SARS-CoV-2 vaccines and various new treatments for COVID-19 may be on their way even before 2020 ends, but the damage caused by the deadly novel coronavirus may linger for months or even years, said Anthony S. Fauci, MD, during an exclusive interview presented during a Saturday plenary session of the November 2020 AMA Section Meetings.
In his interview with AMA Executive Vice President and CEO James L. Madara, MD, Dr. Fauci said no one is certain how long vaccine protection will last. He added that physicians and other health professionals in hospitals are learning more about how to treat patients infected with SARS-CoV-2, cutting the COVID-19 mortality rate in the U.S.
“We just get better at treating the disease. We know what works, what doesn’t work,” he said. Experience has taught doctors more about whether to put people on ventilators, how much oxygen to provide during intubation, and managing the treatment process.
“We know that dexamethasone clearly diminishes the death rate in people requiring mechanical ventilation and/or people who require high-flow oxygen,” Dr. Fauci said. “We have remdesivir for hospitalized patients who have lung involvement.”
Treatments or prophylaxis with anticoagulants for some patients is now common for COVID-19, added Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases and a member of the White House coronavirus task force.
Death rates fall as patients get younger
“And we are starting to see a younger population get infected,” people who are most likely to survive the effects of SARS-CoV-2 infection, Dr. Fauci said.
However, while the death rate is improving, the effect of the virus may linger longer than the diagnosed infection.
“We do know for absolutely certain that there is a post-COVID syndrome,” Dr. Fauci said. “Anywhere from 25% to 35%—or more—have lingering symptoms well beyond what you would expect from any post viral syndrome like influenza and others. It’s fatigue, shortness of breath, muscle aches, dysautonomia, sleep disturbances and what people refer to as brain fog,” he said, or an inability to focus or concentrate.
“That can last anywhere from weeks to months,” he explained. Cardiologists also report that even among asymptomatic COVID patients, about 60% have some indication of inflammation of the heart which may or may not have a future effect on cardiac health.
A patient and a physician shared their experiences as COVID-19 long haulers during a recent episode of the “AMA COVID-19 Update.”
Vaccines are on the way
Vaccines are the hope of the future and they are on their way, Dr. Fauci said, with six candidates already at various stages of clinical trials and testing. Five of the six are already in phase 3 trials and two of them—the Moderna and Pfizer vaccine candidates—are fully enrolled and collecting data on efficacy and safety.
“The issue of vaccines is actually good news at a time of considerable concern and stress about the outbreak. As we get into November and then maybe into December, we will get an answer as to whether one or more of these candidates are safe and effective. I am cautiously optimistic,” he said.
Find out with the AMA what doctors can do now to be ready when COVID-19 vaccines arrive.
More questions remain
Following this evaluation, vaccines can then be distributed beginning with individuals with the highest priorities, such as medical workers on the front lines. However, two questions remain, he said.
“How effective would the vaccine be and, as importantly, how many individuals will opt to take the vaccine? But if we get a reasonably effective vaccine of 70% to 75% and a substantial proportion of the population takes the vaccine, I think we will be going in the right direction of some degree of normality as we head into 2021 in the second, third and fourth quarter,” he said.
The more effective the vaccine and the more people take the vaccine, the better a prospect for herd immunity, a situation in which future infection is less possible, he said.
Once vaccines are developed and one or more are chosen for distribution, there still may be more to learn about protecting individuals from COVID-19 with vaccines. The durability of immune protection is still unknown, Dr. Fauci said.
From what researchers know about studies of the coronaviruses that cause the annual common cold, coronavirus immunity is measured in months to a year, not like measles immunity, which lasts a lifetime. Immune response from an illness seems to vary by how serious or systemic an infection is.
“When someone gets sick … we don’t know how long the antibody protection is going to last,” Dr. Fauci said.
The November 2020 AMA Special Meeting of the AMA House of Delegates will be held Nov. 13–17, 2020, via a virtual platform.
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