The Washington Post - USA (2020-08-03)

MONDAY, AUGUST 3 , 2020 .THE WASHINGTON POST EZ RE A

the coronavirus pandemic

New coronavirus casesanddeathsintheU.S.,byday

CASES DEATHS

151,8 79

Total

4,641,

Total

As of 8p.m.Sunday

Feb. 29 Aug. 1 Feb. 29 Aug. 1

0

2,

2,

1,

1,

500

478

49,

0

10,

20,

30,

40,

50,

60,

70,

7-day

average

7-day

average

BYDEREKHAWKINS

ANDMARISAIATI

Deborah Birx, the physician
overseeingthe WhiteHousecoro-
navirusresponse,warne dSunday
thattheUnitedStateshadentered
a“newphase”ofthe pandemic
and urged peopletot akeextreme
healt hprecautions as infections
and deaths rise sharply through-
out the country.
“I want to be veryclear: What
we’reseeing todayisdifferent
fromMarch and April,”Birxtold
CNN’s “State ofthe Union, ”noting
thatcaseswereincreasinginr ural
and urbanareas. “Itisextraordi-
narilywidespread.”
Birxdidnotruleoutanestimate
fromformerFood and DrugAd-
ministration Commissioner Scott
Gottlieb that virus deathscould
top300,000bytheendof theyear,
saying“anythingispossible.” Such
an outcome would be far lesslike-
ly,Birxsaid, if peoplepracticed
social distancingand avoided
large gatherings.
Birxhas faced mountingcriti-
cismoverherhandlingofth ecoro-
navirusresponseafter th eNew
York Timesreported lastmonth
thather optimistic outlookon the
pandemic’s trajectory helped ju s-

tifyreopening decisions thatpre-

ceded newoutbreaks.

HouseSpeakerNancyPelosi

(D-Calif.) said Sundayshe did not

have confidence in Birx. “I think

the presidentiss preading disin-

formationaboutthevirus,andshe

is his appointee,” Pelosi saidin

responsetoaquestion from ABC

News’sMartha Raddatz. “So I

don’thave conf idencethere, no.”

Birxdefende dher decisions in

responding to thecrisis. “I have

tremendous respectforthe speak-

er.Ihavetremendous respectfor

her long dedication to the Ameri-

canpeople,”she toldCNN,before

adding that she has“never been

calledPollyannaish or nonscien-

tific or non-data driven.”

Birxand AnthonyS.F auci, the

nation’s topinfectious-diseaseex-

pert, have warned 20states in the

Sun Belt,the Midwest andthe

Pacific Northwestthatthe vi rus

spreadisacceleratingwithintheir

borders. WhileBirxsaidmitiga-

tionefforts have helpedinsome

places, shestresse dthatpeople

need to practice strictsocial dis-

tancing and wear masks. Birxalso

raised concernsaboutthe virus

spreading within multigenera-

tional households, urging people

in those settings to “r eallyconsid-

er”wearingmask sinside their

homes.

Birx’sremarks cameas theU.S.

economy failstobuild on signs

thatithad started to recover, and

as millions of Americans continue

to waitfor an economic relief

packagethatwould restore their

expiredunemployment benefits.

Pelosi andTreasury Secretary

Steven Mnuchinmadeclear in

separ ateinterviews Sundaythat

theyremain farapartonadeal.

Pelosisaid the administration

continuedto resistapublic health

strategytoattack the virus.

Mnuchin defendedthe adminis-

tration’s response and saidDemo-

crats’ demandfor $1 trillionin

newstate and loca laid was a

non-starter.

Thestalled negotiations fol-

lowed anotherweek of grim signs

for the country’spandemic re-

sponse.Theseven-day averag efor

newcoronavirus-related deaths

rose innearly halfof states over

thepastweek,pushingthenation-

al deathtoll past150,000and

prompting health experts to warn

thatthe trend was unlikely to re-

verse anytime soon.

Nationwide, the dailycoronavi-

rusdeath tollexceeded 1,000 for

the sixth dayinarow on Saturday,

according toThePost’sdata. The

reported number of deathson

Sundaywas478aso f8p.m.

