Doctor Is In by Dr. Adil Manzoor OP/ED
Coronavirus this, the coronavirus that… if you got a penny for every time you’ve heard about the coronavirus this year, you’d probably have more money than cases we’ve had. That’s what you’re thinking. Don’t ask me how I know, though! But seriously, this year has been dominated by the coronavirus pandemic, and over a quarter of a million Americans have lost their lives.
It gets even scarier. In many countries, the peak of the virus has long passed. This is not to say they have fully recovered, no, far from it, but cases and deaths have reduced drastically compared to when the virus first peaked. That’s the case in many countries, but not here. Not even remotely close. Like, we can’t even dare say that about the great United States of America. We have had a first wave, a second wave, and, wait for it, a third and even more terrible wave.
The cases are not petering out; they are increasing. And rapidly at that. Just last week, there was a day with over 190,000 cases. 190,000 cases in a day. Our neighbors are recording 4,000 cases a day and crying ‘crisis,’ but here we are sitting at the top, blazing all the competition, outdoing ourselves, with 190,000 cases.
I’ll interrupt this sweet story right here and say – please, wear a mask. I say it like that, but I mean it like this – PLEASE, FOR THE LOVE OF GOD, JUST WEAR A MASK AND PRACTICE SOCIAL DISTANCING! Whew… where were we? Oh, yes, cases are increasing in record numbers, and we are approaching the holidays. Three weeks ago, it wasn’t looking very promising at all.
But then came our knights in shining armor, Pfizer and Moderna, announcing that their vaccines were over 94% effective in Phase III trials. For those who don’t understand its significance, Phase III is the final stage of clinical trials and having a vaccine with 95% efficacy is great news. For the first time in eight months, I have hope.
Let me try to guess your thoughts again… ‘the vaccines are ready, great! Then let’s start giving them to people.’ Well, it’s not nearly as straightforward as ‘let’s just give it out.’ There are a lot of factors and logistics that come into play before everyone can get the vaccine. In fact, many experts believe that getting the vaccine up to 95% efficacy is the very easy part. And that’s saying something.
Consider it this way, if you want to build muscles and train your body, signing up in the gym is the easy part. That’s like the 95% effective vaccines we have now. You still have to put in months and years of hard training before you can get a truly ripped body. Likewise, it will take a lot of time before we can get total immunity in the country. We can’t accurately predict when that will be because the vaccines have not even rolled out yet. We don’t know how our society will react to it. However, let’s take it one step at a time.
One of the most important factors in vaccination is distribution. As I said, it’s not nearly as easy as just giving the vaccines out to everyone who wants them. There are a lot of other and, rather, complex factors involved, like who will get the vaccine first, who gives the vaccines, how are large quantities of vaccines going to be safely transported, how will the vaccines be distributed among states, and the list goes on and on.
The CDC is working with all the states to develop plans on how the vaccines will be distributed, but it’s not exactly going at rocket speed because states are at different planning stages. How do I mean? Some states had commenced planning for distribution long before the vaccines were ready, while some states are only just starting. Again, it is up to each state to determine the priority populations that get the vaccine first. States have to complete planning before general decisions can be made and enforced.
From the information at hand now, vaccines will be rationed according to population. That seems like the logical thing to do, but again, it’s not that straightforward. The priority populations are usually healthcare workers, essential workers, and high-risk individuals. Speaking of healthcare workers, hospitals in some states are more short-staffed than others. And this becomes important because it is healthcare workers that serve as providers to administer the vaccine. You can probably see where this is going. States with very short-staffed healthcare facilities may end up with surplus vaccines, while states with adequate staff may end up with deficits.
There is also the issue of transporting the vaccines. Pfizer’s model has to be stored at -70 degrees. This will make storage very difficult as the vaccines have to be stored in deep freezers. This is not reasonable as only big facilities will have storage capacities. Smaller facilities will not be able to store the vaccine, and you can’t blame them because no drug in history has had to be stored at that low a temperature. Pfizer plans to give out storage devices involving dry ice, but it remains to be seen how well those will work during distribution.
It is currently estimated that 40 million vaccines can be available for the priority population if the FDA approves the vaccine. Both Pfizer and Moderna’s vaccines require two shots, so we’re looking at about twenty million vaccinated people. Yes, I almost forgot – the FDA still has to approve the vaccine. We should expect a statement from them in the second week of December.
Then there’s the topic of herd immunity. Let me be very clear – that is not feasible right now. We are thousands of miles from herd immunity. Here’s why. The concept of herd immunity involves enough of the population getting immune to an infection. Then the immune people protect the vulnerable fraction of the population by effectively killing the chances of transmission. The measurement metric of the infectiousness of an infection is the reproduction number, denoted as R0. The R0 of the coronavirus is between 2 and 3.2, although believed to be closer to 3.2 than it is to 2.
At that R0, between 50 and 67 percent of the population has to be immune to the virus for herd immunity to work. To achieve 65% immunity in the United States, 213.2 million people have to be immune to the virus. Right now, over 12 million have been infected, and if we assume that they are all immune, which they aren’t, that’s about 3.14%. See, a long way.
It will take time before we can get herd immunity or total vaccination. Or before we reach reasonable immunity levels. However, pending that time, please wear a mask and practice social distancing. Stay safe.
This article was written by Dr. Adil Manzoor DO, a Board Certified Internist & Board Eligible Pediatrician, who works as a Hospitalist, and Emergency Room Physician. He is also the current President of Garden State Street Medicine, a non-profit organization whose sole purpose is to provide free preventive and acute urgent care services for the homeless. He is also the co-founder of his own unique medical practice Mobile Medicine NJ.
References
· https://theconversation.com/amp/achieving-covid-19-herd-immunity-through-infectionis-dangerous-deadly-and-might-not-even-work-148769
· https://www.euronews.com/amp/2020/11/19/covid-vaccine-when-will-it-arrive-will-itwork-how-soon-will-it-end-the-pandemic
· https://mobile.reuters.com/article/amp/idUSKBN27Y124
· https://www.usnews.com/news/national-news/articles/2020-11-18/what-to-know-abouttiming-and-distribution-of-coronavirus-vaccines?context=amp
· https://www.kff.org/coronavirus-covid-19/issue-brief/states-are-getting-ready-todistribute-covid-19-vaccines-what-do-their-plans-tell-us-so-far/
· https://amp.theguardian.com/world/2020/nov/16/us-coronavirus-vaccine-distributionchallenges
