Summer Predictions: There is no doubt that a COVID-19 case surge is upon us. The question is, how long will it last, and how bad will get it. Let me try to answer these questions for you based on existing data. In order to predict a surge, and the severity of a surge, I have several tools and indicators I combine to come up with a prediction around timing and severity. These include waste water trends, case rates, comparison to case waves in other countries, antibody waning schedules (from both natural infection and vaccination), case positivity rates, weather patterns, and policy and behavioral changes. In general, summer will produce less severe case surges than winter will because warm weather lends to outdoor activities and a higher UV index (which affects the half life of the virus—higher UV, less virus). However, summer will also lead to more infections than spring because increased humidity and temperature above a specific threshold actually increases the SARS-CoV-2 viral half life. Because we usually observe a case surge in the winter, and as a result, increased vaccinations and natural infections, this offers the population a certain amount of immunity against infection for some time—which almost completely wanes by summer. (Please note: protection against severe disease and hospitalization remains intact.) Thus, in summer we see several trends coalescing to produce a higher risk scenario than spring. First is weather, second is waning antibodies, and third, unfortunately, is a new set of variants that evade immunity at a higher rate than prior variants. Thus, this summer, I predict that we will see a surge in cases but because of the remaining immunity against HOSPITALIZATION, it is very unlikley we will see our health systems overwhelmed like we did in the winter of 2021. In sum, even in light of the new variants (BA.4 and BA.5) my composite models predict a wave about a third of the severity of the prior winter wave at its peak. This wave should spike and fall quickly due to the fact that the last wave was not prolonged like the prior wave, meaning that everyone got immunity at the same time, and has since lost immunity at the same time. Highly infectious variants like Omicron change the shape of the case waves, making them look like true spikes as opposed to rolling hills. As a result, this changes the length of time we are in a peak and shortens the time it takes to get to the top of the peak. With even more infectious variants we will likely see sharper and sharper spikes, as swaths of people get infected at once and then recover. This will also change the pattern of population-wide immunity and affect the seasonality of the virus—creating more defined “surge seasons”. Vaccine Effectiveness, an evolving story: The booster will only be helpful in preventing omicron infection for approximately four weeks (these four weeks start 21 days after the booster is given). After that infection, protection wanes quite dramatically, but protection against severe disease and hospitalization does not. Thus, what we want to know is when does protection against severe disease start to decrease, and how does this compare to any decreases in protection from natural infection (or a hybrid of natural and vaccine). While reinfection with Omicron is much more likely than other variants (after 90 days), it appears that both natural infection and vaccines (mRNA) protect quite well against hospitalization for some time in those 50 and under. But, as you age, this protection against hospitalization and death wanes much more quickly (hence the need for a booster in the older age groups). If you are elderly, recieving immunity from natural infection is not a risk you want to take, as you may not survive this event. Thus, vaccination and subsequent boosters will remain the safest course of action in preventing hospitalization and death from infection for those over 50 for some time. If you are under 50, you are likely wondering, when does my protection against severe COVID-19 decline enough for it to be worth it for me to get a booster. So far, we haven’t studied boosters in a large enough study group to be able to determine this. Thus, without empirical evidence, we need to make an educated guess based on our knowledge of how the immune system functions. As we get further and further out from an infection or vaccination, our b-cell antibodies decline rapidly and continue to decline over time. Our t-cells decline too, but they stabilize after 3-4 months of decline and stop decreasing. This is what we are watching. Now, while t-cells are unlikely to prevent against infection (meaning they are unlikely to neutralize the virus on the spot to prevent infection), they can get into high gear very quickly (a 10-fold increase in 24 hours) to prevent severe infection. Thus far, research shows they are stable for at least 450 days after vaccination. Unless you are immunocomprised, elderly or at high-risk for infection, a booster is not currently indicated for those reasons. One controversial hypothesis, but which has some moderate empirical support, is that infections from other coronaviruses might be able to cross-react to help prevent clinical, detectable infection from COVID-19. One study, published in Nature in January 2022 showed that workers exposed to COVID-19 who never tested positive on PCR, actually showed some evidence of an anitbody response in the sense that they had a t-cell reaction to the virus (but never tested positive nor had symptoms). This means that there is something called subclinical infection, where one is infected but the infection doesn’t replicate enough to produce symptoms or a postive test. This is where we want to get to. This is the end game for the coronavirus. Thus, studying how we get there and how some people can do this naturally is of immense value.
If you haven’t had a chance to check-out the beta version of my risk calculator yet, head over to www.dunphycalculators.com. This calculator is completely free, easy-to-use, and gives you PERSONALIZED risk data and guidance on how to manage your risk as conditions change. This calculator can also be used to devise a composite score for groups like pods, classrooms, nursing homes, employees, or even social groups. If you have any questions please reach out to me at firstname.lastname@example.org.
In other news, I have an exciting announcment: I hav
e an e-book coming out on toxic exposures. The goal of this book is to help anyone who wants to mitigate their exposure to hidden carcinogens in their every day life. This book incorporates a years worth of research and it results in a concise and easy-to-use guide that both delivers the information you need to make easy, affordable changes and helps you make an easy step-by-step plan. While this book is for everyone, I HIGHLY recommend it to famlies, anyone with small children or anyone who is pregnant or planning to become pregnant. If you are interested in being on the presale list and getting the first available copies, please message me at email@example.com
Stay Safe and Healthy, Dr. Jen Dunphy
**It is important for me to state I am not a medical doctor, but a doctor of public health (DrPH) and I am not giving any clinical advice. My job is to help interpret leading research and make sense of the probable implications. Please consult your physician for any medical advice. Thank you.