With thenew academicyear

starting sooninmanycommuni-

ties, Birx also suggested that

schoolsavoidin-person instruc-

tioninplaceswhereinfectionsare

rising—adeparture from recent

demandsbyTrumpand Educa-

tionSecretaryBetsy DeVos that

schools fully reopen in thefall.

“If you have high caseloadand

activ ecommunity spread—just

likewe’reaskingpeopl enot to go

to bars,not to havehousehold

parties,not to create large spread-

ing events, we’reasking people to

distance-learnat this moment so

we cangetthisepidemic under

control,”Birxsaid.

Thestakes of school reopening

decisions becameclear lastweek

as at leastfour schools reported

thatastude nt tested positive for

the coronavirus during thefirst

fewdaysback in session. Corinth

HighSchoolinMississippi,Green-

field CentralJuniorHigh School

inIndianaandtwoschoolsinIndi-

ana’sGreater Clark County

Schools districtreportedly in-

structed peoplewho had been in

contactwiththe infected individ-

ualstos elf-quarantine.

Theincrease in deaths across

the countryhas trailedamassive

surgeincoronaviruscases by sev-

eralweeks.Thetimelagwasgreat-

er than in the pandemic’searly

months, when deaths followed in-

fections more closely.Expertssay

the changemay be because many

of th enew outbreakshave started

among young, healthyadults who

passedthe virus toolder,more

vulnerablepeopleandbecause ex-

pandedtestin ghasallowedhealth

workers to identifycases closerto

the time of infection.

“Overall, whatthistells us is

thatnow that deaths havestarted

to increase, wecan expectthemto

increase for several more weeks,”

Ellie Murray,ane pidemiologist at

BostonUniversit y, told ThePost.

“Wecannotafford topretendev-

erything isfine and heading back

to normal.”

TheCentersforDiseaseControl

andPrevention’smostrecentanal-

ysisofpandemicfatalitie sshows

weekly reports of newdeath sin-

creasingoverthe next month,

with5,000to11,000 newdeaths

projected in the third week of Au-

gust. Thenational deathtollcould

climb to more than 168,000 by

that time, withahighestimate of

182,000,accordingto th eCDC’s

revie w.

Amidthe ri sing deaths,Trump

struck an optimistic note on Sun-

day, tweeting,“USAwill bestron-

gerthaneverbefore,andsoon!”

Trump andotherprominent

Republicans have continued to

promote the drughydroxychloro-

quineasasolutiontoc ovid-19,the

dise asecausedbythe novel coro-

navirus,despiteevidence that it

does not helppatients recover.

AskedSundayabouthydroxy-

chloroquineonNBCNews’s “Meet

the Press,”Adm.Brett Giro ir,the

official in charge of th eadminis-

tration’s testingefforts,stressed

thatthe dr ug was not aneffective

treatment.

“Atthispoint in time, therehas

beenfive randomized controlled,

placebo-controlled,trials that do

notshow anybenefittohydroxy-

chloroquine,”Giroir said.“So,at

thispointint ime,wedon’trecom-

mend that as atreatment.There’s

no evidence toshowthatiti s.”

[email protected]

[email protected]

EliRosenberg,FeliciaSonmez,Joseph

MarksandJacquelineDupree

contributedtothisreport.

