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  • Writer's pictureDr. Bow Tie

COVID-19: Three Years Later (Pt. 1: VARIANTS)

Updated: Sep 26, 2023

It's been three years since our world changed after a virus spread across the world and, over the course of two years, killed over one million Americans. To date it has killed over seven million people worldwide.

After about a month of trying to stave off the tide of the pandemic, people immediately started trying to go back to "the way things were." For the first year and a half, even I had hopes that we could eradicate SARS-CoV-2 to the point where things could return to what we used to know as normal. It is now clear that that is never going to be the case - our world is fundamentally changed now. Still, there are some who insist that we can just...undo the changes we made and that will make the pandemic go away.

When I talked about those mitigation measures - mostly masks, but also increasing ventilation, avoiding time in crowded areas, and vaccines+boosters - some folks mocked me for "living in fear." But as things have changed, those measures have become a part of living in safety. Seatbelts, traffic lanes, not yelling "fire" in a crowded theater, and now COVID measures - these are things that allow us to live our lives and to be safe within them. But you've heard me say some of these things before.


Don't get me wrong. Things HAVE changed. We are definitely not in the same place we were in March of 2020, or even March of 2021. And at this point, the public health emergency (PHE) has been officially declared over. Great - problem solved, right? Well, not quite. The pandemic has not ended - just the PHE. In the wake of that, though, people have started to try and rewrite the history of the last three years. A great many people, including physicians, have found a platform in contrarianism. The truth about COVID is that it's hard, and it DID change things, and it IS still around and making people sick (and dead). There is a path to instant fame in using your platform to peddle pseudoscience and "easy" cures that have no evidence basis, and to question the actual science (which is fine if you're willing to listen to the answers) while touting their own "research" with complete confidence (when even just a little scrutiny shows glaring flaws, but if you call that out they pivot to myths and grift - that's the difference. Scientific communicators like me who actually follow evidence also acknowledge the research's flaws). Let's set the record straight.


VARIANTS

We have seen viral variants rise and fall over the course of the pandemic. OG COVID, and the exploration of variants with beta and gamma. Then Delta hit in a big and deadly way. During both major waves, we saw significant increases in hospitalizations and reached for every tool we could to try and save our patients. By that time, vaccines had created some impact, though, so that by the time Omicron came around, between vaccine-mediated immunity and infection-mediated immunity, and a lower severity of the variant, we did not see as many hospitalized cases (even as less acute cases swelled and long COVID showed up more). This, despite the fact that mask mandates had been removed.


Now, we face a couple of new variants from the Omicron lineage. XBB1.5, EG.5, and BA.2.86 are currently circulating worldwide. There are still hundreds to thousands of hospitalizations from COVID-19 each day (see the NBC article below) across the country (far less than a year or two ago). There are even more cases outside the hospital, though we have no way of knowing how many given the lack of testing.


Now that the public health emergency is done, insurance companies, other corporations, and even schools are eager to pretend COVID is no big deal and doesn't require time off or even treatment - but it still does. If you have symptoms, you absolutely should get tested (either at home or at your doctor's office or pharmacy), and you should isolate for five days (ideally it should be ten to fourteen, but corporations bullied the CDC into lowering that).


That is one example of how we haven't bothered to create any real infrastructure, any real lasting protection in the interest of trying to forget the past two years - that denial isn't helpful. If anything, it sets us up for more failure.


Myth: Vaccines created variants.

Vaccines helped reduce severe disease and hospitalization. Immunity means less infections and less spread. The less time one spends infected, the less time there is to create variants (because the virus needs to replicate in a human host to mutate).


Myth: Vaccinated people spread COVID-19 more!

This is incorrect, and an example of the base rate fallacy. This stemmed from a couple of events in which there were mostly vaccinated people in attendance, but a handful of unvaccinated folks brought the virus, and it inevitably spread even among the vaccinated. Nowadays, even if we are vaccinated, the virus is so prevalent that without mitigation and updated vaccines, it is hard not to catch it (as we are seeing with the recent surge in cases).


EDIT/UPDATE AFTER A QUESTION ASKED:

Myth: The new variants aren’t detected on home tests.

Thankfully they are! The tests detect the nucleocapsid, which doesn’t evolve as much. However, because of the possible delay in symptoms starting (2-14 days), 1 test may not be enough if you haven’t developed enough of a viral load. The ideal is to test multiple times over several days (which is why the government has started sending out free tests again).


Parts 2-5 (including the new vaccines for 2023-2024) coming next!


REFERENCES


Home tests:

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