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COLD, FEVER AND FLU TREATMENT IN CHILDREN: MEDICATIONS AND HOME REMEDIES

HOW CAN I TREAT MY CHILD’S COLD SYMPTOMS?

Maybe it starts with the sniffles. Maybe it starts with a cough and mild aches and pains. Maybe it’s a long day with an upset stomach. Whatever the cause, curing your child’s cold symptoms is going to take some know-how. This is a great place to start.

Using this visual guide, discover how to relieve your sick children at home and restore them to good health. Discover which medical treatments are effective remedies for the common cold. Also, learn how to safely give over-the-counter (OTC) medication if needed to ease a fever, sore throat, runny nose, or other common cold symptom.

IS IT A LOW-GRADE FEVER, OR MORE SERIOUS?

Does your child’s forehead feel hot? Does he or she wake up in a cold sweat? Fevers can be scary, but how hot does one need to be before a parent should find a way to cool it?

According to pediatricians, if your child is warmer than 100.4 degrees, he or she may be at an increased health risk. Call the doctor if your child is this warm and is fewer than 6 months old, shows other symptoms, has been feverish for three days or longer, or has yet to be vaccinated.

If these are not the case, it is generally safe to use children’s ibuprofen or acetaminophen as common cold remedies, which have the additional benefit of pain relief. Aspirin should never be given to anyone under age 19. Asprin use in children elevates the risk of Reye’s syndrome, a serious but rare illness that can harm the brain and liver.

HOW ELSE CAN I BRING MY CHILD’S TEMPERATURE DOWN?

Beyond calling the doctor and offering over-the-counter medication to your child, there are a few other ways to help reduce their high temperature.

  • Try a sponge bath. Use water that is lukewarm.
  • Avoid rubbing alcohol, cold water, and ice.
  • Instead of piling on blankets, make sure your child is resting at a comfortable temperature and is dressed lightly.
  • Watch out for dehydration symptoms.
  • If your infant’s diaper is dry, has a dry tongue or mouth, or is feeding poorly, call a health-care professional immediately or go to the nearest emergency room.
  • For older children showing signs of dehydration such as not urinating frequently enough, not drinking well, or acting abnormally, call the pediatrician.

WHEN TO CALL THE PEDIATRICIAN

When your child has a high fever or is dehydrated, you need to call the doctor right away. But outside of overheating and dehydration, when else should you seek medical care? Here are some guidelines:

  • Call if you suspect your baby under 12 months old might have the flu;
  • Call if your baby under 12 months old is not urinating or drinking frequently enough;
  • Call if your child’s nasal mucus is either green or yellow, or if you notice any discharge after a period of 10 days, or if discharge appears to come from his or her eyes;
  • Call if the child is feverish for three days or longer.

Some situations are even more serious, and require an immediate trip to the emergency room. Go to the emergency room if your child has difficulty breathing, seems very sick, will not to eat or drink, shows signs of a rash, or anytime you are concerned.

Believe it or not, the answer is yes, for a few reasons. For one, there have been studies that show a connection between eating chicken soup and reducing inflammation.

Even without the possible inflammation-reducing powers of chicken soup, it’s a nutritious brew that can improve health and help promote hydration. But don’t stop at just chicken soup. Give your sick child lots of other fluids, like milk, water, or an electrolyte solution like Pedialyte or Gatorade.

Other Home Remedies

Steam is a great way to help a stuffy nose, and that can help remedy the pain of congestion. Have your child inhale steam from a hot shower or a cool mist vaporizer.

Menthol chest rubs can also be helpful. They help loosen mucus to be coughed out. A word of warning: Do not use medicated vapor on anyone under age 2.

Finally, after nose-blowing has left your child’s face a little raw, try petroleum jelly under the nose to soothe irritated skin.

HOW DO I RELIEVE A SORE THROAT AND COUGH?

Having caffeine-free tea or water with honey and lemon, lozenges, and a salt water gargle can help relieve a sore throat and cough.

Usually colds are the culprits when it comes to sore throats, and they tend to last about four or five days. How to relieve a sore throat depends on age.

  • Children over 2 can find relief from a warm, caffeinate-free tea or water with about 1/2 tsp. of honey with lemon.
  • Children over 1 can receive 1 tsp. of buckwheat honey for cough relief.
  • Children 6 and older can find relief from over-the-counter lozenges with anesthetic that helps ease pain. Hard candy is another suitable option—sugar-free being best for their health. A warm salt water gargle may also be helpful.

