Over the past month, the United States has seen a steady rise in the prevalence of the dangerous new immune-evading Omicron subvariants of SARS-CoV-2, threatening yet another surge of COVID-19 infections, hospitalizations and deaths in the coming weeks, and potentially millions more cases of Long COVID.
On Friday, the Centers for Disease Control and Prevention (CDC) revealed that the highly immune-evasive BQ.1 and BQ.1.1 subvariants increased in prevalence from 11 percent to more than 27 percent in just two weeks, or a doubling time of 10 days. By mid-November, these two subvariants will likely be dominant across the country.
The anticipated COVID-19 surge will take place amid a flood of pediatric hospitalizations across the country for respiratory syncytial virus (RSV) and an unusually harsh beginning to the influenza season. The simultaneous surge of these three respiratory airborne pathogens will severely impact health care systems during the winter months, under conditions in which the industry is already on the verge of collapse three years into the COVID-19 pandemic.
While so far the crisis in children’s hospitals has been most acute, the elderly are particularly predisposed to complications with RSV and flu due to declines in their immunity. Among those 65 years and older, RSV leads to 177,000 hospitalizations and 14,000 deaths annually.
The typical flu season causes upwards of 16,000 deaths among adults. However, a severe flu season can be far worse. In 2017-18, the US experienced 41 million flu-related illnesses, 19 million flu-related medical visits, 710,000 flu-related hospitalizations and 52,000 deaths. Data from the CDC for the first four weeks of October shows that outpatient medical visits for flu-like symptoms are two to three times higher than the five-year average baseline.
The exact magnitude of the next surge of COVID-19 is impossible to predict, but a number of recent studies indicate that it could potentially be the third catastrophic winter of the pandemic.
First, a preprint study by Dr. Yunlong Richard Cao and his team at Biomedical Pioneering Innovation Center at Peking University, first released last month and updated regularly since then, found that the new Omicron subvariants render ineffective the monoclonal antibody drugs Evusheld and Bebtelovimab. The 9 million immunocompromised Americans eligible for these previously life-saving drugs will now have virtually no added protection against COVID-19.
Furthermore, the same study demonstrated that immunity induced from currently existing vaccines will barely stand a chance in protecting against infection with the latest variants. The researchers procured antibodies from individuals previously vaccinated three times with the Sinovac vaccine who were subsequently infected with the Omicron BA.1 subvariant last winter and tested their serum against the new Omicron subvariants. Roughly 7.5 months after the individuals were infected with BA.1, their antibodies were almost entirely unable to neutralize the BQ.1.1 and XBB subvariants. Even individuals infected with BA.5 this summer showed a similar lack of protection against the new subvariants.
Dr. Cao noted, “Results from mRNA vaccines should have overall higher neutralizing titers. But the immunity waning trend and immune evasion pattern should be highly similar.”
The implication of these results is that the billions of people infected with BA.1 globally last winter, and even many who were just infected with BA.5 this summer, remain at risk of reinfection with the new Omicron subvariants this winter, compounding their risks of hospitalization, death and Long COVID.
Another recent report from the CDC showed that the efficacy of vaccines in protecting against hospitalization continues to erode with each new variant. The study found that after three doses of the monovalent COVID-19 vaccines, vaccine effectiveness (VE) against COVID-19 over just a few months, associated hospitalization declined quickly over a few months this year.
During the surge of the Omicron BA.1 and BA.2 subvariants last winter and early spring, individuals who had been vaccinated within four months of being infected had a VE of 79 percent. During the surge of the Omicron BA.4 and BA.5 subvariants over the summer, this same figure dropped nearly 20 points to 60 percent. Both figures are much lower than those seen with previous non-Omicron variants.
Significantly, four months post-vaccination, VE fell to 41 percent and 29 percent for the BA.1/2 and BA.4/5 subvariants, respectively. For this group, which now comprises the majority of Americans who last had a booster shot well over four months ago, the CDC authors concluded that “among immunocompetent adults hospitalized … a monovalent booster dose of mRNA COVID-19 vaccine had limited overall effectiveness against hospitalization caused by currently circulating SARS-CoV-2 Omicron variants, likely because of waning immunity.”
