“We’re in a race to prevent infections, bring cases down, protect health systems, and save lives while rolling out highly effective and safe vaccines to high-risk populations. This is not easy. But if we act together, we can win both races and get ahead of the virus while also limiting the opportunity for the virus to mutate further and threaten the health tools we currently have.” Director-General Tedros Adhanom Ghebreyesus’ opening remarks on January 5 at the World Health Organization’s first press briefing of the year.
More than 835,000 people were infected with COVID-19 across the globe January 6, and almost 15,000 died, while the United States recorded its single highest number of cases at 280,352 COVID-19 infections and a record 4,223 deaths. Already in the first week of 2021, more than 20,000 Americans have perished from complications related to coronavirus. As of this writing, the grim tally stands at 22,372,177 infections and 376,837 deaths.
Highlighting the deadliness of the virus, a CDC statistician told CNN in an email, “We still only have provisional data through December 26. We should be getting more data in very soon. To that point, we estimate there were between 316,252 and 431,792 excess deaths in 2020. Our provisional death certificate data through that point show over 301,000 deaths involving COVID-19, which would likely place it 3rd among leading causes of death.” In a study in the Journal of the American Medical Association, released in October, the authors had found that adults over the age of 45 were more likely to die from COVID-19 than automobile accidents, respiratory disease, drug overdose or suicides.
It should be added that the first reported death in the US from COVID-19 occurred only in February, meaning that COVID-19 has not even had a full year to reach this grim ranking. More problematic has been that half of all COVID-19 deaths in the US have only occurred after September 1. At its current pace, COVID-19 would contend for the leading cause of death with heart disease and cancer.
There are presently more than 132,000 people hospitalized throughout the country. Several states that have seen some of the highest per capita infection rates are expected to see the number of ICU beds needed to reach their peaks next week. In Charlotte, North Carolina, where the surge continues to mount, Mecklenburg County hospitals had reached 90 percent ICU capacity at the end of December and are scrambling to add extra capacity. Rhode Island, Tennessee, Arkansas and Arizona are facing similar crises.
As the disaster is unfolding, a just-released CDC study published in JAMA on January 7 estimates that people without symptoms transmit nearly 60 percent of COVID cases. This implies that pre-symptomatic or asymptomatic people will not be picked up by “symptom-based” screening, such as temperature checking and questionnaires, so such screening will have little effect on the virus's spread.
CDC biologist Dr. Michael J. Johansson warned, “In the absence of effective and widespread use of therapeutics or vaccines that can shorten or eliminate infectivity, successful control of SARS-COV-2 cannot rely solely on identifying and isolating symptomatic cases; even if implemented effectively, this strategy would be insufficient. Multiple measures that effectively address transmission risk in the absence of symptoms are imperative to control SARS-CoV-2.” Presently there is no measure to expand testing of asymptomatic individuals. Testing in the US has remained stagnant since early November.
Virologist Dr. Frank Esper, MD, a pediatric infectious disease specialist at the Cleveland Clinic, acknowledged that we don’t know how many asymptomatic people are actually infected. He pointed out that the new strains of the virus being studied are not only more infectious but may also have a more extended pre-symptomatic stage. “So, the CDC study may actually undershoot asymptomatic infections,” he said. The premise for the CDC study was based on data from early Chinese studies. Esper added, “Older people tend to be more symptomatic and become symptomatic more quickly, so the asymptomatic rate is not the same across the board from young people age 20 to older people.”
According to a state-by-state tally in Bloomberg News, four weeks into the vaccine rollout in the US, 7 million doses have been given. In other words, just 2.1 percent of the US population has received at least the first of the two-dose regimen of the Pfizer or Moderna vaccine. Additionally, only 32 percent of all the vaccines delivered to states have been administered.
Across the globe, close to 19 million doses of the vaccine have been administered. However, of the 42 countries that have initiated a vaccine rollout, 36 are high-income and six are middle-income. These countries have purchased the majority of the supply of multiple vaccines. The bilateral deals being instigated are driving up these vaccines' prices, making access to them impossible for high-risk individuals in the poorest countries.
The B.1.1.7 variant of the coronavirus, also referred to as the UK variant, is estimated to have 50 percent higher transmissibility than the previous versions of the coronavirus. London hospitals have been inundated with patients, prompting Mayor Sadiq Khan to declare a major incident.
The White House Coronavirus Task Force warned in a memo released this week, “This fall/winter surge has been at nearly twice the rate of rise of cases as the spring and summer surges. This acceleration suggests there may be a USA variant that has evolved here.” They also called for an “aggressive mitigation … to match a much more aggressive virus.”
According to an article published yesterday in STAT News, the mutations noted in a variant seen in South Africa and another in Brazil appear to change parts of their spike protein in a way that makes the antibodies less effective at neutralizing the virus. “The mutation seems to help the virus disguise part of its signature appearance, so the pathogen might have an easier time slipping past immune protection,” the authors write. They note that the present concern is not that the vaccines will be useless but they will be potentially less effective, an assessment that does little to reassure the public.