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Can COVID Burst America’s Bubble While The World Battles The Virus?

On May 13, after combating three waves of the coronavirus, the CDC released guidelines stating that  Americans who are fully vaccinated against Covid-19 can resume activities without wearing masks or physically distancing in most settings, indicating that the pandemic may be near an end.

“If you are fully vaccinated you can start doing the things you had stopped doing because of the pandemic,” announced CDC Director Dr. Rochelle Walensky.

But experts at a May 14 Ethnic Media Services briefing questioned whether it was too soon to go back to normal.

“Bubbles are beautiful, but bubbles do not last long in this world,” remarked Dr. Ben Neuman, Chief Virologist at the Global Health Research Complex at Texas A&M University.  “Any vaccine bubble that may exist is going to be fragile, unfortunately.”

As Covid-19 outbreaks occur in Michigan, Florida and Puerto Rico, the AMA reports  there is potential for a fourth pandemic surge.

And yes, the Indian B.1.617 variant is here, says the CDC. It’s monitoring the Indian mutation that the World Health Organization classified as “a variant of concern at a global level” because it may spread easily. According to the CDC, new mutations of the virus are more transmissible and are resistant to treatments or vaccines. These include five notable variants – B.1.1.7: (UK),  B.1.351 (S. Africa), P.1 (Japan/Brazil), B.1.427 and B.1.429 (identified in CA).

Going back to normal could expose adults and children to deadly new strains of the virus and its variants, rippling across the US and elsewhere in the world.

 

Can America survive in its Covid-19 bubble?

Variants can burst our bubble said experts, voicing concerns about our vulnerability to virus mutations and the prospect of ever reaching herd immunity.

Dr. Neuman has been sequencing the virus strains in Texas, and has identified different variants thriving even locally. At the peak of Covid-19 in January, he found that 30% variants of concern were from the B.1.1.7. UK variant. By late April and early May however, he added, “every single virus …has been a variant of concern.”

The virus is changing in unexpected ways, explained Dr. Neuman, driving certain lineages of the virus out of existence.  It’s a Darwinian process that  showcases “an increase in viral fitness.”

But, without any checks or balances on the virus which operates on a short-term risk-reward cycle – a 6-to-8-hour timetable – scientists find it difficult to predict long-term movement.

You can trust a snake, a chicken, or a cat to act in its own best interests to the best of its ability said Dr. Neuman, but “a virus has no such impulse.” Instead, it has an evolutionary incentive that drives it not in the direction we would hope or expect, but in the direction of more severe, sustained disease.

Over time the virus will continue to mutate, and vary unpredictably, warned Dr. Neuman, and solutions will have to be updated continually.

“In this particular place and time, there is approximately a 100% chance that you will run into something that grows faster, and has the potential to spread farther, and perhaps hit harder than one would be expecting otherwise.”

The world has underestimated the virus over and over by relaxing restrictions and causing a virus resurgence, reiterated Dr. Neuman.

 

The question is, “Can we do the wrong things and still expect the right results?”

One outcome that scientists predict could keep the virus at bay or banished altogether is Herd Immunity, a popular concept that is mired in misconception and misunderstanding. Dr. Marc Lipsitch, Professor of Epidemiology and Director of the Center for Communicable Disease Dynamics at the Harvard School of Public Health, described herd immunity as a state in which completely immune completely or partially immune people in a population slow down transmission by making it impossible for the virus to pass through them from one person to another in a sustained way, “till the virus essentially goes away.”

Will vaccinations and infections create herd immunity in the current phase of the pandemic? Dr. Lipsitch believes that’s an unlikely scenario – even with the vaccines we have.

At the start of the pandemic, before lockdowns and social distancing, a person infected up to 21/2 or 3 people each. But compared to early versions of the virus, contagious new variants have increased transmissibility by up 4 to 5 persons each. To reduce transmissibility by a factor of 5, explained Dr. Lipsitch, means immunizing 80% of the population,  a challenge that may be impossible given a number of factors.

At the moment, every variant in the world is present in the US.  Immunizing the nation won’t be easy because vulnerable populations – especially racial/ethnic minority groups and economically and socially disadvantaged communities – lack equitable vaccine access, children under the age of 12 are ineligible, and vaccine hesitancy is prevalent.

