with Alexandra Ellerbeck

The pathway out of the coronavirus pandemic is looking somewhat bumpier than it did one month ago.

Three more transmissible strains are threatening to prolong the United States’s struggle with the virus. These mutations are tempering hopes that life might start feeling more normal by the summer – even as the daily pace of immunizations accelerates.

“The road to herd immunity from the coronavirus suddenly looks longer,” our colleagues Joel Achenbach and Ariana Eunjung Cha report. “The emergence of more transmissible, potentially vaccine-evading variants threatens to extend the global health disaster and make 2021 feel too much like 2020.”

“A complicated mix of good news and bad news makes any forecast for the coming months fuzzy,” they add. “But scientists have one clear and sobering message: The pandemic is a long way from over.”

Herd immunity could require more immunizations.

The three variants — first detected in Brazil, South Africa and the U.K. — don’t appear more deadly (with the possible exception of the U.K. variant). But there’s strong evidence they are more transmissible, which is unfortunate when it comes to trying to slow community spread, and could ultimately lead to more deaths if it infects more people. 

The greater the unvaccinated pool, the greater the playing field for the virus to replicate and mutate, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said on Friday. “If you stop . . . the replication, viruses cannot mutate,” he said, adding that this is the reason “to vaccinate as many people as possible, as quickly as possible.”

This is bad news for the quest to reach herd immunity, which is the point at which enough people are immune from a virus to stop its spread. “Herd immunity from a more transmissible virus requires a higher percentage of immunized people," Joel and Ariana write. “Early in the pandemic, scientists estimated that around 70 percent of people would need to be vaccinated or have developed natural immunity to reach the threshold at which the virus would not freely circulate. That number now seems too low.”

We asked experts to weigh in.

At the beginning of January, we asked epidemiologists and public health experts to predict when the United States might reach herd immunity — and when they personally expect their lives to return to normal.

Over the weekend we contacted them again, asking them to update their predictions based on the new variants. Here are their responses, edited lightly for clarity and brevity.

Health 202: Are these more transmissible coronavirus variants going to raise the 70 percent threshold? By how much?

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

“Yes, if there are variants that are more contagious, and they become the dominant strains in the U.S., it will probably take a higher threshold to reach herd immunity."

“It's hard to predict how much — but consider the case of measles, which is an extremely contagious illness. It's estimated that well over 90 percent of the population must have immunity from measles to develop herd immunity. The emerging coronavirus variants are not as contagious as that, but increasing their level of transmissibility means more people must be vaccinated to have the ‘community immunity’ protection.”

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

“It depends. If the variants increase the [basic reproduction number, the measurement for how transmissible the virus is] (like we think the UK variant does) then yes, we will need to increase the percent vaccinated and infected to reach herd immunity. Thus with an Ro of 2.5, herd immunity is reached at 60 percent. With the Ro increasing to 2.9, then the percent is 66 percent.” 

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

“The immune escape of the B.1.351 (South African) and P.1 (Brazil) variants will make it more challenging to attain population-level immunity. Hard to know what that threshold will be, but certainly [more than] 70 percent now.”

Marc Lipsitch, professor of epidemiology at Harvard University: 

I still hold the view that vaccination will help us get back to more normal function, not by stopping transmission and eliminating the virus through achieving the herd immunity threshold, but by moving in that direction and simultaneously preventing infection of the most vulnerable from being so deadly. The variants don't fundamentally change that.”

Health 202: Do the variants mean it will be even longer before life in the U.S. starts feeling normal again? 

Topol: “Yes, it means it will likely take longer. Instead of midyear to see marked containment of the virus, it’s going to be at least a few months delayed.”

Lipsitch: “Admittedly there is preliminary evidence that the U.K. variant may be more lethal than the prior strains (in unvaccinated people), but this effect, while important to understand, is not huge. More importantly, even in South Africa with the variant, as well as elsewhere, all existing vaccines show very good effects against severe disease and death.”

“Therefore, if we can achieve high coverage in the groups that are at high risk of dying if infected, the toll of the virus will be dramatically reduced, and we will be able to tolerate more cases while having fewer severe cases and deaths, and while returning our health-care systems to normal functions. The evidence so far does not make me think our ability to do that is fundamentally different because of the variants.” 

Wen: “The emergence of these more contagious variants is certainly worrisome, especially as there is preliminary evidence to suggest that the vaccines we are developing may be less effective against some of them. We could end up in a race where we keep on trying to play catch-up, with developing vaccines to variants that are trying to escape the immune protection afforded by vaccines.”

“It may be that the best we can get to is not total elimination of covid-19, but a situation where people who are vaccinated do not get severely ill. That is, people still get infected if they're vaccinated, but they don't end up in the hospital or die.”

