University of Virginia immunologist and COVID-19 researcher Dr. William Petri continues to answer reader questions about COVID-19. Send your questions to Lynne Anderson at email@example.com, and she will forward them to Dr. Petri.
1. Question: UVa’s first COVID-19 patient was admitted to the hospital almost two years ago. Can you explain a little bit about what the process was like as researchers and doctors tried to learn about the virus? It seems like so much happened so fast.
Answer: Two years ago it was clear to me from Wuhan, China that severe COVID-19 was due to the immune response to the virus making things worse instead of better. Acting on that hunch, in March of 2020 my clinical research coordinator Jenny White got permission from the human subjects review panel at UVa to measure that immune response that caused lung failure. We did that by using “left-over” blood test samples (every time you have a blood test there is a tiny bit left over that is normally discarded). Mary Young from my lab went every day to the clinical lab and collected these leftovers throughout the lockdown. Dr. Mayuresh Abhyankar in our research group measured the immune response and Allie Donlan, as a graduate student discovered that an allergic immune response, known to damage the lungs in asthma, was also a problem in COVID-19. Allie proved this in a mouse model of COVID-19 with Dr. Barbara Mann who directs the biosafety level 3 lab at UVa. The visionary philanthropist Paul Manning from Charlottesville stepped forward to financially support a clinical trial at UVa of the allergy drug dupilumab. Dr. Jen Sasson, an infectious diseases fellow in our group, designed and led the clinical trial. Amy Warren and Lori Elder in the Clinical Trials office got approval from the FDA, and clinical research coordinators Heather Haughey and Rachael Coleman were hands-on for the study. Most importantly, 40 members of our community hospitalized with COVID-19 graciously agreed to participate in the study. Their trust in us, and their commitment to help the next person with COVID-19, continues to inspire me today. We just finished the study and now have evidence that the allergy drug dupilumab is safe and appears effective for treating COVID-19. The next step is to plan and run a study that is ten times larger to confirm this. To me, to go from a new illness to understanding what causes it, to having a treatment in two years is both amazing and a testament to so many at UVa working together towards a common goal. And all of these contributions to the global pandemic are happening in our little community!
2. Question: I keep reading about a second booster for older people. Is that something that the CDC is likely to recommend? What are your thoughts?
Answer: A second booster for adults is likely. The reason is that the protection from the first booster begins to diminish after about four months, from 90% to 70%, as reported in a study published by the CDC COVID-19 Emergency Response Team. A fourth booster works: a clinical trial from Israel published in the New England Journal of Medicine last week demonstrated that the second booster increased anti-Spike neutralizing antibodies 10-fold, and decreased new omicron infections modestly from 25% to 18% in the month after. This was in a relatively young group of 450 healthcare workers, so I would expect older individuals to benefit more. Because of these studies, Pfizer and Moderna have this month requested FDA Emergency Use Authorization for the second booster for those over 65, and for all adults respectively.
Don’t forget that a fourth dose (second booster) is already recommended by the CDC if you are immunocompromised. Immunocompromise includes those receiving active cancer treatment for leukemia or lymphoma, organ or stem cell transplants, those receiving 20 milligrams or more of prednisone a day, and for primary immunodeficiency, such as DiGeorge syndrome or advanced HIV infection.
3. Question: With omicron wreaking havoc in Hong Kong, does that mean we are not done with omicron?
Answer: My impression is that we are way better off than at any time since the pandemic, but not free and clear. The BA.2 variant of omicron, which is more infectious than the original omicron, is doubling as a proportion of all COVID-19 infections in the U.S. every week, currently at one out of every four infections. However, COVID cases in the U.S. continue to decline, currently the lowest they have been since last June 2021, although very sadly still with 1,000 daily deaths. Locally transmission levels have fallen from the high level we saw this winter to low according to the CDC, so there is no longer the requirement for masking in public spaces. All good news. The cloud on the horizon is that in the United Kingdom, new cases are up 80% in the last two weeks due to the BA.2 variant. Usually the UK is a month ahead of us with all things COVID-19, so I expect that we will see an increase here as well in the late spring or early summer.
4. Question: Lots of high-profile people are being diagnosed with COVID. I get the feeling that we are not really out of this. Did the CDC change its guidelines too soon?
Answer: I think the CDC is doing a good job with leading us through the pandemic, and with low transmission levels it makes sense to loosen guidelines. Stay tuned as CDC guidelines may change, appropriately so, if we get a BA.2 wave in Virginia. I also agree with you that infections are still happening. I think we all have friends and acquaintances who have been omicron infected this month. And there are still eight members of our community in the COVID-19 ICU and 18 in the acute care ward at UVa. So we are likely not out of this yet, with I anticipate another wave of infections due to the BA.2 variant sometime in the next few months. However, transmission levels locally, and in most of the U.S., are at a low level, which allows loosening of mask and social distancing recommendations. I myself am trying to be cautious but not overly so, wearing my mask at the grocery store, but think it ok, having been vaccinated and boosted, to have coffee indoors with my friends after our morning runs.
5. Question: Should we be afraid of BA.2?
Answer: If you are vaccinated and boosted, not really. The good news is that we are seeing an overall decrease in all COVID-19 infections despite the weekly increase in BA.2 in the U.S. By way of background, BA.2 is a sub-variant of BA.1 which is the original omicron variant from Africa. BA.2 has a few additional mutations, but there is a great deal of cross-immunity, so that an infection with omicron BA.1 provides protection from BA.2. This immunity is likely why BA.2 is not more of a problem. Studies from Japan also indicate that it is not more deadly than BA.2. It is, however, more infectious than even the original omicron, which to me seems incredible as omicron had been the most easily spread infection ever seen. So what is happening in the UK now is that vulnerable members of the population are being infected with BA.2 as mask restrictions have been lifted. Let’s pray that does not happen here.
6. Question: The CDC’s shifting guidelines are confusing. I understand that much of the shift is due to a change in science, but can’t they do something to set the information straight? How do we know whom to turn you – besides you?
Answer: I agree that it has been a lot to take in, as the CDC guidelines have changed almost monthly as we have learned more about this infection. The good thing is that these guidelines are based on the best scientific evidence that is available at the moment. I rely heavily on CDC advice and on the research that the CDC and the NIH support, through all of our taxpayer dollars. The CDC is pretty transparent, and you can go to their web pages which are frequently updated with links to the evidence supporting the recommendations. For example, one can find the COVID-19 transmission level for any city or county in the US through their web page, and know what level of masking is needed. There is also wonderful information about vaccine boosters and treatments. The NIH and the WHO also have great web-based resources. And thank you for your kind words! It has been rewarding for me to be able to contribute to the fight against COVID-19 through education as well as research and clinical care. All of us that are infectious diseases specialists have trained our entire careers to respond to this, while hoping that it would never happen. And I think it fair to say that no one in our profession anticipated that if a pandemic happened, that it would be anywhere nearly as severe as COVID-19 has been.