In the US vaccine hesitancy is based on a lack of trust in its efficacy. At issue also, is that all vaccines currently available in the US do not offer 100% protection. But added Dr. Neuman, “I trust the virus less!”

While Yale Medicine rated Pfizer-BioNTech at 95% for preventing symptomatic disease, its stability depends on strict storage requirements; Moderna has a similar high efficacy of 90% upon full immunization, while the single shot Johnson & Johnson vaccine has a 72% overall efficacy.

There is also concern about waning immunity and about revaccination. Limited studies that exist clarify that antibodies decrease over time, but there is uncertainty about at which point a person is no longer protected.

Annual boosters may be necessary at a minimum, confirmed Dr. Neuman, but although each of the vaccines is reasonably effective against each of the variants, there is definitely a lower effectiveness against some, like those coming out of Brazil and South Africa.

It’s more the virus changing than waning immunity that will drive the vaccination cycle.

 

Defanging Not Defeating the Virus

In the wake of the CDC’s new mask guidelines, Dr. Neuman noted that people calculating what precautions to take – to mask, social distance, or get vaccinated – are making decisions predicated on the original versions of the virus.

As ‘stay-at-home’ lockdown measures gradually ease, NIH reports also say that much of the population may return to spending increasing amounts of time in inadequately ventilated workplaces, offices, schools and other public buildings, where they may be exposed to a risk of acquiring viral infections by inhalation.

So, in the midst of an ongoing epidemic, as social barriers to transmission are lowered without reaching herd immunity, and high-risk populations in the other parts of the world face vaccine shortages, we are “in some sense “ said Dr. Lipsitch, “not ‘totally defeating, but simply defanging the virus,” – just making it less dangerous to have transmission.

He predicts “a quiet summer” followed by “some virus resurgence in the fall” as people move indoors and continue to lower their guard.

 

Fighting the Virus at Warp Speed

All the experts argued that the only way out of the pandemic is to ensure that more vulnerable populations across the world get vaccinated.

Peter Maybarduk, Director of Public Citizen’s Access to Medicines Group, called for a global response at warp speed for the world – a catalyst for more funding, sharing resources and technical assistance, more manufacturing, and a definite plan to vaccinate everyone, everywhere, with at least 8 billion doses of MRNA vaccine within a year to make up the global shortfall.

Apart from the moral argument, added Dr. Lipsitch, “we like having interactions with the rest of the world, and for all the reasons we value the rest of the world, we should value their health as well.”

Dr. Neuman called for a single global solution to vaccinate everyone within a window of six months to a year.

Maybarduk, an expert on the Covax initiative which partners with the World Health Organization to get vaccines to low-income countries by sharing vaccines equitably, pointed out that wealthy countries have purchased much of the global supply of doses in bulk, so less than 5 % of the world’s population – only 340 million (one quarter of the doses already administered in the US alone) – have been vaccinated worldwide.

In Brazil only 17% of Brazilians have been vaccinated, said Dr. Rosane Guerra from the Department of Pathology, Biological and Health Sciences Center at the Federal University of Maranhao (UFMA). Brazil does not have an adequate supply of medication to prevent or control the virus.

Covax aims to vaccinate 20 percent of the world with a 2 billion dose target for 2021 but has only been able to ship 64 million doses, stated Maybarduk.  Worldwide access to vaccines is hobbled by the lack of manufacturing capacity, inefficient distribution channels, and low production volumes, access to raw materials, export controls, meeting regulatory requirements for safety and efficacy, obtaining qualifications from WHO for manufacturing facilities, and by politicians prioritizing their own citizens for vaccination first.

Sharing vaccines and vaccine knowledge (like the Trips waiver) is imperative to overcome the vaccine shortfall Maybarduk suggested, and getting vaccines to those who desperately need it in other countries..

“We should not cross our fingers and assume all is going to work out.”

Fighting the virus is like mobilizing for a world war which requires collective, integrated human effort towards achieving one goal. “I don’t think halfway solutions are going to get us there,” said Dr. Neuman. Getting to the next stage requires an integrated effort that scientists know is doable but is ultimately a political decision that world leaders must make.

“It’s impossible to have any kind of bubble in a world when people can move between countries in the middle of an epidemic. We have to close every border to control the disease,” Dr.Guerra concluded.

The bubble could burst as restrictions are relaxed before the pandemic is under control, said Dr. Neuman. “I don’t think that is the path that leads to the fastest extinction of the virus.”

