“Shared expectations lead to predictability.”
216. National COVID-19 Strategic Plan – (Part 5 of 8)
Q: What’s in the new United States strategic plan for controlling this pandemic?
A: On January 21, 2021, Joe Biden released the 198-page National Strategy for the COVID-19 Response and Pandemic Preparedness. This week’s summary gives details about
Goal 4 – Expand emergency relief and exercise the Defense Production Act
The Strategic Plan states: “It’s past time to fix America’s COVID-response supply shortage problems for good. The United States will immediately address urgent supply gaps, which will require monitoring and strengthening supply chains, while also steering the distribution of supplies to areas with the greatest need.” To expand emergency relief and strengthen the supply chain, the government will:
- Increase emergency funding to the states and bolster the Federal Emergency Management Agency (FEMA) response;
- Fill supply shortfalls by invoking the Defense Production Act (DPA);
- Identify and solve the urgent COVID-19 related supply gaps and strengthen that supply chain. Included is increased domestic manufacturing of:
- Antigen and molecular-based testing;
- PPE and durable medical equipment;
- Vaccine development and manufacturing;
- Therapeutics and key drugs;
- Secure the pandemic supply chain and create a manufacturing base in the US;
- Improve distribution and expand availability of critical materials.
Next week: details about Goal 5 – Safely reopen schools, businesses, and travel, while protecting workers.
217. Issues with vaccination delivery – as of February 22 2021
Q. Has anything changed since last week on the vaccination program?
A. There is an increasing number of vaccination sites opening up. Past problems identifying a site and making an appointment are gradually becoming less frustrating. Still a problem is the lack of coordination between clinics. A person can schedule an appointment in three weeks with a clinic they have just called, while a nearer clinic might have an opening in just two days.
Attention is now shifting to the issue of “equity.” Not all groups are equally able to schedule appointments, or attend vaccination clinics. Many living in poverty may not have a computer or phone to schedule an appointment. Those without cars are unable to get to a distant clinic not on a bus route. And for many minorities, there is the cultural problem of resistance to be vaccinated. For people of color, there is the lingering legacy of the “Tuskegee Experiment.” Starting in 1933, 600 men agreed to participate in a study of the treatment of syphilis. The participants gave their consent without being informed, and proper treatment was not offered. This lasted for 40 years before it was exposed as an illegitimate effort. To this day, distrust of the government and of public health practices have remained a formidable barrier for many Black people. And then, there is the very vocal and expanding “Anti-Vax” movement.
These emerging problems foretell of future intensive efforts to provide multiple vaccination clinics closer to where people live. Also, on the near horizon will be major public education campaigns to encourage people to receive their COVID-19 vaccinations.
218. In Connecticut, religious exemptions from vaccinations are controversial.
Q: Why is the law granting religious exemptions for vaccinations raising such concern?
A: State law in Connecticut requires children to be vaccinated against several infectious diseases such as measles. Those not vaccinated cannot be enrolled in schools unless they have received an approved exception. Currently, there are two allowable exceptions: a medical condition, given by a physician, where a vaccination could cause harm, and a religious exemption declared by the parents. Many people don’t want their children vaccinated for a variety of reasons. Even if the parents don’t hold religious beliefs against vaccinations, it is easy for them to sign the religious exemption form – no verification is required. The legislature has proposed a bill to eliminate this religious exception. Literally over a thousand people had signed up to speak at the hearing last week.
This all illustrates the lack of awareness of public health being different from individual or private medical care. Everyone has the right to refuse medical care for themselves. Even when this offered care is known to be life-saving. But the public health is focused on the protection of the population, protection from being infected and being made sick. Any person who is or could become infected should not be allowed to refuse the public health remedy of being quarantined or being vaccinated to protect others. For years in Connecticut, people wanting to prevent their children from being vaccinated for any reason have been able to sign a religious objection form. As a result, many children attend schools without their vaccinations. A few years ago, a measles outbreak occurred in schools as a result of this. With the vaccination of children just months away, many are concerned that if parents use this exemption, COVID could spread in the schools. Other parents want to defend the exemptions. So the public reacted by attending the hearing.
After 24 hours and 230 speakers had testified, the hearing ended. Further oral testimony from the 1,730 others who had signed up was denied. It will be interesting to watch how this debate will decide between what people want and what public health requires.
219. Children will have to wait before they can be vaccinated.
Q: When can my 8-year-old child get vaccinated?
A: Children under the age of 16 are not yet on the schedule for COVID-19 vaccinations. (For the Moderna vaccine, the cut off is under the age of 18.) During the clinical trials of the already approved vaccines, children under these ages were not included. One major reason for this is the well-known quandary of pediatric medicine: how can parents subject their children to clinical trials of a medicine that has not yet been proven safe? The FDA requires that vaccines used on children must be first tested on children. Children at different ages have maturing immune systems that react differently and thus can become unpredictable unless they are evaluated. The clinical trials in adults provides confidence that new clinical trials can now proceed to verify their safety and efficacy, and to establish dosing guidelines for children. It was decided to first focus on adolescents because they make up 67% of actual cases, while children ages 5-11 make up only 37%.
COVID-19 does affect children. Even though the number of pediatric COVID cases are fewer than for adults, as of February 11, up to 2.3 percent of the more than three million children who have tested positive have been hospitalized. At least 241 children have died from the disease. It can be assumed the vaccine can help control the infection in children and reduce the ability to spread the disease to others. It is not yet known what the vaccine’s effect is on the Multisystem Inflammatory Syndrome that often occurs in pediatric patients. Evaluations are already underway with Pfizer testing its vaccine on 2,500 children between the ages of 12 and 15. Moderna is enrolling 3,000 participants ages 12 to 17. Results on these teenagers should be known by this summer – Dr. Fauci recently projected this is possible as early as April. He also stated studies on younger children will follow with results hopefully by September. But many variables could cause delays.
220. The personal impact of a shortened life span – what it means for you
Q: I hear that COVID-19 has shortened life span by 1 year. Will we will all die earlier?
A: It was announced last week that because of COVID-19, the estimated life span is now one year less than it was last year. This is another statistic publicized to add drama to the impact of the disease. Unfortunately, it is causing concern because it has not been fully explained. A life span is an average calculation – a number which includes the group as a whole. It cannot be applied to one individual. For example, if a program to have people stop smoking succeeds, those who never smoked can be expected to live just as long as they would have earlier. But the average life span for everyone together would increase.
The number of deaths in the U.S. from COVID-19 has steadily increased over the past year. Many of these deaths have been younger people who previously would have died much later from other causes. The average length of life for the group has thus been shortened. Those who were never ill with COVID can expect to live just as long as they did before. Over time, as the pandemic wanes, fewer younger people will be dying from COVID. The continuing calculation of life span will then increase. The pandemic deaths will later be offset by people living in a much healthier future world.
