Hopeful Covid-19 vaccine data won’t help hospitals that are overstretched now, experts say

With the glimmer of promising data from two Covid-19 vaccines, the beginning of the end of the pandemic may be in sight, some experts say — but they warn that the coming winter months may be the most tragic yet, especially if policies aren’t enacted to stop the spread.

“It’s only a few more months that we’re going to have to be this diligent about staying away from our non-nuclear families,” said Dara Kass, an emergency medicine doctor and associate professor at Columbia University, during a panel Monday on the first day of the 2020 STAT Summit.

Those months, though, are especially dangerous for coronavirus transmission. Data from other, similar viruses — as well as reports on SARS-CoV-2 — show that they’re stable for longer in colder, drier air, and that our bodies aren’t as good at clearing them away with mucus. Plus, some U.S. health care systems are already frighteningly overwhelmed with the current surge — not just in terms of bed and equipment but also in terms of the nurses and respiratory therapists and physicians needed to staff them.

“When those resources get stretched, at some point, the system really does start to break down,” said Kass, warning that in some parts of the country, “it’s going to be a breaking point for them in a way that it wasn’t for us in coastal cities” in the spring.

“We are seeing almost every state in the union having surges of patients,” she went on. “The Intermountain [Healthcare] physicians of Utah came to help us, but we cannot go to Utah the same way. There aren’t enough of us in the country.”

Kass was herself diagnosed with Covid-19 in mid-March, and she’s happy to report that she still has antibodies, eight months later, a sign that her immune system might prevent her from being sickened by the virus again.

But to what extent that’s true of the population at large is still an open question. “We’re seeing a lot of heterogeneity with Covid-19,” said panelist Akiko Iwasaki, a Yale professor specializing in our immunity to viruses. “Some people recover with very little symptoms and others go on to die.”

She hopes to understand where those differences come from, and whether they can be predicted by a person’s own antibody or immune response. While it varies from individual to individual, and while in some cases, immunity seems to wane over a number of months, Iwasaki hopes that the protection conferred by vaccines will last longer.

“I have greater hope that vaccine-induced immunity is more durable,” she said, explaining that the virus uses evasion tactics to circumvent our own natural immune response when we’re infected, and that shouldn’t be the case with shots.

Yet even with such great, celebration-worthy data — showing efficacy rates of more than 90% for the Pifzer-BioNTech vaccine, and 94.5% for Moderna’s — the numbers are only preliminary. As Iwasaki cautioned, “There are many unknowns that haven’t been reported yet.”

Caitlin M. Rivers, an epidemiologist at the Johns Hopkins Center for Health Security, said everyone needs to remember that a vaccine is only as useful as the number of people taking it. Everything depends on the ability to manufacture and distribute the immunizations — but also on whether people trust them. “Even after a vaccine receives an emergency use authorization and starts to be introduced into the community, it will still be months until we can all rest a little easier,” she said.

 At the start of the pandemic, she said, no one was sure what the highest-risk settings were. Now, we have a better idea that indoor spaces like restaurants, bars, and gyms can be especially dangerous. “We’re seeing a severe resurgence right now, and that does call for shutdowns” of some activities, she said.

She doesn’t think it makes sense to get angry with any one person for their potential lapses in mitigating spread. “Individual decisions don’t frustrate me as much as I see them as opportunities for engagement,” Rivers said.

Rather, she thinks the most important interventions need to happen at the policy level — now, but also in preparation for the next pandemic. “We cannot wait for a pandemic and hope to mount an effective response,” she said; we need to be funding and preparing those efforts in advance, as we do for military conflicts and extreme weather events, even if we hope that they don’t arise all that often.

As Iwasaki pointed out, the Covid-19 pandemic will leave lasting scars, including its effects on the researchers who are best positioned to understand and work against such diseases. “I do realize that people with family — small children or elderly — at home, we are disproportionately affected. I do worry about the long-term consequences of what this pandemic will do to women and minorities in science,” she said.