As deaths top 500K and cases trend downward, US pandemic fight at 'crossroads'

WASHINGTON (SBG) — The United States faced a grim milestone in its battle against the coronavirus pandemic Monday as the nation’s death toll topped 500,000, but new data suggests brighter times might be on the horizon, even if it is still unclear when life could return to normal.

President Joe Biden was set to mark the loss of a half-million American lives with a candle lighting ceremony Monday night. Nearly 100,000 of those deaths occurred in the last month and over 100,000 more are expected in the months ahead, but recent days have brought several positive developments.

New coronavirus cases have been falling steadily since their high in mid-January, with the 7-day average now around the same level seen last July. Daily deaths are also trending downward, as the 7-day average dropped below 2,000 for the first time since December late last week.

Meanwhile, a Food and Drug Administration advisory panel is expected to recommend emergency authorization for a third vaccine later this week, a single-shot inoculation developed by Johnson & Johnson. If it is authorized, the U.S. is on track to have enough vaccines available to inoculate 300 million people by summer.

Though enormous technical and logistical challenges remain, the distribution and administration of two-shot vaccines from Pfizer and Moderna are accelerating. According to the Centers for Disease Control and Prevention, nearly 20 million Americans have received both doses of a vaccine, and more than 20 million others have gotten a first dose.

In addition to preventing serious illness in most recipients, new research on those who received the Pfizer vaccine in Israel indicates it may effectively reduce transmission of the virus. Moderna’s vaccine has been shown to decrease the likelihood of transmission in monkeys, but similar data on humans is not yet available.

Still, several highly transmissible variants of the virus are circulating in the U.S. and elsewhere, and more could emerge in the future. Some experts fear a surge of new cases as a result, and scientists are still working to determine how well existing vaccines work against those mutations.

“We are at an important crossroads in addressing COVID-19 in the U.S.,” said David Holtgrave, dean of the University at Albany School of Public Health.

The nation has suffered severe human and economic costs in the last year, but epidemiologists and health officials have also learned a great deal about the coronavirus that can help contain it. If vaccines, treatments, social distancing, and other mitigation strategies can be deployed effectively and persistently, Holtgrave said he is “cautiously optimistic” about the trajectory of the pandemic.

Federal officials have offered similarly upbeat yet reserved assessments of where things stand, attempting to balance hope with vigilance. Getting virus transmission to levels seen last summer is surely an improvement, but they acknowledge it is far from ideal.

“The slope that's coming down is really terrific,” Dr. Anthony Fauci, the federal government’s top infectious disease expert, said Sunday on NBC’s “Meet the Press.” “It's very steep and it's coming down very, very quickly. But we are still at a level that's very high. What I don't, and none of my colleagues want to see, is when you look at that slope to come down, to say, ‘Wow, we're out of the woods now. We're in good shape.’”

Some experts are willing to go further, though. Citing a 77% drop in COVID-19 cases since early January, Dr. Marty Makary, a professor at Johns Hopkins Bloomberg School of Public Health, argued in a Wall Street Journal op-ed that the virus could be contained by April.

“Some medical experts privately agreed with my prediction that there may be very little Covid-19 by April but suggested that I not talk publicly about herd immunity because people might become complacent and fail to take precautions or might decline the vaccine,” Makary wrote. “But scientists shouldn’t try to manipulate the public by hiding the truth.”

Others say complacency is a very real concern, and even the rosiest best-case scenarios are dependent on the public continuing to take mitigation strategies seriously. Until the impact of vaccines on infection and transmission is clearer, that includes people who are inoculated complying with restrictions, regardless of how frustrating that might be.

“If vaccines are rolled out rapidly and intensively, and other measures, such as mask use, are widely employed as well for the time being, then one can imagine a much fuller return to such ‘normal’ activities in the fall of 2021,” Holtgrave said.

Biden administration officials are also eying late 2021 to resume some semblance of normalcy, but they have been hesitant to make any concrete assurances. Despite recent positive trends, there are still variables that make long-term projections difficult.

