What to Expect from COVID-19 in 2023 with Dr. Leslie Fang

Dr. Leslie Fang, MD, PhD, reviews the most updated data regarding the COVID-19 virus including the latest variants, vaccine efficacy, and Long COVID.

By Genni Burkhart

After three long years of COVID-19 dominating our lives, it appears there's finally an end in sight. The infection numbers are lower, the vaccines and boosters are doing their job, and mitigation efforts have relaxed. By these indications, this virus appears destined to be remembered in the annals of history as a mere blip in our collective timeline. However, according to the Centers for Disease Control and Prevention (CDC), the newly reported COVID-19 cases are tracking around 226,618 weekly.

While we are all undoubtedly done with this virus, it's not entirely done with us. Furthermore, the latest variant is profoundly more transmissible than its predecessors, and there's increased interest in the causes and long-term implications of Long COVID.

With this, DOCS Education's Medical Director, Dr. Leslie Fang MD, PhD, recently presented an informative COVID-19 webinar, "Let's Get Kraken: Updates for COVID-19 in 2023." In this article, we'll review Dr. Fang's webinar highlighting what you need to know about the XBB.1.5 variant, the effectiveness of vaccines, and the long-term effects of the disease.

Evolution of Variant XBB.1.5

The evolution of COVID first branched out to Omicron, which now has 30+ mutations. However, tracking them all can be complex with so many strains of Omicron. One of the most notable aspects of Omicron XBB was its ability to take the characteristics of previous variants and develop mutations that made it much better at:

  • Vaccine evasion.
  • Ignoring innate immunity.

Strain XBB originated in India, traveled to Singapore, and then evolved into the most transmissible variant to date, XBB.1.5 (nicknamed the Kraken). XBB.1.5 originated in the U.S. and has a much higher binding affinity for ACE receptors, resulting in the highest transmission rate of all COVID-19 variants.

Currently, the U.S. is in a transition period. Because the XBB.1.5 variant has a much higher transmission rate, it will eventually outcompete other variants and become the dominant strain in the U.S.

XBB.1.5 Symptoms include:

  • Sore throat
  • Sinus symptoms
  • Fatigue and malaise
  • Brain fog
  • More GI symptoms than previous strains

Notably, testing for COVID-19 is recommended in situations where it wouldn't have been before due to the increased prevalence of GI symptoms. In some cases, mild symptoms are reported, but that is subjective. It's also known that the XBB.1.5 strain tends to cause more severe sore throats and fatigue.

Does XBB.1.5 Cause More Serious Disease?

There is some concern regarding XBB.1.5. Because of its mutation, XBB.1.5 matches the Delta variant's binding affinity with ACE2 receptors, making it equal in its ability for:

  • Vaccine evasion.
  • Ignoring innate immunity.

How Are Infection Rates Trending?

In the Northeast, infection rates are beginning to plateau. Among the young and healthy, the disease is mild. Yet, among the elderly with comorbidities, the disease is more serious, but deaths are still down. Despite this, the need for continued caution remains, as the virus can still cause severe illness in vulnerable people or those with weakened immune systems.

For young patients, prolonged hospitalization is not deadly. Tracking the infection rate back to July 2020, it was 30 times that of the flu. However, with the vaccination, the infection and fatality ratios are lower than the flu, showing this strain is not more deadly. Public health officials are left to speculate: If not deadly, it will not kill. So, although this virus is inconvenient, we aren't returning in January 2020. Yet, it will be challenging to avoid infection.

Infection and Vaccine Immunity

It's important to note that all vaccines wane over time. And the faster the mutation of the virus, the faster the waning of the vaccine. However, considering that vaccines are still the most effective defense against severe infection and death from the COVID-19 virus.

Furthermore, because of infection and vaccine hybrid immunity, you can protect yourself against serious diseases but can't wholly avoid infection altogether. Having an infection of COVID-19, the vaccines, and all available booster shots provide hybrid immunity, the highest level of protection one can have. 

Vaccine Effectiveness

Dr. Leslie Fang, MD, PhD

Much emphasis is placed on the bivalent COVID-19 vaccine, which is closest to the latest mutation of the virus. However, don't look for another booster anytime soon. Eventually, COVID-19 vaccines will be given yearly, adapted to the latest variations, in the same manner as the influenza vaccine.

A recent study of 700,000 people over the age of 65 showed a significant improvement with the bivalent vaccine, including:

  • 30% less likelihood of infection.
  • 81% reduction in covid hospitalization.
  • 86% reduction of deaths.

