March 16, 2021

few steps forward, few steps backwards

The news on the immunization front is pretty remarkable. We are now able to give more than 2 million shots a day across the country, an amazing increase over the frustration felt by so many in January when it felt harder to get a vaccine appointment than tickets for a Bruce Springsteen concert or a campsite for Fiddle Tunes. This is encouraging and took extra effort from the new administration to get going. Hopefully now, we can get shots into arms in the next few months, rather than having people waiting until the fall. And getting more people vaccinated sooner is starting to have more urgency.

We still face several obstacles before we can start to open up more freely. One is how to reach people who might not have access to the usual routes of health care. A bigger one is how to encourage more people who are hesitant to get their jabs. More on that later.

But one of the biggest urgencies is that the pandemic is still happening. I have heard tragic stories of people getting infected just before they were to get their vaccine. Plus, we hear that cases are starting to rise in some areas of the country, just as Spring Break has brought the biggest increase in air traffic in a year. The IHME forecast is back up to close to 600,000 deaths predicted by July 1.

But more concerning is that the British variant, B.1.1.7, is predicted to become the dominant strain in the US within weeks. I am concerned after Nature published data yesterday showing that B.1.1.7 is more deadly than the older strain in the UK, not just more infectious. Most people are still vulnerable to infections since they have not been immunized yet. More grief for some families to come.

The good news is that so far the vaccines approved here in the US have shown activity against the B.1.1.7 strain, preventing serious illness and death, but we don’t really know yet if the vaccines decrease transmission rates. The faster we get people immunized the better. In the meantime, we stay the course and follow our protective measures.

Why are these new strains an issue and why are they developing? We know that viruses commonly make errors during replication. Some of those new mutations can be advantageous for the virus, such as the B.1.1.7, which makes it easier to be transmitted. Some of the newer variants, such as the one in South Africa, are concerning for having a mutation that can get around the antibodies from the vaccines and decrease their effectiveness.

Now there is evidence that the mutations are happening in people who have underlying diseases that compromise their immune systems so they don’t clear the coronavirus from their system in the same amount of time as healthy people do. Particularly in cancer patients and patients with untreated HIV, this seems to happen. This is why South Africa has more of these newer strain because they have a higher rate of untreated HIV. This is an excellent article in The Seattle Times that explains how this happens better than I can. The bottom line is to keep up your safe practices, help people get vaccinated, encourage the hesitant and answer their questions.

Wash your hands, cover your hands, keep safe six, and get your jab as soon as you can.

And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading.

https://talkingpointsmemo.com/muckraker/we-werent-going-to-get-the-covid-vaccine-until-fall-what-changed

https://www.washingtonpost.com/local/caught-covid-before-vaccine/2021/03/12/4521efaa-80e6-11eb-81db-b02f0398f49a_story.html

https://www.washingtonpost.com/health/2021/03/16/covid-cases-rising-michigan-new-york-city/

https://covid19.healthdata.org/united-states-of-america?view=total-deaths&tab=trend

https://www.upi.com/Top_News/US/2021/03/15/British-COVID-19-variant-become-dominant-US-strain/6871615832383/

https://www.nature.com/articles/s41586-021-03426-1

https://www.seattletimes.com/nation-world/an-accelerated-cauldron-of-evolution-covid-19-patients-with-cancer-hiv-may-play-a-role-in-emergence-of-variants/