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The COVID-19 vaccine is having an amazing impact.
Take, for example, retirement homes. Although they were the site of more than 26,000 deaths from COVID-19 between Thanksgiving and the New Years, they have seen deaths decrease by 66% since vaccinations began in December.
But amid all this success, and with the prospect of the vaccine becoming available to more and more people across the country in the coming months, it’s still unclear what life will be like in the United States as the campaign continues. vaccination starts to lower rates. serious illness and death from viruses. Questions persist about how quickly state and local governments will free companies from their social distancing mandates and whether interventions such as masking demands will survive what could be the end of the deadliest phase of the pandemic .
The Centers for Disease Control has begun drafting guidelines specifically aimed at what people vaccinated against COVID-19 can do, an affirmative list that would counter criticism that the organization has been too pessimistic about the extent to which the mandates of distancing should remain in place. for the vaccinated because the rest of the population is waiting for the vaccine.
The criticism came after the agency suggested that fully vaccinated people should still practice social distancing, as part of an announcement that also said that vaccinated people exposed to the virus should not be quarantined.
The lack of clarity, combined with the Trump administration’s failure to run a public messaging campaign around the vaccine, has left many confused.
“The population of fully vaccinated people is growing, so there is a need for the CDC and the federal government to give much clearer direction on what fully vaccinated people are capable of doing,” Leana Wen, former Baltimore health commissioner and professor guest at Georgetown University’s school of public health, TPM told TPM. “Many people are eager to see their loved ones; we should be providing people with that kind of guidance. “
At the center of the questions surrounding a return to normalcy 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 more general concerns about transmission without serious disease and the possibility of new variants outweigh the benefits of encouraging vaccinees to resume normal lives? And what to do once the most vulnerable are vaccinated and safe from serious disease, but the virus remains circulating among young and healthy?
“This threshold of what we’re going to accept – how much exposure we’re going to allow – is unknown, and that’s where the challenge lies,” said Dr Litjen Tan, a Coalition executive. action for immunization, at TPM.
What is the point here?
The policy debate underlies the question of what level of population immunity needs to be targeted before easing can take place.
The answers will affect how quickly life returns to a minimum of normalcy, including indoor activities as important as concerts.
These decisions are being made now, as the rollout overcomes issues inherited from the Trump administration: Funding is directed at the local level, and a new level of organization on the part of the federal government is accelerating efforts to deliver millions of doses. in American arms. UPS predicted Thursday that its vaccine distribution would increase by 40% next week.
For Dr. Christina Ramirez, professor of biostatistics at the UCLA Fielding School of Public Health, the only real issue at stake should be that of ending serious illness and death.
“Most people care about whether they are going to be hospitalized or whether they or their loved ones really get sick and die,” Ramirez said. “The aim of the vaccine is to prevent hospitalizations.”
But other public health experts argue that the goal of vaccinations should be much broader: to curb transmission to a point where the virus is not only health-inert, but unlikely. ‘it continues to circulate.
“What we need to target 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, epidemiologist of infectious diseases at the University of Florida, TPM said.
The two goals may seem similar, but lead to drastically different conclusions: One projects a level of normalcy this summer, while the larger goal of curbing transmission across the country could push distancing recommendations to the limit. 2022.
“You’ll see baby steps and then gradual opening,” Tan said. “And it goes from the pandemic phase, now, and the transitional phase, then, to the endemic phase.”
Part of the debate revolves around lingering questions about whether vaccinees can transmit the virus. Early data from Israel suggests vaccines limit the propensity of recipients to spread, but it is not known whether these early findings will be confirmed as vaccinations continue.
Prins went further and pointed out that COVID-19 interventions have been successful in achieving other long-standing public health goals, such as significantly reducing influenza transmission this season.
“We have to ask ourselves if we are going to maintain many of the measures that we have put in place,” she said. “I’m not suggesting that we keep all of this indefinitely, but there is still an opportunity to wear a mask, to think about physically outrunning the benefit of that, even in times when you don’t necessarily have an active COVID, but knowing that perhaps a crowded restaurant is where transmission occurs.
The last risk
Much of the debate comes down to the risk of further variations. The risk is twofold: In addition to more contagious mutations infecting more people before vaccines can rule out the possibility of serious disease, higher transmission rates can increase the risk of a virus mutating beyond the protective capacity of current vaccines.
The more people there are incubating the virus, the more likely it is that the virus will mutate out of the range of currently existing vaccines.
This, experts say, could be a problem in part because the group of people least likely to get serious illnesses also played the most important role in transmitting the virus: young people.
A situation where severe disease is under control for older people but the virus is circulating among young people, creating the potential for new variants, has forced some to think about how to better target messages around vaccinations and social distancing.
“If I’m vaccinated and still have to quarantine, isolate, socially remove, then what is there for me to do?” Tan said. “So policymakers are now trying to determine where the balance should be.”
The hugely contagious British variant, in particular, threatens to provoke another outbreak before enough Americans can be vaccinated to dramatically reduce the disease’s death rate, the Scripps professor of molecular medicine told TPM. Research Institute, Dr Eric Topol.
“Hopefully it won’t be a push, but it could be, as we’re loosening things up instead of tightening things up now,” Topol said, adding that next month would likely determine if the new variant causes a soaring cases across the country. . “We’re going to get out of it one way or another, but if we don’t have that push, it’s going to happen a lot faster.”
Dr Syra Madad, senior director of the special pathogens program at NYC Health + hospitals, told TPM that rates of serious illness would likely be low enough with vaccinations to allow “some normalcy” over the summer. .
She projected a situation in which the virus has all but disappeared, aside from “sporadic epidemics where we have to go in and put out the little pocket of fire that we’re going to see, and make sure it doesn’t cause serious illness.” “
“We know this pandemic will not end with a snap, it will end with a whimper, it will stretch,” she added.
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