Column: Reasons for optimism, pessimism in COVID battle

By Jerry Kruse, MD, MSPH, Dean & Provost, SIU School of Medicine

As the burden of COVID-19 cases in our region and in the U.S. declines, there is widespread optimism that the pandemic may be waning. There is good reason for optimism. And some reason for pessimism.

Optimism: Prevention.  We have learned how to live in the presence of this coronavirus. With the appropriate use of preventive measures, there has been very little, and much less than predicted, transmission of the virus in healthcare and educational settings. Most of the spread has been in congregate gatherings in the community and the home. Though there is still uneasiness with the measures we take at this time, it is far more palatable and there is far greater certainty than in April and May last year.

Optimism: Vaccines.  We have excellent vaccines. Just as the Pfizer and Moderna vaccines received Emergency Use Authorization by the FDA, a former FDA official gave the vaccines a grade of A+ for efficacy and safety. These vaccines have now been widely deployed, and they have fulfilled and exceeded expectations. There is a growing body of information that the first dose of each vaccine provides a higher degree of protection than first thought, up to 90%.  Also, it appears that the second dose may provide a higher degree of protection than originally reported, up to 97%.  Those few who are vaccinated and are unfortunate enough to contract COVID-19 very seldom become severely ill, and none have been reported to have died.  New grade: A++.

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Optimism: Vaccination Rates.  The rate of vaccination is rising. Since vaccine distribution began in the U.S. on Dec. 14, more than 65 million doses have been administered, reaching 13.6% of the total U.S. population, according to CDC data released last week. More than 1,800,000 shots are administered in the U.S. each day, exceeding the modest goal of the present administration by 80%, and exceeding the daily rate in December and January by more than 250%. In Illinois, 14.1% of the population has been vaccinated, which ranks 19th among states. Vaccines are in short supply now, but on February 11, the federal government announced deals to purchase 600 million vaccine doses from Pfizer and Moderna, to be delivered by the summer.

Pessimism: Inequitable Vaccine Distribution.  According to a Feb.16 CDC publication, race and ethnicity is known for 55% of people who have received a COVID-19 vaccine. Overall, in the U.S., “the vaccination rate among White people is over three times higher than the rate for Hispanic people (10% vs 3%) and twice as high as the rate for Black people (10% vs. 5%). White people have a higher vaccination rate compared to Hispanic and Black people in all reporting states, but the size of these differences varies widely across states.” While the reason for this disparity is multi-faceted, these statistics once again shine the bright COVID light directly on the racial inequities and injustice in the U.S.

Pessimism: COVID-19 Variants.  Variants occur when there are amino acid mutations on the spike protein of the coronavirus. Variants are not new strains; they are the result of minor variations.  According to a recent report from the CDC, many new variants have recently arisen, and one now causes significant concern. From the United Kingdom, the B.1.1.7 lineage variant has the potential to increase the U.S. pandemic trajectory in the coming months. 

At present, more than 15% of cases in Florida are attributable to the B.1.1.7 strain, and the strain has now been reported in California.  From Lehigh Valley Health Network, here are simple facts about this variant:  1) It’s more contagious than the original strain and other variants.  2) Risk for complications from the infection is similar to the original strain.  3) It is probably more widespread than we realize, and 4) Vaccines provide protection against adverse outcomes and death from B.1.1.7.  The increased transmissibility of the B.1.1.7 variant warrants universal and increased compliance with mitigation strategies, including distancing and masking.  

Some good news within a pessimism paragraph:  Herd immunity will significantly limit the development of new variants. Also, genomic sequence analysis through the National SARS-CoV-2 Strain Surveillance program will enable a targeted approach to identifying variants of concern in the United States. Dr. Keith Gagnon in SIU’s Department of Biochemistry and Molecular Biology in Carbondale is a world-class COVID-19 genome sequencer, and will keep us informed.

Pessimism: The Heavy Personal Burden of COVID-19.  Well, this really isn’t pessimism, it’s just human nature. We are a year into the pandemic. Our lives have been altered. Many of us have been put in high pressure situations, 24/7/365, that we haven’t experienced before. We have stress in our family units – child care, virtual learning and WebEx meetings, altered work schedules. I could go on and on. The stress is very real, sometimes quite noticeable and sometimes invisible. Let’s be mindful of this, and show the grace and kindness that we have throughout the pandemic.

In my March 13, 2020, COVID-19 message to our campuses, I wrote this:

“It is now a time of vital importance to ‘be there for the person.’  We must be there for our patients, for our learners, for each other and for all those in our community. In the face of this pandemic, it is necessary that we steadfastly stand together for each other, … working together, supporting each other, covering for each other, so that we meet our collective and individual needs while we protect ourselves and those close to us…”

We’re getting through this together, and optimism now certainly outweighs pessimism. Keep up the great work!

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