Souvik Datta, Ph.D., Numair Arshad, Aakriti Kapoor, Lawrence D. Jones, Ph.D.* Corresponding author
10225 Barnes Canyon Road, #A207
San Diego, CA 92121
INTRODUCTION AND BACKGROUND
COVID-19 has been a public health menace for the past one and half years with healthcare crises and strained healthcare systems, across the world. There are a multitude of clinical trials ongoing involving a variety of therapeutics and vaccines, attempting to find a cure. Vaccine efficacies and proper coverage are imperative to attain herd immunity. Most people suffering from SARS-CoV-2 infection or coronavirus infections so far, have presented with mild to moderate symptoms. This blog reviews COVID-19 disease burden in September 2021, the ongoing research in its management, and the potential for development of herd immunity to COVID-19. In addition, response efforts, focusing on better management of this disease, will also be highlighted in this report.
According to the World Health Organization (WHO) report of September 2021, the prevalence of COVID-19 seems to have stabilized globally. Over the last few months, a substantial decrease in the number of death cases has been observed, especially in the second week of September. During the first week of September, the emphasis was on securing medical facilities in Vietnam as well evaluating the effectiveness of vaccine dissemination and treatment under the African Regional Monitoring of Vaccine Effectiveness (AFRO-MoVE) program in seventeen countries. For example, the number of new COVID-19 active cases have been increasing as Montenegro enters the peak of the summer tourist season, consequently RT-PCR testing has increased proportionally on all incoming travelers. . In the first week, all the regions of Southeast Asia, Africa, as well as Eastern Mediterranean, reported either a decline or a steady plateau state. Whereas, the Americas reported a 19% increase as compared to August . Although, the incidence of new mortalities declined in the rest of the world according to the official reports, the Americas and Europe, reported an increase in the death cases by 17% and 20%, respectively . The second week of September focused mainly on updating the global distribution of the different variants of concern (VOCs) - alpha, beta, gamma, and delta variants, and special surveillance of adolescent individuals as well as children .
Globally, there has been a continued decline in mortality as well as the new number of cases in the third week. Most of the southeastern region showed a drastic decline in the number of cases and mortality, especially in African and Mediterranean regions, while the Western Pacific region reported a 7% increase in the number of cases resulting in death. The Americas and the Europe reported a similar number of deaths compared to the previous weeks . In the final week, as of 26th September 2021, according to the WHO, there were reports of further decline in the global number of cases. Approximately 3.3 million new cases of COVID-19 were reported, compared with greater than 4 million reported new cases at the beginning of the month. According to the report, over 55,000 new deaths were reported during the final week which was a decrease of 10% in mortality compared with the previous week. The largest decrease in the new cases (17%) was reported from the Eastern Mediterranean region .
The U.S. is also starting to show a slowing in the number of newly infected cases of COVID-19. During the first week of September, the number of infected cases reached a peak which subsequently declined by the end of September . There are ongoing efforts to further reduce the death tolls from COVID-19. Guidance and new precautions have been emphasized and include without limitation, frequent and thorough washing of hands, wearing masks, not touching the face, confinement to the home where reasonably practical, and social distancing, particularly in confined spaces. Many of these protocols have been made mandatory in the U.S. However, some states have been reluctant to enforce the more extreme guidelines. In addition, restrictions on bar-visiting, bans on social gatherings, thorough decontamination of households along with practices of immediate testing, contact tracing, as well as quarantining the individuals exposed to the virus, have been made mandatory in many areas . Interestingly, one study has shown that the “Stay in Place” (SIP) order at state levels was successful in decreasing the compound growth rate of this disease with the largest impact on densely population counties of US . These persistent efforts have led to a reduction of new cases as well as a reduction in the death rate in the USA. To date, as of 30th September 2021, the USA has registered over 42 million infected cases, with 688,099 deceased cases .
FOCUS ON POST-COVID-19 CONDITIONS
There are diverse manifestations of COVID-19 with constantly emerging symptoms . There are adverse health consequences in pregnant women as well as infants and children who have become infected . The post-COVID-19 long-term effect (beyond four weeks or more) is an area of concern even for the asymptomatic and mildly ill groups of individuals. The post-acute COVID syndrome, long-haul COVID, chronic COVID, late sequelae of COVID, and post-acute sequelae of SARS-COV-2 infection (PASC), comprise the major adverse post-COVID consequences. The post-acute COVID syndrome is primarily defined as persistent symptoms along with long-term pulmonary, cardiovascular, renal, hematological, endocrinal, as well as, neuropsychiatric and gastrointestinal complications, presenting after 4 weeks from the onset of COVID-19 symptoms.
According to the literature, the post-acute COVID syndrome is further classified into two categories; subacute or ongoing symptomatic COVID-19 (symptoms present between 4 and 12 weeks after acute COVID-19), and chronic or post-COVID-19 syndrome (symptoms persisting beyond 12 weeks of the onset of acute COVID-19, without a differential diagnosis) . Such post-COVID conditions reflect a lack of return to the normal state of health, following acute COVID-19 illness. Furthermore, the conditions might also include the development of new or recurrent symptoms after acute illness symptoms have resolved. The Centers for Disease Control and Prevention (CDC) continues to explores the complexity of the COVID-19 infection and its concomitant complications . Although the vaccine decreased the risk of succumbing to severe outcomes of the disease such as respiratory failure, to date it has not helped the planet to achieve herd immunity. Factors such as poor vaccination uptake (reluctancy to take the vaccine) in many countries as well as the existence of deadly variants have made achieving global herd immunity more difficult [13, 14, 15]. However, vaccines are being made accessible to children, making it possible to protect a significant share of some countries' populations .
