The pandemic COVID-1 has had a negative impact on various components, not least thelife expectancy of the general population. This is clear from the final US data on observed mortality in 2021. Indeed, in the period 2020-2021, life expectancy in the United States increased from 77 years to 76.4 years (Bridget M. Kuehn) and this reduction is undoubtedly predominantly attributable to the COVID-19 pandemic. The decrease in life expectancy was found to be different depending on the ethnic group involved and the sex, since males show a greater reduction than females.
In a cohort study (Hao Luo and others) approximately 850,000 subjects were identified con dementia diagnosis identified in the databases of: France, Germany, Italy, South Korea, the United Kingdom and the United States. Patients with dementia were assessed for antipsychotic drug prescription rates, comparing the pre-pandemic to the pandemic period. It turned out that the percentage of prescribing antipsychotic drugs to people with dementia, increased in the first months of the pandemic in all 6 countries studied and this did not decrease to pre-pandemic levels after the end of the first acute phase of the pandemic. This finding suggests that the pandemic has disrupted people’s care living with dementia and it is therefore necessary to develop alternative intervention strategies in order to ensure the quality of care of these patients. What we know about COVID-19 has been subject to extraordinary scientific researchboth basic and clinical, which in the space of just three years has resulted in a significant number of publications which as of February 6, 2023 total 335,871, as can be seen from the Pubmed website of the US National Library of Medicine. To better understand this phenomenonan evaluation (Perlis RH et al) on how peer review has changed before and during the COVID-19 pandemic was carried out on 5013 manuscripts sent to an open access general medical journal. Comparing the pre-pandemic period with the pandemic, reviews of manuscripts rated as high quality (very good or excellent) increased slightly and average review times were lower, indicating that, at least in the initial year of the pandemic, there was an improvement as regards the revision of manuscripts which has certainly favored the publication and dissemination of research.
Still on the same topic, a systematic review is reported comparison between the randomized clinical trials on COVID-19 that appeared as pre-prints in the platforms and therefore without review and the corresponding articles that appeared in the journals (Bai AD and others). From this research it emerged that of the 152 pre-prints, 119 of them subsequently appeared in a scientific journal and comparing the initial results with those definitively published, no particular differences emerged, so much so that the conclusions of the studies remained consistent with those previously indicated . This result provides an indirect confirmation of the great utility performed by the platforms during the COVID-19 pandemic, since they rapidly conveyed the dissemination of important scientific results not only among professionals but also, through the media, in public opinion. In recent days, in light of a general reduction in infections that has occurred not only in Italy and in Europebut practically all over the world, including China, the idea is increasingly gaining ground that the pandemic, at least as we have known it in the last 3 years, has passed and that we are starting, if we are not already there, to an endemic phase in which the SARS-CoV-2 virus, even if it has not disappeared, will probably no longer cause serious forms.
A possible succession of small/medium re-ignitions is therefore envisaged for the future epidemicheoften located in specific geographical areas and often supported by the emergence of new variants. At the basis of this possible future scenario, there are some elements represented: by the protection conferred by the vaccine, by natural immunity, by the mix of both (hybrid immunity), but also by the presence of sub-variants which have all been derived from Omicron for more than a year and which are characterized by a greater transmissibility, but for less severity. Indeed, in the light of the current epidemiological situation, the so-called Omicron swarm always produces new variants, some of which are recombinant, i.e. the result of a genetic link between two variants, but which as they appear, disappear just as quickly. For this reason, as has been authoritatively pointed out by many, it is possible to foresee, at least in the near future, an annual vaccinationneither more nor less as is done for the flu, to keep immunity alive against SARS-CoV-2, especially in subjects who are fragile by age, underlying pathologies and immunosuppressed.
The mutations that occur in the spike component of Omicron BA.1 and BA.2 subvariants compromise their function, which in some cases results in a reduction and in others in an improvement. In particular, the mutations that are typical of Omicron and which occur in two specific regions of the spike (NTD and RBD, the latter receptor of the virus to enter cells), are able to reduce the neutralizing capacity exerted by monoclonals which are widely used in therapy and in particular of bamlanivimab and imdevimab , which poses major problems for the clinical treatment of COVID-19 patients (Pastorino C. and others). As far as general epidemiology aspects are concerned, there is an interesting publication drawn up in the form of a technical note by the Istituto Superiore di Sanità, on the impact of vaccination and previous diagnosis on the risk of infection with serious disease associated with SARS-CoV- 2, obtained by analyzing the cases diagnosed in Italy in October 2022 (Sacco C. and others).
In particular, it turns out that the maximum protectionboth against infection and serious illness, it is acquired with hybrid immunity (vaccination plus previous infection) and that the greatest risk of serious forms of the disease is observed among people who are not vaccinated and/or who have not had a previous infection. In all cases, however, the reduction in the risk of serious illness is significantly associated with vaccination, especially if this has been practiced recently. Starting from the observation that patients with inflammatory bowel disease treated with biological drugs have a lower response to vaccines, the intestinal microbiota was analysed, acquiring both stool and serum samples from 43 patients affected by this morbid form under treatment and vaccinated either with adenoviral vector vaccine (AstraZeneca) or mRNA vaccine (Pfizer) (Alexander JL and others). The results clearly show that there is an association between the intestinal microbiota and the production of antibodies after vaccination and this impaired response can be improved if patients treated with biological drugs receive microbial metabolites.