Vaccine reserve was exhausted when Trump administration vowed to release it, dashing hopes of expanded access

https://www.washingtonpost.com/health/2021/01/15/trump-vaccine-reserve-used-up/

Eric Feigl-Ding on Twitter: "BREAKING—We are out of vaccine reserves! Trump  HHS Sec Azar announced this week that the govt would begin releasing  #COVID19 vaccine doses held in reserve for 2nd shots—but

States were anticipating a windfall after federal officials said they would stop holding back second doses. But the approach had already changed, and no stockpile exists.

When Health and Human Services Secretary Alex Azar announced this week that the federal government would begin releasing coronavirus vaccine doses that had been held in reserve for second shots, no such reserve existed, according to state and federal officials briefed on distribution plans. The Trump administration had already begun shipping out what was available, starting at the end of December, taking second doses for the two-dose regimen directly off the manufacturing line.

Now, health officials across the country who had anticipated their extremely limited vaccine supply as much as doubling beginning next week are confronting the reality that their allocations will remain largely flat, dashing hopes of dramatically expanding access for millions of elderly people and those with high-risk medical conditions. Health officials in some cities and states were informed in recent days about the reality of the situation, while others were still in the dark Friday.

Because both of the vaccines authorized for emergency use in the United States are two-dose regimens, the Trump administration’s initial policy was to hold back second doses to protect against manufacturing disruptions. But that approach shifted in recent weeks, according to the officials, who spoke on the condition of anonymity because they were not authorized to discuss the matter.

Operation Warp Speed, which is overseeing vaccine distribution, stopped stockpiling second doses of the Pfizer-BioNTech vaccine at the end of last year, those officials were told. Shipping of the last reserve doses of Moderna’s supply, meanwhile, began over the weekend.

The shift, in both cases, had to do with increased confidence in the supply chain, so Operation Warp Speed leaders felt they could reliably anticipate the availability of doses for booster shots — required three weeks later in the case of the Pfizer-BioNTech product and four weeks later under Moderna’s protocol.

But it also meant there was no stockpile of second doses waiting to be shipped, as Trump administration officials suggested this week. Azar, at a briefing Tuesday, said, “Because we now have a consistent pace of production, we can now ship all of the doses that had been held in physical reserve.” He explained the decision as part of the “next phase” of the nation’s vaccination campaign.

Those in line for their second shots are still expected to get them on schedule because second doses are prioritized over first shots and states are still receiving regular vaccine shipments. But state and local officials say they are angry and bewildered by the shifting directions and changing explanations about supply. Their anxiety was deepened by projections that a highly contagious virus variant would spread rapidly throughout the United States and as daily covid-19 deaths averaged 3,320 this week.

The health director in Oregon, Patrick M. Allen, was so disturbed that he wrote Azar on Thursday demanding an explanation. In his letter, he recounted how Gustave F. Perna, the chief operating officer of Operation Warp Speed, had “informed us there is no reserve of doses, and we are already receiving the full allocation of vaccines.”

“If true, this is extremely disturbing, and puts our plans to expand eligibility at grave risk,” Allen wrote. “Those plans were made on the basis of reliance on your statement about ‘releasing the entire supply’ you have in reserve. If this information is accurate, we will be unable to begin vaccinating our vulnerable seniors on Jan. 23, as planned.”

HHS spokesman Michael Pratt confirmed in an email that the final reserve of second doses had recently been released to states but did not address Azar’s comments, saying only, “Operation Warp Speed has been monitoring manufacturing closely, and always intended to transition from holding second doses in reserve as manufacturing stabilizes and we gained confidence in the ability for a consistent flow of vaccines.”

But the explanations by the federal government were conflicting. The 13 million doses made available for states to order this week — for delivery next week — represented “millions more” than in previous weeks, Pratt said. He also said states have not requested the full amount they have been allocated.

Guidance circulated Friday among HHS officials acknowledged, however, that “the notion that there is a large bolus of second doses that will be released to jurisdictions is not accurate.” And state and municipal health officials said their allocations for next week had increased only marginally, if at all.

Chicago Public Health Commissioner Allison Arwady said her city’s share had gone from about 32,000 doses to 34,000 doses. “I have stopped paying a whole lot of attention to what is being said verbally at the federal level right now,” she said.

Nirav Shah, the director of Maine’s Center for Disease Control and Prevention, said he learned only Friday, by calling his state’s designated contact at Warp Speed, that the reserve no longer existed.

Maine still plans to broaden vaccination next week to those 70 and older. “Who is in line will not change,” Shah said. “The velocity of that line will change because this bolus of doses that we intuited was coming based on Azar’s comments is not coming.”

In an email that reached some state officials Friday morning, Christopher Sharpsten, an Operation Warp Speed director, called it a “false rumor” that “the federal government was holding back vaccine doses in warehouses to guarantee a second/booster dose.”

