New Coronavirus News from 23 May 2023

COVID-19 vaccines may undergo major overhaul this fall [Science, 23 May 2023]

BY JENNIFER COUZIN-FRANKEL

As Omicron persists, consensus grows for abandoning the ancestral coronavirus strain to improve immune responses

Earlier this year, U.S. regulators settled on a new strategy for COVID-19 vaccines. Like the annual flu shot, the vaccines will be updated each year based on the virus’ evolution, then rolled out in the fall. Accordingly, on 15 June, advisers to the U.S. Food and Drug Administration will weigh which strain or strains of SARS-CoV-2 should make up the next iteration of vaccine, so that the agency can greenlight a version for companies to mass-produce.

Regulators may well jettison the original SARS-CoV-2 strain that emerged in China and is long extinct—but which people are still being vaccinated against today. Many scientists favor eliminating it. The ancestral strain “should go out of the formulation,” says William Messer, an infectious disease specialist and viral immunologist at Oregon Health & Science University.

Last week, the World Health Organization (WHO) agreed. But other questions loom, including whether to bundle multiple virus strains into the vaccine or just one.

To date, COVID-19 vaccines have been modified only once, when a bivalent version based on both the original strain and the BA.5 Omicron variant was introduced in September 2022.

Uptake was disappointing: Only 17% of people in the United States have rolled up their sleeves. (By comparison, about 50% get an annual flu shot.) Furthermore, many researchers say the bivalent vaccine packed less of a punch than it could have. The decision to preserve the ancestral strain sprang from worries that if an entirely new variant emerged, an Omicron-only vaccine might falter against it.

This hedging proved unwarranted: All major new variants have flowed from Omicron, which was first detected in South Africa in November 2021. And evidence increasingly shows that a vaccine split between a current strain and one that’s extinct makes it harder for people to mount a strong immune response to the virus.

On 4 May, for example, David Ho, a virologist at Columbia University, and his colleagues posted a preprint study of 72 people, including some who had received four doses of the original vaccine and others who’d gotten three doses and a bivalent booster. Those who got the booster didn’t produce antibodies that were notably better at neutralizing Omicron. The reason, Ho explains, is a phenomenon called immunological imprinting, in which repeatedly exposing the immune system to one strain—in this case, the ancestral one—skews the immune response in that direction. When the decision was made to keep the ancestral strain in COVID-19 vaccines, Ho says, imprinting “was probably not a dominant consideration, but it is now.”

Florian Krammer, a virologist at the Icahn School of Medicine at Mount Sinai, agrees. He and his colleagues published a study this month in The Lancet Microbe in which they studied blood from 16 people 1 month before and about 2 weeks after they got a bivalent booster. After the booster, antibodies in the blood did a slightly better job of neutralizing the ancestral strain than BA.5. Krammer says his team also couldn’t find “specific” antibodies solely reactive to BA.5, which could be especially protective if they’re plentiful.

Last week, a WHO advisory group said in a statement that although current COVID-19 vaccines guard against severe disease, “protection against symptomatic disease is limited and less durable.” In place of a bivalent shot, the group recommended a single-strain fall vaccine based on the XBB.1 lineage now dominating across continents, although it left the door open to other effective vaccine recipes.

Whether a single-strain XBB.1 vaccine is the best bet or whether multiple Omicron strains should be included is a point of debate. In the past few months, two closely related XBB substrains, XBB.1.5 and XBB.1.16, have crowded out other Omicron variants. “We’re basically trying to guess what the next generation of variants will be, descending from which lineage,” Ho says.

“From what we know now, matching the vaccine to whatever circulating variants you’re trying to protect against probably does best,” says Angela Branche, an infectious disease specialist at the University of Rochester. She co-leads a study called COVAIL that’s examining immune responses spurred by different boosters. It has found that monovalent vaccines against Omicron perform somewhat better than those that include the ancestral strain.

An important question is whether vaccines better matched to current strains could reduce not just severe illness, but also transmission—something current vaccines appear to do poorly. An April study in The New England Journal of Medicine showed that after BA.5 faded and other Omicron strains surged, the bivalent vaccine’s ability to prevent transmission peaked at about 30% 2 weeks after someone got the shot and fell to 0% at 16 weeks. “It’s not an unreasonable supposition” that a closer match could perform a bit better, though the effect is still unlikely to persist, Messer says.

Some researchers also think the updated vaccines should not be limited to the messenger RNA formulations made by Pfizer and Moderna. Novavax makes a protein subunit vaccine, the technology used in hepatitis B and human papillomavirus vaccines. “It would be good to have protein vaccines for the fall,” as those may give more durable protection, Branche says. But it’s unclear whether the company would be able to mass-produce a new vaccine in time.

Robert Frenck, who directs the Vaccine Research Center at Cincinnati Children’s Hospital and helped conduct trials of Pfizer’s COVID-19 vaccine, points out that most vaccines for other infectious diseases “use one methodology,” without causing concern. The strategy against COVID-19 need not be any different, he says.

Messer hopes regulators and companies will stay flexible as COVID-19 knowledge continues to grow—and urges targeting the new vaccines to people at highest risk. In the fall, “vaccine fatigue, COVID fatigue, is still going to persist,” he says, and “triaging your efforts to get good vaccine uptake” will be vital.

New Coronavirus News from 16 May 2023

What do we know about the Arcturus XBB.1.16 subvariant? [The BMJ, 16 May 2023]

BY Mun-Keat Looi

The “Arcturus” subvariant of SARS-CoV-2 has been making headlines for weeks. Mun-Keat Looi reports what we know so far

What is XBB.1.16?
XBB.1.16 is yet another in the line of omicron subvariants that began with BA.2. It follows on from XBB and XBB.1 and is related to the XBB.1.5 subvariant (“Kraken”) that began to dominate at the start of the year.1 Some have nicknamed this new subvariant “Arcturus” (meaning “Guardian of the Bear” in Greek) to distinguish it from the confusing number of other omicron versions. The X signifies that these subvariants came about through a recombination of two or more sublineages (in this case BA.2.10.1.1 and BA.2.75.3.1.1.1).

Francois Balloux, professor of computational systems biology at University College London, says, “XBB.1.16 is very closely related to XBB.1.5, the currently dominant variant in the UK.”2
Maria Van Kerkhove, World Health Organization (WHO) covid-19 technical lead, said in a press briefing that it has “one additional mutation in the spike protein, which in lab studies shows increased infectivity, as well as potential increased pathogenicity.”

Where is XBB.1.16 spreading?
First reported in India in January 2023, WHO has since found XBB.1.16 present in at least 33 countries.3 Alarm has been raised in Asia: at one point in April India was seeing 10 000 confirmed cases a day—nearly two thirds of all covid-19 in the country, and necessitating the return of mask mandates. Case numbers are now receding.

