“WHEN I’M vaccinated and everyone around me is”—was the response to the question “When would you personally feel comfortable returning to the office?” from New York Times coronavirus reporter Donald G. McNeil Jr. in a daily New York Times email.
At this point, most predictions place widespread availability of the coronavirus vaccine around May or June—depending on the smooth rollout of approval, production and distribution.
On the other hand, “social gatherings will again be common and largely safe by the summer,” Johns Hopkins epidemiologist Caitlin Rivers predicted in another New York Times email. After the first batch of vaccines has gone to high-risk healthcare workers and others, according to a rollout timeline created by a panel of scientific advisors to the CDC, February and March are the target dates for “people over the age of 65 (and especially those over 75),” along with several other groups.
The order of distribution is up to individual states—with healthcare workers at the top of most lists, although definitions of these includes anything from ICU and emergency health services workers to those employed in long-term care facilities. Also near the top in most locales are the three million or so residents of these facilities, which have accounted for almost 40% of deaths caused by the coronavirus to date.
Other high-priority groups with varying definitions are “essential workers” and/or those whose jobs cannot be done from home—usually emergency transportation workers and often those in the food industry. In Colorado, these include “ski industry” workers who live in congregate housing.
Local rankings are important because the distribution of doses will occur in waves of limited allotments. In DC, the currently assigned initial batch of 6,800 doses (with each vaccine requiring require two doses) will cover 3,400 people—about 10% of the District’s healthcare workers. With these workers numbering close to 85,000—of whom about 75% reside in Maryland or Virginia—District health officials are requesting more doses.
“Vaccines don’t save lives,” Yale public health professor David Paltiel told the New York Times. “Vaccine programs save lives.” Worrying that the U.S. has not built adequate infrastructure to distribute the vaccines, Paltiel described models assessing the effects of vaccination on infections, hospitalizations and deaths, which concluded that deployment mattered as much as the vaccines’ efficacy.
The first two vaccines from Pfizer and Moderna are products of new mRNA (messenger RNA) technology that has never before produced a marketable vaccine. With the intention of offering a range of vaccine types, others should win approval soon.
The more conventional vaccine from AstraZeneca and Oxford University, created by modifying an adenovirus to contain the disease-causing gene from the SARs-CoV-2 virus, is less expensive and does not require the extreme frozen storage conditions as the other two. But testing of this ADZ vaccine produced a puzzling result: while half of the study participants received two full doses, the other group received a reduced initial dose due to a lab error— a protocol that unexpectedly resulted in greater efficacy.
Because the research to date is limited to comparing each vaccine against a placebo, it remains unclear whether one company’s vaccine might work better for different groups. In the case of flu, for example, specific vaccines recommended for ages 65 and older are either high-dose or bolstered by an adjuvant.
Also unknown about these vaccines is whether, while creating immunity in a vaccinated individual, they will also prevent that individual from spreading the virus. The trials assessed the severity of disease in vaccinated versus placebo groups, but did not account for asymptomatic cases, which are considered major spreaders of this virus.
All three front-runner vaccines have shown impressive rates of efficacy. However, that refers to results obtained under conditions of clinical trials, with certain people more likely to sign up than others. Effectiveness, by contrast, indicates how well vaccines work in the real world; and impact, how well they slow the spread of a virus and protect society as a whole —both of which can emerge only after the vaccination of much larger numbers of people.
When asked how to respond to people desperate to see friends and families over the holidays, McNeil suggests a comparison to American soldiers and Red Cross workers in Europe during World War II, who “missed the holidays. Life went on. There were happier years later.”
McNeil, along with other journalists covering the pandemic, also contributed to a three-step guide for reducing risk: Eliminate time spent in a confined space outside your household where anyone is unmasked; minimize time spent in indoor spaces even with universal masking; and relax during activities that are less risky, including errands (wearing a mask, staying distant from others) and outdoor exercise. For the latter, says McNeil, “I consider keeping six feet distant outdoors more important than wearing a mask.”
To give individuals an idea of their place in line for the vaccine, The New York Times created a quiz. With my answers—age (70), county (DC) and other factors (not an essential worker; no Covid-related health risks)—my place in the DC lineup will follow 237,200 others (in a total population of 705,000). To make sure I understand the magnitude of these numbers, an accompanying drawing shows one person for each of the categories ahead of and behind me—in what looks like a very long, winding line.
Well-Being Editor Mary Carpenter keeps us updated on Covid-19. To read more of her posts, click here