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Pandemic’s Future Comes Down to Vaccinations

There is good news. “We do know there is going to be sufficient vaccine supply.” By late summer, 70 percent to 80 percent of the population should be immunized, enough to create herd immunity.

by .Ed Stannard, New Haven Register, Conn. / March 31, 2021
TNS
(TNS) - Mar. 28—The possible future of the pandemic: Most adults are vaccinated, including almost all of the oldest, who are most likely to die of COVID-19. People feel safe getting together. Warmer weather brings more people outside. It looks like the worst may be over.
 
Or this: New coronavirus variants arrive that are immune to the vaccines. People wait in line for booster shots. States open up too quickly, removing mask mandates and crowd controls. Young people and older conservatives don't get vaccinated. Another major surge in infections and deaths ensues.
 
Experts in public health and medicine say the pandemic could go either way, and it's difficult to predict which direction we are headed. There are both positive and negative signals.
 
"There's a lot of 'we don't knows'" when it comes to the coronavirus, said Dr. Howard Selinger, chairman of family medicine at Quinnipiac University's Frank H. Netter MD School of Medicine. "They're studying it, but it's going to take time."
 
One concern is how quickly states are opening up, especially in the South. "Between now and the end of summer, as states open up, we don't know if we're going to facilitate the spread of mutants that are both more easily transmitted and apparently make people sicker," Selinger said.
 
If people aren't wearing masks and taking other precautions — especially if they are not vaccinated — infections can rise and "what creates mutation is transmission," he said. It's best "if you can tamp down the spread, not just through vaccination but through good old-fashioned masking and social distancing," he said.
 
"When the governor opens up bars and restaurants 100 percent but continues to keep the mask mandate in place, it's kind of a mixed message," Selinger said, because people take off their masks when eating and drinking.
 
"You are likely to see surges in those states that are not yet hitting the tipping point of 70 to 75 percent immunized," he said. That has happened in Italy, which is locking down parts of the country because of a surge in infections.
 
"So one scenario of states prematurely opening up: We lose the race because we can't immunize fast enough," Selinger said. "We get a lot more sick people as we continue to vaccinate, but at a high cost of death and illness."
 
There is good news. "We do know there is going to be sufficient vaccine supply," Selinger said. By late summer, 70 percent to 80 percent of the population should be immunized, enough to create herd immunity.
 
Connecticut ranks fourth in vaccination rates, according to Becker's Hospital Review, with 18 percent of the population fully vaccinated as of Thursday. Leaving out children 15 and younger, that percentage is 22.
 
The state Department of Public Health reported that as of March 22, 36 percent of Connecticut residents 16 and older had received at least one dose of vaccine and 30 percent of all residents had.
 
Some state residents over 16 have been vaccinated, but as of April 1, everyone from 16 to 44 years old will become eligible, totaling 1.9 million people, more than half the population.
 
In looking at vaccination rates and variant strains of the coronavirus, "I think of them as very intertwined," said Lisa Cuchara, professor of biomedical sciences at Quinnipiac University. "The virus doesn't mutate in the air or in the water. ... It mutates inside human beings."
 
If most people are vaccinated and aren't getting infected, there are far fewer hosts available to serve as mutation factories, she said.
 
Cuchara said there are danger signs that young people and white conservatives are less likely to get their shots, making the 75 percent to 80 percent rate required for "herd immunity" harder to reach. She said it appears "young people aren't as worried about COVID and spring break reinforces that. ... They don't think that this is as serious for them, so they're not as leery."
 
In addition, "they're more likely to do other risky behaviors," she said. "I don't think they have a scientific reason, a political reason. I just think they don't think this is a big deal to them."
 
Florida Gov. Ron DeSantis has not ordered that masks be worn in the state and has kept businesses open. Thousands of young adults have jammed Miami Beach, where the city imposed an emergency 8 p.m. curfew as partiers have broken into fights and stampeded through the streets.
 