The latest UK Health Security Agency (UKHSA) technical briefing (21 April) had the variant making up 2.3% of all covid-19 cases sequenced in the UK.4 The agency has sequenced 105 cases of patients testing positive and five people have died from their infection. UKHSA says that, based on the available epidemiological and laboratory data, it is “unclear” whether the spread seen in India and elsewhere will be replicated in the population immunity landscape of the UK. “XBB.1.16 is currently at a low prevalence in the UK, showing some early evidence of growth advantage (low confidence due to low sample numbers), and will be monitored,” its report stated.

The US Centers for Disease Control and Prevention’s latest figures (22-29 April) have XBB.1.16 accounting for about 11% of all US covid cases.

Does it cause more severe illness?
WHO said on 17 April 2023 that, thus far, “no changes in severity have been reported in countries where XBB.1.16 are reported to be circulating…Disease severity is not higher compared to previously circulating variants” (in pre-immune populations).

In terms of clinical considerations, WHO did note a slight rise in bed occupancy in some states in India (2-4%) but emphasised that “these levels are much lower compared to the level recorded during the delta wave or omicron BA.1/BA.2 waves.”

Van Kerkhove said, “It’s been in circulation for a few months. We haven't seen a change in severity in individuals or in populations.”

An early study, posted as a preprint to medRxiv and yet to be peer reviewed, looked at over 300 cases in India from December 2022 to April 2023. It found mild symptoms similar to those from earlier omicron variants, with few hospitalisations and deaths.5

WHO notes that the antiviral monoclonal antibody sotrovimab exhibits antiviral activity against XBB.1.16, similar to other XBB subvariants.

Do current covid vaccines protect against XBB.1.16?
It’s too early to say definitively because no data are available on vaccine efficacy against XBB.1.16 yet. Studies6 have found that the neutralising properties of vaccine induced antibody responses against the closely related XBB and XBB.1 were significantly poorer than against other variants. In India over 70% of the population has had a booster dose.

Hybrid immunity in those who have been both vaccinated and previously infected with XBB.1.5 should offer stronger protection. Given the dominance of omicron and XBB.1.5 in many countries today, such immunity is likely to cover most individuals.

Is XBB.1.16 a cause for concern?
On the whole no, at least not at the moment for those who have been vaccinated (as with any form of covid, the risk is still severe for the unvaccinated).

On the one hand, it is showing signs of stronger growth, hence its advantage over other variants in circulation. But this has not so far caused more severe disease.

The European Centre for Disease Prevention and Control has XBB 1.16 as a “variant under monitoring,” its third level (under variant of concern and variant of interest). So do WHO and the US Centers for Disease Control and Prevention.

Balloux says that in places that didn’t have an XBB.1.5 wave (for example, India or China), XBB.1.16 is expected to “do well.” “Conversely, in places like the UK, it is not expected to have much of an impact on case numbers, and even less so on hospitalisations and deaths,” he says. “XBB.1.16 is still at low frequency here in the UK, but it may become the next dominant variant in the future.”

References
1. Mahase E
. Covid-19: What do we know about XBB.1.5 and should we be worried?BMJ2023;380:153. doi:10.1136/bmj.p153 pmid:36657748

2. World Health Organization. WHO press conference on COVID-19 and other global health issues—29 March 2023. Press briefing. https://www.who.int/multi-media/details/who-press-conference-on-covid-19-and-other-global-health-issues-29-march-2023
3. World Health Organization. XBB.1.16 Initial risk assessment. 17 April 2023.
4. UK Health Security Agency. SARS-CoV-2 variants of concern and variants under investigation in England. Technical briefing 52. 21 April 2023.
5. Karyakarte RP, Das R, Rajmane MV, et al. Chasing SARS-CoV-2 XBB.1.16 recombinant lineage in India and the clinical profile of XBB.1.16 cases in Maharashtra, India.medRxiv2023https://www.medrxiv.org/content/10.1101/2023.04.22.23288965v1doi:10.1101/2023.04.22.23288965

6. Wang Q, Iketani S, Li Z, et al. Alarming antibody evasion properties of rising SARS-CoV-2 BQ and XBB subvariants. Cell2023;186:279-286.e8. doi:10.1016/j.cell.2022.12.018 pmid:36580913

New Coronavirus News from 24 May 2023

China is bracing for a massive new wave of COVID cases. What this means for the rest of the world [Fortune, 24 May 2023]

BY ERIN PRATER

Cases of Omicron variant XBB are mounting in China, forming a new wave expected to crest around 65 million cases weekly by the end of June.

Infections will likely reach 40 million per week by the end of the month, senior health adviser Zhong Nashan told attendees at a biotech conference in Guangzhou, according to Bloomberg.

The wave could swell to become the country’s second largest, experts tell Fortune. It will undoubtedly pale in comparison to the country’s first major wave late last year, during which an estimated 37 million people were infected on one day—Dec. 20—alone.

That wave—equivalent to the early days of the pandemic for the rest of the world—occurred after the country abruptly abandoned its yearslong “zero COVID” policy, effectively letting the virus “rip” through a population that had been largely sheltered from it—and that was vastly under-vaccinated.

A ‘largely invisible’ wave
XBB, the “first major highly immune-evasive” group of COVID variants, “will sweep through China,” but the wave will be “largely invisible” owing to low rates of testing and reporting, Raj Rajnarayanan, assistant dean of research and associate professor at the New York Institute of Technology campus in Jonesboro, Ark., and a top COVID-variant tracker, tells Fortune.

When it comes to XBB variants, “the rest of the world has seen them all.” But up until recently, “China hasn’t,” he says, adding that the country has a substantial population at high risk of severe outcomes from COVID owing to age, immune status, and comorbid conditions.

Increased circulation of XBB variants in China—and elsewhere—is likely to result in the evolution of new XBB variants, Rajnarayanan said. So far, XBB spawn have remained relatively innocuous for those not at increased risk of severe disease, according to the World Health Organization’s latest situation report, released Thursday.

‘Go back for regular checkups’
It remains to be seen whether hospitalizations will rise in China, Rajnarayanan and fellow variant tracker Ryan Gregory—a Canadian biologist who has assigned “street names” to so-called high-flying variants like XBB.1.5, dubbed “Kraken”—tell Fortune.

Hospitalizations can, however, be expected to rise if variants that combine the transmissibility of XBB with the lung involvement of Delta catch on, in China or elsewhere. Trackers are eyeing variants that have a mutation in the spike protein that could cause such a phenomenon. So far, variants with Delta signature mutations are still lingering in New Zealand and the European Union, Rajnarayanan says.

The evolution of a veritable XBB-Delta combo isn’t an inevitability, though, Rajnarayanan says.

And while the virus is capable of pivoting at any point, evolving into a more lethal version of itself, it so far hasn’t—and the chance of its doing so isn’t any greater in China than it is in the rest of the world, where the virus is also spreading unchecked, Ali Mokdad, a professor at the University of Washington’s Institute for Health Metrics and Evaluation, tells Fortune.

