Updated on: December 16, 2020

COVID-19: The Eight Obstacles Ahead

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Original story posted on: December 14, 2020

There is great news on the COVID-19 vaccine front. Scientists and pharmaceutical companies have developed a series of safe and effective vaccines in record time. The Food and Drug Administration (FDA) approved Pfizer’s COVID-19 vaccine last Friday, with Moderna’s likely to follow this week. Other vaccines are in the pipeline. Do these vaccines signal the beginning of the end of the pandemic? Perhaps, but there are many obstacles.

Obstacle #1: Skyrocketing Numbers
COVID-19 is out of control. An American dies of COVID-19 every 35 seconds. We are experiencing the equivalent of another 9/11 every day. Some 300,000 Americans have died from the coronavirus in the past nine months. In the past six weeks, hospitalizations have more than doubled. There are currently more than 100,000 patients hospitalized with the coronavirus, leading to a shortage of hospital beds. More importantly, as numbers soar, hospitals are running out of nurses, doctors, and other healthcare workers.

Obstacle #2: Disease Denial
Last week, a congressman-elect from Virginia called COVID-19 a “phony pandemic.” A fall survey showed that half of all Republicans and a quarter of all Democrats say the coronavirus is no more serious than the flu. There are multiple reports from nurses about patients on their death beds still denying that they had COVID-19. People who believe that it’s a phony pandemic are less likely to listen to the disease prevention recommendations of our public health experts or consider getting a vaccine.

Obstacle #3: COVID Fatigue
It has been nine months since the start of the pandemic. Americans are understandably tired of the isolation, the economic devastation, the total disruption of normalcy, and wearing masks. People are understandably getting sloppy with observing preventive measures. Even worse, some ignore rules and recommendations restricting large gatherings and social distancing. Many young adults have simply had enough. COVID fatigue has been blamed for the high volume of Thanksgiving holiday travel, despite the advice of the Centers for Disease Control and Prevention (CDC) to avoid it.

Obstacle #4: Anti-maskers
Many Americans refuse to wear masks. They claim that the request to wear a mask is an infringement of their personal freedom. There have been “no-mask protests” in a number of states. At a time when they had more coronavirus infections than any other state, North Dakota had a mask-wearing rate of less than 50 percent. President-elect Biden is recommending a 100-day mask mandate after his inauguration. Mask compliance will greatly impact the duration and severity of this pandemic.

Obstacle #5: Ineffective Therapeutics
There is no “magic bullet” that cures COVID-19. Treatment is primarily supportive care focusing on the delivery of supplemental oxygen. Dexamethasone, a steroid, is the only medication that scientific evidence shows improves survival, and it’s only beneficial in patients with severe disease. None of the other medications reduce deaths, and hydroxychloroquine actually appears to be harmful. The antiviral agent Remdesivir is currently the only drug that is approved by the Food and Drug Administration (FDA) for treatment, and three weeks ago the World Health Organization (WHO) stopped recommending it because it has "no important effect" on survival.

Antibody cocktails, like the Regeneron product that President Trump was given in October, show some promise, but Emergency Use Authorization (EUA) isn’t the same as evidence-based efficacy. As of now, these new treatments are still too expensive and are generally unavailable unless you are a VIP.

Obstacle #6: Vaccine Availability
There is limited early production and a two-dose requirement, along with distribution and storage challenges, for both the Pfizer and Moderna products. Immunization of front-line health care workers and elderly living in long-term care facilities commences this week, but it could be more than six months until a vaccine is available for all Americans.

Obstacle #7: Vaccine Acceptance 
The success of a vaccination program is contingent upon the public’s willingness to get vaccinated. Even after excluding the anti-vaxxers, polls show that many Americans are hesitant to take it. They are distrustful of the both the speed of development and the politicization of the process. Annual flu vaccination rates are usually less than 50 percent. That percentage for COVID-19 will be too low to reach herd immunity, which is the presence of enough immune individuals in the population, or 70 percent of all Americans receiving a vaccine. Government officials and celebrities will have to lead by example and get vaccinated to help promote confidence and broaden public support of the vaccines.

Obstacle #8: Vaccine Unknowns
There are many vaccine questions. Duration is the biggest one. How long will they provide protection? A month? six months? A year? Longer? Will we need booster shots to stay protected?

Will vaccines prevent transmission after virus exposure, or will they primarily reduce disease severity? We don’t know. It still may be possible to transmit COVID-19 after being vaccinated.

Are vaccines safe for everybody, especially young children and pregnant women, who have not been included in any of the vaccine trials? These groups may be among the last to be offered immunization. Of note, last week a few people vaccinated in the United Kingdom with the Pfizer product had dangerous allergic reactions, so individuals with a past history of severe allergies will also likely need to wait for new vaccines and additional scientific studies.

Are we at the beginning of the end of the pandemic? The end will be when we reach herd immunity. When depends on us: our willingness is to look at the data and acknowledge that COVID-19 is real. Our willingness to listen to our public health experts and avoid large gatherings, (especially around the upcoming holidays), maintain physical distancing of at least six feet, wash our hands regularly; and get vaccinated. And most important is our willingness to wear masks until we reach herd immunity. If we don’t willingly take these steps, despite the excitement and promise of COVID-19 vaccines, there will be a whole lot of hurt well into 2021.

John Foggle, MD, MBA

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