A laboratory technician prepares COVID-19 patient samples for semi-automatic testing at Northwell Health Labs, Wednesday, March 11, 2020, in Lake Success, N.Y.
| Photo Credit: AP

Five years since Covid-19 started upending the world, the virus is still infecting and killing people across the globe — though at far lower levels than at the height of the pandemic.

Here is the current state of the play.

Still with us

Around 777 million Covid cases and more than seven million deaths have been officially recorded since the first infections emerged in December 2019, according to the World Health Organization (WHO).

However, the true toll is believed to be far higher.

The pandemic also crippled health systems, crashed economies and sent the populations of many countries into lockdown.

In the second half of 2022, infection and death rates tumbled due to growing immunity from vaccinations or prior infection. The virus also mutated to become less severe.

In May 2023, the WHO declared the emergency phase of the pandemic was over.

Since then, the virus seems to have gradually become endemic, according to experts, with occasional resurgences similar to the flu — although less seasonal.

It has also largely receded from the public eye.

“The world wants to forget this pathogen that is still with us, and I think people want to put Covid in the past as if it’s over — and in many respects pretend it didn’t happen — because it has been so traumatic,” WHO pandemic preparedness director Maria Van Kerkhove said last month.

From October to November last year, there were more than 3,000 deaths from Covid across 27 countries, according to the WHO.

More than 95 percent of official Covid deaths were recorded between 2020 and 2022.

Variants

Since the Omicron variant emerged in November 2021, a succession of its subvariants have been replacing each other as the dominant strain around the world.

At the moment, the Omicron variant KP.3.1.1 is the most common.

The rising XEC is the only “variant under monitoring” by the WHO, though the United Nations agency rates its global health risk as low.

None of the successive Omicron subvariants have been noticeably more severe than others, although some experts warn it is not out of the question that future strains could be more transmissible or deadly.

Vaccines and treatments

Vaccines were developed against Covid in record time and they proved a powerful weapon against the virus, with more than 13.6 billion doses administered worldwide so far.

However rich countries bought up a large portion of the early doses, creating unequal distribution across the world.

Booster shots updated for the JN.1 Omicron subvariant are still recommended in some nations, particularly for at-risk groups such as the elderly.

However, the WHO has said most people — including the elderly — have not kept up with their booster shots.

Even among healthcare workers, the booster uptake rate was below one percent in 2024, according to the WHO.

Long Covid

Millions of people have been affected by long Covid, a still little-understood condition that lasts months after the initial infection.

Common symptoms include tiredness, brain fog and shortness of breath.

About six percent of people infected by coronavirus develop long Covid, the WHO said last month, adding that the condition “continues to pose a substantial burden on health systems”.

Much about long Covid remains unknown. There are no tests or treatments. Multiple Covid infections seem to increase the chance of getting the condition.

Future pandemics?

Scientists have warned that another pandemic will strike sooner or later, urging the world to learn the lessons of Covid and prepare for next time.

Attention has recently focussed on bird flu (H5N1), particularly after the United States reported on Monday the first human death from the virus.

The patient in Louisiana had underlying medical conditions and contracted H5N1 after being exposed to infected birds, US health authorities said, emphasising there was no evidence of person-to-person transmission.

Since late 2021, the WHO’s member states have been negotiating a world-first treaty on pandemic prevention, preparedness and response.

However, an agreement has remained elusive ahead of a May deadline, with a key faultline lying between Western nations and poorer countries wary of being sidelined when the next pandemic occurs.

The Covid pandemic also saw a massive increase in scepticism and misinformation about vaccines.

Experts have warned about the prospect of having vaccine sceptic and conspiracy theorist Robert F. Kennedy Jr. — US President-elect Donald Trump’s pick for health secretary — in charge of the US response to a possible pandemic threat over the next four years.

Many tiny organisms including bacteria, fungi and viruses normally live on our bodies, and even inside us. These are called the microbiome. The large number of these organisms living in the gastrointestinal tract are collectively known as the gut microbiome.

Increasingly the gut microbiome is recognised as playing a large part in health and disease, particularly relating to human physiology, metabolism and immune function.

There are now more than 700 published papers looking at the interaction between COVID and the gut microbiome. Many of these studies demonstrate the possible contribution of gut bacteria to COVID infection and severity, as well as the effect COVID (and its treatment) potentially has on our gut bacteria.

Now, a new study has found severe COVID may be related to fungal bugs in our gut microbiome. This could be through a variety of changes to the immune system in response to specific fungal species.

Also Read | Humans evolved with their microbiomes – like genes, your gut microbes pass from one generation to the next

What the study did

Fungal organisms in the microbiome are referred to as the fungal microbiota, or mycobiota. While it’s normal to have a range of fungal organisms in the gut, changes in the types or amount can be linked to disease, just like with variations in gut bacteria.

In the study published in Nature Immunology, the researchers investigated the possible relationship between mycobiota and COVID in a few different ways.

First, they compared patients with and without COVID, looking at the levels of certain fungal organisms in samples from their gastrointestinal tracts. This included 66 people with severe COVID, 25 with moderate COVID and 36 without COVID.

The researchers also measured antibodies in the participants’ blood against these same organisms, which lets us know that they triggered an immune response.

Explained | How does the gut microbiome link to autism spectrum disorders?

To investigate further, the researchers conducted experiments in mice. They gave the mice some of the fungal organisms taken from COVID patients and measured some of the same outcomes, including antibodies in the blood. They also looked to see if certain treatments, such as antifungals, would make a difference.

