Dr. Loh: It's time to talk about COVID, whether you like it or not

It has been so nice to write about not-COVID. Break’s over.

When viewed in the context of my COVID columns starting in January 2020, this update is not nearly as ominous or dark, but should fall into the category of concerning, but most important, serve as a heads up column.

When we knew next to nothing about this virus, essentially any and all information was newsworthy. The important thing to rationale humans was that information was vetted, validated, verified, and referenced from evidence-based sources. Given social media, where everyone is an expert, the environment was ripe for people to leverage anxiety and fear for commercial and political gain, with pseudo-science and opinions interchanged for facts. Remember alternative facts?

One of the earliest principles of biology I mentioned in my original article was that lifeforms, from humans to viruses, have a prime directive to optimize survival by enhancing reproduction. Organisms do so by adapting to whatever environment in which they find themselves by a constant trial and error process, enhanced by short reproduction cycles and propensity for spontaneous mutations to test out new variations for survival advantages. Most genetic tweaks are not successful, so those strains do not dominate. Some may be slightly more advantageous, and thus provide some survival benefit. Others may be genetic jackpots that provide huge adaptation edges and these strains end up dominating the organism’s genetics. Remember delta, omicron, etc.? This is evolution in action.

For those who do not believe in evolution or science, well, I can’t help you understand this. You can believe in good and evil, which are real, but they are not forces in biology or true science.

To that point, after we were caught napping (and blinded due to withdrawal of surveillance funding tasked to watch for emergence of potential pandemic organisms) science ramped up and kept up. The characteristics of the disease were sorted, the genetics of the culprit virus were identified, the epidemiology was uncovered, and the principles of randomized, double blinded, placebo controlled clinical trials were foisted upon a mostly naïve world. Old and new treatments for acute disease were evaluated. Old and novel vaccine platforms for prevention and mitigation were developed and validated. Because of the international and multidisciplinary collaboration of clinicians and scientists, adequate research funding, and critically, patients willing to participate in these clinical trials, we had working vaccines and treatments available in record time.

Due to public health interventions (hygiene, masks, social distancing), treatments, population immunity due to vaccines and native infections, and the decrease in the number of vulnerable patients, and a modest degree of herd immunity, the worldwide wildfire of COVID abated enough for the World Health Organization and our CDC/FDA to take COVID off the public emergency list in May of this year. Gratefully, humans have begun to recover from the PTSD of the last 3 1/2 years, although the emotional, educational, financial debts will take years to recover. We all wish COVID to disappear, but wishing does not make it so.

The SARS-CoV-2 virus has not disappeared. It has continued to mutate and test new variations for survival benefits. Note that mutations for lethality are not part of the virus’ M.O. Indeed, killing off its hosts would be counterproductive to enhanced survival as its prime evolutionary goal.

Very recently, a new “variant of concern,” EG.5, nicknamed “Eris,” has evolved, and is rapidly becoming the dominant strain of COVID. Epidemiologic monitoring shows that it is much more infectious than the strains we’ve been seeing, but so far it has not been more lethal. We are seeing an uptick in infections (though that’s hard to track since most people are doing home tests and not reporting, and governmental sites are not tracking infections as assiduously as before when we needed to know the enemy’s movements), hospitalizations, and mortality. Fortunately, the mortality statistic is not disproportionate to the increased number of infections, so it’s following the rules of evolution, playing for reproduction. So far, our treatment strategies are also holding up.

But now there’s yet another virus designated as BA.2.86 that has even more mutations than Eris, raising the specter that it may be more immuno-elusive and thus be even more infectious. As of this writing, its ability to cause worse disease is unclear. So far, the CDC is saying that all prevention and treatment standards remain the same until there are more data. But a worry is that the proliferation of mutations that distinguishes BA.2.86 from its Omicron lineage may make even the new upcoming vaccines less effective in preventing infections, as well as reduce the chances that prior infection with COVID will be protective. Good for the virus, potentially bad for humans.

If one is at high risk or particularly susceptible, one can still be hospitalized and die from COVID, and one also should be concerned about the development of long COVID, a real and chronically debilitating disease with protean manifestations, including possibly neurodegenerative diseases in the long-term. It just seems prudent to resume a bit of vigilance when in situations where the risk of contracting COVID is higher.

Returning to offices and restaurants with less ventilation, and where there are humans in close quarters and of unknown vaccination or testing status, should cause us to be a bit more cautious. Maybe get that table outdoors. Keep that mask handy, especially when flying. Use that sanitizer if you can’t wash your hands. And get the new vaccine due out this fall that has been configured to be more effective against EG.5 because it targets its sibling XBB.1.9.2’s similar spike protein mutation. It will at least reduce the risks of a severe bad outcome.

And get the flu and RSV vaccine as well. Since it’s harder to get government information, best to track local hospital admissions to gauge trends through regional public health websites. And pay attention to reputable news stories. You know, consider the source.

Irving Kent Loh, M.D., is a preventive cardiologist and the director of the Ventura Heart Institute in Thousand Oaks. Email him at drloh@venturaheart.com.

This article originally appeared on Ventura County Star: Dr. Loh: It's time to talk about COVID, whether you like it or not