Public Health Weekly

Vaccinations Are Saving Lives and This Wily Enemy of a Virus Persists

The latest Covid insights from former CDC Director Tom Frieden

Photo: SOPA Images/Getty Images

Vaccinations have already saved at least 40,000 lives in the United States, and the pace keeps increasing. But explosive spread of variants in Brazil and lower interest in vaccination are ominous portents.

A fourth surge is likely in the U.S., but most likely a less deadly one.

Epidemiology tells the story

First, the epidemiology. Cases are trending down, but have stopped decreasing in many places, and are increasing in some areas. New cases are plateauing nationally at about 50,000 per day, as reported by the CDC Covid Data Tracker (shown below), as are test positivity rates, with a concerning trend of PCR test positivity increasing slightly to 4.3% last week.

Vaccinations are preventing deaths

The faster decline in deaths is striking and undoubtedly due to vaccination. Look how steep the decline in the red line is in the graph below. Because vaccination rates in people over 65 are so high, especially those in nursing homes, the lethality of the virus is decreasing — and that’s a result of vaccination.

We estimate that vaccines have likely saved at least 40,000 lives in the United States. Here’s a simple way to calculate that. Previously, about 40% of reported Covid deaths were among nursing home residents vs. about 19% of the roughly 200,000 deaths in 2021 so far. If nursing home residents still accounted for 40% of Covid-19 deaths, 40,000 more people would have died since January. That may be a slight overestimate for nursing homes, but when you factor in other vaccinated people whose lives the vaccine has saved, the number would be much larger.

Expect a fourth surge

Will we have a fourth surge? I think so, but it won’t be as huge and not nearly as deadly as past surges, because so many of the most vulnerable people have now been vaccinated. The more we mask up and distance, the less we travel, and the faster we vaccinate, the fewer cases, hospitalizations, and deaths there will be.

Although it’s winding down, the Covid Tracking Project is still providing important information. The trends in Michigan are concerning — where cases and hospitalizations are increasing.

Cases are increasing in parts of Europe, often despite masks and distancing, following vacation travel. Travel is an accelerator of viral transmission. Traveling over spring break — while the virus isn’t taking a break — is not a good idea.

Vaccines are increasingly available — for some

As reported in the CDC’s MMWR, there has been surprisingly high second dose vaccine completion — largely among the long-term care population and health care workers. We should expect this proportion to decrease as more groups get vaccinated. The single-dose Johnson & Johnson vaccine will be a big help in terms of ease of delivery.

You shouldn’t have to live in the right place or know the right people to access vaccines. The New York Times highlights inequities in vaccine distribution; 43 countries, nearly all of them high-income, are on track to vaccinate all or most of their populations in 2021, but 148 are not. Ramping up mRNA production is a promising approach to getting more shots in arms.

In the United States, it will be increasingly difficult to keep up the pace of vaccination. Many of the most eager got vaccinated right away. Next will be the willing, then the reluctant, and finally the late converts. For each area and demographic, the key will be to listen to and address concerns with the right messages — from the right messengers. Last week I participated in a fascinating focus group on this. Guess what Trump voters wanted most? Being respected and listened to and having their factual questions answered honestly and forthrightly. Exactly what every group deserves and needs.

Variants are the wild card

Brazil presents a cautionary tale. Uncontrolled spread and slow vaccination rollout led to a huge wave, even though there had already been a devastating earlier wave. It seems likely that the P.1 variant can reinfect people, although evidence for this is still emerging.

The B.1.1.7 variant is spreading throughout the United States and may be associated with a higher risk of death. Growing evidence suggests that available vaccines protect against this variant, according to a preprint article by Oxford University researchers, but the bigger problem is the possibility of newer variants. Immunity after infection isn’t perfect, and immunity after vaccination may be able to be overwhelmed by variants that haven’t yet emerged.

Those who have had Covid-19 should still be vaccinated! An interesting study from Denmark published online by The Lancet suggests that previous infection provides 80% protection against reinfection, but that protection among those ages 65 and older was only 47%.

More people getting vaccinated means that selective pressure on the virus will increase, and if strains emerge that can evade this immunity, these strains can spread. We don’t know if this will happen, but we know it’s a risk, and we know that we can reduce that risk by reducing uncontrolled spread wherever it occurs and increasing the pace of vaccination.

Inching toward the new normal

The virus is a wily enemy, and STAT writer Helen Branswell highlights an investigation published in CDC’s Emerging Infectious Diseases journal that demonstrates just how contagious it can be. If we let our guard down too early, Covid will take advantage.

With protections in place, especially masks, we can begin to do more as vaccination makes the virus less lethal — and adjust our response if cases start to rise. The virus has had a major impact on many facets of our lives, from schools to jobs, and recovery will take a while.

Multiple studies demonstrate that schools can open without excess Covid risk, and CDC has appropriately updated its guidance. However, the more Covid spreads in a community, the higher the risk for everyone, including school staff and students.

Covid is reversing health progress

In some places, the pandemic’s impact has been as harmful as Covid itself. Data from 19 African Union member states, reported by the Partnership for Evidence-Based Response to Covid-19 (PERC), shows the extent that the pandemic has driven food insecurity and disruptions to health services. We must increase equitable access to vaccines.

A new report from the Stop TB Partnership shows that Covid set us back years in tuberculosis control. As many as 1 million patients may have been missed as a result of the lack of access to health facilities. Each one can potentially infect other people. This is a truly devastating setback.

As reported in Nature, this timeline of progress from the past year is remarkable. Scientists across the globe made rapid progress against the most disruptive health threat of the past century — but there is so much more we need to learn!

“We ignore public understanding of science at our peril.”

— Eugenie Clark

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

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