As the USA approaches the once-unthinkable threshold of 300,000 COVID-19 deaths Sunday, experts fear the country is hurtling nonstop toward the next milestone of surpassing the total of American fatalities in World War II – even as vaccines are on the way.
A weeks-long surge in coronavirus transmission, leading to an average of more than 210,000 new infections and nearly 2,500 deaths a day this month, has public health experts considering the next major round number practically inevitable. According to Johns Hopkins University data, the USA had recorded more than 298,000 coronavirus deaths as of 1:30 p.m. EST on Sunday.
Robert Redfield, director of the Centers for Disease Control and Prevention, warned the country could reach 450,000 fatalities before Feb. 1, days short of the one-year anniversary of the first known COVID-19 death in the USA.
The influential model from the University of Washington’s Institute for Health Metrics and Evaluation predicts more than 460,000 deaths by March 1, with or without a rapid vaccine rollout. By comparison, about 405,000 American service members perished in World War II over nearly four years.
“The way the number of infections has been growing so fast, it’s hard to believe we won’t be at half a million deaths,” said Dr. John Swartzberg, a professor emeritus of infectious diseases and vaccinology at the University of California-Berkeley who in late August predicted the current spike. He expects cases, hospitalizations and deaths to continue climbing until late January.
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The dreadful near-term outlook, which may get worse as travel and social gatherings increase during the holidays, is playing out against the backdrop of highly encouraging developments on the vaccine front.
A vaccine produced by Pfizer in conjunction with the German company BioNTech was authorized by the U.S. Food and Drug Administration on Friday and could start getting administered Monday. Another vaccine by the Massachusetts firm Moderna may get FDA clearance in a matter of days. Both inoculations showed 95% effectiveness in late-stage clinical trials.
Other vaccines, from Johnson & Johnson and the British-based firm AstraZeneca, are in the pipeline as well.
“This really is a story of darkness and light in respect to the pandemic and how much worse we’re all hearing and we’re all expecting things to get in the month ahead, on the one hand,” said Jason L. Schwartz, assistant professor of public health at Yale University. “On the other hand, we have these two really promising, really efficacious vaccines that are going to be rolled out in the next week or two.”
Schwartz is one of four authors of a paper published in the journal Health Affairs, a group that includes Dr. Rochelle Walensky, President-elect Joe Biden’s pick as director of the CDC.
The study says implementation of the vaccines – including issues of manufacturing, distribution and public willingness to accept them – will play a bigger role in their success than their efficacy. The authors point out the vaccine program won’t be as beneficial introduced in the middle of a raging pandemic, so it would help enormously to get it under control.
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With more than 16 million cases – including more than 2.5 million this month alone – the USA is the runaway world leader in coronavirus infections. In a report, the White House Coronavirus Task Force told state governors the vaccines won’t reduce spread of the virus, hospitalizations or deaths until late in the spring.
“So it’s going to be the vaccine plus mask wearing, social distancing and restrictions on large gatherings for several months to come before we’re really going to see the dent being made,” Schwartz said. “The vaccine is an incredibly valuable, desperately needed new weapon in our arsenal. But it is not the only weapon we have, and we can’t think of it as a replacement for those weapons we had all this time.”
Functional immunity or sterilized immunity?
The USA is likely to have 35 million to 40 million doses of vaccine by the end of the year, and both the Pfizer and Moderna inoculations require two shots separated by three or four weeks. The Advisory Committee on Immunization Practices, a group of public health professionals that offers guidance to the CDC, recommended that health care workers and residents of nursing homes be the first to get vaccinated.
Schwartz is among those troubled by the lack of reliable figures on how much vaccine will be available in the initial months, and by what he deems inadequate planning by the federal government to get the vaccines not just to the states for distribution but to specific locales where they’re needed.
He said he’s heartened by the science-driven messages from senior health officials of the incoming Biden administration who will be tasked with convincing the public of the vaccines’ safety and effectiveness. The president-elect vowed to get 100 million doses applied in his first 100 days in office.
Even if the new administration manages that, the duration and type of immunity provided by the vaccines remain major unknowns.
Swartzberg said some vaccines prompt functional immunity, meaning recipients can contract a virus and transmit it but not develop a disease. If that were the case with the new inoculations, there would still be a need for preventive measures such as social distancing and mask wearing until about 70% of the general public were protected, thereby achieving herd immunity.
If the vaccines produce what’s known as sterilized immunity, as the measles and polio vaccines do, recipients wouldn’t get sick or spread the virus. Obviously, that’s the ideal scenario.
Swartzberg said data from Pfizer “suggests that the vaccine may tilt toward sterilized immunity, not completely, but it may tilt there. Let’s say it protects 95% of the people from getting sick and maybe it will prevent 90% or 85% of the population from being contagious. That would be fabulous.”
‘We need all hands on deck’ to beat COVID-19
There will be benefits from the vaccines even before a large percentage of the population can be immunized, although they might not be readily apparent to many.
Nursing homes and other long-term care facilities – which account for 38% of COVID-19 deaths, according to a New York Times database – stand to become much safer quickly.
The spike in cases nationwide has put a major strain on hospitals and especially intensive care units in many parts of the country, and getting workers in those settings protected from the virus would be another big early benefit, said Dr. George Rutherford, an infectious disease expert at UC-San Francisco.
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“The ICUs are more than beds. It’s beds plus personnel, and the personnel is the larger issue,” Rutherford said. “We can’t tolerate absenteeism, people being in quarantine. We need all hands on deck, and we need to protect them to do that.”
Rutherford takes an optimistic view of the impact lockdown measures adopted by some state and local governments may have on the pandemic, saying he expects a downturn in infections by the end of the year or in early January.
He’s less bullish on the prospect of life returning to normal any time soon, partly because of widespread vaccine hesitancy among the public. Surveys show about half of Americans are willing to get coronavirus shots if approved by the FDA, although those numbers have been ticking up. A Gallup poll showed the figure going up to 63%.
In most years, less than 50% of Americans get a flu shot, which is always strongly recommended by doctors and has been around for decades. Side effects, such as those experienced by two of the early recipients of the coronavirus vaccine in England, may scare off some people or keep them from coming back for a required second dose.
“In terms of getting enough people vaccinated so they can throw away their masks and kiss it all off, that’s going to be late summer,” Rutherford said, “and that’s only if we get enough people vaccinated.”
For some public health specialists, the biggest challenge lies in the monumental undertaking of inoculating more than 300 million people in a country as vast as the USA.
The task is further complicated by the requirement that the Pfizer vaccine be stored at minus-94 degrees, necessitating specialized freezers. The Moderna vaccine also has to be frozen, though not at such low temperatures.
Dr. Robert Murphy, executive director of the Institute for Global Health at Northwestern University Feinberg School of Medicine, said he expects the vaccines to become popular after an initial period of reluctance and even mistrust.
“I think the rollout is going to be slower than they expect, for a couple of reasons,” Murphy said. “One, we’re talking about hundreds of millions of people. And then, you have a cold-chain issue in delivering these vaccines. It’s not going to be an easy operation. I’m not as optimistic as other people. I think it will take the whole year to vaccinate everyone, at least.”