By Anne Blythe
We’ve lived with COVID-19 for three and a half years now, and just when it seems like we’re close to declaring checkmate, the SARS-CoV-2 virus shows its uncanny ability to survive.
This coronavirus is a master at evolving, throwing variant after variant at us.
“It is a skilled variant producer,” said Elizabeth Cuervo Tilson, the state health director and chief medical officer for the N.C. Department of Health and Human Services. “It reproduces on such a quick cycle. … It’s like watching evolution in real time.”
The latest known variant, BA.2.86, an offshoot of Omicron nicknamed pirola, was first detected in Denmark in July. The Centers for Disease Control and Prevention reported that the variant had been detected in the U.S. as of Aug. 23.
“It has been found in multiple countries and in multiple locations in the United States,” David Montefiori, director of the Laboratory for HIV and COVID Vaccine Research and Development at Duke University Medical Center, said during a Sept. 6 webinar with reporters. “It’s not real prevalent in terms of what the genetic surveillance show, but that could be an underestimate because there’s not nearly as much genetic surveillance going on now. We really don’t have a good idea of how widespread it is.”
COVID cases have been on a steady rise in North Carolina since late June, according to wastewater monitoring and the number of people reporting to emergency departments with COVID-like symptoms, the DHHS dashboard shows.
Hospitalizations have been rising too. Over the past week, according to the DHHS dashboard, 638 admissions were for COVID-19, up from 493 admissions the week before.
But as the virus has shown its masterful ability to evolve, scientists and public health experts have shown their wherewithal by adjusting vaccines that help prevent severe illness caused by previous variants.
New COVID boosters should be available this week at pharmacies and other health care facilities. The Food and Drug Administration approved the updated vaccines on Monday, and the CDC weighed in on Tuesday with guidance on who should get the shots.
The recommendation? Anyone six months and older should roll up a sleeve.
Cameron Wolfe, an infectious disease specialist at Duke Health, told reporters during the Sept. 6 webinar with Montefiori that the release of the new vaccines was well-timed for patterns that have emerged over the course of the COVID pandemic.
For the past several years, North Carolina has seen several waves of COVID, including one in the late summer and another in the winter after the November and December holidays.
“We’ve always had this sort of late-July/August/September spike,” Wolfe said about cases at Duke Health. “But to put numbers around that, our lowest point almost at any point in the pandemic was probably May and June when we were down to … maybe 10 to 15 patients. By comparison, we’re sitting around 50 to 55 in-patients who have COVID. So that’s a three- to fourfold increase.”
When BA.2.86 emerged, public health experts were on alert, anxiously awaiting to see whether the new variant could evade built-up immune protection from earlier vaccines and from widespread COVID infection.
“What we have found recently is the updated booster that will be rolled out this fall is still generating very high titers of these neutralizing antibodies,” Montefiori said. “There’s very little concern about that variant as far as the vaccines go. The vaccines are expected to remain very effective against it.”
Not in the rearview mirror
Mandy Cohen, the former DHHS secretary who recently became head of the CDC, encouraged people to get the booster in an opinion piece published Wednesday in the New York Times.
“While we would all love to leave Covid-19 in the rearview mirror for good, the virus is still here,” Cohen wrote. “And it will probably always be with us. The good news is that we have the tools to help people avoid serious illness, hospitalization, death and long Covid symptoms. We can minimize the virus’s damage to our lives by using one of our most effective tools in combating the virus: updated Covid-19 vaccines.
“Covid-19 vaccines are the best way to give the body the ability to keep the virus from causing significant harm.”
For those who wonder why they need to get a booster if they have already gotten a vaccine, Cohen noted that COVID has changed over time, much like the flu.
“That’s why our vaccines need to be updated to match the changed virus,” Cohen wrote. “Even though many Americans have been exposed to previous versions of the virus because they’ve been infected, that protection decreases over time. This is partly why you can get COVID more than once and why you can still get very sick even if you had it before.”
Don’t want cost to be a deterrent
In North Carolina, public health officials are encouraging people to get a COVID booster and a flu shot and to speak with their health care providers about the RSV vaccine.
“COVID-19 continues to be a very real risk for many people, and, last fall, COVID-19, flu and RSV spread widely at the same time,” said Zack Moore, North Carolina’s state epidemiologist. “Safe and effective vaccines are the best way to protect against these viruses. They are especially important for those at higher risk of complications — people 65 and older, children younger than 5, pregnant women and those with certain medical conditions, like asthma, diabetes and heart disease.”
Now that we’re no longer in a national state of emergency, COVID vaccines will not be universally free in North Carolina. Physicians and public health workers say they are developing strategies to ensure that boosters are available to people of color and other communities where historically there have been health care access disparities.
“We are trying already to think through that, to make sure to think of ways to get vaccines into spaces where our more marginalized individuals encounter health care,” Wolfe said. “That’s part of the aim here. The other part will be to message this really clearly: There have been offers put forward by the federal government and the companies who say we don’t want anyone left behind in this, financially. It remains to be seen how that plays out, and it does bother me that there’s a risk here, that the message of vaccination will get to people … but also the access gets restricted.”
Tilson told NC Health News in a phone interview last week that DHHS is working to get a limited supply of vaccines from the federal government that can be administered at no cost to uninsured and under-insured individuals.
These vaccines will be distributed through the federal Bridge Access Program to community health centers, local health departments and other safety-net providers as well as to pharmacies participating in the program.
For people with health insurance, most plans are expected to cover the COVID-19 vaccine at no cost.
In North Carolina, there is a Vaccines for Children program through which children younger than 18 can get vaccines at no cost if they are insured by Medicaid, uninsured or underinsured.
Educating people on why they should get a booster is one of the larger challenges facing public health workers. Vaccines can’t prevent someone from getting infected with the virus that causes COVID, but they help minimize severe illness and the number of hospitalizations, physicians say. Boosters also appear to help prevent long COVID, which can cause lingering symptoms such as shortness of breath, cardiac issues, extreme fatigue and headaches.
“The current CDC statistics show that only 17 percent of eligible Americans got the bivalent boosters,” Montefiori said. “I think this is one of the biggest concerns that we have. The fact of the matter is most of the people in the United States haven’t been boosted in over a year. And we know immunity to this virus wanes over time. So the best thing people can do to maintain a normal way of life is to continue to get their booster shots. And the good thing is the booster shots are working.”