In fact, that information had come fromAzar, who said Tuesday that the “next phase” of the country’s vaccination campaign involved “releasing the entire supply we have for order by states, rather than holding second doses in physical reserve.”

Azar’s comments Tuesday followed a Jan. 8 announcement by President-elect Joe Biden’s transition team that his administration would move to release all available doses rather than holding half in reserve for booster shots. Biden’s advisers said the move would be a way to accelerate distribution of the vaccine, which is in short supply across the country.

Azar initially said the Biden plan was shortsighted and potentially unethical in putting people at risk of missing their booster shots. When he embraced the change four days later, however, he did not say that the original policy had already been phased out or that the stockpile had been exhausted. Trump administration officials and Biden’s team alike have sought to reassure the public that increasing the pace of immunizations would not endanger booster shots.

Azar also signaled to states that they would soon see expanded supply, urging them to begin vaccinating adults 65 and older and those under 64 with high-risk medical conditions. Officials in some states embraced that directive, while others said that suddenly putting hundreds of thousands of additional people at the front of the line would overwhelm their capacity.

In subsequent conversations with state and local authorities, federal officials sought to temper those instructions, said people who participated in the conversations. Perna, for instance, spoke directly to officials in at least two of the jurisdictions receiving vaccine supply, explaining that allocations would not increase and that they did not have to broaden eligibility as they had previously been told, according to a health official who was not authorized to discuss the matter.

The revised instructions led some state and local officials to hold off on changes. One state health official noted that the updated eligibility guidance announced Tuesday did not appear on the website of the CDC, even though it was stated as federal policy by Azar and by Robert R. Redfield, the CDC director, in their remarks. Under the original recommendations, adults 65 and older and front-line essential workers were to comprise the second priority group, known as Phase 1b, after medical workers and residents and staffers of long-term-care facilities.

There was additional confusion from another change Azar announced this week — making allocation of doses dependent on how quickly states administer them. He originally said that would not take effect for two weeks.

But Connecticut Gov. Ned Lamont (D) on Thursday tweeted that federal officials had notified him that the state would receive an additional 50,000 doses next week “as a reward for being among the fastest states” to get shots into arms. West Virginia, meanwhile, which is moving at the fastest clip, according to CDC data, did not get any additional doses, said Holli Nelson, a spokeswoman for the state’s National Guard.

In a sign that the incentive structure may not be long-lived, a senior Biden transition official, speaking on the condition of anonymity to address ongoing deliberations, said this week that the team did not look kindly on a system that “punishes states.”

Biden has said he wants to see 100 million shots administered within his first 100 days — an aim that will depend on quickly accelerating the pace of immunization. Together, Pfizer and Moderna have agreed to sell 200 million doses to the United States by the end of March, which is enough to fully vaccinate 100 million people.

2 months to slow the new spread

How does coronavirus spread: Community spread and COVID-19

🚨New CDC warning: The highly contagious variant B.1.1.7 originally detected in the U.K. could become the dominant strain in the U.S. by March.

Why it matters: The variant is estimated to be 30% to 50% more transmissible than other forms of the virus, threatening efforts to push the U.S. past its record high case count.

  • The variant is in 12 states, but has been diagnosed in only 76 of the 23 million U.S. cases reported to date, the AP reports.
  • It’s likely that the variant is more widespread than currently reported.

The big picture: Americans are exhausted and burned out, and COVID wariness is slipping.

  • So far, the variants do not appear to be resistant to the existing vaccines or cause more severe disease.
  • But the health care system is on the brink in places like Southern California.
  • Another spike in cases could lead us to a very dark place.

The bottom line: There’s no evidence that this variant is transmitted differently, so keep up the masks and social distancing.

Go deeper … The coronavirus variants: What you need to know.

CDC warns highly transmissible coronavirus variant to become dominant in U.S.

The highly contagious variant of the coronavirus first seen in the United Kingdom will become the dominant strain in the United States within about two months, its rapid spread heightening the urgency of getting people vaccinated, the Centers for Disease Control and Prevention predicted Friday in its most sobering warning yet about mutations in the virus.

In every scenario explored by the CDC, the U.K. strain, which British researchers estimate is roughly 50 percent more transmissible than the more common coronavirus strain, will account for a majority of cases in the United States by some point in March.

The CDC released modeling data to back up its forecast showing a rapid spike in infections linked to the U.K. strain. The agency said the emergence of these mutation-laden variants requires greater efforts to limit viral spread — immediately, even before the U.K. variant becomes commonplace.

So far, no variant is known to cause more severe illness, although more infections would inevitably mean a higher death toll overall, as the CDC made clear in an informational graphic released Friday: “MORE SPREAD — MORE CASES — MORE DEATHS,” it said.