Strep throat tends to arise quickly. Sometimes strep comes with no other cold symptoms. If you think your child has strep, call your doctor for a strep test and antibiotics if necessary.

AT WHAT AGE CAN MY CHILD TAKE COUGH OR COLD MEDICINE?

If your child is under age 4, don’t give him or her cough medicine or over-the-counter cold medication. These OTC medications will do little to help symptoms in toddlers, according to several studies. Not only are they ineffective, but these medications may cause serious and potentially life-threatening side effects in young children. Instead, give your child extra fluids to prevent dehydration. Employ a nasal aspirator and a humidifier to further restore health.

ONE MEDICINE OR TWO?

Medications that relieve multiple symptoms may be tempting, but use them cautiously. Stick with medications that match your child’s symptoms. That means it’s OK to use multi-symptom over-the-counter treatment – just as long as those symptoms match the ones your child is suffering from.

To make sure you’re not over-medicating your child, read the directions on the back of all medication and follow them carefully. If your OTC medicine came with a measuring device, use it. Don’t choose products that treat symptoms your child isn’t suffering from. A multi-symptom cold medicine would be a poor choice, for example, for a child who is only experiencing a sore throat.

USING TWO MEDICINES? DON’T DOUBLE UP ON A DRUG

When administering medication to children, read the label carefully. Don’t give your child two over-the-counter medications with the same active ingredients, which could lead to an overdose.

Oftentimes children’s cold medications come with acetaminophen — the same as Tylenol. So if you don’t read carefully, it can be shockingly simple to over medicate your child. Medicine comes with a “drug facts” box, which is a great place to start. Compare ingredients found there to reduce the risk of an overdose.

WHEN SHOULD I CHOOSE A DECONGESTANT, AN EXPECTORANT, OR A SUPPRESSANT?

Decongestants and expectorants work in different ways, and both remedies can lead your child to better health when used in the right way.

Stuffy nasal passages shrink when decongestants are used. This helps relieve pain. These forms of medication are available as nasal sprays or drops or as oral treatments. Nasal drops or sprays should be discontinued after being used for two or three days straight.

On the other hand, expectorants help to thin mucus, making it easier to cough up. For an expectorant to work properly, your child needs to drink plenty of water.

Cough suppressants don’t do much in the way of removing mucus. That’s why it is often not to suppress a cough, even the cough is keeping a child awake at night.

Don’t give any cold medication to anyone under 4 without speaking to your child’s doctor.

FINDING THE RIGHT DOSE

Over-the-counter treatments can be a great remedy for the common cold, but exercise caution when using them. Administer OTC medication only according to the directions. Make sure you base the dosage on your child’s weight and age. And don’t forget to read the “Warnings” sections for potential side effects and drug interactions.

Also be mindful of these common abbreviations often found on labels:

  • Tbsp (tablespoon) and Tsp (teaspoon),
  • oz. (ounces),
  • ml. (milliliter), and
  • mg. (milligram).

Those are all very different measurements.

Also, use the measuring device that is packaged with the medication for most accurate dosing.

IT’S TIME FOR A DOSE: SHOULD I WAKE MY SICK CHILD UP?

One of the best common cold remedies is rest, so let your children sleep as much as they need to. If you need to skip a dose of over-the-counter medicine so that your child may sleep longer, go ahead and skip the medicine. Remember: you’ll have a chance to administer that medicine again when your child wakes up, or possibly the next morning. Take your child to a doctor if he or she has been taking an OTC medicine for four days or longer.

It can make a difference. Common kitchen spoons vary in size. It is safer to use the cup or spoon that comes with over-the-counter medication.

Wondering what to do if no measuring device came with the medication? The label will recommend something like 2 teaspoons be administered. In that case, use an actual dosing cup or measuring spoon that comes with teaspoon marks. You can then rest easy knowing you’ve given him or her the right amount.

SHOULD I GIVE ANOTHER DOSE IF MY CHILD VOMITS?

So the first dose didn’t agree with your child, who went and spit it out or vomited after taking medicine. A concerned parent may want to follow up with another full dose, but don’t do it. Some of that medication may have been absorbed, and if you give another full dose you risk overdosing him or her.

It’s better to call the pediatrician in times like this. If your child tends to spit up medication because he or she doesn’t like it, ask your pharmacist if it’s alright to mix the remedy with a bit of food or drink.

