Covid Epi Weekly: First Sighting of Vaccine-Induced Immunity
Tom Frieden
President and CEO of Resolve to Save Lives. Former CDC director and NYC Health Commissioner. Focused on saving lives.
Imagine you’ve been on a dangerous sea voyage. One of 200 people over the age of 65 have perished as have many others. Safe land is sighted in the distance. Everyone on board must do everything possible to reduce deaths until safe harbor is reached.
At this stage of the pandemic, we’re facing a tale of two realities. On one hand, the U.S. is experiencing the worst spread of Covid since pandemic started. Cases, hospitalizations, and deaths continue to set records. At the same time, the rollout of highly effective, safe vaccines has given us the most hope we’ve had for a beginning of the end.
First, let’s discuss the latest epidemiology. It’s great that CDC and HHS have FINALLY been allowed to release some of the information they have. This information belongs to the public, not to anyone in Washington. It’s 10 months late, but the headline says it all.
Unfortunately, what the data shows isn’t great. Every US region and most counties for which there are data are at the highest level in terms of case incidence — more than 200 cases per 100,000 a week. That’s about six times the rate at which we figured contact tracing would be hard or impossible.
Counties across the US are sustained hotspots, meaning there is a high case burden and a risk of overwhelming health care systems. Here’s the point: the longer you delay closures, the longer you have to keep things shut, the higher the risk of overwhelmed ICUs, and the more people die.
Hospital beds are being filled by Covid patients. There were 156,000 admissions in the past week and there are more than 113,000 people currently hospitalized. Cases are still increasing, and a further increase in hospitalizations will follow. Note the increase after Thanksgiving in most regions.
This post-Thanksgiving bump is evident in cases and test positivity. With December holidays coming, it’s best to celebrate at home. When people travel, the virus travels. When people share air, the virus spreads. Not every state had a bump — protection protocols save lives.
Now that this CDC and HHS information is finally public, it’s clear what’s happening. There are very high rates in most of the country, but much of the country has seen decreases over the past week, particularly the Upper Midwest. The Thanksgiving surge is ebbing, just in time for the next holiday surge. Tennessee has become a new hottest spot: deeply red, deeply concerning.
It’s worth focusing on the graphic below, which gives a sense of both test positivity and trend. States all over the map are … all over the map. Some states are high and increasing, some are high and decreasing, some are staying high, and some are staying low. Hawaii, Vermont, and Maine are the Covid-safest places in the United States to be today.
Farewell and thanks to Covid Exit Strategy, which provided excellent data and visualizations of the state of the pandemic in the US. Welcome Covid Act Now, which will be taking its place. However, if CDC and HHS continue to improve their data sharing, these sites — and this weekly thread! — will become unnecessary. (I’d like that a lot!) Communication, based on facts, is an essential weapon to fight the pandemic.
Now for the view of the safe harbor — vaccine-induced immunity. It’s coming, but there will be barriers: production, distribution, adverse events, uptake, and more. It won’t be fast or easy, but it will happen. Two authorized vaccines are good, four authorized vaccines will be better. More are coming next year.
Production is a big unknown. Johnson & Johnson is the only company that has extensive vaccine production experience of the first four companies likely to have a vaccine. We can expect adverse events -- some related to vaccines, some not. Complete transparency and immediate communication are both essential.
There’s not enough vaccine now, so we MUST do better protecting the most vulnerable. There have been horrific outbreaks and deaths in nursing homes, the grim harvest of misguided advice to let infections spread among young people. Monoclonal antibody treatment must be scaled up fast. It’s simply inexcusable that this isn’t happening.
It’s misguided to debate whether the elderly or essential workers should get vaccinated first. Essential workers who are more likely to be infected and die (for example, a bus driver with diabetes) should also be at the front of the line. But an 85-year-old is at massively higher risk than a 65-year-old. Granularity can help de-conflict. ACIP guidelines released over the weekend are sensible and thoughtful; key will be fair and effective allocation. The beginnings of would could be one encouraging example from Tennessee.
Outbreaks and deaths among incarcerated people continue. Sensible decarceration is a public health and ethical imperative. A prison sentence shouldn’t be a death sentence.
We’ve made some progress on global vaccine access -- potentially 2 billion doses will be made available to countries through COVAX. More doses, more money, and more support for vaccination programs are all needed. Ironically, many countries last on line for the vaccine have vaccination systems that are best able to deliver it.
It’s literally now or never to fix public health at local, city, state, national, global levels. If this isn’t a teachable moment, there will never be one. Vaccination may end this pandemic, but not the risk of pandemics. Money, technical capacity, and operational capacity are all needed.
We must work together to make 2021 the year the world got serious about preventing pandemics.
So we come to the end of my last weekly analysis of this awful year. We’re in this world together. Those who die diminish us all. Those who build community strengthen us all. Seasons and years pass.
What could possibly be more important than preventing disability and death?
“As are generations of leaves, so are those of humanity.
The wind scatters leaves on the ground, but the trees burgeon
With leaves again when the spring season returns.
So one generation of people will rise while another dies.”
-Homer, The Iliad
Tom Frieden Access to health and health data is a human right ... right ?