After 5 consecutive weeks of a slow upward trend in U.S. cases, we have seen nearly a 12% drop in the case rates over the previous week. There may be a slight anomaly here as one state has not reported data for several days, but this was a low-volume state with dropping rates up to now, so the national drop is still likely at least 10%.
More than 50% of U.S. adults have received at least 1 dose of vaccine and more than 33% have had both doses. This represents about 40% of the overall population. This success in getting the U.S. vaccinated is important for two reasons:
First, since we believe that at least 20% of the U.S. has already had COVID and thus has at least some immunity, we will likely start to see herd immunity effects at around 70% (plus or minus 10%). If we add the 40% and the 20% together, we are getting very close! We are immunizing about a half percent per day (first immunizations), so that means that over the next 3 weeks or so, we will likely be at around that 70% mark.
Second, out of the 77 million fully vaccinated U.S. adults, the breakthrough rate (which means people who got COVID despite vaccination) has only been 0.008% with deaths attributable to COVID at 1 per 1.2 million vaccinees. This is an incredible success, and especially since the data is consistently, across multiple countries, showing that the vaccine decreases risk not only of disease but even infection but greater than 90%, vaccination can break the back of this pandemic.
So, what are the headwinds: There are mainly two:
First, vaccine hesitancy. With the concern regarding clots and both the Johnson & Johnson and AstraZeneca vaccines, the vaccine refusal or hesitancy rate has shot up to the high 30’s. The effect of vaccine hesitancy is being seen clearly in the UK, with the government having to market hard to keep people coming through the doors to get vaccinated and maybe starting in the U.S. as data is showing a decrease in the number of vaccine doses this week. To be sure, the decrease is also a function of the pause in J&J vaccines, but it is likely a dual effect. Marketing and education are going to be critical to ensure we can get to the herd immunity point.
The second is vaccine manufacturing. There is no excess manufacturing capacity for either of the two mRNA vaccines and both adenovirus vaccines (AstraZeneca and J&J) have big question marks as well as some manufacturing slowdowns for Johnson & Johnson specifically. Fortunately, the ACIP decision on Johnson & Johnson vaccine is expected on April 23, so that may help with availability in the United States. The European Medications Agency has come out in support of AstraZeneca as having a benefit greater than risk, so that may begin to open up the spigot around the world if the education and marketing campaigns can be successful.
A third issue that has not been a problem in the U.S. but is increasingly a problem in other parts of the world is counterfeit vaccines. People should ensure that they are getting their vaccines through a recognized program administered by a trusted authority. Purchasing vaccine through any kind of secondary market is a very high-risk proposition.
To fill out the rest of the world statistics, India is really having a hard time. They are responsible for about 40% of the world’s cases and have not had a large vaccination program because they were doing so well as recently as a month ago. Fortunately, India has huge manufacturing capability and a fairly well-developed public health infrastructure, so the groundwork is being laid for a large vaccination push. The United Kingdom continues on the road to near negligible levels of COVID with a national rate of fewer than 4 cases per 100,000 per day. Europe has definitely reversed the upward course seen in late winter and early spring with now 3 weeks of decreasing case rates, and Asia continues with negligible case levels, although a surge in Japan is raising concern with the upcoming Olympics.
Major chain stores in the U.S. are now selling home use, no prescription needed, molecular and antigen tests. The cost respectively is just under $50 and around $25. They also have facilitated mail-off self-sampling kits for actual PCR tests with a 24-48 hour turnaround. These kits will all be very helpful for getting people the information they need with rapid turnaround but may cause difficulty in keeping the statistics consistent.
The only treatment news is that the FDA revoked the emergency use authorization for single antibody monoclonal antibody therapies, but only because combined multi-monoclonal therapies have been shown to be much more effective. If you or someone you know gets COVID and has risk factors, get to a hospital that can give these treatments and do not take no for an answer, unless of course, someone can give you a medical reason why the monoclonal antibody treatment should not be used for a patient-specific reason.
Finally, in one more sign that we are getting close to a more normal daily life, the U.S. Centers for Disease Control and several U.S. States have said that they are either considering or have already picked dates to remove recommendations for mask-wearing outdoors. Since it has been clearly demonstrated that the virus rarely (not never, but rarely) transmits outdoors, and over half of U.S. adults have been vaccinated. People will inevitably stop following these guidelines and the public health system has finally recognized that instituting guidelines that people do not believe are needed is actually counterproductive.