Three Paths This Coronavirus Nightmare Could Take

Dr. Vin Gupta was nervous.
The pulmonologist and intensive care doctor wasn't worried about the COVID-19 vaccine - or the fact that he received the shot live on The Today Show the next morning. But, as he told The Daily Beast over the phone that Tuesday afternoon, the faculty member of the Institute of Health Metrics and Assessment (IHME) at the University of Washington had been showered with messages, emails, and Twitter mentions, including threats, from vaccine skeptics Life and the invitation to "come make me wear a mask".
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It was more than enough to stir some anticipation at the kind of backlash he might get after actually getting the shot - and what the land around him lay ahead of him.
In the days after receiving his first dose of the Pfizer vaccine, Gupta caught the attention of Fox News' Tucker Carlson and Senator Ted Cruz. The latter called Gupta part of a "bizarre, wacky, totalitarian cult" because he said vaccination "doesn't mean you should participate in things like traveling in the middle of a runaway pandemic or being exempt from masks. "
In other words, to remind people that this coronavirus nightmare is not over yet.
Anthony Fauci explains: The vaccine will be released in the spring
"They were obviously trying to distort what I was saying to confuse people," Gupta told The Daily Beast this week. He added that he was “exhausted” by these types of malicious attacks, which he described as “the public piece” of his job, “because there are people trying to make it appear like doctors and nurses To scare. ”
Ultimately, the Air Force veteran said he felt an obligation to use his platform responsibly and put it down.
However, disinformation and extremist rhetoric could have a huge impact on what the next year of vaccine distribution and pandemic surveillance looks like - and how quickly life could return to something that is nearing normal.
As of this week, there were two COVID-19 vaccines in the US that are approved for emergency use. One was developed by the American pharmaceutical company Pfizer and the German company BioNTech, the other by Moderna from Massachusetts. More are in the pipeline, such as a vaccine from Oxford University and AstraZeneca, which is expected to seek Food and Drug Administration (FDA) approval in the coming months.
JOSEPH PREZIOSO / AFP via Getty Images
But after a year of economic, physical, and emotional devastation in which more than 18 million Americans contracted the virus, glaring questions remain, even if help is clearly on the way.
Among other things, will there be less community transmission early in the year or will only those who received the vaccine be significantly safer? Will Americans Refuse to Get Vaccinated in Large Numbers? Will the virus itself mutate faster than scientists predicted? And will healthcare workers finally get a break?
Last but not least, the early response to the vaccine was a ominous sign in the darkest corners of the internet.
The dir ideal
In the best case scenario, vaccine batches will from now on be redistributed with relatively few hurdles. Then more vaccines from the same companies or others like AstraZeneca will quickly be added, which can step up efforts to give the opportunity to as many Americans as possible. In this scenario, researchers can also develop a vaccine that children under the age of 16 can take that is not currently approved for the drugs Moderna or Pfizer.
If so, the entire country could see some level of pandemic relief as early as the spring. Healthcare workers would enjoy a break from the mind-boggling physical and emotional strains of their jobs that care for the hundreds of thousands of Americans who became critically ill and died. There would be significantly fewer severe cases and deaths from COVID, and nowhere would this be more evident than in hospitals.
"I think we'll see some real differences by April and May," said Dr. Arnold Monto, infectious disease expert and acting chairman of the Advisory Committee on Vaccines and Related Biological Products, who advocated both vaccines.
He repeated Dr. Anthony Fauci on Monday, when the director of the National Institute of Allergies and Infectious Diseases told The Daily Beast that aggressive vaccinations in May, June and July could mean an "overwhelming majority" of the population will be vaccinated by August.
This scenario answers the big questions about the vaccines and the answers are good. Do the vaccines prevent transmission from healthy or moderately ill people to others? Yes. Doctors who get mild or asymptomatic cases of the virus after vaccination will not pass it on to their families. Does the immunity last at least a year? Possibly longer? Yes. In other words, we don't need to treat booster shots - beyond the second starting dose - or frightening virus mutations until researchers and frontline staff have some room to breathe.
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"I'm pretty optimistic," Monto told The Daily Beast. Because symptomatic cases of the virus spread more easily than asymptomatic ones, the least bad answer to this question is possible and even likely.
In this scenario, although there may be some relatively small pockets of transmission - superspreader events or breakouts - during the summer, some people can wander outside of their homes without a mask without feeling guilty. Still, public health leaders like Fauci have determined that mask use in general will continue for a long time.
In this future at least, anyone or almost everyone who should receive the vaccine will receive the vaccine, despite anti-vaccination reports or prior hesitation about the vaccine.
Meanwhile, researchers have been able to discover, test, and spread more therapies - like monoclonal antibodies - for severe cases of the virus, or act as prophylactic agents and protect those who have not yet received the vaccine.