According to a Civiqs poll, 27 percent of 18- to 34-year-olds don't plan to get vaccinated, while 64 percent do or already have gotten their shots.
 
Another group that is resistant to vaccination is white Republicans. According to Civiqs, 43 percent of that group said they will not get the vaccine if it becomes available, compared with 2 percent of white Democrats and 26 percent of white independents. Twelve percent of Black Americans say they won't take the vaccine, a number that has declined over time, and 15 percent of Hispanics say they won't.
 
"I see a huge partisanship with people refusing to get vaccinated and that scares me the most," Cuchara said. In addition to those who have made COVID a partisan issue, there are those who get misinformation and even intentionally misleading propaganda from social media. "People who spend more time on Facebook are going to be more hesitant," she said.
 
"Being hesitant is normal but where do you get your information? Where do you get your answers from?" she said. "You've got to make sure that hesitancy is met with facts and not oddities," such as the president of Brazil, Jair Bolsonaro, warning that women taking the Pfizer vaccine could grow facial hair or that men's voices might become effeminate.
 
Dean Sten Vermund of the Yale School of Public Health said there is more good news for the state. "In the big national surveys, Connecticut has one of the lowest rates of vaccine hesitancy of all the states. I think it's in the bottom three to five," he said. "There are more willing people in Connecticut than nearly all the other states."
 
Those who are unwilling to get vaccinated see a false choice, Cuchara said. "The decision isn't, get vaccinated / don't get vaccinated," she said. "The decision is, how do I want to get exposed to this virus? The whole virus or just the spike protein?" The messenger RNA in the Pfizer and Moderna vaccines triggers antibodies because it has the same genetic code as the coronavirus' spike protein, which cannot cause infection.
 
If we don't reach that 75 percent threshold of immunization, those who have compromised immune systems will be especially at risk and will put those around them in danger as well, Cuchara said. "They could actually harbor that virus for a long period of time."
 
In one case, immunocompromised patients "were actually positive for COVID and shedding virus for five months," she said. "The variants are going to be allowed to occur within them. They are going to be the main source of the variants."
 
Some good news is that viral mutations are not necessarily more lethal. However, if they are more contagious, those who get sick are at greater risk of death, especially if they are old or have underlying health conditions.
 
"We tend to think the virus wants to kill us. It really doesn't; it just wants to make more copies of itself," Cuchara said. "If you're a virus, your point of view is you would not want to kill people because you're not going to spread very far."
 
That's why vaccination is so important. Unlike influenza, which can spread via pigs, birds and even dogs and cats, "99.99 percent of the spread [of coronavirus] is human to human," Cuchara said. If everyone is vaccinated, "there's nobody to make a variant in."
 
It's also important even for people who have had COVID-19 to get their shots. "Natural immunity — immunity after infection — doesn't seem to last very long," Cuchara said.
 
Another risk is that the vaccines we are receiving now won't work against future variants, but that we won't realize we are at risk of another infection because we believe we are safe. "Those variants could pop up that are basically immune to our immunity," Cuchara said. "We could have disease and death and hospitalizations occurring in vaccinated people."
 
One question "that hasn't been answered definitively yet: Is the vaccinated person still a menace to other people?" Vermund said. "Are they infectious because they harbor virus in their nasal passages? The tentative answer is no, because there are some small studies that are very promising in suggesting that there is a lower viral load in the immunized person ... who's infected with the virus."
 
According to current research, in someone who's vaccinated, "their immune system kicks in and knocks the viral load down very quickly," Vermund said. "And they also are unlikely to be major transmitters because there's also a dampening of virus in the nasal passage." But research still is being conducted, he said.
 
Now, vaccinated people are able to get together and not risk infecting each other, Vermund said. In public, "We're still going to wear a mask ... because we're not 100 percent sure that we might not be a risk to someone else, but we are not going to be concerned about acquiring coronavirus."
 
