These days, headlines heralding some hopeful — or horrifying — new finding about the coronavirus are multiplying nearly as fast as the bug itself. To help you get a better handle on the latest things we’ve learned about COVID-19, and our prospects for vanquishing it, Intelligencer is assembling periodic rundowns of all the good and bad news that’s come our way. (You can check out last month’s list here.)
Critically, all research findings described here are preliminary. Humanity still has limited experience with the virus formally known as SARS-CoV-2. Our understanding of it is partial and subject to change. So take the following with a grain of salt (but not, under any circumstances, an unprescribed dose of hydroxychloroquine).
The good news.
1) COVID cases in the U.S. are declining — and the absence of a resurgence of cases in hard-hit New York City suggests the threshold for effective herd immunity may be lower than previously assumed.
America’s coronavirus epidemic is still far from contained, with new daily confirmed cases hovering between 35,000 and 45,000 a day over the past week. Throughout much of the Midwest, cases and test positivity rates are rising. And there are some reasons to fear that the virus could pick up steam as autumn arrives (more on those later). But for the moment, America’s rolling seven-day average of confirmed COVID-19 cases has been falling since the last week in July. Despite implementing only limited economic restrictions, Texas, Arizona, and Florida have all managed to curtail outbreaks that had been growing exponentially in early summer.
Most promisingly, New York State saw only two days with double-digit COVID-19 deaths throughout the entire month of August. And in New York City, the seven-day rolling average of new COVID-19 cases now sits at just 147, the lowest that figure has been since March 12. Which is to say, NYC has managed to “crush the curve” of infection while reopening outdoor dining and nonessential retail, maintaining the nation’s largest mass-transit system, and hosting some of the largest anti-racist protests in its history.
This is partly attributable to exceptionally high prevalence of COVID-19 antibodies among the Big Apple’s population. And yet, serological studies suggest that the percentage of New Yorkers with such antibodies lies under 30 percent, whereas the level necessary for achieving natural herd immunity had been pegged at 60 percent. Thus, the fact that New York’s limited reopening has produced no uptick in infection whatsoever suggests that the threshold for effective herd immunity might be lower than initially thought.
This notion is buttressed by recent research indicating that a significant portion of humans who have never been exposed to the novel coronavirus — but who have had run-ins with the common-cold coronavirus — possess T cells (or, more rarely, antibodies) capable of quickly neutralizing either bug. The science is far from settled on precisely how effective this “cross-reactive” T cell response is, much less on exactly what percentage of the public has them. But it does appear that the population susceptible to coronavirus infection was always lower than 100 percent.
None of this means that New York can safely reopen its bars and indoor restaurants tomorrow. It does mean, though, that existing levels of immunity in both NYC and the U.S. are likely higher than they look — and thus, that vaccinating a significant minority of the population, while retaining mask-wearing requirements, may be sufficient to facilitate a return to normalcy long before 60 percent of Americans have been infected with or inoculated against the coronavirus.
2) You might be able to take the vaccine up your nose.
In July, a Yahoo,News/YouGov poll found that only 42 percent of Americans plan on taking a coronavirus vaccine when one becomes available. Some sources of majority aversion to vaccination may be incurable (tinfoil hat libertarianism has long been endemic in the United States). But to the extent that the public’s disinclination for inoculation is rooted in fear of needles, we may be in luck: A new study from the Washington University School of Medicine has found that a nasal form of a SARS-CoV-2 candidate vaccine proved more effective in mice and monkeys than an injected version of the same substance.
If this finding holds up — and proves applicable for whichever vaccine first secures FDA approval — then it might be possible for Americans to self-administer the vaccine, thereby mitigating the logistical challenges to its mass dissemination.
3) It is possible that giving COVID patients interferons could reduce the severity of their disease.
There are many reasons why COVID-19’s fatality rate has fallen in the United States. But one is that doctors have gotten better at treating the disease as they’ve gained familiarity with its effects. And soon, they may have a few more therapeutic tools at their disposal.
In recent months, multiple research teams have concluded that the coronavirus represses the production of interferons. These immune proteins are the body’s frontline defense against infection, serving as both a direct impediment to a virus’s progression through its life cycle, and as the body’s lookouts, calling forth squadrons of killer T cells at the first sight of a viral invader.
The discovery that the novel coronavirus has a knack for sidelining interferons presents a promising path toward a potent treatment. If doctors can provide COVID-19 patients with interferon injections early in their infections, it is conceivable that severe illness could be averted. Further, interferons are already commonly prescribed for the treatment of a range of ailments, including multiple sclerosis, so it should be relatively easy to make such a treatment widely available.
This said, while supplementing the body’s innate supply of interferons would, in theory, seem helpful in for virtually any infection, it’s shown only limited efficacy in practice. And the existing research suggests that an infusion of interferons would be most useful to coronavirus patients early in their ailments, possibly well before the typical patient will arrive in the hospital.
4) Recent events on a U.S. fishing boat indicate that antibodies protect COVID survivors from reinfection.
One nightmare scenario that has long haunted discussions of the pandemic’s prognosis has been the possibility that COVID-19 antibodies do not actually confer resistance to reinfection, even over a relatively short time horizon. For a while now, we’ve had a solid basis for believing this fear is misplaced, including studies demonstrating that COVID-19 antibodies protect animals from reinfection. But until last month, we lacked direct evidence that antibodies do humans the same favor.
