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Solving COVID: May 5, 2021

1. Where things stand Globally, the COVID-19 pandemic is as bad as it has ever been, with a seven-day average of more than 800,000 new cases and 13,000 deaths per day reported. But in the U.S., the "number of reported infections dropped to its lowest point in seven months" on Tuesday, The Washington Postreports. For the first time in 208 days, the daily average of new infections in the U.S. dropped below 50,000. And the last time the average death toll was as low as it is now, about 725 deaths per day, was in October. Public health experts attribute America's declining numbers to the relatively high vaccination rate, but warn that if new variants take root before enough people are vaccinated, the numbers will start rising again. [The Washington Post]

2. Biden announces new goal of vaccinating 70 percent of U.S. adults by July 4 President Biden said Tuesday his administration's new goal is that by the Fourth of July, 70 percent of American adults will have received at least one COVID-19 vaccine shot, and 160 million Americans will be fully vaccinated. "That means giving close to 100 million shots, some first shots, others second shots, over the next 60 days," Biden said. "Of course, Americans can still get shots after July 4, but no one should wait. Let's try to hit that 70 percent mark." Meeting this goal, Biden added, will be a "serious step towards a return to normal." The U.S. is currently administering about 965,000 first vaccine doses per day, which is down from a few weeks ago, but nearly twice the pace required to hit Biden's new goal. Over 56 percent of American adults have received at least one vaccine dose. [The Associated Press, The Week]

3. Experts suggest U.S. unlikely to reach herd immunity The United States may not reach herd immunity to COVID-19, experts say, but the virus can still be controlled to the point that it's no longer a "society disrupter." The New York Times says there is now a "widespread consensus among scientists and public health experts" that in the U.S., the "herd immunity threshold is not attainable — at least not in the foreseeable future, and perhaps not ever." While experts once thought the U.S. may be able to reach this threshold when 60 to 70 percent of the population had immunity to COVID-19, it's now believed reaching 80 percent or more may actually be required due to the spread of the more transmissible B.1.1.7 variant. This level may be out of reach, experts say, in part due to vaccine hesitancy. However, vaccines can help turn it into a milder threat that could be like the seasonal flu. Epidemiologist Marc Lipsitch said by protecting those most at risk, COVID-19 can be turned "from a society disrupter to a regular infectious disease." [The New York Times, The Week]

4. Pfizer to seek vaccine authorization for kids age 2 to 11 in September Pfizer said on Tuesday it expects to apply for emergency use authorization from the Food and Drug Administration for its COVID-19 vaccine for children between 2 and 11 in September. On Monday, it was reported that the Food and Drug Administration is set to authorize Pfizer's vaccine for adolescents between 12 and 15 by early next week. A study to examine the safety and efficacy of the vaccine among those between 6 months and 11 years old is ongoing. Additionally, Pfizer said it's expecting to seek authorization for its vaccine among children between 6 months and 2 years in the fourth quarter of 2021. Pfizer also announced Tuesday it plans to file for a full FDA approval of its COVID-19 vaccine by the end of the month, which CNBC notes would mean "the company will be able to market the shot directly to consumers." [The New York Times, CNN]

5. Researchers are racing to develop a test that shows how long COVID-19 vaccines work Researchers want to know how long the current crop of COVID-19 vaccines protect against infection, and also want a quicker way to test the efficacy of new vaccines. They are trying to check both of those boxes by studying antibody levels in people already exposed to the virus. A study at Oxford University is deliberately re-exposing previously infected healthy young volunteers to the coronavirus, using blood tests to learn what level of antibodies will protect people against getting sick again. When researchers find that level of antibodies — or antibody cutoff titer — they can develop blood tests to determine how long vaccines are effective. A separate study involving the U.S. government's Biomedical Advanced Research and Development Authority (BARDA), the Fred Hutchinson Cancer Research Center, and Moderna is also trying to find the cutoff titer by examining antibodies in people who got COVID-19 symptoms after getting inoculated with Moderna's vaccine. They should soon be able to calculate whether a certain level of antibodies can show that new vaccines are effective without having to test the vaccines on tens of thousands of people. [NPR]

Source: here

The Week article is again very USA centric but it does provide a global insight into the trends with an average of 800,000 infections and 13,000 deaths per day. India accounts for almost 50% of the new infections with probably significant under reporting of COVID related deaths. It is expected that India may reach the peak infection rate towards the end of May but while the Indian government blames the double mutant strains for the spike in cases, it is a reflection of their failure to maintain social distancing (election rallies and religious gatherings) together with an inability to effectively vaccinate their population.

On this point, President Biden’s administration supports waiving COVID-19 vaccine patent protections meaning that poorer countries may have the opportunity to manufacture their own vaccines at a fraction of the cost of US production and without waiting in line for vaccine production from developed countries. While this sounds very admirable, the practicalities of setting up production of vaccines is a complex interchange and integration of logistics, especially for the vaccines using the newer technologies such as mRNA. For example, Pfizer BioNTech requires technical expertise for the 17 steps for production, source 25+ components / substrates from several countris, and have production facilities in 3 cities and on 2 continents. This is not easily transmissible to any country so while appearing altruistic, practicalities will deem this does not occur anytime soon, if at all. The immediate effect was shaken investor confidence in the vaccine manufacturers whose share prices plummeted on this news.

While President Biden hopes to have 70% of the American population vaccinated by 4 July to achieve the magical number for ‘herd’ immunity, the CDC has already started to notice slowing vaccination rates. If this trend continues, the USA will then experience a spike in infections and hospital admissions amongst unvaccinated individuals. A widespread consensus among scientists and public health experts suggests that the herd immunity threshold is not attainable in the foreseeable future, or perhaps not ever. They go further to state the level of immunity needed to combat the more transmissible B.1.1.7 variant may be 80% or more.

Turning now to children, Pfizer BioNTech is ready to submit emergency use authorisation of their vaccine to the FDA for 12-15 year olds after completion of a study which shows it is 100% effective. This will probably be followed rapidly by an application for an ongoing vaccination study of 6 month to 11 years.

A question often asked is how long will immunity last for? There are two pieces of news on this front. Researchers are looking at the level of antibodies needed to prevent infection and the lowest limit cutoff of antibodies without having to test new vaccines on thousands of people to aid future vaccine roll out. Oxford and Moderna are currently undergoing clinical trials. In the UK, Chris Whitty the Chief Medical Officer for England, is looking at a third vaccination in the fall or winter of this year with vaccines to combat the newer variants. Moderna has developed a COVID-19 booster vaccination which shows promise in Phase II trials against against the B.1.351 and P.1 variants, first identified in South Africa and Brazil.

- Doctor Donald Greig


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