How the Pandemic Shortened Life Expectancy, and New Drugs on the Horizon: COVID, Quickly, Episode 40

How the Pandemic Shortened Life Expectancy, and New Drugs on the Horizon: COVID, Quickly, Episode 40
Credit: Ryan Reid

In this episode of the COVID, Quickly podcast, we talk about why we’ve had years shaved off our average collective life since 2020. We also discuss “mabs” and why it might be important to know what they are.

Tanya Lewis: Hi, and welcome to COVID, Quickly, a Scientific American podcast series!

Josh Fischman: This is your fast-track update on the COVID pandemic. We will bring you up-to-date on the science behind the most pressing questions about the virus. We help you understand the science behind the disease and dispel myths about research.

Lewis: I’m Tanya Lewis.

Fischman: I’m Josh Fischman.

Lewis: And we’re Scientific American’s senior health editors. Today, we’ll discuss how COVID has led to a significant decline in U.S. live expectancy…

Fischman: … and some new monoclonal antibodies that could protect us from variants.

Fischman: People in the U.S. have been living longer and longer during most of the past century. Then COVID came along. We’re now going backwards. We are losing years of our lives.

Lewis: Life expectancy has only declined a few times in recent memory: during the 1918 pandemic, during World War II, and during the HIV/AIDS crisis. It has declined by almost three-years in the past two years. That’s equivalent to the U.S. life expectancy in 1996.

Fischman: That’s pretty astounding.

Lewis: It is. However, while almost all demographics saw a decline in life expectancy, there were some groups that lost more years than others.

Fischman: Which groups had the biggest declines?

Lewis: Native American and Alaska Native populations’ lost a total of 6.6 years from 2019 to 2021. Hispanics lost 4.2 years. The non-Hispanic Black population lost 4 years. The white population lost 2.4 year. The Asian population lost 2.1 year.

The data come from the CDC’s National Center for Health Statistics, which recently published provisional data for 2021. Elizabeth Arias and her NCHS colleagues created a “life table”. It basically takes a hypothetical group of infants born in 2021, and applied the real-world death rates of every age group to those infants across their whole lives. The result is an estimate for the life expectancy of the entire population.

Fischman: So, what are the reasons for all the lost years?

Lewis: Well, COVID was the primary cause–more than a million people in the U.S. have died from the disease. Unintentional injuries, mainly drug overdoses, were also a major reason for the decline.

Deaths from heart disease, chronic liver disease and suicide also contributed to the decline in life expectancy over the past year. Economists Anne Case and Angus Deaton first brought attention to these “deaths of despair“–deaths from overdoses, alcoholism and suicide. They were already on the rise before the pandemic. The trend was only accelerated by the epidemic.

Fischman: In other words, COVID pushed people who were already struggling over the edge.

Lewis: Most likely. This was especially true for Native Americans. Native Americans have the lowest levels of housing, education, and health care. Crystal Lee, an assistant professor at University of New Mexico’s College of Population Health explained to me that a lot of this is due to the colonialist policies of the U.S. government.

Lee, a member of Navajo Nation, is Dine’ and is also the CEO of the non-profit organization United Natives as well as the company Indigenous Health. Lee states, “We must hold the U.S. government responsible by honoring the existing treaties.”

Fischman: Those treaties would improve healthcare, among other things.

Lewis: Exactly. The biggest takeaway here is that we weren’t prepared for this pandemic. We need to reform our health care system and make sure it works for everyone if we want to live longer and healthier lives.

Lewis: Josh, we’ve both talked about the several hundred people who are getting severely sick and dying from COVID every day. Some of the medications that were originally developed to treat people with COVID don’t work well with the newer variants. You’ve heard about drugs that may work better.

Fischman: I have. The new drugs are variants of older medicines called monoclonal antibody. They have long, complicated names but end in “mab” which is the identifier.

Lewis: For COVID, those have been around for a year or so, haven’t they?

Fischman: Yep. They were developed to glom onto the early 2020 form of the virus, and prevent it from penetrating into a cell. They did a good job at first.

Lewis: But recently, not so much, right? I saw a study in which scientists tested 21 different “mabs” against the BA.4 and 5 variants, and only one was able to neutralize them.

Fischman: And that’s precisely the problem. These mabs were designed to fit the early virus like a key into a lock. There are now 5 or 6 newer variants of the virus. BA.5 is still the most popular, but those have mutations that alter the shape of the lock. Most of the mabs are no longer suitable. One, bebtelovimab still does a good job, but most other FDA-approved mabs do not.

Lewis: So what’s the solution?

Fischman: Go broad. These mabs were chosen by scientists based on their attachment to a particular virus. Now they seek out antibodies that are “broadly neutrizing.” They are able to grab onto multiple variants of viruses, and not just one.

I’ve been talking to Bill Haseltine about this, the molecular biologist and pioneer in AIDS treatments. This approach is very promising, he believes. Mab developers are developing antibodies that target “highly conserved” areas of the virus. That means that the virus doesn’t change from one variant to another, so the mabs can keep their hands on them.

Lewis: Can people use these now?

Fischman: Not yet. There are about 10 of these mabs in various stages of testing. Some of these mabs are being tested on humans, while others are still in animal testing.

Lewis: But don’t a lot of drugs that work well in animals actually fail when they get to humans?

Fischman: Not mabs, in general. The antibodies are often created in mice that have been genetically altered to have human-like immune system. This technique dates back to the days when AIDS drugs were being developed. Haseltine states that they are generally well-suited for people because of this.

Another advantage mabs have is they can be used to prevent infection in people who are in high-risk situations. Mabs can be used to prevent infection in people who are immunocompromised. Others may work in nursing homes that have seen high outbreak rates.

Lewis: I can see that. While I don’t want you to keep chasing after problems, mabs aren’t a pill like Paxlovid. They must be infused or at the very least, injected. This creates a problem of accessibility.

Fischman: You’re right. They are not something you can do at home. However, injection technology is improving. For example, many people with diabetes have learned how to inject insulin themselves.

Cost is also an issue. Mab manufacturers can charge just over $2000 per dose. The government pays the COVID patients right now. It turns out that mabs these days are very affordable to produce, only one or two hundred dollars per pop.

There’s a possibility that we’ll see new and affordable therapies that can handle the many variants of COVID.

Lewis: Now you’re up to speed. We appreciate you joining us. Tulika Bose and Jeff DelViscio edited our show.

Fischman: Come back in two weeks for the next episode of COVID, Quickly. For the latest COVID news, visit sciam.com.

[The above text is a transcript of this podcast. ]

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ABOUT THE AUTHOR(S)

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    Josh Fischman is a senior editor at Scientific American who covers medicine, biology and science policy. He has written and edited about science and health for Discover, Science, Earth, and U.S. News & World Report. Follow Josh Fischman on Twitter.

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      Tanya Lewis is a senior editor at Scientific American who covers health and medicine. Follow her on Twitter @tanyalewis314 Credit: Nick Higgins

        Jeffery DelViscio is chief multimedia editor in charge of video and podcasts at Scientific American. Follow Jeffery DelViscio on Twitter

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