Tennesseans seek to move on from COVID, even as a new variant appears

Get used to it, but not over it. That may be the best advice for living with COVID-19 as 2023 starts and as the recent XBB.1.5 variant debuts in Tennessee.

More than three years since COVID first arrived, the virus that causes it – SARS-CoV-2 – continues to mutate. XBB.1.5 is more contagious than the Omicron variant from which it descended, and Omicron already was highly contagious. So far, it does not appear to make people sicker than earlier subvariants, according to a Jan. 5 update on COVID-19 from Johns Hopkins University’s Bloomberg School of Public Health. 

Bill Christian, spokesman for the Tennessee Department of Health, said earlier this month in an email that the department “is continuously monitoring COVID-19 in all its variants and forms.” In the Jan. 6 email, he said, “We have not identified cases of XBB.1.5 in Tennessee at this time.”  

The Tennessean reported on January 18 the XBB.1.5 variant has appeared in the state.

Omicron is “not trivial,” even though it seems to create a milder version of the disease than previous COVID strains, said William Schaffner, professor of preventive medicine in the department of health policy at Vanderbilt University School of Medicine. Omicron can still make some people very sick, he said. “It hasn’t disappeared,” Schaffner said. “It will continue to mutate.” Currently, COVID deaths are rising nationwide, with the Centers for Disease Control’s Data Tracker showing a weekly total of 3,907, or more than 550 per day as of Jan. 11.

“There’s almost no organ system that’s not impacted by COVID – brain, heart, liver, skin. … You don’t want to get infected,” said Georges C. Benjamin, executive director of the American Public Health Association. And then there’s long COVID, a “spectrum of diseases” that can linger for a long time after a person has been infected with the virus. Being vaccinated reduces the risk of long COVID, he said. 

Since late 2019, COVID-19 has killed 6.7 million people around the world, including 1.09 million in the United States, the Johns Hopkins update for Jan. 12 stated, citing World Health Organization and CDC data. 

In Tennessee, COVID-19 has claimed 28,669 lives through the week ended January 7, according to Tennessee Department of Health data. For perspective, the 2020 U.S. Census estimated population of Carroll County, in West Tennessee, is 28,440.

Despite COVID-19’s persistence and potential lethality, many just seem tired of it.

“Folks have not embraced an ongoing keeping-your-guard-up approach,” Schaffner said. People want to “put COVID in the rearview mirror. … We need to be able to communicate better with the general public about COVID.” 

Donald Alcendor, associate professor of microbiology and immunology at Meharry Medical College, has worn at least two hats during the pandemic: researching antiviral therapies to treat COVID and engaging with regular people about the disease.

“We have learned that a pandemic can occur in modern times and can lead to the death of millions even in the U.S.,” he said in an email. He also said society wasn’t prepared for COVID. The pandemic showed that medically underserved communities are at higher risk during a public health crisis, he said, and delay in services can lead to more diseases and deaths.

“Science-based information was key in navigating the pandemic,” he said, and “vaccine hesitancy and resistance is a powerful force against science-based information.”  Support from the federal government was needed to spur development of timely vaccines and antivirals.

Vaccination is key to dealing with COVID going forward, those contacted for this article said. The vaccines aren’t perfect; no vaccine is, particularly against a constantly mutating and contagious virus like SARS-CoV-2. People who have had COVID will also have a level of immunity from having had the disease, but vaccines account for much of the progress made against COVID-19.

“We are largely back to normal and that is largely because of the vaccine,” said Christian an email. “It’s been more than two years since the COVID-19 vaccine rolled out. In that time we’ve had 10 million doses that Tennesseans have rolled up their sleeves to receive and at the same time we know that this virus is constantly mutating.

“Vaccination is our best defense against COVID-19 and protecting against severe outcomes, including death,” Christian said. “We encourage anyone who is eligible to receive a COVID-19 vaccine to do so, including the bivalent booster. We know this booster adds extra protection for you, your family and everyone around you.” The bivalent booster was designed to protect against both the original SARS-CoV-2 virus and two versions of the Omicron variant. It was developed before XBB.1.5 emerged.

According to the Tennessee Health Department’s most recent vaccination data, posted online and last updated on Jan. 9, more than 10.8 million doses of COVID vaccines have been given. Some 47% of people statewide are fully vaccinated and 5.58% have received a bivalent booster shot. Nationally, the CDC reports that as of Jan. 13, about 15.9% of people age 5 and older had received a bivalent booster.

To Vanderbilt’s Schaffner, acceptance for the bivalent booster has been “underwhelming,” despite being readily available at no charge.

