Global Challenges: Between Crisis and Innovation

On December 7th, a 2-hour virtual summit between President Joe Biden of the United States and President Vladimir Putin of the Russian Federation was held on the subject of Ukraine. The summit, which came amid the backdrop of alarming intelligence reports of a 100,000-175,000 Russian troop buildup near Ukraine and fears of a Russian invasion of the rest of Ukraine, achieved no diplomatic breakthrough. Following the conclusion of the summit, Victoria Nuland, Biden’s Undersecretary of State for Political Affairs, repeated previous threats of severe economic sanctions should Russia invade. Russia, for its part, denies that it has any intention to invade Ukraine and blames the crisis on the West pushing Ukraine to join the North Atlantic Treaty Organization (NATO) and renege on its commitments in the 2014-2015 Minsk Protocols. The Minsk Protocols were the agreements signed by all sides to stabilize the Ukrainian situation in the wake of the instability unleashed in the 2014 Maiden Revolution that ousted a duly elected pro-Russian president from Ukraine. Since 2014, Ukraine has been through a series of war scares. In April of 2021 reports of Russia amassing 100,000 soldiers to invade Ukraine created a similar war scare that touched off an international crisis only for it to come to naught. In June, an international incident occurred again when a British warship was caught sailing close to the Russian controlled coast of Crimea in a show of solitary with Ukraine.

This crisis over Ukraine has brought various outstanding issues to the fore. Ukraine’s various bids for NATO membership to the Russians represent an unacceptable threat of having yet another bordering country that has traditionally been under their sphere of influence becoming aligned with anti-Russian powers. Russia often claims that promises were made to it prior to the end of the Cold War that NATO would not expand. NATO itself claims that there is no record of such a promise made by it. While there may be no organizational record of such an understanding, there are records of major NATO countries (the United States included) assuring the Soviets that NATO would not expand eastward. Obviously, after the end of the Cold War, these assurances were broken by NATO incorporating countries that were former members of the Warsaw Pact and former republics of the Soviet Union into the fold.

When Russia intervened in 2014, it further defended its decision as reacting to Ukraine’s hostile policy toward its Russian minority. The Russian minority in Ukraine have been subject to various laws that demote the use of Russian in official institutions like education and in the media. (Incidentally, the Ukrainian language was historically also subjected to hostile policies going back to the days of Czarist Russia.) Prior to the 2014 Revolution, President Yanukovyck attempted to address this issue by allowing localities to pass legislation that determined what their official languages were. However, since the Revolution the hostility toward the Russian language has intensified. When Russia intervened in the aftermath of the Revolution, this action was popular among the Russian Ukrainians who welcomed a return to the motherland.

What the Ukrainian government seeks to do is regain control over the entirety of the territory they controlled prior to the 2014 Revolution. Since the 2014 Revolution, which sparked the pro-Russian eastern portion of Ukraine to secede from the country or, as in the case of Crimea, to be annexed to Russia itself, it has ceased to have complete sovereignty in its own land. Ukraine refuses to recognize Russian control over Crimea as Ukraine has legal title to Crimea ever since this territory was gifted to Ukraine by the Soviet Union in 1954. Russian intervention in Ukraine further directly violates the 1994 Budapest Memorandum where it (in addition to the US and Great Britain) agreed “to respect the independence and sovereignty and the existing borders of Ukraine” in exchange for Ukraine transferring the nuclear arsenal that the Soviet Union stationed there to Russia. The Russians, disingenuously insist that they have not violated this memorandum as they claim it only prevented them from discharging their nuclear weapons on Ukraine and not on intervening in Ukraine using conventional weapons. More plausibly, however, the Russians claim that since the 2014 Maiden Revolution overthrew the legitimate democratically elected government, the memorandum does not apply to the post-revolutionary government.

All the outstanding issues ranging from Western broken promises regarding NATO, the question of Ukrainian sovereignty over its territories, and the language issue over the use of Russian in Ukraine have contributed toward Ukraine being a very potent geopolitical hotspot of tension between the great powers. The fact that domestic tensions over, among other things, language rights has touched off several war scares between not just Russia and Ukraine but between Russia and the West shows just how unstable the situation is. The various crises over Ukraine have already deepened Russian-Chinese cooperation since both countries have found themselves at opposite ends with the US. It is no surprise then that a virtual meeting between Putin and Xi, the leader of China, was scheduled for December 15th - a mere few days after Putin’s call with Biden. A diplomatic resolution of Ukraine is needed both to avoid a general war and to resolve the fundamental tension between Russia, the United States, and its European allies over the West’s eastward expansion of its sphere of influence. A NATO that swallows up yet another country that borders Russia is to the Russians a clearly provocative act. Similarly, a full-on Russian invasion of Ukraine would be extremely worrisome to the West.