Our newfound reassurance comes courtesy of a fishing vessel that set sea from Seattle in May 2020, only to fall prey to a massive COVID-19 outbreak shortly after it left shore. By trip’s end, 104 of the crew’s 122 members had contracted the virus. Happily, virtually the entire crew had been tested for the presence of COVID-19 antibodies before their voyage. Looking back at the results of those tests, researchers at the Washington School of Medicine in Seattle discovered that all three crew members who had tested positive for COVID antibodies before setting sail were among the minority of seafarers who evaded infection on the water. This is statistically significant enough to serve as confirmation that COVID antibodies do, in fact, protect humans against reinfection, even in the most unfavorable of circumstances.
The bad news.
1) That said, it is still possible to become reinfected with the novel coronavirus for a second time in four months — if you are exposed to two different strains of the virus.
Anecdotal reports of apparent COVID-19 reinfections have been around since the pandemic’s early months. But subsequent research revealed these to be false alarms: Individuals were testing positive for the coronavirus months after recovering from COVID-19 because the tests they were using could not distinguish between the RNA of a live virus, and that of inactive virus fragments that linger benignly in the body long after recovery.
Researchers at the University of Hong Kong have now identified an individual who was genuinely infected twice in the space of four months — albeit, from two disparate strains of the coronavirus. The man did not develop symptoms from his second infection, suggesting that he retained some immunity to the virus, even in slightly altered form. Still, that example suggests that individuals who have been infected with one strain of coronavirus can potentially serve as spreaders of another. It seems unlikely that this will have significant public-health implications; the fact that it has taken this long to confirm a single instance of reinfection arguably constitutes good news. But it nevertheless renders the threat of a coronavirus mutation limiting the efficacy of a vaccine a bit more concerning than it was when we had zero confirmed cases of reinfection.
2) Turns out, it’s difficult to keep feral young adults living in group housing from spreading infection.
America’s colleges and universities have just begun opening their doors, and the New York Times has already linked more than 20,000 COVID-19 cases to their campuses — which means that there is a decent chance our nation’s bastions of enlightenment and wisdom will breathe new life into the pandemic this fall by prioritizing solvency over reason.
3) Getting from an approved vaccine to herd immunity may be twice as hard as previously thought.
Some vaccines are a one-shot deal. Others, like those for chickenpox and hepatitis A, require multiple doses to confer immunity. At present, both of the coronavirus vaccine candidates that have made it to phase three trials in the U.S. fall into the latter category. In Moderna’s trial, volunteers are injected with the substance twice, with four weeks of lag time between the two inoculations; in Pfizer’s, that interim is 21 days. Johnson & Johnson plans to use its phase three trials to test its vaccine’s efficacy in both single and double doses. So it remains possible that the first vaccine to secure FDA approval will be a one-and-done affair.
But for the moment, it looks more likely that getting a vaccine into the blood of a critical mass of the American public will require surmounting roughly twice as many logistical and political obstacles as authorities had bargained for. America’s efforts to distribute PPE and tests in a timely fashion were stymied by supply-chain bottlenecks. Securing the syringes, vials, droppers, and doses necessary to rapidly disseminate a vaccine to hundreds of millions of Americans would be a tall order, even if each recipient only needed to take it once. Similarly, convincing the public to take time off work, stand in line, take a needle in the arm (or, fingers crossed, a spray up the nose) twice — when early trials indicate that the vaccine is not painless, and could trigger mild cold-like symptoms in many users — may be more than our nation’s paranoid individualism can abide.
4) The U.S. president is still a madman advised by sycophantic knaves. After hosting a social-distancing-free convention on the White House lawn, President Trump has reportedly mulled scaling up his efforts to ease the coronavirus’s spread (for imagined political gain) from sea to shining sea. The Washington Post reports that White House pandemic adviser Scott Atlas has been pushing the president to embrace a strategy of encouraging America’s young and healthy residents to shop, eat, and fraternize with abandon — while the elderly cower at home — to accelerate herd immunity. Atlas, a former neuroradiologist and conservative think-tanker, has no epidemiological expertise. Rather, he has become one of the president’s top advisers on a world-historic crisis “by advocating policies that appeal to Trump’s desire to move past the pandemic and get the economy going.”
Given what we’ve learned about the potential for COVID-19 to cause durable health problems in young and healthy people, the fact that multiple vaccines are in phase three trials, and polls showing an overwhelming majority of Americans do not want schools to reopen without restrictions (let alone the whole country, save senior centers), Atlas’s plan makes little public-health or political sense. But of course, one could say that about a great many things that this president has done since the pandemic began.
5) The pandemic is seeding a global hunger crisis that could end up killing more people than COVID-19 itself.
The United States boasts more wealth and fiscal capacity than any major nation on Earth. It has managed to spend trillions on economic relief programs without incurring significantly higher inflation or borrowing costs. Even so, child hunger in the U.S. has skyrocketed since the pandemic’s onset.
Children in the developing world have fared even worse. COVID-19 has brought about the first truly global economic crisis since the Great Depression. In poor countries reliant on tourism or commodity exports, workers have suffered catastrophic losses in income. Meanwhile, food-distribution systems have broken down. In the U.S., agricultural producers who are accustomed to servicing restaurants have seen demand plummet. Lacking the infrastructure and relationships to get their wares into grocery-market aisles, farmers have been dumping great quantities of rotting milk and eggs.
Put all this together, and you end up with the worst hunger crisis the world’s seen in a generation, and one that is playing out under the perverse condition of agricultural abundance; there is plenty of food, but great swaths of humanity lack the funds necessary to purchase it.
As a result, COVID may increase the ranks of the world’s hungry by 132 million this year, according to Bloomberg. An Oxfam International report suggests that, by year’s end, up to 12,000 people could be dying from hunger each day.
