Building towards 'vaccine confidence'

Now, three vaccines appear to work against COVID-19, but getting millions of people immunized remains a major hurdle to overcome - and many answers still needed.

The week begins with more good news on the COVID-19 vaccine front: the vaccine developed by AstraZeneca and Oxford University appears to be either 70% or 90% effective, depending on dosing. This vaccine is more like traditional vaccines, so it does not require the extreme cold storage that the Pfizer and Moderna mRNA vaccines need. Experts will be poring over the data from the global studies to better assess the safety and effectiveness of this latest vaccine candidate. Remember that we still don’t know how long the immune response lasts — and how durable the protection is. Stay tuned.

Even in science, serendipity comes into play: The lower dose arm of the AstraZeneca/Oxford trial was not part of the original clinical trial plan. It was added because of a dosing mistake that turned out to be a lucky break.’

The USA now is recording 30% more COVID-19 deaths than one week ago, with the worst rates (per capita) in South and North Dakota. Hospitalizations are up 20%. The 7-day average now is almost 1,500 deaths, according to the Washington Post. Watch the numbers for people in nursing homes. We must do better across-the-board. now shows 49 states and the District of Columbia are in the “uncontrolled spread” (dark red) category. Hawaii stands alone in the “caution warranted” yellow.

You may notice that public health professionals are starting to refer to “vaccine confidence” instead of “vaccine hesitancy.” The idea is that the latter term gives too much credence to people who have irrational objections to safe immunizations.

For a discussion on COVID vaccine communications, check out this article from July (I am among the experts quoted.)

Other news: The FDA has authorized early access to monoclonal antibody treatments for COVID-19 by Eli Lilly & Co., and another by Regeneron. Research appears to suggest that these biotech treatments work best when given to patients at the earliest stages of infection and offer less benefit to those already hospitalized. You can learn much more about this and other related clinical information from UCSF Department of Medicine Chair Bob Wachter’s informative Twitter thread from a couple days ago, including a link to the interviews/presentations by noted experts from around the country:

Speaking of useful posts from Twitter, former FDA Commissioner Scott Gottlieb shared this calculation that COVID-19 has spread so much in the USA that you have a 50% chance of being in a room with an infected person if you enter a room with 47 people in it. But the risk varies dramatically from place to place. In North Dakota, the risk is five times greater - the room needs to have only 10 people, while in New York, the 50% risk is only when around 100 people are present.

But perspective is important. A new study is out that concludes COVID-19 is highly infectious until about five days after symptoms begin — and not so much afterwards, even though viral particles can be detected sometimes for months. This puts the value of widely used antigen tests into some doubt, but it also emphasizes the importance of early detection of new infections — and for anyone who might be infected to isolate immediately and until they know they are not risking infecting others.

Preparation and planning also matters. CNN reports on a Virginia gym owner who worked with a local expert to improve safety during the pandemic. The effort was put to the test when a trainer reported that he had COVID-19.

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