Every TIME COVID-19 MUTATES, it's “like somebody who runs a two-hour-and-thirty-minute marathon changing their sneakers and all of a sudden running a two-hour marathon,” said Harvard Medical School (HMS) instructor in medicine Jake Lemieux, M.D. ’15 during Tuesday’s HMS-led Massachusetts Consortium on Pathogen Readiness (MassCPR). Lemieux, also an infectious disease specialist at Massachusetts General Hospital (MGH) said that one of the puzzling things about the COVID-19 virus is that new variants exhibit increased fitness and transmissibility, despite minor changes in structure. He said, like a marathon runner with new shoes, variants are only subtly changed, “and yet, they are behaving categorically differently.”
As new variants emerge and cases rise around the country (particularly in the Northeast), MassCPR experts briefed the public about potential treatments for COVID, as well as the state of the pandemic. Lemieux said that, while cases first began to rise in the Northeast and Puerto Rico, now they’ve “expanded geographically” to the upper Midwest and “really, all across the country.”
“We are not in the endemic phase yet,” Lemieux said. “It doesn’t seem like a good sign that there’s a lot of immunity in the population…and yet, there are still significant outbreaks.” The rise in hospitalization is a cause for concern. “I, and I think many other people, had expected that as treatments became more available and as vaccinations more widespread, we would see a decoupling of case counts and hospitalizations.” We have seen this separation to some extent, but he added, “it has not been the complete decoupling that we hoped for.”
The public can expect to see cases rise for at least the next week or two, according to Lemieux. The cause of the influx is uncertain, but “novel variants seem to be a big part” of it, he said, namely BA2.12.1 in the United States.
Relaxed distancing standards also could be contributing to the rise in cases, according to HMS assistant professor and MGH infectious disease specialist Amy Barczak, M.D. ’02. “Non-pharmaceutical inventions like mask-wearing are incredibly protective,” she said, and suggested that “the removal of mask mandates for public transportation and on flights is contributing to the current surge.”
Promising antiviral treatments might temper rising cases. Jonathan Abraham ’05, M.D.-PhD ’10, an instructor at HMS and infectious disease specialist at MGH, said that, repurposing existing drugs such as steroids “hasn’t really worked in this pandemic,” but antivirals such as remdesivir and Paxlovid have been effective in reducing the length of symptoms and contagiousness in infected individuals.
However, “There is a really significant gap between when a drug is approved and actually knowing how to use it clinically,” Barczak said. Treatments are tested clinically only as individual treatments, so it’s still unknown whether they could be more effective when combined with other therapies. Drugs that block aspects of viral replication, like remdesivir, are proving effective now, but she added that “if we want to stay on top of COVID-19, we need more drugs that target more aspects of the viral life cycle, in order to outpace viral evolution and the inevitable resistance that will emerge.” She also advocated for expanding clinical trials to better understand how new drugs might be used in combination therapy and in immunosuppressed populations.
Recent pediatric research led by Adrienne Randolph, HMS professor of anesthesia and an immunobiologist at Boston Children's Hospital, found that immunizing pregnant mothers in turn immunized their infants for up to six months post-birth. She added that children ages five and older are eligible for vaccination, and those 12 and older can be treated with Paxlovid and remdesivir.
The jury is still out on whether a second booster (or fourth shot) is necessary for everyone, said Barczak. However, adults ages 50 and older, moderately or severely immunocompromised individuals ages 12 and older, and those who received two doses of the Johnson & Johnson vaccine stand to benefit from a second booster, she says.
As new treatments emerge, Barczak called for “global equity” in their distribution. “COVID is really a global disease,” she said, and it’s crucial to ensure people around the world have equal access to treatments. “If we don’t make every effort to control [COVID-19] around the world, it will continue to evolve.” She added that distribution equity is important, above all, from a “human, ethical standpoint.”
For more information about MassCPR’s public briefings, or to watch recordings of past panel discussions, visit https://masscpr.hms.harvard.edu/masscpr-public-briefings.