In this increasingly multipolar world, there is an American interest in seeing if it is able to build a détente with Russia and decouple them from China. History may yet borne out again the veracity of Bismarck’s quip that the secret of good politics is to make a good treaty with Russia. To do this, Russia and the West must build up mutual trust by coming to a basic understanding that is respected in order for the Russians to consider competing for influence in Central Asia where China is trying to expand its sphere of influence in areas that once were also under Soviet control. An agreement over Ukraine will not magically do this all on its own but it will be a serious step. The best framework to do this is by making Ukraine a devolved federal union with stronger minority protections that is prohibited from joining military alliances with either Russia or the United States (such as in the form of NATO). While it is doubtful that Russia will give up Crimea, which it has already annexed, an attempt should be made to sweeten the offer for the Ukrainians by Russia returning the Donbass region in eastern Ukraine to Kiev’s control. This general offer should be tempting to the Russians as it roughly conforms to what they themselves have stated to be the future they want for Ukraine. Whether upheld or violated such a hypothetical treaty would at the very least make the intentions of all parties clearer. If Russia should violate it then the West now has evidence that the Russians care more about their own territorial expansion, than any real desire to reach an understanding with the West. If the West would violate it then Russia will have evidence that Western policy is so hostile to Russia that even when things are committed to paper the West cannot be trusted.

There is a strong public perception in the United States that crime has increased in 2020 and continuing into 2021. The first question to ask is, is that true? According to an article in The Atlantic in September 2021, there is a different answer depending on whether one looks at property crimes or homicide rates. Based on their investigations, which uses the FBI’s Uniform Crime Report, there was a 12% increase in aggravated assaults in 2020 (which were defined as attacks or even threats that cause serious injuries or in which weapons are used. By this definition even pointing a loaded gun at someone would be an aggravated assault.) There was also a shocking 30% increase in murders in the same time period, but not in property crime. Burglary and larceny (theft of personal property) were overall down by 8%, perhaps because so many people were stuck at home and criminals did not want to engage them directly. Motor vehicle theft and thefts of things inside motor vehicles did increase. People want to protect their property, but even more so they want to protect their lives and the lives of people they care about. In addition to individual shootings and violence, the very highly publicized murder of George Floyd in May 2020, while he was being taken into police custody in Minneapolis, MN led to months of civil unrest, demonstrations, and protests that sometimes turned into riots, throughout the US.

Almost two million articles were written in the two weeks after George Floyd’s death and the unrest that immediately followed. Politics played an important role in how the events were portrayed. CNN discusses how both the GOP and the Democratic Party used data to advance their agendas on crime in general. The Democrats can point to the amazing number of individually owned guns in the United States, which will be discussed later in this article. The Democratic narrative suggests that gun control legislation would stem the tide of violent altercations. Some Democrats called for defunding the police after George Floyd’s death. The Republicans pointed to the “defund the police” movement as being a primary cause for the crime wave. Their contention and messaging was that, due to widespread “defunding” there were far less police available to make arrests. They also contended that there was a vast number of police quitting their jobs during this time. Let’s examine both of these contentions.

Looking at Minneapolis, MN, the city where George Floyd was murdered by a police officer while arresting him, and which was a flashpoint for the “defund the police” effort, at the end of 2020, the city moved $8 million out of a total $179 million police budget to cover additional violence prevention services, including mental health services. In a sharp reversal of policy, Minneapolis increased the police budget for 2022 by $27 million. The theme of cutting some parts of the police budget in 2020 and then restoring some of it in 2021 was repeated in multiple cities across the country. In short, while many cities and counties across America were pressured to cut funding to the police, within the next year the population pressured local governments to increase their funding to their police departments.

Regarding the argument that police officers were quitting in droves, we have data to show that the police ranks were thinning, but so were many other jobs. In fact, the level of recent job resignations has been termed the “great resignation”. Using Federal Data to substantiate the claim that police were quitting in droves, the Marshall Project found that there were far fewer police who quit during 2020 than people who quit jobs in other industries. The Marshall Project argued that a stable police workforce existed throughout the nation and cutting police funding is generally last on the list of budget items to face cuts. According to the Bureau of Labor Statistics (US Federal Government), there was a 1% attrition rate, nationwide, in law enforcement personnel, from 2019 to 2020. In many cases, digging deeper into the data it was revealed that police were taking early retirement or moving to other, less community-facing positions, within the same or neighboring public service structure.