The CDC report “speaks to the urgency of getting vaccines out. It’s now a race against the virus,” said William Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health.

Scientists both in and out of government have stressed the need for the public to stick to proven methods of limiting viral spread, such as wearing a mask, social distancing, avoiding crowds and having good hand hygiene.

“We know what works and what to do,” CDC scientist Jay Butler said Friday.

The emergence of highly contagious variants has grabbed the full attention of scientists, who in recent weeks have warned that these mutations require closer surveillance. The CDC and its partners in private and academic laboratories are ramping up genomic sequencing efforts to gain better awareness of what is already circulating. Experts think there could be many variants containing mutations worth a closer look.

“This is a situation of concern. We are increasing our surveillance of emerging variants. This virus sometimes surprises us,” Butler said.

Mutations could limit the efficacy of vaccines or therapeutic drugs such as monoclonal antibodies. Scientists believe vaccines will probably remain effective because they produce a robust immune system response, but such reassurances have been paired with cautionary notes about how much remains unknown.

The coronavirus mutations are not unexpected, because all viruses mutate. There are now several “variants of concern” receiving close scrutiny, including ones identified first in South Africa and Brazil, and U.S. officials have said genomic surveillance is still ramping up here and that there may be other variants in circulation, not yet identified, that are enhancing transmission.

“We’re going forward with the assumption that these three variants that we know about now are not going to be the only variants that emerge that are of concern to us,” Greg Armstrong, head of the CDC’s strain surveillance program, said Friday.

The CDC model suggests that the level of pain and suffering in March, when the new variant is expected to be dominant, depends on actions taken today to try to drive down infection rates. Because the threshold for herd immunity depends in part on how infectious a virus is, the emergence of a more transmissible strain can prolong efforts to crush a pandemic.

The emergence in recent weeks of mutation-laden variants has alarmed the CDC and the scientific community because of accelerating infections in Britain, Denmark, Ireland and other countries where the variant named B.1.1.7 has been spreading.

“Increased SARS-CoV-2 transmission might threaten strained healthcare resources, require extended and more rigorous implementation of public health strategies, and increase the percentage of population immunity required for pandemic control,” the CDC wrote. “Taking measures to reduce transmission now can lessen the potential impact of B.1.1.7 and allow critical time to increase vaccination coverage.”

It is unclear if the winter surge in the United States is at a peak, but the numbers are staggering, with more than 200,000 new infections confirmed every day on average.

This is not the first warning from the CDC about variants of the virus, but it is the first to offer a plausible timeline for when and to what degree the mutations seen recently could complicate efforts to end the pandemic.

It shows that vaccination, performed rapidly, is critical to crushing the curve of viral infections. Without vaccines, under one CDC scenario, the country could be dealing with even greater levels of infections in May than in January.

But if public health agencies can ramp up to 1 million vaccinations a day, the CDC model forecasts that daily new infections will decline in the next few months — even with the extra boost from the highly contagious U.K. variant. It has been identified in 12 states, the CDC said Friday, and the agency has informed officials nationwide that they should assume the variant is present in their state.

The CDC and unaffiliated scientists have said they see no evidence that this particular variant is driving the winter surge in cases. So far, it has been involved in fewer than 0.5 percent of infections nationwide, testing data suggests.

Friday’s sobering CDC forecast is based on simple models and has limitations, the agency acknowledged.

The model looks at just the B.1.1.7 variant and does not consider the impact of other variants already discovered or not yet identified. The variants in South Africa and Brazil could prove to be even more problematic, though they have not been spotted so far in the United States. Researchers have noted the disastrous spike in cases in Manaus, Brazil, in recent weeks, despite the high percentage of the population believed to have been previously infected — a situation that raises suspicions, not confirmed by data, that some people who had recovered are becoming re-infected by the new strain.

The CDC model treats the country as a single unit even though the virus is spreading at different rates locally and regionally. No one knows, even at the national level, the current “R,” the reproduction number, of the common coronavirus variant. That’s the number of people an infected person will infect, on average.

The CDC model used plausible reproduction rates of 1.1 (faster spread right now) and 0.9 (slower). The CDC then used British data to project that the U.K. variant is 50 percent more transmissible than the common variant. The model assumes that between 10 and 30 percent of the population has been infected already and recovered and now has immunity.

“It would be foolish to say that this is never going to end, and we might as well stop trying,” the CDC’s Butler said Friday. “But there is reason to be concerned. We’re not out of the woods on this pandemic yet. We need to continue to press ahead.”

Past Covid-19 Infection Gives Vaccine-Like Immunity For Months, Study Finds

Coronavirus immunity: What do we know? | COVID-19 Special - YouTube

TOPLINE

Most people who have recovered from Covid-19 have similar levels of immunity against future infection to those who received a coronavirus vaccine, a study by Public Health England found, offering early hope against fears of a short-lived immunity spurred on by reports of people catching the virus twice, though the researchers warn that those with immunity may still be able to carry and transmit the virus to others. 

