There has been a significant drop in the life expectancy in the United States. The CDC has published data regarding this. Life expectancy at birth in the year 2021 is now 76.1 years. There has been an overall 2.7 years loss in total life in the last two years; for females, the life expectancy has declined by 2.3 years and for males by 3.1 years.

• The BA.5 Omicron sublineage accounts for 87.5% of total samples collected since the last 3 weeks. BA.4 has declined to just 2.2% of the total samples.
• There has been a reduction in vaccine efficacy in this period of BA.4/5. The variants are escaping the immune protection of the vaccine. This raises the need for a pan vaccine or novel vaccine.
• Many intranasal vaccines are under clinical trial including BBV154 from Bharat Biotech developed in collaboration with Washington University. Intranasal vaccines can be an alternative vaccine for those who are reluctant to take the injectable doses. 
• The world’s first inhaled Covid-19 vaccine developed by the Chinese company CanSino Biologics has been approved for use as a booster dose in China. It is an adenovirus-vectored Covid-19 vaccine similar to the injectable vaccine.
• The first nasal Covid-19 vaccine has been approved (EUA) in India. It has been developed by Bharat Biotech in collaboration with Washington University. This vaccine can be refrigerated. In this vaccine, the spike protein inserted adenovirus, which is unable to cause illness. The new vaccine also incorporates two mutations into the spike protein that stabilize it in a specific shape that is most conducive to forming antibodies against it.  
• When the virus enters the body, the dendritic cells grab the pieces of virus. They recruit helper T cells, which match with the viral pieces. This is followed by the B cells that also match with the virus. The activated B cells form plasma cells that produce antibodies, which attach to the virus and fight off the infection. Some B cells become memory cells which remain in the body and are reactivated in case of reinfection with the same virus. 
• The older antibodies are not a good match for the newer variants. The antibodies to the original virus may still be able to attach to some parts of a newer variant, which have not changed.
• The US FDA has approved the updated Moderna and Pfizer-BioNTech bivalent Covid-19 vaccine for use as a booster dose. 
• Bivalent vaccines have the same total antigen amount as the monovalent vaccines. Moderna’s monovalent Covid-19 vaccine contains 50 µg of spike protein from the ancestral (original) SARS-CoV-2 strain. The bivalent Moderna vaccine contains 25 µg of spike protein from the ancestral SARS-CoV-2 strain and 50 µg of spike protein from the Omicron (BA.4/BA.5) SARS-CoV-2 strain.
• Similarly, the Pfizer-BioNTech vaccine contains 30 µg of spike protein from the ancestral (original) SARS-CoV-2 strain. The updated booster vaccine contains 15 µg of spike protein from the ancestral SARS-CoV-2 strain and 15 µg of spike protein from the Omicron (BA.4/BA.5) SARS-CoV-2 strain.
• The US is planning to shift to annual Covid-19 booster doses similar to flu shots, though the elderly may require more frequent vaccination.
• For long Covid, the CDC requires an interval of more than 4 weeks after acute Covid-19. One in five Covid-19 survivors aged 18–64 years and one in four survivors 65 years and older experienced at least one incident condition that might be attributable to previous Covid-19.
• The incidence of PASC is approximately 14% in adults and 21% in children and adolescents.
• A report from the US has documented the  prevalence of SARS-CoV-2 infection and long Covid in US adults during the BA.5 surge in June-July 2022; 21.5% had symptoms > 4 weeks. 19% were boosted, 25% were vaccinated but not boosted, while 22% were unvaccinated.
• The prevalence of long Covid in children varies from 1:4 to 1:100. About 25% continue to have symptoms months after hospitalization for Covid-19. The diagnosis is a challenge because of the heterogeneous symptoms. Symptoms persistent at 12 weeks are required to meet the definition of Long Covid.
• An international consensus for a pediatric Long Covid definition is anticipated in 2023; this will be an important step in the illness being recognized and managed consistently.
• At the population health level, there is a suggestion that the incidence of type 1 diabetes is increased in children with Long Covid, although the cause of this is unclear and requires further investigation.
• New research has found the spike protein of the SARS-CoV-2 virus in the blood of long Covid patients up to a year after infection but not in people who have fully recovered from Covid. The virus has also been found in tissues including the brain, lungs, and lining of the gut.
• The findings suggest that leftover reservoirs of the virus could be provoking the immune system in some people, causing complications such as blood clots and inflammation, which may fuel specific long Covid symptoms.
• Acute COVID-19 correlates with biomarkers of systemic inflammation, hypercoagulability, and comorbidities that are less prominent in PASC.
• Macro vessel thrombosis, a hallmark of acute COVID-19, is less frequent in PASC. 
• Female sex at birth is associated with reduced risk for acute COVID-19 progression but increased risk of PASC. 
• Persistent microvascular endotheliopathy associated with cryptic SARS-CoV-2 tissue reservoirs has been implicated in PASC pathology.
• Autoantibodies, localized inflammation, and reactivation of latent pathogens may also be involved, potentially leading to microvascular thrombosis, as documented in multiple PASC tissues.
• The US government has outlined a plan to get Americans the best available protection through free and easy access to new, updated COVID-19 vaccines and ensuring easy access to Covid testing and treatment to mitigate the spread of Covid-19. The plan also calls on all Americans to use every tool at their disposal to keep communities safe and schools and businesses open and to prepare for potential surges and new variants and building a resilient national COVID-19 response moving forward.

(Excerpts from presentation by Dr Monica Vasudev, Allergist & Clinical Immunologist, Fellow of American Academy of Asthma, Allergy and Immunology, Advocate Aurora Health, Wisconsin, USA) 

10th September 2022, Saturday; 9.30-10.30 am 

Participants

Member National Medical Associations

Dr Yeh Woei Chong, Singapore, Chair of Council CMAAO

Dr Alvin Yee-Shing Chan, Hong Kong, Treasurer, CMAAO

Dr Marthanda Pillai, India Member World Medical Council, Advisor CMAAO

Dr Mvuyisi Mzukwa, South Africa

Dr Angelique Coetzee, South Africa

Dr Akhtar Hussain, South Africa

Dr Md Jamaluddin Chowdhury, Bangladesh 

Dr Marie Uzawa Urabe, Japan

Dr Salma Kundi, Pakistan

Dr Mulazim Hussain Bukhari, Pakistan

Invitees

Dr Russell D’Souza, Australia UNESCO Chair in Bioethics

Dr Monica Vasudev, USA

Dr Nicholas Veliotes

Dr Pinki Chauhan

Dr Colin Goldberg

Dr EC Ng

Dr Roy Teow

Dr Rashid Mahmood

Dr Anita Jain

Dr S Sharma, Editor IJCP Group

Moderator

Mr Saurabh Aggarwal