“Get the vaccine, wear a mask, and when the numbers go down, then you know it’s safe to relax!”


Meera Kymal is the Contributing Editor at India Currents

Photo by Marc Sendra Martorell on Unsplash

Photo by Fusion Medical Animation on Unsplash


 

Did It Feel Like A Truck Hit You After Your Covid Vaccination?

If you think vaccination is an ordeal now, consider the 18th-century version. After having pus from a smallpox boil scratched into your arm, you would be subject to three weeks of fever, sweats, chills, bleeding and purging with dangerous medicines, accompanied by hymns, prayers and hell-fire sermons by dour preachers.

That was smallpox vaccination, back then. The process generally worked and was preferred to enduring “natural” smallpox, which killed around a third of those who got it. Patients were often grateful for trial-by-immunization — once it was over, anyway.

“Thus through the Mercy of God, I have been preserved through the Distemper of the Small Pox,” wrote one Peter Thatcher in 1764, after undergoing the process in a Boston inoculation hospital. “Many and heinous have been my sins, but I hope they will be washed away.”

Today, Americans are once again surprisingly willing, even eager, to suffer a little for the reward of immunity from a virus that has turned the world upside down.

Roughly half of those vaccinated with the Moderna or Pfizer-BioNTech vaccines, and in particular women, experience unpleasantness, from hot, sore arms to chills, headache, fever and exhaustion. Sometimes they boast about the symptoms. They often welcome them.

Suspicion about what was in the shots grew in the mind of Patricia Mandatori, an Argentine immigrant in Los Angeles, when she hardly felt the needle going in after her first dose of the Moderna vaccine at a March appointment.

A day later, though, with satisfaction, she “felt like a truck hit me,” Mandatori said. “When I started to feel rotten I said, ‘Yay, I got the vaccination.’ I was happy. I felt relieved.”

While the symptoms show your immune system is responding to the vaccine in a way that will protect against disease, evidence from clinical trials showed that people with few or no symptoms were also protected. Don’t feel bad if you don’t feel bad, the experts say.

“This is the first vaccine in history where anyone has ever complained about not having symptoms,” said immunologist Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia.

To be sure, there is some evidence of stronger immune response in younger people — and in those who get sick when vaccinated. A small study at the University of Pennsylvania showed that people who reported systemic side effects such as fever, chills and headache may have had somewhat higher levels of antibodies. The large trial for Pfizer’s vaccine showed the same trend in younger patients.

But that doesn’t mean people who don’t react to the vaccine severely are less protected, said Dr. Joanna Schaenman, an expert on infectious diseases and the immunology of aging at the David Geffen School of Medicine at UCLA. While the symptoms of illness are undoubtedly part of the immune response, the immune response that counts is protection, she said. “That is preserved across age groups and likely to be independent of whether you had local or systemic side effects or not.”

The immune system responses that produce post-vaccination symptoms are thought to be triggered by proteins called toll-like receptors, which reside on certain immune cells. These receptors are less functional in older people, who are also likely to have chronic, low-grade activation of their immune systems that paradoxically mutes the more rapid response to a vaccine.

But other parts of their immune systems are responding more gradually to the vaccine by creating the specific types of cells needed to protect against the coronavirus. These are the so-called memory B cells, which make antibodies to attack the virus, and “killer T cells” that track and destroy virus-infected cells.

Many other vaccines, including those that prevent hepatitis B and bacterial pneumonia, are highly effective while having relatively mild side effect profiles, Schaenman noted.

Whether you have a strong reaction to the vaccine “is an interesting but, in a sense, not vital question,” said Dr. William Schaffner, a professor of infectious disease at Vanderbilt University Medical Center. The bottom line, he said: “Don’t worry about it.”

There was a time when doctors prescribed cod-liver oil and people thought medicine had to taste bad to be effective. People who get sick after covid vaccination “feel like we’ve had a tiny bit of suffering, we’ve girded our loins against the real thing,” said Schaenman (who had a slight fever). “When people don’t have the side effects, they feel they’ve been robbed” of the experience.

Still, side effects can be a hopeful sign, especially when they end, says McCarty Memorial Christian Church leader Eddie Anderson, who has led efforts to vaccinate Black churchgoers in Los Angeles. He helps them through the rocky period by reminding them of the joyful reunions with children and grandchildren that will be possible post-vaccination.

