The COVID-19 vaccine has a beautiful impact.
Take nursing homes, for example. Although more than 26,000 COVID-19 deaths were between Thanksgiving and New Year, deaths have dropped by 66 percent since vaccinations began in December.
But amid all the success and the prospect that the vaccine will be available to a growing number of people across the country within the next few months, it remains unclear what life in the US will look like as the vaccination campaign sets the course. begin to dampen. of serious illness and death to the virus. Questions depend on how quickly state and local governments will release enterprises from social distancing mandates, and whether interventions such as masking requirements will survive 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 could counter criticism that the organization was too pessimistic about the extent to which in which distantable mandates must remain. for the vaccinated as the rest of the population is waiting on the lap.
The criticism comes after the agency suggested that the vaccinated should still distance themselves socially, which is part of an announcement that also says that vaccinated people who have been exposed to the virus do not have to be quarantined.
The lack of clarity, coupled with the Trump administration’s failure to conduct a public message campaign on the vaccine, has left many confused.
“The population of people who are fully vaccinated is increasing, so there needs to be much clearer guidance from the CDC and the federal government on what people who are fully vaccinated can do,” said Leana Wen, a former Baltimore health commissioner and visiting professor in Georgetown, said. University’s School of Public Health, told TPM. “Many people are eager to see their loved ones; we must give people such guidance. ”
The crux of the questions surrounding the return to normal is an important debate in the public health response to the virus: is the purpose of vaccination to end serious illness and hospitalization? Or do heavier concerns about the transmission without serious illness, and the possibility of new variants, outweigh the benefits of encouraging the vaccinated to resume normal life? And what should be done after the most vulnerable have been vaccinated and are safe from serious diseases, but the virus remains circulating among young and healthy?
“This threshold of where we are going to accept – how much exposure we are going to allow – is unknown, and that is where the challenge is,” said Dr. Litjen Tan, a leader of the Immunization Action Coalition, told TPM. .
What is the purpose here?
The debate on the guidelines underlies questions about what level of immunity in the population should be targeted before relief can take place.
The answers will affect how fast life is back to normal, including major indoor activities such as concerts.
These decisions are now being made as the implementation overcomes problems inherited from the Trump administration: funding is moving at the local level and a new degree of federal state organization is accelerating efforts to deliver millions of doses in U.S. weapons get. UPS predicted on Thursday that the distribution of the vaccine would increase by 40 percent next week.
For dr. Christina Ramirez, a professor of biostatistics at the UCLA Fielding School of Public Health, should be the only real question to end serious illness and death.
“Most people care if they are admitted to the hospital, or if they or their loved ones get really sick and die,” Ramirez argued. “The purpose of the vaccine is to prevent hospitalizations.”
But other public health experts argue that the goal of vaccinations should be much broader: the transmission should be limited to a point where the virus is not only inert from a health point of view, but is unlikely to continue to circulate.
“What we need to target is a point where transmission is such that people with COVID-19 are unlikely to come into contact even if they are not vaccinated,” said Dr. Cindy Prince, an epidemiologist at Infectious Diseases at the University of Florida, said. , told TPM.
The two goals may seem similar, but end with drastically different conclusions: one is projecting a level of normality this summer, while the more extensive goal of limiting transmission across the country could push the removal of recommendations until 2022.
“You see baby stairs and then gradually open,” Tan said. “And it goes from the pandemic phase, now, and the transition phase, then and into the endemic phase.”
Part of the debate involves lengthy questions about whether the vaccines can transmit the virus. Early data from Israel suggest that vaccines do limit the tendency to spread to recipients, but whether the early findings will be confirmed as the vaccination continues remains unclear.
Prince took it a step further, pointing out that COVID-19 interventions have succeeded in achieving other long-term public health goals, such as drastically limiting flu transmission this season.
“We have to consider whether we will maintain many of the measures we have taken,” she said. ‘I do not suggest that we keep it all indefinitely, but there is still the opportunity to wear a mask, to think about its physical benefit, even in times when you do not necessarily have an active COVID , but know that busy restaurant is where transfer takes place. ”
The last risk
The bulk of the debate comes down to the risk of new variants. The risk there is twofold: in addition to more infectious mutations that infect more people before vaccines can eliminate the possibility of serious diseases, higher transmission rates can increase the chance of a virus mutating than the current vaccines protect.
The more people incubate the virus, the greater the chance that the virus can mutate beyond the reach of current vaccines.
Experts said it could be a problem in part because the group of people least likely to be dealing with serious illnesses also played the biggest role in transmitting the virus: young people.
A situation where serious diseases for the elderly are brought under control but the virus is circulating among young people, creating the potential for new variants, has forced some to think about how to better set up messages around vaccinations and social distance.
“If I’m vaccinated and I still have to isolate, isolate at a social distance, should I do it?” Tan said. “So policymakers are now trying to figure out where the balance should be.”
In particular, the highly contagious British variant threatens to cause a new upsurge before enough Americans can be vaccinated to significantly reduce the mortality rate from the disease, said Professor of Molecular Medicine at the Scripps Research Institute, Dr. Eric Topol, told TPM.
“Hopefully it will not be a boom, but it could be, because we are relaxing things instead of getting stricter now,” Topol said, adding that next month will likely determine whether the new variant has the effects of the land will rise. . “We’re going to get through it somehow, but if we don’t have that boom, it’s going to happen a lot faster.”
Dr Syra Madad, senior director of the special pathogen program at NYC Health + Hospitals, told TPM that the number of serious illnesses is likely to be low enough thanks to vaccinations to allow for some normalcy during the summer.
She projected a situation in which the virus mostly disappeared, apart from ‘sporadic outbreaks where we have to go in and put out the small bag of fire we are going to see, making sure it does not cause serious illnesses and diseases. ”
“We know that this pandemic will not end at once, but that it will end in a whimper, but that it will be prolonged,” she added.