On A Fun Summer, With Covid Anxiety

No more traffic light alert system. No more vaccine mandates, even for those in healthcare. Masks are no longer mandatory in retail outlets or on public transport, and required only in healthcare settings, and for those caring for the sick and elderly. Who’s afraid of the Big Bad Virus? Not us, not anymore.

“This will be the first summer in three years when there won’t be the question of what if?” PM Jacinda Ardern said on Monday. Oh happy day. “Events won't be cancelled because of Covid cases. Where our borders are fully reopened. and there isn’t the fear of being separated or stranded. The first summer where we have our certainty. And that means, I hope, the Covid anxiety can start to heal.”

Hate to be a killjoy, but this sounds more like the centre left version of “She’ll be right?” Yes, reported case numbers are falling, and so are hospitalisations. Warmer weather will see more people heading to the relative safety of outdoors. On the downside, summer will also mean people packing into densely crowded sports events, music festivals, tourism venues, bars and restaurants.

Meanwhile, the virus will have kept on evolving. For many, the joint immunity provided by (a) their prior infection and (b) the big vaccination drives of late last year and Jan-Feb of 2022 will now be wearing off. It isn’t as though any country in the world has got Covid-19 licked. As White House COVID-19 coordinator Dr. Ashish Jha said recently, this virus will be with us for the rest of our lives. That’s not “necessarily a scary or bad concept,” Jha claimed, provided that we maintain a strategy informed by science. “Obviously if we take our foot off the gas — if we stop updating our vaccines, if we stop getting new treatments — then we could slip backwards.”

Right. Science, and not political expediency (voters don’t like masks) needs to be driving official policy. That involves a constant updating of Covid vaccines, keeping new treatments affordable and available, and maintaining the measures that have proved to be successful to date. Mask-wearing is a proven safeguard against this airborne virus – especially for the vulnerable and the unvaccinated. But we’re now making masks an optional extra. As yet, there hasn’t been even a ballpark indication as to when New Zealanders will be able to avail themselves of the updated (ie. Omicron-sensitive) version of the Pfizer vaccine approved by the US authorities late last month. In fact, the government’s vaccine strategy in the future is a mystery. In the meantime though, we’re taking our foot off the gas.

The Health Ministry’s own statistics confirm the sense of official complacency. As immunity conveyed by the original two shot Pfizer vaccine course (plus one booster) wear off, the second booster is the last line of protection. As of yesterday though, only 20.3% of the 50-64 population eligible for a second booster have received it. In the 65+ population, the uptake has been better, but still barely half (52.8%) of those eligible have received their second booster shot.

At the other end of the age scale, the uptake among 5-11 year olds of the paediatric version of the Pfizer vaccine is not too flash, either. Only 28% of those eligible in this age group have completed Pfizer’s “primary” course of vaccination, and only 51% of eligible children under 12 are even partly vaccinated. Surely, these figures should be compelling the government to be ramping up a new “get vaccinated” drive among young and old alike, while retaining mandatory mask use in the meantime, at least on public transport.

Instead, the government is making jauntily premature statements about the end of Covid anxiety. Epidemiologist Siouxssie Wiles has argued the need for a new Covid Protection Framework. In her view, this should include free RAT test kits to every household. These could then be self-administered, she explained, before people head off to a café or social gathering. Wiles has also advocated maintaining fairly strict isolation measures when infection occurs, in order to help break the chain of transmission. Her full text can be read here.

The vaccine situation

Less than two weeks ago, Moderna and Pfizer (the pioneer firms in the development of mRNA Covid vaccines) won “emergency use” authorisations from the US Food and Drug Administration for their new booster vaccines. These are single-dose inoculations to be given at least two months after the primary two shot course (and initial booster vaccination dose) has been completed

[These] updated boosters each house two messenger RNA (mRNA) components of the coronavirus—one of the original SARS-CoV-2 strain, and another one in common between the BA.4 and BA.5 lineages of the Omicron variant.