While caution is always warranted when it comes to COVID, people everywhere need to “go back for regular checkups, and bring their kids in for vaccinations,” Mokdad said.

COVID precautions “saved a lot of lives,” he added. “It’s time for us to go back to normal and make sure it’s not at the expense of other preventative programs.”

New Coronavirus News from 7 Jun 2023

China’s rolling COVID waves could hit every six months — infecting millions [Nature, 7 Jun 2023]

By Yvaine Ye

The latest surge is unlikely to crash the country’s health-care system, but scientists fear hundreds of millions of infections.

The latest surge in COVID-19 cases in China is not surprising to researchers, who say that China will see an infection cycle every six months now that all COVID-19 restrictions have been removed and highly infectious variants are dominant. But they caution that rolling waves of infection carry the risk of new variants emerging.

“Unfortunately, a new reality with this virus [is that] we will have repeated infections,” says Ali Mokdad, an epidemiologist at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle. “The fear is that this virus will produce a new variant that can compete with the current ones and is more severe.”

The current surge is caused mainly by a highly infectious subvariant of Omicron called XBB.1.5, first identified in India last August. According to Nanshan Zhong, a prominent respiratory physician in China, as many as 65 million people could become infected per week by the end this month.

This is the first major reinfection wave that China has seen since the central government dropped all its COVID-19 control measures in December, prompting a widespread Omicron outbreak.

China has vaccinated more than 90% of its population, and the outbreak in December infected at least 85% of its people, says Zhong. But immunity is waning, and XBB can evade protection from vaccines and prior infections. Mokdad says that, although XBB has not caused a major rise in hospitalizations and deaths, the sheer number of infections could put pressure on China’s health-care system.

XBB is also causing minor waves in other parts of the world, such as Singapore and the United States.

“This is what we see everywhere, but with a large population such as China, it is more apparent,” says Mokdad.

Yunlong Cao, an immunologist at Peking University in Beijing, and his team have found that antibodies generated against Omicron variants BA.5 and BF.7, the dominant strains during the December wave in China, can provide about four months of protection against strains such as XBB1.

Kayoko Shioda, an epidemiologist at Boston University in Massachusetts, says that previous COVID-19 surges in other countries have shown that XBB is more transmissible than earlier forms. “Once it enters the population, XBB spreads and becomes the predominant variant much quicker than other variants,” she says.

Last December, more than 200 million people in China contracted COVID-19 in 20 days. This time, the wave is spanning several months, owing to the differences in people’s immune backgrounds, such as antibody levels, says Cao. “The peak of COVID-19 waves will generally become flatter and more stretched out after each cycle, which is a pattern we see in countries like the US. People are still getting infected in the US, just not all at once,” he adds. A flatter wave would also lessen the burden on health-care systems, Cao says.

New boosters
Because China no longer publishes its COVID-19 case count, it is unclear how many people are becoming infected in the latest wave; however, the Beijing health authority says the number of COVID-19 cases reported in the capital city quadrupled between late March and mid-April. Cao says it’s hard to make estimates without accurate data. But on the basis of his past research, he estimates that at least 30% of the population could become reinfected in this wave, amounting to more than 400 million people.

Scientists say having a good surveillance system to monitor and track emerging virus variants is very important, given that infection cycles will continue to happen. A new variant that could supersede current ones remains a concern, says Mokdad. “Imagine a Delta type of variant with XBB capacity of spreading. This will cause us a lot of damage.”

Tracking the virus’s evolution also means that scientists can update booster vaccines accordingly.

Facing the ongoing COVID-19 wave, several major Chinese cities, including Beijing and Shanghai, have started to inoculate residents with a quadrivalent COVID-19 booster, made by the Chinese biotechnology company Sinocelltech Group. The vaccine, first approved for emergency use in March, is designed to provide broad-spectrum protection against the Alpha, Beta, Delta and Omicron BA.1 coronavirus variants. Sinocelltech announced last month that one booster shot using this jab can prevent 82% of SARS-CoV-2 infections — including ones caused by XBB — for up to four months. The final results from the vaccine’s clinical trial are not yet available.

Zhong says that China is developing vaccines targeting XBB. Although current vaccines can provide good protection against severe disease and death, they are not very good at providing long-lasting protection against infection. “But that doesn’t mean we should just give up.

Repeated infections, even with a mild virus like XBB, can still lead to health problems like long COVID. Vulnerable people, such as older adults, are still at risk of getting very ill,” Cao says.

doi: https://doi.org/10.1038/d41586-023-01872-7

References
1. Chen, X. et al. Lancet Reg. Health West Pac. 33, 100758 (2023).

New Coronavirus News from 29 May 2023

How Worried Should the World Be of China's New COVID Wave? [TIME, 29 May 2023]

BY CHAD DE GUZMAN

China Might Have 65 Million COVID Cases a Week by June. How Worried Should the World Be?
ast week when a Chinese senior health adviser projected 65 million COVID-19 cases per week in China by June, some health experts sounded the alarm.

China has been facing a new COVID-19 wave fueled by the XBB variant since April. Data from Zhong Nanshan—a respiratory disease doctor who was among the first to confirm COVID-19’s easy transmissibility—provided a rare insight into how the disease could possibly be spreading in China almost six months after Beijing abruptly ended its draconian zero-COVID strategy.

Since pivoting to “living with the virus” policy from early December, the Chinese Center for Disease Control and Prevention stopped updating weekly infections. But the sudden relaxation of anti-epidemic protocols also led to an estimated 37 million new infections a day weeks later.

By January, experts said they believed almost 80% of China’s 1.4 billion population had already been infected in this first wave.

For the second wave since April, Zhong’s modeling revealed that the XBB variant is expected to cause 40 million infections weekly by May, going up to 65 million in June. This goes against the grain of Chinese health officials’ estimate that the wave had peaked in April. In Beijing, the number of new infections recorded between May 15 and 21 grew four times in four weeks.

While Zhong said vaccines targeting this specific variant will be rolled out soon, the projection of new COVID-19 infections nonetheless frazzled markets. China’s collective immunity has always been in question: a refusal to use foreign-sourced mRNA vaccines meant the public got inoculated against COVID-19 with a jab that proved less effective in preventing infection during early clinical trials, say researchers, and the stringent virus containment protocols restricted the possibility of developing natural immunity.

Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations, tells TIME that although only mass testing can detect the true extent of the COVID-19 surge, the population has obtained some immunity from the preceding wave.

“We shouldn’t worry if China doesn’t worry,” Huang says. “Public health officials try to downplay the severity of this second wave. The Chinese people seem to have learned to co-exist with the virus. There’s that social adaptability.”

Compared to countries like the U.S. and Australia, China has just begun transitioning COVID-19 from a pandemic to an endemic disease. Catherine Bennett, an epidemiologist at Deakin University in Australia, says the new wave “tests the effectiveness of their vaccines and their boosters,” adding that Beijing must ensure everyone’s vaccines are up to date—especially the elderly and the vulnerable population.

