COVID: an ecological view

Now that COVID occurs in people who are vaccinated and/or treated, it is time call a truce. The fact that COVID continues to be part of our daily lives requires an ecological view of our relationship to our environment, which includes all living organisms and those that live within us.

We must make friends of our enemies

Let’s look at the strategies we have been using to combat this weakening foe called COVID. First there is COVID testing. Both the RAT and PCR tests were designed as screening tools for initial assessments. None of the COVID tests have shown reliability when they are used for serial testing. The RAT, even when conducted properly, at best identifies 50% of people with COVID. At worst, it returns a negative test for more than a third of people who have COVID.

When any two different COVID antigen tests are conducted, there is at least a 1 in 10 chance of producing discordant results, that is positive and negative results in the same person at the same time.

Then there is vaccination. COVID two-dose, booster and second booster vaccinations do not prevent you getting COVID, especially not the Omicron variants, more than once; they just decrease your risk of hospitalization and death. Reinfection is increasing, now around 10% – irrespective of vaccination status.

Where treatment is concerned, the evolving story with oral medications is a similar one of much promise and limited results. Oral COVID medications at best reduce hospitalisation rates by two thirds, if administered within the first three days of exhibiting COVID symptoms and continued for five days.

Now that mild breakthrough COVID symptoms have been reported in treated patients, COVID is no longer the mortality threat of other viruses such as HIV. Lifelong continuous treatment, which has transformed the prognosis of HIV, comes at a cost to the patient’s immunosuppression abilities, albeit the cost is relatively small. With HIV, the trade-off between efficacy and short- and long-term safety is clear. At this stage of our understanding of COVID, there are few proven treatments, and the cost-benefit analysis is far from complete.

We must make friends of our enemies as we have done before. We cannot eradicate the flu and it still kills more people world-wide every year than many wars. We live with E.Coli in our lower intestines to help us digest our food. And we have a symbiotic relationship with Staph albus on our skin. These symbiotic infective friends are under reasonable control – not eradicated. It is time to think the same way about COVID and perhaps in the future about Monkeypox as well.

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