More Covid-19 FAQs

  “Shared expectations lead to predictability.”

Comment: From the start, this column has focused on the science of epidemiology – the study of the coronavirus-19 virus and its resulting disease, COVID-19.  Scientific research and preventive programs have been our focus.  It is now increasingly difficult to separate this science from political influences.  This conflict will probably increase as the upcoming elections approach.

  

  1. Draft priorities developed for groups to receive vaccines when approved.

            Q:  Has the scientific group finished its proposed recommendations for who gets an approved vaccine first, and in what order others will be vaccinated?

  1. (The outline of this activity was previously discussed in FAQ #94.)  The National Academies of Sciences, Engineering, and Medicine has released a draft proposal for distributing a coronavirus-19 vaccine in the US. The proposal states the vaccine would be distributed in four phases as additional doses are manufactured and become available
  • Priority 1: Healthcare workers, the elderly and those with underlying health conditions. It is estimated this would cover about 15% of the population.
  • Priority 2: Essential workers, teachers, people in homeless shelters, people in prisons, jails and detention centers, and older adults not included in Phase 1. This would include up to 75% of the population in phases 1 and 2.
  • Priority 3: Young adults, children, and workers in industries essential to the functioning of society who are at risk of exposure to the virus. About 90% of the public would be included at the end of Phase 3.
  • Priority 4: All others not included in the prior three phases.

This proposal was submitted to the CDC and the Department of Health and Human Services.  A period for public comment was quickly announced: between Tuesday, September 1, and Friday, September 4, or for just 4 days!  The CDC will decide on the final prioritization by the end of October.  

  1. The CDC is authorized to manage a program to postpone evictions

            Q: Under what authority is the CDC acting to eliminate evictions?

A: On September 1, president Trump signed an executive order giving the CDC this role under its broad authority to establish quarantines.   The objective is to prevent people who have or may have COVID-19 from becoming homeless and thus unable to be quarantined.   While not usually thought of as a regulatory agency, the CDC is now publishing draft regulations in the Federal Register.  Individuals who are anticipating being evicted can then make application to the CDC, and if they are approved, be free of eviction during the pandemic.  It is not clear how this application and approval process will be implemented, and what penalties might exist for the CDC to impose on landlords and lending institutions that evict people anyway.  House speaker Nancy Pelosi and senate minority leader Chuck Schumer have jointly stated there are now over 40 million Americans who are at risk of eviction.  This could lead to a lot of applications!

In addition to providing exemption from being evicted, this order provides financial assistance to property owners as well as tenants.  The White House stated this assistance will be from the CARES Act passed by Congress earlier this year, as well as other government agencies such as the Treasury, and Housing and Urban Development.

There are caveats, however.  First, this order is open to all tenants and owners, not just those covered by the previous CARES Act who needed to be living in federally subsidized housing or homeowners with federally backed mortgages.  To qualify, a single applicant must show they earn less than $99,000 a year (or, if a married couple, less than $198,000).  Many other people will now be left out – including immigrants without a Social Security Number, and high earners who may have lost their jobs.  Applicants must also show they have made active efforts to seek government assistance to make rental payments, and demonstrate how they would become homeless or have to move into crowded housing if evicted.  It is unclear how managing the details of this complex application/approval process will deflect the CDC from its primary missions of research and disease prevention. It is also unclear how long approvals will take for each applicant. 

  1. CDC directive to states – submit plans to distribute vaccines by October 1

Is it true that states have to immediately plan for vaccine distribution?

A: The CDC, reportedly directed by the White House, has written the 50 states and 5 large cities asking them to submit plans to the CDC to provide vaccinations to the public beginning as early as November.  Each state has to identify where these vaccinations will be offered, and the logistics for receiving, storage, and inventory control of the doses they will receive.  Also required is identifying the workers in each of the 16 identified areas of critical infrastructure who will need to be trained.  One of the possible trial vaccines currently being developed has to be shipped and stored at minus 70° Celsius (- 90° Fahrenheit) requiring dry ice.  A second is required to be kept at minus 20°C (- 4° F).

A separate 3-page document lists assumptions to be considered in each state’s plan.  This includes identifying the individual vaccination providers who will each need to sign a separate agreement form.

  1. Public’s unwillingness to immediately get a new “untested” vaccine   

            Q: I don’t want to get a new vaccine if it hasn’t been thoroughly tested.  How do other people feel about this?

            A:  On September 4, a USA Today/Suffolk poll of 1,000 voters was published.  It shows that if a vaccine was introduced “fueled by mistrust of the Trump administration’s push to speed up its development,” 33%, or less than half of the population is ready to be vaccinated.  David Solmon is a professor at the School of Public Health at John Hopkins Medical Center.  He stated, “If you have 330 million doses of a vaccine and nobody wants it, it accomplishes nothing. You probably need between 70% and 80% of the population to get control of COVID.”

Laurie Garrett is a Pulitzer Prize winning science writer.  She is well known for her landmark book The Coming Pandemic.  Her work and opinions are frequently cited in the popular press.  On September 3, Laurie, speaking on behalf of science, strongly stated, “In its mad sprint to Election Day, the White House has ordered government agencies to execute their public health duties at breakneck speed that defy credulity.”  She continued, “I can no longer recommend that anyone retain faith in any public health pronouncements issued by government agencies.”  News media reports of scientists’ criticism of politics directing the efforts are clearly playing a part of this change in public perception.

The most likely vaccines for initial approval are being developed by three pharmaceutical companies.  Each of these companies has stated they will not request authorization until all the scientific protocols have been completed.  Their concern about long-term public distrust over the early release assures these commitments are firm.  This will frustrate any proposed public vaccinations until December, at the earliest. 

  1. Trump pivots on coronavirus strategic planning.

Q:   What’s with this shift in national strategy over control of the coronavirus-19?

A:  Over the past few weeks, actions have surfaced that that national strategy for mitigating coronavirus is shifting away from the science of epidemiology.  (Issues previously discussed in FAQ #102). The recommendation for self-isolating or quarantines when traveling from a state or country with a high COVID-19 case load has been removed.  The need for testing of people who have been in contact with someone testing positive has now been eliminated.  On September 2, Politico published an article that tied these to a broader shift in national strategy.  The White House has brought on a new coronavirus medical advisor, Scott Atlas, MD.  He is a neuroradiologist trained in X-Ray, CAT Scans and MRI imaging of the brain and spine.  He is not a specialist in public health, epidemiology or infectious diseases.  The recommendations he is expounding are being picked up and implemented by president Trump.  This includes not wearing masks, putting aside the trace, test and quarantine public health model; minimizing testing of the public and opening all the schools.  In other words, expanding the number of people who will be infected    His medical recommendations are focused on building immunity in the population by letting those infected people who recover build public immunity in this way.  He does not use the term herd immunity (previously discussed in FAQ #84), but the process he is advocating is the same.  Scientists have reflected this approach if carried out would result in an estimated 2,000,000 deaths in this country, and take years to achieve.  Dr. Atlas has stated he wants to protect the elderly and those who are at-risk.  But, with asymptomatic patients making contact with family members, the elderly and those with health-risk co-morbidity, it will be nearly impossible to protect these groups.