“God willing, this Christmas will be different than last,” President Biden said Friday, although he quickly added he could not guarantee that.

In an interview with CNN Sunday, Fauci predicted the U.S. would likely reach “a degree of normality” by the end of 2021, but he noted many factors could impact that timeline. If virus levels are still high because of the spread of variants or if vaccination slows, it is possible restrictions like mask use will still be necessary into 2022.

“I want to see it go way down,” Fauci said. “When it goes way down, and the overwhelming majority of the people in the population are vaccinated, then I would feel comfortable in saying, we need to pull back on the masks, we don't need to have masks.”

Vaccines have been developed at unprecedented speed, and several others could be authorized in the near future. Because of that rapid process, much is unknown about how long protection against the coronavirus lasts and whether the vaccines will prevent those who are immunized from spreading the infection.

Initial vaccine trials have been focused on preventing severe illness and death, and research is still ongoing on infection and asymptomatic transmission by those who have gotten shots. The data so far on Pfizer and Moderna’s vaccines is promising, but it is not conclusive.

In Israel, which has inoculated a larger share of its population than any other country, researchers say the Pfizer vaccine appears to drastically reduce symptomatic infections by more than 90%. Studies there have found that the vaccine does not prevent infection, but those who get infected after vaccination carry a much smaller viral load, likely diminishing the risk of transmission.

Some experts say true herd immunity is not necessarily the goal and might not even be possible, given how the coronavirus transforms and adapts. Ensuring most Americans, particularly those at high risk of severe symptoms, have some level of protection against serious illness could be sufficient.

“COVID is going to continue to circulate at a low level,” Dr. Scott Gottlieb, former director of the Food and Drug Administration and a member of Pfizer’s board of directors, told CBS News Sunday. “Hopefully, we'll continue to vaccinate the vulnerable population, so we'll protect them from hospitalizations or severe illness and dying from this.”

Experts believe at least 70% of the population will need to have either a vaccine or natural immunity to stop the spread of the virus, and it is hard to predict when that threshold will be reached. Even if the U.S. succeeds in getting most adults vaccinated, about 75 million children might not be eligible to get shots until late this year or early next year.

No matter how effective the vaccines are or how rapidly they can be distributed, convincing people to line up to take the shots also remains a challenge. Many health care facilities and the U.S. military have reported high rates of refusal to get vaccinated, and a significant share of the public is still wary.

A recent AP-NORC poll showed 67% of Americans plan to take a vaccine or have already done so. Most of the remaining one-third said they were concerned about side effects or do not trust the vaccines, and many believe they simply do not need to get vaccinated at all.

Racial disparities in vaccine acceptance have been apparent for months, with many Black Americans citing concerns about historical abuses of their communities by the government and the medical establishment. Partisanship is becoming a much larger factor, as well, with a Monmouth University Poll finding more than 40% of Republicans would avoid ever getting a coronavirus vaccine if they can.

The notion that people who have been vaccinated should still avoid close contact with others, wear masks, and forego public gatherings might be good health policy, but it is proving to be a problematic message to communicate. Media reports encouraging such measures have spurred a backlash on social media.

“For many people, the reason they’re willing and interested to get vaccinated is they want to return to life as it was before the pandemic,” said Glen Nowak, director of the Center for Health and Risk Communication at the University of Georgia.

Nowak said the anger is understandable, but health officials must clearly communicate the reasons why those precautions are necessary and why they are unsure of the effects of the vaccines. There are also broader benefits to the community of getting vaccinated and exercising caution that should be emphasized.

“People have to see the value in protecting other people,” he said. “It’s not just about protecting yourself.”

According to Holtgrave, it is also important to stress that recommendations for social distancing and mask use are temporary and will be eased when transmission is lower. That might take longer than some Americans would like, but he warned it could take even longer if people let their guard down before it is safe to do so.

“One thing we’ve learned in other areas of public health is that it is important to accelerate and not skid across the finish line to remove the threat of an infectious disease,” he said. “Sadly, infectious diseases tend to make us pay if we as a nation ease up too soon before the threat is truly well in hand.”