“Shared expectations lead to predictability.”
236. Science v. science! Different decisions from looking backward or forward.
Q: Why are some scientists disagreeing with the CDC about relaxing restrictions?
A: Michael Osterholm, Ph.D., MPH, is the Director of the Center for Infectious Disease Research and Policy at the University of Minnesota. He had served President Biden on transition team advising on plans to manage the pandemic. After the inauguration, he now is outside the government, but he retains his decades-long reputation at predicting the course of infectious diseases. For weeks, he has been one of many scientists opposed to CDC guidelines for slowly relaxing the preventive measures for controlling COVID-19. The premise of his opposition is that CDC bases its recommendation on scientific examination on how COVID-19 has reacted in the past as preventive measures have been introduced. These retroactive studies can predict how various measures can control the disease studied. It also identifies measures no longer useful that can be loosened. Dr. Osterholm has studied the mutations of the coronavirus-19. Variant strains or mutations can change the way past measures may have value in the future. This prospective view requires a different approach for making decisions.
Dr. Osterholm has classified the variants into three groups based on their effects. First are those variants that are more infectious than the original strain. Next are the mutations that evade some or all the natural immunity or protection offered by current vaccines. Finally, are the variants that are more virulent – not affected by any of the therapeutics or treatment procedures we have learned over the past year. He points out that a particular variant may have one or more characteristics of each of these classifications. The UK variant may be 60% more infectious, but vaccines and therapeutics can prevent hospitalizations or death. The newly discovered New York variant may be even more infectious than the UK variant, but it may also evade protection from natural or vaccine immunity. A future variant that is more infectious, evades natural or vaccine immunity and is also more virulent could be unlikely, but quite possible. And this would be quite disastrous. Dr. Osterholm’s perspective is to shift from a primary focus of changing guidelines based on retrospective studies, and instead first focus as a priority our full attention on significantly reducing the very large caseload of infected people through accelerated vaccinations. This will greatly reduce the emergence of new variants significantly reducing this underlying threat.
The CDC last week came out with new guidance for opening schools. A thorough scientific study of schools in Massachusetts demonstrated that seating students wearing masks in grades 1-6 closer than 6 feet apart did not increase their risk. That was a retroactive study. Dr. Osterholm had urged the CDC to delay its new guidance that student seating at 3 feet apart would be the “new normal” until more prospective analysis could be done. It might be more difficult to change back to 6 feet distancing in just a few weeks if it is learned that these current new variants are more infectious than the one studied retrospectively in Massachusetts. A better understanding of retrospective v. prospective factors may help slow down the decisions needed for a successful outcome.
237. Europe is facing a major COVID surge with lockdowns being put in place.
Q. Why are several European countries now being locked down because of COVID?
A. It is true that European countries are experiencing a rapid daily increase in the number of COVID-19 cases resulting in a third wave. Three countries, the U.S., Israel, and the United Arab Republic have rapidly deployed an increased production of vaccines to their citizens, and this correlates to the reduction of their cases in the past several weeks. European countries have lagged in vaccinating their citizens, correlating with this oncoming surge. The New York Times last week tracked the 3 major reasons for this difference. First was the focus on bureaucracy. The EU spent much time working to get the 27 nation members to negotiate and sign an agreement with manufacturers on how to fairly allocate the vaccines throughout the EU. Their initial approach placed process over fast development and rapid availability of the vaccines. Second was reluctance to invest the funds needed for rapid deployment of the vaccines. Time was spent on negotiating low prices. Israel paid Pfizer for each rapidly available dose about $25, the U.S. about $20 and the EU paid from $15 to $19. From a national standpoint, the money saved by a lowered price will be more than offset by greater economic losses from having to initiate new lockdowns. The third factor is vaccine skepticism. In a published survey asking if they would take a proven-safe and effective COVID vaccine, in China 89% of the people said yes. In the U.S., 75% agreed. As did 68% in Germany, and 65% in Sweden, 59% in France, and 56% in Poland. Another variable at play is the lack of confidence in the EU over the medical science approving vaccines. After authorizing the AstraZeneca vaccine in the EU, a news report was published that several patients had developed blood clots. France’s President Macron last week made the political decision to block this vaccine from being used. Germany and Italy followed suit. Scientists have pointed out that the percentage of vaccinated patients with blood clots was less than those in the general populations. The WHO is now urging the return of AstraZeneca to wide-spread use.