KEY FACTS

Naturally acquired immunity from a previous Covid-19 infection provides 83% protection against reinfection when compared with people who have not had the disease before, government researchers found in a study of more than 20,000 healthcare workers.

The study, which has not yet been peer reviewed for rigor by other scientists, shows that this protection lasts for at least five months and is at a level just below that offered by vaccines from Pfizer-BioNTech (95%) and Moderna (94%) and significantly above that of the vaccine developed by the University of Oxford and AstraZeneca (62%), though manufacturers don’t know for how long this immunity lasts.

The figures suggest reinfection is relatively rare — occurring in fewer than 1% of the the 6,614 people who had already tested positive for the disease — though the scientists warned that while “those with antibodies have some protection from becoming ill with Covid-19 themselves,” early evidence suggests that they can carry and transmit the virus to others.

“It is therefore crucial that everyone continues to follow the rules and stays at home, even if they have previously had Covid-19, to prevent spreading the virus to others,” Public Health England wrote.

The study will continue to follow participants for another 12 months to determine “how long any immunity may last, the effectiveness of vaccines and to what extent people with immunity are able to carry and transmit the virus,” as well as investigate the highly-contagious new variant of coronavirus spreading across the U.K.. 

CRUCIAL QUOTE

Professor Lawrence Young, a virologist and Professor of Molecular Oncology at Warwick Medical School in England, said an important takeaway from the study is that we don’t yet know how long antibody protection will last outside of the five month window. He said it is “possible that many people who were infected during the first wave of the pandemic may now be susceptible to re-infection.” Young said it will be interesting to see whether people previously infected with Covid-19 and are subsequently vaccinated have “an even longer-lived protective immune response” and whether or not these findings hold true for the new virus variant currently spreading in the U.K..

WHAT TO WATCH FOR

The information gathered from reinfection cases could prove important as the pandemic progresses, especially when it comes to designing and implementing an effective vaccination program and deciding whether to ease lockdown measures. Whether or not those who are immune to serious illness are capable of transmitting the infection to others will be a crucial deciding factor.

WHAT WE DON’T KNOW

It’s not yet clear for how long the protection provided by vaccines last. This will have to be studied over time, as with this case of natural immunity, and is something manufacturers are already doing. Moderna believes their vaccine offers at least a year’s protection against disease. Whether or not this protection prevents individuals from infecting others will also need to be figured out. 

BIG NUMBER

384,784. That’s how many people have died from Covid-19 in the U.S. since the pandemic began, according to Johns Hopkins university. According to CDC projections, this figure is set to grow 25% in the next three weeks. At the moment, more than 23 million people have contracted the disease in the U.S..

Recovered coronavirus patients should still get the vaccine, experts say

Research suggests most people who recovered from covid-19 are immune for at least eight months. Yet epidemiologists are largely still urging this population to get the vaccine if it’s their turn in line. 

Official guidance says vaccines should be offered regardless of whether people were previously infected. 

That’s per the Centers for Disease Control and Prevention, which also says the vaccine is safe for people who have had a prior infection. Former CDC director Thomas Frieden said he’d advise most people to get the vaccine, even if they’ve had covid-19.

But Frieden added that he doesn’t think it’s wrong for someone in a low-risk group who’d already had the illness to defer if they thought someone else could use the dose. 

The limits on vaccine supply bolster the argument that recovered people should let others go first. 

As administration of the vaccine bottlenecks across the country, the pressure is on to get the shots in as many arms as quickly as possible. 

Researchers at the University of Colorado Boulder found that prioritizing people who don’t already have natural immunity could allow health officials to get more impact from limited supplies, especially in areas where many people have already been infected, according to a modeling study that has not been peer reviewed

The researchers found that you would need to vaccinate 1 in 5 elderly people in New York to bring death rates down by 73 percent. But you can get the same result vaccinating only 1 in 6 people if you prioritize people who don’t already have antibodies to the virus, according to Kate Bubar, a PhD student in applied mathematics and quantitative biology, who co-authored the study.

And although a previous covid-19 infection isn’t a guarantee of immunity, it’s pretty good protection on its own.Researchers have found that eight months after infection, about 90 percent of patients show lingering, stable immunity. 

Still, risk can vary from person to person.  

“If I were over 70 or otherwise ill, I would certainly take the vaccine even if I’d had [covid-19]. If I were 30 and healthy, I should not be getting it now (unless a health care worker), but if for some reason I did get offered it I would probably decline,” Marc Lipsitch, an infectious-disease specialist at the Harvard T.H. Chan School of Public Health, said in an email.  

Some epidemiologists worry about the logistics of trying to weed out people with natural immunity.

