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Could we return to pre-COVID-19 normality by summer?

Health and Benefits|Bienestar integral
COVID 19 Coronavirus

By Jeff Levin-Scherz, MD | March 2, 2021

With two additional vaccines and falling infection rates, there is reason for optimism.

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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.

We continue a string of excellent news on the vaccine front. The Food and Drug Administration (FDA) staff has strongly endorsed the safety and effectiveness of the Johnson & Johnson (J&J) vaccine, which is likely to gain emergency use authorization (EUA) from the FDA by the time you read this. The J&J vaccine requires only refrigeration and is a single dose. 

Highlights from the FDA report:

  • There were 44,000 people in the research trial.
  • The vaccine was 100% effective at preventing hospitalization 28 days after vaccination (and 93% effective at preventing hospitalization 14 days after vaccination).
  • The vaccine was 100% effective at preventing COVID-19-related deaths (seven deaths in the placebo group, none in the group that got the vaccine).
  • The vaccine prevented asymptomatic cases of COVID-19 too. Thirty-seven who got the placebo and only 10 who got the vaccine developed antibodies without having any evidence of a clinical infection. This is important in terms of preventing community spread.
  • The vaccine’s effectiveness at preventing mild or moderate COVID-19 appeared lower in those over 60 with medical comorbidities (like diabetes); however, the numbers were small and this could just be chance.
  • Half of recipients had injection site pain, and around a third experienced headaches, fatigue and muscle aches.

J&J will be supplying 20 million doses by the end of March, so this vaccine can certainly help the U.S. raise vaccination rates. This vaccine is better positioned for employer-sponsored vaccination clinics than the Pfizer or Moderna vaccines, since it requires only refrigeration and a single dose. It also does not appear to have caused severe allergic reactions, so there might be less need to have onsite resuscitation capabilities.

I worry that reports that this vaccine is less effective at preventing mild disease might make some employers reluctant to offer this vaccine or might make some individuals want to wait for a different vaccine. It looks like all the available vaccines are similarly effective at preventing hospitalization and death.

People should get the first vaccine that is available to them. A J&J vaccine in early March will prevent more cases of COVID-19, hospitalizations and deaths than waiting until April for a different vaccine. I’m confident we’ll also eventually have a blood test for immunity, and that those who received any vaccination and have inadequate antibody response will be able to get a booster.

A fourth vaccine on the horizon

Four other pieces of good vaccine news:

  1. The New York Times reports that Pfizer got the go-ahead from the FDA to have its vaccine stored in standard freezers for up to two weeks. This is set to be announced formally next week.
  2. Moderna announced it is already testing a new vaccine engineered to be more effective against B.1.351, the South Africa variant.
  3. Novavax will complete its 30,000-person clinical trials in April and expects to seek an FDA EUA shortly thereafter.
  4. Bloomberg reports that the U.S. will have enough vaccine to inoculate every adult by July.

Long-term complications from COVID-19

Longer-term complications from COVID-19 infections continue to be a concern. JAMA Network Open published data showing that about one-third of those who recovered from COVID-19 had symptoms between three and nine months later. The study is small, but longer than most previous studies. Results were similar for those who were hospitalized and those who were not.

About one-third of those in the study experienced post-COVID symptoms up to nine months later: Five out of 10 inpatient and 49 out of 150 outpatient.
Post-COVID-19 symptoms

About one-third of those in the study experienced symptoms up to nine months later.
Source: JAMA Network Open

Previous studies have suggested symptoms persisted in between 10% to 60% of patients who recover from COVID-19. The most common symptoms are brain fog, depression, loss of smell and/or taste, and fatigue. COVID-19 has been associated with severe symptoms after initial recovery including orthostatic hypotension (where blood pressure drops when people stand or exercise), heart inflammation and shortness of breath. Those who have recovered have often been found to have abnormal lung and heart imaging, even if they felt fine. It is possible these long-term complications will fade away and are not of long-term clinical importance.

Anthony Fauci announced a new name for what we’ve been calling “long COVID” or “long haul COVID.” It will be called PASC or Post-Acute Sequelae of SARS CoV2. We’ll see if that name sticks. Naming the condition is important; it will help researchers study those who suffer from these symptoms and could also help us learn which treatment might be helpful. The syndrome looks similar to chronic fatigue syndrome, which has been difficult to treat and causes a significant amount of disability.

I shouldn’t end a COVID-19 post without pointing out that infection rates and hospitalizations continue to decline throughout the U.S.

As of the end of February, new cases and hospitalizations are down – daily test at 1.35 million, daily cases at 54,288, hospitalized 47,352, and dealths 1,049.
Nationwide COVID-19 metrics since April 1, 2020

New cases and hospitalization numbers continue to decrease.
Source: COVID-19 Tracking Project

Our rate of new daily diagnoses is down by about 75% from the peak, and our hospitalization rate is down by more than half. Although we won’t likely reach herd immunity until after we start vaccinating children, I’m increasingly confident that we will start to see a return toward normality by this summer.

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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