Food and Drug Administration (FDA) RESPONSE EFFORTS TO COMBAT COVID-19
As of September 2021, FDA has been continuously regulating and controlling the problems of false-positive results in the detection of SARS-CoV-2, by the Alinity m SARS-CoV-2 AMP or Alinity m Resp-4-Plex AMP Kits. . Under emergency use authorization (EUA), two prophylactic therapeutics were approved for use in post-COVID- 19 exposed adults and children aged twelve years and above (with at least 40 kg bodyweight), who were at high risk for hospitalization and death. These drugs are bamlanivimab and etesevimab, which must be administered in combination, under the recommendation, these drugs are not an alternative for COVID-19 vaccination. Vaccinations must be administered according to the established protocols. Considering the current emergency, FDA has also approved some batches of Janssen vaccines for use, as of mid-September. The agency further emphasized expanding the accessibility and availability of barrier face coverings, face shields, as well as face masks including surgical masks, and particulate filtering facepiece respirators (FFRs) such as the N95 respirators .
DIFFERENCE BETWEEN HERD IMMUNITY AND ENDEMIC STATE OF DISEASE
Herd immunity of a population is the endpoint of a pandemic when maximum individuals become immune by either developing natural immunity or through vaccine. Natural immunity stems from the inbuilt immunity of the body to fight against pathogens such as coronavirus. Whereas immunity through vaccines is a mode of inducing the body’s immunity by external stimulants such as antigens or antibodies. The exact percentage of the population which develops herd immunity is still a matter of intense debate (Figure 1).
When herd immunity is not reached, the disease becomes endemic, which means similar to seasonal colds and flu, the viral strains keep on circulating yearly but not to the same degree as in a pandemic .
It is likely that some prophylactic measures in the form of booster vaccines are required for an indefinite period to fight this disease. Even if herd immunity is attained, prolonged surveillance as well as booster vaccines will still be required. If certain areas of the planet fail to attain herd immunity, these areas may see the disease becoming endemic to their regions, but with lower infection rates than during the pandemic. Constant surveillance to keep the disease in check is expected. Clinical trials on repurposed drugs and vaccines are ongoing to address the management of patients, but social awareness and priority planning from policymakers on a regional and global basis to reduce the impact of this disease, is a necessary ongoing focus.
'Weekly operational update on COVID-19 - 6 September 2021'. https://www.who.int/publications/m/item/weekly-operational-update-on-covid-19---6-september-2021
'Weekly epidemiological update on COVID-19 - 7 September 2021'. https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---7-september-2021
'Coronavirus Disease (COVID-19) Situation Reports'. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
'Weekly epidemiological update on COVID-19 - 14 September 2021'. https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---14-september-2021
'Weekly epidemiological update on COVID-19 - 21 September 2021'. https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---21-september-2021
'Weekly epidemiological update on COVID-19 - 28 September 2021'. https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---28-september-2021
'United States of America: WHO Coronavirus Disease (COVID-19) Dashboard With Vaccination Data'. https://covid19.who.int
Shanmugam, R. et al. 'A Report Card on Prevention Efforts of COVID-19 Deaths in US'. Healthcare. (2021) 9(9), 1175. DOI: 10.3390/healthcare9091175.
Cobb, J.S. et al. 'Examining the effect of social distancing on the compound growth rate of COVID-19 at the county level (United States) using statistical analyses and a random forest machine learning model'. Public Health. (2020) 185, 27–29. DOI: 10.1016/j.puhe.2020.04.016.
Malcangi, G. et al. 'COVID-19 Infection in Children, Infants and Pregnant Subjects: An Overview of Recent Insights and Therapies'. Microorganisms. (2021) 9(9), 1964. DOI: 10.3390/microorganisms9091964.
Nalbandian, A. et al. 'Post-acute COVID-19 syndrome'. Nat Med. (2021) 27(4), 601–615. DOI: 10.1038/s41591-021-01283-z.
'Post-COVID Conditions: Information for Healthcare Providers'. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/post-covid-conditions.html
Zhang, S. 'What If We Never Reach Herd Immunity?' The Atlantic (2021). https://www.theatlantic.com/health/archive/2021/02/herd-immunity-might-be-impossible-even-vaccines/617973/
'Consumers are interested in a COVID-19 vaccine | McKinsey'. https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/covid-19-consumer-healthcare-insights-what-2021-may-hold
'When will the COVID-19 pandemic end? | McKinsey'. https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/when-will-the-covid-19-pandemic-end
Commissioner, O. of the. 'Coronavirus (COVID-19) Update: September 17, 2021'. FDA (2021). https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-september-17-2021
'What Is Herd Immunity—And Will We Reach It With COVID-19?' https://www.henryford.com/blog/2021/04/herd-immunity