Covid-19 cases, hospitalizations, and deaths, all continue to fall.  Yet the US has just crossed the tragic threshold of 495,000 deaths. New daily cases have dropped to under 85,000 as compared to the peak 250,000 daily cases in mid-January 2021. These diminishing case numbers, which represent the fastest rate of decline since the beginning of the pandemic, have come about because of several reasons. First, there may be as many as 100M Americans who have been infected by the SARS-CoV-2 with only 29 million clinically diagnosed. Remember that there is an extremely high percentage of asymptomatic spread as well as a plethora of undiagnosed cases due to our testing inefficiencies. Even though it is not known how long already infected individual’s natural immunity will last, they do have some protection and they are not susceptible to infection during that time. Yet, they all should still be vaccinated.  Secondly, the positive effect of widespread vaccination is starting to be realized. Approximately 60M Americans have received at least one dose of either the Moderna or the Pfizer vaccine. Before this week’s winter storms, we had reached 1.9M injections per day.  The vaccination campaign will need to redouble its efforts to get back on track. Another factor for the decreasing numbers is “declining seasonality”, i.e., winter virus season is ending. Lastly, the positive results of most people WEARing masks, WASHing hands, WATCHing distances, and avoiding large CROWDS is being realized. While some experts project that there will be another surge over the next 14 weeks, others says that we will reach “herd immunity” by the end of April.  

By way of update, there is a new report on 2020 life expectancy data up until July 1, 2020. It shows that, due to COVID-19, life expectancy in the USA decreased by one year to age 77.8 years.  The life expectancy for Black folks decreased by 2.7 years. That means that life expectancy for Blacks is now SIX (6) years shorter than our fellow White Americans. The gap was closing but no more! Latino life expectancy decreased by nearly two years.  Note that this data is only for the first six months of last year. Further update based on the entire year of is likely to be worse.

The cautionary news is that superimposed on a baseline level of cases higher than last summer’s surge, we will experience the foreign and home-grown variants. Currently, the UK variant (B.1.1.7) has been identified in 42 states. It is 40-70% more contagious and recent studies show it to be more lethal that the original strain of the SARS-CoV-2 virus. Less than 1500 cases caused by this variant have been identified in the US. Nevertheless, it is predicted to be the dominant strain by the end of March. Unfortunately, the USA does not perform adequate genomic testing which is necessary to identify viral mutations.  Only 0.4% of our testing facilities have the capability of the specific testing necessary. A corollary is that 43% of the genomic testing performed in the world is done in the United Kingdom.  A bit of good news is that both the Moderna and the Pfizer vaccines appear to be effective against this variant, as do the J&J and AstraZeneca.

The other foreign variants are the South African (B.1.351), which has been identified in seven (7) states, and the Brazilian (P.1) which has been found in only two US states. Although the Pfizer and Moderna have been found to be effective against the South African strain, the use of the AstraZeneca vaccine in South Africa has been suspended due to a lack of efficacy.  The J&J vaccine is scheduled for Emergency Use Authorization hearing on February 26. Unfortunately, a manufacturing glitch will prevent the planned availability of 12M doses available at the time of EUA, and the contracted 100 million doses will reportedly not be available until June 2021.

Because of the world record proliferation of the virus in the US during December and January we now have ten variants of our own. The good news is that the pharmaceutical companies are confident that future vaccines can be adjusted to meet the challenge.

 

Clyde E. Henderson, MD

Cincinnati Medical Association