“I’m a Christian pastor,’’ he said. “I tell them, ‘If you make it through the pain and discomfort, healing is on the other side. You can be fully human again.”


This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

image credit: getty images at KHN

Stanford’s Dr. Nirav Shah on Vaccines VS. Variants

Breaking news that virulent variants from Brazil, South Africa, and the UK are multiplying across borders even as homegrown strains are mutating on US soil, has raised a number of questions.

Are variants more contagious?
Will they cause worse infections?
Are current vaccines effective against mutating variants?
And should we take different precautions to keep safe?

Dr. Nirav Shah, MD, MPH, of Stanford University’s Clinical Excellence Research Center, fielded questions and concerns from ethnic media reporters at a press briefing on March 19. Along with other COVID 19 experts from the Bay Area, Dr. Shah shared information about new strains of the virus and safety net information for communities of color who want to sign up to get their vaccine shot.

“We cannot start to celebrate just yet,” said Shah, even though America reached an important milestone when the 100 millionth vaccine was administered on March 19.

The Story of Virus Variants

The emergence of variants has raised the specter that the current generation of vaccines might be rendered obsolete before they have even been fully rolled out. Are variants gaining ground and will they be immune to distinct vaccines before we reach herd immunity?

“It’s a race between how fast we get people fully vaccinated versus the level of disease in a community and how much transmission is going on,” explained Shah, about how a variant becomes dominant.

In heavily infected communities, the more virus particles there are, the greater the chance of one being different. All you need is a spike protein change, said Shah, which will give the variant a better chance of attaching to cells, so it spreads better and faster, becoming the dominant strain.

Simultaneously, as more people get vaccinated to combat COVID19, “the selective advantage of some particles relative to other particles, allow them to spread much faster.”

Now the race is on to get everyone vaccinated before the B.1.1.7. variant – the most dominant variant takes over.

“The story of virus variants is the story of evolution and natural selection,” added Shah.

Investigations of Variants

Currently, the CDC and WHO are studying the spread of three designated variants. Variants of interest -like the P2 which have ‘caused a cluster of infections’  in some countries, seem to be driving a surge in cases, though less is known about their transmissibility and lethality, or even if vaccine recipients are ‘fully neutralized against them or not’.

Their genetic sequence has some changes which suggest they may be more contagious, said Shah, and likely to be resistant to immunity bestowed by vaccines, treatments, or tests.

People are at greater risk from variants of concern that could reinfect survivors of certain Covid19 strains. Therapies and vaccines may be less effective against these strains which have “proven to be more contagious and cause more severe disease,” explained Shah.

Recent studies report that COVID-19 survivors and fully vaccinated people seem able to fight off infection from the virulent B.1.1.7 variant but may have less protection against the B.1.3.5.1 variant. Shah referred to research that shows the B.1.1.7 variant spreads about 50% faster and is more lethal, relative to prior strains of the virus.

The good news is that the existing range of vaccines (Pfizer, Moderna, Oxford/Astra Zeneca, and Novavax) have proven effective against this variant.  But less is known about the transmissibility and lethality of the P1, B.1.4.2.7, and  B.1.4.2.9 strains.

So far, however, assured Shah, no variants have met the definition for variants of high consequence which refer to strains that cause “more severe disease, more hospitalizations, and have been shown to defeat medical countermeasures” – like vaccines, anti-viral drugs, or monoclonal antibodies.

In the contest between vaccines and variants, “We will win the race by …vaccinating people as quickly…and broadly as possible” noted Shah.

An Annual Shot

Infectious disease experts liken variants to flu viruses which require new flu vaccines every year; scientists are even considering the possibility of multivalent vaccines designed to immunize against two or more strains of the virus.

“It’s a race of the mutant viruses against the vaccines…and to date, none of the mutants have escaped fully the major vaccines. The hope is that with minor modifications, we can get the continued evolution of the vaccines to match the evolution of the viruses.” It wouldn’t be surprising if the COVID vaccine was administered like a flu shot every year, added Shah.

Getting to Herd Immunity

The likelihood of reaching herd immunity will be a reality if at least  70% or more of the population are resistant to existing strains of the virus. However, as states relax public health restrictions as well as mask and social distancing mandates, herd immunity may be challenging to achieve.  “More people getting infected simply means more chance of variants,” cautioned Shah.

