Here is Dr. Klotman’s COVID update for Week 151 of the smoldering pandemic. This update is a Q&A for some of the more difficult questions that have been circulating on the net about COVID vaccines and treatments. The salient points are:
- Merk’s antiviral Molnupiravir works by inducing viral mutations that ultimately lead to viral death, and there is some chance that such mutations could bring about more contagious or virulent varients. It may not be the best drug to fight the pandemic.
- There are now five intra-nasal COVID vaccines – none approved for use in the US. We do not know whether they are as effective as our vaccines, but in theory, they could induce IgA antibodies in the upper airways that might be more effective in reducing infections. Our vaccines only reduce infection rates by half; their main effect is in preventing severe infections, hospitalizations and deaths.
- Vaccine booster uptake in the US is pretty low – especially among young children. This is more a threat to older, vulnerable adults than it is to children themselves. Although the mortality rate of COVID in young children is low, that doesn’t matter much if it is your child or grandchild that dies.
- A recent, unpublished and unreviewed study suggests that more booster doses actually increase the risk of COVID infection. That study has serious methodological problems and a selection bias that render the study conclusions invalid.
- Despite all the foregoing, US COVID test positivity rates, hospitalizations, and deaths all seem to be falling.
Not in Dr. Klotman’s update are the following:
- The CDC has issued COVID vaccination schedules for adults and children.
- There will likely be a forthcoming recommendation for annual COVID boosters.
- Recent analyses indicate that vaccine protection from serious COVID probably lasts only six to nine months.
My retired IM colleague AD Smith sent me a link to a Cochrane review that questions the efficacy of masks in preventing COVID infection. My take on this and other meta-analyses is that preventive strategies show greater efficacy when the prevalence of the condition that we seek to prevent is high. When the prevalence is low, prevention has a much smaller effect. Dr. Smith cautions that skeptics and conspiracy theorists may latch onto this analysis to justify their mask-rejecting attitudes. I think that he is right, and I can only wish those individuals the best of luck. Alas!