Chinese data a concern
With the virus continuing to circulate in China coupled with a waning public immunity, the possibility of a new, more dangerous sub-variant emerging still exists, Bennett adds, although the likelihood is much smaller now. The latest mutations in the genetic makeup of the SARS-CoV-2 virus have not been significantly different from the last major variant, Omicron, and the symptoms of infections are relatively milder. “It’s somewhat reassuring, thus, now a year and a half into Omicron, that we haven’t seen a major shift that’s either undermined our immunity, our testing capability, and importantly, antivirals,” Bennett adds.

But another factor that affects the prognosis for China is its willingness to share information. Independent experts have been skeptical of China’s official COVID-19 figures, forcing many to record their own statistics. A delayed release in China’s marriage and funeral data for the October-December 2022 period has also raised speculation that the country has yet to determine the true extent of the infection spread of its first wave.

Vincent Pang, an assistant professor at the Duke-NUS Medical School in Singapore, says data on the spread and impact of COVID-19 will only be of use if shared with others on a global, well-regulated platform, so that these countries can perform their own risk assessment.

“Infectious disease does not respect geographical boundaries,” he tells TIME. “No one is safe until everyone is ready and safe.”

How Worried Should the World Be of China's New COVID Wave? [TIME, 29 May 2023]

China Might Have 65 Million COVID Cases a Week by June. How Worried Should the World Be?

BY CHAD DE GUZMAN

Last week when a Chinese senior health adviser projected 65 million COVID-19 cases per week in China by June, some health experts soundedthe alarm.

China has been facing a new COVID-19 wave fueled by the XBB variant since April. Data from Zhong Nanshan—a respiratory disease doctor who was among the first to confirm COVID-19’s easy transmissibility—provided a rare insight into how the disease could possibly be spreading in China almost six months after Beijing abruptly ended its draconian zero-COVID strategy.

Since pivoting to “living with the virus” policy from early December, the Chinese Center for Disease Control and Prevention stopped updating weekly infections. But the sudden relaxation of anti-epidemic protocols also led to an estimated 37 million new infections a day weeks later.

By January, experts said they believed almost 80% of China’s 1.4 billion population had already been infected in this first wave.

For the second wave since April, Zhong’s modeling revealed that the XBB variant is expected to cause 40 million infections weekly by May, going up to 65 million in June. This goes against the grain of Chinese health officials’ estimate that the wave had peaked in April. In Beijing, the number of new infections recorded between May 15 and 21 grew four times in four weeks.

While Zhong said vaccines targeting this specific variant will be rolled out soon, the projection of new COVID-19 infections nonetheless frazzled markets. China’s collective immunity has always been in question: a refusal to use foreign-sourced mRNA vaccines meant the public got inoculated against COVID-19 with a jab that proved less effective in preventing infection during early clinical trials, say researchers, and the stringent virus containment protocols restricted the possibility of developing natural immunity.

Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations, tells TIME that although only mass testing can detect the true extent of the COVID-19 surge, the population has obtained some immunity from the preceding wave.

“We shouldn’t worry if China doesn’t worry,” Huang says. “Public health officials try to downplay the severity of this second wave. The Chinese people seem to have learned to co-exist with the virus. There’s that social adaptability.”

Compared to countries like the U.S. and Australia, China has just begun transitioning COVID-19 from a pandemic to an endemic disease. Catherine Bennett, an epidemiologist at Deakin University in Australia, says the new wave “tests the effectiveness of their vaccines and their boosters,” adding that Beijing must ensure everyone’s vaccines are up to date—especially the elderly and the vulnerable population.

Chinese data a concern
With the virus continuing to circulate in China coupled with a waning public immunity, the possibility of a new, more dangerous sub-variant emerging still exists, Bennett adds, although the likelihood is much smaller now. The latest mutations in the genetic makeup of the SARS-CoV-2 virus have not been significantly different from the last major variant, Omicron, and the symptoms of infections are relatively milder. “It’s somewhat reassuring, thus, now a year and a half into Omicron, that we haven’t seen a major shift that’s either undermined our immunity, our testing capability, and importantly, antivirals,” Bennett adds.

But another factor that affects the prognosis for China is its willingness to share information. Independent experts have been skeptical of China’s official COVID-19 figures, forcing many to record their own statistics. A delayed release in China’s marriage and funeral data for the October-December 2022 period has also raised speculation that the country has yet to determine the true extent of the infection spread of its first wave.

Vincent Pang, an assistant professor at the Duke-NUS Medical School in Singapore, says data on the spread and impact of COVID-19 will only be of use if shared with others on a global, well-regulated platform, so that these countries can perform their own risk assessment.

“Infectious disease does not respect geographical boundaries,” he tells TIME. “No one is safe until everyone is ready and safe.”

New Coronavirus News from 5 Apr 2023

COVID-origins data from Wuhan market published: what scientists think [Nature, 5 Apr 2023]

Authored by Dyani Lewis, Max Kozlov & Mariana Lenharo

First peer-reviewed analysis of the Chinese swabs confirms animal DNA was present in samples that tested positive for SARS-CoV-2.

Researchers at the Chinese Center for Disease Control and Prevention (China CDC) have published an eagerly awaited analysis1 of swabs collected at a wet market in Wuhan, China, in the early weeks of the COVID-19 pandemic — as well as the underlying data, which the international research community has been calling for since the beginning of the outbreak.

The analysis, published in Nature on 5 April, confirms that swabs from the Huanan Seafood Wholesale Market — which closed in January 2020 and has long been linked to the start of the pandemic — contained genetic material from wild animals and tested positive for SARS-CoV-2. This suggests that it’s possible an animal could have been an intermediate host of a virus that spilled over to infect humans. But researchers say the latest findings still fall short of providing definitive proof that SARS-CoV-2 originated from an animal-to-human spillover event. (The study authors, led by former China CDC director George Gao, did not respond to requests for comment from Nature’s news team, which is editorially independent of Nature’s journal team.)

Still, researchers say that the publication of the genomic data, which have been deposited on open repositories, is crucial — because it will allow further analyses that could offer clues about the pandemic’s origin. “It’s one of the most important data sets we’ve had since the emergence of the pandemic,” says Florence Débarre, an evolutionary biologist at the French national research agency CNRS in Paris, who was part of a team that caused controversy by publishing its own analysis of the China CDC data last month. “They exist because at the time the right things were done.”

Evolutionary virologist Jesse Bloom says that although the swabs, which were collected in January 2020, provide useful information about what animals were at the market, even earlier samples are needed to find the pandemic’s origins. “If we ever learn the exact origins of SARS-CoV-2, I suspect it will come from new information about cases or events in early December or November of 2019, or earlier,” says Bloom, who is at the Fred Hutchinson Cancer Center in Seattle, Washington.