I asked Dr. Shah if we would need a new generation of vaccines before the current vaccine roll is complete and if boosters would be introduced. “I am an optimist”, said Shah. “I imagine we would have booster shots by the fall but what’s important is that we all get that first shot, and make sure the vulnerable and elderly get theirs. That will make us collectively win”.

Dr. Shah reiterated that the Moderna, Pfizer, and Johnson & Johnson vaccines authorized by the Food and Drug Administration (FDA) for emergency use, are still the most powerful tools to fight all the strains of COVID-19.

“This is a race for the world,” said Dr. Nirav Shah. “We know the virus doesn’t respect any borders, and so we should be as broad as possible in our thinking about getting the vaccine to everyone across the world.”

Helpful links:


Meera Kymal is the Contributing Editor at India Currents

The Virus & The Vaccine

Getting the COVID19 vaccine out of the freezer and into people’s arms has been slow. And, even as people battle unsympathetic websites to find slots for a shot, there still are many unanswered questions.

Will people who have been vaccinated still be asymptomatic and carriers who could infect others?

Will non-vaccinated people still need to wear PPE when interacting with them?

Will the vaccine protect against two new contagious strains of the virus?

What will the Biden administration do differently in its COVID19 response?

These questions and more, were answered by experts at an Ethnic Media Services briefing on January 13.

One of the biggest concerns to the country is the slow pace of the vaccine roll out. Though the US has 20 million doses of the Pfizer & Moderna vaccine, we face innumerable challenges at both the federal and state level, in getting the vaccine out to people. Only 5 million vaccines have been distributed as of January  11th.

According to Dr. William Shaffner, Professor of Preventive Medicine and Health Policy, and Professor of Medicine in the Division of Infectious Diseases at Vanderbilt University, a number of bottle necks choked a smooth vaccine roll out. At the national level, the uncertainty in vaccine shipments put a strain on the local level. States were not sure when vaccines would arrive, sometimes delivery was delayed, or fewer doses were received than anticipated. Occasionally shipments were sent to the wrong state in error.

Dr. William Shaffer

The Pfizer Deep Freeze

A key challenge for local distribution outlets was storing the Pfizer vaccine which requires “a really deep freeze” to keep it stable and intact. So only large medical centers with appropriate freezer storage capacity and personnel trained to handle it, first received the vaccine.  Fortunately, the Moderna vaccine does not need similar storage requirements and was distributed more easily, so vulnerable populations and frontline healthcare workers in long term care facilities, nursing homes and smaller community hospitals were able to access the vaccine.

Not Just Another Flu Campaign

“Quite frankly,” said Dr. Schaffer, many facilities assumed it would be “just another flu campaign,” but they were wrong. Insufficient preparation to administer the COVID19 vaccine rather “gummed up the works.”

                      Dr. Robert Wachter

California did get the science right, added Dr. Robert M. Wachter, Professor and Chair of Medicine at UCSF, “but did not get the logistics right.” Based on the way California managed its PPE and testing protocols, he was not surprised that vaccine distribution fared poorly. It’s a complicated process which ‘would have benefitted from a thoughtful national plan’ to determine for example, how to get a vaccine from a manufacturing plant in Michigan into a Fedex box that arrives in a central Californian distribution center. Glitches occurred because states, left to devise their own distribution process, “handed off responsibility to local institutions” which improvised protocols in “the last mile” of the roll out.

The lack of national guidance allowed too much “wiggle room” for error, stated Dr. Wachter.

Health Equity Gridlock

Another problem was created by rules about which cohorts got the vaccine first in a well-meaning effort to ensure health equity and that certain groups  – frontline healthcare workers, the elderly and essential workers – were prioritized for the vaccine. But how does a “Walgreens decide if you are a pre-school teacher or a grocery store worker or someone with a pre-existing condition,” argued Dr. Wachter. Do you need a note from your doctor or employer? “I haven’t received a convincing answer from anybody.”

‘We’ll Figure It Out’ Won’t Work

The lesson to learn is that “we’ll figure it out is not going to work with COVID19,” declared Dr. Wachter. He called it ‘scandalous’ that only 30% of all vaccines distributed have been injected when “millions of people should have received the vaccine by now.”

