The Beginning of the End of the American Pandemic

A tree branch emerging out from the shadows to the light with blooms and bird perched on top.

The country is reopening. What does the future hold?

The story of the American pandemic has unfolded in three chapters. The first began last January, when the coronavirus emerged and the world was plunged into uncertainty about how covid-19 could be treated, how the virus spread, and when it might be defeated. The second started on the morning of November 9, 2020, when Pfizer-BioNTech announced the extraordinary efficacy of its vaccine. Those results made clear that this pandemic would end not through infection but vaccination. Our goals shifted from merely slowing the spread to beginning immunization as quickly as possible. In America, much of the past half year has been devoted to administering vaccines and gathering evidence on how well they work in the real world.

Earlier this month, the Centers for Disease Control and Prevention ushered in the American pandemic’s third chapter. The agency announced that vaccinated people could go without masks or social distancing indoors and outside, in crowds large and small. It carved out a few exceptions—for hospitals, public transportation, and the like—and noted that people still needed to obey federal and local laws. But the broad message was that vaccinated Americans could resume their pre-pandemic lives. The C.D.C. is an agency known for caution, and its new guidance shocked many public-health experts; just two weeks earlier, it had issued far more restrictive recommendations. During the same period, a survey of nearly six hundred epidemiologists found that more than three-quarters of them believed that indoor mask-wearing might remain necessary for another year or more. Still, immediately after the announcement, a number of states lifted their mask mandates. Others will surely follow, as the pressure to return to normal grows. America is now moving swiftly toward reopening.

Despite the C.D.C.’s early stumbles on communication, masks, and tests, it remains perhaps the world’s preëminent public-health agency. Its recommendations carry unparalleled scientific force in the U.S. and beyond. Ultimately, the C.D.C.’s decision reflects real shifts in the weight of the evidence on several fundamental epidemiological questions: Are the vaccines as effective as they were in the trials? Can they protect us against the coronavirus variants? And do they prevent not just illness but transmission? The answers to these questions give us good reason to think that the pandemic’s newest chapter will be its last. Read The New Yorker’s complete news coverage and analysis of the coronavirus pandemic.

On the first question, the nationwide rollout of covid-19 vaccines has proved, beyond any doubt, that they are astonishingly effective at preventing serious illness, even for the most vulnerable people. So-called breakthrough infections, in which the virus weaves its way around some of an individual’s immune system, do occur. But such infections are extremely rare, and—because a person almost always has some effective antibodies and other immune-system defenses—they usually cause mild or no symptoms. In one study, the C.D.C. examined post-vaccination infections among nearly fifteen thousand nursing-home residents and staff members, and discovered only two covid-19 hospitalizations and one death. Another study, involving half a million health-care workers from around the country, found that getting two shots reduced the risk of a symptomatic infection by ninety-four per cent. Moving forward, we should expect to continue seeing breakthrough infections from time to time—but, for the most part, we shouldn’t worry about them. (At the same time, the covid vaccines have proved exceptionally safe. Few dangerous side effects have been linked to the vaccines from Pfizer-BioNTech or Moderna, and the over-all risk of concerning blood clots after receiving Johnson & Johnson’s vaccine is rare—as of last week, when more than nine million doses had been administered, there were thirty confirmed cases.)

The most striking vaccine-efficacy statistic draws on data shared by state governments. Around a hundred and thirty million Americans are fully vaccinated, and the C.D.C. has said that it has received reports of fewer than fourteen hundred covid-19 hospitalizations and three hundred deaths among them. This means that, after vaccination, one’s chances of dying of covid-19 are currently about two in a million, with the likelihood of being hospitalized only slightly higher. Statistics reported by hospitals tend to be accurate; still, even if state governments have missed a few cases here and there, the results are staggeringly good. “The evidence on vaccines just keeps getting better and better,” Robert Wachter, a physician and the chair of medicine at the University of California, San Francisco, told me. “When the trial results first came out, I thought, They can’t actually be this good. The real world is always messier than the trials. What we’ve learned since then is that the vaccines are probably even more spectacular than we initially believed.”

The answer to the second questionwhether the vaccines work against the major coronavirus variants—is also now clear. Earlier this month, a study conducted in Qatar, where the B.1.1.7 and B.1.351 variants predominate, found that the Pfizer-BioNTech vaccine was ninety-seven per cent effective at preventing severe disease. Vaccines from Moderna and Johnson & Johnson also appear to be highly effective against the variants; in fact, these vaccines are already successfully fighting them here in the United States. The B.1.1.7 variant, which is vastly more contagious than the original virus and caused a devastating surge in the U.K. this past winter, now accounts for three-quarters of new U.S. cases—and yet, largely thanks to vaccination, daily infections in this country have fallen by nearly ninety per cent since their peak in January, and are now lower than at any point in the past eight months. The existence of more contagious variants isn’t a reason to doubt the vaccines but to vaccinate people as quickly as possible.