“People have a lot of vaccination fatigue. … They’re just not energized” to get the bivalent booster, he said. That may be because COVID caused by the Omicron variant isn’t as severe as previous iterations, he said. Also, he said, vaccinated and boosted people can still get breakthrough cases of COVID, and some breakthrough infections were mild, leading some to question whether it’s worth it to keep getting vaccinations, he said.

Individual risk tolerance plays a part in vaccination decisions, the American Public Health Association’s Benjamin said. 

Think of it like wearing seat belts in your car, he said. If you have never been in a serious car accident, you may decide seat belts aren’t necessary. A similar thing may happen with people who don’t get vaccinated for COVID and don’t get sick, he continued. Four out of five people infected with COVID experience very few symptoms. The other 20% do get sick and some of them have serious symptoms; some will die, he said. “The problem is that you’re OK until you’re not OK.”

Current vaccines and medications for COVID-19 are “holding up reasonably” in their effectiveness, said Benjamin. The vaccines’ aim was to reduce the risk of serious disease or death. “They’re very good at that,” he said. “We continue to get really good evidence that mRNA vaccines are safe and effective. They continue to demonstrate their superiority to other vaccines.”

A small number of people will have very severe allergic reactions to vaccines, Benjamin said, but for most people, any allergic reactions will be minor. There is evidence that some of the most serious adverse reactions, such as inflammation affecting the heart, are not permanent but are transitory. The risk of side effects should be weighed against the risk of contracting COVID-19, he said. People who were fully vaccinated tend to do much better if they have a breakthrough infection than unvaccinated people.

Meanwhile this year, scientists are keeping a close eye on COVID hospitalizations and deaths, as well as on emerging variants of SARS-CoV-2. Reported cases are no longer a reliable measure of COVID’s spread, since people often test at home and don’t report results. Nationally, hospitalizations and deaths are well below what they were at peak points in the pandemic, but still bear scrutiny as the virus continues to evolve. 

Scientists are also tracking what happens in China, population 1.4 billion, which recently and suddenly reversed course on its longstanding zero-COVID restrictions after widespread citizen protests.

A “variant incubator is occurring in China,” Benjamin said. “We don’t have a good visibility into what’s going on there. … There’s a possibility of a wave of a new-type virus coming from China. … The biggest fear is that we have a do-over for COVID” based on a new, more dangerous variant. 

Schaffner also is keeping an eye on COVID cases in Ukraine, as war continues there.

Whatever happens around the world, scientists say, COVID is here to stay.

“My prediction is that cases (of COVID) will kind of wax and wane like what happened last year. The question is what comes after XBB.1.5,” said Shirin Mazumder, associate professor at the University of Tennessee Health Sciences Center in Memphis, where she teaches about infectious diseases. She treats adults for infectious diseases, including COVID, in her medical practice at Methodist University Hospital.

Benjamin of the APHA also foresees periodic surges, although it remains to be seen whether COVID will surge once or twice a year. He said he expects to see a surge this winter.

New vaccines will continue to be developed to deal with new strains of the virus that causes COVID, scientists said. New COVID vaccines will be rolled out each year, similar to each year’s new seasonal influenza vaccine. 

Some companies are working on a combined seasonal flu/COVID vaccine, several scientists said. Work is proceeding on a possible nasal vaccine for COVID, Benjamin said. 

Another focus of research is a vaccine that targets the part of the SARS-CoV-2 spike protein that seems less likely to mutate, Schaffner said. The reasoning is that targeting a relatively constant part of the spike protein will provide protection even as other parts mutate. If this type of vaccine protected against COVID for several years, some people might overcome vaccine hesitancy, Schaffner said.

So, what can the average person do to stay healthy?

“We can protect ourselves by being fully vaccinated and boosted and adhering to updated CDC guidelines,” Alcendor said. “If you are elderly or have underlying health conditions you should manage the conditions via your health provider and avoid crowded indoor poorly ventilated venues and mask when appropriate.”

Mazumder still sees patients contracting COVID, but not as many as earlier in the pandemic. She encourages people to stay up to date on vaccinations. “I do think masking can be helpful. Stay home if you’re sick. Get tested if you feel sick,” because there’s a window of time when antiviral drugs can help those with COVID. People also should continue with good sanitary practices: wash hands and avoid touching the face and eyes.

The CDC has been emphasizing personal responsibility, Schaffner said. Look at who you are, your risk of catching COVID and how severely it might affect you, he said. People going out in public now, when many respiratory viruses are circulating, may want to consider masking and social distancing.

And, he said, support others who choose to mask even without a mandate. “They may be taking care of someone who isn’t healthy and they don’t want to bring the virus home to them.”