There are many important questions that remain unanswered about COVID-19. This is mainly because there is no data to guide us yet.
Here are just a few questions with no solid answers that seemed particularly relevant when this was written.
The Pandemic in General:
- If and when will it all end?
- Will the next variant of concern be sensitive to:
- Existing vaccines?
- Existing COVID-19 monoclonal antibody treatments and preventatives, including Evusheld?
- Existing antivirals?
- Will the virus evolve to be more or less severe?
- What antibody level equates to protection from infection and/or progression to severe disease for those with CLL / SLL?
- What about T-cell response to vaccines in those with CLL / SLL, and how much are other parts of the immune system stimulated by the COVID-19 vaccines (not measurable outside of a research laboratory setting)?
- How common is long COVID for CLL / SLL patients, and are there any unique concerns?
- Will society ever recognize the immunocompromised and make accommodations for the needs of its most vulnerable?
Prevention and Treatment:
- Ideal timing and number of future COVID-19 vaccine doses for the immunocompromised.
- Future timing of repeat doses of Evusheld.
- When is a second dose of Evusheld recommended?
- Will there be adequate supplies, appropriate distribution, and adequate uptake of:
- Existing vaccines
- Existing COVID-19 monoclonal antibodies used for treatment
- Existing COVID-19 monoclonal antibodies used for pre-exposure prophylaxis (PrEP), including Evusheld
- Existing antivirals
- Will additional vaccine doses for the public be needed annually or more often?
- Will the next generation vaccines improve and increase the durability of response by specifically targeting new variants, stimulating T-cell function, or will they reduce transmission if given nasally?
- Are oral vaccines coming?
- How common is the Paxlovid rebound phenomenon, and should CLL / SLL patients who continue to test positive or have worsening symptoms after one five-day course of Paxlovid retreat?
- What is the reemerging role of convalescent plasma as a COVID-19 treatment?
CLL Society is working with others to find answers to these questions. They will come slowly and with time. We will certainly add more questions to the above list, while hopefully crossing off some of the items as the data emerges. We will inform you here.
Coping with all the unknowns:
I remind you of one of my most important commandments on how to cope with CLL / SLL that has served me well from the beginning of my journey:
You may need to make difficult decisions with imperfect knowledge and contradictory advice.
Did any of us really think that SARS-CoV-2 would change that imperative?
Take some deep breaths, stay informed, examine all the options, and make the best choices based on the present data. Then recorrect as needed as new information becomes available.
In the meantime, stay strong. We are all in this together.
Brian Koffman, MDCM (retired) MS Ed (he, him, his)
Co-Founder, Executive VP, and Chief Medical Officer
CLL Society, Inc.