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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


 

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

Take the Time, Check In

WHO reports suicide is the second leading cause of death among 15-29 year-olds globally, with a total of 800,000 lives lost every year. This data was compiled pre-pandemic and the assumption is that this year the data is going to look worse. 

As an actor and storyteller, I wanted to capture mental health in a short story, focus on one of the potential solutions, and drive that point home. It was an active decision to remove focus from the underlying reasons for depression. As of late, we’ve learned that depression can happen without an obvious trigger, as in the case of Deepika Padukone.

As one would expect, initially it took time to find people who wanted to invest time in a project about mental health but I found my key collaborators – Christina Perez and Emmanuel Vega. Christina Perez directed, edited, and created the background score. Emmanuel worked the sound and lights, among other things. The shoot was done in one location and completed in 3 hours.

In these trying times, the relevance of the message has increased and the collective consciousness has been almost forced to develop empathy to understand it. However, the message was relevant even before and will remain relevant even after. The ending of the short was designed to be something that lived online given the ubiquity and the growing relevance of the Internet in the current world. 

As a volunteer project, my team and I have nothing to gain from this video other than spreading a beneficial message. Please take the time, just 96 seconds, to watch the short film below!

Since the release of the short, the response has been very positive. A young musician from Kerala was inspired by the short and composed a song using the visuals from the short film. A doctor messaged me and said how this movie had impacted him; he started making calls to his coworkers to check in on them as they are working 80 hours/week.

Almost everyone who watched the short has loved the art and has had a key takeaway from it, however, not many have watched it. While it may seem that 70k views are a lot, remember that 800,000 people die due to mental health every year. We are just getting started!

Uday Krishna is an actor, writer, and data professional. Uday has acted in a bunch of shorts, plays, commercials and has written/directed plays and shorts.

World Health Organization: The Lost Genie

Love him or hate him, you can’t ignore US President, Donald Trump. Known for not mincing his words and rarely playing diplomatically, he recently tweeted that, Corona Virus is a very bad ‘gift’ from China to the World. 

https://twitter.com/realDonaldTrump/status/1266014911127306240?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1266014911127306240&ref_url=https%3A%2F%2Findianexpress.com%2Farticle%2Fworld%2Fvery-bad-gift-from-china-trump-in-his-latest-rant-on-coronavirus-pandemic-6431932%2F

Whatever Trump says or does makes a difference. He has provisionally suspended the funding to the World Health Organization (WHO) and accused the WHO of being Pro-China, mishandling the Corona Crisis. A few days back he wrote a letter to the Director-General of the WHO, threatening to exit the global organization. 

Dr. Tedros Adhanom Ghebreyesus, Director-General of WHO.

And now he has finally announced to end US’ relationship with the World Health Organization… 

It is evident in history that whenever any crisis emerges, it challenges all the previously existing structures, organizations, and institutions. A global crisis like COVID-19 is very much capable of either reducing our existing institutions as redundant or tagging them as completely outdated.

Donald Trump has put WHO in an embarrassing spotlight and while, we may or may not agree with him, we also cannot ignore a few basic analysis points.

WHO came into existence on 7th April 1948 and its identity centered around the global population’s health. WHO, as a global health body, should be held liable, accountable, and responsible for missteps regarding the current pandemic.

Covid-19 has threatened the very existence of humanity. The invisible attack has proved that the WHO is not adequate enough for serving Global Health.

From the very beginning of the pandemic, WHO failed to gather timely information with its epidemic surveillance system, and paradoxically praised China for its effort to contain the virus. 

China mislead the World, as well as the WHO, about COVID-19, many global reports clearly suggest. Whistleblowers were targeted by the Chinese government and human-to-human transmission was completely denied, initially. WHO should have kept a close eye on misinformation and disinformation surrounding COVID-19.

WHO is obligated to inform communities about their rights and obligations with respect to health. Undeniably, acting as ‘Information Intermediary’ is the most vital function of WHO.

If one goes on to analyze the WHO’s Constitution, Article 1, states the objective of WHO is the attainment of the highest possible health for all. Article 2, highlights various functions of WHO, which include taking all ‘Necessary Action’ required to attain the highest possible level of health. Note that, Article 2(q), says that it is the function of WHO to provide information, counsel, and assist in health-related fields. Article 2(r), says that WHO work will be to assist in developing an ‘Informed Opinion’ among all the people about any matter related to health. 

Generally, there are few distinguishing essentials that determine efficient governance by any international organization.

First, the one who leads the organization makes a significant difference. Without a proactive leader, an organization as paramount as WHO may remain inert and passive. This is especially true in WHO’s context, where Article 28(i), authorizes the Director-General of WHO to take all necessary steps to combat epidemics.

Second, what power does the organization has if any member State violates its guidelines or recommendation?

According to the WHO’s constitution, Article 63 mentions that each member shall communicate promptly to WHO on important laws, regulations, official reports, and statistics related to health. Article 64 says that each member shall provide statistical, epidemiological reports in a manner determined by the Health Assembly. And Article 65 points that each member State shall transmit on the request of the Board such additional information pertaining to health.

To ensure the credibility of any organization, it is most important that its guidelines are binding on member States. In case any member violates its mandate, then the organization should have the power to penalize it. 