The paper is the latest in a series of published analyses of these market samples, and the first to be peer reviewed. The findings agree with a separate preprint analysis that the swabs contain genetic data from wild animals and from SARS-CoV-2. But these environmental samples do not confirm that any of the animals present were infected with the virus.

The Chinese team behind the latest report had published a preprint version2 of its study in February 2022 that did not include an analysis of animal genetic material in the swabs, and did not make public the underlying sequence data. The team that included Débarre found the China CDC swab data in the online genomics database GISAID and published its own analysis on the research repository Zenodo3. That report identified wild-animal material in the swabs that tested positive for SARS-CoV-2 and pointed to animals, including raccoon dogs, as species of interest.

Contentious study
The latest report lends weight to one of the two competing theories about how the COVID-19 pandemic began. Debate has raged over whether it had a natural origin, with a virus passing from animals to humans, or arose from a laboratory leak at the Wuhan Institute of Virology.

The Huanan market has been at the centre of the natural-origin theory because several of the earliest known cases of COVID-19 were linked to the market. Animals that were sold there are known to be hosts for respiratory viruses called sarbecoviruses, which include SARS-CoV-2.

However, the lab-leak hypothesis gained momentum in 2021 and has not been definitively ruled out.

The latest paper, like the Zenodo report, contains details about mammalian genomic sequences present in the market samples. The authors analysed 60 samples that tested positive for SARS-CoV-2 — 11 more than in the Zenodo report — and a further 112 swabs that were negative.

The findings support the natural-origin hypothesis, says a researcher who was not involved in either study and wishes to remain anonymous owing to the controversy surrounding COVID-origins work. The presence of many wild-animal species means that a viral spillover that resulted in the COVID-19 pandemic could have occurred, says the scientist. Some of those species, such as raccoon dogs, have the potential to transmit SARS-CoV-2 infections, the source adds. “The extent of circumstantial evidence [in the latest paper] is greater than one can find for the alternate hypothesis, which is that it leaked from a laboratory.”

The study also offers clues about the role of the market in the pandemic’s origin. In the early weeks of the outbreak, two lineages of SARS-CoV-2 — dubbed A and B — were circulating.

Initially, tests identified only lineage B at the market. This led some researchers to conclude that the market might have acted only as a site for an early ‘superspreader’ event, rather than as a site of an animal spillover, because lineage A is thought to be more ancestral.

But the China CDC’s preprint posted last year identified lineage A in one sample. “It’s the result that really made me shift, that made me really say, ‘OK, it’s very likely to come from the market,’” says Débarre. But she says that some questioned whether the result was real. The new analysis confirms the presence of lineage A, addressing those doubts, she says.

David Relman, a microbiologist at Stanford University in California, agrees with the authors’ assessment in the study that the market might have acted as an amplifier of SARS-CoV-2 transmission. “It’s just as possible that humans brought the virus into the market, as animals might have.”

Spurious findings
Alice Hughes, a conservation biologist at the University of Hong Kong, has concerns about the quality of the analysis. As well as genomic fragments from animals including raccoon dogs, Hughes says that the paper identifies genetic material from pandas, mole rats and chimpanzees. Given that killing a panda attracts the death sentence in China, “there is absolutely no way any trace of panda could possibly be in that market”, she says.

The strange results could be from laboratory contamination, or improper processing of the data that failed to weed out spurious species identifications, says Hughes. “We must be exceedingly careful with interpreting or putting too much faith in the paper.”

Débarre also questions aspects of the results. The China CDC authors used two genomic-analysis methods: one that searches through all available genes and genomes, and another that zeroes in on specific sequences in the mitochondrial genome. The whole-genome method detected only a few raccoon-dog sequences in a sample that was full of raccoon-dog nucleic acids, according to the Zenodo analysis and the China CDC’s mitochondrial genome analysis, says Débarre.

The data do not clearly point to a specific animal as an intermediate host that passed the virus onto humans. But the researcher who wished to remain anonymous says that the results again highlight some animals, including raccoon dogs, that can be studied for how well they transmit SARS-CoV-2.

Débarre says that further forensic analyses could reveal whether any animal DNA in the swabs bears signs of immune-system activation, which could indicate active infection. That could help to address concerns that the presence of virus and animal DNA in the same sample does not necessarily indicate that an animal was infected.

But Relman doesn’t think that further analyses of the same data set could lead to significant answers about the virus’s origin. “What we really need are other kinds of data. Good verifiable data on the early clinical events in Wuhan.”

doi: https://doi.org/10.1038/d41586-023-00998-y

References
1. Liu, W. J. et al. Nature https://doi.org/10.1038/s41586-023-06043-2 (2023).
2. Gao, G. et al. Preprint at Research Square https://doi.org/10.21203/rs.3.rs-1370392/v1 (2022).
3. Crits-Christoph, A. et al. Preprint at Zenodo https://doi.org/10.5281/zenodo.7754299(2023).

New Coronavirus News from 8 Feb 2023

The political polarization of COVID-19 treatments among physicians and laypeople in the United States [pnas.org, 8 Feb 2023]

Authored by Joel M. Levin, Leigh A. Bukowski, Julia A. Minson, and Jeremy M. Kahn

Abstract
In the United States, liberals and conservatives disagree about facts. To what extent does expertise attenuate these disagreements? To study this question, we compare the polarization of beliefs about COVID-19 treatments among laypeople and critical care physicians. We find that political ideology predicts both groups’ beliefs about a range of COVID-19 treatments.

These associations persist after controlling for a rich set of covariates, including local politics. We study two potential explanations: a) that partisans are exposed to different information and b) that they interpret the same information in different ways, finding evidence for both.

Polarization is driven by preferences for partisan cable news but not by exposure to scientific research. Using a set of embedded experiments, we demonstrate that partisans perceive scientific evidence differently when it pertains to a politicized treatment (ivermectin), relative to when the treatment is not identified. These results highlight the extent to which political ideology is increasingly relevant for understanding beliefs, even among expert decision makers such as physicians.

A growing literature on political polarization has documented unexpected links between political ideology and beliefs that are unrelated to the principles of liberalism or conservatism (1, 2). During the COVID-19 pandemic, liberal and conservative Americans have disagreed sharply on matters such as the origins of the virus (3), the severity of the pandemic (4, 5), and the effectiveness of a range of interventions, including masking, distancing, vaccination, and drugs like hydroxychloroquine and ivermectin (3, 5–7). Such disagreements inhibit cooperation, fuel partisan antipathy, and threaten public health.

Prior work offers clues about the roots of this polarization: Partisans consume different information (4, 8, 9), evaluate the same information in different ways (10, 11), and often lack the tools (12) or motivation (13, 14) to discriminate between accurate and inaccurate claims. On these bases, we might expect beliefs about COVID-19 treatments to be dramatically less polarized among people who are particularly informed, trained, and motivated, such as physicians.