It is never a good idea to give your child OTC treatments designed for adults. You can do no better than guess at how much your child might need, and some remedies are specifically formulated for adults and should not be administered to children. For that reason, avoid any products not specifically labeled for use in infants, babies, or children with the words “for pediatric use.”

DON’T CALL OTC MEDICINE “CANDY.”

You may be tempted to call medicine “candy” in order to encourage your children to take it. But it’s not a good idea. Little kids love to imitate the adults in their lives. To make sure you’re setting the best possible example, consider these tips:

  • Try to avoid taking medicine in front of your children, whether it’s for a prescription or over-the-counter.
  • Never call any medication “candy.”
  • Avoid rewarding children with medication that tastes sweet — children’s vitamins included. Instead, offer a favorite drink after medicine has been administered to help wash away the taste

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Diet and Lifestyle

SUPPORTING EXAM STRESS and Kids going back to School.

stress

Tests and exams can be a challenging part of school life for children and young people and their parents or carers. But there are ways to ease the stress.

Watch for signs of stress

Children and young people who are stressed may:

  • worry a lot
  • feel tense
  • have headaches and stomach pains
  • not sleep well
  • be irritable
  • lose interest in food or eat more than normal
  • not enjoy activities they previously enjoyed
  • be negative and have a low mood
  • feel hopeless about the future

Having someone to talk to about their work can help. Support from a parent, tutor or study buddy can help young people share their worries and keep things in perspective.

Encourage your child to talk to a member of school staff who they feel is supportive. If you think your child is not coping, it may also be helpful for you to talk to their teachers.

Try to involve your child as much as possible.

Make sure your child eats well 

A balanced diet is vital for your child’s health, and can help them feel well during exam periods.

Some parents find high-fat, high-sugar and high-caffeine foods and drinks, such as energy drinks, cola, sweets, chocolate, burgers and chips, make their children hyperactive, irritable and moody.

Where possible, involve your child in shopping for food and encourage them to choose some healthy snacks.

Read more about healthy eating for teens.

Help your child get enough sleep 

Good sleep improves thinking and concentration. Most teenagers need 8 to 10 hours’ sleep a night. Learn more about how much sleep children need.

Allow half an hour or so for your child to wind down between studying, watching TV or using a computer and going to bed, to help them get a good night’s sleep.

Cramming all night before an exam is usually a bad idea. Sleep will benefit your child far more than a few hours of panicky last-minute study.

Be flexible during exams

Be flexible around exam time. When your child is revising all day, do not worry about household jobs left undone or untidy bedrooms.

Staying calm yourself can help. Remember, exams do not last forever.

The Family Lives website has more about coping with exam stress.

Help them study

Make sure your child has somewhere comfortable to study. Ask them how you can support them with their revision.

Help them come up with practical ideas that will help them revise, such as drawing up a revision schedule or getting hold of past papers for practice.

To motivate your child, encourage them to think about their goals in life and see how their revision and exams are related to them.

Talk about exam nerves

Remind your child that it’s normal to feel anxious. Nervousness is a natural reaction to exams. The key is to put these nerves to positive use.

If anxiety is getting in the way rather than helping, encourage your child to practise the activities they’ll be doing on the day of the exam. This will help it feel less scary.

For example, this may involve doing practice papers under exam conditions or seeing the exam hall beforehand. School staff should be able to help with this.

Help your child face their fears and see these activities through, rather than avoiding them.  

Encourage them to think about what they know and the time they’ve already put into studying to help them feel more confident.

Encourage exercise during exams

Exercise can help boost energy levels, clear the mind and relieve stress. It does not matter what it is – walking, cycling, swimming, football and dancing are all effective.

Activities that involve other people can be particularly helpful.

Support group Childline says many children who contact them feel that most pressure at exam time comes from their family.

Listen to your child, give them support and avoid criticism.

Before they go in for a test or exam, be reassuring and positive. Let them know that failing is not the end of the world. If things do not go well they may be able to take the exam again.

After each exam, encourage your child to talk it through with you. Discuss the parts that went well rather than focusing on the questions they found difficult. Then move on and focus on the next test, rather than dwelling on things that cannot be changed.

Make time for treats

With your child, think about rewards for doing revision and getting through each exam.

Rewards do not need to be big or expensive. They can include simple things like making their favourite meal or watching TV.

