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COVID Monthly Recap
By invited columnist Katelyn Jetelina,
MPH PhD, aka, Your Local Epidemiologist
In the first half of
October, cases in the United States continued to decline nicely and
Americans ultimately saw a 53% decrease in cases. We were well on our
way to recovering from the Delta wave. Unfortunately, the United
States plateaued around October 20.
Idling was not a good
sign for a few reasons. First,
we idled at a high transmission rate—73,000 cases per day. This case
rate was higher than the peak of the first two waves (Wave 1
peak=32,000; Wave 2 peak=66,000). This is not how we want to enter the
winter season— when coronaviruses typically thrive.
Second,
almost every country in Europe had exponential increases in cases.
Europe has consistently acted as an early warning signal for the U.S.,
and at this point in the pandemic, they are far more vaccinated than
the United States. Notably, Germany has the highest case rate since
the beginning of the pandemic.
Third,
also looking to Europe, the case make-up was shifting. In Summer, the
European wave was largely driven by younger populations (i.e. unvaccinated).
By the end of October, the wave was driven by all ages equally. In
Germany, for example, 1 out of 3 people over the age of 60 in ICU were
vaccinated. This meant vaccines were waning and people needed to get
boosters. In Germany, only 4% of the population was boosted.
Ultimately, the United States needed to heed this warning from
European countries across the pond and prepare for Winter.
Vaccines
Thankfully, October
was a huge month for vaccine authorizations. After many advisory
committee and agency meetings at CDC and FDA, several policies were
finalized:
1.
Vulnerable populations with
the Moderna primary
series
were authorized to get a booster 6 months after the 2nd
shot
2.
Everyone
with a primary J&J shot was authorized for a booster 2 months after
3.
Mixing
or matching vaccines was authorized. So, for example, J&J person could
get a Pfizer booster, and,
4.
5-11
year olds were now eligible for a vaccine.
As
expected, the FDA and CDC didn’t provide recommendations on how
to effectively mix vaccines. This is because results from only one
study were released at the time. From this landmark study, authors
reported that mixing vaccines was safe with no severe events linked to
the vaccines. The authors also reported that some vaccine combinations
were more robust than others. For example, those that received the J&J
shot first and then got a Moderna booster had, by far, the most
superior response with a 76.1 fold
increase in neutralizing antibodies.
Pediatric Vaccines
At another meeting,
regulatory agencies extended eligibility for the pediatric
population. As ACIP pointed out, there have been more than 1.8 million
infections among 5-11 year olds resulting in more than 8,500
hospitalizations. Interestingly, 1/3 of pediatric hospitalizations
have been with children with no underlying medical conditions. And, in
one year, 100 5-11 year olds succumbed to COVID19, which placed it as
the 8th leading cause of death for children.
COVID19 infections
kept close to 1.2 million children out of school and 7-8% of children
will experience long COVID19. There are also population benefits to
vaccinating, as mounting evidence shows that kids are incredibly
effective transmitters of SARS-CoV-2. Thankfully, this is now a
vaccine-preventable disease for 5-11 year olds.
Barriers
That is
if we can convince parents of the need, safety, and effectiveness. The
latest Kaiser Family Foundation
poll
reported that 1 in 3 parents will “wait and
see” and 1 in 3 of parents will “definitely not” get the vaccine for
their child. Top concerns include not enough known about the long-term
effects and children might experience serious side effects.
Importantly, access concerns were also voiced, with 25% of parents not
being able to get the vaccine from a place they trust, concerns of
having to pay out-of-pocket costs, and difficultly in traveling to a
place to get their child vaccinated.
By the end of October, 56% of Americans were fully vaccinated.
Boosters were ramping up in the U.S. with more than 18.6 million
doses
administered. This equated to 9.7% of our vaccinated
population (at the time, 60% of our population was eligible). Those
with a primary J&J vaccine seem to be opting for a Moderna (46%)
booster followed by Pfizer (36%) and J&J (18%). Those with a primary
mRNA series are largely sticking to their original vaccine sponsor for
the booster.
Treatments
In October, we also got our first antiviral treatment.
Merck announced a
new antiviral that can be used against COVID19:
molnupiravir. When approved, high risk people would take four capsules
twice a day for five days early in their infection. Antivirals are
incredibly difficult to create because viruses can change fast (think
flu), antivirals are very specific to a certain disease (we usually
can’t use an HIV antiviral for COVID19), and/or the virus’s life cycle
has limited targets for treatment.
Nonetheless, scientists figured it out for COVID19 and
this pill series cuts the risk of hospitalization or death in half.
It’s certainly not as effective as vaccines, but we can use all the
help we can get. The FDA advisory committee has planned to vote on the
approval at the end of November.
What to
look for in November?
To avoid
a winter wave, we need to improve our breadth (getting unvaccinated
vaccinated) and depth (boosters) of vaccinations, we need to implement
treatments, and remain vigilant. If we make it through the Winter
months without a mutation, many epidemiologists, including myself, are
hopeful for an endemic state
in Spring. An endemic
state would mean we
have an outbreak here and there (maybe at a nursing home or at a
school), but there will not be high levels of transmission statewide.
Stay tuned. ■
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