The new coronavirus is constantly updating and iterating, and under the epidemic, these high-risk groups need to strengthen protection

In mid-September, US President Joe Biden declared that "the coronavirus pandemic in the United States is over"
.
As soon as this remark came out, it caused an uproar, and many mainstream media in the United States such as the New York Times published articles, pointing out that the new crown virus is still raging, and about 400 people still die from the new crown in the United States ^{every day [1].}

In fact, with the continuous mutation of the new coronavirus, the current epidemic prevention and control work is still facing severe challenges
.
For example, the new Omicron variant BF.
7 is extremely contagious and spreads very quickly
.
Not long ago, the World Health Organization (WHO) warned that BF.
7 may soon become the main strain
circulating worldwide.
Recently, BF.
7 variants have been detected in Hohhot, Inner Mongolia, Shaoguan, Guangdong and other places, and BF.
7 has led to a new round of epidemics
in many places in China.

At the same time, other new variants are emerging around the world, such as the latest Omicron variant, XBB.

Studies have pointed out that the immune escape ability of XBB is temporarily the strongest of all variants ^[2].

At present, XBB has become the main strain circulating in Singapore and has been detected
in Australia, India, Denmark and Hong Kong.

At the press conference of the joint prevention and control mechanism of the State Council on October 13, Liang Wannian, head of the expert group of the leading group for epidemic response and handling of the National Health Commission, said in a response to why China insists on "dynamic zero", although the case fatality rate of the Omicron variant has decreased, its transmission speed is fast, the transmission is more insidious, and the phenomenon of immune escape is gradually increasing, so the overall incidence is high, which means that there will be a large number of infections in the population, even if the individual case fatality rate is low, the number of deaths will be relatively large.
And it may also lead to a run on medical resources, causing "excess death"
.
China has a large population, a high proportion of the elderly population, and a large number of patients with underlying diseases, these people are high-risk groups of new coronavirus infection, and the probability of severe illness or even death after infection is higher than that of the general population, and if the epidemic prevention and control is relaxed, it may cause intolerable consequences
.
In addition, the long-term harm of new coronary pneumonia ^[3]
should be taken into account.

People at high risk of coronavirus threat: Higher risk of severe illness or death after infection

In the face of the constantly updated and iterative new coronavirus, it is important to strengthen the new crown protection, especially for high-risk groups, who face a higher risk of
new crown infection and severe illness or death after infection.
So who are the people at high risk?

1

senior citizen

According to data published by the Centers for Disease Control and Prevention (CDC), the elderly have a higher risk of severe illness, critical illness and even death after infection than the younger group, and most of the new crown pneumonia deaths occur in
people over 65 years old.
Compared with people aged 18~29 years, the risk of hospitalization is increased by 3 times, 5 times, 8 times and 15 times in people aged 50~64, 65~74 years, 75~84 years and over 85 years old, and the risk of death is 25 times, 60 times, 140 times and 340 times, respectively ^[4,5].

2

People with underlying medical conditions

People with underlying diseases such as overweight/obesity, cardiovascular and cerebrovascular diseases, chronic obstructive pulmonary disease, diabetes, chronic liver disease, kidney disease, and neurological lesions (such as dementia) also face a higher risk of
new crown infection and severe disease.
Moreover, the more comorbid underlying diseases, the higher the risk of severe new crown disease ^[6].

3

Immunocompromised people

Immunocompromised people are also at high risk of
being threatened by the new crown.
People with moderate or severe immunocompromise mainly include ^[7]:

• Patients
  with solid tumors and hematologic malignancies undergoing treatment.
  

• People
  who have received solid organ transplants and are receiving immunosuppressive therapy.
  

• Patients
  receiving chimeric antigen receptor T cell (CAR-T) therapy, or hematopoietic stem cell transplantation (within 2 years of transplantation or being treated with immunosuppressive therapy).
  

• Patients with
  moderate or severe primary immunodeficiency (eg, DiGeorge syndrome, Wiskott-Aldrich syndrome).
  

• People
  with advanced or untreated HIV infection.
  

• Patients
  receiving high-dose corticosteroids (i.
  e.
  , prednisone ≥ 20 mg or equivalent daily for ≥ 2 weeks), alkylating agents, antimetabolites, transplant-associated immunosuppressive drugs, cancer chemotherapy drugs that cause severe immunosuppression, and immunosuppressive or immunomodulatory biologic agents.
  