As for the final questionwhether vaccinated people can spread the virus to others, especially unvaccinated people, including children—the evidence is similarly encouraging. Because vaccinated people are unlikely to contract the virus, the vast majority won’t be passing it on. And even the small number of vaccinated people who experience breakthrough infections have much less of the virus circulating in their bodies, and may be less infectious. Real-world data from Israel, which has mounted one of the world’s fastest and most effective vaccination campaigns, is instructive. The country’s progress in immunizing its adults has been linked to significant declines in infections among unvaccinated people; according to one preliminary estimate, each twenty-percentage-point increase in adult vaccination rates reduces infections for unvaccinated children by half. When vaccinated people remove their masks, they pose little threat to others, and they face little peril themselves.

The shift toward reopening is not without risk. The first issue is timing. Less than half of Americans have received even one shot of a covid-19 vaccine, and only around four in ten have been fully vaccinated. This means that the majority of the country remains susceptible to infection and disease. Meanwhile, the pace of vaccinations has slowed: in April, the U.S. was routinely vaccinating about three million people per day, but the daily average is now nearly two million. It’s unclear whether the new guidance will encourage or deter unvaccinated Americans from getting immunized. In a recent survey, unvaccinated Republicans said that they would be nearly twenty per cent more likely to get the shots if it meant that they wouldn’t have to wear a mask anymore. We’ll now find out how they really feel.

Vaccine hesitancy is only part of the picture. Some thirty million Americans—a group larger than anti-vaxxers or the vaccine-hesitant—say that they want to get immunized but haven’t yet done so. Some face language barriers, or fear immigration problems; others have difficulty navigating the health system, or can’t take time off from work. Many of the willing-but-unvaccinated are working-class Americans; four in five don’t have a college degree. The Biden Administration has sent billions of dollars to health centers serving low-income populations, offered tax credits to businesses that provide paid time off for employees to get immunized, and helped assemble thousands of volunteers—known as the covid-19 Community Corps—to assist with vaccine outreach to underserved populations. States, too, are trying to reduce barriers to vaccination, and offering incentives—including payments in Maryland, a lottery in Ohio, and a “Shot and a Beer” program in New Jersey—for residents who remain on the fence. There are, in short, real efforts under way to sway the vaccine-hesitant and make vaccines more accessible.

Still, the new C.D.C. guidance makes these efforts even more urgent. Until now, unvaccinated people have been shielded from high levels of viral exposure by government mandates and social norms that have kept their friends, neighbors, and colleagues masked and distanced, to varying degrees. But, in the coming weeks, those protections will likely erode. For unvaccinated Americans, this could be the most dangerous moment in the pandemic. In most contexts, there is no reliable mechanism for verifying who has and hasn’t been vaccinated. Inevitably, against the C.D.C.’s advice, many unvaccinated people will resume normal life, too, threatening their own health and that of others. When asked how businesses are to know which customers can enter unmasked, Anthony Fauci, the nation’s top infectious-disease expert, told CNN, “They will not be able to know. You’re going to be depending on people being honest enough to say whether they were vaccinated or not.”

“Unvaccinated people are now going to have much higher levels of exposure,” Wachter told me. “That’s especially true in places with lots of community spread and in places where more contagious variants are circulating.” Wachter suggested that the C.D.C. could be making an epidemiological bet. The move “will cause some additional covid cases that otherwise would not have occurred,” he said—but, “if it leads to even a small uptick in vaccination, it will save lives in aggregate.”

Since the start of the pandemic’s second chapter, public-health officials have been working to prevent a catastrophic collision between the ship of reopening and the iceberg of the unvaccinated. By slowing the speed of the ship or shrinking the size of the iceberg, we have sought to reduce the force of the collision. But barring a hundred-per-cent vaccination rate, or something close to it—an outcome that the U.S. was never likely to achieve—a crash of some sort has been inevitable. India’s collision has been titanic—it reopened with a population of more than a billion, even though hardly anyone was vaccinated. In the U.S., the situation is different. Our iceberg has been melting, and we’ve been approaching it slowly. Now we’re taking off the brakes.

The C.D.C. issues guidance, not laws; there are several quantitative measures that states, counties, cities, companies, and individuals can consult in pacing their reopening and squaring the agency’s broad recommendations with local realities. A community’s immunization rate is perhaps the most obvious statistic to track. Experts have argued for meeting a seventy-per-cent immunity threshold before relaxing masking and distancing requirements. No states have got there yet, although some, such as Vermont and Maine, are well on their way. The Biden Administration has said that it hopes to hit the seventy-per-cent target for first shots by the Fourth of July.