Congress only passed a coronavirus relief bill in late December 2020, to provide supplies necessary for distributing and administering the COVID-19 vaccine.

What we have  is a “9/11 or a Pearl Harbor worth of people dying a day” when we should be treating the distribution of the vaccine as an emergency, added Dr. Wachter.

Vaccines Going to Waste

Stories about vaccines going to waste make great news stories, but that’s not the real problem, said Dr. Shaffer. The issue is that doses are sitting in refrigerators and freezers but not making it into the final phase of delivery.

At UCSF, medical, 84% of vaccines have been distributed -15 thousand of about 18 thousand doses have been injected. The worry is how doses will make their way into rural or underserved communities.

Interestingly, Dr Shaffer reported that at Vanderbilt, a survey of healthcare providers found that they were hesitant and skeptical about the vaccine before it arrived. Vanderbilt responded with a major effort to educate its staff and address concerns to reassure reluctant people and change their minds. For example, the program had to counter fears  that the vaccine is not safe for pregnant women.

Both physicians reiterated that the vaccines were safe and effective to use.

Single or Double Dose

Data from all clinical trials find that two doses are required. The first shot offers partial protection after ten days and up to 80% to 90% protected  up to the minute before getting the second dose. “The second dose boosts  you up to the ultimate number of 95% and creates more durable immunity,” confirmed Dr. Wachter.

While models show that giving more people a first shot of the vaccine will save more lives than withholding doses for the follow up shot, there are legitimate concerns about delaying the second dose – will immunity fall off, will it promote mutations by having more people partly vaccinated, or will people forget to come back for their second dose? A single dose only will not work in the long term, but deferring a second dose will get more people vaccinated sooner. So the Biden administration’s plan to get more first doses out is ‘a good strategy’ agreed Dr. Shaffer.

Will You Still Be Contagious?

Preliminary data from a Moderna study indicated that ‘a substantial proportion of people vaccinated would not be able to transmit the virus. However, until final data sounds the all clear, warned Dr. Shaffer, people should continue to observe precautions with masks and social distancing.

Biden Roll Out

The best first step for the new administration must be to lead its Covid19 response based on science and clearly communicate its national policy, emphasizing “public health and scientific principles,”  said Dr. Shaffer. They also need to address the bottlenecks in vaccine distribution and reinforce they will work together with state and local levels to troubleshoot and resolve problems. Instituting a federal policy to ensure consistency in the COVID19 response across the country will be invaluable, he added.

Challenges Ahead

There is a real risk of politically driven resistance to the vaccine especially in rural areas and persuading people that it is safe and necessary will be quite difficult, Dr. Shaffer pointed out. But as demand grows for the vaccine, websites will have to handle thousands of people going online to make appointments, and venues will have to manage large cohorts arriving for their shot. A fair system needs to be established to ensure health equity in who gets the vaccine.


Meera Kymal is the Contributing Editor at India Currents
Image by Wilfried Pohnke from Pixabay

Vaccines Bring Hope As COVID’s Third Wave Hits

In welcome news and within a week of each other, pharmaceutical giants Pfizer and Moderna announced breakthrough vaccines to combat the deadly coronavirus.

Pfizer and its German collaborator BioNTech, say their vaccine may be 90% effective in preventing COVID19 in participants, while Massachusetts-based Moderna expects a vaccine efficacy of 94.5%.

It’s a promising sign in the yearlong battle against an out-of-control pandemic. But though the trends in clinical trials seem positive, don’t throw out your face masks just yet. Experts warn of a long wait before the general public gets access to these newly minted vaccines.

It may be spring 2021 before the vaccine is widely available, which means the coronavirus will continue unabated for a few months more. COVID19 positivity rates reported by the Kaiser Family Foundation indicate that every state is now a blood-red ‘hotspot.’

As epidemiologists predicted, the third wave of coronavirus ‘forest fires’ are raging across the country with devastating effect. Currently the US leads the worldwide COVID death toll at over 250K and counting; we also have surpassed the 11 million mark in total COVID cases.

Despite warnings from experts, the federal coronavirus task force failed to deliver a comprehensive plan to counter the coronavirus threat. In fact, their strategy has been to “just let the infection run…which is not based on science,” remarked Dr. Ashish Jha, Dean, School of Public Health at Brown University, at a November 13th EMS briefing on the pandemic.

