Issue 32: Vaccines Just Out of Reach
10.24.20| We'll have effective Covid vaccines soon, but there's a chasm of infections to cross between now and then
Hello,
Nationwide, Thursday and Friday of this week set back-to-back records for new Coronavirus infections, in an unprecedentedly broad-based surge of the virus that saw 14 states simultaneously set their highest-ever seven day averages for new cases. Wisconsin has opened up a field hospital on its state fair grounds to handle patient overflow. Utah’s ICUs are at capacity. And where earlier state-level outbreaks, like Arizona’s, were curbed by mask mandates and business closures, new intervention measures are unlikely in many of the hardest hit states and regions. We could well be entering some of the darkest weeks of the pandemic.
And yet, several vaccine candidates are tantalizingly close to approval. They will not arrive in time to stave off the worst of the coming wave, but they do offer substantial hope for the spring and summer.
It’s worth noting that, as infections surge across the country, the White House Coronavirus Task Force has been largely sidelined and fractured by internal divisions. The task force has not met directly with the president in “quite some time,” Dr. Francis Collins, director of the National Institutes of Health told NPR this week. I really recommend listening to his interview, which is revealing of both where we are with vaccines and where we are with the rest of the federal response.
The president gets most of his information on the pandemic from Vice President Mike Pence and Dr. Scott Atlas, Collins continued. Atlas, it bears repeating, does not have any expertise in infectious disease and has endorsed the roundly-rejected Great Barrington Declaration, which argues for a herd immunity approach to fighting the pandemic. The president, as he did in the final presidential debate this week, is fond of citing epidemiological modeling from early in the pandemic that forecast more than 2 million deaths in the U.S. over the course of the crisis, and saying that his administration’s actions avoided that worst outcome. Except that 2.2 million fatality figure was for a scenario without any non-pharmaceutical health interventions, which is essentially what the Great Barrington Declaration recommends.
The paralysis of the Covid task force has led to a sort of Great-Barrington-by-default on the national level. “If your goal is to do nothing, then you create a situation in which it looks okay to do nothing [and] you find some experts to make it complicated,” epidemiologist Marc Lipsitch told The Washington Post, commenting as part of an assessment by the paper of the task force’s recent effectiveness. The White House has “given up on everything else” to end the pandemic except for mass vaccination, a senior administration official told the Post. “It’s too hard of a slog.”
So the next few weeks will have a sort of strange dissonance to them. We’re likely to see truly truly troubling rates of infection, hospitalization, and death, while at the same time the first interim reports from the Phase 3 vaccine trials will be released, hopefully showing that the shots are at least 50 percent effective. There are currently five vaccine candidates in Phase 3 trials in the U.S. alone. Moderna, which is fielding one of those candidates, expects to release its interim efficacy results as early as next month.
If the interim data show that a candidate is effective and safe, vaccine makers will begin to seek regulatory approval from the FDA, a process that could take until January. But once that approval is won, distribution should be relatively rapid, since under the aegis of Operation Warp Speed, vaccine makers have been manufacturing candidate doses to keep stockpiled for distribution the moment they’re approved. That distribution process is itself full of intrigue and difficulty — the vaccine candidate stockpiles are currently kept in secret locations to ward off potential theft, and tight security precautions are being set up across the supply chain to prevent diversions and counterfeits.
The approval and release of Covid vaccines will be necessary but not sufficient on their own to really bring the pandemic to an end. And even after a hypothetical January approval we will need additional months of safety data to be fully confident that there are no long-term health effects associated with the shots, a process that may be hampered by the fact that the Trump administration last year disbanded the National Vaccine Program Office, merging it into other programs within the Department of Health and Human Services.
Still, effective mass vaccination will do a great deal to alleviate suffering once it’s available. That future should arrive in a few months. But not in time to turn back what seems likely to be an extremely difficult period between now and January of next year.
[Capped vials being produced in Italy for the Oxford University/AstraZeneca Covid vaccine candidate. Vincenzo Pinto for Agence France-Presse]
// Link Roundup
Redefining ‘close contact’: Since the start of the pandemic, it looked like Covid mostly transmitted between people who spent a fairly long time together — more than 15 minutes, as a rule of thumb. That’s still probably where most transmission occurs, but the CDC reports a case of a corrections officer who contracted the disease after several brief (less than one minute each but 17 minutes cumulative) close interactions with incarcerated or detained people who were Covid positive but asymptomatic. The officer wore a mask and goggles for all encounters; the detainees were masked for most but not all of those interactions. The CDC also announced this week that it was changing its guidelines for what counts as close contact with a Covid-positive person, to 15 minutes cumulative over a 24 hour period, rather than 15 minutes of sustained contact.