They added, “These findings demonstrate the importance of staying up to date with COVID-19 vaccinations through receipt of booster doses, which currently consist of bivalent mRNA vaccines for all eligible adults.”
There is no doubt that the COVID-19 vaccines have been crucial in saving lives. But to continue to ask the population to get their boosters considering the steady decline in their efficacy is a tough pill to swallow.
Certainly, the working class must take these vaccines in order to prevent severe illness and death. But without a public health initiative to eliminate the virus and stop viral evolution, the “forever COVID” policy is becoming increasingly disastrous. The great danger remains that new variants could evolve that dramatically erode the vaccines’ ability to prevent hospitalization, or cause a higher infection fatality ratio (IFR), which would quickly overwhelm hospitals.
Even more disconcerting news has recently emerged about the benefits of the new bivalent COVID-19 booster shots that have been promoted as the latest and greatest. In two recent studies from Columbia and Harvard, researchers found the bivalent vaccines offered no better protection than the original booster based on the ancestral strain of SARS-CoV-2. Dr. David Ho, a professor of microbiology and immunology at Columbia and an author of their study, told CNN, “We see essentially no difference.”
White House Coronavirus Response Coordinator Dr. Ashish Jha quickly sought to counter these findings and continue to promote the bivalent boosters, telling CBS News, “I do think that the protection against infection is going to be better than if you were getting the original prototype booster.” However, he acknowledged that he wasn’t “surprised” by the studies’ findings and offered no data to back-up his claim.
Drawing on studies conducted with the BA.1 subvariant, some scientists have speculated that the BA.5-based booster could potentially cause a “maturation” process in one’s immune system and provide slightly enhanced protection against future variants that descend from BA.5, but this remains to be proven.
The development of the new bivalent booster shots was predicated on warnings made by experts of a severe winter surge. However, without any clinical evidence to inform their decisions, the White House used the last remaining pandemic funds to buy millions of bivalent boosters from Pfizer and Moderna. Since the booster campaign was inaugurated at the beginning of September, less than 10 percent of the US population has availed itself of the vaccines.
One of the most glaring failures of the Biden administration’s response to the pandemic has been its lack of initiative to fund and promote the development of nasal and other vaccines that could potentially provide sterilizing immunity to entirely prevent infection. Since 2020, scientists have been warning about the shortcomings of the current vaccines and the need to explore more viable and enduring treatments to stop viral transmission.
In this regard, a recent study published in Science by Dr. Akiko Iwasaki and her team from the immunology department at Yale University bears mentioning. They showed that in animal models who received intranasal boosting after receiving systemic (a shot in the arm) vaccination, what they term “Prime and Spike,” subjects had a persistent and significant level of immunity against infection, severe disease and death.
The authors wrote, “We find that an intranasal unadjuvanted spike booster can be administered months out from primary immunization and that it offers comparable systemic neutralizing antibody booster responses to intramuscular mRNA boost. … [We] find that prime and spike leads to durable responses with protective vaccine efficacy 118 days from the initiation of vaccination.” However, funding to test these concepts in human trials is still lacking.
As the US enters another deadly winter of the pandemic, New York has once again become the bellwether for the rest of the country. The BQ.1 and BQ.1.1 subvariants now make up more than 40 percent of all variants in the state. Hospitalization rates are trending upwards rapidly, leading the New York State Department of Health to issue a warning on the “triple threat” posed by COVID-19, seasonal flu and RSV with hospital capacity in some regions reaching their limits.
The evolving storm of sickness and death is not a natural phenomenon. The experiences of the last three years of the pandemic have shown that capitalism and the ruling elites will sacrifice countless lives in order to prop up the financial markets. To stop the coming catastrophe, rank-and-file public health and health care workers must take matters into their own hands and link up with their class brothers and sisters internationally in a common struggle to end the pandemic.