COVID Update April 29, 2023: Paxlovid Resistance, Emerging Variants, and a World Overview

"If we lose Paxlovid, we could easily double the number of deaths"

"The Presidential Range in the White Mountains of New Hampshire is a symbol of persistence and resilience. The mountains stand tall and proud, weathering the toughest of storms and the most challenging of conditions. They are a reminder that with determination and strength, we too can overcome any obstacle that comes our way." Image credit: T.A.C.T. (Together Against COVID Transmission)

URGENT MESSAGE: We are caught in a vicious cycle of new COVID variants breaking through immunity walls, adapting to evade treatments and vaccines, and causing serious and long-term health issues, including autoimmune disorders, cancers, vascular, neurological, musculoskeletal, and cognitive dysfunction. With each new variant, the virus is getting better at infecting and persisting in the human body, while our immune systems are struggling to keep up.

It is crucial to take the time to recover following an infection and do everything possible to avoid another infection of any other pathogens. The immune system recovery can take weeks in healthy people, and many months in those with weaker immune systems. The lack of surveillance to quickly identify new variants is a serious problem. The XBB.1.5 variant spread around the world before it was even acknowledged. In the west, our governments are in complete denial, ignoring this obvious cycle of events. We need to take proactive measures like India did as Arcturus surged, running hospital readiness drills, warning citizens of risks, increasing testing and contact tracing, and isolating those infected. We cannot afford to be complacent - the next variant could cause more long term damage and be even more deadly.

The map above was released by the W.H.O. this week. While cases and hospitalizations are declining or leveling off, represented by the blue green shades, in the U.S., the U.K., South Africa, and Australia, new cases and hospitalizations are increasing (orange and red shades) in countries like India, Indonesia, Singapore, and France.

The emergence of new variants of COVID-19 follows a cyclical pattern. The arrows on the map are an over simplification but the point is that we are seeing the same pattern repeated. A variant, like Delta, breaks through immunity walls in India, leading to a rapid spread that spans the globe. As population level immunity builds and the weakest die, then cases and hospitalizations fall but it isn’t over. The immunity gained wanes over a few months and at the same time, somewhere else in the world, another variant arises, like Kraken (XBB.1.5) in the U.S., adapting to evade the immune response gained and again spans the globe, even before it is officially reported.

Currently, Arcturus (XBB.1.16) arose in India and further breaks through immunity, evading and suppressing the immune system, persisting in organs including the brain. We can see on the map above that they have increasing cases. Why would we end masks in hospitals, end the public health emergency, and close dashboards when we know the next variants are already spreading at a time we have less treatments, no updated vaccines and waning immunity?

It is important to note that some new symptoms have developed with Arcturus. A larger number of people are having pink eye symptoms, and lower respiratory tract infections. T.A.C.T. reported the higher prevalence of pink eye with XBB.1.5, but this variant has increased the number of people having pink eye like symptoms, from infected eyes.

COVID Eye Infection

We have another emerging variant that we are watching very closely. XBB.2.3, nicknamed, Acrux, named after the brightest star in the southern constellation of Crux. Acrux, the XBB.2.3 variant and its sub-variants are possibly behind the increasing hospitalizations in Singapore.

Signapore Hospital Admissions, ICU Admissions and By Age

The increasing number of mutations found in the body of the virus suggest that it is actively searching for ways to better evade T-cells, allowing for more replication and infiltration into the lower respiratory tract. This is leading to a greater frequency of COVID pneumonia, especially in the elderly population, but also in younger patients. A 45-year-old man died of COVID pneumonia in India on April 20th, for example. Persistent COVID in the lungs in the weeks and months following a COVID infection, often aren’t picked up on PCR tests, according to this study. That means doctors may not be utilizing the most effective treatments and COVID Pneumonia deaths may be misclassified as Pneumonia.

This continuous cycle of mutation and adaptation is concerning as each new variant becomes more adept at evading treatments and vaccines. It is very important to maintain monitoring of the spread of new variants and continue developing effective treatments and vaccines to combat them. It is vital to take proactive measures like providing Clean Air for Kids and installing CO2 monitors, and increasing ventilation and filtration in schools to significantly reduce transmission.

Unfortunately, many Western nations have reduced their mitigation efforts and surveillance, which is a serious concern. Governments had previously promised to support those at higher risk with effective tools such as testing, treatments, monitoring dashboards, and research funding, yet these promises have not been fulfilled. Rather than taking proactive steps to tackle the virus, many Western governments seem to have given up and are proclaiming victory over the pandemic, despite their failure to protect their citizens.

It is crucial for governments to tell the truth about the situation, no matter how unpleasant it may be, and work together with their citizens to protect everyone from the virus. Denial and misinformation will only lead to more harm, and it is essential to move forward together to ensure that no one is left behind.

COVID's Evolutionary Advantage During Wide Spread Transmission

Deborah Birx, "If we lose Paxlovid, we could easily double the number of deaths" In an article published in Fortune, April 29, 2023, they report Deborah Birx is sounding the alarm on the lack of effective treatments and the very real possibility Paxlovid will soon become ineffective like many earlier treatments. We previously reported on this, and below is a study showing the mutations that would make Paxlovid resistance possible.

"Paxlovid resistant SARS-CoV-2 viruses with mutations in the main protease have been identified from clinical isolates."

“I’ve been really upset that the federal government has not prioritized next-generation vaccines that are more durable, next-generation monoclonals, and long-acting monoclonals,” Birx told Fortune in an interview at the magazine’s Brainstorm Health conference, held earlier this week in Marina del Rey, Calif.

Omicron is mutating to bypass the initial arsenal of weapons developed for use against it. Already, its changes have rendered every universal monoclonal antibody treatment—administered to people at high risk of hospitalization and death—useless. Eventually, it will take down Paxlovid, too, Birx says.

She added: “If we lose Paxlovid, we could easily double the number of deaths,” which currently sit at just over 1,000 per week, according to data from the U.S. Centers for Disease Control and Prevention.

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United States Variant Proportions

Arcturus (XBB.1.16) is expected to continue spreading rapidly and displacing XBB.1.5. Additionally, Acrux (XBB.2.3) sub-variants have already emerged in the United States but are still gaining a foothold in most areas. Within the next three to four weeks, Arcturus is likely to become dominant, as it has already reached around 25% prevalence in some areas. Unfortunately, this surge will coincide with events like proms and graduations. Closing schools a few weeks early could protect families and communities from this highly transmissible variant. With additional ventilation, these important events could occur with less virus circulating in the community. Schools could consider using the unused snow days in areas that did not experience much snow. Every day schools remain open past mid-May and into June, the transmission gains momentum and prevalence in any one space will be higher, making the odds of infection and more severe symptoms higher. By cutting off thousands of potential transmission paths, we can significantly reduce the spread of the virus and protect our communities.

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United Kingdom Variant Proportions

U,K. prevalence through April 3, 2023. Arcturus (XBB.1.16) (pink) is just beginning to gain momentum. Like past years, new cases will grow through schools and homes first and then spread out into communities.

The Zoe Health Study is indicated that the number of cases of COVID-19 is steadying off and is probable to escalate once more towards the middle of July, similar to the previous two years. The reason cases stop escalating and decline in July lies in the fact that this is the period when schools close for the summer break. However, with the presence of the Arcturus variant, the spread of the virus may surpass the levels seen in the previous two years. This brings us back to the importance of providing Clean Air for Kids in schools. This is the single most important thing society could do to protect our collective future. Airborne viruses spread in schools and COVID is the most contagious airborne virus of our time.

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