When Will COVID End?

David Hamer, a BU School of Public Health and School of Medicine professor of global health, discusses the future of the pandemic, what must happen next for the coronavirus to become more of a seasonal virus, and if annual booster shots will be a key step. 

For more information, check out Hamer's recent interview with The Brink,  “Myths vs Facts: Making Sense of COVID-19 Vaccine Misinformation,” where he debunks widespread myths about the vaccines, the Delta variant, and more.

Transcript

Dana Ferrante: This is Question of the Week, from BU Today. 

When will COVID end? In this episode, Doug Most talks to David Hamer, professor of Global Health and Medicine at the Boston University School of Public Health and School of Medicine, about the trajectory of the pandemic and whether annual COVID-19 booster shots will be needed.

Hamer, who also serves as a faculty member at NEIDL, or BU's National Emerging Infectious Disease Lab, also explains why we must do more to control COVID-19 transmission around the globe.

Doug Most: Our question this week is actually a question a lot of people are thinking about these days, especially with school starting up again: when will COVID end?

David, thanks for joining us.

David Hamer: Thank you for having me Doug. This is a question that many people have, and there's no easy answer to. You know, the challenge with COVID is this is not a—at least the virus that causes SARS-CoV-2—it's not gonna disappear. I think we're going to have to learn how to live with it.

Coronaviruses, historically, we have had four coronaviruses that cause seasonal outbreaks usually in the fall, winter of respiratory disease, usually upper respiratory, they come and go. People develop some immunity, but you can become reinfected and the RNA viruses have evolved over time.

Most: Can you just help us understand some of these other viruses like SARS?

Hamer: [SARS-CoV-1] came and went, but we were able to control that. And we don't fully understand how...I think the control measures seemed to contain it, and then it just disappeared. And that was fortunate. The Middle East Respiratory Syndrome, MERS Coronavirus, is still with us. It was recognized around 2014, and it still is causing sporadic outbreaks, and that has very different epidemiology because it infects camels.

So it's going camel to human, or human to human after that. So that's another one where I think it's just gonna be with us, but it's going to be sporadic, and probably limited to places where people have contact with camels, or transmission in health care centers after that.

Most: So what does that mean when you say, we just have to learn to live with it?

Hamer: The SARS CoV2 is different, it's the cause of global pandemic, is still causing major outbreaks in different parts of the world, it keeps evolving. And I think that with time if we reach higher levels of vaccination, if we figure out how to best strengthen the immune response, which may be boosters with original vaccine, it may be boosters with a modified vaccine that targets the circulating spike proteins, or variants of concern, or variants of interest, that are around at the time that we will be able to better contain it in.

And hopefully get it to a point where we're routinely looking for it, and we have a response where we test for it frequently, we isolate people, we basically contain it with containment measures, that becomes more of a seasonal respiratory virus like influenza it is. It may be that it will sort of have cycles, where it becomes worse again and we'll have to put masks on and be cautious with indoor events, and then control again, and then things will be fine for a while and then we have another surge.

So I think we're gonna need to be both proactive in terms of vaccination, but also reactive in terms of testing, isolation and quarantine, and increased, as they’re called non-pharmaceutical interventions, things like mask use, closing down businesses, working remotely, and so forth. I don't think it's gonna go away, that's sort of the short version.

Most: So it sounds like you do see us getting a seasonal shot, but it's not clear yet if that means actually annual booster shots.

Hamer: I, and some other medical epidemiologists that I've spoken with, believe that this will become seasonal and it would make sense, many respiratory viruses are more commonly seen in the fall/winter.

And so far it's been sort of hard to tell. I mean, yes, last winter, we had a big surge in the fall into the winter, and then it quieted down in the spring, but then it came back again in the summer, and that was really because Delta [variant of COVID-19] began to circulate.

And so I think, every time I think [that] we're okay, we're getting to a season where there should be less transmission, there's another wave, so that's one challenge. I think in terms of boosters, annual boosters, I'm not sure yet whether that will be necessary, that may become necessary, but it also maybe that… so far, everyone has had the vaccines, we've had basically their initial series. They've not had a booster, the second dose is really part of the priming of one's immune system. When we get a booster now, that's going to be truly a booster. It's going to lead to a response, with what are called memory cells that say we've seen this before and they're gonna kick into high gear, and lead to a very high level of antibodies and cell mediated immunity.