Without adequate federal funding or guidelines, each state has devised its own COVID19 response, but many did not heed the science on containing the spread.

That haphazard approach has had catastrophic consequences. Coronavirus cases are surging across the country. Since November 1, more than 1000 Americans have died of the coronavirus everyday and that number is steadily rising.

“This is not a surprise,” said Dr. Nirav Shah of Stanford University’s Clinical Excellence Research Center. “We predicted that in the fall, with people staying indoors and without broad protections ..such as masking, and not gathering in large groups, the numbers would continue to rise.”

Desperate to jumpstart their economies and reopen businesses and schools for a populace weary of quarantines, lockdowns and job losses, states made some bad choices by ignoring the science, said Dr.Jha. Several states (the Dakotas for example), raced to get back to normal by rolling back restrictions on large gatherings, travel and mask mandates.  According to the AARP only 35 states mandated face coverings in public. In Boston for example, schools closed but casinos stayed open. “Those are the wrong tradeoffs,” added Dr. Jha.

Inevitably, the subsequent spike in COVID19 rates has left the country scrambling to reimpose certain restrictions; even so, cases are mounting. The Kaiser Family Foundation reports hotspots in every state. In fact, ‘super spreader’ events are happening even at the White House.

The COVID Tracking Project currently (as of Nov. 15) has recorded a staggering 76,000 hospitalizations and over 155,000 confirmed cases a day. Experts at the briefing say that figure is much higher.

“Hospitals are being overwhelmed,” warned Dr. Tung Ngyuen (Professor of Medicine, UCSF), as they face bed shortages and burnout from healthcare workers who have “been doing this close to seven or eight months now.”

“We are in the worst moment in the pandemic” said Dr. Jha. He admitted he is baffled by the disconnect between how bad things are and how little attention the country is paying to it. “Right now we have about 150 thousand new cases being identified every day. But the truth is that the true number of infections occurring in the US right now, is between 300 and 400 thousand a day, maybe even closer to 500 thousand. We’re missing them because our testing is inadequate. All those people who are not being identified are of course out there spreading it to others. We are in a moment of exponential growth. We will get to two thousand deaths a day by mid-December.”

Calling it ‘unconscionable,’ Dr. Jha estimates that a 100 thousand more people will die between now and Inauguration Day (January 20th).

However, the advent of two promising vaccines may be a start in the right direction, even though the world has a long wait before it’s rescued from the virus.

“The reality is that it’s just 10 to 20 million doses maximum by the end of the year,” said Dr. Shah. “But it’s going to be some time before we get the kind of widespread availability of multiple vaccines, with secure supply chains to get everyone the two doses they need to actually start to achieve even partial herd immunity.”

It’s unlikely the ‘mRNA vaccines’, created from brand new technology and currently awaiting FDA approval, will arrive before the year end warn experts. Initially, limited supplies of the vaccine will likely be rationed and given to frontline healthcare workers, the vulnerable and the elderly. It could be spring before most of America gets the vaccine.

Though the clinical trials have produced strong results, enough data is not yet available to determine the longevity of the vaccine’s effects, or even its side effects. No one knows what level of protection it will offer younger vs older people, or whether we will need regular vaccinations like the flu shot.

The logistics of storing and distributing the vaccine are equally difficult. The vaccine has to be stored at extremely low temperatures which will make its distribution to remote and rural areas challenging and especially so among communities of color, where “skepticism is high and strong.”

Realistically, to reap the benefits of having a vaccine, states global health expert Tom Bollyky, at least 75% of the population will need to be vaccinated and that will take time.

“We are entering the hardest days of the pandemic,”  said Dr. Jha on Twitter. “The next two months will see a lot of infections and deaths. But he added, “There is a light at the end of the tunnel. Today, that light got a bit brighter.”

The disregard for advice from health experts and a lack of trust in science have precipitated some of the worst outbreaks so far, so it’s time say experts, for leaders and the general public to “rebuild the trust” and to stop politicizing the science.

Getting back to normal in the short term will mean that people have to take precautions to avoid transmissions until they can roll up their sleeves to be immunized.

Testing has to ramp up. But in the meanwhile, said Dr. Jha, “Wearing masks are a good thing to do for yourself, you family and community.”


Meera Kymal is the contributing editor at India Currents

Photo by CDC on Unsplash