What to Expect From COVID This Fall

ON HOW SEVERE THE NEW COVID STRAIN IS

Dr. Cameron Wolfe, infectious disease specialist, Duke Health

“We’ve had a steady increase since probably the middle of July. To put that in context, that’s the same as what we’ve seen in a timeline point of view in the last three years of the pandemic. We’ve always had this sort of late-July/August/September spike. But to put numbers around that, our lowest point almost at any point in the pandemic was probably May and June when we were down to … maybe 10 to 15 patients. By comparison we’re sitting around 50 to 55 in-patients (at Duke Health) who have COVID. So that’s a 3-to-4-fold increase.”

ON WHEN THE NEXT COVID BOOSTER WILL BE AVAILABLE

“I suspect certainly by the end of September or early October they’ll be available in local pharmacies and health care institutions like Duke.”

“We still see COVID and if you use today’s, at the moment, late-summer spike as a prediction of what may be to come, we typically see a larger spike occurring through January and February, and I don’t see any reason that won’t be the case here. I think you’d be brave to predict against that. So the timing of this release is actually really helpful. We know it takes a good few weeks to develop full antibody-related immunity. So getting patients the chance through October and into November of getting vaccinated, like we do with flu season, would be advantageous for the arrival of those waves in the winter.”

ON CONCERNS OVER COST OF A NEW VACCINE TO CONSUMERS

“We are trying already to think through that, to make sure to think of ways to get vaccines into spaces where our more marginalized individuals encounter health care. That’s part of the aim here. The other part will be to message this really clearly: There have been offers put forward by the federal government and the companies who say we don’t want anyone left behind in this, financially. It remains to be seen how that plays out, and it does bother me that there’s a risk here, that the message of vaccination will get to people … but also the access gets restricted.”

ON HELPING IMMUNOSUPPRESSED PATIENTS

“We certainly have lots of other tools. Immunosuppression is a broad umbrella that encompasses many types of patients. For the most part, most of those patients will respond partially at least to vaccines. Many of them may require more vaccination to get the same response as someone who is healthy. There’s different ways your immune system can adapt to a vaccine and learn from it. It doesn’t take away the desire to vaccinate someone; in fact it enhances it.”

ON VACCINE EXPECTATIONS

“I think we need to make sure we level-set what the aims of a vaccine really convey. When we started out on this pathway in early 2021 when the vaccine became available, it looked like the preventative efficacy was in the high 90s percent … maybe we fell into the trap that the target should be no infection. That’s a great target, don’t get me wrong. But I think we actually have two aims when we vaccinate patients. Exactly the same with flu. Number one, does this vaccine substantially reduce the number of infections that are actually occurring? The guidance there is that it is still being very effective.”

“The second thing, though, is severity. This is the hammer-home point to make. Even if you happen to get flu, or COVID, if I can turn what would have been a hospitalizing-requiring severity of illness … into something you can manage at home, that is absolutely a success.”

ON COVID STILL BEING DEADLY FOR THOSE WITHOUT BOOSTERS

“We have 55 people in the hospital today (with COVID), many if not all of whom could have been avoided if they tried to maintain their immunity. We still see people die of COVID. This is still orders of magnitude larger than the flu. And we should view that as unacceptable. I don’t see any way around how that is an acceptable position, where we say, ‘Oh, it’s less than what it was 18 months ago.’ That doesn’t mean this is not highly impactful. That doesn’t mean people still do not still get long COVID. That doesn’t mean there’s no interruptions to work and scheduling and family and all the rest. And if vaccines are a pathway to try to avoid that, and happily for many decades we have accepted that as a truism for influenza, how do we not view COVID through the same lens?”

ON NEW VARIANT

David Montefiori, director, Laboratory for AIDS Vaccine Research and Development, Duke University Medical Center

“We’re no longer in a period of this pandemic where we have a single dominant variant that is circulating. For some time now we have had multiple variants circulating.”

“The vaccines are holding up very well against them. But now we have (a new variant) that is somewhat less susceptible to neutralizing antibodies, which is what people rely on to measure how effective, or predict how effective, the vaccines will be.”

“What we have found recently is the updated booster that will be rolled out this fall is still generating very high titers of these neutralizing antibodies. There’s very little concern about that variant as far as the vaccines go. The vaccines are expected to remain very effective against it.”

ON ANOTHER NEW VARIANT, BA.2.86

“It has been found in multiple countries and in multiple locations in the United States. It’s not real prevalent in terms of the genetic surveillance show, but that could be an underestimate because there’s not nearly as much genetic surveillance going on now. We really don’t have a good idea of how widespread it is.”

“What scientists are concerned with, though, is that BA.2.86 differs from all the different variants by about the same extent that Omicron was different from earlier variants. It’s a major leap in terms of the additional mutations it has in its spike proteins.”

“This was very reminiscent of when Omicron first appeared and it raised concerns about BA.2.86 to further evade immunity.”

“But just in the past few days, several groups have reported data, actual experimental data, looking at how sensitive this virus is to the neutralizing antibodies that people have from vaccination and infection and a combination of the two. And what they’re finding is that BA.2.86 is only slightly more evasive that other circulating variants. So that’s really good news, and scientists expect that the coming booster … will remain highly effective against that variant and all the currently circulating variants.”

ON WHAT TO EXPECT FROM NEW COVID VARIANTS DURING FALL AND WINTER

“One thing that we’ve learned over the past three-and-a-half years is that this virus isn’t a seasonal virus like the flu is. It’s with us constantly. And as immunity wanes in the population, we’re going to continue to see increased numbers of infections and associated increases in hospitalizations and deaths.”

“The current CDC statistics show that only 17 percent of eligible Americans got the bivalent boosters. I think this is one of the biggest concerns that we have. The fact of the matter is most of the people in the United States haven’t been boosted in over a year. And we know immunity to this virus wanes over time. So the best thing people can do to maintain a normal way of life is to continue to get their booster shots. And the good thing is the booster shots are working.”

ON VACCINES WORKING

“One of the main messages with the recent data is the BA.2.86 variant that we’ve been hearing about a lot in the news … have sort of settled down now that we have some real data. That variant doesn’t look nearly as bad as scientists feared it was going to be.”

“It’s also interesting that we continue to have this evolution of the virus and the virus acquiring mutations in regions that could be very critical for how long the vaccines will continue to work. And yet the vaccines are continuing to work, and the updated vaccines are very important in that regard to assure people do have adequate immunity.”

“I’m optimistic right now about the vaccines that are available in the future, of being able to keep up with variants that arise later on.”

The Participants:

David Montefiori, Ph.D.

David Montefiori is a professor and director of the Laboratory for AIDS Vaccine Research and Development at Duke University Medical Center, where he has studied the effectiveness of COVID-19 vaccines against new variants of the virus.
Contact: Sarah Avery: sarah.avery@duke.edu

Cameron Wolfe, M.D.

Dr. Cameron Wolfe is an infectious disease specialist at Duke Health and an associate professor at the Duke University School of Medicine. His areas of study include infectious diseases and biological and emergency preparedness for hospital systems.
Contact: Sarah Avery: sarah.avery@duke.edu

An online version of this release is viewable here.

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