More than two years since COVID-19 first reared its ugly head, the pandemic has become endemic, the virus widespread. And while the virus is significantly less fatal now, thanks in no small part to Australia’s strong vaccination uptake, immunity-evading new variants continue to emerge. So, what does that mean for the future?
Fortunately, the researchers at Hunter Medical Research Institute, a Newcastle-based research body that works in partnership with John Hunter Hospital and University of Newcastle, have been working hard to find the answer.
Respiratory disease researcher and physician Professor Peter Wark and HMRI viral Immunologist Associate Professor Nathan Bartlett recently joined forces to answer some of the community’s burning questions about COVID-19.
Professor Nathan Bartlett
Professor Peter Wark
Q: I had COVID-19 3 months ago and had very minor symptoms. Since then, I’ve experienced extreme tiredness and a general lack of motivation and a general lack of energy levels. Is that common?
In the first month about 50 per cent of people talk about fatigue and tiredness. It’s usually mild and improves in the majority of people, but a small minority can have residual symptoms.
It’s more likely in women than men.
Up to 4 – 5 per cent of people who get omicron COVID-19 develop long COVID-19.
Q: Is there a longer long COVID-19?The simple answer is we don’t know. Long COVID-19 is defined as a persistence of symptoms beyond 12 weeks. If people have significant symptoms after 12 weeks, they will probably continue for 6 – 12 months.
Q: When can we expect to have a new kind of COVID-19 vaccine that might target a different part of the virus?
The WHO (World Health Organisation) lists vaccines in various stages of clinical development. There’s a number that are in Phase 3 that are intranasal vaccines, and they could be ready as early as next year.
The aim of developing the vaccines is to stop infection rather than manage infection once it has occurred.
There are two issues with developing new vaccines for COVID-19:
- Covering the current and potential future variants.
- Getting protective immunity in the upper respiratory tract, where the virus is entering and transmitting and causing infection.
We’re experimenting with vaccines that might provide greater coverage, are less variable, less likely to change as the virus evolves, and is less likely to provide an ability for the virus evade to the vaccine.
Q: Should we expect future vaccines to last longer than the first generation of vaccines?
It depends on the virus. It has changed enough that we have to have a very high antibody response to it. That’s very dependent on the type of antigen, and makeup of the virus itself that our immune systems have become used to.
If the virus had stayed the same as it was when it started in 2019 we would probably have had more effective response with the vaccines and they would have had a success rate of about 95 per cent.
But as the virus has started to change and become a lot less like the original ancestral strain, unfortunately the efficacy of the vaccines has waned.
Q: Should we expect more mutations?
Yes, the predominant mutation circulating in NSW is either BA4 or BA5 but there are other mutations emerging, such as BA2.75 in the Indian sub-continent.
It’s important to remember that the majority of the world is unvaccinated; this is a global problem. It’s circulating everywhere and will continue to mutate.
This virus is not able to mutate any more than any other RNA virus. What’s driving this is the level of infection; it’s adapted to its human hosts very quickly. COVID-19 is as infectious as the most infectious disease known, which is measles.
When COVID-19 started, it had a reproduction rate of 3, Delta was about 5, and Omicron is about 18.6.
Q: Is it better to get the fourth vaccine or wait for a better vaccine?We strongly recommend you get the fourth vaccine. If you get COVID-19 it will reduce the severity.
Q: What are some of the practical things people in the community can do to help stop the infections?There’s a number of things you can do to stop infections of COVID-19:
- Wear masks when you’re going into public places indoors.
- If you are unwell, stay at home; do not go to work.
- Do not go and see susceptible and vulnerable friends and relatives. You will make them sick.
- If you have a negative RAT test but have symptoms such as a scratchy sore throat, get a PCR test to make sure. This is because the sensitivity of RAT tests has probably waned because the virus has changed now.
Q: What are some of the antivirals being used and who should take them?
There are two antivirals. They are Molnupiravir (sold as Lagevrio) and Nirmatrelvir/ritonavir (sold as Paxlovid). They’re tablets for the use of people who have acute COVID-19.
They need to be used within the first five days of symptoms, before COVID-19 starts to cause the inflammatory response that makes people unwell.
They are available on the PBS through Medicare for people who are susceptible to getting this infection.
These antivirals are available if you are:
- Over the age of 75.
- Over the age of 65 who have another chronic medical condition.
- Live in residential aged care facility.
- Over the age of 18 and have a serious condition or on immunosuppressant drugs.
- At risk due to other medical conditions.
They are not available for use in children and in most cases are not able to be used if you are pregnant or breastfeeding.
If you think you might have COVID-19 and are taking an antiviral, you need to do it very quickly. There is a five day window
You really need to jump on this virus and limit its replication before your body mounts that immune response, which is essentially what makes people sick. So that’s why we’re acting quickly and getting PCR and actually determining it is COVID-19 is so important because the clock is ticking, and you only have those five days to start antivirals.
Still got questions? Click here to watch the Q&A.