Where We Stand with Covid-19 — March 26

Welcome back to Week 50 in my weekly reports analyzing the Covid-19 pandemic and its effects on the country and higher education in the Biden-Harris administration. For those of you reading this on my blog, Off the Silk Road, I have also launched a newsletter, where these reports can be sent directly to your email each week. Click here to subscribe.

Last week, we focused on the race between vaccines and variants as the administration accomplished its goal of 100 million shots in just 58 days. This week, we will examine the beginnings of a possible fourth surge as more vaccines continue to be distributed.

A national look

We begin today’s discussion by mourning the loss of the 10 victims in yet another mass shooting in America, this one in the King Soopers supermarket in Boulder, Colorado. As Brown University physician Dr. Megan Ranney points out, gun violence is a public health problem. When we politicize human suffering, we all lose.

In the national data, we are beginning to see the signs of a possible smaller fourth surge, driven by the B.1.1.7 and other variants. National cases and hospitalizations are starting to increase. In Michigan, which has the highest confirmed B.1.1.7 cases per capita in the country, vaccinations are still lagging and cases are on the rise. In addition, the nearby state of Minnesota has the second-highest number of B.1.1.7 cases per capita in the country, indicating that the outbreak may be spreading to neighboring states.

With 71.8% of Americans over the age of 65 with at least one dose of the vaccine, this next surge will likely primarily be driven by young people, especially those returning from spring break. In many states, the median age of new Covid-19 diagnoses is dropping.

This week, President Biden and his administration continued to take aggressive action against the pandemic. In addition to confirming Dr. Vivek Murthy and Dr. Rachel Levine to history-making positions, the administration announced a new goal of 200 million vaccinations by the end of the first 100 days. This would mean that the U.S. would have to vaccinate 2.5 million people each day, a goal which we can expect to meet. The administration also announced an investment of nearly $10 billion to expand access to vaccines and better serve communities of color and rural areas. In a round of surprising news, President Biden’s team announced that Johnson & Johnson will meet its goal of distributing 20 million vaccines in March, with around 11 million being shipped next week.

President Biden’s administration continues its commitment to transparency with the hard work of White House Covid-19 Data Director Dr. Cyrus Shahpar. Just this week, the CDC has released de-identified data on demographics, exposure history, underlying conditions and disease severity of millions of Covid-19 cases. This will enable researchers to best analyze Covid-19’s characteristics. On Friday night, the CDC also released county-level vaccination data for most states.

Let’s take a look at some of the latest scientific developments:

• Regeneron said its antibody drug reduced the risk of Covid-19 hospitalization or death by about 70% in a large clinical trial.
• According to a paper published in The Lancet, pre-travel testing (PCR 3 days before travel or rapid antigen test on travel day) reduces risk of being infectious on an airplane by ~88%, but post-travel quarantine/testing are needed to reduce risk of importation.
• We’ve heard the constant conflict of the virus vs. the economy. This paper from two of the nation’s top economists found that “while overall consumer traffic fell by 60 percentage points, legal restrictions explain only 7 of that.” (It’s the virus, stupid.)
• According to a preprint, current vaccines and therapeutic monoclonal antibodies will remain protective against the B.1.526 variant, first discovered in New York.
• A study published in JAMA with antibody levels in >3600 adults and 85 kids showed that children ages 19-24 had lower antibody levels than children and older adults, a rather odd finding.
• Covid-19 testing nationally has continued to drop, which is problematic because testing helps us see the effects of vaccination.
• Research from Andrew Atkeson of the University of California at Los Angeles determined that implementation of robust efforts to halt the spread of the virus last May — widespread testing, mask mandates — could have held the country’s death toll below 300,000 in total, a gap of nearly 4000,000 deaths by the time vaccines are fully rolled out.
• There continues to be almost no flu in the U.S. this season. In the week ending March 20, only 21 people in the US tested positive for the flu, and just one child has died from influenza this flu season. To put that in perspective, last year there were 198 pediatric flu deaths.

• The incidence of other respiratory viruses decreased ~80% compared to previous years after mitigation efforts were implemented to decrease SARS-CoV-2 transmission in Boston, according to a paper published in Open Forum Infectious Diseases.
• Seven in 10 people hospitalized for Covid-19 have not fully recovered five months after discharge, a new study from the UK found. The Covid survivors continued to experience concerns with their mental and physical health, with 1 in 5 people developing a new disability, and a similar number either not working or having to change jobs due to their health.
• Results from a mass testing campaign in Slovakia last fall paid off, according to a new study in Science. Observed prevalence decreased by 58% within one week in the 45 counties that were subject to two rounds of mass testing, an estimate that remained robust when adjusting for multiple potential confounders.
• According to a CDC report, during August 2020 to February 2021, the percentage of adults with recent symptoms of an anxiety or a depressive disorder increased from 36.4% to 41.5%, and the percentage of those reporting an unmet mental health care need increased from 9.2% to 11.7%. Increases were largest among adults aged 18–29 years and those with less than a high school education. 

