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COVID-19 Realities, Challenges and Vaccination

08/10/2020

A number of realities are now apparent as we move into the eighth month of the COVID-19 epidemic in the U.S.:

 

  • The virus responsible for COVID-19 is now endemic and widespread through our population with extensive community spread.

 

  • Control measures intended to “flatten the curve” were temporarily successful but have plunged the economy into recession with every prospect of a depression.

 

  • The economy will not improve until COVID-19 is effectively controlled.

 

 


Chaotic Status of Testing

Drs. Anthony Fauci and Deborah Birx
  • In comparison with other industrialized nations the response by the U.S. has been dysfunctional, fragmented on a state-by-state basis and variable in its effectiveness.

 

  • Scientific data cannot be denied or facts “spun” to deny the reality of five million confirmed infections with 160,000 fatalities and the prospect of an increase to 200,000 by the end of 2020.

 

  • Scientifically-proven prevention measures including masking, avoiding gatherings and  common-sense hygiene are ignored by a large proportion of our population. In some cases preventive measures have been actively opposed to the detriment of the regions concerned.

 

  • In the U.S. COVID has been politicized with intensifying rhetoric, misinformation, and distrust of science contributing to rising public anxiety as we approach the 2020 election.

 

  • A safe and effective vaccine would contribute to alleviation of the burden imposed by COVID-19 but there are biological and logistic limitations on establishing immunity in our population.

 

After delays in initially recognizing the severity of COVID-19 and the potential for disruption of the economy, the Administration initiated a crash program of vaccine development termed “operation warp-speed.” While laudable in intent, rapid development of one or more vaccines applying as yet untested technology with accelerated field evaluation detracts from confidence that a vaccine will be both safe and effective. In the event that a vaccine, even if satisfying the two principal criteria is available by the end of 2010 cannot be regarded as panacea or an ultimate and immediate solution to the problem of COVID-19.

 

Faced with the intensity of the outbreak and the need for speed, pharmaceutical companies have been awarded immense sums of money to apply as yet untested technology and to commence clinical trials.  What characterizes the current approach to vaccine development is that capital is being invested in manufacturing facilities in the anticipation (or hope) that one or more candidates will prove effective.  Fortunately initial trials demonstration stimulation of antibodies and T-cell activity but it is yet to be shown that the immune response will actually provide protection against challenge. This will be evaluated in Phase 3 clinical trials involving natural exposure or even controlled infection of volunteers.

 

Based on other than scientific considerations, some in the political spectrum are projecting an unrealistic assumption on when an effective and safe vaccine will be available. Dr. Vijay Samant, a vaccine specialist affiliated to Merck, a company with considerable experience in vaccine production stated, “Spreading false hope and failing to come through is just one of the things that could further damage public trust.  Ken Frazier, CEO of Merck commented, “We don’t have a great history of introducing vaccines quickly in the middle of a pandemic.”

 

Some of the questions relating to introduction and administration of a safe and effective vaccine to 320 million citizens of the U.S. have yet to be addressed.  Even if a comprehensive national plan has been developed, which is doubtful given the track record of the Administration, the details have yet to be released.  Considerations include how will limited vaccine initially available be allocated?  Dr. Francis Collins, director of the National Institutes of Health has requested the National Academy of Medicine to develop guidelines and Dr.Victor Dzau, president of the Academy has accepted the challenge.  Ethical considerations will dictate the priorities but practical and emotional factors will confound predetermined plans.  It is evident that citizens with predisposing conditions such as diabetes, obesity, pulmonary and renal disease and the elderly will represent one priority category.  Frontline workers in public health will be an equally important population although this group should be willing to receive a vaccine. There are questions regarding those who will be most affected by exposure to COVID-19. Potential early recipients will question whether they are in effect guinea pigs and many well adopt a wait-and-see approach despite their vulnerability due to their potentially precarious state of health.

 

Even if the government launches a campaign to encourage vaccination there will be considerable distrust based on their track record over the past eight months. Confusion over optimistic and unfounded and frequently repeated statements such as “the disease will just go away”, the debacle over promotion of hydroxychloroquine despite scientific evidence that it is ineffective and potentially harmful, denigration and criticism of acknowledged specialists in infectious diseases and public health, lack of transparency over the warp-speed vaccine initiative, concern over side effects of vaccination will all deter enthusiastic uptake of one or more approved vaccines. The overriding fear lies in the speed at which vaccines have been developed and tested. Surveys of U.S. citizens suggest that if an FDA-approved vaccine were to be available at the end of the year and requiring two successive doses, 30 percent of those interviewed would not be willing to be vaccinated, 20 percent are unsure or will wait and only 50 percent will be willing to receive the vaccine.  Antivaxxers will intensify their unfounded, unscientific objections to vaccination and will confound the adoption of an approved product with pseudo-ethical, religious and anecdotal negative publicity. 

 

Without knowing the duration of immunity simulated by even two doses of vaccine it is impossible to predict when the level of herd immunity will rise to a threshold that will inhibit transmission of virus, necessary to reduce incident rates.

 

To the credit of the Administration, progress has been made in ordering the necessary equipment to support a mass vaccination program.  This includes 800 million syringes, needles and glass vials.  The resources of the military will be used to distribute vaccine.  Mass administration, if it is to become reality will itself impose dangers of infection in a susceptible population unless appropriate masking and social distancing are followed.

 

It is evident that widespread immunization even if a safe and effective vaccine is available will only be accomplished by the late summer of 2021.  In the interim, protection against COVID-19 rests in masking, social distancing and common-sense precautions.   A vaccine when available, will not necessarily allow the U.S. to resume a pre-2020 lifestyle and activities until a satisfactory level of herd immunity is attained. Until then we are individually and collectively obliged to follow the advice of public health specialists and to conform to practices and habits that suppress transmission.

 

Until we control COVID-19 we cannot hope to restore our economy and benefit from increased demand for eggs and other food products. There are obvious limits and restraints to government support and stimulus programs.