Awaiting the Mutant Storm(s)

The daily average of coronavirus cases remain stubbornly high, above 146,000 on Feb 1, but they are down almost 30% in two weeks, according to The New York Times. Hospitalizations, just below 94,000, have dropped by over 20%, the lowest since Nov. 29, according to The COVID Tracking Project. And Covid-19 deaths have finally "begun to decline in every section of the U.S., the latest sign of relief as cases continue to drop and the vaccination push accelerates," reports Bloomberg News' Jonathan Levin.

"But just as there are signs of progress, another problem has taken root: the spread of the variants, which scientists warn must be contained before they become dominant, report Ethan Hauser and Melina Delkic for the Times on Monday.

Several hundred cases of the more contagious variant discovered in Britain, which experts have said could be the dominant form in the United States by March, have already been confirmed.

A day earlier, Michael Osterholm, director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota, appeared on the NBC Sunday show, "Meet the Press" and issued the warning in stark terms during an interview with host Chuck Todd. [For a short version, see Twitter video].

“The fact is that the surge that is likely to occur with this new variant from England is going to happen in the next six to 14 weeks. And, if we see that happen, which my 45 years in the trenches tell me we will, we are going to see something like we have not seen yet in this country...."

"Imagine, Chuck, at 120,000 to 130,000 people hospitalized at one point we saw our health care system literally on the edge of not being able to provide care. Imagine if we have what has happened in England, twice as many as those cases – that's what we have to prepare for..."

In order to prepare for the coming surge, Osterholm, who served on the Biden-Harris Transition COVID-19 Advisory Board, and other public health experts are promoting a strategy of "vaccinating as many people as possible with one dose of COVID vaccine before ensuring people receive the recommended second dose," reports Stephanie Soucheray for CIDRAP News (source article) on Feb. 1.

Such a dosing strategy has already been used in the United Kingdom and Israel, two countries further ahead in vaccinating their populations than the United States.

"The maximum public health benefit would come from giving a single dose to as many people as possible, and following up with a second dose when supply improves," said Neal Halsey, MD, of Johns Hopkins University, in an interview. Halsey and Stanley Plotkin, MD, co-authored a letter in Clinical Infectious Diseases last week explaining how delaying a second dose of vaccine would accelerate the US vaccine rollout.

"But top Biden administration officials said Monday they are not changing their strategy, noting that the clinical trials were conducted with two doses, so that is what has been shown to work," reported Peter Sullivan for The Hill.

Anthony Fauci, the government’s top infectious diseases expert, added: “The first priority will always be to get the people who've gotten their first doses to get their second dose.”

While sticking with a two-dose strategy, Andy Slavitt, senior adviser to the White House coronavirus team, said some health care providers are holding back doses that could be given immediately, instead saving them to be used as second doses, which they should not be doing. 

In addition to the U.K. variant, "[t]he country has also recorded its first two cases of the variant spreading rapidly in South Africa, which has proved to reduce the effectiveness of vaccines," added Delkic and Hauser for the Times.

“If we didn’t have these variants looming,” we would be in a good place, said Dr. Peter Hotez, a vaccine scientist and pediatrician at Baylor College of Medicine in Houston. If those variants take over by spring, “as many of us are predicting,” he said, “it changes everything. Now, we really have to vaccinate the American population by late spring, early summer.”

• Pandemic Endgame: The Goalposts are Moving, December 30, 2020
• The Pandemic Expert in the Biden Cabinet Who is Not on the Biden Health Team [scroll down to "Biden-Harris health team" which now goes by "White House COVID-19 Response Team," December 28, 2020
• Biden-Harris Transition Covid Task Force Announced, November 11, 2020
  
• Report: Expect to Live with Two More Years of Social Distancing, May 4, 2020