Ahh, oof and ouch

AHH: President Biden has invited 10 Republican senators to the White House this afternoon to discuss coronavirus relief.

White House Press Secretary Jen Psaki said the meeting would involve “a full exchange of views” about their $600 billion counterproposal to his $1.9 trillion coronavirus relief plan, dubbed the American Rescue Plan.

“The group announced plans Sunday to release an approximately $600 billion coronavirus relief package as a counter-proposal to Biden’s much larger plan, posing a test for the new president who campaigned on promises to unify Congress and the country,” Erica Werner, Jeff Stein and Seung Min Kim report.

The senators, led by Sen. Susan Collins (R-Maine), have said they'll reveal the details of their proposal today.

“The planned meeting comes even as Democrats prepare to move forward this week to set up a partisan path for Biden’s relief bill, which Republicans have dismissed as overly costly given some $4 trillion Congress has already committed to fighting the pandemic, including $900 billion in December,” our colleagues write. “The GOP proposal jettisons certain elements that have drawn Republican opposition, such as increasing the federal minimum wage to $15 an hour.”

OOF: Top Trump officials lobbied Congress last fall to deny state governments extra funding for vaccine rollout.

“The push, described to STAT by congressional aides in both parties and openly acknowledged by one of the Trump officials, came from multiple high-ranking Trump health officials in repeated meetings with legislators,” Stat News’s Nicholas Florko reports. 

“Without the extra money, states spent last October and November rationing the small pot of federal dollars they had been given. And when vaccines began shipping in December, states seemed woefully underprepared,” he writes. 

Paul Mango, the former deputy chief of staff for policy at the Department of Health and Human Services, was central to the push. He argued that states did not need more money because they had not spent $200 million provided by the government earlier that year. 

“It’s true that the states hadn’t spent most of the money by October. State health departments, for their part, say there are several good reasons why. For one, they hadn’t begun vaccinating anyone yet. States were also drawing down other sources of funding that were set to expire. And they were reluctant to immediately spend the new funding because they were unsure when new funding would be appropriated by Congress,” Florko writes.

Congress eventually allocated $4.5 billion to state governments, but the money only began to flow earlier this month. In the meantime, the government fell far short of delivering the number of vaccinations that it had predicted.

OOF: The Biden administration is experiencing growing pains in its first 10 days of coronavirus response.

When Biden announced on the sixth day of his administration that he was hoping to achieve 1.5 million vaccines a day, instead of the 1 million his top coronavirus officials had been promising, it surprised everyone, “including many of his aides,” The Post’s Ashley Parker, Isaac Stanley-Becker and Annie Linskey report.

Biden’s team quickly reasserted that the official goal was still 100 million vaccines in 100 days but that it constituted a floor not a ceiling. But the episode underscored the struggles of an administration that is reckoning with the complexity of a mass vaccine campaign while still trying to control its message.

“Administration officials say Biden is regularly briefed about the pandemic and often asks about top-line issues as well as about how different communities are being affected, while largely leaving the technical specifics to public health officials and other government experts,” Ashley, Isaac and Annie write.

The administration has sought to improve forecasting of vaccine allocations to states and increase the federal role in administering shots. Biden’s team is also seeking to procure an additional 200 million doses of vaccine of the two coronavirus vaccines authorized in the United States. 

But this last hurdle may hinge on the administration’s ability to expand supply. Biden has said he will make greater use of the Defense Production Act to compel companies to produce certain goods, but many outside experts think that the law will have only a limited impact in the short term.

A failed freezer triggered a rush to give out 1,600 doses of the coronavirus vaccine.

When a freezer failed at Seattle’s Swedish Health Services, staff and volunteers rushed to administer hundreds of coronavirus doses that were set to expire in the morning.

“By the last shots, staff and volunteers were running out to the road on a cold night, at one point jabbing someone through the window of a car, Brooks said. One elderly woman in flip-flops was photographed rolling up her sleeve on the sidewalk just as the clock ran out,” The Post’s Hannah Knowles reports.

“It was a familiar story: Faced with expiring vials, health-care workers distribute vaccine doses at top speed, sometimes to whomever they can find. These impromptu giveaways have been controversial at times, with both waste and out-of-turn vaccinations sparking anger. Officials are juggling strict plans meant to prioritize the most vulnerable with the urgency of inoculating as many people as possible as quickly as possible against a deadly virus,” she writes.

In the end, none of the vaccines in Seattle were wasted, as people eagerly lined up in their pajamas to receive the shots. The race to give out the shots started at around 9 p.m. and ended when the last shots were given out at 3:45 a.m.  

Sugar rush

Power is shifting in the Senate as the Biden administration tries to negotiate a new round of coronavirus relief measures. (The Washington Post)