Yesterday, the U.S. reported a record of 3.5 million doses administered, with the 7-day average now at 2.68 million shots per day. 44 states have announced dates to open vaccine eligibility for all adults, with many moving up their timelines to before May 1.

We are seeing early evidence that widespread vaccination of the older population is already having an effect. In CDC data from select states, including California and New York, we see a steep decline in hospitalizations in those 65+. In addition, nursing home deaths are down.

In the coming weeks, I will be posting more insights into the outlook of vaccine distribution in the U.S. The U.S. monthly vaccine output will triple from 48 million in February to 132 million in March. The increased output should be enough to fully vaccinate 76 million people in the U.S. in March, another 75 million in April and then 89 million more in May. From now, focusing on delivery channels will be key. As former CDC director Dr. Tom Frieden notes, “many people who are reluctant to get vaccinated elsewhere will get vaccinated by their doctor.” We will need to focus on getting vaccines everywhere and using all distributed doses as efficiently as possible. In the past week or so, the gap between the doses distributed and administered has widened, possibly pointing to inefficiencies within the system or vaccine hesitancy.

The New York Times’ Nathaniel Lash explores vaccine barriers by classifying states as having vaccine oases and deserts.

Until states open eligibility to all adults, many of the prioritization systems used actually worked, according to a new analysis from the AP and Surgo Ventures. The analysis shows that states who opened vaccinations to wide ranges of the population too early actually made the system less efficient.

A few other updates on vaccines:

• The beginning of the week was full of controversy from AstraZeneca, who initially announced that its vaccine was 79% effective at preventing symptomatic Covid-19. Only hours after AstraZeneca announced encouraging news about the effectiveness of its Covid-19 vaccine on Monday, a group of medical experts charged with monitoring the company’s clinical trial made a highly unusual accusation: the company had essentially cherry-picked data to make its vaccine look better. Days later, the company issued a new analysis that showed its vaccine was 76% effective at preventing symptomatic Covid-19 and 100% effective against severe disease. It was 85% effective against symptomatic Covid-19 in people 65 and up. The bottom line: It is likely this vaccine is an excellent one, however its messaging and missteps may undermine public trust.
• Three studies in The New England Journal of Medicine found evidence of vaccine effectiveness in real-world settings. In Israel, cases declined among healthcare workers following vaccination. In California, the absolute risk of testing positive for SARS-CoV-2 after vaccination was 1.19% among health care workers at UCSD and 0.97% among those at UCLA. In Texas, 2.61 of unvaccinated employees were infected, compared to 1.82% of partially vaccinated employees and 0.05% of fully vaccinated employees. The number of employees in isolation and quarantine decreased by over 90%. Vaccines work!

• Krispy Kreme is providing a sweet incentive to encourage more people to roll up their sleeves for the Covid-19 vaccine: Free doughnuts through the end of 2021. The campaign drew outrage from some people online, who said that the company is promoting obesity and unhealthy lifestyles. My view: It’s a donut — just take it and if it helps more people get vaccinated, that’s fabulous.
• Pregnant women who receive a coronavirus vaccine not only acquire protective antibodies against the virus for themselves but also may pass along immunity to their babies, emerging research shows.
• According to reporting from POLITICO’s Erin Banco, there is wide variability in the deployment of the Johnson & Johnson vaccine — which we see in the data. While some states may be holding supplies back to better reach specific groups, others are using them as soon as possible.
• The Washington Post’s Julie Zauzmer dives into a question I’ve been thinking about and tracking for weeks: Why is DC’s vaccination rate so low? The answer is a combination of vaccinating non-residents and allocating to federal agencies.
• Vermont currently leads the nation in vaccinating people over 65% — 85.1% of Vermonters have received at least one dose of the vaccine. This comes as a preprint finds that age-prioritization would reduce deaths during a vaccine campaign by about 93% relative to no vaccine and 85% relative to age-neutral vaccine distribution.

• President Vladimir Putin of Russia was inoculated against the coronavirus on Tuesday.
• Pfizer has started a vaccine trial in kids aged 6 months to 12 years.
• In an insightful piece, The Texas Tribune’s Reese Oxner dives into vaccine hesitancy among Texas’ white Republicans.
• One way to track possible vaccine hesitancy or gaps in access is to look at the number of unclaimed first-dose vaccine appointments. Mississippi State economics professor Todd Jones has found that unclaimed appointments have risen, despite vaccinations being open to all adults.

