offering a fourth dose, and&nbsp;early results&nbsp;seem promising: A second booster of the Pfizer vaccine appeared to be safe and increased antibodies fivefold.&nbsp;The New York Times&nbsp;reported&nbsp;this week that people with compromised immune systems are going rogue and getting fourth and even fifth shots against recommendations.</p><p>And on Friday,&nbsp;Moderna CEO Stephane Bancel&nbsp;said&nbsp;another round of vaccine boosters&nbsp;will probably be needed this fall, even if immunity to&nbsp;omicron&nbsp;becomes widespread,</p><p>There are a few things to keep in mind, though. The first is that the primary goal of the vaccines is to prevent people from becoming severely ill and hospitalized, not to prevent them from getting the virus at all (though prevention is of course ideal).&nbsp;</p><p>&ldquo;While it is possible at some point that we may be recommended to get a fourth vaccine dose in the United States, it is a bit premature to say we will definitely need one,&rdquo; says&nbsp;Katrine Wallace, an epidemiologist at University of Illinois. Scientists are still in the process of gathering data about how well a third dose works, and for how long.</p><p>&rdquo;If the third dose continues to give significant protection, a fourth dose may not be needed. For now, we will continue to follow the data,&rdquo; she says.</p><p>&ldquo;The exception is for people who are immunocompromised or are taking medicine that causes them to mount a less robust immune response to the vaccine. This group is already authorized for a fourth shot,&rdquo; Wallace says.&nbsp;</p><p>But before we start worrying about our next doses, there are still plenty of Americans who haven&rsquo;t gotten the shots they&rsquo;re already allowed&nbsp;to get&nbsp;&mdash; a critical step toward slowing the spread of the virus and stopping new variants of concern from emerging.&nbsp;</p><p>In the U.S,&nbsp;only about 38%&nbsp;of eligible adults&nbsp;have&nbsp;gotten a&nbsp;booster, and about 34% of those 5 and older haven&rsquo;t completed their&nbsp;primary vaccination series, according to the Centers for Disease Control and Prevention.</p><p>Also key is getting vaccines to&nbsp;places where they are still in short supply. Unvaccinated populations allow the virus to spread and potentially mutate.</p><p>&rdquo;Only 9.5% of the population of Africa has been vaccinated with their primary series,&rdquo; says&nbsp;Wallace. &ldquo;Vaccine equity should be prioritized above a fourth dose of vaccine in order to prevent more viral variants from emerging.&rdquo;</p><h3>What I learned in a&nbsp;year covering vaccines</h3><p>It&rsquo;s been a long and crazy year since the first Covid vaccines were rolled out. There have been more waves of viral variants than I ever would have predicted. Here are four things I learned over the past year of covering the global vaccination campaign for Bloomberg:</p><p><strong>Covid vaccines work well in the short term, but how well they will hold up over time against a mutating virus remains to be seen.</strong></p><p>When the initial results from big trials of the Pfizer and Moderna shots came out, the world was euphoric. But lost amid the excitement about the great results was that the initial readout from the trials had&nbsp;followed people for only a relatively short period of time, about two months after the second dose. What we&rsquo;ve found since then is that the shots&rsquo; efficacy&nbsp;fades over time,&nbsp;especially&nbsp;against milder symptomatic infection, even as protection from&nbsp;severe consequences holds up better.&nbsp;Booster shots clearly help, but for how long? And will repeat boosters against the variant-of-the-year be needed indefinitely?&nbsp;Those are two murky questions that should become much clearer in 2022.</p><p><strong>Vaccines don&rsquo;t work if people don&rsquo;t use them or can&rsquo;t get them.</strong></p><div class="slate-resizable-image-embed slate-image-embed__resize-left"><img src=";v=beta&amp;t=BVGi1BDfWLAlcFwsuYmpT7gvdT_UkzpFaQp78x3kLI4" alt="No alt text provided for this image" data-media-urn="" data-li-src=";v=beta&amp;t=BVGi1BDfWLAlcFwsuYmpT7gvdT_UkzpFaQp78x3kLI4" /></div><p>When the delta variant hit the U.S. last summer, I knew that deaths were about to go up. But this fall, they rocketed far higher than I ever would have imagined. That&rsquo;s because delta turned out to be highly efficient at finding pockets of vulnerable, unvaccinated folks&mdash;and there were lots of them in the U.S. In many poorer countries, there has been a different problem: not enough supply for people who need them. That&rsquo;s left millions of unprotected people for the virus to infect&mdash;enhancing the odds of more variants developing.&nbsp;The&nbsp;Covax global distribution program&nbsp;was supposed to solve that&nbsp;problem, but it hasn&rsquo;t so far. Additional solutions are needed.</p><p><strong>Covid is such a fast-moving target, deciding when and how to switch to strain-specific boosters may be tricky.</strong></p><p>Vaccine companies are preparing for a day when variant-specific booster shots are needed. Both Pfizer, with partner BioNTech, and Moderna are racing to develop omicron-specific boosters in case they&rsquo;re needed. On paper, speedy messenger RNA, the technology that both vaccines use, is perfect for that. Moderna and Pfizer expect to have omicron-targeted boosters ready within 100 days. But omicron&rsquo;s fast spread shows how hard it will be to keep up a fast-changing virus. By the time the companies have results, the omicron wave could be well past its peak.</p><p><strong>Solving the coronavirus problem for good may require a universal vaccine.</strong></p><p>Given how fast variants are arising, and how many other coronaviruses there are out there in animals that could spread to humans, many top experts say broader-acting vaccines will be needed in the long run. The idea of a&nbsp;universal coronavirus vaccine&nbsp;emerged early in the pandemic and is being pursued by numerous academics and several biotech companies. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, has been blunt about the need for a pan-coronavirus shot that&rsquo;s more broadly protective and more durable. Existing vaccines &ldquo;will ultimately need to be replaced&nbsp;by second-generation vaccines,&rdquo; Fauci and two colleagues&nbsp;predicted recently&nbsp;in the New England Journal of Medicine</p>
KR Expert - Dr. Chris Stout

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