COVID Transmissions for 6-9-2021
Greetings from an undisclosed location in my apartment. Welcome to COVID Transmissions.
It has been 569 days since the first documented human case of COVID-19.
Look, we can do this! We need to keep vaccinating, though, and get the population really protected, but we CAN do this. The data show it to be true.
Bolded terms are linked to the running newsletter glossary.
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Now, let’s talk COVID.
97% of new COVID-19 cases in King County WA are among people who haven’t been vaccinated
According to health officials in Washington state, 97% of COVID-19 cases there are occurring in people who haven’t been vaccinated. A breakdown of how this conclusion was reached can be found here, along with other supporting information: https://www.seattletimes.com/seattle-news/health/the-two-societies-97-of-new-covid-cases-are-among-people-who-havent-gotten-the-shots/
This is pretty incredible. It is, of course, terrible for those who have not been vaccinated, but it is very clear that the vaccines work effectively based on these results. It is also a great argument to get vaccinated. This is convincing evidence that if you are vaccinated and spend time only around people who are vaccinated, it is very hard to get COVID-19. That’s tremendous. I hope it convinces more people to protect themselves.
Vaccines for young children expected in the fall in the US
Apoorva Mandavilli of The New York Times reports on the current status of COVID-19 vaccination research in children under 12: https://www.nytimes.com/2021/06/08/health/us-vaccines-children-fall.html
I understand that—appropriately—these trials are using lower doses of the vaccines in question. It was established in prior work that this dosing level could work, and that makes sense; children’s lower body volume often allows for reduced dosing of various pharmaceuticals.
Because children of very young ages are not always overtly affected by COVID-19, the trials are using different endpoints than the adult studies and will focus on quality of immunological responses primarily, relating back the results to what was seen in adults who are known to be protected.
It’s worth mentioning that just because overt disease is not typically seen in children, that doesn’t mean the risk to them is zero. Death and long-term complications are still possible, and also, children are capable of giving COVID-19 to others. Vaccinations for the youngest people will be a good thing.
I look forward to the results of these trials.
Nature magazine reporting looks at claims of lab-engineering of SARS-CoV-2
The popular news arm of Nature has produced a story that weighs the current status of lab-leak debate and tries to bring down the fever pitch of argumentation that the discussion has reached in the past few weeks. I like this article because it is not condescendingly dismissive of the possibility of a lab-origin, but still appropriately contextualizes the various arguments about different origin hypotheses. If this is to be investigated as a scientific question, we need more evaluation of the arguments that follow this type of format: https://www.nature.com/articles/d41586-021-01529-3
What am I doing to cope with the pandemic? This:
Growing herbs
I started a small herb garden on my balcony after moving into my new apartment a couple of months ago. It’s thriving, and I’m delighted to have fresh herbs to cook with. Right now I have dill, oregano, basil, and mint going.
Tending plants, I think, is one of those activities that can be really calming in a chaotic world. If you have the space for it—even if they’re not as useful as herbs might be—I think it’s a restorative thing to do.
I’ve gotten some comments from various people asking about what the implications of the B.1.617.2 variant might be, that I’d like to address in summary here.
Does this mean that we will be hiding from variants forever? Will the pandemic ever end?
Does this mean we will need booster vaccines?
These questions are related. I think that the emergence of increasingly threatening variants obviously does not bode well, but full vaccination is still protective. I am concerned about the variants but I do not think they have emerged quickly enough to meaningfully compromise vaccine effectiveness. That may not remain true forever, but so far that has held true. So I do not think we will be in pandemic mode, with repeated lockdowns, endlessly.
Instead, I think that the virus will become endemic in communities around the world, much like the common cold viruses that we generally do not need to concern ourselves with. Largely, unvaccinated people will be affected, and I expect the population of unvaccinated people to gradually shrink. When vaccinated people become infected, I expect that the infection will reinforce their immunity, and potentially allow it to expand to cover new variant mutations. COVID-19 will become a rarer viral infection, and will still be serious in many of those who are infected, but hospitals now have more treatment options for it than at the beginning of the pandemic. As it becomes rarer, it will also mean that hospital capacity is freed up and patients will not die for lack of clinician availability or supplies. Death from COVID-19 will not be impossible, but it will be minimized by vaccine effects, treatment, and attentive medical care.
Of course, this is not an ideal vision. At this point, every COVID-19 death that happens is a preventable one, because the vaccines are very effective. That will continue to be true. But, the majority of affected people, at this point and going forward, will be people who chose not to protect themselves. I don’t want to see them suffer either, but it’s better than absolutely everyone being vulnerable with few possible ways to protect themselves.
As for the possibility that a booster vaccination will be required, that remains to be seen, but I think that the emergence of this particular variant does make it seem more likely. It is possible that exposure to this variant will offer vaccinated people a boost of sorts, and perhaps the rate of mutation in the virus will not outpace the degree to which natural infections can update the protection of vaccinated people. But that seems a somewhat dangerous game to play, and if boosters are made available, they strike me as the safest bet. I don’t know that they will be strictly needed, but I am glad they are in development.
The vaccines we have are still protective, but I don’t know if that will be true for the next threatening variant. Universal global vaccination is a long way away, and I am not sure that the mutation rate of existing variants will be slow enough that vaccine effectiveness against new strains will remain robust. It’s a big unknown, that, and I don’t want to rely on wishful thinking. Instead, I would prefer to rely on what we know—that it is relatively easy to create a booster using the various vaccine platforms that have been developed. I would say to be prepared for the idea that booster vaccines will be needed. It may not turn out that way, but if it does, don’t be surprised. I will, of course, continue to follow that story and will tell you new information when it is available.
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Always,
JS
It seems to me that, in addition to preventing death and hospitalization, we need to figure out how to prevent and manage conditions to like PASC and MIS-C, and soon. It would be nice to know, among other things, whether we're seeing these conditions with the same frequency following vaccine breakthrough infections. The Pfizer EUA review memorandum specifically states, "Additional evaluations will be needed to assess the effect of the vaccine in preventing long-term effects of COVID-19, including data from clinical trials and from the vaccine’s use postauthorization," but I haven't seen anything yet.
Another issue is testing. Potentially we could have treatments that prevent a mild infection from developing into more severe disease -- this is what the antivirals currently being trialed by Merck and Pfizer are hoped to do, I believe. So we need to be able to detect infections ASAP. But we're still stuck with mostly just PCR tests that take days or antigen tests that aren't that accurate, at least on an individual level. What is being done, or can be done, to make more, better, and faster testing widely available?