Covid Epi Weekly: To Arms, To Arms!

  1. Denominators: What percentage of nursing home residents and staff have been vaccinated? This is the highest risk group; vaccinating these people will sharply reduce spread in long-term care facilities and greatly reduce deaths, even if the overall number of cases in the entire population isn’t substantially reduced.
  2. Improve equity. We need to do better at reaching Black, Latinx, Native American, and all underserved groups now. Racial and ethnic minorities experience disproportionately higher rates of hospitalizations and deaths. They also make up a disproportionately large segment of our front-line workforce — health care workers as well as store employees, delivery drivers, teachers, and everyone else who risks their health by keeping our economy and society functional.

How fast can vaccination help?

Some encouraging data from Israel. The more quickly we vaccinate, the more quickly we reduce deaths. How fast can vaccination against COVID-19 make a difference? Two weeks after 40% of those over 60 who had been vaccinated, the number of critically ill in the age 60+ group grew by 7% compared with the previous week’s growth of over 30%. There was less of a decrease in the growth of critically ill among the 40–55 age group — who were not as widely vaccinated as those over 60. If this trend continues, hospitalizations and deaths may already be dropping.

Source: The Economist. Rapid decrease in critical illness following vaccination.

Better, but still bad

First, let’s get clear about the epidemiology and continued trajectory of the pandemic. Better does NOT mean good!!! In this case, it just means less terrible. The peak of hospitalizations in the prior two Covid surges in the US this past spring and summer was 60,000. Now we’re at 100,000. So our lower number is nearly double what it was at any prior peak.

Vaccine news

There have been a lot of scientific developments on vaccine, not all of of which are encouraging.

Adapt or else!

SARS-Cov-2 is evolving to adapt to the human context. As we develop vaccines and as more people become infected, the virus will mutate to evade our defenses. We may eventually need multivalent vaccines to fight these multiple strains. This wouldn’t be new. Vaccine protects against 3 different strains of polio, up to 9 of HPV, and up to 23 different pneumococcal strains. This could be where we’re headed with Covid vaccines, but it’s far too soon to know this for sure.

Ramp up vaccination

We can use four platforms to get as many people vaccinated as quickly as vaccines are ready:

  1. Mass vaccination clinics (there’s a great article describing how LA’s Dodger Stadium has been transformed into a high throughput vaccination center) — but it’s important not to reduce post-vaccination observation time to less than 15 minutes in case of very rare but potentially serious allergic reactions
  2. Pharmacies (chains as well as independent pharmacies)
  3. Pop-up, community-outreach sites set up anywhere they are needed that could be run by any of the first three.‌

Protect our health care workers

We also need to make sure we protect health care workers as Amanda McClelland and I wrote for CNN. Countries all over the world have failed our caregivers for far too long. We must improve infection prevention and control in all health facilities, strengthen training and continued education so health workers can stay up to date on best practices, and provide socioeconomic, legal, and other support, as well as PPE of course, so they can continue to save lives when we need them most.

Vaccine nationalism

Vaccine nationalism — and failure to support developing economies with massive vaccination campaigns — is self-defeating. New financial modeling by the ICC World Business Organization warns of the cost of vaccine nationalism: $9.2 trillion, with nearly half, $4.5 trillion, incurred by wealthy economies including the United States.

  1. Don’t focus on individual variants. What variants are telling us is the virus is wily: it can evade our defenses. We need better tracking of not just genomes but how they relate to epidemiology. More infectious variants will spread — that’s how natural selection works.
  2. Masking is important. A mask not worn doesn’t protect anyone; any mask is a lot better than none. Better masks might reduce spread, but this is far from certain. Double masking, surgical masks, and N95/K95/KN94 masks all have theoretical benefits, but the key is to increase the proportion of time people wear ANY mask when they’re in an at-risk situation.
  3. Improve implementation of our “Box It In” strategy to test/isolate/trace/quarantine, even if we can’t do much at the current sky-high levels of spread. When cases come down, we need to be ready to reduce spread even further through rapid isolation and effective tracing. This will help reduce emergence of escape-mutant strains and protect our vaccines so they continue to work.
  4. Congress must act, and act quickly. Funds are needed to reimburse people for isolating or quarantining in order to prevent spread to others. For paid sick leave. For the US Public Health Job Corps. For schools to stay open more safely. For restaurants and bars to stay afloat while they are closed. To protect our country by improving global health security. And much more.‌

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Dr. Tom Frieden

Dr. Tom Frieden

President and CEO, Resolve to Save Lives | Former CDC Director and NYC Health Commissioner | Focused on saving lives. twitter.com/drtomfrieden