When we all thought that the new year would give us back many of the things that COVID-19 had taken from us, COVID-21 is already pressing very hard: more infections than ever, new strains, more confinements and restrictions, more economic difficulties, and Above all, a lot of accumulated fatigue and tiredness of society, in any corner of the planet.
How will this new year be? Will we be able to go out and meet and hug soon? Could we travel with some peace of mind? Will we have a job? Will the vaccine give us all these things? After a year of pandemic, it seems that there are still many unresolved questions.
Here are 10 issues that many of you may still have.
1. Will vaccines be subject to the virus in 2021?
Most experts think that SARS-CoV-2 will never go away. When the majority of the population is vaccinated, the pathogen will begin to weaken and cause asymptomatic infections in adults. It will also be necessary to check how long someone is immune to COVID after being infected or having received the vaccine. Therefore, it does not appear that COVID will be under control during this year.
The vaccines currently authorized by the European Medicines Agency (EMA) to prevent COVID-19 and available for distribution in Europe have an efficacy of around 95%.
2. What do we know about the new British, South African and Brazilian Amazon strains?
The British strain appears much more contagious (between 50% and 74%), it does not appear to be more lethal, and the scientific community claims that vaccines are still effective. The South African strain appears to spread 50% faster, like the British strain, it does not cause more serious disease or increase the risk of mortality. The strain found in Manaus, the Brazilian Amazon, also seems more contagious, as it has genetic alterations similar to the British and South African, and experts have not yet determined how high the degree of contagion is.
There is suspicion that the South African and Manaus variants may have the ability to bypass the immune system and therefore render current vaccines ineffective. However, the BioNTech laboratory (creator of the first authorized COVID vaccine in the world, together with Pfizer) has ensured that if it is necessary to respond to a mutation, they could have a new product ready in six weeks.
3. What percentage of asymptomatic people transmit the coronavirus?
According to JAMA Network Open magazine, transmission from people without symptoms accounts for more than half of all transmissions. Therefore, it seems that the isolation of individuals with COVID symptoms alone would not be able to control the current spread. Transmission by infected people who do not present any symptoms can be pre-symptomatic individuals (infectious before developing any symptoms) or individuals who never experience symptoms (asymptomatic). According to the research article, 59% of transmission comes from asymptomatic transmission (35% come from pre-symptomatic people and 24% from people who never develop symptoms).
4. Can a person who has overcome the coronavirus be a carrier of the virus?
At the beginning of the pandemic, it was considered that immunity would last two or three years, hypotheses that were based on the behaviors of other coronaviruses that would not have to replicate with SARS-CoV-2. Today, we know that there are many people who continue to have antibodies six or seven months after having passed COVID. Although it has been observed that most of the people infected by the new coronavirus develop an immune-protective response, it is unknown how long the protection lasts or if the disease would be milder in the event of a new infection.
To date there have been very few reinfections and it is very rare for it to occur within 90 days of initial infection. The variability of immunity remains a mystery at the moment and it seems difficult to know if a person with antibodies is capable of being a carrier and transmitting the virus, we need more time to follow up.
5. Can I transmit COVID-19 after receiving the vaccine?
The vaccines have been tested in clinical trials to measure protection against disease with symptoms. It is not yet known whether the vaccine prevents vaccinated people from becoming infected and, even if they have no symptoms, if they can transmit the virus. It is also worth remembering that the effectiveness of the vaccine leaves out 5% of the population, according to these preliminary trials.
6. When can we stop wearing a mask and avoid contact after receiving the vaccine?
Currently, we do not have enough information available to determine when we will stop recommending that we wear masks and avoid direct contact with others to help prevent the spread of the virus. Before making this decision, we need to learn more about the protection offered by COVID vaccines.
7. Will I be able to travel abroad once I have been vaccinated?
There is a very active international institutional debate on whether or not a COVID vaccination passport should be issued to allow those who have it to travel, and thus reactivate international tourism.
There are countries that indicate that a vaccination passport would tremendously limit mobility, since, taking into account that developed countries can take a year to vaccinate their entire population, imagine what will happen in countries that have not been able to stock up on vaccines. Could your citizens not travel until they have been vaccinated? On the other hand, as we have indicated above, having been vaccinated is not a sufficient guarantee of not carrying the virus with you, therefore, it seems that the idea of a vaccination passport may be discriminatory and insufficient.
8. Will I still need a PCR test to travel?
Although some countries accept antigen tests as valid, today, PCR tests are the most required tests – and with the greatest sanitary guarantees – to enter any country in the world that has opened its borders. There are countries that are making their entry even more complex, such as China, which requires very strict sanitary certifications, and which authorizes only a few laboratories in each country to carry out these tests. Life Length Laboratories is on the white list of the Chinese embassy in Spain.
It seems that the PCR tests must meet sufficient guarantees from the laboratories, such as demonstrating, without a doubt, that the person traveling was the one who did the PCR test. Or certify that the test carried out by the laboratory has a very high reliability. The PCR test that we carry out at Life Length has a 99.9% reliability. In our laboratory we detected 3 regions of viral RNA: protein S (spike), protein N (nucleocapsid) and ORF1 ab. Other laboratories detect 1 or 2 regions of the viral RNA to save time or costs, their results being much less reliable, in fact, the new British strain of COVID can go unnoticed if only 1 or 2 regions of the viral RNA are detected.
Life Length delivers the PCR test results report on the same day, as long as the appointment is before 3:00 p.m. We are open 7 days a week.
Another issue to be resolved is the authenticity of the results report, for this, the laboratories will have to develop a valid patient identification system and the results of their tests can be contrasted in the destination country (as they do in China: if a laboratory issues negative reports of PCRs that turn out to be positive in the tests they do in Chinese airports, the laboratory is immediately disallowed). The encryption of the results so that they cannot be falsified is a solution that Life Length is developing.
9. Why is knowing the viral load so important when having a PCR test?
Very little effort has been made to know the viral load in COVID patients. Clinical laboratories could report not only whether a person is infected, but could also give an estimate of how much virus they have in their body. Shortly, our laboratory will begin to include ranges with viral load in the PCR test reports, for more information on our patients.
Which patients are more likely to deteriorate quickly and which are more likely to fight the virus and recover?
Knowing how much virus is in the body could help doctors measure risk or predict how well a patient will do. The idea is not new as, for example, viral load control has long been the basis of treatment for HIV patients and of containing its transmission.
10- Are future waves of COVID inevitable?
As countries around the world grapple with successive increases in infections and lockdowns returning to many countries, it seems clear that COVID will be with us for a long period of time.
In short, it is still too early to clear many of our doubts and the new normal is this: we do not know when we will get out of this.
FINAL NOTE: During the pandemic, many of us have gone through the five phases of grief that, according to psychiatrist Elisabeth Kübler-Ross, take place to a greater or lesser degree whenever we suffer a loss. On this occasion, many have lost loved ones, and we have all lost our life as we knew it. After the denial, to think that this couldn’t be happening; after anger, where we have all sought guilty; after the negotiation, where we still hoped that everything would return where we left it in December 2019; After these 3 phases, depression and acceptance arrive, where we can begin to definitively assume the reality of what we are experiencing: the economic repercussions, the political and social upheaval, our fear of the unknown and, of course, the inevitable change that we all resist.
Assuming that there is a new reality is part of the process and the sooner we get there, the sooner we will understand that there are things that are beyond our control and that we have to look forward with optimism and solidarity.
Photos: Ibrahim Boran, Daniel Schludi, Danielñ Tafjord, Ulises Guareschi Corvetto