Amid a worsening death toll and other ugly news, glimmers of hope on vaccines and immunity

Robert Roy Britt

Jan 8·7 min read

If you thought 2020 was the year of Covid overload and we’d soon move beyond the fatigue of daily pandemic revelations, well, welcome to the first week of 2021, in which this preventable pandemic continues to rip through the U.S. populace, shatter finances and tear at the very binds of society. While the bad and ugly news this week came via a firehose of science and data, some hope trickled out, too, including several brand new findings from scientists and a fresh expectation that President-Elect Joe Biden will release more vaccine doses to states as soon as he takes office.

The good news

Immunity from infection seems to last months, at least. People who catch Covid-19 appear for the most part to retain immunity to reinfection for at least eight months, according to a small new study in the journal Science. The research involved 188 people who mostly had mild symptoms, though 7% of them had been hospitalized. The study, which builds on previous research indicating the disease conferred six months of immunity, concluded that multiple aspects of the immune system remember the coronavirus and are prepared for a response if it invades again. The scientists speculate that immunity could last years, not months, but that hopeful outlook remains to be studied.

Blood plasma lessens Covid symptoms if given early. A new study in the New England Journal of Medicine, small but touted as well designed, finds Covid-19 patients 65 and older on average experience lesser symptoms if given convalescent plasma, which is derived from other people who have recovered from the disease. The catch: the plasma has to be administered within a few days of illness onset. The plasma lowered the risk of severe cases by about 48% compared to a placebo, but it did not prevent severe symptoms from developing in all cases.

Vaccine rollout poised to ramp up. For now, this is a promise, not a fact, and only some 6.25 million shots have been given (a drop in the bucket in a nation of 330 million people). But health experts note that it’s been a colossal effort to set up distribution across the country and get shots in arms, and the number of daily vaccinations will go up. The White House this week pushed to accelerate the launch of vaccines in ubiquitous existing pharmacies, which could ultimately involve 40,000 locations. Nancy Messonnier, a top CDC official involved in the rollout, said earlier this week that the rollout should begin to speed up. “I really expect the pace of administration to go up pretty massively in the next couple weeks,” she told Statnews.

An aside: Who’s to blame for slow vaccine rollout? Perhaps plenty to go around, but consider: “States have said for months that they need funding for vaccine distribution,” tweets Caitlin Rivers, PhD, an assistant professor at the Johns Hopkins Center for Health Security. “It was only in the recent bill, signed weeks after the first vaccine was authorized, that money was allocated. Surely one reason that rollout is bumpy. Underfunding public health is never a good buy.”

Biden to release more vaccine doses immediately. Today it was revealed that Biden plans to release nearly all available doses of vaccines to states as soon as he’s in charge, so that more people can get initial shots, instead of holding some back for the second doses a few weeks later, as required under the current FDA plans and based on the double-dosing used in the clinical trials. Scientists have been debating this strategy, which could roughly double the number of near-term vaccinations at the risk of not providing all those who do get the first shot with the optimum effect conferred by a second dose a few weeks later. The argument in favor of delaying second doses is that the first dose provides the bulk of the immunity — and that’s crucial right now —and while it’s not known how long the one-shot immunity will last, history suggests it might be longer than the mere weeks determined by vaccine trials. The debate remains unsettled, but Michael Mina, MD, an assistant professor of epidemiology at Harvard T.H. Chan School of Public Health, called Biden’s new approach “good news.”

Vaccines are expected to work against the more contagious, mutated UK coronavirus strain. It will take time and reflective research to learn whether existing vaccines are just as effective against any of multiple emerging strains of the coronavirus, including one that has spread from the UK to the United States and several other countries. But experts generally agree that for now there is no reason to expect they won’t. They note, however, that the more the virus spreads, the more opportunities there are for mutations that could lead to different scenarios. Meantime, one new study, published yesterday but not yet peer-reviewed, indicates the Pfizer vaccine holds up against the new variants. More studies are planned.