On a side note, the idea that Black communities in America want the police to leave doesn’t stand the test of polls and interviews. In reality, most Americans, including Black Americans in urban settings, want the police to be available and to do their job of protecting the community. Eric Adams was elected to the Mayor’s office in New York City by providing that assurance to his public. This leaves the very real and very statistically supported fact that there was a sharp, sharp uptick in homicides and other violent crimes in the United States in 2020 and 2021, compared to 2019. Who is affected? Who is dying and who are the killers?

The homicide numbers have been supported by the FBI and the Pew Research Foundation, a non-profit, non-partisan think tank. Homicide numbers are still being compiled and analysis is far from over. The FBI shares homicide statistics for 2020 at between 17,720 people and 18,519 people. The reason for the discrepancy is that they are compiling data from only a little over 60% of the 15 thousand agencies that operate nationwide and in Washington, D.C. Given the constraints in reporting data on homicides, it is important to note that of the 17,813 murders reported through the FBI Crime Data Explorer, 13,663 deaths were attributed to some form of firearm, comprising 76% of murders reported.

Are the perpetrators being apprehended? Yes and no. Of the reported 18,519 victims in the FBI Crime Data Explorer database, 9,564 were killed by unknown assailants at the time of the murder been reported. This is approximately 50% of the murders. Of the known perpetrators, about 10% were strangers to their victims. In all other known cases, there was a familial, work, or romantic relationship. A third and last assessment of the homicide victims was to determine why the event took place. In nearly half the homicides there was no known cause. About a quarter was determined to be the result of arguments, domestic or social. Drugs, burglary, and gang violence were the other causes, but surprisingly enough they accounted for less than 20% of the total.

Digging a little deeper into the high homicide spike states in the US we looked at Philadelphia, Pennsylvania which experienced a 13% increase in killings from the previous year. Unenviably, Philadelphia had 501 homicides in 2021. Fully 89% of these deaths were due to firearms. Violent crime doesn’t always lead to death and there were also 2,332 people shot in the same time frame. Who are the victims of these shootings? In Philadelphia 80% of those shot were Black and young Black men were the greatest number of casualties accounting for 280 deaths, more than half the total.

Illinois has tough gun laws only in Chicago. In the rest of the state, there isn’t even a requirement to register your guns. Those stronger local laws did nothing to stop Chicago from experiencing 800 homicides in 2021. Police in Chicago and the surrounding area were on track in October 2021 to confiscate over 12,000 illegal guns. Considering how frequently the homicides in the US are a result of gun violence it might be instructive to evaluate if there was a general increase in gun ownership. Because every state in the US has different gun laws and citizens perceive a need or desire to own guns an average is hard to evaluate accurately. The number of guns owned by individuals in the US ranges from 200 million to 350 million plus. An analysis of rates of gun ownership in various states shows that Wyoming and Montana have gun ownership rates of approximately 66% of all households there. Although Wyoming has a population of over 578,000 people, there were only 14 murders in 2020. And, yes, most of them were committed with guns. That still doesn’t explain why the roughly 381,000 gun-owning citizens of Wyoming didn’t commit a gun murder.

You might think that a large increase in firearm purchasing would drive more firearm violence. The studies available to date do not support that at a state level. Previous surges in firearm purchases that followed mass shootings and political events have been shown to lead to an increase in shootings. The pandemic timeframe where there was an uptick in firearms purchases has so far not been shown to be a major factor in this surge of violence.

To understand the current rise of violence one must look beyond simplistic catchy slogans to understand why the trend of more violence, aggravated assaults, and murders occurred in the United States occurred in 2020 and 2021. It is clear that the people in the United States are reacting by buying more guns if legal and easily accessible in their area, obtaining guns through other means if not, and looking to elect officials who say the right things about protecting them as well.

COVID-19, which has dominated world attention for over two years now, will continue to be in the forefront of public health for the foreseeable future. With “COVID fatigue” setting in, health authorities are facing a crisis in public confidence. For example, The Centers of Disease Control and Prevention (CDC) recently announced that they are pivoting their language on what it means to be fully vaccinated. If you recently got your second dose of a COVID-19 vaccine and you aren’t yet eligible for a booster shot, you are considered up to date. But, according to Dr. Rochelle Walensky, director for the CDC, if enough time has elapsed since your second shot and you’re eligible for the booster but haven’t gotten it, you would need to get it to be fully up to date. Dr. Anthony Fauci adds, “One of the things that we’re talking about from a purely public health standpoint is how well you are protected, rather than what a definition is to get someone to be required or not required.” This announcement follows on the heels of many cities, such as Washington DC, requiring vaccines to enter restaurants and gyms, with staff demanding that customers show their vaccination cards as proof to comply with this rule. Chicago City Inspectors have cited 13 bars and restaurants and 9 fitness centers for failing to enforce city rules that require all customers to present proof of vaccination. One can legitimately question whether it makes sense for those who have recovered from the virus, especially Omicron, to get further boosters, or if this is a shortcoming of establishing mandates based on vaccination status rather than immune status.