Studies have found that immunocompromised people may have a lower antibody response after vaccination, have difficulty resisting the new coronavirus, and have a higher risk of breakthrough infection and the risk of severe disease and death after infection compared with the general population ^[8,9].

。 A real-world study from the United States analyzed the risk and outcomes of breakthrough infection in cancer patients who had received the new crown vaccine and found that patients with solid tumors and hematologic malignancies had a significantly higher risk of breakthrough infection (OR 1.
12 and 4.
64, respectively) and serious outcomes (OR 1.
33 and 1.
45, respectively) compared with non-cancer patients ^[10].

Solid organ transplant recipients receiving immunosuppressive therapy are also at higher risk of
severe COVID-19.
In a national survey conducted at 88 transplant centers in the United States from March 24 to 31, 2020, 148 solid organ transplant recipients (69.
6% of kidneys, 15.
5% of livers, 8.
8% of hearts, and 6.
1% of lung) were diagnosed with new coronavirus infection, of which 54%, 21%, and 25% of patients with mild, moderate, and critical cases were diagnosed with new coronavirus pneumonia ^[11].

Preliminary reports of transplant recipients hospitalized with novel coronary pneumonia indicate a mortality rate as high as 28% ^[12-16].

In addition, high-risk factors (eg, old age, underlying medical conditions, carrying type I interferon autoantibodies) and ongoing therapies, such as T-cell depleting agents or T-cell inhibitors (eg, antithymocyte globulin, calcineurin inhibitors, mycophenolate mofetil, belacept) or B-cell depleting agents (eg, rituximab, Ocrelizumab, Obinutuzumab), are also associated with more severe COVID-19 outcomes in ^{immunocompromised populations [17-19].}

。

Even if it is "cured", the sequelae of the new crown can last for months

It should be noted that even if patients with new crown infection have recovered, the sequelae can last for months
.
According to the definition of the World Health Organization, long-term symptoms of new crowns usually occur within 3 months after infection, which can be the appearance of certain new symptoms after recovery from acute infection, or the persistence of certain symptoms in the original acute infection period, lasting at least 2 months, repeated, and cannot be explained by other diagnoses ^[20].

Common long-term symptoms of COVID include fatigue, shortness of breath and cognitive dysfunction, which often affect daily life
.
These symptoms can persist for weeks, months, or even longer and are more common in severe cases ^[21].

In August 2022, a Dutch observational cohort study published in The Lancet found that 1 in 8 recovered from COVID would develop long-term COVID symptoms, including chest pain, dyspnea, muscle pain, loss of taste/smell, tingling in the hands/feet, sore throat, alternating hot and cold, heavy arms/legs, and general fatigue ^[22].

。 The latest data released by the CDC show that as of September 26, 15% of American adults who have previously been infected with new coronary pneumonia have long-term symptoms of the new crown, and 81% of them have been affected in their daily activities, and about one-quarter have been significantly affected ^[23,24].

。 Recently, an article published in the Journal of the American Medical Association (JAMA) summarized and analyzed data from about 1.
2 million new crown infections (from 22 countries) from 54 studies and 2 electronic medical case databases, and found that about 6.
2% of new crown infections experienced at least one long-term new crown symptom after three months, of which 3.
7% had persistent breathing problems, 3.
2% experienced persistent fatigue and physical pain or mood swings, and 2.
2% had cognitive problems ^{[ 25]}
。 Although the incidence of long-term symptoms of the new crown varies between studies, at least tens of millions of people around the world are still suffering from the long-term symptoms of the new crown, causing a huge public health burden
.

brief summary

A few days ago, the World Health Organization issued a reminder that many countries have recently increased new crown infections, hospitalizations and deaths, and with the arrival of the northern hemisphere influenza season, it is expected that the new crown and other viruses such as influenza will spread at the same time in the future, and countries should not take it lightly
.
Although we are very much looking forward to the early end of the new crown epidemic, we cannot ignore the epidemic prevention and control at present, especially for high-risk groups, we should pay more attention and attention, strengthen new crown vaccination, and develop effective prevention and treatment drugs, so as to protect their lives and health during the epidemic
.