While this isn’t the first study looking at gut mycobiota and COVID, it’s very comprehensive and reports some interesting findings.

What the study found

The researchers detected a greater amount of fungal organisms in patients who had COVID compared with controls who did not.

Antibodies to certain fungi were also heightened in the blood of COVID patients. In other words, the presence of these fungal organisms and an associated immune response seems to be linked to a more severe COVID infection. In particular, two Candida species and S. cerevisiae were linked to disease severity.

When the researchers isolated live fungi from fecal samples of COVID patients, Candida albicans was common in the gut of patients with COVID, and its growth correlated with more severe disease.

Also Read | COVID and your gut: How a healthy microbiome can reduce the severity of infection – and vice versa

To look at the impact of these fungal species on immune responses, mice were colonised with Candida strains isolated from the COVID patients.

The researchers found older mice who were colonised with C. albicans and then infected with COVID showed a very different immune response compared to mice that weren’t given the Candida fungus. This included having more immune cells called neutrophils in the blood and increases in other markers of inflammation including in the lungs.

Some of these changes were partially resolved with anti-fungal treatment or other specific anti-inflammatory medications that have shown benefit in COVID patients.

Some limitations

All of this suggests variations in the mycobiota may contribute to the excessive inflammatory immune response seen in severe cases of COVID. A link between the fungal microbiome and inflammation isn’t completely new – other studies have shown an impact on inflammatory conditions linked to similar changes in the mycobiota.

As with all studies, there are some limitations to consider here. First, the number of human participants was relatively low, with only 91 patients with COVID included, and 36 in the control group. Many parts of the study analysed even smaller groups of patients or patient samples.

Also Read | Are you sure you contain 10x as many microbes as human cells? 

Second, the study was conducted in 2020 during the first wave of COVID infections. A lot has changed since then including the virus itself. And most people have now not only been vaccinated but also previously exposed to the virus.

Nonetheless, this study raises many possibilities including perhaps being able to look at who might be a greater risk of more severe COVID based on their mycobiota. There may even be a possibility of trying to change the mycobiota to reduce the risks from COVID infection. But to get to these points we need a lot more research.

There are multiple factors that determine the make-up of our microbiome, including mycobiota. These are likely to include diet and lifestyle factors alongside other factors like medical conditions and treatments, such as antibiotics.

At this stage there are fewer proposed interventions for influencing mycobiota than for gut bacteria. But studies such as this one demonstrating the importance of the fungal bugs in our gut will hopefully lead to more research in the area.

Image used for representative purpose only. File
| Photo Credit: AP

The U.S. Centers for Disease Control and Prevention director on Tuesday signed off on the use of the updated COVID-19 shots from Pfizer/BioNTech and Moderna in people aged 6 months and older, the agency said.

The final recommendation from director Mandy Cohen paves the way for a broad use of the updated vaccines, targeting the XBB.1.5 variant, as the country prepares to launch a vaccination campaign within days.

Image used for representative purpose only.
| Photo Credit: Reuters

The U.S. approved updated COVID-19 vaccines Monday, hoping to rev up protection against the latest coronavirus strains and blunt any surge this fall and winter.

The Food and Drug Administration decision opens the newest shots from Moderna and Pfizer and its partner BioNTech to most Americans even if they’ve never had a coronavirus vaccination. It’s part of a shift to treat fall updates of the COVID-19 vaccine much like getting a yearly flu shot.

There’s still another step: The Centers for Disease Control and Prevention must sign off. A CDC advisory panel is set to issue recommendations Tuesday on who most needs the updated shots. Vaccinations could begin later this week, and both the COVID-19 and flu shot can be given at the same visit.

A third vaccine maker, Novavax, said its updated shot is still being reviewed by the FDA.

COVID-19 hospitalizations have been rising since late summer although –- thanks to lasting immunity from prior vaccinations and infections –- not nearly as much as this time last year.

But protection wanes over time and the coronavirus continually churns out new variants that can dodge prior immunity. It’s been a year since the last time the vaccines were tweaked, and only about 20% of adults ever received that earlier update.

“Vaccination remains critical to public health and continued protection against serious consequences of COVID-19, including hospitalization and death,” FDA vaccine chief Dr. Peter Marks said in a statement. “We very much encourage those who are eligible to consider getting vaccinated.”

Just like earlier vaccinations, the fall round is cleared for adults and children as young as age 6 months. FDA said starting at age 5, most people can get a single dose even if they’ve never had a prior COVID-19 shot. Younger children might need additional doses depending on their history of COVID-19 infections and vaccinations.

The FDA pointedly isn’t calling this latest round a “booster” but instead a vaccine updated to better match the currently circulating virus. The new recipe targets an omicron variant named XBB.1.5 — replacing outdated combination vaccines that mixed protection against the original coronavirus strain and an older version of omicron.

And while even the XBB.1.5 variant is no longer dominant, FDA determined that it’s close enough to coronavirus strains causing most COVID-19 illnesses today to offer good cross-protection. Like earlier versions, they’re expected to be most protective against COVID-19’s worst consequences rather than mild infection.

But while the FDA’s decision allows for wide use of the updated shots, the CDC will decide how strongly different groups are urged to get them.

Federal officials have said the shots still will be free to most Americans through private insurance or Medicare. But for the uninsured or underinsured, the CDC is working with health departments, clinics and certain pharmacies to temporarily provide free shots.