This article will attempt to review and set the record straight on what we know about vaccines in general, the COVID-19 vaccine, and what public health messaging should focus on when any future pandemics arise. The seven topics covered will be: (1) a definition of what vaccines are and how they work; (2) why immunity conferred by some vaccines is more durable than for others; (3) the two major types of immunity: humoral (antibody mediated) and adaptive (mediated by subsets of white blood cells); (4) COVID-19 vaccines and their efficacy; (5) vaccine evasion and breakthrough infections by the Omicron variant; (6) transitioning from a COVID-19 pandemic to an endemic disease; and (7) lessons learned from the COVID-19 pandemic.

Let us begin with the definition of a vaccine and a brief explanation of how vaccines work. According to the World Health Organization (WHO), vaccines trigger your immune system, your body’s natural defenses, to create antibodies to fight infections just as it would do if it were exposed to infectious agents (pathogens) such as bacteria, toxins, or viruses for the first time. The key ingredient in a vaccine can be a killed, or otherwise weakened, whole viral particle or bacterium, individual specific parts (subunits) of the germ, known as antigens, to trigger your immune system, or just the genetic material, DNA or RNA, that provide the blueprints for your own cells to produce specific protein antigen components of the virus or bacterium. Vaccines trigger your immune system to respond as much as it would have if it were exposed to the actual pathogens themselves, but without actually causing the disease itself. The antibodies produced by the vaccine work in several ways to prevent or mitigate infections. They can bind and directly inactivate the pathogens; these types of antibodies are called neutralizing antibodies. Other types of antibodies when bound to the pathogen act as sentinels or flags to recruit other components of your immune system to punch holes in bacterial cells, or to enable your white blood cells to engulf and digest the pathogens in a process known as phagocytosis.

Some vaccines can give you life-long immunity to a pathogen while others need booster doses a few months or years later. For example, tetanus boosters are given every 10 years, the shingles vaccine, Shingrix, requires a second shot 2-6 months after the first dose, and flu shots are given annually. According to Hai Tran, PharmD, the associate director of Pharmacy Services at Cedars-Sinai, the length of vaccine-induced immunity depends on several factors. If the virus replicates quickly, there is a greater chance that more mutations, also known as variants, will arise which makes generating a vaccine a moving target. Viruses that are stable, meaning that they have low mutation rates, offer a big advantage to vaccine makers in that immunity from a vaccine will be durable over time. Examples of highly contagious viruses that were almost eradicated by vaccination alone are smallpox and polio; these have low mutation rates. Measles is also a stable virus that is not likely to replicate and immunity from the vaccine is long-lasting. On the other hand, the influenza virus replicates quickly and mutates frequently and so poses a challenge for vaccine development. Every year there are multiple new strains of the flu virus. This year’s flu shot was quadrivalent, meaning that it was developed to protect against 4 different variants of influenza. Next flu season there will likely be new variants yet again which is why annual flu shots are recommended.

Immunity given by the initial production of antibodies in response to a vaccine or the pathogen itself is known as humoral immunity. However, there is another form of immunity known as adaptive immunity that is mediated by T and B cells which are subsets of your white blood cells. Adaptive immunity functions as an immunologic memory to handle subsequent infections from the same pathogen. Memory T cells remain in circulation from the initial exposure to the vaccine or pathogen. Memory B cells are those which produce the antibodies. Adaptive immunity helps your immune system distinguish foreign, or “non-self” antigens from pathogens from “self” antigens which are components from your own cells which you obviously don’t want your immune system to attack. Ethan Smith, PharmD, Manager for Drug Use Policy at Cedars-Sinai explains, “Counting antibodies doesn't give you a full picture of how well you're protected, because vaccines also train B cells and T cells.” Dr. Smith continues, “When confronted by a known enemy, 'memory' B cells quickly deploy new antibodies to stop infection. When scientists are developing a new vaccine, they do preliminary studies to get an idea of how many doses may be needed. They measure how many antibodies are produced from one shot, and how much more protection you might get from a second dose. If researchers decide that one dose gives enough protection and that a second dose doesn't significantly improve things, they'll develop it as a one-dose vaccine.”