Birx warns of ‘new phase’ of pandemic and calls for greater precautions

Seven-day average for

new deaths has risen in

nearly half of states

muddle through afew more
months, thevaccine will land, the
pandemic will end andeveryo ne
can throw theirmasks away.But
best-case scenarios have failed to
materialize throughout the pan-
demic,and experts—who believe
wholeheartedlyinthe powerof
vaccines—foreseealongpath
ahead.
“Itseems, to me, unlikely thata
vaccine is an off-switch orareset
button where we willgoback to
pre-pandemic times,”said Yona-
tanGrad,anassistantprofessorof
infectiousdiseases and immunol-
ogyatthe Harvard T.H. Chan
School ofPublic Health.
Or,asColumbiaUniversityvi-
rologistAngela Rasmussen puts
it, “I t’snot li ke we’regoingtol and
in Oz.”
Thedeclaration thatavaccine
has been shown safe andeffective
will beabeginning,not th eend.
Deployingthevaccinetopeoplein
the United States and aroundthe
worldwilltestandstraindistribu-
tion networks, the supply chain,
public trustand global coopera-
tion. It will takemonths or,more
likely ,years to reachenough peo-
ple to makethe worldsafe.
Forthose whodoget avaccine
assoonasshotsbecomeavailable,
protection won’t be immediate —
it takes weeks for the immune
system to call up full platoons of
disease-fighting antibodies. And
manyvaccin etechnologies will
requireasecond shot weeks after
thefirsttoraiseimmunedefenses.
Immunity could be short-lived
or partial, requiring repeated
boosters thatstrain thevaccine
supplyorrequire people tokeep
social distancing and wearing
maskseven after they’vereceived
theirshots.Andifavaccin eworks
less wellfor some groups of peo-
ple,ifswathsofthepopulationare
reluctant togetavaccine or if
there isn’tenough togo around,
somepeoplewillstillgetsickeven
after scientistsdeclare victoryon
avaccin e—whichcould help
fosterafalseimpressionitdoesn’t
work.
Aproven vaccine will pro-
foundly changethe relationship
the world has with the novel coro-
navirus and is how manyexperts
believe the pandemic will end.In
popular conception,avaccine is
regardedasasilve rbullet. But the
truth—especially with the earli-
estvaccines—islikely to be far
more nuanced.Public healthex-
pertsfearthatcouldleadtodisap-
pointmentand erode the already
delicatetrustessential to making
the efforttovanqu ish thevirus
succeed.
Thedrive tode velopvaccinesis
frequentlycharacterizedasarace,
with one countryorcompanyin
the lead.Therace metaphor sug-
geststhatwhatmatters is who
reaches thefinishline first. But
firstacrossthelineisn’tnecessari-
lythebest—anditalmostcertain-
ly isn ’t the end of therace, which
couldgo on for years.
“Therealisticscenarioisproba-
bly going to be more like whatwe
sawwithHIV/AIDS,”saidMichael
S. Kinch, anexpertind rugdevel-
opm ent and researchat Washing-
ton UniversityinSt. Louis. “With

VIRUS FROM A

HIV,wehad afirstgeneration of,

looking back now,fairly mediocre

drugs.Iamafraid—and people

don’tliketoh earthis,butI’mkind

of constantly preaching it—we

have to prepare ourselves for the

idea we do not haveaverygood

vaccine.My guess is thefirstgen-

eration ofvaccines maybemedio-

cre.”

Vaccine Day

On April 12, 1955,avaccine

against polio was showneffective

and safe.Itsinventor, JonasSalk,

becameanational hero.Church

bells rang and peopleranintothe

streets to hug one another,said

HowardMarkel, amedical histo-

rianattheUniversityofMichigan.

But there were bumps along

the way, even as scientists and

public health authorities sought

to thwartadisease thatwas of

greatestthrea ttochildren.The

“Cutter incident”becameani nfa-

mous moment in medicine, when

one of the suppliers of thevaccine

failed to fully inactivatethe vi rus

in the shot, infecting about

40,000 children, paralyzing

andkillingfive.Those infections

seededtheir own epidemic, para-

lyzing113 others and killing an

additionalfive people.

“What’sincredibleisitwasonly

ablip. Parents were so trustwor-

thyofdoctors and scientists, and

it went on, peoplegottheir shots,”

Markel said.

TheSalk vaccination was a

transformative moment, but it

wasalsonottheendofpolio.Over

the course oftwoyears, cases in

the United States droppedby

percent, but outbreaks continued

for several years,even as thevac-

cinewasrolledout.Sixyearslater,

anoralpoliovaccinethatcouldbe

given asasugarcube thatdis-

solved on children’s tongues was

introduced.Polio was eliminated

in theUnited States in 1979.