Because the vaccines prevent almost all cases of severe covid-19, the number of covid-19 hospitalizations is another good metric to watch. “With vaccines, cases become uncoupled from severe disease,” Monica Gandhi, an infectious-disease doctor at the University of California, San Francisco, who has studied asymptomatic coronavirus transmission, told me. Gandhi was among the first researchers to show that masks protect not just others but wearers, too; when we spoke, before the C.D.C.’s announcement, she said that, in her view, most precautions could end when half of Americans had received their first shot and covid-19 hospitalizations had fallen below sixteen thousand nationally, or about five per hundred thousand people. (At the peak of most flu seasons, the U.S. records five to ten influenza hospitalizations per hundred thousand.) Hospitalizations appear to be falling, unevenly, across the country. However, there are currently thirty thousand Americans hospitalized with covid-19—roughly a quarter of the January peak, but still about twice Gandhi’s threshold.

Herd immunity offers a third benchmark for reopening. The idea is that, once about eighty per cent of the population has been vaccinated or infected, the virus will struggle to spread. Recently, some experts have argued that we might never get to herd immunity because of variants, vaccine hesitancy, and the fact that children under twelve, who make up some fifteen per cent of the U.S. population, are unlikely to be immunized for some time. But the C.D.C.’s recommendation could change the equation. As states lift restrictions and unvaccinated people face higher levels of exposure, more of them are likely to get infected, pushing us closer to the herd immunity threshold. In all likelihood, the U.S. will be able to reach sixty-per-cent vaccination in the coming weeks; meanwhile, perhaps a third of Americans have already been infected. Even assuming significant overlap between the two groups, the combination of vaccination and infection is likely to make it harder for the virus to find new hosts. Marc Lipsitch, the director of Harvard’s Center for Communicable Disease Dynamics, emphasized that, because some parts of the country may reach herd immunity, or something close to it, before others—Connecticut’s current covid-19 immunization rate, for instance, is nearly twice Mississippi’s—unvaccinated adults will face different levels of risk depending on where they live. “There won’t be one national end,” Lipsitch told me. “We’re going to see a fundamental change in terms of what it means to live in this country, but there’s also going to be a lot of local variation.”

Covid-19 deaths give us another way of tracking the pandemic. Experts have argued that the U.S., with a population of three hundred and thirty-two million, should aim for fewer than a hundred coronavirus deaths daily—roughly the toll of a typical flu season. Right now, America is seeing about six hundred covid-19 deaths each day; according to the Institute for Health Metrics and Evaluation, which generates one of the country’s most widely cited pandemic models, that number will likely fall to about a hundred in August. “Things will look very good this summer,” Christopher Murray, the director of the I.H.M.E., told me. “A lot of people will think that we’re done, that it’s all over. But what happens in the fall is the tricky part.” Murray believes that a confluence of factors—the spread of variants, in-person schooling, meaningful numbers of still-unvaccinated people, and the seasonality of the virus—will produce a small winter spike, concentrated in communities with low vaccination rates. It won’t be the apocalyptic surge of New York City in the spring of 2020—or, more recently, those of India or Brazil—but, each week, several thousand unvaccinated Americans could die.

It’s possible, given all this, to imagine a plausible scenario for the conclusion of the American pandemic. The coronavirus disease toll continues to fall throughout the summer. States do away with mask mandates and capacity restrictions; people increasingly return to bars, spin classes, and airports, then to stadiums, movie theatres, and concerts. By midsummer, in communities with high vaccination rates, covid-19 starts to fade from view. In those places, even people who remain unvaccinated are protected, because so little of the virus circulates. But, in other parts of the country, low immunization rates combined with reopening allow the disease to register again. Hospitals aren’t overwhelmed—there’s no need to build new I.C.U.s or call in extra staff—but the collision between ship and iceberg is forceful, and each week thousands of people fall ill and hundreds die. Some victims are vaccine-hesitant; others were unable, for whatever reason, to get vaccinated. Still, perhaps unfairly, these outbreaks come with an aura of culpability: to people in safe parts of the country, the ill seem like smokers who get lung cancer.

In the fall, many unvaccinated children return to school. Scattered infections among them capture headlines, but serious illnesses are exceedingly rare; the overwhelming majority of children remain safe, and, with time, they, too, are immunized. The U.S. approaches something like herd immunity. Some people may still fall ill and die of covid-19—perhaps they are immunocompromised, elderly, or just unlucky—but, by and large, America has gained the upper hand. Meanwhile, in poor nations with few vaccines, the pandemic continues. As crisis wanes in one country, catastrophe ignites in another. Every so often, we learn of a new variant that’s thought to be more contagious, lethal, or vaccine-resistant than the rest; we rush to institute travel bans, only to learn that the variant, or a close cousin, is already circulating in the U.S. and has been largely subdued by the vaccines, as all previous variants have been. In the fall, Americans line up for covid booster shots alongside flu vaccines. The pandemic’s final chapter comes to a close not through official decree but with the gradual realization that covid-19 no longer dominates our lives.