It is important to note at the outset that COVID-19 vaccines cannot and will not make you sick with COVID-19. Any symptoms, such as fever, that you may get after vaccination are not because of the virus. Rather, they are signs that your body is generating an immune response against the virus that causes COVID-19. The virus that causes COVID-19 is a severe respiratory syndrome (SARS)-like coronavirus termed SARS-CoV-2. A virus surface spike protein mediates SARS-CoV-2 entry into cells by binding to its receptor, known as human ACE2. As detailed by Heinz and Stiasny, all current COVID-19 vaccines authorized for general use were developed using the viral spike protein, known as the S protein, of the SARS-CoV-2 virion as their key component to confer immunity by the production of antibodies to the key S protein that allows the attachment and fusion of the SARS-CoV-2 virus particles to cells that line your nose, mouth, and lungs via ACE2 receptors. Thus, these receptors act as a cellular doorway for the virus that causes COVID-19.

Just because antibody levels may disappear after a COVID-19 infection subsides does not mean that your immune system forgets how to combat the virus. The article by Cox and Brokstad, published in Nature Reviews Immunology in August 2020, reports that although antibodies to SARS-CoV-2 are not maintained in circulation following recovery from the virus, their absence does not necessarily mean an absence of immune memory. They write, “Robust immune responses with spike-specific neutralizing antibodies, memory B cells and circulating TFH cells have been found in patients who have recovered from COVID-19 infection,” citing a study by Juno et al.

A critique of the booster policy is that, to date, none of the major COVID-19 vaccine suppliers have altered the original formulations of their vaccines. The contents of your second dose of the COVID-19 vaccine, be it from Pfizer or Moderna, were the same as what you received in the first dose. A COVID-19 booster, which is a third dose of the Pfizer or Moderna vaccines for given at least 5 months after the second dose or a second dose of the J&J vaccine at least 2 months after the initial shot, is also from the manufacturer’s original series; however, only half of the original Moderna dose is recommended as the booster. According to the CDC guidelines, adults over 18 can mix and match their booster shots, with those having received the first 2 doses of either Pfizer or Moderna being able to get boosted with either manufacturer’s vaccine while it is preferred that those who received the J&J vaccine get either the Pfizer or Moderna boosters.

But are these immunizations effective and what are potential limitations to their ability to protect you from COVID-19 infections? Gilbert et al., in an article appearing in the November 23rd 2021 edition of Science, describes the efficacy of the Moderna vaccine to protect from COVID-19 infection by measuring the levels of antibodies a patient produces in their blood serum in response to doses of the vaccine and the ability of those antibodies to neutralize infection. To accomplish the task of screening patient serum samples on a large scale, they built a simulated receptor binding system using a virus-like scaffold expressing the S protein from the SARS-CoV-2 (a spike-pseudovirus), and a genetically engineered cell line overexpressing the ACE2 receptor instead of using the actual SARS-CoV-2 virus and cells from a human respiratory tract. The authors incorporated light-generating components into this system so that when the spike-pseudovirus binds to the ACE2 expressing cells, light is generated. This light, known as chemiluminescence, is then able to be measured and quantified. Antibodies that blocked or neutralized binding of the S protein to the ACE2 receptors significantly reduced the amount of the light produced in the test system as compared to control levels of light generated by binding in the absence of neutralizing antibodies.

The authors conclude that COVID-19 risk decreased incrementally with increasing antibody levels following dosing with the Moderna vaccine. However, they concede that there were limitations to their study, including: the inability to control for SARS-CoV-2 viral exposure levels; a lack of ability to assess spike-specific functional T cell responses which, as mentioned earlier are involved in adaptive immunity; and the inability to assess a booster dose because the study predated the inclusion of a third dose. Most notably the COVID-19 patient serum samples studied were from infections with SARS-CoV-2 viruses that had a spike protein sequence similar to that of the vaccine thus precluding the assessment of vaccine robustness to SARS-CoV-2 variants of concern. In summary, while their findings validated vaccine efficacy by measuring the antibodies produced in response to infection or vaccination, the authors could not establish that these antibodies would provide robust protection against emerging SARS-CoV-2 variants.

The notion that the current crop of vaccines are not as effective against emergent strains is confirmed by a study from Liu et al published in Nature on 23 December 2021 that indeed found that the Omicron variant is markedly resistant to neutralization both by serum from convalescent patients and from individuals vaccinated with the widely used COVID-19 vaccines. Even serum from individuals vaccinated and boosted with the Pfizer and Moderna mRNA-based vaccines had substantially diminished neutralizing activity to Omicron. They conclude that “the Omicron variant presents a serious threat to many existing COVID-19 vaccines and therapies.”

