Weekly coronavirus-related chat, questions, and minor updates - week of February 14

"THE MILLIONS OF PEOPLE STUCK IN PANDEMIC LIMBO: What does society owe immunocompromised people?"

When the coronavirus pandemic began, Emily Landon thought about her own risk only in rare quiet moments. An infectious-disease doctor at the University of Chicago Medicine, she was cramming months of work into days, preparing her institution for the virus’s arrival in the United States. But Landon had also recently developed rheumatoid arthritis—a disease in which a person’s immune system attacks their own joints—and was taking two drugs that, by suppressing said immune system, made her more vulnerable to pathogens. Normally, she’d be confident about avoiding infections, even in a hospital setting. This felt different. “We didn’t have enough tests, it was probably around us everywhere, and I’m walking around every day with insufficient antibodies and hamstrung T-cells,” she told me. And she knew exactly what was happening to people who got infected. One night, she found that in the fog of an earlier day, she had written on her to-do list: Make a will. “And I realized, Oh my God, I could die,” she said. “I just cried and cried.”

Two years later, COVID-19 is still all around us, everywhere, and millions of people like Landon are walking around with a compromised immune system. A significant proportion of them don’t respond to COVID vaccines, so despite being vaccinated, many are still unsure whether they’re actually protected—and some know that they aren’t. Much of the United States dropped COVID restrictions long ago; many more cities and states are now following. That means policies that protected Landon and other immunocompromised people, including mask mandates and vaccination requirements, are disappearing, while accommodations that benefited them, such as flexible working options, are being rolled back.

This isn’t a small group. Close to 3 percent of U.S. adults take immunosuppressive drugs, either to treat cancers or autoimmune disorders or to stop their body from rejecting transplanted organs or stem cells. That makes at least 7 million immunocompromised people—a number that’s already larger than the populations of 36 states, without even including the millions more who have diseases that also hamper immunity, such as AIDS and at least 450 genetic disorders.

In the past, immunocompromised people lived with their higher risk of infection, but COVID represents a new threat that, for many, has further jeopardized their ability to be part of the world. From the very start of the pandemic, some commentators have floated the idea “that we can protect the vulnerable and everyone else can go on with their lives,” Seth Trueger, who is on immunosuppressants for an autoimmune complication of cancer, told me. “How’s that supposed to work?” He is an emergency doctor at Northwestern Medicine; he can neither work from home nor protect himself by avoiding public spaces. “How am I supposed to provide for my family or live my life if there’s a pandemic raging?” he said. Contrary to popular misconceptions, most immunocompromised people are neither visibly sick nor secluded. “I know very few people who are immunocompromised and get to live in a bubble,” says Maggie Levantovskaya, a writer and literature professor who has lupus, an autoimmune disorder that can cause debilitating inflammation across the entire body.

Ed Yong has been doing a lot of good journalism highlighting overlooked aspects of the pandemic, and this is one of his best yet. He wrote a little on Twitter about this article:

I want to say something more about this piece on immunocompromised people, and how I’m thinking about journalism in this moment.
I’d love it if these pieces change minds; the odds feel low sometimes but the possibility exists, and we should shoot for it. But even if that doesn’t happen, we can still fulfil the incredibly important goal of making marginalized people feel seen and heard.
Bearing witness to suffering is one of the most profoundly important things we can do as journalists—and as people. In a world where so many folks hear the implicit message that their lives don’t matter, our work can say: Actually, they do.

I'm not traditionally immunocompromised; I just have a weird immune system and illnesses that are likely to get worse long term if I get COVID. But yeah. This kind of reporting does help.

Looking at the graphs at Washington Post's US statistics page, US cases are down 42% since last week, to 53 per 100,000. Every US state is declining except Maine, which is the highest after rising 117% (!). Also, Maine is the only state that increased.

For a while I've been wondering why Maine was so low. It looks like test positivity is declining there, and hospitalizations haven't changed. I don't see any news stories about things getting bad there. This suggests that it's some kind of problem with a test backlog rather than a real rise.

There are only two other states above 100, Alaska and Kentucky.

New York is back where they were in November, at 24 per 100,000. The Omicron wave seems basically over there, though it's still 10x what it was last June. California at 58 is about where we were January 1, but the trend is good like in other states.

South African scientists copy Moderna’s COVID vaccine

Researchers at a South African biotechnology company say they have nearly completed the process of reproducing Moderna’s mRNA vaccine against COVID-19, without Moderna’s involvement.

The company, Afrigen Biologics and Vaccines in Cape Town, has made only microlitres of the vaccine, which is based on data that Moderna used to make its shot. But the achievement is a milestone for a major initiative launched by the World Health Organization (WHO) — a technology-transfer hub meant to build capacity for vaccine manufacturing in low- and middle-income countries.

[...]

Many steps remain before Afrigen’s mRNA vaccine candidate can be distributed to people in Africa and beyond, and it definitely won’t help to curb the pandemic this year. But the WHO hopes that the process of creating it will lay the foundation for a more globally distributed mRNA-vaccine industry.

[...]

Friede says the WHO chose to replicate Moderna’s shot because more information on its development is available publicly, compared with Pfizer–BioNTech’s vaccine, and because Moderna has vowed not to enforce its patents during the pandemic. Moderna did not respond to requests from Nature to comment on the WHO’s decision to copy its vaccine.

[...]

For the next phase of the project, several companies in the global south will learn from Afrigen and attempt to create batches of vaccine themselves, in preparation for testing the shots in rodents. The WHO expects a Moderna mimic to be ready for phase I trials in people by the end of November.