The COVID-19 vaccine is having an impressive impact.
Take, for example, nursing homes. Although they were the site of more than 26,000 COVID-19 deaths between Thanksgiving and New Year, they have seen the death toll drop by 66 percent since vaccinations began in December.
But in the midst of all this success and with the prospect of the vaccine becoming available to an increasing number of people across the country in the coming months, it remains unclear what life in the United States will be like as the vaccination campaign begins. decreasing rates of serious illness and death from the virus. Questions persist as to how quickly state and local governments will release companies from mandates of social detachment, and whether interventions such as masking requirements will survive what could be the end of the most deadly phase of the pandemic.
The Centers for Disease Control have begun to draft guidelines specifically aimed at what people who have been vaccinated against COVID-19 can do, an affirmative list that would oppose criticisms that the organization has been very pessimistic about the extent to which distancing should remain in effect for vaccinees while the rest of the population awaits the shot.
The criticism came after the agency suggested that complete vaccinees should still practice social detachment, part of an ad that also said that vaccinated people exposed to the virus do not need to be quarantined.
The lack of clarity, combined with the Trump administration’s failure to conduct a public message campaign about the vaccine, left many confused.
“The population of fully vaccinated people is increasing, so there needs to be much clearer guidance from the CDC and the federal government on what fully vaccinated people are able to do,” Leana Wen, former Baltimore health commissioner and professor visitor at the University’s Georgetown School of Public Health, TPM said. “Many people are eager to see their loved ones; we should provide people with that kind of guidance. “
At the center of the questions surrounding the return to normality is a key debate in the public health response to the virus: is the goal of vaccination to end serious illness and hospitalization? Or do the broader concerns about transmission without serious illness and the possibility of new variants outweigh the benefits of encouraging vaccinees to resume normal lives? And what should be done after the most vulnerable are vaccinated and protected from serious illness, but the virus remains in circulation among the young and healthy?
“This limit of where we are going to accept – how much exposure we are going to allow – is unknown, and that is where the challenge lies,” Dr. Litjen Tan, executive of the Immunization Action Coalition, told TPM.
What is the goal here?
The orientation debate raises questions about what level of immunity of the population needs to be addressed before flexibility can occur.
The answers will affect how quickly life returns to a minimum of normality, including great indoor activities like concerts.
These decisions are being made now, as the rollout overcomes problems inherited from the Trump administration: funding is reaching the local level and a new degree of federal organization is accelerating the effort to put millions of doses into American weapons. UPS projected on Thursday that its vaccine distribution would increase by 40 percent next week.
For Dr. Christina Ramirez, professor of biostatistics at the School of Public Health at UCLA Fielding, the only real issue at stake should be to end serious illness and death.
“Most people care if they are going to be hospitalized or if they or their loved ones get very sick and die,” said Ramirez. “The whole purpose of the vaccine is to prevent hospitalizations.”
But other public health experts argue that the goal of vaccination must be much broader: restrict transmission to a point where the virus is not only health-inert, but is unlikely to continue to circulate.
“What we need to aim for is a point where transmission is such that people are unlikely to come into contact with COVID-19, even if they are not vaccinated,” Dr. Cindy Prins, an infectious disease epidemiologist at the University of Florida, said. to the TPM.
The two goals may seem similar, but end up with drastically different conclusions: one projects a level of normality this summer, while the broader goal of containing transmission across the country could push away recommendations in 2022.
“You will see baby steps and then a gradual opening,” said Tan. “And this is going from the pandemic phase, now, and the transition phase, then, to the endemic phase.”
Part of the debate involves lingering questions about whether vaccinees can transmit the virus. Early data from Israel suggest that vaccines limit the recipients’ propensity to spread, but whether these initial findings will be confirmed as vaccines continue, it is unclear.
Prins took it a step further and pointed out that COVID-19 interventions were successful in meeting other long-standing public health goals, such as drastically reducing flu transmission this season.
“We need to consider whether we are going to maintain many of the measures we have put in place,” she said. “I don’t propose that we keep it all indefinitely, but there is still some opportunity to wear a mask, to think about physical distance, the benefit of that, even in times when you don’t necessarily have active COVID, but knowing that maybe a crowded restaurant is where transmission occurs. “
The ultimate risk
Much of the debate boils down to the risk of new variants. The risk is twofold: in addition to more contagious mutations infecting more people before vaccines can eliminate the possibility of serious illness, higher rates of transmission can increase the chance of a virus mutating beyond the protection capacity of current vaccines.
The more people incubate the virus, the greater the chance that it will mutate and stay out of reach of existing vaccines.
This, experts say, could pose a problem in part because the group of people least likely to contract serious illnesses also played the biggest role in transmitting the virus: young people.
A situation in which serious illness is controlled for the elderly, but the virus circulates among young people, creating the potential for new variants, has forced some to think about how to better target messages about vaccinations and social detachment.
“If I get vaccinated and still have to quarantine, isolate, distance myself socially, what can I do to do that?” Said Tan. “So lawmakers are now trying to figure out where this balance should be.”
The UK’s extremely contagious variant, in particular, threatens to cause another outbreak before enough Americans can be vaccinated to significantly reduce the death rate from the disease, said Professor of Molecular Medicine at the Scripps Research Institute, Dr. Eric Topol, to the TPM.
“Hopefully it will not be a sudden increase, but it could be, because we are relaxing things instead of tightening now,” said Topol, adding that the next month would likely determine whether the new variant would cause an increase in cases across the country. “We are going to go through this in one way or another, but if we do not have this increase, it will happen much faster.”
Dr. Syra Madad, senior director of NYC Health + Hospitals’ special pathogen program, told TPM that serious disease rates would likely be low enough thanks to vaccinations to allow “some normality” during the summer.
She projected a situation in which the virus practically disappeared, in addition to “sporadic outbreaks where we have to enter and extinguish the small pocket of fire that we are going to see, and make sure that it is not causing serious diseases and illnesses. “
“We know that this pandemic will not end in a bang, it will end in a groan, it will continue,” she added.