As 2021 ended and 2022 began, the COVID-19 pandemic kicked into high gear yet again with the advent of the highly infectious Omicron variant. The US and many parts of the world saw a resurgence in individuals struggling with COVID-related respiratory issues in their homes and in hospitals, which were often hammered with patients while also experiencing staffing shortages. As people gathered with extended family and friends to celebrate holidays, home COVID tests became a hot and often elusive commodity.

Pulmonology Advisor looked to leading physicians who treat patients with COVID-19 for their views on the most important pandemic- and virus-related developments in 2021 and what lies ahead in 2022.

Triumphs of 2021

Vaccines are the greatest COVID-19-related triumph of 2021, said Ryan Maves, MD, Chair of the American College of Chest Physicians COVID-19 Task Force, in a recent interview with Pulmonology Advisor. Dr Maves is also an infectious disease and critical care specialist, and a professor of medicine and anesthesiology at the Wake Forest School of Medicine.


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“The rapid rollout, widespread availability, and still high level of protection against severe COVID-19 from the currently available MRNA vaccines is one of the great public health and scientific triumphs of our lifetimes,” said Dr Maves.

“The dark side” of this triumph is the level of resistance to vaccination, as well as “the ongoing pandemic of misinformation” about vaccines, including “the refusal of some media figures and politicians to accept vaccination and to advocate for vaccination,” added Dr Maves, “That is not something I saw coming.”

Although the “anti-vax” movement in the US predates the pandemic, said Dr Maves, that movement has changed significantly. “The demographics and the political leanings of the people opposed to vaccination were very different than the groups currently refusing vaccination, and that was also a surprise to me,” he said.

The many research studies initiated and published on the virus represent another incredibly important achievement of 2021 that is ongoing. “The science of COVID, at least from a clinical trial standpoint, really came into maturity in 2021. We no longer were relying on case theories and observational studies and anecdotes to guide care, but instead could start relying on large, well designed, well reported peer-reviewed clinical trial evidence to make decisions at the bedside.”

What Clinicians Can Do Now

For the present, Dr Maves points out that influenza season will still be here for several more months and it’s important for clinicians to continue advocating for the influenza vaccine, as well as for the pneumonia vaccine for patients over the age of 65 and for younger patients with certain chronic conditions. Indeed, January has seen increasing reports of “flurona,” where individuals experience COVID-19 and influenza at the same time.1 Such cases have been detected not only in the US, but also in several other countries, including Brazil, Israel, and the Philippines.

Clinicians have a key role to play in persuading their patients to get these vaccines, said Dr Maves. “Risk reduction is important,” he stressed. “Think of [it] as a package of vaccines to reduce the risk of respiratory infection, hospitalization, and death,” he said, adding: “It’s untrue that if you are not going to get the flu shot there is no point in getting the pneumococcal vaccine. I’ll take what I can get. But then I think we have to continue leveraging our relationships with our patients to persuade them.”

Looking into the future, Dr Maves also said that unlike SARS-CoV-1, SARS-CoV-2 will be an endemic disease that the world will have to contend with for a very long time.

Potential Scenarios for 2022

What lies ahead in 2022 and beyond with respect to the COVID-19 pandemic? Peter Hotez, MD, PhD, professor of pediatrics and molecular virology and microbiology and dean of the National School of Tropical Medicine at Baylor College of Medicine, outlined some likely scenarios in a recent Op-Ed in last month’s Los Angeles Times.2

With the Delta and Omicron variants causing massive spikes in COVID-19 cases, and the country’s health care force exhausted, the near future does not look bright, he noted. Recent projections from the Institute for Health Metrics and Evaluation indicate that the US may reach 900,000 COVID-19 deaths in March; at that point, however, the spike in deaths is projected to flatten out.3

Additionally, Dr Hotez pointed out:

1) Booster shots might not protect for very long. “While the British government estimates the current vaccine effectiveness against Omicron around 70% to 75% against symptomatic illness after a booster,[4] this may represent the best case scenario,” he wrote. “Preliminary data [that is yet to be peer-reviewed] in a preprint from the Institute of Medical Virology in Frankfurt, Germany, suggests that the levels of virus-neutralizing antibody to the Omicron variant falls sharply just a few months after boosting.[5] The study is a small one in terms of number of subjects (and of course, it must be replicated) and there are other parts of the human immune response that could provide protection against severe disease even if neutralizing antibodies fall, but it could mean that the effect of boosting is not long lasting against Omicron infections,” Hotez wrote. Notably, 3 other preliminary studies seem to support this preliminary finding, according to a news article published online by Nature last month.6 Consequently, said Dr Hotez, health care workers might need a fourth shot.

2) Since the start of the pandemic, 18% of health care professionals (almost 1 in 5) have quit or left the profession, according to the data intelligence firm and website Morning Consult.7 Dr Hotez said that it’s “reasonable to expect” this trend to continue, and even those health care workers who don’t quit may burn out on treating COVID-19 patients. “As Britain faces the Omicron rise, the Sunday Times of London reports that traumatized National Health Service workers are saying they won’t go back to COVID wards,[9]Dr Hotez wrote. Americans should anticipate this possibility as well, he warned.

References

1. Hassan J. What is ‘flurona’? Coronavirus and influenza co-infections reported as omicron surges. The Washington Post. Published January 5, 2022.                           

2. Hotez P. Op-Ed: How can we prevent a second winter of despair with Omicron? Los Angeles Times, December 17, 2021.

3. Institute for Health Metrics and Evaluation. COVID-19 Projections. Updated January 8, 2022. Accessed January 13, 2022.

4. UK Health Security Agency. SARS-CoV-2 variants of concern and variants under investigation in England: technical briefing 31. Updated December 10, 2021.

5. Wilhelm A, Widera M, Grikscheit K, et al. Reduced neutralization of SARS-CoV-2 Omicron variant by vaccine sera and monoclonal antibodies. medRXiv. Published online December 8, 2021. doi:10.1101/2021.12.07.21267432

6. Callaway E. Omicron likely to weaken COVID vaccine protection. Nature. Published online December 8, 2021. doi:10.1038/d41586-021-03672-3

7. Galvin G. Nearly 1 in 5 Health Care Workers Have Quit Their Jobs During the Pandemic. Morning Consult. Published online October 4, 2021.

8. Lintern S. We won’t go back to Covid wards, say traumatised NHS staff. The Sunday Times. Published online December 12, 2021.