When the exams are over, help your child celebrate by organising an end-of-exams treat.

When to get help

Some young people feel much better when exams are over, but that’s not the case for all young people.

Get help if your child’s anxiety or low mood is severe, persists and interferes with their everyday life. Seeing a GP is a good place to start.

Some basic rules coming up to exam time

A quiet place to study – A suitable environment to study is important to help concentration levels.

A balanced diet – Good nutrition is essential at any time of year, but especially during exam time. Batch cook some healthy meals and stock up on nutritious snacks. Having some of the student’s favourite dinner to hand is important too.

Omega 3 is essential to fuel the hard-working brain at this time. Keep brain and vision in tip top shape by making sure to top up your good fats daily. Consider taking Cleanmarine® Krill Oil High Strength. It contains 590mg of concentrated, high strength Omega 3 Krill Oil. This concentrated formula of EPA, DHA, Astaxanthin and Choline provides the essential fatty acids required for the normal function of the heart, brain and vision. DHA contributes to the maintenance of normal brain function and vision, the beneficial effect is obtained with a daily intake of 250mg. Also eating 2 – 3 portions of oily fish a week will provides more essential fats for your body. Examples include salmon, mackerel and herring. Easy to cook in steam parcels in the oven with garlic, lemon and oil.

A good night’s sleep – Studying all night may seem like a good idea but if your child doesn’t get enough sleep, they are more likely to forget the information or under perform. When your mind is buzzing with exam questions, quotes and scientific theories, having something to help you switch off, relax and support deep sleep is a must. Try melissa-dreams which contains all-natural ingredients including the herbs lemon balm (Melissa officinalis) and Chamomile in combination with selected B-vitamins, Magnesium and the amino acid L-theanine. Magnesium contributes to a reduction of tiredness and fatigue while vitamins B6 and B12 contribute to the normal function of the nervous system. With no drowsiness or side effects the next day, Melissa Dream helps you to wake up rested and full of energy.

Exercise – Even a 20-minute walk will help your child to relax and destress their mind, this will also help oxygenate the entire body.

Stress is the biggest obstacle to overcome. It’s so important to get enough B vitamins in foods like broccoli. Kale, spinach. Getting your 5-a-day is bound to be the least of your worries as exam time approaches; ironically this is when your nutritional and energy needs are at their highest. Make sure you keep your nutrient and energy levels up with One Nutrition® Organic Power Greens. This is a unique combination of nature’s finest green foods including kale, broccoli, spirulina, wheat grass and barley grass juice powders in a handy capsule or powder to add to your morning smoothie.

Take time out to do something you love such as walking your dog, reading a magazine, chat online to your best friend. Journaling is also therapeutic, to put your thoughts and feelings onto paper. Try family time such as playing a board game to distract your mind from the books for a while.

Don’t forget to celebrate – when the exams are over, go out and celebrate together, hopefully everything will be back to normal by then.

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Can vitamin D really prevent Covid-19? Here’s what the evidence says.


Vitamin D supplement sales have soared amid the pandemic as people try to curb their risk of contracting the novel coronavirus—but some experts are urging caution, noting that not enough research has been done to establish a definitive relationship between taking the supplement and fending off Covid-19.

What the research says about vitamin D and Covid-19

According to Sabyasachi Sen, a professor of endocrinology and medicine at George Washington University (GW), deficiencies of vitamin D are “not rare” and are especially common in older adults, obese people, and people with darker skin—some of the same populations most affected by Covid-19.

While vitamin D is known for protecting bone health, it also helps with the immune system, Sen said. It’s believed that vitamin D improves the function of certain cells, including T cells, which fight off pathogens and can assist in modulating inflammatory responses.

In addition, Sen continued, research has found vitamin D deficiencies have been associated with an increased risk of infection. “Now, what is unknown is whether it’s a cause and effect rather than an association,” he said.

According to the Washington Post, researchers studying the relationship between vitamin D and Covid-19 outcomes are interested in precisely that question: whether there’s a cause and effect relationship, or merely an association.

For example, one study, published in JAMA Network Open, looked at the health records of 489 people in Chicago and found patients with a vitamin D deficiency in the year prior to testing for Covid-19 were 77% more likely to test positive for the disease than those with normal vitamin D levels. Taking a converse approach, another study looked at a small group of Covid-19 patients in Italy who had been hospitalized with acute respiratory failure and found that 81% of them had a vitamin D deficiency.