— “Covid-19 in a Correctional Facility Employee Following Multiple Brief Exposures to Persons with COVID-19 — Vermont, July–August 2020.” Julia C. Pringle et al, CDC MMWR.
— “CDC Expands Definition of ‘Close Contacts,’ After Study Suggests Covid-19 Can be Passed in Brief Interactions.” Andrew Joseph, STAT News.
— “CDC Expands Definition of Who is a ‘Close Contact’ of An Individual With Covid-19.” Lena Sun, The Washington Post.Election infections: In the closing weeks of the campaign, the president has held a string of large outdoor rallies. Often, in their wake, Covid outbreaks have flared up in the communities where the rallies were held.
— “Community Outbreaks of Covid-19 Often Emerge After Trump’s Campaign Rallies.” Zach Nayer, STAT News.
— “Almost Two Dozen COVID-19 Infections Tied to Trump’s Minnesota Rallies.” Daniel Politi, Slate.
— “Rising Covid-19 Cases Raise Worries About Trump Rallies.” Jessie Hellmann, The Hill.An unstoppable festival: The Sturgis Motorcycle Rally in August was very probably the largest in-person mass gathering in the world since the pandemic began, drawing some 500,000 people from around the country to South Dakota. City officials in Sturgis say they considered calling off the event, but worried a wave of motorcycle enthusiasts would come regardless, so they might as well plan for it. Weeks later, the Dakotas led the country in per-capita Coronavirus infections and the region had become a new epicenter of the pandemic.
— “How the Sturgis Motorcycle Rally May Have Spread Coronavirus Across the Upper Midwest.” Brittany Shammas and Lena H. Sun, The Washington Post.Planning for the holidays: Around the world, major holidays have been inflection points setting off new surges of Covid — the Labor Day and Memorial Day weekends in the U.S., the Chinese New Year, Purim in Israel, and Nowruz in Iran. Now, Thanksgiving is approaching amid a record-setting resurgence of the disease in the U.S., and health experts caution against large, in-person family gatherings for the holiday. “Let this be your COVID year,” epidemiologist Michael Osterholm told Kaiser Health News. “It’s a very challenging year, but you don’t want to introduce this virus into family settings and experience the consequences.”
— “Travel on Thanksgiving? Pass the Covid.” Anna Almendrala, Kaiser Health News.“The pandemic is like a mirror”: This is an extraordinary piece on life in Wuhan, China in the months after the city was unsealed following its initial lockdown, as people try to make sense of the sacrifices, losses, and victories of that early period. In a stand-out passage, a manager who worked on the rapid construction of isolation facilities in the frenzied quarantine period tells writer Peter Hessler “the pandemic is like a mirror. A person can see himself more clearly, both his good qualities and his bad qualities.”
— “The Sealed City.” Peter Hessler, The New Yorker.About those deluxe preparedness kits: While you’re looking ahead to a long winter, maybe you’re thinking about building a little emergency stockpile. If you see an ad for one of those slick, fashionable preparedness kits, close the tab and move on to something else. You can’t buy preparedness. The point of assembling a Go Bag is thinking through your unique needs, strengths and vulnerabilities, and talking with your friends, neighbors, and family about what you all might do in a disaster. Preparedness is a lot like heart health. It’s not something you can buy at the last minute right when you need it, or stockpile and forget until something goes wrong. It has to be built up and maintained over time. Buying one of these high-end kits separates you from your money and almost certainly leaves you less prepared. More in the article below.
— “Meet the Prepsters: Inside the World of High-End Apocalypse Gear.” Mira Ptacin, InsideHook.Listening to Covid-19: Late last month I gave a talk with my colleague Denise Milstein outlining some of our preliminary findings from the Covid oral history project we’re conducting. We analyzed 90 interviews conducted between April and the end of May to better understand how the crisis manifested itself in the social and relational lives of New Yorkers. A recording of our talk just became available, and you can see it here.
— “Listening to Covid-19: Oral Histories of New York in Pandemic.” Denise Milstein and Ryan Hagen, The Heyman Institute for the Humanities.
That’s it for this week. See you in your inbox next Saturday! As always, if you find the newsletter helpful, share it with a friend. If you haven’t already, subscribe through the box below.