Infections and vaccines are evolving

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In early July the number of active cases of Covid-19 was increasing rapidly in Arkansas going up from 10,141 on June 27 to 11,985 on July 5—levels last seen during the omicron surge early in the year. Carroll County active cases increased from 77 to 86 during that time period. Cases were likely undercounted because of the July 4 holiday as fewer people get tested during holidays. Also, many people are using home tests that aren’t reported, or aren’t testing at all.

Eureka Springs Hospital reported 10 positive results out of 66 overall tests in the past week.

The Centers for Disease Control and Prevention has changed the Covid risk level in Carroll County from low to moderate. New cases in Carroll County as of July 5 were up 51 percent in the past two weeks, according to the Arkansas Department of Health, while new cases in Arkansas were up 47 percent. ADH reports Arkansas hospitalizations in that time period increased 32 percent but are still far below what was seen during the omicron surge early in the year.

The CDC recommends that people who live in counties with moderate risk should take the following steps:

  • If you are at high risk for severe illness, talk to your healthcare provider about whether you need to wear a mask and take other precautions.
  • Stay up to date with Covid-19 vaccines.
  • Get tested if you have symptoms.
  • People may choose to wear a mask at any time. People with symptoms, a positive test, or exposure to someone with Covid-19 should wear a mask.

The surge occurs at a unique time in the pandemic. At one point, there was widespread hope that the combination of vaccinations and prior infections with omicron would stop the pandemic in its tracks. Instead, there are new versions of omicron that are the most infectious yet.

A recent New England Journal of Medicine article said a rapid increase in Covid-19 cases due to the omicron (B.1.1.529) variant in highly vaccinated populations has aroused concerns about the effectiveness of current vaccines. The article that looked at cases in the United Kingdom, which experienced the omicron surge earlier than the U.S., said that between November 27, 2021, and January 12, 2022, primary immunization with two doses of AstraZeneca or Pfizer vaccine provided limited protection against symptomatic disease caused by the omicron variant. Boosters after the primary course substantially increased protection, but that protection waned over time.

Now there are two new omicron variants, BA.4 and BA.5, dominant in the U.S. that have been referred to as “escape artists” or “stealth omicron” because they are able to cause symptomatic illnesses even after previous vaccinations and infections by earlier versions of omicron.

The New York Times reports that in recent weeks, more than 100,000 new coronavirus cases have been reported each day on average in the U.S., “a figure that captures only a portion of the true number. Many infections go uncounted in official reports. Some scientists estimate that the current wave of cases is the second largest of the pandemic.”

CDC Director Dr. Rochelle Walensky was quoted recently as saying the deaths that the U.S. has been experiencing lately are among people who are either elderly, frail, have many comorbidities [two or more diseases or medical conditions] and have had a lot of vaccine shots, or people who are unvaccinated. People at higher risk may feel abandoned as most Americans have decided to stop taking precautions to prevent the spread of Covid.

A number of local residents who were fully vaccinated and boosted have reported catching Covid recently. Some reported only mild symptoms; others are taking longer to recover. And several locals have concerns about large numbers of their family members in other states catching omicron during summer vacation gatherings. In some cases, they have family members in several states catching omicron at the same time even though there has been no contact between different family members.

One resident reported that of family members who traveled by air last week for a family reunion in the West, 11 of 16 family members caught Covid. All except an infant were fully vaccinated and boosted. The older adults all took the antiviral medication Paxlovid and reported feeling better after several days.

Another resident said Covid swept through her sister’s family in a southern state. The sister texted: “Good news: We’re all gonna live, and we’re going to look ahead with optimism and assume no longer term damage. No other choice.”

This is the third summer of the pandemic, air travel has reached pre-pandemic levels, and many people in the Eureka Springs area and elsewhere is the state not masking or social distancing. Some feel it is better to risk a hopefully mild case of Covid than to be socially isolated.

A local emergency room nurse said the Covid vaccines are not as effective at producing mucosal antibodies (nose and mouth), as they are at producing lower respiratory antibodies (lungs).

“Because of this, Covid infections will not improve until the vast majority of the population has had an active Covid infection,” said the RN, who has treated hundreds of Covid patients. “That does not mean that the vaccine is ineffective or not valuable. The Covid vaccine decreases lower respiratory disease, like pneumonia and acute respiratory distress syndrome. Lower respiratory infections are what kill people, not upper respiratory infections. Covid in the vaccinated population is typically an upper respiratory infection that makes you feel miserable but doesn’t hospitalize you.

“Zero Covid infections is not a realistic goal and never has been. Political rhetoric has led portions of the population to have these unrealistic expectations. At-risk populations should use the highly effective and readily available N95 masks. Everyone else is going to have to get Covid.”

However, Katy Turnbaugh, a local retired science educator, thinks it is unwise that people should just ignore mitigation efforts like masking and social distancing.

“We have to slow the mutations by having less spread of Covid,” Turnbaugh said. “Every person it infects can create the next mutation. It is just going to keep evolving and we are just going to keep getting it again and again. You should shift your behavior depending on circumstances, and people are not doing that. The more often someone catches Covid, the more likely it is they will develop long Covid symptoms. How is this country going to be able to afford large numbers of people who can’t work and need medical treatment because of long Covid?”

The FDA has recommended manufacturers seeking to update their Covid-19 vaccines develop modified vaccines that add an omicron BA.4/5 spike protein component to create a two component (bivalent) booster vaccine. Manufacturers are predicting the bivalent vaccines won’t be available until October. But new variants could emerge before that, which could limit the effectiveness of the bivalent vaccines—just as the annual flu vaccines are sometimes limited in effectiveness because they are manufactured in advance of the flu season and not a good match for the flu strain currently in circulation.