with Alexandra Ellerbeck

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Around half a million Americans are now getting a coronavirus vaccine shot every day. But that pace must accelerate considerably if the United States has any hope of quashing the virus in 2021.

Public health experts differ on how quickly that might happen and when things might start to feel “normal” again around the country.

To inaugurate our first Health 202 of the new year, we asked eight experts for their predictions.

After all, we all want to know when we can go to concerts and ballgames again. Or even just go to the office. (Let’s start small.)

We asked two questions. The first has to do with when the United States will reach “herd immunity” — the point at which enough people are immune to a virus, either by recovering from it or getting vaccinated against it. Herd immunity generally kicks in when about 70 percent of people are immune, although experts differ on the precise threshold.

To reach herd immunity with the coronavirus, approximately 230 million Americans would need the vaccine. As of yesterday, just 4 million had gotten the first of two shots. Daily immunizations have increased considerably over the past few days, with about 500,000 people getting the shot each day, but experts say that number needs to at least double and ideally quadruple.

We also asked these experts when they personally expect their lives to return to normal.

Here are their responses, edited lightly for clarity and brevity.

When will enough Americans be vaccinated for the U.S. to reach herd immunity, based on how things look right now?

Carlos del Rio, professor of medicine and global health at Emory University

“At the current pace it will take a really long time. … I think if we can get our act together and start vaccinating 1 million people a day like President-elect Biden is promising, then we can get to 260 million people getting at least one dose … more or less or by late August or early September. If we really scale up and get to 3 million per day, then we can get to 260 million people in [less than] 100 days or three months. Can we do it? Yes! But it will require coordination, leadership and funding. So, as you see, my answer is: It depends.”

Eric Topol, director and founder of Scripps Research Translational Institute:

“I think by July, if we get 2 to 3 million people vaccinated per day, and even sooner, if we have a rapid neutralization antibody assay to be able to defer those who have had a prior infection and mounted a durable immune response. Yes, that is optimistic, but it can be done.”

Jay Bhattacharya, professor of medicine at Stanford University:

“There is a lot of disagreement in the scientific literature about the herd immunity threshold, which is certain to vary from place to place. I don’t think anyone responsible would confidently say what it is, and would never put forward a single number for the U.S. as a whole. Rather, the key question is how rapidly we inoculate people who have a high risk of mortality conditional on infection — most older folks and some late middle-aged folks with severe chronic conditions. Prioritizing them for vaccination will yield the greatest benefit in reducing covid-19-related mortality, regardless of when herd immunity is hit.”

Jesse Goodman, professor of medicine and infectious diseases at Georgetown University:

“I am not sure that in the near future we will reach a level of population immunity where the virus will be virtually shut down, as we are accustomed to with measles. Through immunity due to vaccination, combined, unfortunately, with infections in the unvaccinated, we should reach a state where the risk of exposure is reduced due to a mostly immune population. While cases will still occur, our health system will no longer be stressed and large outbreaks should be less common.

“I am hopeful we can get to such a situation in the last quarter of this year, provided vaccine production, access and acceptance go well and no mutant viruses arise that gain the ability to escape current vaccines.”

Kimberly Powers, associate professor of epidemiology at the University of North Carolina at Chapel Hill:

“That question is difficult to answer, as there is considerable uncertainty around the level of immunity we would need in the population to achieve herd immunity, along with the speed with which we can expect widespread vaccine uptake to occur.”

Leana Wen, public health professor at George Washington University and former Baltimore health commissioner:

“Right now, vaccine distribution is progressing at an unacceptably slow speed, and at this current rate, it will take years to reach herd immunity — if ever. If we are able to pick up speed by many times in January, there is still a chance we could substantially slow down the infection and perhaps approach herd immunity in 2021.”

Marc Lipsitch, professor of epidemiology at Harvard University:

“I think you mean ‘will enough Americans be vaccinated to reach the herd immunity threshold?’ My answer is possibly not because we don't know if the vaccines protect enough against transmission for the threshold to be achievable, and because the new variant may increase that threshold substantially.”