In the present work, we examine physicians’ beliefs about treatments for COVID-19, benchmark their polarization against that of lay adults, and provide evidence for two psychological mechanisms that give rise to polarized beliefs among both groups.

Methods

We study two samples: a novel panel of 592 board-certified critical care physicians (“physicians”) and a sample of 900 adults recruited from an online panel (“laypeople”), all based in the United States. We focused on critical care physicians because they are important decision makers in the treatment of severe COVID-19 and because their day-to-day judgments are less influenced by patient preferences, compared to other physicians. Additional information about both samples and other methodological details are in SI Appendix.

We surveyed physicians in three phases between April 2020 and April 2022 and surveyed laypeople concurrently with the final physician survey. In each survey, physicians evaluated a clinical vignette about a severely ill COVID-19 patient and made decisions about which treatments to administer. For each treatment option, physicians reported beliefs about effectiveness and the quality of clinical evidence and made incentivized predictions about the proportion of their peers who made the same decision. Laypeople reported beliefs about treatments but did not make treatment decisions. All participants also reported beliefs about the effectiveness of COVID-19 vaccines and their support for vaccine mandates as well as a range of individual characteristics. Most estimates are based on data from Phase 3 surveys, administered in March and April 2022.

To investigate the role of information consumption on belief polarization, we asked participants in both samples to report how they consume news (e.g., print, social media, television) as well as their preferred cable news source (if applicable). Cable news consumption is a particularly plausible source of variation in public exposure to COVID-relevant information because partisans watch different cable news networks (4), and networks differed markedly in their coverage of hydroxychloroquine, ivermectin, and vaccination (9, 15, 16). Physicians also reported how they engage with scientific research.

To measure bias in the evaluation of information, we embedded an experiment in surveys administered to both samples. Participants read an abridged research abstract (physicians) or a research summary written in a journalistic style (laypeople), both of which reported the results of the TOGETHER trial (17), a well-powered randomized controlled trial that failed to find evidence that ivermectin was effective for treating COVID-19.* Between subjects, we randomized whether the treatment was identified as ivermectin or was anonymized (“GL-22”). We then elicited beliefs about the study’s informativeness, its methodological rigor, and the likelihood that its authors were biased. We expected partisans’ beliefs on all three measures to diverge more sharply when the drug was identified as ivermectin.

We measure political ideology on a 7-point scale bounded by “very liberal” and “very conservative,” with the midpoint defined as “middle of the road” (18). To compare polarization across samples and outcomes, we standardized all outcome variables by subtracting the mean response of political moderates (“slightly liberal,” “middle of the road,” “slightly conservative”) from each response and dividing by the standard deviation.† Our primary analyses control for a range of plausible confounding factors, including demographic, professional, and regional characteristics (Fig. 1A caption).

For simplicity and statistical power, we collapsed measures that were collected at multiple time points after ruling out significant temporal variation (ANOVAs; ps > 0.18).‡ The timing of key elicitations can be found in SI Appendix, Table S1. Full study materials are at https://github.com/pitt-healthsciences/covid_polarization/. A preregistration specifying some elements of our analytical approach can be found at https://aspredicted.org/11M_35D.

Following our prespecified exclusion criteria, we retained 410 physician responses and 882 layperson responses. Research was approved by the University of Pittsburgh Institutional Review Board. All subjects provided informed consent.

Results
We find robust evidence of polarization on eight of ten physician outcomes and all six layperson outcomes (ps < .001; Fig. 1A). To illustrate the magnitude of these effects, conservative physicians were approximately five times more likely than their liberal and moderate colleagues to say that they would treat a hypothetical COVID-19 patient with hydroxychloroquine (Cohen’s h = .37). On average, physicians’ beliefs were less polarized than laypeoples’ (

New Coronavirus News from 1 Dec 2022

Ivermectin shown ineffective in treating COVID-19, according to multi-site study including KU Medical Center [University of Kansas Medical Center, 1 Dec 2022]

By Anne Christiansen-Bullers

Results of the study of the antiparasitic medication, once a much-discussed potential treatment for COVID-19, were published in the Journal of the American Medical Association.

Researchers at the University of Kansas Medical Center were part of a multi-site collaboration that found that ivermectin has no measurable effect in improving COVID-19 outcomes.

In an article recently published in the Journal of the American Medical Association (JAMA), the researchers concluded that taking 400 mcg/kg ivermectin for three days, when compared with a placebo, did not significantly improve the chances for a patient with mild to moderate symptoms of COVID-19 to avoid hospitalization.

The use of ivermectin also showed no measurable decrease in the severity of COVID-19 symptoms or the length of time these patients experienced COVID-19 symptoms.

“The most important takeaway from the study is that ivermectin does not help improve outcomes from COVID-19 infection and thus should not be used as a treatment for COVID-19,” said Tiffany Schwasinger-Schmidt, M.D., Ph.D., associate professor of internal medicine at the University of Kansas School of Medicine-Wichita, director of the Center for Clinical Research and site director of the study for the KU Medical Center location in Wichita.
Mario Castro, M.D., MPH, vice chair for clinical and translational research and division director of pulmonary and critical care medicine for KU School of Medicine, provided oversight of the study.

About the study
KU Medical Center was part of a nationwide initiative that allowed research institutions to collaborate on COVID-19 studies in hopes of getting results sooner than any one site could achieve on its own.

This initiative, the Accelerating COVID-19 Therapeutic Interventions and Vaccines Study Group and Investigators, is also known as ACTIV. This study to examine ivermectin, as well as a few other current medications to gauge their effectiveness against COVID-19, goes by the name of ACTIV-6.

The ACTIV-6 study enrolled 1,800 participants. These participants received packages at their residences that contained either a dose of ivermectin or a placebo. Because it was a double-blind study, the participants did not know whether they received ivermectin or not.

Of the initial enrollment, 1,591 participants with confirmed cases of COVID-19 reported receiving their shipment, and follow-up data were collected by 93 separate study sites across the United States.

“This trial was innovative in that it used a remote clinical trial design, allowing people in all areas in the U.S. to enroll in a clinical trial and have the investigational drug shipped directly to their house,” explained Schwasinger-Schmidt. “This is different in that most clinical trials require participants to come to a center to receive study medication.”

The study results
When the participants’ data were analyzed, researchers came up with two results. The first was the median recovery time, or the amount of time it took patients to report having recovered from COVID-19. The second was the number of hospitalizations or deaths within each study group.

Researchers found that the median recovery time for those taking ivermectin was 12 days, and those on the placebo was 13 days. There were 10 hospitalizations or deaths in the ivermectin group and nine in the placebo group. But these differences failed to be statistically significant, leading researchers to their conclusion that “these findings do not support the use of ivermectin in patients with mild to moderate COVID-19.”

What is ivermectin?
Ivermectin is an oral medication initially introduced as an animal de-wormer in 1971 and approved for human use in 1986. Its main purpose (to remove parasites from the body of either animals or humans) means it was initially classified as an “anti-parasitic agent,” according to Schwasinger-Schmidt.