It could complicate the process as health providers are already struggling to get the vaccine distributed quickly. So far around 6.7 million people have been vaccinated, even though 22.1 million doses have been distributed, according to a Washington Post analysis.

Eleanor Murray, an assistant professor of epidemiology at Boston University School of Public Health, worried that trying to verify someone’s past illness would add bureaucratic hurdles. 

“Confirming whether or not someone has had COVID already adds an unnecessary layer of red tape onto vaccine prioritization. Given that the prioritization is designed to get vaccine first to those people who are most likely to get infected and/or get very sick from infection, it makes sense to reduce the barriers to vaccinating this group as much as possible,” Murray said. 

Murray also cautioned that we don’t know how long people’s natural immunity lasts and that it could vary from person to person. This uncertainty may be an added reason to encourage people to get the vaccine.

There’s also a risk that telling people who had covid-19 to hold off on getting the vaccine could end up feeding into anti-vaxxer narratives. Some experts are reluctant to discourage anyone from getting the vaccine if they are eligible, especially given that vaccine hesitancy is widespread. 

There’s already a problem with people being offered the vaccine but not getting it. 

In Santa Rosa County, Fla., only about 40 percent of emergency responders who are eligible to get the vaccine have gotten it or signed up to do so soon. In New York, where around 30 percent of health care workers have declined the vaccine, the state’s Gov. Andrew Cuomo (D) has threatened that anyone who skips a dose now won’t be eligible for a priority vaccine later. 

The low participation rate is concerning, especially at long-term care centers. 

But not everyone who turns down a vaccine is a hardcore anti-vaxxer, Frieden cautions. He says that there is a “movable middle” of people. They aren’t going to be camping out overnight to get an early vaccine, but they may be convincible if costs and other barriers are low. Frieden says it’s crucial to keep a door open for those people, for instance, seeing whether they might be willing to schedule a shot three weeks from now instead of immediately. 

The slow pace of vaccinations has sparked a heated debate over how to stretch supplies.

A vocal group of experts has pushed for officials to consider giving as many people as possible the first dose of the two-shot regimen, even if it means risking a delayed second dose. President-elect Joe Biden has announced his incoming administration will take this approach, sending all doses out the door as quickly as possible instead of holding half back. 

“The plan, announced Friday by the Biden transition team, pivots sharply from the Trump administration’s strategy of holding in reserve roughly half the doses to ensure sufficient supply for people to get a required second shot,” our colleagues reported.

But some epidemiologists, including Frieden, argue that distribution is a bigger problem than supply at this point. Although he said he supports releasing most vaccines, he worries that some of the debates about how to stretch supply are “distractions” from the real obstacles of administration, which he blames in part on a lack of a coordinated federal plan for getting shots into arms. 

“What Operation Warp Speed has generally done is said, ‘We’re responsible for getting the drugs to the states, and after that, it’s their problem,’ ” Frieden said. “That’s a way to facilitate finger pointing; that’s neither a plan nor a solution.” 

Can you spread Covid-19 if you get the vaccine?

https://qz.com/1954762/can-you-spread-covid-19-if-you-get-the-vaccine/?utm_source=YPL

Can you spread Covid-19 if you get the vaccine? — Quartz

We know that the vaccines now available across the world will protect their recipients from getting sick with Covid-19. But while each vaccine authorized for public use can prevent well over 50% of cases (in Pfizer-BioNTech and Moderna‘s case, more than 90%), what we don’t know is whether they’ll also curb transmission of the SARS-CoV-2 virus.

That question is answerable, though—and understanding vaccines’ effect on transmission will help determine when things can go back to whatever our new normal looks like.

The reason we don’t know if the vaccine can prevent transmission is twofold. One reason is practical. The first order of business for vaccines is preventing exposed individuals from getting sick, so that’s what the clinical trials for Covid-19 shots were designed to determine. We simply don’t have public health data to answer the question of transmission yet.

The second reason is immunological. From a scientific perspective, there are a lot of complex questions about how the vaccine generates antibodies in the body that haven’t yet been studied. Scientists are still eager to explore these immunological rabbit holes, but it could take years to reach the bottom of them.

Acting the part

Vaccines work by tricking the immune system into making antibodies before an infection comes along. Antibodies can then attack the actual virus when it enters our systems before they have a chance to replicate enough to launch a full-blown infection. But while vaccines could win an Oscar for their infectious acting job, they can’t get the body to produce antibodies exactly the same way as the real deal.

From what we know so far, Covid-19 vaccines cause the body to produce a class of antibodies called immunoglobulin G, or IgG antibodies, explains Matthew Woodruff, an immunologist at Emory University. IgG antibodies are thugs: They react swiftly to all kinds of foreign entities. They make up the majority of our antibodies, and are confined to the parts of our body that don’t have contact with the outside world, like our muscles and blood.