The bad news

The mutated UK strain is widespread and expected to dominate. This strain of the coronavirus, also called a variant, has been found in more than a half-dozen U.S. states and is likely in many more, experts say, but most testing sites aren’t yet set up to distinguish it. Infectious-disease experts say it’s likely to spread rapidly and become the dominant strain. That bodes ill for the pace of new infections, because this strain, named B.1.1.7, is thought to be 50% more infectious than the current dominant strain. “We need to increase our speed in which we act so that we don’t allow this virus to spread further and allow this variant to become the dominant one in circulation,” says Jennifer Nuzzo, an epidemiologist with the Johns Hopkins Center for Health Security. “The clock is ticking.”

People with no symptoms cause most new Covid cases. About 30% of people who catch Covid-19 never develop symptoms, and they tend to be about 75% as infections as people who do suffer symptoms, according to a new study in the journal JAMA Open Network. Those asymptomatic people, combined with people who are infectious before they develop symptoms (presymptomatic), cause 59% of new infections, the researchers conclude. The findings are no surprise—I’ve reported the rough view on this several times going back to spring 2020. But they underline the particularly insidious nature of the coronavirus: its ability to spread via hosts who don’t know they are infected, which has led to both small events like infections of many people in the same household to superspreader events in public gatherings where dozens or hundreds are ultimately infected.

Hospitals run short on staff and … oxygen. It’s no secret that front-line healthcare workers are worn out. But exhaustion is not the only problem. Amid record numbers of hospitalizations, beds are running short in some locales, but for some hospitals, staffing is even more of a problem. Meantime, echoing the shortages of personal protection equipment that have plagued the pandemic from the start, some California hospitals and ambulance crews are struggling with and even rationing supplies of oxygen, critical to the survival of people with severe cases of Covid-19. (Staffing shortages have further complicated vaccination efforts, too.)

The ugly news

The United States set a record for daily deaths. The daily toll of Americans killed by Covid-19 reached 4,112 yesterday, the most yet. That’s 2.86 deaths every minute. It is more than the average number of daily deaths combined from the two leading causes of death in America: Heart disease (1,773 per day) and cancer (1,641).

Nursing homes are being hit particularly hard again. New data finds that the nation still fails to protect the most vulnerable, revealing the morbid result of a strategy favored by some to just let the virus run its course. Covid-19 infections among nursing home residents reached 11.5 per 1,000 resident-weeks by July 26, fell to 6.3 in mid-September, then rose to 23.2 by November 22, according to a CDC report out today. A similar pattern was revealed among nursing-home staff, who not only move in and out of a facility on a daily basis but often work at multiple facilities.

The worst is yet to come. Scientists and health officials have made clear that the pandemic has yet to peak in the United States, and past is prologue. We’ve seen this movie before: The ongoing rise in new cases and hospitalizations portend higher daily death counts in coming weeks — the latter statistic baked in by the former. Until at least 70% of the population is vaccinated or immune through infection, and perhaps as many as 85% — targets that are by all accounts months away — the pandemic is not expected to subside on its own.

The upshot

Turning the corner on the pandemic sooner than later would require some heavy lifting in at least two critical areas, say Dr. Anthony Fauci, the nation’s top infectious-disease expert, and other health officials and scientists who’ve been broken records on mitigation: greater efficiency in vaccination programs, and more stringent prevention efforts coordinated nationally and embraced by more Americans.

But perhaps the most important thing the nation seems to lack right now is simple empathy.

“I lived through the first horrible years of the AIDS pandemic desperately trying but failing to help my patients survive,” Dr. Tom Frieden, former director of the CDC, tweeted today. “Because society didn’t sufficiently value the lives of those dying, many people died preventably. I can’t help feeling the same thing is happening with Covid. Wouldn’t we do better — masking, distancing, vaccinating — if we valued older, Black, Latinx, and Native American lives as we should?”