Emerging patterns in the pandemic—the good news and the bad news

Ryan C. Maves, MD, FCCP
Ryan C. Maves, MD, FCCP

More than a year and a half into the COVID-19 pandemic, patterns are starting to emerge. SARS-CoV-2 has, and almost certainly will continue, to mutate. Novel treatments continue to emerge, giving clinicians additional tools to deal with both disease prevention and illness. And, whether by vaccination or natural infection, 100% of the population will develop some degree of immunity.

“Virus variants have changed the face of the pandemic, from the initial wild type to the Delta variant that surged first in India, then the UK, and now across the United States,” said Ryan Maves, MD, FCCP, Professor of Medicine and Anesthesiology at Wake Forest School of Medicine and Chair of CHEST’s COVID-19 Task Force. “That transition says a lot about the current state of immunity and where it is likely headed.”

Dr. Maves will chair the session Viruses, Variants, Vaccines, and Virulence: The Present and Future of COVID-19 today at 2:15 pm CT. Presentations will cover the very latest developments on vulnerable populations, approaches to protecting immunocompromised individuals, and strategies to encourage vaccination.

“COVID is a huge burden to transplant patients and anyone else who is immunocompromised,” Dr. Maves said. “With organ transplant recipients in particular, the timing of immunization becomes a challenge.”

One common concern is around whether to vaccinate before a transplant or after.  If a patient is vaccinated after transplant, do they need a booster dose or should they get a third primary vaccine dose?

“Sometimes the difference between a third primary dose and a booster is semantic and sometimes it means something,” Dr. Maves explained. “Between people receiving transplants and those who are on chronic steroids for a variety of indications, there is no shortage of patients for whom it matters.”

One of the barriers is simply getting the vaccine into enough arms to halt, or even slow, the pandemic. About 95% of hospitalized patients with COVID-19 are unvaccinated, he said, a population large enough and geographically diverse enough to keep the pandemic alive, spreading and evolving.

The good news, Dr. Maves noted, is that vaccine mandates from government, military, and private employers are reducing the unvaccinated population in the United States. Better vaccine information is also making a difference.

“The number of people who are adamantly opposed to vaccination is relatively small, though it adds up to a lot of people in such a big country,” he said. “Vaccination has gotten wrapped up to some degree in questions of identity. Many people have chosen to harden their positions in opposition to vaccination as part of who they are, which becomes very hard to give up.”

That said, it’s not impossible. It takes a lot of one-on-one time in a situation where time is in short supply. But those conversations can happen, Dr. Maves said, and they can have an impact, especially in the hospital.

“I’m not going to talk about vaccination with a patient I’m about to intubate,” he said. “But for the patient who is recovering, it is a good time to have that discussion. Natural immunity plus vaccination is an extraordinary level of protection, and a lot of people are more receptive to the conversation after infection.”

For expert-vetted articles, infographics, research summaries, webinar recordings, and more, visit CHEST’s COVID-19 Resource Center.




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