Reopening a country after a pandemic isn’t like flipping a giant switch. It’s more like lighting a series of candles, illuminating one part, then another, until the whole place shines. Many states, counties, cities, and businesses will further loosen their restrictions; others will wait. Communities and individuals will approach the end of the crisis differently, as they’ve approached the rest of it. Some unvaccinated people have already been forgoing precautions; on the other hand, I’ve been vaccinated for months and, since the C.D.C. announcement, have yet to leave my mask behind—whether because of a lingering, irrational fear or simply to avoid dirty looks, I can’t say. Social norms take time to change, even when one of the world’s most respected public-health agencies is telling you to change them.

The pandemic has created not just chaos and suffering but uncertainty. It’s easy, therefore, to be doubtful about the fortunate position in which we seem to find ourselves now. As a physician, I spent the early months of the pandemic caring for covid-19 patients in New York City; they streamed into the hospital day after day, deathly ill. We raced to build covid wards, I.C.U.s, and hospice units. At the time, we had little to offer. There were no proven therapies, and certainly no vaccines. There were weeks when thousands of New Yorkers died, many of them alone in their final moments, while more people were dying across the world. I felt fear, anxiety, and sometimes despair. The scale of the damage—the lives lost, businesses shuttered, dreams shattered, children orphaned, seniors isolated—was crushing, and the path forward was both frightening and unknown.

As good news began to arrive, I greeted it with a blend of guarded skepticism and cautious optimism. First came evidence that outdoor transmission was unlikely. Then we learned that contaminated surfaces rarely spread disease; that some patients can breathe better simply by lying on their bellies; that P.P.E. works; that dexamethasone saves lives. We discovered that immunity lasts many months, perhaps years; that repeat infections are unlikely; and that variants present a surmountable challenge.

Now, study after study, in country after country, has shown that the vaccines are capable of transforming a lethal pathogen into a manageable threat. Examining and reëxamining the vaccine results, I’ve gone through stages, too—caution, hope, and, finally, clarity. We really are that close. The beginning of the end is here.

Your questions, answered

No mask, no service, but enforcing the rule at restaurants will be a  challenge | Business Local | buffalonews.com

“A vaccinated friend attended an indoor gathering of 35 people, half of which were unvaccinated. Nobody wore masks or socially distanced. I am vaccinated, but should I avoid contact with this person for some period of time? I am concerned that my friend may have inadvertently been exposed to variants, although no problems as of three days post-event.”

The scenario you describe is likely to be low risk to you and your friend because you’re both vaccinated. It’s not ideal — mostly from the perspective of the people at the meet-up who weren’t vaccinated yet. When non-immunized and immunized people gather in a space, precautions should account for those who haven’t had their shots yet, the Centers for Disease Control and Prevention advises. Those precautions include everyone wearing masks inside in public or indoors if there’s a multi-household mix of people who aren’t vaccinated.

Mingling indoors without masks or distancing is “likely low risk for the vaccinated people,” the CDC writes (the emphasis is the agency’s). That’s because the vaccines are so protective. 

Real-world results continue to support clinical trial conclusions that coronavirus vaccines are highly effective at preventing symptomatic covid-19. In a CDC study of almost 2,500 fully vaccinated health-care workers, only three had confirmed infections. “Front-line workers were 90 percent less likely to be infected with the virus that causes covid-19,” an epidemiologist and author of that study told The Post last month.

Emerging reports also suggest vaccines hinder asymptomatic infection. Two doses of an mRNA vaccine reduced that by 92 percent in Israel, according to a study published this week in The Lancet. And there’s encouraging news that vaccines protect against variants of concern. As we mentioned above, and reported Wednesday, research in the New England Journal of Medicine showed the Pfizer-BioNTech vaccine was “90 percent effective at blocking infections caused by the B.1.1.7 variant,” which is the more transmissible variant first detected in the U.K. The vaccine was slightly less effective, at 75 percent, against the B.1.351 variant identified in South Africa.

It’s good to hear that there haven’t been any problems in the days after this gathering. From what you’ve described, it doesn’t sound as though your friend needs to take any actions like quarantining. In fact, the CDC advises quarantine is generally unnecessary for fully vaccinated people, even after known exposure, unless an immunized person begins to show symptoms.

