Kevin Kavanagh, MD

COVID-19 mutations are evading our immunity and at the same time our immunity is waning. Herd immunity to disease and the eradication of SARS-CoV-2 is no longer possible.

Contrary to the “vaccinate and all will be well” narrative, “mild” does not mean just avoiding hospitalization, nor does surviving a COVID-19 acute illness means you have recovered. Vaccines are an important layer of armor but they, in themselves, will not stop COVID-19.

Animal infection sets the stage for an independent evolution of SARS-CoV-2 which, after an extended evolutionary period, can jump back to humans causing disease with an unpredictable infectivity and case fatality rate.

We may need to pivot to the strategy adopted by Singapore, to have voluntarily unvaccinated individuals to pay at least a portion of their care. It is very easy to act irresponsibly when others are funding your safety net.

Infectivity causes more harm and deaths than lethality and in the case of Omicron more than makes up for its somewhat milder infections in immunologically naive individuals.

SARS-CoV-2 causes a system infection and is commonly detected in the heart and brain, exemplified by the loss of smell from brain tissue destruction and loss of cardiac function from myocarditis.

Omicron can significantly avoid immunity created by both prior infections and vaccines, and younger people and people of “African ethnicity” have higher rates of infection with Omicron than with Delta, says a new study.

Even though Omicron may not have as high of a fatality rate, its infectivity being 3 times higher than the Delta variant creates a grave risk to nations. Overstressed health care systems may collapse.

Omicron poses a grave risk to the US health care system. The US has a low rate of vaccination and obtaining boosters, and a relatively large segment of our population is elderly or immunocompromised. A 2-dose mRNA vaccine's immunity appears to rapidly wane and unlike South Africa, many in the US were fully vaccinated very early in the pandemic.

Only a small percentage of the Omicron variant of COVID-19 cases require hospitalization so far, but high infectivity may turn this small percentage into a large number of patients, which will further stress our health care system.

The looming surge from the Omicron variant may well have a lower case-fatality-rate but its high infectivity will further strain our health care system and fill our hospitals.

If the infectivity, lethality, and immune avoidance of the Omicron variant is confirmed, it will be of utmost importance that all who can, become vaccinated. In addition, antiviral medications will become of prime importance.

There is growing evidence that fully vaccinated should be defined as having 3 doses of an mRNA vaccine.

If smallpox reemerges, it could be devastating with its 30% fatality rate and an ability to spread comparable to the Delta variant of COVID-19.

Many believe that super immunity can develop in those who have had SARS-CoV-2 infections and have become vaccinated. Meanwhile, fully vaccinated might mean getting 3 doses, not 2.

As of today, the outlook is very good and the pandemic is on a trajectory of burning out, but there are valid concerns which require that we continue our vigilance and public health strategies.

The term “mild COVID-19” is an oxymoron. The devastating long-term effects of long COVID, along with future emergence of cardiovascular disease in those with minimal initial symptoms, reminds us that all SARS-CoV-2 infections may pose grave dangers to those who contract the virus.

Unlike influenza, SARS-CoV-2 uses ACE2 receptors to infiltrate cells. Similar to HIV, SARS-CoV-2 can silently spread throughout the host’s body and attack almost every organ.

Even if not hospitalized, COVID-19 often produces the most severe infection individuals will experience in their lifetimes and can produce lasting symptoms of fatigue, weakness, brain fog and cardiovascular damage.

Health care workers know all too well the lasting and debilitating effects of long COVID-19. They were one of the first to become vaccinated and are some of the first experiencing breakthrough infections. They are tired, burned out, and many are on the brink of collapse.

Some medical experts say that in this case, inaction is also an action—either the US gives boosters or does not. That decision needs to be based on the best available evidence. Instead, there seems to be a desire to wait another 6 months for pristine randomized controlled studies.

The further away from an infected person you are, the less likely you are to contract the disease. But you are still not safe at 6 feet. The virus is airborne and can spread much further to the back of the classroom.

After the Delta surge subsides, another surge is expected, possibly from the Mu variant. If Mu completely escapes immunity from vaccines and past infections, we must resort to stringent public health strategies.

In Beijing the total cases in an outbreak were reported to be less than 10. China used over 100 million tests to eradicate what would be classified as a very small outbreak by US standards.

In the Middle Ages a pandemic wiped out 50% of the world’s population. Presently we have a much higher population density, making us a feeding buffet for infectious disease…. If we do not follow the recommendations of modern science and public health, we are no better off than if we were living in the Middle Ages.

Herd immunity is no longer possible, the virus is mutating and likely has animal hosts. We must raise the bar on public health outcomes, not only focusing on deaths but also morbidity and long-hauler syndrome which can be all too common, even occurring with vaccine breakthrough infections.

A CDC investigation shows 2.3 times the number of reinfections with natural immunity compared to breakthrough infections in those who are vaccinated.

While not perfect, the mRNA vaccines do markedly reduce the chances of hospitalizations from critical disease and death. This is a huge plus.

Data collected by Britain’s Scientific Advisory Group for Emergencies, Japanese researchers, and the US Department of Agriculture paint a picture of a growing challenge.

Should older people get boosters? The data from Israel indicate that this needs to be given strong consideration in those above 60 years old who were fully vaccinated by the end of January.