But the poliovaccine cameat a

distinctmoment in American his-

tory, Markel said, when people

had great faith thatscientists,

medicine andgovernment insti-

tutions could changetheir lives

forthebetter.Forthecoronavirus,

arelativelysmall setback—a

miscommunication about vac-

cines,anunpleasantsideeffect, a

much-hoped-for candidatethat

fails in largeclinical trials or a

vaccine thatiso nlypartly protec-

tive —could have outsizeeffects,

especially with anti-vaccine activ-

ists already workingtosow dis-

trust.

AnthonyS.Fauci, director of

the NationalInstitute of Allergy

and Infectious Diseases, testified

Fridaybefore Congress thatheis

“cautiously optimistic”thata

30,000-person, Phase3clinical

trial justgetting underwaywill

yield an effective vaccine. But

there has been little talk about

how to think about failures,even

thoughthose are an inevitable

partofscience.

“Whathappensifa ny of them

fail aPhase 3trial —are people

justgoingtog ive up?Isitgoing to

be likeentering Dante’s inferno?”

Columbia’sRasmussen said.“I’m

really worried people have been

relyingonthishopethatavaccine

is going tofixeverything,and

vaccines are not perfect, justlike

anytypeoft herapeutic.They do

fail.”

All approvedvaccines mustbe

showntobesafeandeffective,but

thatdoesn’t meantheyperform

the same.Themeaslesvaccine is

one of the best—98percent

effective at preventing disease.

But the fluvaccine clocks in most

yearsat 40 to 60 percenteffective.

And somevaccines work less well

in groups of people—older peo-

ple, forexample, have less robust

immuneresponses and need a

special high-dose fluvaccine or

one with an extraingredient

called an adjuvant.

U.S. regulators will require a

coronavirusvaccineto be 50 per-

cent effective, and ifashot just

barelyclears thatbar,public edu-

cation will be required to help

communicate how manypeople

needtoreceiveittoestablishherd

immunity—athresholdat which

enoughofthe population is im-

munetostopthespread,whenthe

virus is truly tamed.

“If yougetavaccine thatjust

meets the guidelines, the chances

are you’renot going to be able to

achieveherdimmunity,”saidWal-

ter Orenstein, associate director

oftheEmoryVaccin eCenter.“You

tamp down transmission, sub-

stantially.Itd ecreasesyourriskof

getting exposed,but it doesn’t

eliminate it. Buta50percent

effectivevaccine isalot better

than zero percenteffectivevac-

cine. Iwould take it.”

Even the word“effective”will

be parsed byexperts and may

need to be carefullyexplained.

Thegoalis foravaccin etoprevent

infectionsaltogether.But that’s

not the only definition ofasuc-

cessfulvaccine, whichcould also

include shots thatreduce the se-

verityofsymptomspeopleexperi-

ence.Ideally,avaccine would do

both.Butwhathappensinreallife

will influence decisions about

whoshouldgetthe vaccinefirst.

“Wetalk about makingsome-

thing work, and public health is

verymuch about the public,”said

Natalie E. Dean,abiostatistician

at the UniversityofFlorida.“You

can makesomething work per-

fectly in the lab; it’s awhole other

thing to makeitworkout in the

community.”

Avaccine thatmainly lessens

the severityofdisease might be

directedat olde rpeople and oth-

ers at greatestrisk for the worst

outcomes. One thatprevents in-

fectionswell, but perhaps doesn’t

work as muchinolder people,

mightbe directed to the younger

population to trytoprotectolder

people.

Theeffectivenessofthevaccine

also influenceshow manypeople

need togetittoreach herd immu-

nity.

Paul A. Offit, director of the

Vaccine Education Centerat Chil-

dren’s HospitalofPhiladelphia,

ranthrough oneback-of-the-en-

velopescenario with an optimis-

tic outcome: Sayavaccine is 75

percent effective at preventing

peoplefromshedding the virus

and passingiton. Vaccinating

even some peoplewillslow the

spread, with the biggest ef fects

emerging if thefirstdoses are

channeledtotherightpeople.But

he estimated it would be neces-

sarytov accin atetwo-thirds of the

populationtoreachherdimmuni-

ty.

