Back in late December 2021, with the Omicron BA 1 wave onslaught, the CDC came up with a five-day isolation policy with no evidence that it would prevent the spread of infection to others and no support for the need for rapid antigen testing. Indeed, many studies have shown that most people are still infectious after five days, with even rigorous evaluation showing the virus can be cultured from some people with Omicron infections in two weeks. Ending isolation by choosing an arbitrarily short period, with or without symptoms, and advocating coverage has undoubtedly promoted the spread of infections. By steadfastly continuing to support this flawed CDC guidance, our public health agency has failed its eponymous mission to control and prevent Covid disease. For more than a year, we have had strong evidence that the main line of Covid vaccines, consisting of two mRNA vaccines, does not provide sufficient protection due to waning immunity. However, the CDC refuses to change its definition of “fully vaccinated” as two shots. This not only ignores a large body of data, but gives many people the impression that a booster is unnecessary, which explains why the United States’ booster rate is pitifully low at 32% of the population, in stark contrast to most other 37 Organizations for Peer countries of Economic Cooperation and Development (OECD) with percentages exceeding 65%. The United States ranks below more than 70 countries, including Panama, Rwanda, Tajikistan, Sri Lanka, Uzbekistan and Iran. This is just the data for one booster, the third shot. As we progressed through the Omicron wave and its sub-variants, the need for a second amplifier became especially evident for those aged 50 and over. Five different studies, with different age groups from 50 to 80 and older, have shown significantly enhanced protection with less mortality for people who got four shots (two boosters) compared to three shots. But the rate of a second souvenir among Americans aged 50-64 is only 11%, and for those aged 65 and older it is 26%. If the CDC truly cared about protecting the vulnerable, they would make aggressive efforts to educate the public about the life-saving potential of a fourth shot and revise what “fully vaccinated” actually means, as evidenced by abundant data. All of this is consistent with the CDC’s reluctance to stand firm on the boosters mandate, not to fully approve them for adults until late November 2021. With the revised guidelines, the CDC continues to promote a contrived metric it calls a “community level” to “know the risk of serious illness.” As defined by the CDC website, this is “determined by the highest count of new admissions and inpatient beds, based on the current level of new cases per 100,000 population over the past 7 days.” This is not appropriate guidance, given that Americans would rightly be concerned about contamination without straining the resources of hospitals in their community. The right map of the United States is “community transmission” which simply reflects the number of confirmed cases in the last seven days by region. This map currently shows that 94% of the country’s population is at high risk of Covid transmission, while the community level map is only 39.7%. It’s a misleading way for the CDC to present a rose-colored spectacle of lower risk. This also unnecessarily promotes the spread of Covid to others, especially including the vulnerable, which it is supposed to protect. None the less, this further exacerbates the long-standing Covid toll, a condition millions of Americans are suffering from, due to the massive, rampant spread of the virus throughout the pandemic. When it comes to protecting more than 7 million Americans who are significantly immunocompromised, we have Evusheld monoclonal antibodies, for which two intramuscular shots prevent Covid for up to six months. The United States bought 1.7 million doses, but by the end of July fewer than 400,000 people had received that protection. That’s less than 6% of our immunocompromised population – the highest level of vulnerability – left unprotected. All of this is happening while the United States is still in the midst of a wave of BA.5, the most immune-evasive and contagious variant we’ve seen yet, now with over 100,000 new confirmed cases per day (the actual number is unknown, but much higher), over 40,000 people hospitalized and over 500 deaths per day. While we have reached a plateau in hospitalizations, there are no strong signs of a decline in these counts, other than some reduction in high levels of sewage Sars-CoV-2, so the duration of this wave is uncertain. We hope to be over the BA.5 wave by the end of August, as judged by the time it took for many European countries, which preceded it, to pass. Where does this take us in the coming months? In the United States there is only one other variant with significant growth, called BA.4.6, with a genomic sequence that reassembles BA.5, but has been shown to have the ability to escape Evusheld protection. Although it accounts for about 5% of new cases here at present, and in Australia, it may well continue to show a growth advantage and should provide some protection from the large number of people who have had BA.5 infections. In theory, the special BA.5 vaccine booster that may be available later this fall may provide better protection against BA.4.6 infections than the original vaccine, but this remains to be proven. The imminent rise of this variant, however, could extend the current wave. More worrisome is the prospect of a whole new family of variants like Omicron emerging in the coming months that have yet to appear on the genomic surveillance radar, but could pose a greater challenge to our vaccine and infection-induced immunity. So now is the time to prepare and stop the “leakage” of current vaccines – minimal protection or duration against current variants, despite good protection against serious diseases. This can only be achieved through building mucosal immunity, which is why Professor Iwasaki and I have called for Operation Nasal Vaccine. We must also proceed with a universal, mutation-resistant coronavirus vaccine that will preempt potentially pathogenic mutations of the virus rather than hunt down specific variants, the untenable strategy as the virus continues to adapt faster than our response. Predicting resistance to Paxlovid, which we rely heavily on in high-risk individuals, is necessary given the recent findings of multiple, naturally occurring mutations in the virus that could impair its effectiveness in the future. This calls for speeding up trials of backup pills or their combinations that stop the virus from replicating. All these measures do not imply any sense of relaxation against Covid. The CDC’s position that we must “live with Covid,” as advocated by its guidance, should be countered by exploiting the science and our clear potential to completely contain the virus, once and for all.