That may mean that we have a longer duration of protection after that booster. So, we don't know yet that booster at six months, 12 months after the initial series, maybe that will give several years of protection. I mean, that would be ideal. And avoid the need for sort of routine annual boosters.

But again, it's a little too early to tell, I think we'll need some longitudinal follow-up on immune response, but also vaccine breakthroughs. It's really interesting, we're now starting to see, you know, we're six to nine months out from many people having been immunized with several of the vaccines.

But with the Pfizer vaccine in Israel, and then, you know, in the US as well, they're starting to come out and show that protective efficacy against symptomatic infection is decreasing after six months, and it's decreasing further after nine months. What's really important though, is that the protection against severe disease and hospitalization hasn't budged. It hasn't decreased at the same time, so that's really important.

We can make this more of a seasonal disease, and something that we control and prevent severe disease and hospitalization and death. And then I think we can learn to find ways to live with it and control it.

Most: We talked about herd immunity for a while, but that went away. Can you talk about how important it is for us to push far past this 70% level of vaccination, and get upwards towards 80% or 90%?

Hamer: I actually think it's extremely important. I think that what we're seeing in some parts of the country, where it's only at 30%, 40%, 50%, sometimes with only one dose, those are the places that are having massive outbreaks right now.

Their hospitals are full, they're running out of nursing coverage, their ICUs are at capacity. They're starting to see shortages of, you know, PPE and other [things]...Actually, there's a country-wide shortage right now of Tocilizumab, which is one of the drugs we use for managing severe disease, and we're having to shift to other alternatives.

And so it's really a worrisome situation. By contrast, if you look at New England and New York, where there are pretty good levels of vaccination—I mean, Massachusetts is one of the top five states, I think, for vaccination—we're not seeing a real serious increase in hospitalization, we've had a few more cases but not a lot.

So that's seeming to prevent severe disease, we need to get to an even higher level. If we get up to 90% coverage in a population, then I think that's going to really help reduce transmission, and make it so that our lives could be more normal.

Most: I know you're not an ER Doctor, but there have been stories lately of doctors talking very candidly about their frustrations, and struggling to feel sympathetic toward the unvaccinated. Can you talk on a personal level, about what it's been like to see people who have not gotten a vaccine? And what those conversations are like for you?

Hamer: So this is a challenge, I mean, I think as healthcare workers, we have a duty to basically provide care to people.

And if they've made choices not to receive the vaccine, we still need to care for them, and do that compassionately. But then I think we also need to use it as an opportunity to educate them and their families. This illness could be prevented, this ICU admission, this prolonged ventilator dependency, the need for a tracheostomy, these could be prevented with a vaccine.

I have other friends who have told me stories, you know, they are basically doing the right thing and still taking care of people but they're trying to use this as a teaching moment to teach families, and they're still seeing resistance to the vaccine.

But yeah, I think we still have a duty to our patients to provide them the best possible care. And then try and educate and keep working on convincing people to understand the safety of the vaccines. There's a massive amount of safety data now, for both Pfizer and Moderna in particular, and growing for Johnson and Johnson.

You know… Pfizer has been, I think 200 million doses in the US alone, and then hundreds of millions in other parts of the world. So we're talking, you know, more than half billion doses probably, well over that, and only a couple of really minor, very rare side effects.

And I actually did an interview with WBUR yesterday, and one of the questions is, "will we see long-term side effects from these vaccines?" The reality is, almost all vaccines we have, it's extremely unusual to see a long term side effect. The side effects pop up in the first couple of weeks after vaccination or maybe months, and that's when some of the very rare worrisome side effects may be seen.

So, I don't think we're going to have long-term problems with these vaccines. We need to not just be reaching high rates of vaccination coverage in the United States. We need it in other parts of the world, that it's going to take time, but we really need to keep that in mind as well.

Most: David, even though the answer to “when will COVID end?” is complicated, we appreciate your insight. Thanks for taking the time to talk to us.

Hamer: It's my pleasure.

Ferrante: Thanks to David Hamer for joining us on this episode of Question of the Week. Be sure to check out David's recent interview with The Brink, entitled "Myths vs Facts: Making Sense of COVID-19 Vaccine Misinformation," in which he debunks widespread myths about the vaccines, the Delta variant and more.

You can find the link to this piece in the show notes. And while you're there, please remember to rate, share, and review us on your podcast app of choice. I'm Dana Ferrante, see you next week.