Covid awareness: The virus remains a threat to many, even after the crisis years

While politicians and the public have moved on to other crises, such as climate change, the rising cost of living, and international conflicts, covid is still very much present, simmering away in the background.

Over the summer, the latest variant Eris emerged, once again driving new surges of infections, and experts such as Dr Gerald Barry, a virologist at University College Dublin, say it will continue to drive hospitalisations this winter among a minority of vulnerable individuals.

“Every week covid is associated with deaths, regardless of the variant, so with each wave, we would expect deaths to sadly continue and possibly increase,” says Barry. 

“Absenteeism from work and school will continue, and possibly increase as a result of SARS-CoV-2 infections and waves.”

All this is because covid is now endemic within our world, just as the viruses which caused the 1918 Spanish influenza and 2009 swine flu pandemics slowly assimilated into the general population, silently contributing to ongoing seasonal infections and fatalities.

When the Eris variant emerged, HSE’s chief clinical officer Dr Colm Henry clarified there would be no plans to reinforce mandatory mask-wearing within hospitals, but individual hospitals could set their own policies if covid rates were exceptionally high within their area. 

He urged all over-50s, those under five, those with weakened immune systems or other underlying health conditions, and healthcare workers to get the autumn booster vaccine to prevent health systems from being overwhelmed during the winter.

Yet the number of people ensuring their vaccination status is up to date, even in at-risk groups, has tumbled over the last two years. 

While more than 60% of the Irish population received the first booster jab, less than 10% have received the fourth one since it became available in the spring.

TCD immunologist Professor Luke O’Neill describes the biannual booster vaccines as society’s most important defence against covid and the continually evolving variants.

“This is very important — vaccination remains our best weapon against covid-19, as is the case with many infectious diseases,” Prof O’Neill says.

Other prominent covid experts, such as UCC biochemist Dr Anne Moore, emphasise how the overall situation has rapidly changed in the last two years. 

She recommends booster vaccines, saying they can offer protection to everyone and are vital for protecting the vulnerable. 

She also points out that most people now have a high level of immunity to the virus, having either been infected, vaccinated or both on multiple occasions.

Moore predicts that only a small proportion of the population, those most at risk from the virus, will continue getting regular vaccines and taking precautions.

“I don’t foresee the majority of the population getting a covid-19 vaccine,” she says.

“Similar to the influenza virus, only those at risk and their loved ones will be concerned enough to act. But as a society, we must support those at risk not to get the disease, respect decisions to mask, and avoid crowded environments.”

Living with long covid

According to a recent survey, more than 5% of adults in Ireland live with various forms of long covid, which can encompass abnormalities in multiple organ systems and symptoms such as chronic pain, brain fog and dizziness.

Many experts, such as Professor Akiko Iwasaki, a leading immunologist at Yale School of Medicine, believe that the longer-term symptoms could represent the pandemic’s most lasting and far-reaching consequence.

Our understanding of why long covid occurs is still limited, but Iwasaki is pursuing one particular theory — micro clots in the blood which may be driving the crippling fatigue that the majority of patients experience.

“These tiny little clots form in the blood and may be impairing oxygen exchange and other important functions of the circulation,” Prof Iwasaki says.

“People have done these measurements of how well the blood oxygen is being utilised by the body’s tissue and that appears to be quite limited in people with long covid and that could be due to these microclots.”

As a result, some researchers are investigating whether a combination of antiplatelet and anticoagulant drugs can reduce the prevalence of microclots in the blood and thus improve long covid symptoms.

Iwasaki has launched a clinical trial to see whether a 15-day course of an antiviral called Paxlovid could help alleviate symptoms in patients or eliminate remaining traces of the virus.

“We’re probing a hypothesis that persistent viral infection may be causing long covid in a subset of people,” she says. 

“As well as assessing how people feel after the treatment, we’re also looking to see whether there are biomarkers in the blood which can help identify who might benefit from this treatment.”

Immune system damage

While events of the past three years have yielded unprecedented information about how our body responds to the SARS-CoV-2 virus, many mysteries remain. 

In particular, scientists are still attempting to understand whether covid can damage our immune system and make us more vulnerable to subsequent infections.

Last winter, data from HSE showed a particularly high surge in cases of influenza and respiratory syncytial virus.

“There is evidence that SARS-CoV-2 infections can exacerbate other illnesses or health conditions so every wave is likely to contribute to a general increase in illness in our populations, but that may take years to manifest,” says Barry.

Barry believes it is essential for politicians to continue funding epidemiological research into the possible long-term consequences of covid in case it leads to unexpected spikes in chronic illness in years or decades to come.

Outbreaks of HIV, West Nile virus, and Japanese encephalitis have all been linked to an elevated risk of Parkinson’s disease in recent years.

There is also still a risk that over time, another covid super variant will emerge, capable of circumventing the current immune protection offered by vaccines and once more increasing the virulence of the virus.

“Covid will continue to evolve, and this evolution may be associated with increased or decreased illness,” says Barry. 

“It is impossible to predict at this point. All we can say is that this virus is continuing to learn how to infect and move between people and will continue unless we develop a therapy to stop it.”

ABOVE all, experts agree that another pandemic is inevitable, and it will happen sooner rather than later due to factors such as climate change and global connectivity. 

Moore says we can reduce the potential harm by committing funding towards isolating potential viral threats before they become established in the population and developing new generations of vaccine technology.

However, she is concerned that political inertia and public debate around vaccines could mean we will be just as vulnerable as we were to covid-19.

“A number of vaccines are being developed, ready for use, that aim to protect against multiple strains of viruses,” she says.

“From a scientific perspective, we can prepare, if we commit and invest in these resources. The problem is that government commitments wane after an emergency, and I don’t know how political, cultural, and societal issues will affect a population’s response to the next pandemic.

“We can have all the scientific and medical tools available, but they are of zero use if the population rejects them.”