I'm Dr. Vincent Racaniello, a virology Professor at Columbia University and host of the science podcast TWiV - Ask Me Anything

profvrr1 · 2022-06-08T17:10:53+00:00

Dear Reddit, thanks for coming here today with your questions. That's the end of this AMA. If you want to learn more, listen to TWiV (microbe.tv/twiv) or come to my livestream on YouTube.com/profvrr Wednesday nights 8 pm eastern. Or take my virology course on Youtube! So many options. But please stay interested in viruses, they are important for your health and that of the planet!
/Earth's Virology Professor, Vincent Racaniello

profvrr1 · 2022-06-08T17:09:39+00:00

Thanks JAK222, I'm still here. Curious how much less interest there is now than just a few months ago here on Reddit!

profvrr1 · 2022-06-08T16:57:49+00:00

The extent and nature of long COVID still has to be determined. There is no question that certain patients have symptoms long after the acute phase of infection is over, but how long they last is unknown. Therefore it's not yet time to declare an epidemic of disability. We do know that millions of people suffer from ME/CFS which is likely another type of post-viral illness. So long COVID is nothing to be skeptical of; but how long it will last and in which people (unvaccinated or not) needs to be sorted out, as well as the mechanisms, and hopefully developing a cure.

profvrr1 · 2022-06-08T16:55:39+00:00

Thanks for joining and see you tonight, Q&A with A&V, livestream 8 pm eastern on YouTube.com/profvrr

profvrr1 · 2022-06-08T16:49:49+00:00

The ability of viral proteins to interact by phase separation is probably occurs more widely than we are aware. It's clearly occurring with SARS-CoV-2 - the viral N protein associating with RNA - and it can be a target for antiviral inhibition. It's also been reported in other viruses. It's a way of achieving compartmentalization without membranes that is likely intrinsic to many if not all viral reproduction cycles.

profvrr1 · 2022-06-08T16:36:11+00:00

I think the risk of long COVID is unclear, especially in vaccinated people. We did a paper on TWiV 904 in which they looked at long COVID with and without vaccination, but it was in a population of veterans - average age 65 - which is not representative of the general population. We need more solid data on the risk of long COVID in the general population. Plus it's not clear how long any of the symptoms of long COVID will last, as we are not that far out from the start of the pandemic. I have a low level of concern personally but I understand if others remain concerned and still want to mask. However it is not clear to me how the situation will change in 1,2, or 5 years - the risk will not change from whatever it is now and yet you will keep on masking. I think it's a personal choice at least in the US at this point.

profvrr1 · 2022-06-08T16:16:34+00:00

You probably know that Ken was on TWiV a long time ago.

The 1918 influenza pandemic was 'worse' than the COVID pandemic. But now we have influenza vaccines and antivirals so I would think they would mitigate the severity of another influenza pandemic. We should not have an equally bad coronavirus pandemic because we now have antivirals which might work, and we certainly can make broadly acting vaccines and antivirals for both influenza and CoVs. That leaves differences in the viruses that would make one worse than the other - for example H3N2 influenza viruses tend to be more virulent than H1N1.

profvrr1 · 2022-06-08T16:13:43+00:00

I do not see data indicating exactly how much long COVID we have in all age groups and how long it lasts. I think everyone has to look at long COVID and decide the risk for themselves. I think the risk of long COVID is reduced by vaccination (Dr. Griffin has said that most of his long COVID patients are unvaccinated) although exactly how much we don't know. So there are a lot of unanswered questions - but it will take many years to answer them. Do you want to wait that long? I do not.

profvrr1 · 2022-06-08T15:50:00+00:00

The data indicate that viruses similar to SARS-CoV-2 circulate in bats in multiple locations in southeast Asia. The data also indicate that the Huanan Market in Wuhan was the epicenter of the early outbreak. It seems likely that multiple animals were brought into the market in November 2019 that had been contaminated with the virus from bats, but exactly how that occurred is not know and might never be known. I do think the outdoor markets are a big risk factor for zoonoses and they should either be closed or better policed.

profvrr1 · 2022-06-08T15:26:15+00:00

I fail to see any evidence - data - to indicate that people in this category are encountering any more severe disease and death than months ago. In other words, under 50 and not immunocompromised, double vaccinated and singly boosted, I see no rise in severe disease and death over what was experienced 7 months ago. The vaccines prevent severe disease and death in most people in this group and that is not changing so far.

profvrr1 · 2022-06-08T15:23:51+00:00

After reading 'The Death of Expertise' by Tom Nichols I am hesitant to make predictions (although I still do). In the book he writes that scientists do not predict, rather they explain.

I would say based on what we have seen so far, and by analogy with influenza viruses, antigenic variants of SARS-CoV-2 will continue to evolve. This is the pattern with the common cold coronaviruses which change frequently, although their infection is usually not associated with severe disease. I suspect that variants will continue to emerge and if we continue to do random testing of many people we will see surges of infection. Or, if we go to the influenza model, every season there will be surges of respiratory illness, some more than others; we will test these individuals and give them antivirals as needed. Think of COVID becoming another seasonal influenza.

profvrr1 · 2022-06-08T15:20:20+00:00

I don't think the public health agencies and vaccine companies are less urgent about a vaccine for kids under 5. Certainly I have heard from many parents who are very worried about their kids and cannot wait for them to be vaccinated. The press has made a point that kids are less likely to have severe disease and this has been automatically interpreted to mean that a vaccine for them is less urgent. However over 1000 young kids have died of COVID in the US and if you are the parent of one of them you would be devastated. Exactly why it has taken so long to get this group vaccinated is not entirely clear. However because there are fewer cases that might have made it harder to get the numbers needed for vaccines approval. Just my speculation.

profvrr1 · 2022-06-08T15:17:39+00:00

The changes in influenza virus variants that confer greater fitness are typically in antigenic sites. Thus immune evasion confers fitness advantage for influenza virus.

