Building an impenetrable fence against new COVID-19 variants
Think of it as a protective fence we are building as a community against intruders. Do we want to leave holes in the fence?
That’s how Internal Medicine Physician Kumara Sidhartha, MD, MPH views the need for people to get the COVID-19 vaccine booster.
“I’ve been trained in public health and I have studied epidemiology, and one fundamental thing we know about a virus is that it’s constantly trying to survive as a species by creating an environment where it can thrive and keep on multiplying,” he said. “That is its primal goal and so it’s always going to look for opportunities in the population to keep propagating and securing its survival. It achieves this by finding vulnerable hosts to become their unwelcome guests.”
One of the best ways to close the gaps in the population where the omicron and potentially new variants can multiply is for us to be vaccinated and boosted against the COVID-19 virus, said Dr. Sidhartha, who is also medical director of the Cape Cod Healthcare Accountable Care Organization and its Employee Health Plan.
“Everybody coming together with the booster shot puts up a fence against it and doesn’t give it a chance to mutate,” he said. “The more time we give, the more time the virus has to come up with new tricks.”
The omicron variant, which is responsible for most current COVID infections, originated in South Africa and spread to the United Kingdom (UK) before arriving here, Dr. Sidhartha pointed out. A group of researchers from institutions like the UK College of London, Oxford University, and St. George University in London looked at how immunity against the virus is affected with and without the vaccine booster. The data showed that without the booster (in people who had received the initial vaccine series), immunity drops to 40 percent, and with the booster, their immunity jumps to 80 percent.
What that tells experts is that the COVID-19 booster dose re-establishes an active immune response to the virus and provides a greater degree of protection against being hospitalized with severe disease, he said. Based on this knowledge, researchers from institutions like the Yale Center for Infectious Diseases, York University in Toronto and the Commonwealth Fund, an independent research organization, set out to model and forecast the rate of hospitalizations and deaths based on various scenarios of booster shot rates in the population.
“The modeling data shows that tripling the current rate of booster shots being given nationally in the U.S. would cut the daily rate of hospitalizations by 30 percent through April,” Dr. Sidhartha said.
The data also showed that by tripling the number of booster shots, we could prevent 21 million infections nationwide and prevent more than 63,000 deaths through April.
If you take that national data and apply it to Cape Cod, that would mean that if the number of booster shots was tripled, it could free up about 30 out of 100 beds used by patients who would have been hospitalized without the improved booster rate, he said. This would go a long way toward saving lives, alleviating suffering and lightening the burden on healthcare workers and the healthcare system, he added.
Evidence of the booster shot’s effectiveness is reflected in Dr. Sidhartha’s clinical practice, he said. “Those patients who have received the booster shots either don’t get the illness or get a milder illness that doesn’t send them to the hospital,” he said.
Another analysis published last week on January 21, shows that the booster shots cut the risk of hospitalizations from Omicron variant by 90 percent.
Will We Need More Boosters in the Future?
The COVID or any virus’ ability to change its appearance, called a mutation, makes it more difficult for the body’s immune system to adequately confront and neutralize it, Dr. Sidhartha explained. He likens it to an artist’s rendition of a criminal suspect that is circulated among police departments for quick identification.
“It is pretty much like that,” he said. “Our immunity identifies these shapes of the virus structure and the original vaccine is designed to track this (COVID virus) ‘face’ every time it sees it and attack it right away.”
The original vaccines are designed to recognize that particular COVID ‘face.’ But, the virus is a ‘master of disguise,” he said, and changes its appearance with each variant, as it has done with the omicron version. This makes it harder for the immune system to recognize it.
The good news is that we will likely not continue to need boosters (if we are aggressive about boosting now) because a virus cannot mutate indefinitely, Dr. Sidhartha said. It will eventually start to mutate its fundamental structural components, leading to its demise.
Currently, the COVID virus has changed its spike protein (the part of the virus that facilitates attaching and entering into a human cell) in 30 different ways since it was discovered, he said. With better rates of booster shots, the virus will likely keep running into walls with not many human ‘hosts’ and no easy way to propagate. This will trigger the virus to mutate more and start digging into changing its own foundational protein structures, which would be suicidal for the virus. And the more it does this, without the ability to infect new hosts, the sooner the pandemic will end, he said.
It is for this same reason that people should not be actively trying to get the omicron infection, as has been in the news, based on its reported less severe symptoms, Dr. Sidhartha said. The more people who ‘let it through the fence,’ so to speak, the more viable the virus becomes and the more havoc it will wreak.
“The more it encounters resistance in the population, it’s going to react and try to mutate more. But there are only so many mutations it can do, and it will have to start changing its whole body and then it’s not viable anymore,” he said.
If the population hosts of the virus can build that strong fence Dr. Sidhartha speaks of, by getting the vaccine boosters, they will deny the virus a free playground where it can act at its will and thus frustrate it until it burns itself out.
“This is one of those public health situations where cooperation is key,” he said. “By coming together, united against this threat, such as masking, distancing protocols and boosters, the virus is stumped, and we can put this behind us and return to normalcy."