Meanwhile, an experimental study in France at a nursing home with 66 people found that taking vitamin D supplements was “associated with less severe Covid-19 and a better survival rate.” Similarly, a study in South Korea of 200 people found that a deficiency of vitamin D could “decrease the immune defenses against Covid-19 and cause progression to severe disease.” And a small study in Spain involving 76 hospitalized Covid-19 patients found that those treated with calcifediol—an activated version of vitamin D, distinct from the over-the-counter supplement—seemed to curb the severity of the disease.

On the flipside, however, a recent paper considered by the National Institute for Health and Care Excellence in the United Kingdom looked at vitamin D levels from up to 14 years ago and didn’t find any correlation between vitamin D levels and Covid-19 mortality. And while the lead author of that study has in other papers called for further research on the link between vitamin D and Covid-19 outcomes, the researchers concluded, “For now, recommendations for vitamin D supplementation to lessen Covid-19 risks appear premature and, although they may cause little harm, they could provide false reassurance leading to changes in behaviour that increase risk of infections.”

Similarly, a double-blind randomized controlled trial of 240 patients in Brazil, which has yet to be peer-reviewed, found that one large dose of vitamin D didn’t reduce hospital stay length or mortality rates among patients with a severe case of Covid-19 compared with those in a placebo group.

Correlation—not necessarily causation

“We do know that people who have lower blood levels of vitamin D tend to have a higher risk of being infected with Covid-19 and having severe Covid-19 illness,” JoAnn Manson, chief of the Division of Preventive Medicine at Brigham and Women’s Hospital, said. “But as we say in epidemiology, ‘Correlation doesn’t prove causation.’ We don’t know for sure that the low vitamin D level is causing an increased risk of Covid-19.”

According to Natasha Chida, an infectious disease expert and assistant professor of medicine at Johns Hopkins University, people who have a vitamin D deficiency typically have other health factors that could affect how likely they are to develop a severe case of Covid-19—and people who do develop diseases such as Covid-19 often experience a drop in vitamin D levels.

“Unless you take into account all those factors and separate all those out and look at just vitamin D … it’s really hard to make any inferences about what vitamin D is doing here,” she said.

Chida added that there’s “some biologic plausibility” that vitamin D could help Covid-19 patients. “It’s just that despite years of research into the use of vitamin D in respiratory tract infections, there still hasn’t really been a clear, slam-dunk answer that there’s a benefit.”

Research into the relationship is ongoing, however. According to the Washington Times, about 70 clinical trials assessing vitamin D and Covid-19 have been filed in the U.S. National Library of Medicine database.

Should you take vitamin D supplements?

As of now, experts say people who know they have vitamin D deficiencies should continue their treatment, and those thinking about taking supplements should talk to their health care provider first, given there’s no firm evidence that vitamin D supplements curb people’s risk of infection or serious Covid-19 illness.

“People should be wary of taking mega doses of vitamins or unproven interventions specifically for Covid-19, because we don’t have good quality data yet to suggest that this is of any help,” Hana Akselrod, an infectious disease specialist at GW, said.

Instead of supplements, people can add more vitamin D to their lives by being outdoors for 15 or 20 minutes a day, Akselrod added. And some foods, such fatty fish or fortified dairy products, could also improve vitamin D levels, Manson said.

“There are all of the positive confluences around nutrition and outdoor exercise that aren’t just limited to the number of how many units of vitamin D you get every day,” Akselrod said. “And on top of that, people absolutely need to continue all the other safety precautions, like masking and safe distancing and avoiding gatherings, because we’re in the most dangerous phase of the pandemic yet”.

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COVID-19 will likely be with us forever. Here’s how we’ll live with it.

As COVID-19 continues to run its course, the likeliest long-term outcome is that the virus SARS-CoV-2 becomes endemic in large swaths of the world, constantly circulating among the human population but causing fewer cases of severe disease. Eventually—years or even decades in the future—COVID-19 could transition into a mild childhood illness, like the four endemic human coronaviruses that contribute to the common cold.

“My guess is, enough people will get it and enough people will get the vaccine to reduce person-to-person transmission,” says Paul Duplex, director of the University of Pittsburgh’s Center for Vaccine Research. “There will be pockets of people who won’t take [the vaccines], there will be localized outbreaks, but it will become one of the ‘regular’ coronaviruses.”