Another study by the Mayo Clinic showed a 30% reduction in infection with bivalent boosters. Furthermore, CDC data shows those who've had the bivalent vaccine to be:

  • 3.1 times less likely to get infected.
  • 18.6 times less likely to die.

Effectively, bivalent vaccines are shown to be highly beneficial in every country where they are used (BA1 or BA4.5).

What Is the Vaccine Booster Protocol Going Forward?

All the latest data suggest that the most recent booster (the fourth) was quite effective. But, unfortunately, there's no next booster in production right now and no protocol for it.

As Dr. Fang addresses, "I'm sure you're wondering – why not?"

Public health officials plan to reduce the number of boosters in the future so that there will be a yearly shot similar to the flu every fall.

Currently, in terms of the next COVID-19 vaccine, there are:

  • A meeting of public health officials and advisors in June/July 2023 to determine what variant will most likely emerge.
  • A duration of 3 months to make the vaccine.
  • Expectations of getting the next vaccination out around September 2023.

Does the Rapid Antigen Test Still Work?

The short answer is yes.

It's significant that if you continue to have symptoms, yet you test negative – keep testing! This is because the lower viral load, as seen in those considered "hyperimmune," will only turn positive on home tests when the viral load is high enough, given that they have more immunity. Remember: Symptoms and viral load are two very different things. Symptoms are the body combatting the virus; the viral load is how much the virus is attacking you. The rapid antigen test depends on the viral load, not symptoms, which can linger long after the virus is gone. So, this relatively accurate test does work, but it may be skewed because of the viral load, vaccinations, and hybrid immunity.

COVID-19 Therapy Drugs

Administered over five days, Paxlovid is the preferred therapy after a COVID-19 infection. However, there are many drug interactions. The most common are:

  • Statins
  • Oral anticoagulants
  • Sedatives: Benzodiazepines
  • Hypnotics
  • BPH medications

Why Paxlovid?

The drug has shown an 89% reduction in hospitalization and death. Among test groups, 0 people died while taking Paxlovid. (Age >65 with comorbidities) However, younger patients with no comorbidities show no significant benefits.

Paxlovid rebound is something to consider with younger patients with no comorbidities. Paxlovid rebound is just that – the symptoms return after the medication stops. The viral load goes back up—symptoms return, and the patient tests positive again. Data shows patients can have a 16-day positive testing rate with Paxlovid rebound. However, the commonality of this is difficult to interpret. Therefore, Paxlovid is generally yes for high-risk patients and no for low-risk patients.

Long COVID

COVID-19 has infected approximately 651 million people worldwide, and at least 65 million have Long COVID (or post-acute sequelae of COVID-19 (PASC)). However, this figure is likely underestimated since 1 in 8 to 1 in 10 people are affected, and the number of people with Long COVID is likely to be much greater than previously thought. Moreover, the impact of Long COVID is still relatively unknown, making it difficult to predict the full scope of the pandemic's effects yet to come.

Most people recover completely from mild or moderate COVID-19 within two weeks. However, for some people, COVID-19 can cause long-term health problems for months, even years. For these individuals, the long-term effects of COVID-19 can profoundly negatively impact their overall health and wellbeing. These long-term effects can include fatigue, shortness of breath, impaired lung function, and mental health issues such as depression and anxiety. In some cases, the virus can cause permanent damage to vital organs, leading to a lifetime of disability and health issues.

As a result, Long COVID has received more attention and research recently.

Some of the risk factors for Long COVID include:

  • Ages 36-50.
  • Unvaccinated.
  • Slightly higher rates among females.
  • Less likely in recent variants than in the original COVID-19 strain.
  • Fifty percent of patients hospitalized for COVID-19 will have Long COVID.

A VA study showed that when taking Paxlovid, 25% of people are less likely to develop Long COVID. This suggests that Paxlovid may be an effective preventative measure for Long COVID.

In Conclusion

Wrapping up the webinar, Dr. Fang took questions and reminded the audience to stay diligent. While infection is likely unavoidable, staying current on vaccines offers the best level of protection.

Dr. Fang emphasized that staying informed and up to date on vaccines, virus mutations, and Long COVID should be the primary focus to help reduce infection risk and to protect public health.

 

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Author: With over 13 years as a published journalist, editor, and writer Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides on the western shores of the idyllic Puget Sound, where she works as the Editor in Chief for the Incisor at DOCS Education out of Seattle, WA.

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