It has been almost a year since the coronavirus first emerged in the United States, and it’s still spreading uncontrolled through much of the country. Several mutant variants have emerged — some of them with alarming new properties — and the vaccination campaign that was supposed to finally save the world from this crisis is faltering badly.
It’s hopeful, then, that the country is just days away from leadership that takes these problems seriously. President-elect Joe Biden has announced plans to revamp the nation’s flagging coronavirus response. The scope and tenor of his vision seem commensurate with the task at hand. Mr. Biden says he will ask Congress for $415 billion — to scale up testing, vaccination and genomic surveillance, to increase domestic manufacturing, and to create a national corps of public health workers.
But to prevail, the new administration will have to win numerous political battles and overcome a growing undercurrent of national apathy and exhaustion.
It has been nearly 11 months since the coronavirus was first detected in the United States, and it continues to spread relentlessly, sickening and killing as officials dither and debate, and repeat obvious mistakes. In spring and summer, the problem was testing and personal protective equipment; this fall and winter, it has been vaccination and genomic surveillance. Time and again, the federal government has foisted responsibility for unwieldy initiatives onto individual states without providing the support those states need to succeed. Time and again, the states have fumbled and faltered. Time and again, the virus has surged.
More than 23 million Americans have been infected, and nearly 400,000 have died. With each passing month, the bizarre features of pandemic life — the Zoom funerals, the end of regular haircuts and restaurant dining, the sports arenas filled with cardboard spectators — have become that much more familiar. It’s tempting to succumb to indifference after so much suffering and loss. The nation has passed so many grim milestones, and none of them have shaken leaders from their complacency or nudged the country onto a different course.
But the change in administration is an opportunity to finally heed the lessons of this pandemic and get it under control before things get even worse.
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Stop the spread
Covid-19 is most likely now the leading cause of death in the United States. It’s tempting to think that the measures employed against the virus — the face masks, physical distancing, closures and travel restrictions — don’t work. Because if they did, we wouldn’t be in such a state, right?
Wrong. All of these measures work when they are used consistently and correctly, and all of them have a role to play in fighting the virus. The incoming administration will have to drive this point home as forcefully as possible.
The bigger the crisis gets and the longer it drags on, the harder it becomes to believe that something as simple as a face mask or as nontechnical as a quarantine can save lives. But these measures can be incredibly effective if everyone sticks with them. The incoming president will have a rare opportunity to make that message new again.
Map the mutants
Several mutant variants of the coronavirus have popped up around the globe in recent months, each seemingly more worrisome than the last. The country needs to do a much better and faster job of tracking these variants and of keeping an eye out for new ones that are sure to emerge in the months ahead.
While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.
Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.
Yes, but not forever. The two vaccines that will potentially get authorized this month clearly protect people from getting sick with Covid-19. But the clinical trials that delivered these results were not designed to determine whether vaccinated people could still spread the coronavirus without developing symptoms. That remains a possibility. We know that people who are naturally infected by the coronavirus can spread it while they’re not experiencing any cough or other symptoms. Researchers will be intensely studying this question as the vaccines roll out. In the meantime, even vaccinated people will need to think of themselves as possible spreaders.
The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection won’t be any different from ones you’ve gotten before. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. But some of them have felt short-lived discomfort, including aches and flu-like symptoms that typically last a day. It’s possible that people may need to plan to take a day off work or school after the second shot. While these experiences aren’t pleasant, they are a good sign: they are the result of your own immune system encountering the vaccine and mounting a potent response that will provide long-lasting immunity.
No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.
That means more clinical tests designed to rapidly identify such mutations in patients who turn up with symptoms, and larger-scale genomic surveillance efforts that can track them at the community level. States that are not already using wastewater surveillance should start doing so now: Studies show it’s a fast and cost-effective way to monitor the virus’s spread, and if wastewater surveillance is paired with sequencing, it can help ferret out dangerous variants much more efficiently than clinical testing does.
That information can then be used to guide the nation’s flagging contact tracing efforts.
Many states have all but abandoned their contact tracing programs because the virus has spread far beyond their ability to track it. But if contact tracers can’t do much against the regular coronavirus, they can still have a huge impact on its mutant siblings. If every case of B117 — which is the most alarming variant that we know of so far, because it spreads much faster than any others — were immediately assigned to a team of contact tracers, and if everything possible were then done to test, isolate and quarantine those contacts as needed, this more contagious strain could be held at bay long enough for vaccination to work its magic.
State and city health officials should make this an immediate priority — every bit as much as vaccination — and stomp out these mutant variants before it’s too late.
The national vaccination effort is in a state of chaos. Only about one-third of the 30 million or so shots provided to states have been injected into arms. The rest have been held up by a roster of factors, including vaccine hesitancy, cumbersome federal prioritization guidelines, and poor coordination between major pharmacies and the thousands of nursing homes whose staff and residents they are supposed to inoculate.
This week, in an attempt to speed things up, the outgoing administration abandoned its own prioritization guidelines, and deemed some 152 million more people immediately eligible for vaccination. Officials also indicated that they would release an untold number of additional doses to the states quickly, rather than holding them in reserve as was originally planned. But those pronouncements have only made matters worse. Health departments have been overrun, web portals and phone lines have crashed, and consumers scrambling to secure appointments have been outraged to find that the vaccine is still not widely available. As The Washington Post has since reported, there are no reserve doses to be had.
To get more people vaccinated, states need trained vaccinators. They also need the technical capacity to schedule appointments for hundreds of thousands of people and public messaging campaigns to combat hesitancy. Officials need to inform people of where they stand in line and tell them when and how they should sign up to be inoculated.
President-elect Biden has vowed to get those measures in place quickly, and to vaccinate 100 million people in his first 100 days. That’s a worthy goal. But to succeed, he’ll have to do a much better job than his predecessor of communicating with and supporting states. The mass vaccination sites the Biden administration plans to establish will work great in some places, but support for community clinics will be the wiser course in others, and pharmacies will have a much bigger role to play in yet others.
The incoming president can help keep the overall effort on track by adhering to a clear national vaccination strategy: Is the goal to save as many lives as possible or to reopen businesses? Is the goal to vaccinate as quickly as possible or to ensure that precious shots are equitably distributed?
Congress can help make sure that the decided-upon vaccination strategy succeeds, and that the overall coronavirus response prevails, by approving and releasing the necessary funds as quickly as possible.