Public Health Weekly

The End Is Near for the U.S., but Not the World

The latest Covid insights from former CDC Director Tom Frieden

Vaccinations are saving lives

As reported by the New York Times, there has already been tremendous progress in driving down Covid-19 deaths in nursing homes, which has happened more rapidly as compared to deaths in the United States as a whole. As I’ve been predicting for the past two months, we can expect even larger reductions in deaths in March as vaccine-induced immunity kicks in. The risk of death from Covid-19 among all those infected will fall by at least two-thirds.

Covid-19 tamed?

Will vaccination make Covid-19 no deadlier than seasonal influenza? There are at least two major problems with that question: First, with high infectivity and moderate case fatality, Covid-19 would still at best be like a moderately severe flu. And flu is the Rodney Dangerfield of infectious diseases — it doesn’t get the respect it deserves.

Variants are the wild card

Now, the bad news. The worst news of the past month is that data from the Novavax trial in South Africa suggests that prior infection might not prevent reinfection with the B.1.351 variant. But the validity of the antibody tests used in that trial is uncertain — so the jury is still out.

Two puzzlers for the week

Why are U.S. cases dropping so fast?

See the arrows I’ve drawn in the second graph below from the Covid Tracking Project: U.S. cases are dropping much faster in surge three, the most recent surge, than they did in surges one and two. Was this because we started from a higher peak (driven by travel and holidays that are now over), increased masking, and rapid rollout of rational national policy? Maybe.

Why are cases in New York City not dropping nearly as fast?

I remain puzzled about New York City, which was hit hard and fast early in the pandemic. The decline there is real, but it’s much slower than the national decline. The baseline infection rate in New York City is higher, so it can’t be because of less immunity — there’s more. Test positivity rates are trending down, but only slowly, as shown in the graph below from the city’s excellent site (which also shows tenfold differences in risk in different neighborhoods of the city). Variants are one theory (and a new variant has just been identified in New York City) but at this point, it’s just that — a theory. Time will tell, for better or for worse, what is happening there.

Vaccine equity

After variants, the second big risk is the lack of vaccine equity, both in the United States and globally. Anywhere the virus spreads, more dangerous variants have a chance to emerge and threaten health everywhere. We need to scale up control measures, including vaccination, everywhere.

A safer future

The third big risk is that we fail to learn the lessons Covid-19 has to teach us. We need new funds to improve preparedness ($5 billion to $10 billion or more per year, for at least a decade) and for strengthened primary care. The World Health Organization and other global institutions need to be stronger. There needs to be more technical collaboration, better management, and better immunization of public health from politics. In short, we need substantial changes in how we approach pandemic prevention and response.

We’re near the end — but will we get there?

When will it be safe to go out again? This summer, the United States will be much safer. Will we learn to cluster-bust, stopping spread promptly, even though Covid-19 won’t be as lethal since the most vulnerable people will have been vaccinated? Will variants evade our defenses? And will we help the world stop Covid-19?

Not everything that is faced can be changed, but nothing can be changed until it is faced.—James Baldwin



A blog from Medium for Covid-19 news, advice, and commentary.

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Dr. Tom Frieden

President and CEO, Resolve to Save Lives | Former CDC Director and NYC Health Commissioner | Focused on saving lives.