It seems to me that, in addition to preventing death and hospitalization, we need to figure out how to prevent and manage conditions to like PASC and MIS-C, and soon. It would be nice to know, among other things, whether we're seeing these conditions with the same frequency following vaccine breakthrough infections. The Pfizer EUA review memorandum specifically states, "Additional evaluations will be needed to assess the effect of the vaccine in preventing long-term effects of COVID-19, including data from clinical trials and from the vaccine’s use postauthorization," but I haven't seen anything yet.
Another issue is testing. Potentially we could have treatments that prevent a mild infection from developing into more severe disease -- this is what the antivirals currently being trialed by Merck and Pfizer are hoped to do, I believe. So we need to be able to detect infections ASAP. But we're still stuck with mostly just PCR tests that take days or antigen tests that aren't that accurate, at least on an individual level. What is being done, or can be done, to make more, better, and faster testing widely available?
Well, I think you’re right that we need to focus on long-term impacts of COVID. MIS-C, multi-inflammatory syndrome in children, is one condition that I think COVID-19 is actually going to positively impact. While it is not great that children have been affected by it during the pandemic as a result of COVID-19, it has also offered us insight into what may have been causing cases of this syndrome before the pandemic. MIS-C isn’t a new thing. It happened in a small population of children each year already, and nobody was really sure why. Now it is thought that human coronaviruses might be responsible. Other clues have been collected from these cases as well, and I am hoping that this will mark a step forward in addressing this rare condition.
PASC—another name for what’s more commonly called “Long COVID”—is a different matter. I have heard indications that vaccination van resolve symptoms in some patients. It’s not clear why, but Akiko Iwasaki is exploring this over at Yale: https://www.yalemedicine.org/news/vaccines-long-covid
When it comes to testing, I’m not sure that I agree with your characterization of the available testing modalities. PCR and antigen tests, together, are rather impressive. On an individual level, antigen tests are pretty good at identifying symptomatic cases and have a high level of agreement with PCR testing. They’re not perfect, but no test is perfect for anything. The bigger problem with identifying patients for treatment right now, to my mind, is a human one. People are either not using testing, or they are not accepting/being offered appropriate treatment. I have heard many stories about things like this happening. People get sick and they don’t get tested—even though an at-home antigen test is $20-30 and free PCR testing is available with next-day turnaround in many places right now. People who do get tested say they don’t want treatment because their disease isn’t currently serious. Well, I heard one story (through Dr. Daniel Griffin on TWiV) about a married couple where the wife accepted monoclonal cocktail therapy and the husband didn’t because he felt his disease wasn’t too severe. He died, she lived. That’s not the kind of thing that we want to have happening. Dr. Griffin has told many other stories similar to this one as well.
I’m most concerned about these sorts of situations as far as patient identification for treatment. I don’t think testing modalities are going to meaningfully improve beyond where they are now. There aren’t a lot of testing technologies and a large number of them are in use. Each has its limitations but together they will help substantially—provided that the right actions are taken when cases present or are identified.
It seems to me that, in addition to preventing death and hospitalization, we need to figure out how to prevent and manage conditions to like PASC and MIS-C, and soon. It would be nice to know, among other things, whether we're seeing these conditions with the same frequency following vaccine breakthrough infections. The Pfizer EUA review memorandum specifically states, "Additional evaluations will be needed to assess the effect of the vaccine in preventing long-term effects of COVID-19, including data from clinical trials and from the vaccine’s use postauthorization," but I haven't seen anything yet.
Another issue is testing. Potentially we could have treatments that prevent a mild infection from developing into more severe disease -- this is what the antivirals currently being trialed by Merck and Pfizer are hoped to do, I believe. So we need to be able to detect infections ASAP. But we're still stuck with mostly just PCR tests that take days or antigen tests that aren't that accurate, at least on an individual level. What is being done, or can be done, to make more, better, and faster testing widely available?
Well, I think you’re right that we need to focus on long-term impacts of COVID. MIS-C, multi-inflammatory syndrome in children, is one condition that I think COVID-19 is actually going to positively impact. While it is not great that children have been affected by it during the pandemic as a result of COVID-19, it has also offered us insight into what may have been causing cases of this syndrome before the pandemic. MIS-C isn’t a new thing. It happened in a small population of children each year already, and nobody was really sure why. Now it is thought that human coronaviruses might be responsible. Other clues have been collected from these cases as well, and I am hoping that this will mark a step forward in addressing this rare condition.
PASC—another name for what’s more commonly called “Long COVID”—is a different matter. I have heard indications that vaccination van resolve symptoms in some patients. It’s not clear why, but Akiko Iwasaki is exploring this over at Yale: https://www.yalemedicine.org/news/vaccines-long-covid
When it comes to testing, I’m not sure that I agree with your characterization of the available testing modalities. PCR and antigen tests, together, are rather impressive. On an individual level, antigen tests are pretty good at identifying symptomatic cases and have a high level of agreement with PCR testing. They’re not perfect, but no test is perfect for anything. The bigger problem with identifying patients for treatment right now, to my mind, is a human one. People are either not using testing, or they are not accepting/being offered appropriate treatment. I have heard many stories about things like this happening. People get sick and they don’t get tested—even though an at-home antigen test is $20-30 and free PCR testing is available with next-day turnaround in many places right now. People who do get tested say they don’t want treatment because their disease isn’t currently serious. Well, I heard one story (through Dr. Daniel Griffin on TWiV) about a married couple where the wife accepted monoclonal cocktail therapy and the husband didn’t because he felt his disease wasn’t too severe. He died, she lived. That’s not the kind of thing that we want to have happening. Dr. Griffin has told many other stories similar to this one as well.
I’m most concerned about these sorts of situations as far as patient identification for treatment. I don’t think testing modalities are going to meaningfully improve beyond where they are now. There aren’t a lot of testing technologies and a large number of them are in use. Each has its limitations but together they will help substantially—provided that the right actions are taken when cases present or are identified.