In “The Last of Us,” a video game and recently-wrapped HBO series, giant mutant fungi turn much of humanity into zombies. In…
Pandemic Predictions Take a Turn Towards the Positive – Finally
An end may be in sight. For the first time since the pandemic began, I listened to a press briefing from medical experts that did not give me nightmares.
It was December 11, 2022, the weekly zoom from the Massachusetts Consortium on Pathogen Readiness (MassCPR). The group of eloquent experts formed at the dawn of the pandemic. They’ve held sporadic briefings for journalists over these many months, ramping up to weekly as Omicron loomed in early December.
From JAMA to MassCPR
At the beginning, I was a fan of the online Conversations with Howard Bauchner, who was then editor-in-chief of the Journal of the American Medical Association. Dr. Bauchner’s laid-back manner got the superstars of the pandemic – from Anthony Fauci to Rochelle Walensky to Paul Offit – to relax, in an environment far from Clorox-pitching presidents and the like. Those were the days when the experts talked of the goal of herd immunity. I suspect none of them imagined that so many people would shun life-saving vaccines and even make the decision political, endangering us all and providing fertile ground for Omicron and the other variants to evolve, emerge, and threaten us in new ways. I know it blindsided me.
One of Dr. Bauchner’s first Conversations was with Maurizio Cecconi, from Humanitas Research Hospital in Milan. In Coronavirus in Italy, Report from the Front Lines, Cecconi detailed the dire situation in Lombardy. It was March 16, 2020. I stared at my screen, at the image of a somber and seemingly endless parade of coffins moving slowly down a broad avenue. I never imagined that very soon, my daughter would see even worse out her window overlooking an ER in Astoria, Queens. Those corpses were not horizontal like in the Italian promenade, but vertical, in piles awaiting the white refrigerated trucks to haul them away.
Alas, Dr. Bauchner was jettisoned in June 2021, following his failure to halt a racist podcast that JAMA had unfortunately and inexplicably sponsored. In it, two white editors claimed that structural racism doesn’t exist in medicine because it is illegal – here it is.
Yes, Dr. Bauchner failed to jump on the two editors, but I miss his podcasts in the way that I miss Chris Cuomo on CNN.
So I drifted to the MassCPR press briefings. One from about a year ago became my DNA Science post Is COVID Optimism Finally Overtaking Pessimism? Harvard Experts Weigh In. Vaccines were rolling out, sleeves were rolling up, and the idea and ideal of herd immunity had yet to be extinguished. I’d just had my first shot, which took me back to getting polio vaccine in elementary school. (See my post Vaccine Memories: From Polio to Autism.)
The MassCPR briefing schedule accelerated, going weekly, in pace to Omicron’s spread from South Africa as December dawned.
What the speakers told us, based on preprints and what they knew from colleagues and direct experience with those sick with and dying from COVID, was always days if not weeks ahead of what was in the news. So I had this sense of reverberating doom in the following days as friends sent me articles from mainstream media, from other journalists on the zoom.
The December 14, 2021 MassCPR press briefing forms most of my DNA Science post “Pandemic Too Fast to Follow as Three Waves of Infection Wash Over the US: Delta, Omicron, and Flu.” I ended with gloom and doom, under the subheading “What Kept Me Up At Night,” with an extended quote from Jacob Lemieux, infectious disease specialist at Massachusetts General Hospital. The looming extensive travel to celebrate Christmas and New Year’s terrified me.
I skipped the first MassCPR briefing of the new year after seeing the steeply ascending curves of hospitalizations on the nightly news, the spikes of disaster driven mainly by those still refusing vaccination. They may finally be starting to plateau.
Hope From T Cells
The mesmerizing Dr. Lemieux again ended the MassCPR session two days ago, January 11, and I was stunned at his positive tone. Much of it stemmed from building evidence and inference that declining levels of neutralizing antibodies against Omicron, and the generally mild symptoms, mean that T cells are providing protection.
Brief biology lesson. T cells instruct B cells to spew antibodies, and also destroy virally-infected cells. T cells are much harder and take longer to detect compared to antibodies, but they may be the most reliable “correlate of protection” – predictor of overcoming infection. That is, antibodies do not tell the whole story. Most media reports I’ve seen screech to a halt at explaining anything beyond antibodies, ignoring the vital cellular immune response, the T and B cells. Antibodies constitute the humoral immune response (“humor” means “fluid”; antibodies are detected in blood serum). End of biology lesson.
The speakers collectively sensed a change two days ago, and clichés spilled forth. A light at the end of the tunnel. Darkest before the dawn. And so I’ll end with what Dr. Lemieux had to say:
“On these briefings it is getting harder to answer the questions. We don’t know what the future holds.
In the beginning I thought, ok, what do we make of Omicron? We knew that it is scary looking, and we’d have to see if that signaled an increase in transmissibility. Over the next couple of weeks it became clear that it is a lot more transmissible. And when lab data came in, they showed it is the most immune evasive variant on record. Then largely the trajectory was determined – it was highly transmissible and immune evasive, so clearly it was going to spread, and it did. It became easy to say that next week there will be more cases, but we didn’t know how well vaccination works, if there would be a difference in severity.
Fortunately vaccines still show efficacy and the variant is less virulent. But in terms of predicting what happens now, it is much more difficult. Everything we say must be taken with a much larger grain of salt.
We can talk about the bread-and-butter scientific questions now, like the observation that fewer people are dying with Omicron. That’s good news. But why? What is the source of their persistent immunity? T cells? A non-neutralizing function of antibodies? All hypotheses are going to be evaluated, and we’re beginning to see a stream of publications getting at these questions. It feels like a normal scientific process. But in terms of what happens now, I would just say we’re all in this together and we’re about to find out.
First, we are at a very different point in the pandemic than we were 2 years ago. It looked grim, with zero treatments or vaccines out and high numbers of cases, but there is light at the end of the tunnel. We’re still in the tunnel, but the vaccines work and we’ve learned the public health measures that work, like masks and social distancing. And we’re about to see the roll out of medications that currently have limited availability but will increase and be given to outpatients and have a high degree of efficacy.
We are also seeing that the virus is becoming less virulent over time. Will that trend continue? We hope so, but we don’t know for certain. We’re looking at something toward a more normal future, particularly as the winter begins to tail off.
But is it endemic yet? No. It is very clearly still an epidemic now because cases are rising.
Will there be another variant? Yes, mutations occur.
Will new variants have the same impact as Omicron? We don’t know, but we can certainly know that we as a society need to prepare for the possible and inevitable emergence of variants. And that means to increase the quality of surveillance systems and increase access to vaccines and medications that already exist. We need to develop a strategy of how we deal with variants over a long time. In the coming months we will see a return to normalcy.”
Added moderator Bruce Walker, director of the Ragon Institute of MGH, MIT and Harvard, “There are lots of reasons for optimism. The bottom line is that we must do everything we can to prevent becoming infected over the next month while we are in the middle of a surge and then I think we’ll be re-addressing how we come to an equilibrium with this pandemic as we move forward.”