To be clear: The first and second “booster” shots currently available in New Zealand are of the original pre-Omicron, pre Delta version of the Pfizer vaccine. By contrast, the “booster” shots the US FDA has just authorised include components of the BA.4 and BA5 families of variants currently responsible for most of the world’s infections, hospitalisations and deaths that have occurred over the course of 2022.

Among other things of note: The travellers from abroad that will now be waived into New Zealand without need for proof of vaccination, are likely - if they’re infected – to be carrying either the BA 2 sub-variants, or of the BA4 and BA5 lineages The US data on the prevailing subvariant infections is updated regularly here.

The Pfizer vaccine currently available in New Zealand offers little or no protection against the infections that these Omicron strains convey, although it does still offer significant protection against the most serious outcomes, including hospitalisation, long Covid and death. Presumably, the new Omicron sensitive Pfizer booster just approved by the FDA will provide a more effective shield against infection.

Or so everyone – including the FDA – is hoping. At this point, the FDA approval of the new Pfizer shot for emergency use has been based on the testing documentation provided for the vaccine’s earlier formulations…

Pfizer-BioNTech and Moderna have also telegraphed their readiness to ship doses [ to US customers] shortly after the FDA’s authorization. Meanwhile, some critics have taken issue with the speed at which Pfizer and Moderna’s updated shots passed muster with regulators. A major point of contention has been whether the boosters should have been greenlit without data from human trials.

For its part, the FDA said it based the decisions on the "totality of available evidence," including the large body of data in the original COVID-19 shots, plus a clinical study in an earlier BA.1-targeted vaccine.

This could be a problem for our Medsafe authorisation process given that Pfizer has not (as yet) provided anyone with test data from medical trials carried out with its new formulation. In fact, it is reportedly just commencing those trials. (The Chinese firm Sinovac is currently conducting human trials in Chile on its own Omicron-sensitive vaccine.)

As things stand, if the new Pfizer vaccine was to be rushed into service in New Zealand, the necessary approval here would have to be based – as in the US – largely on how well the previous Pfizer formulation has worked. For these and other reasons, Pfizer hasn’t signalled just when its new anti-Omicron vaccine will be commercially available beyond the US.

Logically then, the new Pfizer vaccine formulation would be likely to be available here only by autumn 2023, at the earliest. (Who knows what Omicron subvariant – or entirely new Covid variant – may be dominant by then). In the meantime, we are heading into summer without a clue as to when Pfizer will be able to send us its new Omicron-sensitive booster vaccine. Good luck with your anxiety levels, over summer.

Footnote: The government is making make anti-viral pills more readily available to those in vulnerable age groups and with pre-existing conditions. Good. There’s a good Yale University information sheet on the Covid anti-virals available here.

If taken in time, Pfizer’s Paxlovid anti-viral pill will significantly reduce serious outcomes. The problem is that there is only a narrow window between confirming the infection via a RAT test, and getting access to the pill in time to maximise the benefits that it delivers under laboratory conditions. As the Yale advisory says:

You have to take Paxlovid within five days of developing symptoms. Like all antivirals, Paxlovid works best early in the course of an illness—in this case, within the first five days of symptom onset, says Jeffrey Topal, MD, a Yale Medicine infectious diseases specialist who is involved in determining COVID-19 treatment protocols for Yale New Haven Hospital patients. “Once you’ve been ill with the virus for more than a week, the damage done to the body in a severe case can’t be undone by the antiviral,” he says.

This short time frame supports the case for RAT test-kits being delivered – free of charge – to every household, as we head into summer. Otherwise, the protection offered by the anti-virals will be largely theoretical for many people – and especially so for those in the rural areas that the expected influx of potentially unvaccinated foreign tourists will be visiting. Are rural hospitals sufficiently equipped to cope?

No Protection?

Back in 1979, Graham Parker wrote the book on anxiety, infection and the available protections… Apparently, not even three Rottweilers can suffice:

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