Michael Osterholm, chairman of the Center for Infectious Disease Research and Policy at the University of Minnesota:

“There are three factors that will independently determine when enough Americans will either be protected from covid-19 via vaccination or development of antibody following actual infection.

“First, when will there be sufficient vaccine produced and distributed so everyone can receive their two doses? This includes vaccinating those who may have immune protection from actual infection but are vaccinated anyway to increase durable protection. Second, will enough people agree to be vaccinated? And finally, what is the durability of vaccine-induced protection over time? 

“Each of these factors will play a role in achieving local, regional or national herd immunity protection. I feel confident we can achieve the first factor of sufficient vaccine by the late summer or early fall. But ultimately, the second two factors, how many will be vaccinated and how durable is immune protection will determine the answer to this question. I hope, when considering all three factors, it will be late summer or early fall, but we all realize hope is not a strategy.”

When do you expect your own daily life to feel similar to pre-pandemic times?

Carlos del Rio:

“I am hoping to be ‘close to normal’ by December 2021 more or less. However, as a physician seeing patients, I will probably continue to wearing a face mask and goggles for much longer.”

Eric Topol:

“In 2022.”

Jay Bhattacharya: 

“Given the changes that the previous year has had on my professional and personal life, I do not expect my daily life to ever feel similar to pre-pandemic times. More broadly though and given the disappointingly slow roll out of the vaccine to the vulnerable in many states, I anticipate that American society will start to feel more like normal by April 2021.

Jesse Goodman:

“Hopefully late this year, life should begin to feel similar to pre-pandemic times. However, it is likely that both great vigilance and some social distancing will still be needed, particularly if the population is not nearly all vaccinated. In addition, we may well require periodic immunization against the current and, possibly, other emerging coronavirus variants.”

Kimberly Powers: 

“I expect daily life to feel more normal by sometime this summer, but I think it will be 2022 before some mitigation measures can be fully relaxed.  And I expect that our society will feel ongoing consequences of this pandemic — physical, mental, emotional, and economic — for years to come.”

Leana Wen: 

“I don’t know. I was much more optimistic a few weeks ago. But given the lag in vaccine rollout thus far and how under-resourced our public health systems are, I am concerned things for much of 2021 will feel more like 2020 than 2019.”

Marc Lipsitch:

“I think that sometime in the second half of the year there will be enough vaccination in the U.S. and some other countries that we will begin to treat covid-19 more like seasonal flu, which is deadly to large numbers of people but does not overwhelm health care and does not cause us to curtail normal social contact. This is because with enough vaccine in those at high risk of death and hospitalization, transmission may continue (at a reduced level thanks to some immunity in the population from prior infection and vaccine) but the outcomes will be less severe.”

Michael Osterholm:

I’m not sure it ever will. We will not go back to a pre-covid-19 normal. We will instead exist in world with a new normal. And even that will in part be determined by the availability of adequate vaccine supply to cover everyone in high, middle and low income countries. I look forward to the day when my office hours are as they were pre-covid-19.”

Ahh, oof and ouch

AHH: Federal official says the U.S. may cut its Moderna doses in half to stretch the shots further.

Operation Warp Speed chief adviser Moncef Slaoui said Sunday the administration was in talks with Moderna and the Food and Drug Administration about giving people two half-doses of Moderna’s vaccine.

Slaoui told CBS’s “Face the Nation” that giving half-doses to people between the ages of 18 and 55 triggers the same immune response as two full shots of the recommended 100 microgram dose and would allow officials to immunize twice as many people with the vaccine currently available. Any changes to the vaccine doses would ultimately require FDA approval.

Slaoui described two half-doses as “a more responsible approach” compared with stretching out the time between shots. Health officials in the United Kingdom have said that they are aiming to get a first dose of the coronavirus vaccine to as many people as possible, even if it means delaying the second shot in the two-dose regimen.

