The pandemic is far from over, as evidenced by the rapid rise to global dominance of the JN.1 variant of SARS-CoV-2. This variant is a derivative of BA.2.86, the only other strain to have carried more than 30 new mutations in the spike protein since Omicron first appeared on the scene more than two years ago. This should have justified the designation by the World Health Organization as a variant of concern with a Greek letter, like Pi.
By wastewater levels, JN.1 is now associated with the second largest wave of infections in the United States during the pandemic, after Omicron. We have lost the ability to track the true number of infections, as most people test at home or don’t get tested at all, but very high levels of the virus in wastewater indicate that around 2 million of Americans are infected every day.
In several European countries, wastewater levels reached unprecedented levels, surpassing Omicron. It is evident that this variant of the virus, with its plethora of new mutations, has continued its evolution with mutations adapted to infect or reinfect us.
However, there is good news about this large wave of infections. Does not have resulted in the increase in hospital admissions seen with Omicron. The “updated” booster (based on the XBB.1.5 variant that reached dominance in the US in February), available here since September, has some cross-reactivity with JN.1 in laboratory studies to induce neutralizing antibodies against the virus, yeah recent Kaiser Permanente report showed that the booster provided protection against hospitalization in the range of about 60% against JN.1 and other recently circulating variants.
With the marked differences in the spike protein between XBB.1.5 and JN.1, we are very lucky to see this level of immune response induced by the vaccine. However, only 19% of eligible Americans have received the updated booster. The Kaiser study also showed low levels of protection against hospitalization and emergency room visits for people who had received only earlier versions of the vaccine, without the updated booster. This aligns with even more striking differences in the virus sequence of the early strains compared to JN.1, and the problem we have with waning immunity four to six months after vaccination.
All of this is happening in addition to flu and RSV waves, Both are at very high levels.although it clearly hasn’t peaked yet, with some people experiencing two of these infections at once.
With all three respiratory viruses circulating in full force, you would think we would see people wearing masks everywhere in public. That couldn’t be further from the truth. The state of denialism and the general refusal to take simple measures to reduce the risk of infection can be seen everywhere.
It took many weeks after JN.1 appeared in October for health systems to recognize the threat. Only very recently have some mask mandates been reinstated. for healthcare workers and patients. Little has been done nationwide to improve indoor air quality by improving filtration and ventilation.
Now in its fifth year, SARS-CoV-2 has once again proven to be very resilient, capable of reinventing itself to infect us. Yet we continue to pretend that the pandemic is over, that infections have transformed into a common cold due to previous exposures, and that life has returned to normal. Unfortunately, none of this is true.
The huge number of infections in the current wave will undoubtedly lead to more people suffering from long COVID. For a high proportion of people, especially those who are elderly, immunocompromised or with coexisting illnesses, contracting COVID is nothing like a simple respiratory infection.
What is the exit strategy that could get us “back to normal”? It certainly cannot happen with the current complacency and false belief that the virus will die out and disappear. Inevitably, there will be another stress in the future that we are not at all prepared for and which will lead to another very large wave across the planet.
Still, there have been Interesting new facts about oral and inhaled vaccines that achieve high levels of mucosal immunity and protection against infections, which would be proof of variants. The United States has invested hundreds of millions of dollars to accelerate clinical trials for two different nasal vaccines with promising data from early clinical trials, and for improved variant-proof injections with greater protection and durability. But most of these efforts began recently and are not urgently prioritized for completion during 2024, nothing like what we saw with Operation Warp Speed in 2020.
Now it’s crickets from the White House about COVID, with no messages about getting the updated booster or masking. The Biden administration has done very little to accelerate research into effective treatments for long COVID.
This passivity reinforces the illusion that the pandemic is behind us when in reality it is wreaking havoc. And this season will be followed by a quieter period, which, once again, will make us think that the pandemic is over. But we won’t be able to overcome it until we acknowledge reality and redouble the research that will allow us to block infections and the spread of the virus, and achieve long-lasting, variant-proof immunity.
Eric J. Topol is a professor of molecular medicine at Scripps Research and author of the Substack newsletter. Fundamental truths.