That said, you’ve asked journalists, not doctors — here’s our usual disclaimer to consult your primary-care physician if you have specific concerns about your susceptibility to the virus. If you’re wary about jumping back into social life, that’s okay, too, and not unusual after living through an ongoing pandemic. Some psychologists suggest easing into social situations post-vaccination, borrowing from principles of exposure therapy; for instance, if you’re anxious and would like to take extra precautions for your next visit with your friend, you might suggest meeting up while outside or you can wear a mask. 

‘Distancing isn’t helping you’: Indoor COVID-19 exposure risk same at 6, 60 feet, MIT researcher says

Risk of COVID-19 indoors is the same at 6 feet and 60 feet apart even when  wearing a mask | Daily Mail Online

People who maintain 60 feet of distance from others indoors are no more protected than if they socially distanced by 6 feet, according to a peer-reviewed study published April 27 in the Proceedings of the National Academy of Science of the United States of America.

Cambridge-based Massachusetts Institute of Technology professors Martin Bazant and John Bush, PhD, developed a model to calculate indoor exposure risk to COVID-19 by factoring in the amount of time spent inside, air filtration and circulation, immunization, variant strains, mask use, and respiratory activity such as breathing, eating or talking.  

“We argue there really isn’t much of a benefit to the six-foot rule, especially when people are wearing masks,” Mr. Bazant told CNBC. “It really has no physical basis because the air a person is breathing while wearing a mask tends to rise and comes down elsewhere in the room so you’re more exposed to the average background than you are to a person at a distance.”

As with smoking, even people wearing masks can be affected by secondhand smoke that makes its way around the enclosed area and lingers. The same logic applies to airborne droplets of the virus, according to the study. However, the study did note that mask use by both infected and susceptible people reduces “respiratory plumes” and thus increases the amount of time people may safely spend together indoors. 

When crafting guidelines, the CDC and World Health Organization have overlooked the amount of time spent indoors, Mr. Bazant claims.  

“What our analysis continues to show is that many spaces that have been shut down in fact don’t need to be,” Mr. Bazant said. “Oftentimes, the space is large enough, the ventilation is good enough, the amount of time people spend together is such that those spaces can be safely operated even at full capacity, and the scientific support for reduced capacity in those spaces is really not very good.”  

Opening windows or installing new fans to keep air moving may be just as effective or more effective than purchasing a new filtration system, Mr. Bazant said.

The CDC currently recommends staying at least 6 feet away from other people and wearing a mask to slow the spread of COVID-19, citing the fact that the virus spreads mainly among people who are in close contact for a prolonged period.  

“The distancing isn’t helping you that much and it’s also giving you a false sense of security, because you’re as safe at six feet as you are at 60 feet if you’re indoors. Everyone in that space is at roughly the same risk, actually,” Mr. Bazant said. 

After three rounds of peer review, Mr. Bazant says he hopes the study will influence social distancing policies.

A preview of a longer pandemic

Featured image

All the things that could prolong the COVID-19 pandemic — that could make this virus a part of our lives longer than anyone wants — are playing out right in front of our eyes.

Driving the news: The British variant is driving another surge in cases in Michigan, and Gov. Gretchen Whitmer has resisted reimposing any of the lockdown measures she embraced earlier in the pandemic.

  • Variants are beginning to infect more kids — “a brand new ball game,” as University of Minnesota epidemiologist Michael Osterholm recently put it.
  • New research confirms that our existing vaccines don’t work as well against the South African variant.
  • And some experts fear the pace of vaccinations in the U.S. is about to slow down.

Between the lines: The concern isn’t necessarily that the facts on the ground right now could end up being disastrous, but rather that we’re getting a preview of the longer, darker coronavirus future the U.S. may face without sufficient vaccinations.

  • If we don’t control the virus well enough, then even years into the future, we could be living through more new variants — some of which might be more deadly, some of which might be more resistant to vaccines, some of which might be more dangerous for certain specific populations.
  • That would translate into an ongoing risk of illness or potentially death for unvaccinated people and new races to reformulate vaccines as new variants keep emerging.
  • And it would lead to a world in which today’s vaccine-eager population would have to stay on top of those emerging risks, get booster shots when they’re available, and perhaps revive some of the pandemic’s social-distancing measures, in order to stay safe.

CDC director walks tightrope on pandemic messaging

https://thehill.com/policy/healthcare/546269-cdc-director-walks-tightrope-on-pandemic-messaging

Images: Tightrope walk across the Grand Canyon

Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky finds herself in a delicate position as she seeks to balance the optimism of increasing vaccinations with the reality that the U.S. is still very much in the grip of a deadly pandemic.

Walensky started the CDC job with a reputation as a savvy communicator, tasked with salvaging the reputation of an agency that took a beating under the Trump administration.

“When I first started at CDC about two months ago, I made a promise to you: I would tell you the truth, even if it was not the news we wanted to hear,” Walensky told reporters recently.