The impetus to rethink recommendations comes as vaccine distribution falls far short of the Trump administration’s prediction that 20 million people would be vaccinated by the end of December.

Anthony Fauci, the government’s top infectious-disease expert, has cautioned against changing vaccine protocols, arguing that the emphasis should be on improving distribution. 

OOF: Top health advisers are pushing back against Trump’s claim the coronavirus death toll is exaggerated.

Yesterday, Trump tweeted that the U.S. numbers on coronavirus cases and deaths are “far exaggerated" compared with other countries.

“The numbers are real,” Fauci said during an interview with NBC’s “Meet the Press.” “Go into the trenches, go into the hospitals, go into the intensive care units and see what is happening. Those are real numbers, real people and real deaths.”

More than 350,000 people have died of the coronavirus in the United States this year and more than 20 million cases have been recorded. 

Surgeon General Jerome M. Adams also defended the numbers, although he declined to comment directly on Trump’s statement. “From a health perspective, I have no reason to doubt those numbers,” Adams said on CNN’s “State of the Union.”

Trump has repeatedly made baseless claims aimed at shedding doubt about the severity of the coronavirus, but health experts say the official coronavirus statistics match closely with excess mortality data showing many more people dying in 2020 than would be expected in a normal year.

OUCH: A new variant of the coronavirus is more transmissible.

A new variant of the coronavirus, originally identified in the United Kingdom, has been spreading around the globe, and a growing body of evidence suggests that genetic mutations have made it more transmissible. The United States has reported infections from the new variant in California, Colorado and Florida.

Public health officials have reassured the public that the new variant does not appear to be more deadly or cause people to get sicker, and they say the leading vaccines will still be effective against it. But the Atlantic’s Zeynep Tufekci argues that a more transmissible virus may be far more dangerous than a more deadly strain due to the mathematics of exponential growth, as each new infected person infects more people. With vaccinations lagging, a new variant could be potentially catastrophic.

“Take a virus reproduction rate of about 1.1 and an infection fatality risk of 0.8 percent and imagine 10,000 active infections — a plausible scenario for many European cities,” Zeynep writes, based on an analysis conducted by Adam Kucharski, a professor at the London School of Hygiene and Tropical Medicine. “As things stand, with those numbers, we’d expect 129 deaths in a month. If the fatality rate increased by 50 percent, that would lead to 193 deaths. In contrast, a 50 percent increase in transmissibility would lead to a whopping 978 deaths in just one month — assuming, in both scenarios, a six-day infection-generation time.”

Initial estimates suggest that the virus could be 50 to 70 percent more transmissible, although there’s still much that we don’t know about the new variant. It could turn out that the transmissibility has been overstated and that the dominance of the virus in the U.K. is due to chance or changed behavior among people.

But the United States may not have time to wait for better data before it acts. It appears that the new variant is still rare in the United States, but that could change quickly. “For exponential processes, small initial differences can mean gargantuan differences in the long run,” Zeynep writes. “We are in a race against time, and the virus appears to be gaining an unfortunate ability to sprint just as we get closer to the finish line.”

As new variants of coronavirus continue to be discovered, here's what you need to know about how these mutations work and how they spread. (The Washington Post)

Coronavirus latest

Chicken plants where the Trump administration approved faster line speeds were more likely to have virus cases.

A Washington Post analysis found that poultry plants that received waivers to increase the speed of their slaughter lines were 10 times more likely to have coronavirus cases than plants without waivers. Since 2018, the Trump administration has issued waivers to 54 poultry plants allowing them to increase the line speeds by 25 percent. Fifteen waivers were approved during the pandemic.

“Workers say the fast line speeds make it difficult, sometimes impossible, for them to socially distance during their eight-hour shifts as they struggle to work faster. Most of these plants are also large, employing thousands of workers who work in tight quarters, creating conditions that can fuel the spread of the virus,” The Post’s Kimberly Kindy, Ted Mellnik and Aurelis R. Hernández report.

