COVID Transmissions for 5-3-2021
100 million people now vaccinated in the US
Greetings from an undisclosed location in my apartment. Welcome to COVID Transmissions.
It has been 532 days since the first documented human case of COVID-19. In 532, Emperor Justinian I began construction of the Hagia Sophia, which became the largest church in the Byzantine Empire.
In the US, the historic project of COVID-19 vaccination has reached 100 million patients.
As usual, bolded terms are linked to the running newsletter glossary.
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Now, let’s talk COVID.
US reaches 100 million vaccinated—and blocks travel from India
CIDRAP covers both stories: https://www.cidrap.umn.edu/news-perspective/2021/04/us-100-million-now-vaccinated-against-covid-19
It’s amazing that the US has gotten to 100 million people vaccinated in just four months. This is truly a remarkable achievement. That said, that’s just 1/3 of the way to the total population, and the pace of vaccinations is slowing somewhat. If you know anyone who is eligible who hasn’t gotten vaccinated yet, get out there and help them make it happen.
It’s easy to forget, when you’re already a supporter of vaccination, that vaccines can be mystifying and frightening. But, really, the concept is simple: we try to simulate infection in a way that doesn’t make you sick, so that the immune system can rehearse a response and learn how to fight off the threat. That way, you are much less likely to get sick. That’s all. I think it’s important that more people hear that message.
On another note, the US State Department is going to be restricting travel from India, due to the massive national outbreak there. I just want to say that I don’t understand what the point of this is. SARS-CoV-2 is very much already in the US, so this move is not going to meaningfully impact the outbreak in the US in any way. I understand that the presence of concerning variants in India has also been cited here, but realistically, there are variants emerging all over the world, and the ones that we see in the US are similar to the ones we see appearing in other countries. This is because when it comes down to it, humans are extremely similar to one another, and our immune systems apply very similar evolutionary pressures to the viruses that infect us. While there are of course unique aspects to health in many specific places, when you compare the 320 million people in the US with the 1.4 billion people in India, they’re pretty similar in these large groups.
What might be better would be to just screen travelers between India and the US—in both directions—to protect passengers on those flights. We have rapid tests that can be performed in 15 minutes now, before someone gets on the plane. They cost about $30, which, compared to the price of a plane ticket, is minuscule. I’d prefer to implement something like that instead of an ineffective restriction on one direction of travel.
Johnson and Johnson clinical study now published
This is not earth shattering news, but the clinical study results that supported authorization of the J&J vaccine in the US has now been published in The New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMoa2101544
We’ve seen these results before, at least at a top level, so I’m not going to dig in. However, I do want to share a little inside baseball here. In my day job, I work to create publications just like this one. A lot of that involves the management of author relationships and also management of editorial support—in the form of medical writing services—that help to craft the manuscripts. If you scroll down to the very end of most manuscripts, you’ll see these medical writers acknowledged.
This paper thanks a very large number of people, which stuck out to me. It’s clear that this was a tremendous effort to work these data up into a final publication, and a lot of attention was given it by the team at J&J—or specifically, the Janssen subsidiary.
What am I doing to cope with the pandemic? This:
Visiting a new friend
One of the things I love about doing this newsletter, compared with other online writing that I’ve done, is that it has fostered a real sense of community with those who read it. Communication is a means of interaction, and I really do love to connect with people.
This weekend, I met up with a reader who has become a new friend (and who lives right down the street from me). It was really lovely to talk to someone who I didn’t know before the pandemic, and it was facilitated in part by a hyperlocal Facebook group that we’re both part of—the Buy Nothing group for our area. Such groups encourage people to give away things they no longer need, so that their neighbors do not need to keep buying new things.
My new friend had an office chair to get rid of, and I happened to need an office chair, which made for a great excuse to finally meet her and her wife in person. It was lovely, and felt like a big step on the return to normalcy.
I’m honestly delighted to be sharing such a mundane story!
Reader Lisa Schwartz asked the following:
Hi John,
Thank you for this newsletter!! My son and daughter-in-law (both vaccinated) live on The West Coast with their 3 & 5 year olds. They were hoping to travel to the East Coast where we live, this July for a visit. They are still very nervous about putting their little ones who are very active, at risk, at the airport and plane. What is your professional opinion about the safety of flying with children in July assuming we continue to keep our numbers down. We flew to the West Coast recently and witnessed many families traveling, much to our surprise.
