Publisher’s note: Kent Sepkowitz is a physician and infectious disease expert at Memorial Sloan Kettering Cancer Center in New York. The opinions expressed in this comment are his own. Read more opinions on CNN.
CNN
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In recent weeks, a new viral villain has emerged in the US: respiratory syncytial virus, or RSV. Right now, children’s hospital beds are full, classrooms are empty of RSV and similar viruses, and parents are even more concerned than usual.
To explain this, many experts have suggested that the masking and social isolation put in place to protect against Covid-19 have created an abnormally long period without exposure to RSV or other viruses. The result has been called an “immunity gap,” a weakness in our ability to respond to the latest virus or bacteria with the necessary high-precision choreography, simply due to lack of practice. It turns out that to protect ourselves from an infection, we must expose ourselves to it early and often.
This kind of tug-of-war problem where too much exposure is a pandemic and too little is preparation for future problems is built into the world of infectious disease. In this world, the golden mean does not exist and balance is a pipe dream. The upside-down problem was apparent early in the pandemic and will haunt us for the duration of our interactions with Covid-19 and each and every other infection.
The modern way to circumvent this problematic relationship is to substitute a fake infection for a real infection, a vaccine. All the benefit without any cold. The problem is that we do not yet have a vaccine available to prevent RSV and mitigate the increase in cases that we are experiencing.
Of note, there is some hopeful news about RSV protection that could be available in the next year for use in infants and newborns. This vaccine approach resembles the monoclonal antibodies used to treat covid-19 and, in severe cases immunocompromised people, to prevent it, unlike the conventional vaccines you might get for the flu, or the new mRNA vaccine platform for Covid-19. these injections do not enhance a person’s immune repertoire as a conventional vaccine does; rather it replaces a missing piece with a synthetic antibody that can protect for weeks or months.
A more traditional vaccine for next season is also possible; this will be given to pregnant mothers who would produce antibodies that would naturally cross the placenta into the fetus’s bloodstream: a novel approach that uses traditional vaccination knowledge.
The current outbreak of RSV, with very sick children across the country, is a particularly brutal way of proving, once again, that masks and social distancing work and work well. The so-called immunity gap is nothing more than an indisputable live demonstration of the effectiveness of this type of old-school maneuver. A double-blind, placebo-controlled trial is not needed.
In addition to adding much pain to parents in the United States, the current chaos also sends a message loud and clear about the future of our ongoing fight against Covid-19. Much of the crystal ball observation draws on our experience with influenza to model various scenarios. This makes sense: we have a vaccine for everyone and an approved oral antiviral, albeit imperfect.
But this vaccine is all that stands between us and an RSV-like spread of some future strain of Covid-19. To be sure, the vaccines we have against Covid-19 do a miraculous job of preventing death and serious illness, but they have only a modest impact on the risk of infection.
But in many important ways, RSV is a good comparator for what might be next in the world of common infectious diseases (especially since there are important similarities between RSV and the family of coronaviruses, including SARS-CoV-2, the virus responsible for our pandemic). For these three respiratory illnesses (Covid-19, RSV, and the flu), the evasiveness of the virus, combined with the often short-lived durability of our own antibody response, combine to cause continued increases in illness.
This means that what we are seeing from RSV may help inform what we can expect from this triad of infectious diseases in the future: disease (not just infection) every year. Some years will see more disease than others. The group, about 20% of the US population for Covid-19 vaccines, who refuse vaccination compounds the problem. A large number without the injection of antibodies provided by vaccination will remain susceptible year after year. And not only will they get sick themselves, but they will spread the virus to the rest of the population, new mutations and all, perpetually throwing us off balance.
However, there is some good news. The increase in RSV cases based on this year’s immune gap is clear evidence that the best way to manage SARS-CoV-2 is not a fleet of better vaccines and stronger antivirals, but to wear masks and avoid closed spaces crowded. Today’s RSV crisis is tomorrow’s way forward. In other words, in the “too much exposure, too little exposure” problem, it’s always better to prevent now and worry later. There is no other option than to do, as evidenced by the deaths of more than a million Americans from covid-19.
So what does this mean for your next Thanksgiving dinner? Does everyone need to sit 6 feet apart and slide morsels of turkey under a mask? Although I don’t know what the official recommendations will be, this is what I will do: When I take the subway or the bus to go to the supermarket, I will wear a mask. When I’m in the store, I’ll wear a mask. When I walk around the city from one place to another, I will take off my mask and enjoy the fresh air. And, in addition to insisting that only attendees be vaccinated and imploring family members to stay home if they feel sick, I will be enjoying my Thanksgiving dinner at a table full of people, 100% mask-free.
I hope to be right.
Source: news.google.com