Vermund said getting to the critical tipping point of immunity is going to be essential to getting back to something resembling normal. "If we have a conspicuous shortfall on achieving herd immunity, then we may have continuing transmission in the subset of population that is still susceptible, the unvaccinated subset, and then it's very hard for society to go back to normal because we continue to drive cases, continue to drive deaths," he said.
 
In that case, "there's going to be a lot of concern in society about going to the movie theater, about going to the bowling alley, about going to the arts event or music event, thinking about school and business as usual, restaurants as usual," Vermund said.
 
"You're going to be wondering whether you're really, truly safe. So even though I would be very secure, if I were ... fully vaccinated, to go and sit with somebody who's susceptible, a lot of people are not going to feel very secure," he said.
 
Herd immunity works even if 20 percent of the population isn't vaccinated because "that transmission cycle becomes very inefficient and has a tendency to die out on its own, so that nobody gets infected from the infected person entering a group setting," Vermund said.
 
As an example, at a party, "pretend like 80 percent of the people are wearing red and 20 percent are wearing green. You may simply not talk to the green person in that particular dinner party. ... So then there isn't the transmission at the event, and, after a couple of days, you're no longer infectious."
 
Vermund said the reason we need to get flu shots every year is not just because of the different strains. "The reason we have between 10,000 and 50,000 deaths a year from from flu is because we only manage 65 percent vaccine coverage," he said. "If we managed 100 percent, we'd probably have 1,000 deaths, a very tiny number, if any.
 
"So it's all about the vaccine coverage. That is our easiest route to a COVID-free autumn and keeping COVID to a very minimum level next winter," Vermund said. "It's very plausible that COVID will surge in the winter like it did this year, but it may not surge very much. It may be much, much, much lower if there are many fewer susceptible individuals."
 
edward.stannard@hearstmediact.com; 203-680-9382
 
___
 
(c)2021 the New Haven Register (New Haven, Conn.)
 
Visit the New Haven Register (New Haven, Conn.) at www.nhregister.com
 
Distributed by Tribune Content Agency, LLC.
 
 
 
(TNS)
 
Mar. 28—The possible future of the pandemic: Most adults are vaccinated, including almost all of the oldest, who are most likely to die of COVID-19. People feel safe getting together. Warmer weather brings more people outside. It looks like the worst may be over.
 
Or this: New coronavirus variants arrive that are immune to the vaccines. People wait in line for booster shots. States open up too quickly, removing mask mandates and crowd controls. Young people and older conservatives don't get vaccinated. Another major surge in infections and deaths ensues.
 
Experts in public health and medicine say the pandemic could go either way, and it's difficult to predict which direction we are headed. There are both positive and negative signals.
 
"There's a lot of 'we don't knows'" when it comes to the coronavirus, said Dr. Howard Selinger, chairman of family medicine at Quinnipiac University's Frank H. Netter MD School of Medicine. "They're studying it, but it's going to take time."
 
One concern is how quickly states are opening up, especially in the South. "Between now and the end of summer, as states open up, we don't know if we're going to facilitate the spread of mutants that are both more easily transmitted and apparently make people sicker," Selinger said.
 
If people aren't wearing masks and taking other precautions — especially if they are not vaccinated — infections can rise and "what creates mutation is transmission," he said. It's best "if you can tamp down the spread, not just through vaccination but through good old-fashioned masking and social distancing," he said.
 
"When the governor opens up bars and restaurants 100 percent but continues to keep the mask mandate in place, it's kind of a mixed message," Selinger said, because people take off their masks when eating and drinking.
 
"You are likely to see surges in those states that are not yet hitting the tipping point of 70 to 75 percent immunized," he said. That has happened in Italy, which is locking down parts of the country because of a surge in infections.
 
"So one scenario of states prematurely opening up: We lose the race because we can't immunize fast enough," Selinger said. "We get a lot more sick people as we continue to vaccinate, but at a high cost of death and illness."
 