“It kills parasites that cause river blindness and other illnesses and has been used safely in millions of people,” she said.

Ivermectin and COVID-19
Ivermectin entered the American lexicon as a possible treatment for COVID-19 when Pierre Kory, M.D., a pulmonologist and president of Frontline COVID-19 Critical Care Alliance (FLCCC) testified before a U.S. Senate committee hearing in December 2020. Kory called ivermectin a “miracle drug” against COVID-19 and urged the government to issue prescription guidelines for its use in treating the coronavirus.

Prior to Kory’s testimony, Australian researchers in the spring of 2020 had observed that ivermectin killed the coronavirus in a laboratory setting. But a story in The Seattle Times pointed out that the amount used in the lab was much higher than the approved use for humans and could be fatal.

Tests continued throughout the world, however, building that hope that Kory shared with the Senate committee. “Ivermectin had been studied in the laboratory prior to implementation in this trial, and it appeared to decrease replication of the COVID-19 virus through decreasing responses in the inflammatory pathway to the virus,” Castro said.

Ivermectin became an especially hopeful solution for individuals not convinced in the safety or efficacy of the COVID-19 vaccine. But these worldwide studies — including a clinical trial of ivermectin in Brazil called TOGETHER and now the ACTIV-6 trial in the U.S. — have failed to find ivermectin helpful for COVID-19 treatment.

“In clinical trials, it is equally as important to discover which medications don’t work to treat illness as well as medications that do,” Schwasinger-Schmidt said. “This study showed what didn’t work.”

New Coronavirus News from 19 Mar 2023

COVID-19 pandemic expected to end this year 'as a public health emergency,' says World Health Organization [Kaiser Health News, 19 Mar 2023]

By Melissa Rudy

Optimism declared about declining deaths, though WHO falls short of declaring end of emergency now

The director of the World Health Organization (WHO) announced on Friday that he is "confident" the COVID-19 pandemic will end in 2023.

Director-General Dr. Tedros Adhanom Ghebreyesus made the comments to reporters at a media briefing in Geneva.

"We are certainly in a much better position now than we have been at any time during the pandemic," Dr. Ghebreyesus said.

He noted that in the past four weeks, the weekly number of reported deaths has been lower than it was before the pandemic was declared in March 2020.

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"I am confident that this year, we will be able to say that COVID-19 is over as a public health emergency of international concern," he added.

COVID-19 cases and deaths continue to trend downward worldwide.

As of March 6, weekly deaths stood at 5,048 globally.

That's a decrease of more than 26% from the prior week — and down from a peak of 102,000 deaths in January 2021, per data from WHO.

Weekly cases of COVID-19 are down to 812,255 globally, a 21.65% decrease over the prior week. They peaked at 44.3 million in December 2022.

"Last week, there were still more than 5,000 reported deaths."

In the U.S., as of March 15, weekly cases were down to 149,955, after peaking at 5.6 million on Jan. 19, 2022, per data from the Centers for Disease Control and Prevention (CDC).

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Weekly deaths in the country were at 1,706, down from an all-time peak of 23,478 on Jan. 13, 2021 and another surge of 17,357 on Feb. 2, 2022.

‘We are not there yet’

However, despite its optimistic prediction, the WHO is not quite ready to announce the end of the pandemic at this precise moment in time.

"We are not there yet. Last week, there were still more than 5,000 reported deaths," Dr. Ghebreyesus said during the briefing.

"That’s 5,000 too many for a disease that can be prevented and treated."

Dr. Ghebreyesus also stressed the need to determine how the pandemic began.

"Last Sunday, WHO was made aware of data published on the GISAID database in late January, and taken down again recently," he said.

"The data, from the Chinese Center for Disease Control and Prevention, relates to samples taken at the Huanan market in Wuhan in 2020."

Dr. Ghebreyesus said that while this particular data did not provide a "definitive answer" to the pandemic’s origins, all information is important in achieving that goal.

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"These data could have — and should have — been shared three years ago," he continued. "We continue to call on China to be transparent in sharing data, and to conduct the necessary investigations and share the results. Understanding how the pandemic began remains both a moral and scientific imperative."

"We are certainly in a much better position now than we have been at any time during the pandemic."

Dr. Marc Siegel, clinical professor of medicine at NYU Langone Medical Center in New York City and a Fox News medical contributor, said this weekend that he questions the WHO’s hesitancy to signal the end of the international emergency despite the weekly COVID death count being lower than pre-pandemic.

"Under the heavy influence of China, WHO leadership actions have been erratic at best, delaying calling it a pandemic for almost two months after it was spreading widely and failing at getting China to be open and transparent about origins," Dr. Siegel told Fox News Digital in an interview.

"The pandemic has revealed WHO at the highest levels to be woefully inadequate."

In January 2023, President Joe Biden announced that he would end the COVID emergencyon May 11.

He had previously declared the pandemic to be "over" in September 2022.

New Coronavirus News from 3 Mar 2023

When covid politics collides with covid science, public health loses [Grid, 3 Mar 2023]

By Jonathan Lambert

Quick takes about what works and what didn’t obscures the inherent uncertainty of the scientific process, eroding trust in science.

With covid now an afterthought rather than an emergency in the minds of many Americans, politicians and pundits are rushing to have the final word on who handled the crisis well — and who dropped the ball.

These recent declarations of pandemic winners and losers often ignore the iterative and uncertain nature of science in favor of blunt headlines and slogans bolstered by cherry-picked studies. And they often elide scientists’ and policymakers’ honest grappling with major decisions in the face of limited and evolving data.

“The Mask Mandates Did Nothing. Will Any Lessons Be Learned?” New York Times columnist Bret Stephens declared last month, flattening a highly nuanced, heavily caveated scientific study of mask-wearing into a single talking point. And after reports this week that the Energy Department concluded with “low confidence” that a lab leak in China likely caused the pandemic, several prominent Republicans touted it as ruling out a natural origin. They included Sen. John Barrasso (R-Wyo.), who tweeted that “China is responsible for COVID.”

Such black-and-white pronouncements can muddy the public’s understanding of what worked (like vaccines), what didn’t (ivermectin), and the wide gray area around other measures, like mask mandates or school closures, that scientists are still evaluating. Three years into the pandemic, the United States’ political war over covid has eroded public trust in science, with the biggest drop — more than 20 percentage points — among Republicans. That polarization makes responding to the next crisis, whether it’s a pandemic or something else, even harder.

“Those who have dogmatic positions and are playing to the politics can be extreme, use hyperbole and be definitive in their pronouncements,” said Timothy Caulfield, research director of the Health Law Institute at the University of Alberta. “Those who are trying to be close to what the science actually says have to have all these caveats and hedge what they say, and it’s just like [they’re] going to gunfight with a knife.”

Politicization leads to mistrust
Before covid entered the global consciousness in early 2020, Americans’ trust in science was largely bipartisan, with relatively small gaps between the parties.

