Frequently Asked Questions about COVID-19 — February 9, 2022

“Shared expectations lead to predictability.”

466. A nasal spray is on the horizon to partner with Covid-19 vaccine injections.

         Q:  I hate getting shots.  Will there ever be an oral COVID vaccine like there is for polio?

         A:  Currently available vaccines produce powerful, long-lasting immunity against severe illness.  But protection against infection from coronavirus is transient and can falter as new variants of the virus emerge — a failing that has prompted talk of regular booster shots.

Nasal vaccines may be the best way to prevent infections long term because they provide protection exactly where it is needed: the mucosal linings of the airways, where the coronavirus first lands.  Bharat Biotech, based in India, is among the world’s leading vaccine manufacturers.  Its experimental nasal vaccine may prove to be the most important recent advancement to date.   Immunizing entire populations with a nasal or oral vaccine would be faster during a surge than injections. A nasal vaccine is likely to be more palatable to many (including children) than painful shots and would circumvent shortages of needles, syringes, and other materials.

There are at least a dozen other nasal vaccines in development worldwide.  But Bharat Biotech’s may be the first to become available. In January, the company won approval to begin a Phase 3 trial as a booster for those who are fully vaccinated.

Nasal vaccines would coat the mucosal surfaces of the nose, mouth, and throat with long-lasting antibodies, and could prevent infections and the spread of the virus.  It would trigger immune memory cells and antibodies in the nose and throat, strengthening protection from the initial vaccination. The study has not yet been published in a scientific journal.

467. Early research adds sexual impotence to the list of long COVID problems

         QDoes COVID-19 affect sexual functions?

         A:  A new University of Florida Health study found that men with COVID-19 are more than three times more likely to be diagnosed with erectile dysfunction, or ED. The paper adds to emerging evidence that COVID-19 might impact sexual function, researchers said.

The study, published in the Journal of Endocrinological Investigation, is led by Joseph Katz, DMD, a professor at the University of Florida.  The study found 146 patients who were diagnosed with ED after a bout of COVID-19, or 4.7% of all the men who were diagnosed with COVID-19.  The association remains high when adjusted for a number of other factors. For example, the association with ED was 2.3 times higher in those with diabetes and 3.5 times higher among smokers.

“The receptor that the coronavirus binds to is abundant on the penis and testes,” Katz said. “The virus can bind in those areas.  And research has shown that COVID can reduce the amount of testosterone produced. The loss of testosterone has been shown to put someone at risk of having a more severe outcome from COVID-19.”  Researchers at the University of Miami earlier this year said they discovered that several people who had recovered from COVID-19 later became impotent. Scientists said COVID-19 is known to damage blood vessels, and the virus appeared to have damaged the vessels in the penises of these patients and impeded blood flow, impacting sexual function.

Researchers agree more research is needed. Scientists, however, are increasingly viewing the possibility that ED is another long COVID symptom.  Kevin J. Campbell, MD, an assistant professor in the University of Florida said, “You’ve got chronic inflammation going on during viral infection, and getting back to your normal body rhythms can take time,”

Katz said a COVID-19 vaccination is something everyone should get. He believes his study offers one more reason.  “Sex is such an important part of life, that will hopefully make them think, “OK, maybe I should be vaccinated,’” he said.

468. Omicron has a higher death rate in the US than other developed countries.

         Q: If Omicron is a milder disease, why are so many people dying from the disease?

         A:  Compared with other wealthy countries, coronavirus in the U.S. is killing people at much higher rates. Since Dec. 1, when the first Omicron case was detected in the U.S., the share of Americans who have been killed by the coronavirus has been at least 63 percent higher than in any other large, wealthy nation, according to a New York Times analysis of mortality data. The U.S. has now passed Britain and Belgium to have the largest share of its population die from Covid among wealthy nations.

Hospital admissions in the U.S. also swelled and Americans are now dying from Covid at nearly double the daily rate of Britons and four times the rate of Germans.  The only large European countries to exceed America’s Covid death rates this winter have been Russia, Ukraine, Poland, Greece, and the Czech Republic, all of which are less wealthy.

One of the main reasons for this discrepancy is the U.S. vaccination rate has failed to vaccinate as many people as other large, wealthy nations.  The U.S. has fallen even further behind in giving booster shots.

Some lawmakers, health officials, and pundits are desperate to turn the page on the pandemic — urging a return to normalcy.  What level of death Americans decide is tolerable will matter.  “We’ve normalized a very high death toll in the U.S.,” said Anne Sosin, who studies health equity at Dartmouth. “If we want to declare the end of the pandemic right now, what we’re doing is normalizing a very high rate of death.”

469. For those vaccinated, booster shots benefit older patients the greatest.

         Q:  Does age matter if you are vaccinated and want to get a booster shot?

         A:  The Centers for Disease Control and Prevention last week published new data on the risks of hospitalization and death from Covid-19 among people who are unvaccinated and vaccinated, with or without booster doses.  The figures confirm that booster doses are most beneficial to older adults. The numbers for younger Americans are less compelling. In younger people, vaccination itself decreases the risk of hospitalization and death so sharply that a booster shot did not seem to add much benefit.

Several recent studies have found that parts of the immune system remain strongly protective against severe illness and death in most people, even without booster shots, even after Omicron’s appearance.  “I do not think these data support a universal booster rollout for everyone,” said Dr. Celine Gounder, an infectious disease expert and epidemiologist at Kaiser Health News.  Instead, boosters seem most essential for older adults, she said, and those who have certain immune conditions or live in long-term care facilities. In younger Americans, it may have made sense to make boosters available to those with certain medical risks instead of everyone, she said.

“The effect of the booster can be seen in the data sets, but it’s far smaller than the effect of vaccination compared to not,” said John Moore, a virologist at Weill Cornell Medicine in New York. “The real problem is the carnage among the unvaccinated.”

470. A congressional commission is proposed to examine the pandemic.

         Q:  Will we ever be able to examine our responses to Covid to prevent its recurrence?

         A:  When compared to other major catastrophes in the United States, the coronavirus-19 pandemic is high in its impact on the citizens, the economy, and the politics of the nation.  Even in our divided politics, a broad and bipartisan group of senators is coalescing around legislation to create a high-level independent commission, modeled after the one that examined the Sept. 11 attacks, with broad powers to investigate the origins of the coronavirus pandemic and the responses across the Trump and Biden administrations.

A plan proposed by the top Democrat and Republican on the Senate Health Committee — Senators Patty Murray of Washington and Richard M. Burr of North Carolina — a 12-member panel would be created.  It would have subpoena power to “get a full accounting of what went wrong during this pandemic,” Ms. Murray said in an interview.  It would make recommendations for the future.  In interviews last week, more than a dozen senators from both parties embraced the idea, and none raised any substantive objections.  Covid-19 victims and their families, many of whom support the idea of a commission are eager for the kind of airing of grievances that the Sept. 11 panel provided the victims of the terrorist attacks two decades ago.   Most officials speaking publicly predict that even if approved and signed into law, bickering and partisanship would likely interfere, but such an effort may well provide beneficial information.