There is good news. "We do know there is going to be sufficient vaccine supply," Selinger said. By late summer, 70 percent to 80 percent of the population should be immunized, enough to create herd immunity.
 
Connecticut ranks fourth in vaccination rates, according to Becker's Hospital Review, with 18 percent of the population fully vaccinated as of Thursday. Leaving out children 15 and younger, that percentage is 22.
 
The state Department of Public Health reported that as of March 22, 36 percent of Connecticut residents 16 and older had received at least one dose of vaccine and 30 percent of all residents had.
 
Some state residents over 16 have been vaccinated, but as of April 1, everyone from 16 to 44 years old will become eligible, totaling 1.9 million people, more than half the population.
 
In looking at vaccination rates and variant strains of the coronavirus, "I think of them as very intertwined," said Lisa Cuchara, professor of biomedical sciences at Quinnipiac University. "The virus doesn't mutate in the air or in the water. ... It mutates inside human beings."
 
If most people are vaccinated and aren't getting infected, there are far fewer hosts available to serve as mutation factories, she said.
 
Cuchara said there are danger signs that young people and white conservatives are less likely to get their shots, making the 75 percent to 80 percent rate required for "herd immunity" harder to reach. She said it appears "young people aren't as worried about COVID and spring break reinforces that. ... They don't think that this is as serious for them, so they're not as leery."
 
In addition, "they're more likely to do other risky behaviors," she said. "I don't think they have a scientific reason, a political reason. I just think they don't think this is a big deal to them."
 
Florida Gov. Ron DeSantis has not ordered that masks be worn in the state and has kept businesses open. Thousands of young adults have jammed Miami Beach, where the city imposed an emergency 8 p.m. curfew as partiers have broken into fights and stampeded through the streets.
 
According to a Civiqs poll, 27 percent of 18- to 34-year-olds don't plan to get vaccinated, while 64 percent do or already have gotten their shots.
 
Another group that is resistant to vaccination is white Republicans. According to Civiqs, 43 percent of that group said they will not get the vaccine if it becomes available, compared with 2 percent of white Democrats and 26 percent of white independents. Twelve percent of Black Americans say they won't take the vaccine, a number that has declined over time, and 15 percent of Hispanics say they won't.
 
"I see a huge partisanship with people refusing to get vaccinated and that scares me the most," Cuchara said. In addition to those who have made COVID a partisan issue, there are those who get misinformation and even intentionally misleading propaganda from social media. "People who spend more time on Facebook are going to be more hesitant," she said.
 
"Being hesitant is normal but where do you get your information? Where do you get your answers from?" she said. "You've got to make sure that hesitancy is met with facts and not oddities," such as the president of Brazil, Jair Bolsonaro, warning that women taking the Pfizer vaccine could grow facial hair or that men's voices might become effeminate.
 
Dean Sten Vermund of the Yale School of Public Health said there is more good news for the state. "In the big national surveys, Connecticut has one of the lowest rates of vaccine hesitancy of all the states. I think it's in the bottom three to five," he said. "There are more willing people in Connecticut than nearly all the other states."
 
Those who are unwilling to get vaccinated see a false choice, Cuchara said. "The decision isn't, get vaccinated / don't get vaccinated," she said. "The decision is, how do I want to get exposed to this virus? The whole virus or just the spike protein?" The messenger RNA in the Pfizer and Moderna vaccines triggers antibodies because it has the same genetic code as the coronavirus' spike protein, which cannot cause infection.
 
If we don't reach that 75 percent threshold of immunization, those who have compromised immune systems will be especially at risk and will put those around them in danger as well, Cuchara said. "They could actually harbor that virus for a long period of time."
 
In one case, immunocompromised patients "were actually positive for COVID and shedding virus for five months," she said. "The variants are going to be allowed to occur within them. They are going to be the main source of the variants."
 
