Covid’s New Normal

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By Mary Carpenter

OPTMISM has become a buzzword for the current state of the pandemic, while insecurity and caution are replacing fear—and people are beginning to grasp their new normal.

“Optimism in the short term” is how UC Berkeley infectious disease specialist John Swartzberg describes his feeling —based on warm weather allowing more outdoor activities and more than half of American adults having received at least one dose of the vaccine.

Among other reasons for optimism: L.A. County—with a population of 10 million where more than 200 people were dying every day just a few months ago—reported zero new deaths on two days last week. And Broadway has scheduled the reopening of full-capacity shows for September 14— a few on for now and more coming soon.

Swartzberg also finds reasons for insecurity, such as the randomness of the virus’s ongoing spread as hotspots arise unpredictably. He points to Washington State’s recent increase in case numbers and hospitalizations, despite rising vaccination numbers and ongoing restrictions in most parts of the state limiting restaurants and other businesses to 50% capacity.

Increased case numbers in some locations have created concern about the greater contagiousness of variants—notably the B.1.1.7 variant first seen in Britain and responsible for close to 60% of cases in states with recently spiking infections, such as Michigan and Tennessee.

Research on variants, on the other hand, has also led to optimism about the effectiveness of some vaccines, as well as the potential for an early warning system for spiking infections: Genetic sequencing of 20,000 cases in the United Kingdom showed that the appearance of new variants preceded higher levels of transmission.

Breakthrough infections, a concern for some, had as of April 30, occurred in about 1% of fully vaccinated adults—in 10,000 of almost 100 million people—with about 64% in women, as opposed to early higher rates of Covid among men. Also, 46% occurred in people 60 years old or older; about 9% were hospitalized (900); and 1% died.

(The statistics on hospitalizations and deaths may be affected by the difficulty pinpointing the virus as the primary cause and may be skewed because the majority of vaccinations have been given to older age groups, who are more prone to serious cases and death from Covid.)

Breakthrough infections, on the other hand, can be also illuminating, for example, as indicators of circulating virus levels within a community, according to Kawsar Talaat, infectious disease specialist at Johns Hopkins. And circulating virus levels, in turn, depend on the degree—and highlight the importance of — “herd immunity.”

When large numbers of people have developed immunity— either from the vaccine or the virus —if someone develops Covid, the people around them are protected, making it harder for that infection to spread—and “therefore transmission stops,” Talaat told CNN.

While nearly half of American adults (148 million) have received at least one dose of the vaccine, numbers are leveling off in several states—with Texas, Mississippi and Louisiana reporting closer to one third of the population having had one shot. A recent poll found almost one-fourth of U.S. adults probably or definitely will not get inoculated.

Among various unfounded criticisms of the vaccine, the private Centner Academy in Miami cites risk of “shedding” for its refusal to employ vaccinated teachers—based on reports from “tens of thousands of women [of] adverse reproductive issues from…close proximity with those” who have received the injections.  (Shedding is impossible with Covid vaccines, which contain no live virus.)

True herd immunity for the coronavirus—estimated to begin when anywhere from 65 to 90% of the population is protected—may be out of reach, according to former FDA commissioner Scott Gottlieb. “I think [the virus] is always going to circulate at a low level.”

Breakthrough infections can also highlight the effectiveness of different vaccines and the wide variations in individual responses. One study has suggested that protection from severe Covid-19 holds steady while that from infection can drop “significantly”—depending on varying durations of strength of the different vaccines, writes retired Harvard infectious disease expert William Hazeltine.

Based on measurements of neutralizing antibodies, the Pfizer and Moderna vaccines performed best, with an initial efficacy of 95% that didn’t drop to 50% until around day 200, according to Hazeltine. At the other end of the spectrum, the Sinopharm vaccine, with an initial efficacy of 50%, by the 200-day mark offered “next to no protection at all.”

Because duration of antibody response varies so much among individuals, however, the advice remains to take whatever vaccine is available. One Singapore study found a small fraction of individuals experiencing “very long persistence” of antibodies while in another group, “no antibodies at all,” according to Hazeltine.

In the Seychelles, where more than 60% of the population is fully vaccinated, reopening to tourists may have contributed to a recent spike in coronavirus infections—leading to requests for some who received the Sinopharm vaccine to return for a third dose.

Third doses, or annual boosters, look likely to become part of the post-pandemic “normal” for everyone because of such variables as more contagious variants; waning or incomplete vaccine coverage in individuals; and the elusiveness of herd immunity.

And advice that once seemed provisional may become permanent, such as three C’s to avoid—closed spaces, crowded places and close contact; and three conditions, of which two should be met—outdoors, distanced and masked.

For those more resistant to change, like me, preparing for a post-pandemic life means beginning to come to terms with these issues.

Other people, though, have made such momentous changes—in work, home, exercise, friends—that their lives are already a complete do-over, what people are calling a post-pandemic mulligan.

—For the past year Mary Carpenter has been closely following Covid-19 developments.