But this transition won’t happen overnight. Experts say that SARS-CoV-2’s exact post-pandemic trajectory will depend on three major factors: how long humans retain immunity to the virus, how quickly the virus evolves, and how widely older populations become immune during the pandemic itself.

Depending on how these three factors shake out, the world could be facing several years of a halting post-pandemic transition—one marked by continued viral evolution, localized outbreaks, and possibly multiple rounds of updated vaccinations.

“People have got to realize, this is not going to go away,” says Roy Anderson, an infectious disease epidemiologist at Imperial College London. “We’re going to be able to manage it because of modern medicine and vaccines, but it’s not something that will just vanish out of the window.”

The long road to another common cold

One of the essential factors governing the future of COVID-19 is our immunity to the illness. Immunity to any pathogen, including SARS-CoV-2, isn’t binary like a light switch. Instead, it’s more like a dimmer switch: The human immune system can confer varying degrees of partial protection from a pathogen, which can stave off severe illness without necessarily preventing infection or transmission.

In general, the partial protection effect is one of the reasons why the four known endemic human coronaviruses—the ones that cause a common cold—have such mild symptoms. A 2013 study in BMC Infectious Diseases shows that on average, humans are first exposed to all four of these coronaviruses between the ages of three and five-part of the first wave of infections that young children experience.

These initial infections lay the foundation for the body’s future immune response. As new variants of the endemic coronaviruses naturally evolve, the immune system has a head start in fighting them off—not enough to eradicate the virus instantly, but enough to ensure that symptoms don’t progress much beyond the sniffles.

“The virus is also its own enemy. Every time it infects you, it tops up your immunity,” says Marc Veldhoen, an immunologist at the Portugal’s University of Lisbon.

Past studies make clear that partial immunity can keep people from getting seriously ill, even as coronaviruses successfully enter their systems. Long-term, the same is likely to be true for the new coronavirus. Emory University postdoctoral fellow Jennie Lavine modeled SARS-CoV-2’s post-pandemic trajectory based on the 2013 study’s data, and her results—published in Science on January 12—suggest that if SARS-CoV-2 behaves like other coronaviruses, it will likely morph into mild nuisance years to decades from now.

This transition from pandemic to minor ailment, however, depends on how the immune response to SARS-CoV-2 holds up over time. Researchers are actively examining the body’s “immunological memory” of the virus. A study published in Science on January 6 tracked the immune response of 188 COVID-19 patients for five to eight months post-infection, and while individuals are varied, about 95 percent of patients had measurable levels of immunity.

“Immunity is waning, but certainly not gone, and I think this is key,” says Lavine, who wasn’t involved with the study.

In fact, it’s even possible that one of the cold-causing coronaviruses sparked a serious outbreak in the 1800s before fading into the litany of mild, commonplace human pathogens. Based on the spread of its family tree, researchers estimated in 2005 that the endemic coronavirus OC43 entered humans sometime in the late 19th century, likely the early 1890s. The timing has led some researchers to speculate that the original version of OC43 may have caused the “Russian flu” pandemic of 1890, which was noted for its unusually high rate of neurological symptoms—a noted effect of COVID-19.

“There’s no hard proof, but there are a lot of indications that this wasn’t an influenza pandemic but a corona-pandemic,” Veldhoen says.

The crucible of evolution

Though the carnage of past coronaviruses has faded over time, the road to a relatively painless coexistence between humans and SARS-CoV-2 will likely be bumpy. In the medium-term future, the impact of the virus will depend largely on its evolution.

SARS-CoV-2 is spreading uncontrollably around the world, and with every new replication, there’s a chance for mutations that could help the virus more effectively infect human hosts.

The human immune system, while protecting many of us from a serious illness, is also acting as an evolutionary crucible, putting pressure on the virus that selects for mutations that make it bind more effectively to human cells. The coming months and years will reveal how well our immune systems can keep up with these changes.

New SARS-CoV-2 variants also make widespread vaccination and other transmission-blocking measures, such as face masks and distancing, more crucial than ever. The less the virus spreads, the fewer opportunities it has to evolve.

We’re going to be able to manage it because of modern medicine and vaccines, but it’s not something that will just vanish out of the window.

ROY ANDERSONIMPERIAL COLLEGE LONDON

Current vaccines should still work well enough against emerging variants, such as the B.1.1.7 lineage first found in the United Kingdom, to prevent many cases of serious illness. Vaccines and natural infections create diverse swarms of antibodies that glom onto many different parts of SARS-CoV-2’s spike protein, which means that a single mutation can’t make the virus invisible to the human immune system.