Fortunately, infection by Omicron, which bypasses the immunity conferred by the vaccine, is notably less severe than previous variants. An article by Kuhlmann et al. published in The Lancet on 18 January 2022, documented breakthrough infections with the Omicron variant in seven individuals despite receiving three doses of mRNA vaccines. In these breakthrough cases, illness was either mild or moderate and none required hospitalization. They also noted that Omicron is much more transmissible but less virulent than other strains of SARS-CoV-2; as it infects rapidly but does not yield as severe respiratory symptoms seen in previous variants. Their findings demonstrate “insufficient prevention of symptomatic infection in otherwise healthy individuals who had received three doses of COVID-19 mRNA vaccines … [and] support the need for updated vaccines to provide better protection against symptomatic infection with Omicron.” T cell responses were also detected from these recovering individuals. These cell-mediated responses were not limited to only the spike protein, but also included the nucleocapsid and membrane proteins which are additional components of the SARS-CoV-2 particle. This is an encouraging sign that a broad, adaptive immunity is also developing in response to Omicron infections.

As mentioned earlier, vaccine boosters serve to boost levels of circulating antibodies when immunity from earlier shots wanes. However, if these circulating antibodies are not at all effective, or are less effective, against the Omicron variant as compared to their efficacy with earlier variants, one must question whether it is prudent to keep boosting with the original formulations of the COVID-19 vaccines. Pfizer’s CEO, Albert Bourla, has said that they could be ready to file for approval for a redesigned vaccine to fight Omicron and be able to mass produce it by March 2022. However, he feels that from a public health perspective, an annual vaccine that covers Omicron while not neglecting other variants would be a good solution.

But for an Omicron vaccine to be effective in stemming the current tide of cases, according to Dr. William Moss, executive director of the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health, it would have been needed to be introduced to the general population back in December 2021. Dr. Moss further commented that, “it [developing and mass producing an Omicron vaccine] still could be valuable but I do think in many ways, it’s too late” for the current wave of COVID-19 cases. More than 95% of reported COVID-19 cases were due to the Omicron variant as of early January 2022. If such a vaccine had been available earlier, it “might have been sufficient to prevent some of these illnesses and better protect our workforce, particularly health care workers,” says Moss. But since infection from Omicron spread so rapidly, a targeted vaccine could not be developed in time.

All this information about Omicron bypassing the vaccines and being highly transmissible while causing less severe infections raises the question: Is COVID-19 transitioning from pandemic to endemic? “What an endemic phase of a viral infection means is that it’s not causing the terrible hospitalizations of the pandemic phase but that we’ll have enough immunity of a population so it’s kept down to low levels,” said Dr. Monica Gandhi, an infectious disease doctor at the University of California, San Francisco. She feels that the Omicron variant could be the driver of COVID-19 into endemic status. What would life be like when Omicron is declared an endemic disease? Dr. Ghandi feels that it will be managed more like we manage the flu virus, using vaccines, treatments, and recommending those individuals who are more vulnerable to wear masks inside. “We will likely not be masking, distancing, contact tracing, doing asymptomatic testing,” Dr. Gandhi said. She continues that “There’s [an] incredible number of cases in both vaccinated and unvaccinated. What that does is it exposes you to the entire virus and you develop antibodies, T cells and B cells across the entire virus.” In other words, by recovering from an infection of Omicron, you develop both humoral and adaptive immunity.

Even public health officials like Dr. Fauci are now positing on learning to live with endemic COVID-19. "Control means you're not eliminating it, you're not eradicating it," he explains. "But it gets down to such a low level that it's essentially integrated into the general respiratory infections that we have learned to live with." In other words, just like the flu or the common cold. "If we have those things in place – vaccine testing, masks, therapy – we could keep it at that low level," Fauci said. He confirms that the durability of protection from boosters requires further studies and explains that waning antibody levels are normal. However, Fauci is now invoking that adaptive immunity may also be at work. "But there's an element of the immune response — B cell memory and T cell responses — where, even though you do see a diminution of antibody levels, it is quite conceivable, and I hope it's true, that the third shot boost will give a much greater durability of protection."

So, as physicians and scientists in medical communities across the globe are beginning to talk increasingly more about COVID-19 finally transitioning to endemic status, what are some of the reasonable lessons that we can derive from this pandemic?

I was fortunate enough to study pathogenic microbiology as an undergraduate at Rutgers University in the early 1980’s with Dr. Morris Solotorovsky, of blessed memory, who was an author of “Three Centuries of Microbiology” first published in 1965. Dr. S, as we used to call him, was already a septuagenarian when he was my professor. We used to joke that he was around for all three of those centuries of microbiology. He became especially animated when regaling us about Ignaz Semmelweis, the pioneer of antiseptic procedures, who discovered that instances of childbed fever could be drastically reduced using hand disinfection in obstetrical clinics. Nearly 160 years later, frequent handwashing is at the top of the list to prevent infections.