Walensky’s expertise is in HIV research, like her predecessor Robert Redfield, and before being appointed to lead the CDC, she was head of infectious diseases at Massachusetts General Hospital.

While former colleagues say Walensky is the perfect fit for the CDC post, her skills are now being put to the test as she faces criticism for being both too negative and too hopeful.

“She is quite a compelling and clear communicator, but it’s a challenging set of messages to try and get out there,” said Chris Beyrer, a professor of epidemiology at Johns Hopkins Bloomberg School of Public Health.

Public health messaging during a global pandemic is complicated enough, but experts say this particular moment is especially difficult.

After weeks of decline and then stagnation, the rate of coronavirus infections has once again started to climb across much of the country. Cases are up about 12 percent nationally compared with the previous week, averaging around 62,000 cases per day, according to the CDC.

At the same time, nearly 100 million Americans have received at least one dose of a coronavirus vaccine. Many states are expanding vaccine eligibility, in some instances to all adults, and federal health officials say there will be enough supply for everyone to be vaccinated by the end of May.

Walensky tried to emphasize both aspects this week when she issued an emotional appeal to the public.

“We have so much to look forward to, so much promise and potential of where we are, and so much reason for hope. But right now I’m scared,” Walensky said, adding that she had a “sense of impending doom” if people continued to ignore public health precautions.

Yet almost in the next breath, she talked about a “tremendously encouraging” new study showing that vaccinated people were 90 percent protected from infection, meaning they pose an extremely low risk of spreading the virus.

While that may come across as mixed messaging, experts say it accurately reflects not only where things stand right now but also how the country has been reacting to the virus for the past year.

“Whiplash is a true reflection of how we’re all experiencing the epidemic and the response to it. So I’d rather she be honest about that and others be honest about that than give people something that they want … to make them feel better,” said Judith Auerbach, a professor in the University of California San Francisco School of Medicine.

Auerbach, who previously worked with Walensky on HIV research, praised the director’s openness, which she said had been missing from agency leadership during the Trump administration.

“She’s being really honest about her own emotions. That’s hard for a fed to do and get away with,” Auerbach said. “The science that says we all still need to be, in fact, quite scared because we’re in this race between the vaccines … versus the emergence of these variants, and she felt it at a visceral level, and she conveyed that in a way that I thought was quite telling.”

Glen Nowak, director of the Center for Health and Risk Communication at the University of Georgia and a former CDC media relations director, said Walensky’s candor helps establish credibility.

“She has embraced the fact that credibility comes from being transparent and honest and genuine about your fears and your concerns,” Nowak said.

The CDC declined to make Walensky available for an interview, but in a statement to The Hill, an agency spokesman said every communication reflects the latest science and epidemiology.

“At times, moments must balance hope that we will move out of the pandemic with the reality that we are not out of it yet,” the spokesman said.

“We acknowledge the challenge of conveying such hope and promise that vaccines offer with the reality that cases and deaths are rising. While we are sending the critical message that people cannot and should not let up on their prevention measures, we do remain very optimistic about what the future of a fully vaccinated public will offer,” the spokesman added.

On Friday, Walensky again came under criticism for her messaging. In updated guidance, the CDC said it is safe for people who have been fully vaccinated to travel.

But Walensky struck a cautionary tone by saying the CDC still recommends anyone, vaccinated or not, avoid nonessential travel because infection numbers are so high.

“We know that right now we have a surging number of cases,” Walensky said during a White House briefing. “I would advocate against general travel overall. Our guidance is silent on recommending or not recommending fully vaccinated people travel. Our guidance speaks to the safety of doing so.”

Nowak said part of what makes public health messaging so difficult is the fact that science doesn’t always deal in absolutes and that the public overall doesn’t do well with nuance.

“Often people don’t want to listen to the nuance; they want advice and guidance to be stable. They get frustrated with the changes or when it seems to be contradictory. They also get frustrated if it doesn’t match their everyday living experiences,” Nowak said.

With the travel guidance, Walensky attempted to spell out the balance she was trying to strike and asked the public for patience and understanding.

“I want to acknowledge today that providing guidance in the midst of a changing pandemic and its changing science is complex,” Walensky said.

“The science shows us that getting fully vaccinated allows you to do more things safely, and it’s important for us to provide that guidance, even in the context of rising cases. At the same time, we must balance the science with the fact that most Americans are not yet fully vaccinated, which is likely contributing to our rising cases,” she said.

Jen Kates, director for global health and HIV policy at the Kaiser Family Foundation, who has known Walensky for decades, said she thinks the CDC director is aware that she can’t escape criticism, especially when so many people have pandemic fatigue.