“If you’retalking about throw-

ing arms around each other,sit-

ting with 67,000 peopleat aPhila-

delphia Eagles game, I’dimagine

thatwould take acouple years,”

Offitsaid.

‘A rollout,not athunderclap’

Thecoronavirus descended

quickly,alteringdaily life in un-

imaginable ways practically over-

night. People’ssocial circles

shrank to theirhousehold con-

tacts. Schools closed. Even the

Earthstopped vibrating as much.

Impatient for the pandemic to lift

its heavy weight offthe world, all

eyes have turned to thevaccine.

“I thinkeverybody’s so sick of

this pandemic and this damn vi-

rus they’re really looking to the

vaccine asasavior,”said Mark

Mulligan, director of the New

York UniversityLangoneVaccine

Center.

Mulligan said he believes peo-

ple should viewvaccines in much

the same waytheyhaveregarded

reopening—assomething that

mustoccur in gradualphasesto

be safe and couldeven double

back on itself as we learn more.

Governments and companies are

investing billions of dollars to

ramp up thevaccine supplynow,

but even so, it won’tbe possible to

vaccinate everyone in thefirst

week oreven thefirstmonth after

the firstvaccine becomesavail-

able. Theworld will become safer,

bit by bit, not allat once.

“The vaccine isgoing to be a

rollout, notathunderclap,” said

AndrewNoyme r, an epidemiolo-

gistatt he UniversityofC alifornia

at Irvine.

And failuresthathavesnarled

testingcapability—includingdis-

tribution challenges and making

sure the supply chain of basic

ingredientsisr obust—are ahuge

risk.

Public communication will

have to be nuanced, with leaders

setting responsible examples.

PresidentTrump, able to takead-

vantageofd ailytestingwithrapid

turnaroundtimes, did notmodel

untilrecentlytheprecautionsthat

public healthexperts said the rest

of the nation musttake, helping

sow confusion on masks. Sports

stars and celebrities have ap-

pearedtohaveeasier access to

testingthanthe masses through-

outthepandemic.Ifsuchinequal-

ities occur withvaccines, it may

givepeoplefalseconfidenceabout

whatiss afe.

“Whathappens when politi-

ciansgetprioritized [foravac-

cine]...there’sthe projection of

invincibilityand others who are

not vaccinated lettheir guard

down,”said Saad B. Omer,direc-

tor of theYale Institute for Global

Health.“Thathas happened for

testingandmasks.It’s notafanta-

sy,and we’renot preparedfor

that.”

Thequestfor avaccin ehas

convinced manyscientists that

success is possible. But if the

promiseofavaccinedangleslikea

get-out-of-jail-free card, it’s possi-

bletheworlddoesn’tdoenoughto

build out all the other tools —

treatments, testing,contacttrac-

ing —needed togetback to nor-

mal.

“There’s averymyopic focus on

this one little partofoutbr eak

response, the research and devel-

opment,”Dean, of theUniversity

of Florida, said.“Then, we neglect

thestuffthat’salittlelessexciting,

but probably more immediately

impactful and in the long run is

going to be really important, as

well in terms of feeling confident

thatwe’ll be safe.”

[email protected]

Scientists: Vaccine won’t offer instant safety; caution is needed to slow spread

BILL BRIDGES/THE LIFE IMAGES COLLECTION/GETTY IMAGES

Adrive-in poliovacci ne clinicinGlendale,Calif.,around 1960.Thepoliovaccine’seffectiveness in

eradicating thedisease was due in part to trustindoctors andscientists despiteseveral setbacks.

AMANDA ANDRADE-RHOADES FOR THE WASHINGTON POST

Chao Wang,aphysician, disinfectsRabbi ShmuelHerzfeld’s armin

aclinicaltrial for acoron avirus vaccine in Rockville onJuly 27.

“I’m really worried

people have been

relying on this hope that

avaccine is going to fix

everything, and

vaccines are not perfect,

just like any type

of therapeutic.

They do fail.”

Angela Rasmussen,

Columbia University virologist