Dr. David Finegold, may he rest in peace, my professor of microbiology in graduate school at University of Pittsburgh School of Medicine who also wore a large pin on the lapel of his lab coat that said, ‘Wash your hands!’, taught us that droplets from sneezes can travel at speeds approaching 100 mph, with coughs expelling droplets at 50 mph. Dr. Finegold’s motto was to cover coughs and sneezes. This is something else that remains an absolute truth.

And I learned from my immunology professors, Dr. Howard Passmore at Rutgers, and Dr. Christine Milcarek at Pitt, that the very young, the very old, and those with underlying medical conditions or taking immunosuppressants are most vulnerable to infection. Again, this has been borne out by morbidity and mortality in the current pandemic.

My mother, neither a microbiologist nor an immunologist, had her own rule: If you’re sick, stay home! (Her chicken soup wasn’t bad either…) No one needs you feeling miserable with fever, coughing, sneezing, or having frequent diarrhea in school or at work. One of the realizations arising from life during the pandemic is that there is an increased ability to work from home for certain types of jobs. Students have also gotten used to remote learning during the pandemic. If you’re sick and shouldn’t be present to potentially infect coworkers, clients, or customers but are still able to muddle through the work or school day, hopefully your employer or school will continue to be able to support remote work or schooling in your home. For those employees who must be physically present at their workplace, employers should be mandated to provide ample fully paid leave as needed for workers when either they or a dependent are duly documented to be sick so that the spread of germs is limited. This is one law that should garner bipartisan support in both houses of Congress!

While Operation Warp speed was extraordinarily successful in bringing about a brand new modality of mRNA vaccines to prevent severe cases of COVID-19 arising from the initial variants, rapidly mutating viruses can outpace this protection. Additional effort must be made to develop rapid tests to further discern the ability of antibodies generated in response to first generation vaccines to neutralize emerging variants.

It is clear that you can’t have a single pronged “vaccine only” approach: parallel paths must also be taken at the same time to develop new types of therapeutics or screen old drugs to find promising leads for further development and make them widely available to those who do get infected. Be prepared for the next pandemic: devote resources to making sure ample supplies of hospital equipment, personal protective gear for front line workers, and tried and true standard operating procedures are in place for manufacturing in our own country to ramp up testing, vaccinations, and therapies, and medical supplies as needed.

Finally, educate the public more effectively on basic principles of immunology and epidemiology in laymen’s terms so they can grasp this information to make more informed decisions about their own health without the need for harsh proclamations or condescension. Individuals must be able to rely upon the relationships that they have with their own trusted healthcare providers for advice that’s tailored perfectly to their own situation.

*About the author: Dr. Keren Hulkower earned a BS in Biology from Cook College, Rutgers University, an MS in Microbiology and a PhD in Biochemistry from the University of Pittsburgh School of Medicine. He held senior research positions in drug discovery and medical assay development at several major pharmaceutical companies before venturing into the world of biotechnology start-ups. Dr. Hulkower currently works as a senior manager for a major non-profit medical organization. He is the author of more than 30 peer-reviewed scientific manuscripts and dozens of abstracts over the course of his career. Dr. Hulkower is also the author of 2 medical fiction novels, Mirror Images and Broken Records. The views, thoughts, and opinions expressed in this article are solely those of Dr. Hulkower and do not reflect those of his employer or this website.

Chile has changed. These last two years have been full of historical moments that will have repercussions for the future of society and in the anti-capitalist movements of the world. Tensions between Chilean protesters advocating for economic reforms and the Chilean government and their oligarchy went to the constitutional convention, with new actors arising now who promise to fix the moribound and obsolete political and economical system. On December 19th, Apruebo Dignidad, a coalition of social democratic parties, won the presidential elections for the first time, with the populist president-elect Gabriel Boric promising to address the grievances of the protestors and deliver solutions to long standing structural issues that has plagued Chilean democracy. Once again people will have to trust populist politicians. Is social democracy the final destination of the October insurrection? To answer this question we have to look back a little in recent history. The recent protest movement by the Chilean people against their own government was a natural outcome of the fact that Chile has been ruled by the same oligarchy since colonial times which has imposed its own long-standing social, political and economic model on society.

