The Pandemic Surges, But Vaccines Are Coming
By Nayyer Ali MD
With the US elections out of the way, attention is shifting back to the massive surge of COVID infections occurring in both the US and Europe. In per capita terms, it is even worse in places like the UK, France, Spain, Italy, Poland, and Russia, than it is in the US, but case counts are surging to massive levels everywhere. While Europeans did a great job of suppressing the virus in the late spring and summer, they let their guard down and renewed social interaction has led to a massive rise in both cases and deaths.
The US is a slightly different case. Because of its large size, the original wave of infection was concentrated in New York City, and in nearby areas like New Jersey and Massachusetts. With harsh lockdowns, the Northeast got the pandemic under control. A second wave hit the sunbelt in July, with surging cases and deaths in Florida, Texas, Arizona, and to a lesser extent, Southern California. But by September, case counts had dropped and deaths nationally had dropped to about 700 daily. Still bad, but much better than the 2500 per day in April.
However, with the passage of time, the virus has gradually seeped into all fifty states, and into rural areas with little disease earlier this year. We are now seeing massive spikes of new infections all around the country, but particularly in the Midwest and upper Plains, places like the Dakotas, Wisconsin, Illinois, and Michigan. The US is now suffering over 170,000 new infections per day.
While new infections have surged, the corresponding rise in hospitalizations and deaths have lagged by a 2-3 weeks. But that is now rapidly catching up. Hospitalizations are at a record national high now, and deaths are climbing. The US is now averaging 1,200 deaths per day, but within a few weeks that number should rise to over 2,000. If governments do not take aggressive action, cases could go over 200,000 per day in the next 2 weeks, and deaths could reach 3-4 thousand per day by New Year.
Unfortunately, there remains little or no coordinated federal response. It is simply each state and county for itself. This is no way to manage a national emergency. President Trump is chasing his own demons about a rigged election causing his defeat, and appears to have no interest in guiding the country through this mess. He has not attended a single meeting of the White House Coronavirus Task Force in several months, and takes medical advice from a radiologist who has no expertise in infectious disease but has many appearances on Fox News.
President-Elect Biden is stuck. He has no authority until January 20, and even if he were to speak out and denounce Trump’s inaction, it would likely not result in much positive response. He must sit and wait. When he enters the White House, if the pandemic is truly out of control and 5,000 people are dying every day, then he will have no choice but impose a hard national lockdown to bring infections down. This might need to last six weeks.
Despite a rather gloomy winter heading our way, there are some bright lights at the end of the tunnel. Two major American firms, Pfizer and Moderna, have reported that their vaccines work extremely well in the large 30,000 patient trials they have just completed. In both cases, the companies were using a brand new vaccine technology that involves injecting muscle with RNA that codes for viral protein. No actual virus is used. RNA is similar to DNA, but it has the ability to use the cells machinery to translate the RNA into a protein. By coding for the critical spike protein of COVID, the patient’s own muscles are tricked into releasing these proteins for a few days which then interact with and incite an immune system response that creates immunity to future infection.
When vaccines were first being designed earlier this year, the FDA wanted proof that the vaccines were at least 50% effective for them to earn approval. Both the Pfizer and Moderna vaccines were over 90% effective. This is wonderful news. The full data from the trials needs to be submitted to the FDA, and the FDA will then hopefully grant Emergency Use Authorization. The companies can each make about 20 million vaccine doses per month (each patient needs two doses of vaccine a few weeks apart). We should start seeing the first groups get vaccinated in late December or early January. These will be the extremely elderly, health care workers, and perhaps first responders and transport workers that have to interact with a lot of the public.
By March widespread vaccination will be available for the country. There will likely be some anti-vaxxers who refuse the vaccine, but there will be a lot of pressure on people to get vaccinated. Children and university students will likely not be allowed into school without vaccines. Many professions like health care, transport, food service, hospitality, schools and education, tourism, travel, and police and fire will be required by their employers to be vaccinated. The elderly will vaccinate readily as they are the most susceptible to severe illness. Foreign travel may even require proof of vaccination to enter other parts of the world from the US and vice versa.
While Pfizer and Moderna were the first two to report positive results, there are several other groups that are close to reporting their final results. Combined, these companies will be able to make enough vaccine to immunize almost everyone on the planet next year that is high or medium risk, and most that are low risk. Third World countries, because their age distribution is much younger, have suffered much lower death rates and serious illnesses from COVID. Thankfully for humanity, COVID is not a difficult virus to immunize against. Not like the flu, or HIV for which no vaccine has ever been developed. COVID is a simple virus that does not shape shift and mutate rapidly allowing it to get past our immune responses. As such, mass vaccination will allow us to get back to normal rather quickly. We may finally be able to take off our masks before the end of Spring 2021.
