Akiko Iwasaki, top immunologist at Yale University’s School of Medicine, is working on a nasal COVID vaccine that could transform the current MRNA vaccine’s immunity into one which creates a nasal barrier, utilizing IGA antibodies, to block infection and transmission.
She told me about it during an interview on SiriusXM’s “Doctor Radio” this past week, and I immediately envisioned the powerful tool it would give me and other practicing physicians in our clinical battle against COVID-19. Unfortunately, it hasn’t been tried in humans yet, and it is still many months away from clinical use.
In the meantime, we must rely on boosting the current MRNA vaccines to maximize their use — though, even when recently boosted, a person is more protected against severe disease than against spread, especially against the widespread immune-evasive omicron variant of COVID. While it certainly is true that combining vaccinated immunity with immunity from recovered infection provides the most formidable defense we have against COVID, the disease is far too risky to hope for this.ADVERTISEMENT
Instead, we need to be able to add readily available monoclonal antibodies (especially GSK’s Sotrovimab, which works well against the omicron variant), as well as the new Pfizer protease inhibitor drug Paxlovid to our armamentarium, and rapid home testing in order to have a better sense of who has omicron and who does not. We can’t treat what we cannot see.
Unfortunately, what I call President BidenJoe BidenPredictions of disaster for Democrats aren't guarantees of midterm failure A review of President Biden's first year on border policy Vilsack accuses China of breaking commitments in Trump-era trade deal MORE’s “Operation Snail Speed” response to the latest wave of COVID variations is not bringing us either therapeutics or tests in a timely enough manner to fight omicron. Instead, the Biden administration is doubling and tripling down on the one incredible tool they do have — the vaccine, delivered to the American public under the previous administration.
The current vaccine mandate case before the U.S. Supreme Court is somewhat spurious, because it focuses on the issue of public safety, despite the fact that the current MRNA vaccines appear to be mainly effective at decreasing severity, mainly impacting omicron spread in the first several weeks after receiving a boost. If we had Iwasaki’s nasal vaccine available, one could make the argument that mandating it ensures public safety by decreasing spread, much like banning cigarette smoking in a public place protects the health of nonsmokers. But the Pfizer and Moderna vaccines don’t work well enough at stopping omicron's spread to make that argument. It makes much more public health sense to include a testing option and to count immunity after infection when trying to keep a workplace safe.
Omicron, meanwhile, is burning like a hot fire across our land, not only in terms of case numbers but also in terms of hospitalizations and persistent symptoms (including brain fog and fatigue) that will likely turn to “Long COVID.” The only good news is that the true case numbers are so many times more than is being reported that it is quite likely that, over the next few weeks, the number of available hosts for omicron will begin to be exhausted and the outbreak will slow down. Clearly it is, on the whole, milder than the delta variant, but with close to a million cases per day, hospitalizations are close to the highest they have been for the entire pandemic.
I believe that omicron is so highly transmissible that it is not likely to be quickly replaced by another variant that out-competes it. Everyone hopes I am right, that it will soon burn down to a smoldering endemic rather than a raging pandemic.ADVERTISEMENT
In the meantime, we can all do our part by getting boosted as soon as we are eligible, slowing omicron’s path.
And the White House can do its part, too, by paying industry billions of dollars to quickly provide us with all the tools — including next-generation vaccines — which we need to fight omicron and all other COVID variants.
Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent and author of the new book, "COVID; the Politics of Fear and the Power of Science."