That said, even in the best-case scenario, when it comes to January and February, mass death is inevitable. As Gupta put it, "The vast majority of people who will die from this virus will die regardless of the vaccine distribution strategy."
It should be noted that public health experts also suspect that a potentially more communicable variant of the coronavirus is already on US soil and that millions of Americans are still planning to travel on vacation. How many millions of people actually travel, what precautionary measures they take and what burdens are associated with them, creates a lot of uncertainty.
In all scenarios, says Dr. Jennifer Horney, founding director and professor in the University of Delaware's epidemiology program, American hospitals will be working on the cases contracted on Christmas Day for the next six to eight weeks.
"We have to live with the cases we have now for the next few months," said Horney.
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The brutal setback scenario
The worst-case scenario for 2021 starts with people still gathering in January and breaking public health guidelines without having been vaccinated. Horney is not optimistic in this regard.
"I think it will be a good time before we feel a cumulative public health impact in 2021 because we are still not changing our behavior," she said. "We still have to live with the coming hospital stays and death."
"We will have nearly 500,000 deaths by March," she continued, reiterating the predictions published last week by Gupta's colleagues at the University of Washington. The leading research group's models used by the White House estimated that 562,000 Americans will have died from the virus by April 1, 2021.
At worst, it will answer the big questions about the vaccines, and the answers are terrible. In addition to a severe infection, will the vaccines prevent transmission? No. It turns out that the vaccine prevents you from getting sick, but not from you passing it on to someone who hasn't had any shots. Does the immunity last at least a year? Possibly longer? No. We might even be forced to re-evaluate our priority lists to allow those already vaccinated to get booster vaccinations by the end of the year.
Then there is vaccine hesitation. There have been multiple studies of Americans and vaccines, and as of this week, millions are still saying they won't take the COVID-19 vaccine. Fauci told The Daily Beast earlier this month that his "greatest fear is that a significant proportion of people will be reluctant to get vaccinated".
The "terror gram" used by neo-Nazis to seduce anti-Vaxxers
In this scenario, vaccine skepticism, actual doses issues, unforeseen side effects, human error in the logistics of vaccine shipping, or distribution issues - such as wasted doses due to problems with Pfizer's required ultra-cold storage - hamper the effort to achieve something close to herd immunity . Many people don't get the vaccine until after the next year.
One possibility is that "we have so many mutations that the vaccine stopped working," said Monto in that scenario. The consensus among experts - including Monto - is that such a situation is very unlikely.
Then the lower-income countries, which Horney said should receive the vaccine as early as 2024, would take even longer to maintain their share of the world's supply. In that case, community transmission would not be controlled as expected by the summer, and if the fall is cold again, things will still not look "normal" before the pandemic.
In fact, deaths and cases could explode again.
At the same time, years of health problems that people felt unsafe to get checked out at annual doctor's appointments - mammograms, colonoscopies, skin cancer screenings - are again being skipped and one nightmarish year rolls on in the healthcare sector.
The messy, deadly center
The model of the Institute for Health Metrics and Evaluation assumes that the introduction of the vaccine by April 1, 2021 will save around 34,500 lives. A faster introduction would save 55,400 lives compared to a scenario without a vaccine. The model assumes an estimated 100.1 million people in the United States will be vaccinated by April 1. With an even faster but unlikely rollout, the number of people vaccinated could reach 194 million.
Dr. Maimuna Majumder, a computer epidemiologist and faculty member at Harvard Medical School and the Computational Health Informatics Program at Boston Children's Hospital, pointed out that the journey to the vaccinated United States will not be linear. Some counties, where the vast majority of the population is older, will be safer and safer sooner than others than others.
It also works the other way around, she said.
"We need to be very aware of the fact that some of the same communities that have been hit by this pandemic will stay high and dry even from the vaccine," Majumder told The Daily Beast, noting health inequality still falling down of the racing lines in the United States. "If we leave some pockets underinoculated, it means they are prone to outbreaks in the future."
It is of the utmost importance for health authorities to keep an eye on issues of logistics and the distribution of two doses per vaccine to ensure that everyone who receives a dose receives two. These issues "will disproportionately affect underserved groups," added Majumder, noting that these areas are likely to have been affected by the virus the longest.
So what is realistic, said Majumder, is that some communities will first achieve lower levels of community transmission or herd immunity. But what about the whole country?
"I think there are different stages," said Horney. "Given the percentage of people who will ingest it, will we achieve absolute herd immunity once it is fully available?" I think this will take a long time.
"But for the next 6 months, can we vaccinate anyone who is ready and make things hugely safer for people?" She asked. "Yes, yes, we can."
Read more at The Daily Beast.
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