COVID-19 DIARIES, WEEK OF 4 DECEMBER 2020

Vaccines Alone Aren’t Enough

Impressive as they are, vaccines are only one element of the public-health toolkit

About the coronavirus vaccines now under development: There are dozens of them, and while the safety of each will be independently verified before public distribution, vaccines are not by themselves a panacea. We will need continued vigilance and good public-health hygiene for several more months after initial distribution.

I’m very encouraged by what I’ve read about mRNA vaccines, and not just for coronavirus treatment. I plan to get one of these vaccines as soon as I can, but recognize I’ll need to continue to take precautions well after that.

There are three issues here, all related: Fear of vaccinations, vaccine effectiveness, and vaccines in the larger public-health context.

Suspicions about vaccines, especially rapidly developed ones, are understandable. Vaccine development, testing, and distribution often takes 5–20 years, but there is at least one recent precedent for a safe, successful vaccine created and distributed much faster.

Following an ebola outbreak in the mid 2010s, a vaccine developed by the CDC and permitted under a compassionate use protocol effectively slowed the disease’s progression. Even though ebola is much more virulent than the novel coronavirus, the result was only two U.S. deaths.

There is a sizable percentage of antivaxxers, exact number unknown, for whom any vaccine is anathema. I’ve yet to see an evidence-backed argument from this group that stands up to scrutiny.

There are others, especially African-Americans, whose distrust of government-run vaccine programs is based on hard evidence, even though COVID-19 kills 2x more African-Americans than whites.

We have a terrible history of testing medicines on disadvantaged groups, often without their knowledge or consent; consider, for example, the Tuskegee study that continued to leave subjects with untreated syphilis even after a treatment became available. Education and transparency are essential parts of public health, at least as important as the vaccine itself.

As for vaccine effectiveness, there’s evidence that even with the mRNA vaccines it will take 6–8 weeks from first dose to reach full protection. Again, public education is key here to warn against the temptation of returning to normal as soon as a vaccine is available. Quoting David Liu, a chemistry and biology professor at Harvard and HHMI, “Don’t fumble on the 1-yard line!”

The pandemic won’t disappear as soon as vaccinations begin. That brings up the final issue: What are the other tools at our disposal?

The places with the greatest success in COVID-19 control have effective regimens of large-scale masking, testing, tracing, and containment. We could do all these things at much greater scale, and with greater coordination between public-health agencies at all levels.

Consider, for example, that testing this past week fell by 2% nationally and 14% in California despite the week’s dire news about virus spread. (See complete statistics at the end of this report.) Efforts at contact tracing and containment remain spotty as well.

This was a grim week in US coronavirus history. We’re now averaging nearly 200,000 new cases per day; hospitalizations are at record levels; and deaths shot up 31% compared with the previous week.

One bit of potentially good news is that new-case rates are falling in 16 states, including Great Plains and Midwestern areas that had been the most infectious places on Earth for the past few weeks. Still, new-case rates are rising in 32 other states.

In California, the virus continues to spread at a rapid rate. New cases, hospitalizations, ICU admissions, and deaths all rose by double-digit percentages compared with the previous week.

Despite somewhat lower new-case rates in Midwestern and Great Plains states, much of the nation remains in the most infectious tier, with more than 1,000 new cases per million people. California is “only” in the third most-infectious tier, but the situation here is rapidly deteriorating. ICU availability in the Southern California region fell below 14% late Friday. In Ventura County, ICU availability fell from 18% to 14% this past Wednesday.

Public-health measures such as mask-wearing and physical distancing continue to meet resistance. Multiple sheriffs around California won’t enforce public-health orders, leading to continued impunity.

Another approach is herd immunity — the point where a sufficiently large group of the population becomes immune to a disease — but it hasn’t worked in the absence of a vaccine.

Even Sweden, which long tried to contain the virus without orders for masking and other restrictions, this week ended its experiment in the face of evidence its approach has failed. Last week, the country recorded its 7,000th coronavirus death. In contrast, its neighbors Denmark, Finland, and Norway — all of which did institute safety measures — have recorded 878, 415, and 354 deaths respectively.

None of these situations maps neatly onto the US. We have some unique challenges, such as the politicization of mask wearing and, importantly, relatively high rates of obesity, diabetes, and other diseases that complicate responses to any public-health crisis.

Above and beyond that, we chose our current path. Early on in the spread of the virus, the Trump administration, in consultation with public-health officials and drug makers, made the decision that rapid vaccine development would be our primary response.

There’s no point in arguing now whether that decision was correct; it’s where we are. And whatever one thinks of the administration’s response — and I think it’s generally been a train wreck — the scale and speed of vaccine development is impressive and unprecedented.

The important thing, it seems to me, is that a big bet on vaccines doesn’t rule out other measures, measures we’ll need for the next few months.

We can do more than one thing at a time — vaccinate and mask and test and contain. Be safe out there!

Here are this week’s coronavirus stats, all sourced from covidtracking.com.

US stats for the week ending Friday, December 4 (with % change from previous week):

Total tests (positive, negative, pending): 12,086,086 (-2%)
Average daily tests this week: 1,726,584
Average daily tests last week: 1,759,249
New cases: 1,244,935 (+8%)

Average daily new cases this week: 177,848
Average daily new cases last week: 164,600
Cumulative US cases: 14,146,191

Confirmed COVID-19 hospitalizations: 101,276 (+13%)
Average daily hospital patients this week: 97,485
Average daily hospital patients last week: 87,319

Confirmed COVID-19 ICU patients: 19,858 (+10%)
Average daily ICU patients this week: 19,149
Average daily ICU patients last week: 17,068

Deaths: 13,659 (+31%)
Average daily deaths this week: 1,951
Average daily deaths last week: 1,481
Cumulative US deaths: 269,791

CA stats for the week ending Friday, December 4 (with % change from previous week):

Total tests (positive, negative, pending): 1,359,560 (-14%)
Average daily tests this week: 194,223
Average daily tests last week: 226,481

New cases: 115,233 (+16%)
Average daily new cases this week: 16,462
Average daily new cases last week: 14,150
Cumulative CA cases: 1,286,557

Confirmed COVID-19 hospitalizations: 9,948 (+35%)
Average daily hospital patients this week: 8,932
Average daily hospital patients last week: 6,599

Confirmed COVID-19 ICU patients: 2,248 (+30%)
Average daily ICU patients this week: 2,003
Average daily ICU patients last week: 1,512

Deaths: 549 (+15%)
Average daily deaths this week: 78
Average daily deaths last week: 68
Cumulative CA deaths: 19,582