But to prevent Covid-19 transmission, another type of antibodies could be the more important player. The immune system that patrols your outward-facing mucosal surfaces—spaces like the nose, the throat, the lungs, and digestive tract—relies on immunoglobulin A, or IgA antibodies. And we don’t yet know how well existing vaccines incite IgA antibodies.

“Mucosal immunology is ridiculously complicated,” says Woodruff. “Rather than thinking of immune system as a way to fight off bad actors, it’s really a way for your internal environment to maintain some sort of homeostatic existence with a really dynamic outside world,” as you breathe, eat, drink, and touch your face.

People who get sick and recover from Covid-19 produce a ton of these more-specialized IgA antibodies. Because IgA antibodies occupy the same respiratory tract surfaces involved in transmitting SARS-CoV-2, we could reasonably expect that people who recover from Covid-19 aren’t spreading the virus any more. (Granted, this may also depend on how much of the virus that person was exposed to.)

But we don’t know if people who have IgG antibodies from the vaccine are stopping the virus in our respiratory tracts in the same way. And even if we did, scientists still don’t know how much of the SARS-CoV-2 virus it takes to cause a new infection. So even if we understood how well a vaccine worked to prevent a virus from replicating along the upper respiratory tract, it’d be extremely difficult to tell if that would mean a person couldn’t transmit the disease.

Making it real

Because of all that complication, it’s unlikely that immunological research alone will reveal how well vaccines can prevent Covid-19 transmission—at least, not for years. But there’s another way to tell if a vaccine can stop a person from transmitting a virus to others: community spread.

As more and more people get both doses of a Covid-19 vaccine (and wait a full two weeks after their second dose for maximum immunity to kick in), public health officials can see how fast case counts fall. It may not be a perfect indicator of whether we’re stopping the virus in its tracks—there are many other variables that can slow transmission, including lockdown measures—but for practical purposes, it’ll be good enough to help make public health decisions.

Plus, even though the data we have from clinical trials isn’t perfect, it’s a pretty good indicator that the vaccine at least stops some viral replication. “I can’t imagine how the vaccine would prevent symptomatic infection at the efficacies that [companies] reported and have no impact on transmission,” Woodruff says.

Each of the vaccines granted emergency use in western countries—Moderna, Pfizer-BioNTech, and AstraZeneca—have all shown high efficacy in phase 3 clinical trials. (The Sinopharm and Sinovac vaccines from China and the Bharat Biotech vaccine in India have also been shown to be effective at preventing Covid-19, but aren’t widely approved for use yet.)

Frustratingly, it’s just going to take more time to see if people who got the vaccine are involved in future transmission events. That’s why it’s vital that even after receiving both doses of the Covid-19 vaccine, all individuals wear masks, practice physical distancing, and wash their hands when around those who haven’t been vaccinated—just in case.

Two Dead Every Minute: U.S. Covid-19 Cases Surge In 2021

COVID-19 on pace to become the third-leading cause of death in Arizona this  year - The Gila Herald

TOPLINE

In the first week of 2021, roughly two people died from Covid-19 in the U.S. every minute, amid a struggling national vaccination effort, soaring coronavirus cases and the deadliest day of the pandemic yet.

KEY FACTS

According to data from the Covid Tracking Project, 19,418 people died from the disease in the first seven days of 2021.

The U.S. is the country hardest hit by the novel coronavirus — more than 4,000 people died on Thursday, the deadliest day yet of the pandemic, and over 355,000 people have died from the disease since the pandemic began. 

Experts warn that things are likely to get worse before they get better as hospitals across the country are stretched to breaking point — hospitals in LA are reportedly rationing oxygen and many are running out of beds. 

More than 132,000 Americans are currently admitted in hospitals for Covid-19-related care. 

Widespread vaccination, which could help turn the tide against the virus, has failed to gain momentum and the U.S. is way behind its inoculation targets.

The Centers for Disease Control and Prevention says that only 28% of the more than 21 million vaccines it has distributed have been used —  many are reportedly languishing in storage. 

WHAT TO WATCH FOR

President-elect Joe Biden has said he will release all available Covid-19 vaccine doses for immediate use upon taking office, ending Trump’s strategy of saving doses to ensure people have access to a recommended second shot. Some countries, such as the U.K., have decided to space out doses beyond what manufacturers recommend in a bid to provide as many people as possible with some degree of immunity. Experts are torn on the strategy. The U.S. Food and Drug Administration recommends the vaccines are distributed as intended, with a second shot after a 21 or 28 day gap. The British medical regulator, and more recently the World Health Organization, say the second shot can be delayed, although they do not agree on how long this should be.

CRUCIAL QUOTE

Biden warned that the U.S. is falling “far behind” what is needed to control the pandemic. Trump’s approach would take “years,” he said. 