“There just wasn’t much of a political divide,” said Cary Funk, director of Pew Research’s science and society team, which has tracked public opinion on the topic since 2016. But during the pandemic, a gap appeared — and it continues to widen.

In January 2019, a Pew poll found that 88 percent of Republicans had a great deal or a fair amount of confidence that medical scientists act in the best interests of the public, compared with 87 percent of Democrats. By September 2022, only 68 percent of Republicans reported the same, compared with 91 percent of Democrats. The partisan gap is even wider — 63 to 89 — for trust in scientists generally.

That split didn’t start right when the pandemic hit, said Funk. “For about six weeks, we saw very little partisan division about what was happening,” she said. “But shortly thereafter, we started to see this political division open up, and that really became a hallmark of public opinion around everything connected with the coronavirus outbreak.”

By that point, the country was in the throes of the first covid wave — battling a virus the world knew little about, while politicians sniped over how to handle it and who to blame.

President Donald Trump called the coronavirus a “new hoax” at a campaign rally in late February 2020, and continually downplayed the threat during weeks of daily White House press briefings. Democrats lobbed heavy criticism at Trumpfor moving too slowly and minimizing the potential risk, at times exaggerating how Trump’s policies affected the nation’s readiness to detect and fight pandemic threats.

“Those political cues can be very sticky and hard to strip away,” said Rebekah Nagler, a health communication researcher at the University of Minnesota. “When you introduce that politicization element, you’re inviting people to interpret new information through a political lens.” A recent history of polarization around health policy, including support for the Affordable Care Act, may have also primed the public to take political sides on covid, she said.

In those early weeks and months, uncertainty about the scale of the threat the virus posed, how it spread and what could be done to stop it further fueled the partisan divide, creating an opening for mis- and disinformation to flourish.

“Politicization can involve the strategic elevation of uncertainty around science for political gain,” said Sarah Gollust, a health policy researcher at the University of Minnesota.

In early 2020, “science was moving so rapidly, for good reason, as the scientific community was trying to make sense of a novel pandemic,” she said. Scientists raced to post new findings online as preprints, bypassing the normal slow process of peer review, to get information out as quickly as possible. That created a flurry of often conflicting information that was challenging for the research community to sift through, much less the public.

“There was so much evidence being produced so rapidly, there was so much more to pick from and potentially elevate conflict,” said Gollust.

Shifting guidance
Official guidance often shifted as a result of that evolving understanding and a dynamic environment. Initially, public health officials dissuaded people from buying masks to ensure limited supply could be used by medical professionals. But in early April 2020, that guidance changed, in part because of new science on how the virus spread.

The rapidity of such changes, while likely necessary, can erode trust, said Gil Eyal, a sociologist at Columbia University: “If the surgeon general says you don’t need masks, because they won’t protect you, and then the CDC corrects course, that sequence is not going to elicit trust.”

Often, public health officials failed to clearly communicate the rationale for those changes.

“Guidance was necessarily going to change because so much was unknown,” said Nagler. But how those changes get communicated is crucial for maintaining trust. “I think CDC in particular really let us down by not being more transparent and clear about setting that expectation,” she said. For example, in May 2021, the Centers for Disease Control and Prevention said vaccinated people no longer needed to wear masks indoors but abruptly reversed advice in July because of the delta variant. Administration officials tried to explain that the situation had changed, but not being explicit and forceful about that uncertainty upfront opened them up to charges of “flip-flopping.”

“Political actors weaponized this uncertainty,” said Caulfield. “It creates an opportunity for those who want to generate distrust to generate distrust because they can say, ‘This institution said X, and now they’re saying Y, that means you can’t trust them,’” he said. Fast-forward to today, and virtually every aspect of the pandemic — from treatments to the value of masking — is viewed through a partisan or ideological lens.

“Once something becomes about ideology, it becomes very difficult to change people’s minds,” said Caulfield. “It almost doesn’t matter what the science says.”

Despite evidence that covid vaccines and boosters are safe and effective, uptake remains lower among Republicans, likely contributing to partisan gaps in covid deaths that emerged after the vaccine. And ivermectin — an anti-malaria drug touted by Trump in 2020, which study after study has shown to be ineffective for treating covid — continues to be pushed by some doctors, who are even expanding their recommendations to diseases like RSV and flu. (In the meantime, the promotion of ivermectin as a covid cure resulted in a rise in poisonings linked to the drug, which is also used to deworm horses and other animals.

While evidence against ivermectin is well established, questions around the effectiveness of policies aimed at reducing covid’s spread, from masking to school closures, are still being studied. Answers are likely going to be complex and context-dependent, arising from many, many studies carried out in the coming years. Some questions, like whether the coronavirus was leaked from a lab or jumped naturally from animals to people, may never be definitely answered.

Polarization around these questions favors quick and easy answers, as the past several weeks have shown. Ideological actors can seize a study and label it as completely definitive when it’s anything but, said Caulfield. But that nuance can get lost among those of a similar ilk, he said, creating a revisionist history of the pandemic.

“There’s this profound cherry-picking, they select a favored scientific story, then try to ossify it as the truth,” said Caulfield. “It’s damaging on so many levels.”

Can trust in science be rebuilt?
Three years into the pandemic, the trust-in-science partisan gap shows no sign of shrinking.
Covid politicization is still on display as candidates and potential candidates for the 2024 presidential race look to score covid points, and as House Republicans launch inquiries into the Biden administration’s handling of the pandemic.

That has profound implications that go well beyond how we understand this pandemic — which is still killing more than 300 people a day in the U.S. — to what we do when the next public health crisis emerges.

Depoliticizing covid after so long may be challenging. “I wouldn’t say I’m super optimistic about a reframing at this point, in part because these beliefs are so sticky,” said Nagler. But there are strategies scientists and public health officials could employ going forward.

One is to be clearer about how science works. Emphasizing that the scientific process is our best way of making sense of the world, but that it’s iterative and inherently uncertain, can go a long way, said Nagler. “We have some data to suggest that if you remind people about how science works, it can be somewhat protective in how they respond to conflicting health information,” said Nagler. That doesn’t change the messy information environment, she said, but it can improve people’s ability to operate within it.

For public health officials, being transparent about decision-making is crucial, said Kasisomayajula Viswanath, a health communication researcher at the Harvard T.H. Chan School of Public Health. “We have to admit that we don’t know certain things and will get some things wrong, that’s just the nature of science,” he said. “But we’ll need to be honest and open [with the public] and provide that information,” on how decisions are being made, he said. “This needs to come from the highest levels of government.”

But public health messaging can’t come solely from on high, Viswanath said. Local organizations and leaders often hold more credibility for community members, making them better messengers, he said. “We need to engage them in this process of rebuilding trust.”

There’s no easy way to reverse the loss of trust in science and public health — but “we don’t have a choice,” said Viswanath. “How we do that is the big question.”