AAs a scientist who works every day on the immunology of Covid-19 and the long Covid, I am well aware that as we approach autumn and the start of the new school year, the UK is facing still no more Covid confusion and discord. Where are we going next? Isn’t it over? And why keep talking about mitigation when we now have so many other concerns?
Any discussion of our current Covid situation must consider the legacy of disability and misery associated with the long Covid. In my opinion, there is now good news among the old bad news. In recent months, data from the Office for National Statistics shows that the estimated number of people with long-term Covid is starting to fall, from a peak of 2 million in May to around 1.8 million. I guess that means some are gradually recovering. And while the long Covid following Omicron BA.5 infection is clearly occurring, new cases of long Covid are appearing at a lower frequency. Colleagues from Singapore, a country with a large spike in Omicron infections following a relatively mild early pandemic, mention talking about long quiet Covid clinics without patients.
There are also indications that we may be getting closer to a more precise definition and treatment of long Covid. Numerous studies around the world have been set up to recruit groups with a long history of Covid to compare them to “rapid recovery” cases – people who have recovered quickly and completely from Covid – to try to find differences in levels of antibodies, hormones, immune cells, or other things that can be measured with a blood test. These so-called “defining biomarkers” can be a game-changer. They can help health departments define and refer cases, provide more complete evidence to employers and courts, and also point to the identification of therapies and treatments.
One of the first such studies was reported this month in a preprint by Akiko Iwasaki, David Putrino and colleagues at Yale. They report a clear biomarker delineating the differences in the long Covid group, with signals including low serum cortisol (a hormone involved in controlling the stress response) and evidence of latent Epstein-Barr virus reactivation. It’s not yet an outright diagnostic test for long Covid, but it expands our knowledge of exactly what’s going on behind the symptoms, as well as signaling potential treatments.
Despite some glimmers of good news, it bears repeating that long Covid continues to be a source of largely unresolved despair, particularly for long-haul ‘first wave’ runners aged two and over, unable to return to work and in many cases being overlooked by employers. The cruel irony of this is evident for a group of patients in which our much-lauded “frontline heroes” are massively overrepresented.
Long Covid remains a very real risk, but the best way to avoid it is to avoid getting infected (or re-infected) in the first place. The initially successful deployment of the vaccine in the UK in 2020-21 is ancient history in terms of the current battle. The BA.5 subvariant has so many immuno-evasive mutations that it is a distant relative of the ancestral strain of Sars-CoV-2 against which these early vaccines were generated. In any case, most people’s neutralizing antibody levels have declined to around baseline levels – or similar to unvaccinated levels – even if they are triply vaccinated. Hence the enormous burden of breakthrough infections and re-infections. There is a strong consensus around the pressing need for fall boosters.
Immunologists and vaccine producers have engaged in considerable debate about the complexity of ensuring that the next generation of variant-specific boosters are the best possible. At the international level, approaches have diverged. The United Kingdom has procured doses of a bivalent booster – that is to say targeted on two strains -, carrying the original and ancestral Sars-CoV-2 sequence as well as the BA.1 sequence, the variant Omicron who was with us at the end of 2021. In the United States, meanwhile, the government has ordered 170 million doses of a bivalent vaccine targeting the original ancestral Sars-CoV-2 sequence and the currently relevant BA.5 sequence.
Data from trials of these approaches are still thin. The current sentiment is that strengthening against BA.1 may not provide strong cross protection against BA.5. But the data for specific BA.5 boosters is also minimal. How much do these details matter? A Sydney team, led by Miles Davenport, analyzed data from eight other studies to model the effectiveness of variant-specific boosters. The data there is reassuring. Even the original first-generation booster is expected to increase protection against symptomatic infections over a six-month period by 50% to 85.6%. The new variant modified boosters, typically 1.5 times more powerful in terms of Omicron neutralization, would provide over 90% protection.
There will likely be differences between recalls once more studies are completed. But that complexity should never erode public confidence that you (and the clinically vulnerable people around you) will be safer this fall and winter with a booster, any booster, than without.
There should be no ambiguity about a comprehensive recall program. Indeed, it should not be forgotten that vaccination in the UK, at 80%, lags behind other European countries such as France, Italy and Portugal, with lower vaccination coverage biased towards groups lower socio-economics in which Covid-19 is often more severe. We need to increase vaccination coverage in unvaccinated people, along with a strong message from the government and the Joint Committee on Vaccination and Immunization that protection and normalization now depends on the widespread and effective deployment of the new boosters. Those following the data who are also concerned about protecting the clinically extremely vulnerable will also wear masks and maximize ventilation.
Danny Altmann is Professor of Immunology at Imperial College London, Trustee of the Medical Research Foundation and Long Covid Support, and co-author of The Long Covid Handbook
There is good news in the battle against the long Covid | Danny Altman