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Deaths from COVID-19 surge while states face distribution hurdles

Health and Benefits|Wellbeing
COVID 19 Coronavirus

By Jeff Levin-Scherz, MD | January 25, 2021

At this point in time, our priority needs to be getting vaccines into more arms.

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About our “The COVID-19 Crisis” series

“The COVID-19 Crisis” series is a weekly update from Dr. Jeff Levin-Scherz, Population Health Leader and Health Management Practice Co-Leader, Health and Benefits, North America.

Weekly cases, hospitalizations and deaths from COVID-19 continue on an upward climb. There continue to be geographic differences: The Midwest hospitalization rate is falling a bit, and the hospitalization rates in the South and Southwest continue to rise alarmingly. Hospitals in both California and Arizona are running out of beds and staff to care for COVID-19 patients, and are considering triage measures to allocate care to those most likely to survive. Overwhelmed hospitals will lead to lower survival rates not just from COVID-19, but also from all life-threatening illnesses. The U.S. had 25% more deaths from COVID-19 last week than the previous week.

Impact of the more contagious version of COVID-19

The threat of new, more contagious mutant versions of the virus looms as well. The U.K. and Ireland, where the more contagious variant is most prevalent, have exceptionally high rates of new infections. The variant has now been detected in at least 50 countries and is somewhere between 30% and 70% more contagious than the previous dominant strain. Note that the previous dominant strain, attributed to Italy, was more contagious than the initial Wuhan strain. It's natural that the most infectious strain of the virus becomes the dominant strain over time. This new variant makes speeding up vaccination and adhering to public health guidelines even more important. 

COVID-19 cases from March 2020 to Jan 12, 2021 show a recent dramatic increase for Ireland, the UK and the US.
Daily new confirmed COVID-19 cases per million people

The rolling seven-day average from March 2020 to January 2021.
Source: Our World in Data

Vaccination

Scientists continue to bring us good news.

Johnson & Johnson recently published results of its Phase 2 vaccine trial in the New England Journal of Medicine showing that a single dose of the vaccine is highly effective at inducing antibody production across all age groups. That's promising and means that the vaccine is highly likely to be very effective. We eagerly await the results of the 40,000-person Phase 3 U.S. study, said to likely be released later this month. If the results are good, FDA emergency use authorization and widespread distribution will follow. 

The U.S. vaccination rollout continues to be bumpy. We're not alone; many countries have had a hard time getting vaccine into arms. In the U.S. we've administered at least one dose of vaccine to 11.1 million people so far, and 2 doses to about 1.2 million. Rural states (like Alaska, West Virginia and North Dakota) have vaccinated more than 6% of their populations. Israel has vaccinated over a quarter of its population (outside the occupied territories), and we expect to see a dramatic increase in global vaccination soon. There is still little vaccine available for developing countries though, which could prolong the global epidemic.

Israel and the UAE are the only two countries with at least 20+ doses of the vaccine available per 100 people.
Available vaccine doses per 100 people

Data from Bloomberg’s COVID-19 Tracker. Note: Two doses are needed for full protection.
Source: Bloomberg

President-elect Biden proposed over $400 billion to advance community vaccine distribution and widespread rapid testing.

Prioritization

The Secretary of Health and Human Services announced that the federal government would direct states to offer vaccines to all those over 65 and those with chronic illnesses that increase their risk of complications from COVID-19. This upends the CDC's previously announced prioritization, which has formed the basis of many states' plans. This could inadvertently decrease prioritization of essential workers who do not have underlying illnesses and could make it more difficult for states to distribute vaccine through employers. 

As a practical matter, we should focus most of our attention on getting more people vaccinated more quickly. Some pharmacies and hospitals have found that they have thawed vaccine left over at the end of a vaccine session, and they are offering it to whoever is willing to roll up their sleeves. Even a low-risk person vaccinated helps make everyone at least a tiny bit safer. 

We have to be mindful that suspicion of the vaccine is higher in some communities of color. Kaiser Family Foundation found that the percentage of vaccine given to Black people is far lower than their representation among health care workers in every state that published data by race. The Boston Globe published this data for Massachusetts, and found that while Blacks represent 14% of prioritized health care workers, they only accounted for 3% of first doses given so far. We'll need encourage all prioritized workers to be vaccinated as soon as possible.

On a personal note, I recently got my first dose of the Moderna vaccine. I still do some urgent care, hence was eligible as part of the first wave. I had just a bit of arm soreness and feel relieved and grateful that I got the vaccine. But I'll still be distancing and wearing a mask until we've achieved herd immunity. Protection from the vaccine is minimal in the first two weeks and is best by a week or two after the second dose. I urge everyone to get the vaccine as soon as it's offered.

Everyone should get the first vaccine that is available. Even if a vaccine has lower stated effectiveness than 95%, all the vaccines are highly effective at preventing serious cases of COVID-19. So delivering an "inferior" vaccine a few months earlier could save many lives. At some point, we'll also have blood tests that show immunity level, allowing boosters or revaccination of those who do not have adequate protection.

Author

Population Health Leader, Health and Benefits, North America

Jeff is a practicing physician and has led Willis Towers Watson’s clinical response to COVID-19. He has served in leadership roles in provider organizations and a health plan, and is an Assistant Professor at Harvard Chan School of Public Health.


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