Lastly, the organization’s source of funding should be transparent and autonomous. Independent sources of funding make a tremendous difference in the efficiency of any organization. Financial autonomy plays a very significant role in making any institution equitable, fair, neutral, and bold in taking decisions. But WHO lacks financial autonomy and transparency in its funding.

USA has been the biggest donor to WHO contributing almost 15 percent of its total Budget under Assessed Contribution, the amount each member State pays to WHO according to the GDP. Over time, the Assessed Contribution has declined and Voluntary Contributions have risen, which include funds from private organizations. This reliance on Voluntary Contributions should be reduced to contain transparency of funding.

One thing that is clear is that the WHO has a GREAT responsibility in global health scenarios. The saying goes “with great power comes great responsibility” but the saying holds true the other way around as well. At least some bare minimum power is needed to ensure the efficient working of any institution. If this great responsibility is not complemented with bold, autonomous decision-making power, then failure of such an institution shouldn’t be surprising at all. 

Priyanka Singh is an Economics Assistant Professor, Delhi University(India). 

Sujeet Singh is Political Science Assistant Professor, Delhi University(India).


Featured image by Thorkild Tylleskar and license here.

Image of Director-General by ITU Pictures from Geneva, Switzerland and license here.

Unity in the Face of Virus-That-Must-Not-Be-Named

“This is the Ministry of Magic all over again!” I said.

The Ministry of Magic, as Harry Potter fans know, completely botched up the rise of Voldemort. The Minister and his administration were in denial, then went on a campaign of outright lying with false facts, bravado, and then a rude reckoning of the truth. The Order of the Phoenix is one of those books that really opens our eyes to incompetent leaders.

We were discussing the United States’ handling of the Coronavirus, COVID-19 health threat.

Everywhere on social media there was information – some true, some untrue, some alarmist, some pacifist, many telling us not to worry, but worrisome all the same. Our President, it seems, has not yet arrived at the true reckoning of the situation, and continued his bravado. The President blundered on about his building walls to stop the spread, his biggest problem seemed to be the Stock market index.

Meanwhile, the CDC did not have enough testing kits ready, so we do not know how pervasive the situation really is. While unprecedented, it is also concerning that we knew the world is more connected than ever, and yet did not prepare as a country. 

Vox article: here indicating that US is lagging behind most developed countries for testing Covid-19.

The World Health Organization declared the situation a pandemic on Mar 13th 2020. A pandemic knows no borders. Derived from the Greek roots, pan meaning “all” and demos meaning “people”, it denotes diseases that spread across multiple continents or worldwide.

The article here on WHO site lists the stages of planning and preparedness required for a pandemic. 

We all pass through phases of denial, a state of holy-moly, and a surreal settling in to things. (I had been vacillating between astonished denial & mild panic, up until the 1st week of March in California). We do the best we can. We see the terms quarantine & social distancing, and try to come to terms with this new mode of functioning. We are social animals now united by the need for social distancing.

Our company announced an ‘Encouraged to Work From Home policy’ like many other tech companies. That has now been upped to a ‘Mandatory Work From Home’. I know many of us used the public transit systems to get to the office, so we were obviously grateful to be told this, and to have the kind of jobs that can be done remotely for a short period of time. It was not lost on me that a great many people did not have the same luxury. What will this mean for them?

Covid-19 is unprecedented for many of us. People who had lived through the SARS outbreak 18 years earlier are probably the ones who have seen something similar in their lifetimes. For the vast majority of us though, this is new territory. How do we determine the best sources of information?

How do we learn lessons from the countries who are already dealing with the situation? Taiwan, China, Singapore. How did Italy quarantine their entire populace? What are the ways in which Society will be affected with this social distancing? It remains to be seen.

While the man at the top may not be taking Covid-19 as seriously as he should, local & state governments stepped up with proactive measures such as a call for Sheltering-in-place that was imposed across 7 counties in the Bay area affecting more than 7 million people. These are unprecedented measures. People are turning to their local leaders in their times of need. Many organizations have gone above and beyond canceling unnecessary travel, conferences, gatherings etc.  

To protect the vulnerable among us, we will need immediate plans, short-to-medium term plans and long term plans. We are currently in the immediate response mode. 

Humanity always comes together in the best & worst of times. When our leaders do not provide timely guidance, our collective reasoning can, and much like the Wizarding World united in the face of Voldemort, I am sure we shall do the same this time around: by collectively, voluntarily, distancing ourselves socially, being responsible, and putting the greater good ahead of us.

  • If you are reading every article on Covid-19, and wondering what to do in all the doomsday scenarios described, take heart, practice social distancing and follow guidelines set out by the WHO & CDC. 
  • If you are taking Covid-19 far too lightly and continuing to hang out with your friends, please watch this TED talk given by Bill Gates in 2015. He says our next big catastrophe to prepare for is not missiles but microbes. 

This time, it seems we are struggling against the onslaught of the Coronavirus.

The tiniest virus, it seems, brings us closer to the human condition than any other thing can. We are human and are therefore at risk.

Saumya Balasubramanian writes regularly at nourishncherish.wordpress.com. Some of her articles have been published in San Francisco Chronicle, The Hindu and India Currents. She lives with her family in the Bay Area where she lilts along savoring the ability to find humor in everyday life and finding joy in the little things.


Image licence can be found here.