Some good news is that viral mutations are not necessarily more lethal. However, if they are more contagious, those who get sick are at greater risk of death, especially if they are old or have underlying health conditions.
 
"We tend to think the virus wants to kill us. It really doesn't; it just wants to make more copies of itself," Cuchara said. "If you're a virus, your point of view is you would not want to kill people because you're not going to spread very far."
 
That's why vaccination is so important. Unlike influenza, which can spread via pigs, birds and even dogs and cats, "99.99 percent of the spread [of coronavirus] is human to human," Cuchara said. If everyone is vaccinated, "there's nobody to make a variant in."
 
It's also important even for people who have had COVID-19 to get their shots. "Natural immunity — immunity after infection — doesn't seem to last very long," Cuchara said.
 
Another risk is that the vaccines we are receiving now won't work against future variants, but that we won't realize we are at risk of another infection because we believe we are safe. "Those variants could pop up that are basically immune to our immunity," Cuchara said. "We could have disease and death and hospitalizations occurring in vaccinated people."
 
One question "that hasn't been answered definitively yet: Is the vaccinated person still a menace to other people?" Vermund said. "Are they infectious because they harbor virus in their nasal passages? The tentative answer is no, because there are some small studies that are very promising in suggesting that there is a lower viral load in the immunized person ... who's infected with the virus."
 
According to current research, in someone who's vaccinated, "their immune system kicks in and knocks the viral load down very quickly," Vermund said. "And they also are unlikely to be major transmitters because there's also a dampening of virus in the nasal passage." But research still is being conducted, he said.
 
Now, vaccinated people are able to get together and not risk infecting each other, Vermund said. In public, "We're still going to wear a mask ... because we're not 100 percent sure that we might not be a risk to someone else, but we are not going to be concerned about acquiring coronavirus."
 
Vermund said getting to the critical tipping point of immunity is going to be essential to getting back to something resembling normal. "If we have a conspicuous shortfall on achieving herd immunity, then we may have continuing transmission in the subset of population that is still susceptible, the unvaccinated subset, and then it's very hard for society to go back to normal because we continue to drive cases, continue to drive deaths," he said.
 
In that case, "there's going to be a lot of concern in society about going to the movie theater, about going to the bowling alley, about going to the arts event or music event, thinking about school and business as usual, restaurants as usual," Vermund said.
 
"You're going to be wondering whether you're really, truly safe. So even though I would be very secure, if I were ... fully vaccinated, to go and sit with somebody who's susceptible, a lot of people are not going to feel very secure," he said.
 
Herd immunity works even if 20 percent of the population isn't vaccinated because "that transmission cycle becomes very inefficient and has a tendency to die out on its own, so that nobody gets infected from the infected person entering a group setting," Vermund said.
 
As an example, at a party, "pretend like 80 percent of the people are wearing red and 20 percent are wearing green. You may simply not talk to the green person in that particular dinner party. ... So then there isn't the transmission at the event, and, after a couple of days, you're no longer infectious."
 
Vermund said the reason we need to get flu shots every year is not just because of the different strains. "The reason we have between 10,000 and 50,000 deaths a year from from flu is because we only manage 65 percent vaccine coverage," he said. "If we managed 100 percent, we'd probably have 1,000 deaths, a very tiny number, if any.
 
"So it's all about the vaccine coverage. That is our easiest route to a COVID-free autumn and keeping COVID to a very minimum level next winter," Vermund said. "It's very plausible that COVID will surge in the winter like it did this year, but it may not surge very much. It may be much, much, much lower if there are many fewer susceptible individuals."
 
edward.stannard@hearstmediact.com; 203-680-9382
 
___
 
(c)2021 the New Haven Register (New Haven, Conn.)
 
Visit the New Haven Register (New Haven, Conn.) at www.nhregister.com
 
Distributed by Tribune Content Agency, LLC.
 
 

 

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