Waiting on Vaccines is a Deadly, Incomplete Strategy
Baffled and frustrated scientists say several other vital pandemic solutions are right in front of us
Failure to contain the coronavirus in the United States has some people peddling a false narrative that public health measures don’t work and the only remaining hope is mass vaccinations. Fact is, prevention policies and practices like masking up, social distancing and avoiding indoor crowds never fully hewed to what leading experts advised.
“In most places, public health measures didn’t fail, they weren’t applied,” says Tom Frieden, MD, former director of the U.S. Centers for Disease Control and Prevention. “Most places didn’t stick with the program long enough to get cases to a manageable level, and now masking and distancing aren’t being done reliably.”
Now as the pandemic surges out of control again and an emerging strain called B.1.1.17 — some 50% more contagious — threatens to increase the pace of new infections, these same experts say we can’t afford to wait exclusively for the slow and confusing vaccine rollout to turn the corner months from now. Yes, vaccines are a vital piece of the prevention puzzle, but it will be months before enough people are protected to turn the tide.
“If you are thinking that vaccination (any regimen) will solve this problem, I have bad news for you,” says Angela Rasmussen, PhD, a virologist at Georgetown University’s Center for Global Health Science and Security. “Even if we could magically produce enough doses, we can’t get anywhere near enough people vaccinated with even one shot.”
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What’s needed asap
The costs of continuing with the status quo will be horrendous in coming weeks, as rising case counts and hospitalizations portend higher death tolls after a lag in the progression of the disease.
“If you thought yesterday’s more than 4,400 deaths will be the worst of the American pandemic… you’re not paying attention,” Eric Topol, MD, a professor of molecular medicine at Scripps Research, tweeted today. “We’re not doing the vital things we need to do to go to full prevent mode,” Topol says, including 24/7 emergency inoculating efforts, improved masks and masking (more on that below) and rapid tests for home use (more on that below, too).
“Pandemic control is multi-pronged,” says Deepti Gurdasani, MD, an epidemiologist at Queen Mary University of London. “There is unfortunately no single silver bullet. It’s halfway measures and late action that’s brought us here. Unless we learn from these mistakes, we are doomed to repeat them again and again. At an unacceptable cost.”
Across the board, infectious disease experts are calling for an immediate doubling down of prevention efforts.
“Communities need to tighten restrictions on indoor gatherings sooner rather than later,” says Ashish Jha, MD, dean of the Brown University School of Public Health. “Waiting until the cases accelerate further would be late and unlikely to head off a crisis in hospitals.”
Time to upgrade masks
Linsey Marr, PhD, an aerosol expert at Virginia Tech, is among the leading scientists studying the effectiveness of masks. I spoke with her last year about the effectiveness of masks and how to choose or make the right one.
She now says we can up our game. Marr points to a new New York Times article, in which she offers some suggestions: Two imperfect masks layered can be better than one; masks with pockets for filters can improve effectiveness.
“Last year, it was important to get as many people to wear masks as possible; something was better than nothing,” Marr tweeted today. “Now, it’s time to improve our masks because of B.1.1.7, etc.”
A cheap at-home test
Meanwhile, other lesser-known but already available tactics could be very helpful.
“Vaccinations are not all that’s left,” says Michael Mina, MD, an assistant professor of epidemiology at Harvard T.H. Chan School of Public Health and associate medical director in clinical microbiology at Brigham and Women’s Hospital, Harvard Medical School.
One potentially effective piece of the solution puzzle has been largely overlooked, Mina argues.
For many months, he and other infectious-disease experts have advocated for faster development and approval of rapid-return at-home tests that could be distributed to all American households at low cost, perhaps as low as $1 each. The tests are already developed by multiple companies and shown to be useful, and the FDA issued its first emergency approval for one in December. But there’s no federal Warp Speed effort to deploy the tests.
“How is this not obvious at this point?” Mina says now. “If we can develop, trial, manufacture and roll out vaccines, we can get simple rapid tests to all households.”
The strategy is simple: Instead of venturing out for inconvenient Covid tests and waiting and possibly days for the results, you could test yourself, say, twice a week and have the results in minutes. Rapid tests are not as sensitive as PCR tests by health care professionals. They can miss some infections when a person has low levels of the virus. But that doesn’t make them ineffective, and if used en masse, Mina and others argue they would be more effective on the whole at keeping infected people home and allowing others to more confidently go about their business.
“We must do everything possible to get these test volumes accelerated and more testing out to schools, workplaces, and homes,” Jha says.