• STAT published a useful guide on how to talk to those hesitant about the Covid-19 vaccine.
• Kaiser Health News’ Lauren Weber explored how bypassing Missouri’s local health departments in vaccine rollout has led to inefficiencies and chaos.
• Millions more doses of Johnson & Johnson’s Covid-19 vaccine are expected to be released after U.S. regulators cleared the way for contract manufacturer Catalent to help produce them.
• Epicenter NYC published a list of observations after team members have registered thousands of people for vaccines.

One final note: In a documentary airing tonight at 9 p.m. Eastern, CNN’s Dr. Sanjay Gupta interviews six top doctors, including many serving on the previous administration’s coronavirus task force, and examines critical missteps in an autopsy of the pandemic. It is a program that will definitely be worth watching and sure to elicit headlines.

Let’s move on to our discussion of higher education.

Higher education

This week’s higher education discussion continues to revolve around two issues: spring break and vaccines. The risk of a post-spring break surge is still of concern, as one student told Kaiser Health News her roommate was traveling during spring break to “[make] up for lost time in quarantine.” As most college students have yet to be vaccinated, there is still a significant risk of a Covid-19 outbreak on campuses, not to mention the effects of variants at schools like the University of Vermont and the University of Pittsburgh.

This week we also have seen exciting news on the vaccine front for some schools. Indiana health officials have indicated that Notre Dame will receive enough Pfizer vaccine for every student — undergraduate, professional, and graduate — to be fully vaccinated with the requisite two doses before the spring semester concludes. Students are encouraged to use the site on campus. At the University of North Carolina, students will be vaccinated in the coming weeks, and the Daily Tar Heel published a useful guide on how students can receive their vaccine. UNC will use the Johnson & Johnson vaccine; its one-and-done nature makes it suitable for transient populations, like college students.

As all adults become eligible in many states in the coming weeks, expect some states to work with colleges to provide vaccine supply and delivery points on campus. Rutgers University has announced that proof of a U.S.-authorized vaccination will be required for students planning to attend this fall, the first college to do so. In New Hampshire, Governor Chris Sununu announced that college students from out of state are not eligible to receive vaccines — a misstep in my opinion as college students are possible spreaders and are key to reach herd immunity. Numerous Penn and Drexel University students have received the Covid-19 vaccine despite being ineligible under current Philadelphia vaccine distribution guidelines, city officials confirmed to The Daily Pennsylvanian. My message to college students is this: If you’re eligible to get the vaccine, by all means sign up. If you’re not currently eligible, just know millions more doses are coming in just weeks. We need to first give the most vulnerable their chance. Dickinson State University in North Dakota has a plan to encourage students to get their Covid-19 vaccinations: Students who have been fully vaccinated will receive a pin or a bracelet that will exempt them from the campus-wide mask mandate. While this plan may have good intentions, it is not completely in line with CDC guidance (which urges people to wear a mask and practice social distancing in public even after they are fully vaccinated). Finally, as University of Maryland professor Dr. Zoe McLaren notes for her faculty colleagues, “getting a Covid-19 vaccination is always more important than coursework.”

In the coming months, colleges will also play a critical role in vaccine clinical trials. On Friday, a major study was announced with 12,000 college students to help understand the impacts of Covid-19 vaccination on further spread and transmission. The study, called Prevent COVID U, will take place at 21 universities nationwide. About half of the students will receive the vaccine injections right away, and the other half will receive the vaccine a few months later. The students will each identify “close contacts.” These close contacts, around 25,000 of them, will also be in the study. Students will swab their noses daily for viral load measurements, as well as periodic blood samples. They will also participate in twice-weekly testing through their universities. Students and contacts will also complete daily diary questionnaires. College students are ideal for this type of study as it can give us insight on asymptomatic spread. The daily swabs will enable researchers to see viral latency on a day-by-day basis. I urge my fellow students at the colleges on this map to consider signing up for this trial — more information is available here.

