“If we are facing in the right direction all we have to do is keep on walking.” - Buddha
“Pessimism never won any battle.” - Dwight D. Eisenhower
In his daily newsletter in the February 11th New York Times, David Leonhardt declared, “The pandemic is in retreat.” Many public health experts share Leonhardt’s opinion. Yet some are wary as for months this pandemic has surged then subsided only to resurge again. So, is the pandemic really retreating? And if so, how will this affect our daily lives? In this Germ Gems post I will provide some support (albeit somewhat nervously) for Leonhardt’s case for cautious optimism.
What’s the evidence the pandemic is fading? Since reaching a peak on January 8th (related to holiday gatherings) the number of confirmed new daily cases of COVID-19 has fallen by about 60%. Nonetheless, all public health experts agree that the pandemic is still far from over. The recent decline in new cases in the United States is larger, however, than any decline in the past year. Moreover, the number of people hospitalized with COVID-19 has also fallen. Most important, deaths from COVID-19 are beginning to decline. In the first two weeks of February, the reported number of deaths was down about 5%. Dr. Ashish Jha, dean of the Brown University School of Public Health, predicts that over the next several weeks the number of daily deaths will probably fall below 2,000, and it could even drop below 1,000 by March. If this prediction holds, it would provide evidence that the pandemic may indeed be fading.
Why is the pandemic turning the corner? Immunity appears to be the most tenable explanation behind the decline in COVID-19 cases and deaths. (I’ve seen no data on whether behavioral changes like increased mask-wearing and social-distancing may have contributed to the pandemic’s retreat.) It is estimated that about 110 million people in the United States have likely been infected with SARS-CoV-2, the virus that causes COVID-19, and another 33 million have received at least one vaccine shot. Combined, these two groups comprise about 43% of all Americans, which seems to be a sufficient percentage of the population infected to slow the spread of this virus.
Vaccination status in the United States. Most experts estimate, however, that between 70% and 85% of Americans will need to be vaccinated before we achieve herd or community immunity. As of February 13th, only12.1 million Americans had completed vaccinations, meaning they had received both doses of the vaccine, so we have a way to go before we achieve this goal.
At the current pace of immunizations with the two-dose Pfizer/BioNTech or Moderna regimens, it could take nine more months to vaccinate 70% of Americans. With President Biden’s new deal for getting more vaccines, it is believed there will be enough doses to vaccinate 300 million Americans (91% of the population) by the end of July. This number of doses could increase, however, if other vaccine candidates, such as Johnson & Johnson and Novavax, are approved. And companies are now testing vaccines in children. According to Dr. Anthony Fauci, our well-known Director of the National Institute of Allergy and Infectious Diseases and now also chief medical adviser to the Biden administration, vaccines for children as young as first graders could be available as early as September.
Trust in vaccines. Vaccines prevent serious and life-threatening disease by stimulating the immune system. This is a vaccine’s single most important contribution in the battle against SARS-CoV-2. Many Americans are extremely skeptical about vaccines in general and the COVID-19 vaccines in particular. That skepticism may, however, be abating. A February 10th article in Nature entitled, “Trust in COVID vaccines is growing,” reported that attitudes towards COVID-19 vaccines are improving in some parts of the world. A global survey in January showed more than half of the respondents agreed that they would get a vaccine if it were available. This positive trend, according to a global health researcher at Duke University, seems likely driven by reports of high vaccine efficacy and safety.
Nonetheless, concerns about vaccines (vaccine hesitancy), fostered by misinformation on social media platforms, continue to plague the World Health Organization and the Center for Disease Control and Prevention (CDC). Instagram recently removed the account of prominent vaccine skeptic Robert F. Kennedy Jr. This represents one of the highest-profile steps that Facebook Inc. (Instagram’s parent company) has taken to combat false and misleading information about COVID-19 vaccines circulating on social media.
The CDC and other public health organizations are also intensifying efforts to promote vaccination among racial and ethnic minorities. These groups are hit hardest by the virus. But due to a long history of mistrust of the government, including public health agencies, they also appear to be among the most reluctant to be vaccinated.
Other moves in the right direction. As I discussed in last week’s Germ Gems post, “COVID-19 Treatment: A Roller Coaster Ride,” limited evidence has emerged from randomized clinical trials (RCTs) that any of a multitude of drugs used to treat COVID-19 can reduce mortality. But on February 10th, the Oxford University-led RECOVERY trial reported that the interleukin-6 receptor inhibitor, tocilizumab, does indeed save lives. And on February 5th, a small study from the Karolinska Institute in Stockholm reported that a single dose of the immunomodulator bevacizumab was found to reduce mortality. Given the very large number of on-going RCTs, I’m optimistic that we will see other therapeutic advances in the near future.
SARS-CoV-2 variants—the fly in the ointment. In my February 3rd post “COVID-19 Update—Vaccines, Variants and Rollout: A Puzzlement,” I discussed whether SARS-CoV-2 variant strains were vaccine spoilers. At that time, three so-called “variants of concern (VOC)” were circulating throughout the Western World: B.1.1.7 (first recognized in the UK), B.1.351 (originally identified in South Africa), and P.1 (observed first in Brazil). The latter two variants popped up only recently in the United States. Then on February 11th in the Journal of the American Medical Association (JAMA) researchers from Cedars-Sinai Medical Center reported the emergence of a novel SARS-CoV-2 variant in Southern California. Investigation is underway to determine whether this new variant, termed 20C/S:452R, is more readily transmitted, as has been the case with the other VOCs. And it’s too early to know whether 20C/S:452R, like B.1.1.7, is more lethal.
In an accompanying editorial in the February 11th issue of JAMA entitled, “SARS-CoV-2 viral variants—tackling a moving target,” Dr. Fauci and his co-authors state that it is unclear how effective the current vaccines will be against the new variants. They opine, “current vaccines could retain the ability to prevent hospitalizations and deaths, even in the face of decreased overall efficacy due to antigenic variation.” A similar message (that is, “we need more data”) was reiterated in a February 11th Medscape Medical News article, “As Variants Spread, Top Experts Lay Out Best Protection Plan,” in which all the panelists reinforced the need to double down on practicing the “4 W’s: Wear a mask, Watch your wind (cover your coughs and sneezes), Watch your distance (stay at least 6 feet away from others in public spaces), and Wash your hands.
How safe is it for vaccinated people to get together? In this era of emerging viral variants many questions regarding the efficacy and duration of immunity conferred by vaccination remain unanswered. There is a consensus, however, regarding the importance of continuing to practice the “4 W’s,” even after you’re vaccinated. The CDC has sufficient data to update regularly its guidelines regarding indoor dining, gathering in groups for worshipping, weddings and funerals, and for travelling. I highly recommend checking the CDC’s website before embarking on activities that might put you in harm’s (SARS-CoV-2’s) way.
As University of California Berkeley School of Public Health professor John Swartztberg stated: “The decision for vaccinated people to gather involves mental ‘calculus,’ which should take into account how likely anyone is to be exposed to the SARS-CoV-2 virus, vaccinated or not, because there is still a small chance even a vaccinated person could be infected.” Professor Swartztberg also confided, “I haven’t hugged my grandchildren and children, going on 10 months now, at some point I really need to do that.”
My wife and I are scheduled to get our second vaccine jabs next week. And as we haven’t hugged our children and grandchildren in over a year, at some point we “really need to do that.” Professor Swartztberg’s mental “calculus” is therefore particularly relevant. Fortunately for me, my wife, a former math teacher, can still do the calculus.
