Coronavirus in Context with Dr. John Whyte, WebMD

BMO caught up recently with Dr. John Whyte, Chief Medical Officer of WebMD who discusses the current COVID-19 vaccine risks and answers some of your most frequently asked questions.

The last time you spoke with BMO, you mentioned moving into the mitigation stage of the pandemic. How are we doing on that front?

The mitigation strategy has become more localized – meaning that strategies largely depend on what is happening at the community level. For instance, stages may differ based on the rate of community spread. If community spread becomes medium, then masks likely should be worn, especially for indoor spaces with large numbers of people. Handwashing and staying home when sick are measures that should take place year-round. Testing when one has symptoms or has had exposure is also an important mitigation strategy.  COVID-19 will be around for some time – it’s not going away, but the widescale lockdowns are a strategy of the past.

With students back in school and more employers doing away with COVID-19 restrictions as they try to get people back in the office full-time, would you say the world has finally returned to normal?

I don’t think it’s about “returning to normal” but rather reaching a “new normal.” In many areas, we are not returning to the way we did certain things in our lives. For example, the work environment will continue to be a hybrid environment for some employees that consists of in-person as well as remote work. It will largely depend on the type of work and the culture of the industry. Within recent months, we have recognized that “work from home” is not a “one size fits all” approach but rather a discussion of the needs for both employers and employees.

In terms of school – particularly higher education (e.g. college), an interest in online courses remains high. Many students started their college education remotely, and now are rethinking the value of in-class attendance. An opportunity now exists to determine the multiple ways different types of learners can participate in higher learning. In several ways, this makes college education more accessible.

Elementary and high schools have returned to in-person learning, recognizing the critical importance of in-person learning.

One of the biggest impacts of COVID-19 over the past two years has been the change in expectations. How things were done in the past won’t be the same in the future for many areas of our lives, including work and school.

With more tools at our disposal, including vaccination, improved treatments and testing, would you say there is significantly less risk or are there still some things to worry about?

Although everyone’s personal risk varies, in general there is significantly less risk of contracting COVID-19 and getting very sick. That does not mean we can just ignore COVID-19 or assume it’s gone. Rather, we need to be mindful of how we continue to protect ourselves, our family members and our communities. This means getting fully vaccinated and staying up to date on boosters. It also means staying informed on the rate of COVID-19 transmission in your community. Community transmission rates can be found by county on the CDC website:

https://www.cdc.gov/coronavirus/2019-ncov/your-health/covid-by-county.html

This information can help determine whether and when you wear a mask. Handwashing and good hygiene remain useful elements to reduce viral transmission irrespective of rates.

It is also useful to have rapid antigen tests available at home so that if you develop symptoms, you can test quickly and get treatment if indicated.

Currently, we still have thousands of cases a day as well as hundreds of deaths a day. We are in a much better place than we were at the beginning of the year, but there is still work to do.

Most of the concerns about the fall and winter months revolve around making sure that our current strategies continue to work as the virus continues to mutate. We need to be proactive in addressing COVID-19 as it continues to mutate.

Of note, the COVID-19 public health emergency has been extended to January 11, 2023.

What are your thoughts on the Omicron-specific booster versus a fourth dose of one of the original vaccines? What’s happening right now with mutations?   

We are going to continue to hear about mutations and new variants. Given the less-than-ideal vaccination and booster rate, we still have a significant amount of virus around the world which allows it to continue to mutate.

The bivalent booster which targets Omicron variants BA.4 and BA.5 as well as older COVID strains, was released in early September.

CDC currently recommends that people ages 5 years and older receive one updated (bivalent) booster if it has been at least 2 months since their last COVID-19 vaccine dose, whether that was:

• Their final primary series dose, or

• An original (monovalent) booster

People who have gotten more than one original (monovalent) booster are also recommended to get an updated (bivalent) booster.

Keep in mind that when the vaccine was first developed, the delta and omicron variants did not even exist. That’s why it is important to stay up to date on boosters.

We know that vaccination plays a significant role in reducing the severity of the disease – how have Canada and the U.S. fared in terms of increasing vaccination rates?

As of early November:

Canada has performed better in getting a greater percentage of the population vaccinated as well as boosted.

What new treatments are on the horizon?

We are seeing a slowdown in research funding in the last few months given the decrease in federal dollars.

There is still a reasonable amount of research, particularly for a nasal and/or oral COVID-19 vaccine. A nasal vaccine has been authorized in India, but clinical trials are still underway in the U.S.

In addition, there is interest in developing a single vaccine candidate that includes COVID-19 and influenza.

Given that the new variants have a degree of evading the current antibody treatments, research into new monoclonal antibodies is ongoing to address new strands. In addition, new antiviral treatment is an area of promising research although current options are less effective than originally anticipated.

The other area of active research is in treating long COVID. Approximately 10% of people who got COVID-19 are still experiencing symptoms three months later.

NIH does keep an active list of its currently funded projects as well as areas in which it is providing funding.

https://covid19.nih.gov/nih-strategic-response-covid-19/research-initiatives

What do you see happening as we are in the winter months?

Given that immunity wanes several months after vaccination, and update of boosters is low, combined with the cooler weather that has people spending more time in close quarters with others, we expect COVID-19 cases to increase. We also likely will have additional variants for which vaccination may be less effective. The goal is to keep any COVID-19 infections minor in nature, preventing hospitalization and death. That’s why it is important to remain vigilant and continue to practice public health strategies to stay safe. There will be a focus on rapid antigen testing as well as early treatment for positive cases.

Are there any other viruses we need to be concerned about in the coming months?

We need to be vigilant about the number of respiratory viruses that are currently circulating. Based on data from Australia, we expect this to be an active season for flu. Given the social distancing and mask-wearing of the past couple of years, we had few flu cases, and as a result, we developed little immunity. Given many people are not utilizing mask-wearing or practicing social distancing, cases will likely be at much higher rates than in previous years. That’s why it is important to get the flu vaccine now. Remember, flu can continue to April/May.

We also are seeing much more respiratory syncytial virus (RSV) – which can be particularly dangerous to those who are very young and those who are very old.

As always, we appreciate your optimism! What do you think we have to feel optimistic about right now, in terms of COVID-19?

I feel optimistic that the worst of the pandemic is behind us. There have been several silver linings from the pandemic– we have accelerated innovation in drug development as well as strengthened our public health surveillance symptoms. We advanced the use of telehealth as well as made many more health technologies available in the home. We also started a national conversation about mental health challenges.