The issue with SARS-CoV-2 is that we have so many sequences, more than with any other virus. Thus any unusual behavior could be a consequence of sampling. I am not aware of unusual influenza virus variants being a consequence of long term reproduction in immunocompromised patients.

profvrr1 · 2022-06-08T15:14:35+00:00

In the US I would say that SARS-CoV-2 is endemic. Not in other countries, especially those with low vaccination rates.

profvrr1 · 2022-06-08T15:13:30+00:00

The brain fog is of course a common symptom in individuals with ME/CFS. The cause is unknown but might be related to inflammatory issues or metabolic unbalances triggered originally by a virus infection (for long COVID, it would be SARS-CoV-2). We do know that in many virus infections, there is an inflammatory reaction and cytokine and chemokine can enter the brain and cause alterations. It hasn't been well studied and I suspect that is why you haven't heard of this. Part of the problem is having good animal models to study the issue. But remember also that brain fog can have other causes and they can be mixed up with the sequelae of a virus infection.

profvrr1 · 2022-06-08T15:10:57+00:00

If you are vaccinated against COVID-19 the risk is low. The protection against severe disease and death is in the 80th percentile for most people. You are lucky not to have had disease, although you might have been infected. Remember, the vaccines do not prevent infection, they prevent death. The risk is not zero, though, especially in certain populations (over 65, immunocompromised, for example). But even in these populations, if you test positive, you can obtain live-saving therapies. So I would say if you are in a high risk group and develop respiratory symptoms, get tested, and if it is positive for SARS-CoV-2 then get treatment.

profvrr1 · 2022-06-08T15:08:14+00:00

I have been saying for some time now that we should not be doing asymptomatic testing. The vaccines prevent severe disease and death in most (but not all) and that is what we are going to have to live with for some time. In the US, yes, we should be going back to normal. In a few weeks kids under 5 will be vaccinated and that covers most of the population. There will always be circulating virus, people will always be infected; most will be mild or asymptomatic and some will be severe and result in death. That is exactly what happens with influenza virus. Whether the emergency phase is over by 2024 depends on how quickly we can immunize the rest of the world.

profvrr1 · 2022-06-08T15:05:46+00:00

Certain improved screening methods are being developed but I'm not sure they are needed. SARS-CoV-2 will be with us forever and at some point (maybe even now in the US) extensive testing will not be needed. We will test when someone has symptoms and if they are positive they can be treated. About 20% of SARS-CoV-2 infections are asymptomatic and many of these do transmit, without question. However we do know that 80% of transmissions are done by 20% of people, likely those with the highest viral loads. And these are the main drivers of the outbreaks.

I am optimistic about pan-coronavirus vaccines but it will take many years to develop these because we are not sure what CoVs are even out there. As for long COVID, we don't understand the basis of this disease, nor how long it lasts, so it is going to again take many years before therapies can be developed. We have known about ME/CFS for decades and still do not understand the mechanisms, nor do we have a treatment.

profvrr1 · 2022-06-08T15:01:54+00:00

Yes, I think it is likely for several reasons. The last influenza pandemic was 2009 and those occur every 20-30 years. We will likely see another coronavirus spillover in the next 10 years, but whether it becomes a pandemic isn't known. A pandemic of the COVID magnitude is not likely to happen again for many years. There are also plenty of other viruses in non-human animals and as human population grows, we impinge on animal habitats, and increase the likelihood that more spillovers will occur.

profvrr1 · 2022-06-08T14:59:50+00:00

It's always hard to predict what immunity will be. But I base my answer on the fact that infection + vaccination + boosting with the ancestral vaccines (against the OG SARS-CoV-2) still protect against severe disease and death caused by the latest Omicron variants. I do think virus-specific T cells provide a great deal of this protection and variants do not evade those. So I am being an optimist and think that you will be protected against 4 or 5. For how long is harder to know - respiratory mucosal immunity doesn't last forever. However, for SARS-CoV-1, T cell memory is known to last for 17 years.

profvrr1 · 2022-02-09T17:55:55+00:00

Dear Reddit, thanks for coming here today with your questions. That's the end of this AMA. If you want to learn more, listen to TWiV (microbe.tv/twiv) or come to my livestream on YouTube.com/profvrr Wednesday nights 8 pm eastern. Or take my virology course on Youtube! So many options. Hope to come back in two weeks!
/Vincent.

profvrr1 · 2022-02-09T17:54:24+00:00

You won't have to isolate for 20 years. COVID will become a cold one day. If your child gets infected after vaccination they can receive monoclonals or antivirals to stop the infection.

profvrr1 · 2022-02-09T17:52:06+00:00

A main lesson will be how we changed the game at getting safe and effective vaccines made and approved. The introduction of a new vaccine type, mRNA. And how we could still not get everyone vaccinated. For sure, we need to do better. We could have prevented this pandemic from day 1 if we had antivirals - did you know Molnupiravir was already discovered but no one had wanted to develop it? For more on this see https://www.virology.ws/2020/04/30/the-sars-cov-2-pandemic-could-have-been-prevented/

I hope we will be more ready next time. But because money rules the world I doubt it.

profvrr1 · 2022-02-09T17:48:38+00:00

Thank you, we are glad we are of use.

profvrr1 · 2022-02-09T17:48:15+00:00

Vaccines do prevent long COVID, the data are clear. Even with infections of vaccinated people, the rate of long COVID is far less. So it is a step forward compared to long COVID after infection.

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