WHAT WE DON’T KNOW

A highly infectious variant of coronavirus, first discovered in the U.K., could be circulating in the U.S.. At least 52 cases have been reported so far. Fortunately, scientists do not believe the variant is able to evade the recently-developed vaccines. 

Storming of Capitol was textbook potential coronavirus superspreader, experts say

https://www.washingtonpost.com/health/2021/01/08/capitol-coronavirus/

Wednesday’s storming of the U.S. Capitol did not just overshadow one of the deadliest days of the coronavirus pandemic — it could have contributed to the crisis as a textbook potential superspreader, health experts warn.

Thousands of Trump supporters dismissive of the virus’s threat packed together with few face coverings — shouting, jostling and forcing their way indoors to halt certification of the election results, many converging from out of town at the president’s urging. Police rushed members of Congress to crowded quarters where legislators say some of their colleagues refused to wear masks as well.

“This was in so many ways an extraordinarily dangerous event yesterday, not only from the security aspects but from the public health aspects, and there will be a fair amount of disease that comes from it,” said Eric Toner, senior scholar at the John Hopkins Center for Health Security.

Experts said that resulting infections will be near-impossible to track, with massive crowds fanning out around the country and few rioters detained and identified. They also wondered if even a significant number of cases would register in a nation overwhelmed by the coronavirus. As Americans shared their shock and anger at the Capitol breach Thursday, the United States reported more than 132,000 people hospitalized with the virus, and more than 4,000 deaths from covid-19, the disease caused by the coronavirus — making it the highest single-day tally yet.

“It is a very real possibility that this will lead to a major outbreak but one that we may or may not be able to recognize,” Toner said. “All the cases to likely derive from this event will likely be lost in the huge number of cases we have in the country right now.”

Trump devotees who flocked to the capital this week said they were unconcerned by the virus, belittling common precautions known to slow its spread and echoing the president’s dismissive attitude toward rising case counts. Trump had encouraged them to gather in defiance of his election loss: “Big protest in D.C. on January 6th,” he tweeted last month. “Be there, will be wild!”

Mike Hebert, 73, drove two days from Kansas to participate. Marching toward the Capitol on Wednesday with an American flag, he said he did not feel the need to wear a face covering.

“I am as scared of the virus as I am of a butterfly,” said Hebert, adding that he is a veteran who was shot twice in Vietnam.

Sisters Courtney and Haley Stone left New York at 11 p.m. to make it to the Capitol by morning so they could quietly counterprotest, draped in Biden gear. “Do you want a mask? I have one,” Haley, 22, asked a Trump supporter, only to be rebuffed.

“Oh, you believe in the mask hoax?” the woman replied.

Health experts predicted Wednesday’s events will contribute to an ongoing case surge in the greater Washington region. The average number of daily new infections in Virginia, Maryland and the District of Columbia reached a record high Thursday, and current covid-19 hospitalizations in the District have risen 19 percent in the past week.

They also noted differences with other large gatherings such as Black Lives Matter protests. Fewer people wore masks during the Capitol protests and riot, they said, and crowds were indoors.

“If you wanted to organize an event to maximize the spread of covid it would be difficult to find one better than the one we witnessed yesterday,” said Jonathan Fielding, a professor at the schools of Public Health and Medicine at UCLA.

“You have the drivers of spreading at a time when we are bearing the heaviest burden of this terrible virus and terrible pandemic,” he said.

Calling in to CBS News Wednesday, Rep. Susan Wild (D-Pa.) described her evacuation to a “crowded” undisclosed location with 300 to 400 other people.

“It’s what I would call a covid superspreader event,” she said. “About half the people in the room are not wearing masks, even though they’ve been offered surgical masks. They’ve refused to wear them.”

She did not identify the lawmakers forgoing face coverings beyond saying they were Republicans, including some freshmen. The Committee on House Administration says it is a “critical necessity” to mask up while indoors at the Capitol, and D.C. has a strict mask mandate.

“It’s certainly exactly the kind of situation that we’ve been told by the medical doctors not to be in,” Wild said.

“We weren’t even allowed to get together with our families for Thanksgiving and Christmas,” she said, “and now we’re in a room with people who are flaunting the rules.”

At least one member of Congress has tested positive since the mob spurred an hours-long lockdown. Newly elected Rep. Jacob LaTurner (R-Kan.) tested positive for the coronavirus late Wednesday evening, according to a statement posted on his Twitter account. It said he is not experiencing symptoms.

“LaTurner is following the advice of the House physician and CDC guidelines and, therefore, does not plan to return to the House floor for votes until he is cleared to do so,” the statement said.

Luke Letlow, a 41-year-old congressman-elect from Louisiana, died of covid-19 last month.

Any infections among members of Congress and their staff will be far easier to contact-trace than those among rioters, said Angela Rasmussen, an affiliate at the Center for Global Health Science and Security at Georgetown University.