If the CDC is too strict and refuses to endorse relatively normal behavior, especially after people get vaccinated, it could risk others refusing to get the shot, Kates said.

But if the agency paints too rosy a picture, more people could act like the pandemic is over and risk further spread of the virus.

“It behooves public officials to always be cognizant that their words are being listened to and can be taken out of context or may be hard for people to grasp,” Kates said. “So I think Dr. Walensky is a great communicator, but that doesn’t mean that this is always easy to do and the balance is always straightforward.”

Cartoon – Open the U.S. Now

A. Christian van Gorder: George Washington meets a viral pandemic | Board  Of Contributors | wacotrib.com

Yogi Berra on the Pandemic

Yogi Berra's wordplay wisdom for writers: "It ain't over till it's over"  and more | Stuff Writers Like

Millions of Americans remain vulnerable as cases rise

Coronavirus cases are on the rise again in several states, partially a result of variants of the virus becoming more widespread, experts say.

Why it matters: Even though a remarkable 72% of Americans 65 and older have received at least one dose of the vaccine, millions of Americans — particularly younger Americans with underlying conditions — remain vulnerable.

Driving the news: Coronavirus cases are rapidly rising in places including Michigan, New York, New Jersey and other Northeastern states.

  • In Michigan, the number of hospitalized younger adults has dramatically increased this month. Coronavirus hospitalizations increased by 633% for those aged 30 to 39 and by 800% for those aged 40 to 49, the Detroit Free Press reports.
  • The variant that originated in the U.K., which is partially driving the new surge, appears to be more transmissible and deadlier.

The big picture: “There are certainly many people who are not vaccinated who are still at severe risk themselves because of underlying medical issues,” said Leana Wen, a visiting professor at the Milken Institute School of Public Health at the George Washington University.

  • Because of vaccination demographics and who’s at highest risk of exposure, “the proportion of people who are hospitalized and who will die will likely skew toward a younger subset,” she said.

Between the lines: Those still vulnerable to the virus are disproportionately people of color.

  • That’s because prioritizing people for vaccines based on age disproportionately benefits white Americans, who tend to be older than people of color.
  • But younger people of color are tend to be at higher risk of severe infections because of underlying conditions.

What they’re saying: “To address areas of outbreak, we should allocate more of the increased vaccine supply coming into the market to places where penetration is low and infection rates high, like metro Detroit,” former FDA commissioner Scott Gottlieb tweeted.

America’s nightmarish year is finally ending

America's nightmare year of COVID is finally ending

One year after the World Health Organization declared COVID-19 a pandemic, the end of that pandemic is within reach.

The big picture: The death and suffering caused by the coronavirus have been much worse than many people expected a year ago — but the vaccines have been much better.

Flashback“Bottom line, it’s going to get worse,” Anthony Fauci told a congressional panel on March 11, 2020, the day the WHO formally declared COVID-19 to be a global pandemic.

  • A year ago today, the U.S. had confirmed 1,000 coronavirus infections. Now we’re approaching 30 million.
  • In the earliest days of the pandemic, Americans were terrified by the White House’s projections — informed by well-respected modeling — that 100,000 to 240,000 Americans could die from the virus. That actual number now sits at just under 530,000.
  • Many models at the time thought the virus would peak last May. It was nowhere close to its height by then. The deadliest month of the pandemic was January.

Yes, but: Last March, even the sunniest optimists didn’t expect the U.S. to have a vaccine by now.

  • They certainly didn’t anticipate that over 300 million shots would already be in arms worldwide, and they didn’t think the eventual vaccines, whenever they arrived, would be anywhere near as effective as these shots turned out to be.

Where it stands: President Biden has said every American adult who wants a vaccine will be able to get one by the end of May, and the country is on track to meet that target.

  • The U.S. is administering over 2 million shots per day, on average. Roughly 25% of the adult population has gotten at least one shot.
  • The federal government has purchased more doses than this country will be able to use: 300 million from Pfizer, 300 million from Moderna and 200 million from Johnson & Johnson.
  • The Pfizer and Moderna orders alone would be more than enough to fully vaccinate every American adult. (The vaccines aren’t yet authorized for use in children.)

Yes, millions of Americans are still anxiously awaiting their first shot — and navigating signup websites that are often frustrating and awful.

  • But the supply of available vaccines is expected to surge this month, and the companies say the bulk of those doses should be available by the end of May.
  • Cases, hospitalizations and deaths are all falling sharply at the same time vaccinations are ramping up.

The bottom line: Measured in death, loss, isolation and financial ruin, one year has felt like an eternity. Measured as the time between the declaration of a pandemic and vaccinating 60 million Americans, one year is an instant.

  • The virus hasn’t been defeated, and may never fully go away. Getting back to “normal” will be a moving target. Nothing’s over yet. But the end of the worst of it — the long, brutal nightmare of death and suffering — is getting close.

