The Fallacy of Declining SARS-CoV-2 Infections: New Variants After Debut, Evolve To Cause Asymptomatic Spreads And Are Better Adapted For Viral Persistence!
: A new hypothesis is being proposed by us which will require urgent research as we could be approaching the whole COVID-19 pandemic wrongly.
As the world continues to fight the COVID-19 pandemic caused by the SARS-CoV-2 virus, it is crucial to analyze the trends in infection rates and types of infections and consider the implications of these trends. The assumption that decreasing infection rates in a country signify the virus's decline could be misleading.
This article explores the possibility of the virus evolving to evade immune responses, leading to asymptomatic cases, and whether it could be propagating undetected due to limited testing and pathetic low levels of genomic sequencings.
The Evolution of SARS-CoV-2 and Asymptomatic Infections
Coronaviruses have an innate ability to mutate and evolve, and SARS-CoV-2 is no exception. As it continues to spread globally, the virus has undergone multiple genetic changes, giving rise to new variants. Some of these variants have been more transmissible, virulent, or capable of evading the immune system to some extent.
One of the challenges in controlling the spread of COVID-19 is the existence of asymptomatic cases. Asymptomatic individuals, who do not show any noticeable symptoms of the disease, can unknowingly transmit the virus to others. The possibility of the virus evolving to evade immune responses and cause asymptomatic infections cannot be ruled out. If this were to happen, the actual number of infections could be significantly higher than reported, as asymptomatic individuals are less likely to get tested.
Limited Testing and Misleading Infection Rates
These days a surge is typically detected in a country when the number of symptomatic cases especially those requiring hospitalizations start getting the notice of health officials. When such cases start getting noticed, testing is typically ramped up even for those that have high risk of having contracted the virus but have been asymptomatic.
When symptomatic cases loads and hospitalizations start decreasing, it is typically assumed that COVID-19 cases are going down and testing is reduced.
According to a new hypothesis, most of the newer SARS-CoV-2 variants such as the recombinant Omicron variants including the XBB sub-lineages are extremely immune evasive and have enhanced abilities to disarm the human immune response upon infection thus often leading in lesser or no symptoms upon infection.
However when a new variant debuts from these current sub-lineages, for a small group of individuals due to factors such as their genetic makeups and also other factors such as existing comorbidities or dysfunctional immune functions etc, these new variant or sub-lineage debuts might still cause symptoms and disease severity..which often present the signals that a new onslaught is on but there is a very possibility that due to intrahost evolution and viral “fine-tuning”, the next generations of these viruses after replication in the human host are completely able to disarm the immune responses leading to asymptomatic infections the next time it spreads to the next host (It should also be noted that many with mild symptoms tend to recover fast and we are not sure if its due to declining viral loads or whether the virus is now better at disarming the imm
une responses that leads to receding of these symptoms.)
As more asymptomatic cases start occurring next, testing typically falls and assumptions are made that the infection rates are falling.
The availability and accessibility of COVID-19 testing to everyone irrespective of presence of symptoms play a critical role in understanding the true extent of the pandemic. Limited testing capacity can lead to underreporting of cases, which in turn can create a false impression of declining infections.
As countries ramp up their vaccination and booster efforts and ease restrictions, complacency can set in, leading to a decrease in testing rates as already been covered in past COVID-19 News
reports. This can exacerbate the situation, as undetected asymptomatic cases continue to spread the virus within communities.
The reliance on reported cases as the sole metric to evaluate the success of a country's efforts in controlling the pandemic or whether the virus is on a decline is problematic. To obtain a comprehensive understanding of the situation, it is crucial to consider other factors, such as testing rates especially among the asymptomatic and also genomic sequencings including from those that are asymptomatic.
It has come to our attention that in some countries, genomic sequencings are only conducted in those who are hospitalized or are exhibiting symptoms!
The Silent Spread And Dangers Of Viral Persistence
Asymptomatic transmissions is nothing new as since the beginning of the pandemic, studies have confirmed its existence.
As the newer strains are better at disarming the human immune response, we can expect more asymptomatic transmissions and whenever a new sub-lineages debuts, it will eventually adapt itself while causing a small proportion of symptomatic infections or disease severity for a few upon infection. However, as it getting better to evade all forms of immunity, viral persistence will become a major issue and we can expect to see more health and medical issues developing in the population with some resulting in fatal outcomes including heart failures etc.
Seropositivity rates across many communities in many countries have shown that infection rates do not correlate with seropositivity rates which are often much higher, adding evidence that silent spreads are occurring.
The Importance of Surveillance and Widespread Testing
To counter the potential fallacy of declining SARS-CoV-2 infections, it is imperative to maintain robust surveillance systems and widespread testing including in those than seem healthy. Regular testing, even among asymptomatic individuals, can help identify and isolate cases, preventing further transmission. This is particularly important in high-risk settings, such as healthcare facilities, long-term care homes, and densely populated areas.
Genomic surveillance, which involves sequencing the virus's genetic material, is a valuable tool in tracking the emergence of new variants and understanding their impact on transmission, disease severity, and vaccine effectiveness. By closely monitoring these trends, public health officials can make informed decisions on implementing or relaxing public health measures.
To add on further to the hypothesis, as the result of the intrahost evolution that is set under a limited number of constrains, when the variant spawns the next generation, those sub-lineages are often identical to the same scenario happening in other geolocations. That is why we sometimes identify new sub-lineages that sometimes emerge in more than one geolocation at about the same time! Border spread of the virus did not take place! Also, often most of these spawns produce asymptomatic infections unless due to other factors or some major mutations that appear on these new sub-lineages!
The assumption that declining infection rates indicate the end of the surge could be a dangerous fallacy. The possibility of the virus evolving to evade immune responses and cause asymptomatic infections highlights the importance of maintaining vigilance and robust surveillance systems. Limited testing and underreporting of cases can contribute to a false sense of security, which may lead to complacency and a resurgence of infections.
In conclusion, while it is encouraging to witness declining infection rates in some countries, it is essential to approach these trends with caution and remain vigilant. The possibility of SARS-CoV-2 evolving to cause asymptomatic infections reinforces the need for a comprehensive and proactive approach to tackling the pandemic and safeguarding public health. Further urgent research is needed in this area.
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