Mutations may produce future variants of SARS-CoV-2 that partially resist current vaccines, however. In a preprint posted on November 19 and updated on January 19, Duplex and his colleagues show that mutations that delete parts of the SARS-CoV-2 genome’s spike protein region prevent certain human antibodies from binding.

“What I’ve learned from our own work is how deviously beautiful evolution is,” Duplex says.

Other labs have found that mutations in 501Y.V2, the variant first found in South Africa, are especially effective at helping the virus elude antibodies. Out of 44 recovered COVID-19 patients in South Africa, blood extracts from 21 of the patients didn’t effectively neutralize the 501Y.V2 variant, according to another preprint published on January 19. Those 21 people had mild to moderate cases of COVID-19, however, so their antibody levels were lower, to begin with, perhaps explaining why their blood did not neutralize the 501Y.V2 variant.

So far, currently authorized vaccines—which spur the production of high levels of antibodies—seem to be effective against the most concerning variants. In a third preprint published on January 19, researchers showed that antibodies from 20 people who had received the Pfizer-BioNTech or Moderna vaccines didn’t bind quite as well to viruses with the new mutations as they did to earlier variants—but they still bound, suggesting the vaccines will still protect against severe illness.

The new variants bring other threats as well. Some, such as B.1.1.7, appear to be more transmissible than earlier forms of SARS-CoV-2, and if left to spread uncontrollably, these variants could make many more people severely ill, which risks overwhelming healthcare systems around the world and even higher death tolls. Veldhoen adds that new variants also may pose a greater risk of reinfection to recovered COVID-19 patients.

Researchers are closely monitoring the new variants. If vaccines need to be updated in the future, Anderson says that it could be done quickly—in roughly six weeks for currently authorized mRNA vaccines, such as those made by Pfizer-BioNTech and Moderna. That timetable, though, doesn’t account for the regulatory approvals that updated vaccines would need to go through.

Anderson adds that depending on how the evolution of the virus progresses, lineages of SARS-CoV-2 may arise that are distinct enough that vaccines will need to be tailored to specific regions akin to vaccines for pneumococcus. To successfully guard against SARS-CoV-2 going forward, we will need a global monitoring network similar to the worldwide reference laboratories used to collect, sequence, and study variants of influenza.

“We’re going to have to live with it, we’re going to have to have constant vaccination, and we’re constantly going to have to have a very sophisticated molecular surveillance program to keep track of how the virus is evolving,” Anderson says.

The promise and challenge of widespread vaccination

Experts agree that transitioning beyond a pandemic depends on the prevalence of immunity, especially among older and more vulnerable populations. Younger people, especially children, will build up immunity to SARS-CoV-2 over a lifetime of exposure to the virus. Today’s adults have had no such luxury, leaving their immune systems naive and exposed.

The exact threshold for achieving population-wide immunity that slows down the virus’s spread will depend on how contagious future variants become. But so far, research of early variants of SARS-CoV-2 suggests at least 60 to 70 percent of the human population will need to become immune to end the pandemic phase.

This immunity can be achieved in one of two ways: large-scale vaccination, or recovery from natural infections. But achieving widespread immunity through uncontrolled spread comes at a terrible cost: hundreds of thousands more deaths and hospitalizations around the world. “If we don’t want to push forward vaccines and champion vaccines, we have to decide collectively how many old people we want to die—and I don’t want to be the one making that decision,” Duplex says.

Jeffrey Shaman, an infectious diseases expert at Columbia University, points out that the global push for vaccines also exposes existing inequities in global health. In a widely shared map from December, The Economist Intelligence Unit estimated that rich countries such as the U.S. will have widely accessible vaccines by early 2022, which may not happen for poorer countries in Africa and Asia until as late as 2023.

Efforts to vaccinate the developing world hinge, in part, on vaccines that can be stored with standard refrigeration, such as the vaccines under development by Oxford/AstraZeneca and Johnson & Johnson. (See the latest on COVID-19 vaccine development around the world.)

As of the week of January 18, according to a World Health Organization estimate, some 40 million COVID-19 vaccine doses have been administered around the world, mostly in high-income countries. In Africa, only two countries, Seychelles and Guinea, have started providing vaccines. And in Guinea, a low-income country, only 25 people have received doses.

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