The analysis is based on data from the nonprofit Food and Environment Reporting Network, which has documented more than 51,000 coronavirus infections among workers in beef, hog and poultry plants and 347 deaths.

The USDA is working to finalize a new rule that would make the increased line speeds permanent and expand them to other poultry plants, although it is unclear if the administration will be able to push the change through before Joe Biden takes office. Critics worry that such a rule change could harm worker safety even beyond the coronavirus. Carpal tunnel syndrome, tendinitis and other illnesses are common among people who work in meatpacking plants.

Mismanagement by the D.C. mayor and the intransigence of teachers' unions have kept schools closed in the District.

D.C. Mayor Muriel E. Bowser (D) was determined to reopen schools this fall. But changing plans and communication shortcomings on the part of the city, and shifting, hard-line demands on the part of the union, kept schools closed for months, squandering the chance to return the most vulnerable students to the classroom while infection rates were low, city officials, union leaders, educators and activists told The Post.

“As urban school districts across the country struggled with classroom reopening plans, a close look at the District’s experience shows how hard it has been to develop workable strategies — and how much power teachers wield, particularly when they have a strong union behind them,” our colleagues Perry Stein and Laura Meckler report.

“The District’s impasse meant it squandered the chance to give its most vulnerable children classroom time while infection rates were low," they write. "Now the earliest any students will have face-to-face instruction will be February." Meanwhile, children are falling behind.

Colorado discarded its recommendation to vaccinate prisoners early.

A revised version of Colorado’s vaccination plan no longer lists incarcerated people for priority vaccinations after an earlier plan, which put them ahead of the elderly and those with chronic conditions, sparked a political backlash, The Post’s Isaac Stanley-Becker reports. Accusations that politicians were coddling convicted murderers while the law-abiding elderly went without vaccines caught fire on social media and made their way into newspaper editorials and on Fox News.

A spokesman for Gov. Jared Polis declined to make the governor available for an interview but issued a statement defending the state’s plan, stressing the “moral obligation” to prioritize elderly people most at risk of dying from the virus and “front-line health-care heroes” caring for the sick.

“Inmate status will not make a difference in terms of timing of receipt of the vaccine,” the spokesman said. “Someone who falls into a category for early priority of the vaccine and is in custody will receive the vaccine at the same time as someone in the same category who is outside our correctional facilities.”

Colorado’s new vaccination plan also no longer lists people living in homeless shelters. Some experts say they are troubled by the decision to no longer prioritize vaccinations in congregate care settings. More than 40 of the 50 largest clustered outbreaks have occurred in jails or prisons, according to an article in the Lancet

More on the coronavirus vaccine

 

  • Even as millions of vaccines finally flow into hospitals and health departments, many Americans are confronting overwhelmed health systems. Some counties and hospital systems launched websites for vaccine reservations, only to find them immediately booked or crashed. A Florida health department that offered vaccines to older residents on a first-come, first-serve basis found people lined up in lawn chairs, The Post’s Brittany Shammas and Lori Rozsa report.
     
  • Pregnant women are agonizing over whether to get coronavirus vaccines. While health experts anticipate that the coronavirus vaccines, like most other vaccines, are probably safe for pregnant women and less dangerous than contracting the virus, they have not been tested and there is no safety data available. The Centers for Disease Control and Prevention, and the American College of Obstetricians and Gynecologists, said that vaccines should not be withheld from pregnant or lactating women, leaving the decision up to patients and their doctors, The Post’s Frances Stead Sellers reports
     
  • India approved two vaccines — the Oxford-AstraZeneca vaccine and the homegrown Covaxin — in preparation for a mass vaccination campaign. The country aims to administer vaccinations to 300 million people in the first phase, The Post’s Niha Masih reports.
     

Sugar rush