“It certainly would have been easier if they were detained by Capitol police and identified, but testing suspects may be something to consider as law enforcement begins to identify them,” Rasmussen said in an email.

She noted that some may try to evade identification and criminal charges, and said she is deeply concerned for the households and communities they might expose.

“I think really rigorous contact tracing of people who are not identified as being present on Capitol grounds will not be possible,” she said.

Nearly 60% of COVID-19 spread may come from asymptomatic spread, model finds

How asymptomatic cases fuelled spread of coronavirus - Times of India

People with COVID-19 who don’t exhibit symptoms may transmit 59 percent of all virus cases, according to a model developed by CDC researchers and published Jan. 7 in JAMA Network Open. 

Since many factors influence COVID-19 spread, researchers developed a mathematical approach to assess several scenarios, varying the infectious period and proportion of transmission for those who never display symptoms according to published best estimates.  

In the baseline model, 59 percent of all transmission came from asymptomatic transmission. That includes 35 percent of new cases from people who infect others before they show symptoms and 24 percent from people who never develop symptoms at all. Under a broad range of values for each of these assumptions, at least 50 percent of new COVID-19 infections were estimated to have originated from exposure to asymptomatic individuals. 

The more contagious variant first identified in the U.K. and since found in six states underscores the importance of the model findings, said Jay Butler, MD, CDC deputy director for infectious diseases and a co-author of the study.

“Controlling the COVID-19 pandemic really is going to require controlling the silent pandemic of transmission from persons without symptoms,” Dr. Butler told The Washington Post. “The community mitigation tools that we have need to be utilized broadly to be able to slow the spread of SARS-CoV-2 from all infected persons, at least until we have those vaccines widely available.”

Whether vaccines stop transmission is still uncertain and was not a scenario addressed in the model. 

LA County Paramedics Told Not To Transport Some Patients With Low Chance Of Survival

https://www.npr.org/sections/coronavirus-live-updates/2021/01/05/953444637/l-a-paramedics-told-not-to-transport-some-patients-with-low-chance-of-survival?fbclid=IwAR1BM5NI_SDAuVmU4TqBUg1Hk0qmAWHroUN0b7jIzrbL053BZLgluBNeU1k

Paramedics in Southern California are being told to conserve oxygen and not to bring patients to the hospital who have little chance of survival as Los Angeles County grapples with a new wave of COVID-19 patients that is expected to get worse in the coming days.

The Los Angeles County Emergency Medical Services Agency issued a directive Monday that ambulance crews should administer supplemental oxygen only to patients whose oxygen saturation levels fall below 90%.

In a separate memo from the county’s EMS Agency, paramedic crews have been told not to transfer patients who experience cardiac arrest unless spontaneous circulation can be restored on the scene.

Both measures announced Monday, which were issued by the agency’s medical director, Dr. Marianne Gausche-Hill, were taken in an attempt to get ahead of an expected surge to come following the winter holidays.

Many hospitals in the region “have reached a point of crisis and are having to make very tough decisions about patient care,” Dr. Christina Ghaly, the LA County director of health services, said at a briefing Monday.

“The volume being seen in our hospitals still represents the cases that resulted from the Thanksgiving holiday,” she said.

“We do not believe that we are yet seeing the cases that stemmed from the Christmas holiday,” Ghaly added. “This, sadly, and the cases from the recent New Year’s holiday, is still before us, and hospitals across the region are doing everything they can to prepare.”

Speaking to the CBS affiliate in Los Angeles, Gausche-Hill said personnel would continue to do everything possible to save the lives of patients, both at the scene and in the hospital.

“We are not abandoning resuscitation,” she said. “We are absolutely doing best practice resuscitation and that is do it in the field, do it right away.”

“[We] are emphasizing the fact that transporting these patients arrested leads to very poor outcomes. We knew that already and we just don’t want to impact our hospitals,” she added.

Meanwhile, the state is looking for ways to increase its supply of oxygen for use in treating COVID-19 patients, Gov. Gavin Newsom said, according to the Los Angeles Times.

We’re just looking at the panoply of oxygen support … across the spectrum and looking how we can utilize more flexibility and broader distribution of these oxygen units all up and down the state, but particularly in these areas — San Joaquin Valley and Los Angeles, the larger Southern California region — that are in particular need and are under particular stress,” Newsom said.

Los Angeles County remains the worst-hit county in the U.S. for both confirmed COVID-19 cases and deaths from the disease. Johns Hopkins University listed more than 818,000 confirmed coronavirus cases and more than 10,700 deaths from complications from the virus in Los Angeles County by late Monday.

Last week, the new highly contagious coronavirus strain from the U.K. was discovered in Southern California. Experts have said it spreads faster than the common strain.