Here is a roundup of this week’s higher ed news:

• Nearly eight in 10 college and university presidents say they are confident their institution will be financially stable over the next 10 years, and more than a quarter strongly agree, according to survey results published in Inside Higher Ed.
• The stay-in-place order for Duke students was lifted last Sunday after being in effect for just over a week. This week’s testing data give us hope that the situation has improved, but students must continue to be careful.
• Cornell University’s MBA program will move to virtual learning, effective immediately. The move is in response to 63 positive Covid-19 tests over the last three days among students, “most of which” have come from MBA grad students according to the school’s announcement. 
• The Chronicle of Higher Education wrote about how colleges are preparing for graduation this spring.
• College-going rates among high school graduates declined across the board this fall, but far fewer graduates of low-income and high-poverty high schools, and of high schools with many Black and Hispanic students, enrolled in college during the pandemic, new data show.
• Students at college newspapers play key roles in convincing their peers to be vaccinated, and I am always encouraged when I read an op-ed accomplishing this goal. “Colleges and universities, in particular, have become hot spots for virus transmission — and campus outbreaks are often directly connected with infection peaks in surrounding towns and counties,” the Daily Tar Heel writes. “So by getting vaccinated, you’re not just protecting yourself — you’re protecting the people around you, too.” 
• Students reflect on their learning outcomes over the fall semester in survey results published in Inside Higher Ed.
• The Yale Daily News published a beautiful tribute to Rachael Shaw-Rosenbaum, a first-year student at Yale who recently died by suicide at the age of 18. “Yale has no shortage of intelligence, but Rachael was genuinely the most brilliant person I’ve ever met,” one friend said. The National Suicide Prevention Lifeline is a hotline for individuals in crisis or for those looking to help someone else. To speak with a certified listener, call 1-800-273-8255. Other resources specific to the Yale community are included in the article.
• We have repeatedly discussed how colleges play a key role in protecting the surrounding community. A new study published on MedRxiv found that if a college deployed 45% of its tests to the local community, on-campus cases could be reduced by 25%.

The Good Stuff

Let’s roll the clips of the good stuff. In my usual tradition, I feature my favorite stories from the week. Here are my Top 11.

• Older Americans still make up a majority of those who have been inoculated, and many are now venturing out after a year in isolation.
• Dr. Anthony Fauci, who has served under seven U.S. presidents and has guided the national response to Covid-19, will soon be immortalized in a children’s book entitled, “Dr. Fauci: How a Boy from Brooklyn Became America’s Doctor.”
• Much of this week’s internet discussion has revolved around the Ever Given, a 1,312-foot-long ship currently stuck in the Suez Canal and may take days or weeks to be removed. Every day it is stuck is estimated to cost $10 billion in global trade losses. The Washington Post published an article with the best internet memes of the ship
• CNN asked kids what they would do to fix the ship stuck in the Suez Canal. “I think they’ll need a screwdriver and get down with a ladder,” one said.
• One nurse at the Javits Center describes to The New York Times how she spends her Sundays — vaccinating New Yorkers. “This job makes me feel like I’m part of history,” she said.
• Do you want to see the cherry blossoms in Washington, DC in a pandemic-safe way? Check out the National Park Service’s BloomCam, a live look at the National Mall Tidal Basin.
• Happy Passover to all! Second Gentleman Doug Emhoff hosted a virtual Passover Seder in a series of firsts at the White House.
• POLITICO published a photo essay of 12 unusual places where Americans are being vaccinated, including a concert venue, a school bus and an aircraft carrier.
• The New York Times’ Emma Goldberg virtually dissected a cadaver and lived to tell the tale in her piece on med school students completing coursework online.
• Actor Jenssen Karp sparked internet chatter after he claims he found shrimp tails in his box of Cinnamon Toast Crunch.
• Rest in peace to Beverly Cleary, the beloved children’s book author behind the Ramona and Beezus Quimby series. She passed away on Thursday at the age of 104.

Conclusion

Each week we become more encouraged with news of the impacts of vaccinations throughout the population. These vaccines are proving to be highly efficacious at decreasing hospitalizations and deaths among the most vulnerable. However, with much of the older population vaccinated, it is now the younger population who could drive a fourth surge. We must understand that simply blaming college students for partying will not work. Some people, due to occupational or household risks, are more likely to be infected. This underscores the importance of a public health strategy that protects the most vulnerable to infection. For example, it may not be the best idea to open indoor dining fully with most servers unvaccinated, as this may cause them to transmit the virus to others. Local and state governments have an obligation to protect their populations. I wanted to end this week’s update with advice from Vermont Health Commissioner Dr. Mark Levine: At the beginning of the pandemic, health officials stressed protecting the most vulnerable. Now, with the average age dipping below 30, younger Vermonters should protect themselves. Most Americans are just weeks away from getting their first dose of a life-saving vaccine. The risk of Long Covid and chronic symptoms are too great. To put it simply, it’s not worth it to get sick at this point. Young Americans should do all they can to avoid the virus.

I’d like to thank all the student journalists with whom I have the pleasure of working. In the next weeks and months ahead, they will become vital in chronicling their colleges’ paths forward for the spring and beyond. Support their work by reading it.

My best to all for good health.

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