An important factor that led to the protest struggle to revindicate social rights was the distant and disconnected billionaire ruling class. The disconnect between the “political caste” and the everyday reality experienced by the common people in Chile, has led some to compare the gap between the Chilean economic classes as similar to the dynamics between Louis XVI and the 3rd estate which led to the French Revolution. A common comparison of Marie Antoinette's famous quote “Let them eat cake” is Piñera eating in a Pizzeria while the country was in flames on the night of October 18th. After the first month of protests that led to intense state repression by the oligarchy in an effort to protect their privileges from a revolution against them, members of the neoliberal left, centre and right joined together to sign the “Treaty of social peace and new constitution”, to form together and address the people’s demands. All of the signers were presidents of the political parties of the Chilean political spectrum, all of them except Gabriel Boric Font, the actual president elect.

The figure of Boric, the first millennial president of Chile, appeared in 2011 after winning the presidency of the Federation of Students of the University of Chile in the middle of the Students movement for free education of that year. It is said inside student circles that Boric, Vallejo and Jackson, the main leaders of the student movement of 2011, sold out and ruined the movement just to make careers in politics, accepting poor solutions from the government, forgetting the main goal of free universal access and good quality of education. Now the same is said with Boric as president, and his political partners Vallejo and Jackson. Although he promises that his plans for government will stick close to the social ideas of the popular movement, their political behaviour has been erratic. When Boric was deputy of the lower house of the congress during the October insurrection, he voted in favour of provocative and repressive laws that permitted the mass jailing of protestors, and that’s when he gained the term “Amarillo”, that could be translated as someone who changes their discourse depending on who they are treating with or what they want to gain from it. Camila Vallejo before being deputy for the lower house said that Michelle Bachelet was another neoliberal figure that did not deserve trust. Yet, later when she was in campaign for congress, she called everyone to vote for Bachelet for a second term. How could a coalition with erratic behaviour govern in favour of the people without selling out the popular movement again like in the past? Someone could say the end justifies the means and that we had to choose between Boric or an openly reactionary Pinochetist. The latter figure endangered the loss of all the social victories for the social reform movement, with the real prospect of Chile regressing 30 years.

One of the current fights of the protesters is the liberation of political prisoners of the insurrection. It is said that more than 2500 people are in jail for reasons involving their fight against state oppression. Ciper Chile, an independent journalist media, did an investigation of those jailed for protesting for change in Chile, and found 77 with official detained offences, the rest are still in jail without a proper sentence or judgement. Boric’s close friend and campaign leader, Giorgio Jackson, who also voted in favour of repressive laws, said that when Boric assumed the presidency, they would retire all accusations where the State Security Law was applied. This law was inherited from Pinochet’s dictatorship and it was used for all the governments of the democracy transition, it allowed high prison sentences for public disorder . According to Ciper, just 3 people fit that description, the 74 left behind, who are accused of manufacturing Molotov cocktails, public disorder, making barricades, etc. will stay in jail. Is it another betrayal to the movement? History has demonstrated that insurrections are the engine of national history. Without direct action, nothing could change even a little bit. Showing clemency to these jailed protestors, would be a huge step towards social peace. If the Government continues keeping the fighters in jail, it's just another message that they are another faction of the same oligarchy that ruled the territory of Chile for centuries. If so then the people will not be free even in a so-called Social Democratic government. Who can tell if the new Social Democratic government and the new constitution will give back dignity to the people? Who will give back the lives lost because they did not have enough money to pay for treatments? Who will do so for our dried land that has been destroyed by mining projects? Our fallen comrades who died during the insurrection who were fighting for our rights, what would they say if they found out ‘the Amarillo’ is the new president after all the fighting?

What is true, is that people have to protect all the liberties won along the fight, and occupy all of the resources available to achieve their goals, but never surrender to the bourgeois democracy. We have to be strong and united more than ever and never leave the streets. We have to fight for the freedom of our comrades locked up in the state dungeons. We have to fight against misery and the strong inequality in the distribution of wealth, because poverty is massive in Chile, thanks to the economic model that only defends people privileged with it. Some indicators say poverty was reduced more than 25% thanks to the neoliberalist system. I would ask you, do you consider someone as poor if they are earning 3 USD per day? Is being rich having a smartphone or a computer? We cannot count anymore on common material goods to measure poverty. Poverty in the 21st century is lack of opportunities, lack of social security, not having enough money to pay rent or pay for public transport. Not being able to buy a house and paying for the responsibility of the global financial crisis. The new government will never be social or democratic, every government will always be authoritarian. We, the people, have to build the real democracy with community organisation and popular defence, we have to be smart and alert against the (old) new oligarchy, not just voting for a fair master, but we must fight to the complete liberation of our society against the hands of the so-called authority and their capitalist oligarchs.