238. CT Freedom Alliance continues to ask courts allow students to avoid masks.
Q: I read in the Hartford Courant that a group is suing to let students not wear masks in school. Won’t that put others at risk?
A: This is a continuation of seven months of court action by the Connecticut Freedom Alliance to remove restrictions on opening schools during a public health emergency. In this instance, the group had filed a request to Superior Court Judge Thomas Moukawsher for a ruling without a full trial to invalidate Governor Lamont’s order that children attending in-person classes in schools must wear masks. The Alliance’s position is that wearing masks is not only dangerous to a child’s heath but that “children are constitutionally entitled to a physical learning experience under the Connecticut Constitution.” Judge Moukawsher issued a 36-page ruling denying the request. Governor Lamont has recently been subject to criticism over his issuing of nearly 100 executive orders dealing with the pandemic. Other cases have been heard in court, and many of these are causing appeals to be heard by the Connecticut Supreme Court. The Freedom Alliance will be included in the Supreme Court case by asking it to overturn the denials given by Judge Moukawsher. Who is right – parents who want their freedom to decide what’s best for their children, or the government to protect the public health? That question frames many discussions about how well – even if – we will ever end this pandemic.
239. Follow up: U.S. stockpiled AstraZeneca doses to be given to other countries.
Q: Is Biden going to follow his plan by giving spare COVID doses to other countries?
A: In last week’s column, it was identified that the “National Strategy for the Covid-19 Response and Pandemic Preparedness” plan called for the U.S. to join with the approximately 190 other countries to participate in a global vaccine distribution agreement called COVAX. In this agreement, participant countries agreed to share vaccine doses with other countries that are unable to produce enough for their people. AstraZeneca now has tens of million doses of vaccine in storage in the U.S. that can’t yet be used here because it has yet to be approved by the FDA. Yet this vaccine has been approved by 70 other countries. Earlier, President Biden continued making courtesy calls to national leaders around the world. While broadly discussing issues with the president of Mexico, Andrés Manuel López Obrador, Biden mentioned the problem of children crowding our mutual border overwhelming the U.S. immigration system. It was reported that during that call, an impromptu agreement was reached to explore the possibility of Mexico helping us restrict Central American citizens coming into Mexico before traveling north to our border. In exchange, we would ship millions of doses of AstraZeneca vaccine to help Mexico immunize its citizens. Before the deal was formalized last week, Canada had been brought into the deal. As a result, large quantities of our stored vaccine will be sent to both Canada and Mexico as those countries help us with our immigration problem!
240. OSHA is planning to release regulations requiring masks in the workplace.
Q: Many of my friends want to get back to normal right away. How will things change?
A: The CDC is contemplating guidelines for returning to work. CDC guidelines are only recommendations, and previous problems in the workplace, especially in meat packing plants led to guidelines being ignored. Former President Trump encouraged this avoidance. The Occupational Health and Safety Administration within the U.S. Department of Labor is one federal agency with the power to enforce workplace safety standards. The interim guidelines being considered is to require masks to be worn by all employees in a workplace where they may come within six feet distance of others during the time at work. This requirement would probably be temporary, until the pandemic was under control. But how well would such a rule be received by businesses and by the public? A lot of discussion is taking place at CDC – and OSHA. It will be interesting to watch this unfolding program. Related to this is another workplace consideration being talked about: can an employer require their employees be vaccinated before they can remain on the job, return to work, or be initially hired?
