Vaccine Brings End in Sight, But Fight Not Over

Shane Speights Commentary

Vaccine Brings End in Sight, But Fight Not Over

We have a vaccine, so this COVID thing will be over soon, right? 

Short Answer: As a nation, and as a state, we can expect to see the pandemic get worse over the next couple of months. Once most people have had the vaccine or been infected, we will see cases, hospitalizations, and deaths drop. Current data indicates we can expect to start seeing some sense of "normal" days by this summer, but this really depends on several factors.  The number vaccinated, adherence to guidelines, and changes with the virus (variants). 

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Long Answer: As odd as it sounds, COVID cases, hospitalizations, and deaths are actually pretty predictable. It's based primarily on population movement. By "population movement," I mean when a large number of people travel, or gather in groups or come together and meet at one venue. Typically, this occurs around holidays or events like school starting. The more a population moves around and mixes, the more likely the virus is able to spread from one person to another. 

Sure, there are cases of the virus spreading on surfaces like table tops and doorknobs or "hanging out in the air" for hours, but that is not the primary way it spreads. COVID is primarily spread when one person is in close contact with another person. Throughout this pandemic, there has always been "baseline" spread of the virus, which is the general spread of the virus by people going about their daily activities. 

Running the Baseline

There are things that we do that change that baseline spread.  The peaks that we see are generally attributed to when the population or community as a whole increases their movement outside their normal activities or changes their behavior (i.e. pandemic fatigue).

The same is true when we see cases plateau or go down (i.e. mask mandate). We can look back at both the national and state trends and see this. The piece to remember, which seems to get lost in this conversation, is how long it takes to actually see the effect of that population movement or change in behavior. You will start seeing the effect two weeks after the event, but you won't see the full effect for four weeks or longer. Several factors play into this, but basically, it involves the asymptomatic spread and the long incubation period (up to 14 days) of the virus. 

This is why you heard so much from the CDC and state health departments (ADH) discouraging travel over the holiday period. The Transportation Safety Administration (TSA) released data that over 27 million people traveled through airports in December, which is much lower than the 72 million from the previous year. But it's the most travel that has occurred since the pandemic started last March. Based on that information alone, we can predict with fair accuracy that infections will go up in the next several weeks. 

The Current Surge

If it takes two to four weeks to see the increase, then what's causing the current increase we've been seeing? 

The rise in cases in the U.S. and in Arkansas over the past week was due to the Thanksgiving holiday period, which was a little over five weeks ago. The studious reader will see that there was actually a drop in the number of daily cases in the Dec. 26 time period, which, in theory, would correlate with infections that came from Nov. 26.

The reality is that most people either don't want to, or can't get tested on the actual holiday and have to wait to get tested until a day or two later. Since the 2020 holidays ran into a weekend, it was even harder to get tested.  

Won't having more people vaccinated counteract any increase in cases? 

Absolutely, but that assumes:

  1. people get vaccinated and
  2. a "fully" vaccinated person.

Let's look at that. First, the U.S. was hoping to have about 20 million people vaccinated by the end of 2020. We ended up with only about 2.8 million.

"Fully" vaccinated means you've had both doses of the vaccine and enough time has passed for your immune system to take the vaccine and create "memory."

The Pfizer vaccine is 52% effective after the first dose and it is 95% effective after the second dose. It takes about 14 days after the second dose to be fully protected. Most of the frontline workers I know received their second vaccine dose this week. That means they aren't fully protected until the first of February.

The Moderna vaccine is 80% effective after the first dose and 94% effective after the second dose, but the Moderna rollout has been slower than anticipated.

All that to say, we don't expect that a large percentage of the population will be vaccinated until early/mid spring, which will be after the case increase we are seeing and expect to get worse. 

So, what's the good news? 

The good news — actually great news — is that we have vaccines that work with more on the way, we have great treatments (monoclonal antibodies — ask your local hospital about this) that work with more on the way, the new variant in the U.K. doesn't change the effectiveness of the vaccine or treatment, and I truly believe that we will be back to some sense of normalcy by this summer (fingers crossed). 

The good news is that the end is in sight, it's just going to be rough for the next few months. Hang in there. 

Shane Speights, D.O., is the dean of New York Institute of Technology College of Osteopathic Medicine at Arkansas State University.