Experts warn US risks delaying ‘normal’ summer

https://thehill.com/policy/healthcare/541524-experts-warn-us-risks-delaying-normal-summer

Overnight Health Care: Experts warn US risks delaying 'normal' summer |  Alabama GOP governor extends mask mandate | Senate votes to take up relief  bill | TheHill


President Biden‘s announcement that there will be enough vaccines for all adults by May is raising hopes for a return to normal soon.

But the next few months in the pandemic are critical. Concern is growing over moves by some states to lift restrictions already, while new variants of the virus are on the rise in the U.S. Experts warn that actions taken now risk delaying getting back to some semblance of normal.

Health officials are urging restrictions to remain in place for the final stretch, saying that it will not be much longer before the situation markedly improves, and it does not make sense to lift all restrictions when widespread vaccinations are in sight.    

Biden on Wednesday issued his most forceful comments to date, calling out the governors of Texas and Mississippi for lifting their states’ mask mandates and all capacity limits on businesses. 

He noted that vaccinations for all adults are on the horizon.

The last thing we need is Neanderthal thinking that in the meantime everything’s fine, take off your mask, forget it,” he said. “It still matters.”

Estimates differ on when exactly the country might return to something like “normal,” though many say they expect this summer will be much better.

Former Food and Drug Administration Commissioner Scott Gottlieb said on CNBC on Wednesday that he thinks even as soon as April will be “profoundly better,” given that vaccine supply will have ramped up significantly, allowing vaccine availability to be “wide open” by then.

Centers for Disease Control and Prevention Director Rochelle Walensky on Wednesday put the time frame at three months until the country could be vaccinated. 

“The next three months are pivotal,” she said.   

Thomas Tsai, a researcher at the Harvard T.H. Chan School of Public Health, said that by summer, “I think we can have a much more, I don’t want to say normal, but at least a ‘new normal’ summer.”

But experts warn that the return to normal could actually be delayed if restrictions are lifted too soon, causing a new spike in cases in the near term. 

Tsai likened the current situation to the seventh inning stretch of a baseball game. “Progress has been made; it’s OK to take stock of that,” he said. “How we play the next two innings determines if this is a single game or turns into a doubleheader.”

Maintaining restrictions as people get fatigued and see the end in sight could be a challenge, though, particularly in red states that were skeptical of instituting health restrictions from the start. 

Texas Gov. Greg Abbott and Mississippi Gov. Tate Reeves, both Republicans, pointed to the ongoing vaccination campaign in saying that the time has come to end restrictions. 

“With the medical advancements of vaccines and antibody therapeutic drugs, Texas now has the tools to protect Texans from the virus,” Abbott said Tuesday. “We must now do more to restore livelihoods and normalcy for Texans by opening Texas 100 percent.”

Responding to Biden’s criticism on Wednesday, Reeves added: “Mississippians don’t need handlers.” 

“As numbers drop, they can assess their choices and listen to experts,” he added. “I guess I just think we should trust Americans, not insult them.”

Gottlieb argued for a middle ground, saying that public health officials risk having the public simply ignore all guidance if they do not provide a “realistic glide path to a better future,” though March is “a little bit premature” to lift all restrictions. 

“March really is a difficult month,” he said. “It sits between two worlds. February was a raging epidemic, it was very clear we needed to have measures in place. I think April’s going to be profoundly better, and March is sitting in the middle.”

Variants of the virus also pose a threat that adds another degree of uncertainty. The most common variant spreading in the US, known as B117, or the United Kingdom variant, responds well to vaccines, but is more infectious. 

“The B117 hyper-transmissible variant looms ready to hijack our successes to date,” Walensky said. 

Variants first identified in Brazil and South Africa also pose a risk of reducing the effectiveness of the vaccines, though the extent is not fully clear, and vaccine manufacturers are preparing backup plans to provide booster shots or updated vaccines if necessary. 

“We are at a critical nexus in the pandemic,” Walensky said. “So much can turn in the next few weeks.”

After weeks of declines, both cases and deaths are ticking up. According to CDC data, the seven-day average of new cases per day, at 66,000, is up 3.5 percent from the past week, and deaths, at just over 2,000 per day, are up 2.2 percent. 

Barbara Alexander, president of the Infectious Diseases Society of America, issued a statement Wednesday calling on people to continue wearing masks, distancing from others, and avoiding large gatherings. 

“All of these measures together will bring us closer to ending the pandemic,” she said. “Abandoning them now will postpone the day we can put COVID-19 behind us.”  

Still, the declines in past weeks and the increasing pace of vaccinations is offering some hope after a long year.

“I’m more optimistic than I have been in the last year,” Tsai said.