I’m glad as always that another reader has found the newsletter useful! Unfortunately, for the following reasons listed in my reply, I do not feel entirely comfortable answering this question:
I’m glad you’re enjoying the newsletter!
I have to say I’m not sure I can answer this question specifically. Not being a licensed healthcare practitioner, and knowing little about the specific healthcare situation of your son and daughter-in-law, or their children, I don’t think I can give medical advice in this regard.
That said, I think that in general the CDC now advises that it is acceptable for vaccinated people to travel. Small children are obviously not, at this time, vaccinated, and I think on the topic of the children coming, that’s something they need to talk to the children’s physician(s) about. While the risk to children is thought to be small, it is not nonexistent, and potential long-term negative outcomes are even more concerning if they should happen in children.
However, by July, the epidemic situation in the US could be very different, and it might be much safer to do this.
At any rate, I’m sorry that I can’t really be of more assistance. This is a difficult question and since children are involved I think it’s especially important to seek professional medical advice.
Carl Fink had the following point to make about the epidemic in India:
It's impossible to actually know (because enough testing has not been, and cannot be, done) but by this time, a very substantial percentage of Indians have also been infected and survived. You have to assume their at-least-partial immunity will also help to slow the spread until enough vaccine can be manufactured.
I sure hope this is true, but I am skeptical:
I have to hope, at least, that that will have an effect. I agree with you that the numbers we are seeing in India are an underestimate, but herd immunity is kind of a fantasy in a place with 1.4 billion susceptible hosts. Imagine, for example, that the threshold for some kind of herd immunity effect is just 50%, which is quite low and probably not realistic. That means there must have been 700 million infections in India to see that effect, with what I’d expect would be a minimum of 7 million deaths. I don’t think the underestimation is that substantial. And even then, there would be 700 million more susceptible hosts remaining, and I don’t think these people would be evenly distributed at random across the country.
So, my main point here is that even if the situation in India is underestimated, it is not going to have a big impact on a national scale on containment. There may be local effects, where specific places have reached a high prevalence of immunity, but given the density of India I am not sure this will prevent the virus from continuing to spread.
And then there’s the fact that natural immunity appears to be worse than vaccine-induced immunity, which would mean that even more infections would be needed to achieve some sort of herd immunity than vaccines would be needed. So, not great all around.
In natural settings, naturally-acquired population immunity only tends to have meaningful effects when the host population is a small, closed system. In large, open systems with many many susceptible hosts, it’s hard to get to levels of immunity that slow an epidemic.
But hey, I really do hope that I’m wrong about this in some way.
Reader Kitty posed a really interesting question on the topic of SARS-CoV-2-mediated immune disruption and vaccination:
"without the virus to disrupt the immune response" - it's probably a stupid question, but what about people who got covid between the vaccine doses. Would the infection right after the first dose of the vaccine disrupt the immune response to the first vaccine dose?
Great question; this is good logical scientific thinking, and is exactly the kind of thing that drives virologists to design experiments. My reply:
This is a good question. I have no idea what the answer to this is!
I can speculate, though: it really would depend on when this SARS-CoV-2 infection takes place. If it happens a couple of weeks after the first dose, it might trigger a memory response, which might limit the infection very well. It’s hard to say, because the two-dose vaccines weren’t generally also studied in single-dose format.
If the SARS-CoV-2 infection happened earlier on, before the immune response to the first vaccine dose could have fully matured, I think it could well impact the quality of the immune response to that first dose.
This would be interesting to study somehow! In an animal model, or after the fact, in patient cases.
However, I do feel confident saying that this outcome would not be a big problem in the long run. There is at this point good evidence that getting past COVID-19 followed by even one vaccine dose produces meaningful protective immunity. So that having been said, in this hypothetical situation, the second vaccine dose would be able to strengthen the immune response if it is in any way disrupted. By the time the second dose has been completed and the two-week waiting period expires, such a patient might actually be quite well-protected, having received two doses of vaccine as well as having had experience with the actual virus.
You might have some questions or comments! Send them in. As several folks have figured out, you can also email me if you have a comment that you don’t want to share with the whole group.
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No corrections since last issue.
See you all next time.
Always,
JS