Our country continues in the grips of COVID-19. The number of daily cases has fallen to below 100,000 for the first time since early November 2020. Even this current level remains much higher that the surge that we experienced during the Summer of 2020. US cases, hospitalizations, and finally deaths are all falling. Yet, we have reached over 27 million cases and 468,000 deaths.  We know that the devastating surge from which we are now improving was fueled by family and friend gatherings of late 2020. We can only hope that Superbowl LV Sunday gatherings do not reignite the fire as a superspreader event.

We are getting much better news regarding vaccine availability and distribution.  Nearly 63 million of the Moderna and Pfizer vaccines have been distributed in the US.  Shots in arms are 43 million Americans so far, representing 69% of available vaccines having been administered. Vaccinations have increased to 1.3 million per week with a goal of 1.5 million per week. The NFL has offered its 32 stadia as mass vaccination sites along with various other large facilities around the country.  Several large retail pharmacies (Walmart, Walgreens, CVS, Kroger, Publix) will be able to provide vaccinations soon. The Biden-Harris administration is implementing an all-government approach to fighting this scourge by more extensive use of the Defense Production Act to secure and fortify supply chains for PPE, testing, and vaccine production. Additionally, 1200 active-duty soldiers are to be deployed around the country to assist in achieving vaccination goals. In addition to improved distribution, the supply of useable vaccines will increase when the Johnson & Johnson vaccine comes online.  The two major advantages of this vaccine over the other two which are authorized are that it is just one injection and it only requires refrigerator storage. Our government has purchased 300 million doses. The Emergency Use Authorization that has been requested will be heard beginning on February 26, 2021. Further supply augmentation will come, probably in the Spring, when the Novavax vaccine is made available.  Lastly on the vaccine front is AstraZeneca. This vaccine is the only one that has been proven by trials to lessen the spread of the SARS-Cov-2 virus (67% reduction in transmission), whereas all of them are effective at preventing illness. It should be noted that the AstraZeneca vaccine has been found to be ineffective against the South African variant.

The greatest threat to derailing our country’s journey back from a raging pandemic to more normal activities is rapidly proliferating mutations. Projections from Washington University (IHME) reveal that our daily case rates will continue to steadily decrease at least until June 1, 2021 unless the mutant strains proliferate significantly.  One of our continuing problems is that we do not have enough widespread genomic testing capacity for determining the presence of mutations. The three mutant strains from foreign countries, (United Kingdom, Brazil, and South Africa), continue to spread across the USA. The UK variant (B.1.1.7) is in 32 states. Nevertheless, this strain which is projected to be 45% more contagious, composes about 2% of the total US cases. This is projected to be the dominant strain in March. This spread can hopefully be stopped.  The best defenses against the original and the mutant strains are widespread vaccination and continuing to follow proper masking, hand washing, social distancing, and avoiding large crowds.  Viruses can only mutate if they proliferate.

The CDC recently issued new mask guidelines found at https://www.cdc.gov/coronavirus/2019-ncov/your-health/effective-masks.html. The bottom line of these includes wearing a mask that fits against the face snugly, but not two disposable surgical masks. Secondly, wearing a cloth mask over a disposable surgical procedure mask or a mask fitter form over a 2 -3 ply cloth mask are other options. If you wear a KN-95 or N-95, then no additional second mask is recommended. Our Tristate area is doing remarkably well with mask wearing according to a recent survey by Interact for Health. Greater Cincinnatians are wearing masks at a 90% rate while in indoor public places. Seventy percent of us wear masks outdoors, in public. Please keep it up, the light at the end of the tunnel is getting brighter!

 

Clyde E. Henderson, MD

Cincinnati Medical Association