An examination of the arguments that the coronavirus SARS-CoV-2 escaped from a lab in China, and the science behind them
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As of Tuesday, 178 health care workers employed by a Houston-based hospital system are on a two-week unpaid suspension after failing to meet the hospital system’s mandate to be fully vaccinated against COVID-19 by Monday, June 7.
Houston Methodist CEO Marc Boom announced the mandate in April, telling hospital staffers that if they failed to get vaccinated, they would be fired. The 178 suspended employees now have the two unpaid weeks to become fully vaccinated before termination. They can do so by getting the one-shot COVID-19 vaccine by Johnson & Johnson or a second dose of either of the two mRNA vaccines. Boom noted in a letter to employees sent Tuesday that 27 of the 178 suspended employees have received one dose of vaccine.
The Texas hospital system stood out in issuing the vaccination mandate. Many employers have shied away from mandates, though more employers have followed Houston Methodist’s lead in recent weeks. Overall, the mandate appears successful: about 97 percent of the hospital’s nearly 26,000 employees are fully vaccinated. Boom reported that 24,947 staffers were fully vaccinated, while 285 received a medical or religious exemption, and 332 were granted deferrals for pregnancy and other reasons.
The rate of COVID-19 vaccinations in the US has now slowed to a crawl after weeks of decline in the number of doses given out each day. The continued trend threatens to further drag out the devastating pandemic. It also now imperils a goal set just last month by President Joe Biden to have 70 percent of American adults vaccinated with at least one dose by July 4.
On Monday, the country’s seven-day average of doses administered per day was again below 1 million, where it has been now for several days. The average hasn’t been this low since January 22. In mid-April, the average peaked at nearly 3.4 million doses a day, following a record of over 4.6 million doses administered in a single day.
With less than a month to go until Independence Day, there’s a real possibility that the US will fall shy of Biden’s 70-percent goal. Currently, about 63.7 percent of adults in the country have received at least one dose. But a chunk of daily doses are now going to adolescents ages 12 to 17, who became eligible for vaccination last month. And total vaccination numbers are still on a significant decline. If current trends hold, the US may only have about 67 percent of adults vaccinated with at least one dose by the Fourth of July, according to one analysis conducted by USA Today.
The Centers for Disease Control and Prevention stunned health officials and experts May 13 with the abrupt announcement that people fully vaccinated against COVID-19 could forgo masking in most settings—indoor, outdoor, uncrowded, and crowded alike. The guidance was a stark reversal from the health agency’s previous stance, issued just two weeks earlier, that still recommended vaccinated people wear masks among crowds and in many indoor, uncrowded settings.
The CDC said at the time that it was merely following the science for masking. The agency and its director, Rochelle Walensky, highlighted fresh, real-world studies demonstrating COVID-19 vaccines’ high efficacy and ability to lower transmission risks. But the update was also part of an overt effort to encourage vaccination among the vaccine hesitant by emphasizing the perks of being vaccinated—like not needing to wear masks anymore and reclaiming other bits of normal life.
That messaging shift came as states across the country started to see their pace of vaccination slow despite a glut of vaccine doses. Numerous polls have indicated that most of the people eager to get vaccinated already have. Now, with just 62 percent of the US adult population vaccinated, much of the remaining unvaccinated portion is either hesitant or resistant to being vaccinated. It’s that group of people the CDC was trying to reach with the new mask guidance.
Ohio Gov. Mike DeWine’s “Vax-a-Million” program began Wednesday, running the first of five $1-million weekly lottery drawings open to residents who have been vaccinated. The effort is one of many incentive programs across the country aimed at getting vaccine-hesitant groups to roll up their sleeves, get vaccinated against the deadly coronavirus, and help end the pandemic.
But, while the lottery has already been hailed as a success in boosting vaccination numbers, conservative lawmakers in the Buckeye State appear to be diligently working toward reversing that trend.
Lawmakers are working on legislation to call off the lottery immediately. They’re also trying to head off any plans for “vaccine passports.” And last month, they introduced a sweeping antivaccination bill that would essentially demolish public health and vaccination requirements in the state—and not just requirements for COVID-19 vaccines, requirements for any vaccine.
Moderna’s COVID-19 vaccine appears safe and highly effective in adolescents ages 12 to 17, according to the top-line results of a small clinical trial the company announced Tuesday.
The company plans to submit the trial data to the US Food and Drug Administration early next month, seeking authorization for expanded use in the age group.
If the FDA grants the authorization, Moderna’s vaccine will be the second COVID-19 vaccine available for use in kids as young as 12 in the US. Earlier this month, the FDA authorized the Pfizer-BioNTech vaccine for use in adolescents ages 12 to 15. (The Pfizer-BioNTech vaccine was initially authorized for use in people ages 16 and up, while Moderna’s was initially authorized for use in people ages 18 and up.)
On Tuesday, the Centers for Disease Control and Prevention released the latest data on breakthrough COVID-19 infections, which are infections among people who have been fully vaccinated against the disease. Yet again, the data suggests that the vaccines are highly effective against infection, as well as severe disease and death. The data breakdown also hints that vaccines are winning the race against variants, which don’t seem to be breaking through at higher rates than expected.
Among approximately 101 million vaccinated people in the US as of April 30, the CDC collected reports of 10,262 breakthrough cases from 46 states and territories. That works out to about 0.01% breakthrough cases among the fully vaccinated. This number is almost certainly a significant undercounting, the CDC acknowledges.
Breakthrough monitoring is passive and voluntary; vaccinated people who had asymptomatic or mild COVID-19 infections may not have gotten tested or reported their cases. Only about 27 percent of the 2,725 cases tallied by the CDC were considered asymptomatic. Transmission of COVID-19 was also very high during the monitoring period reported, with about 355,000 COVID-19 cases reported nationally in the week ending on April 30.
Officials in Beijing are reportedly planning to roll out third doses of China’s COVID-19 vaccines. These shots have long been dogged by doubts of their efficacy.
According to a report by The Washington Post, health experts in China say that protection from the vaccines may not last after six months and that people who are at high risk of COVID-19 should get a third dose. Now, state-run media outlets suggest Beijing is on board with the suggestion and is preparing to offer the third doses.
Last week, both the United Arab Emirates and Bahrain said they would offer third doses of China’s Sinopharm vaccine to try to boost protection. UAE is offering the extra shots to anyone who was vaccinated six or more months ago. Bahrain is offering third doses to high-risk groups.
The governors of New York and Maryland on Thursday each announced big cash lotteries to entice their residents to get vaccinated against COVID-19. The announcements came as westward-neighbor Ohio celebrated the success of its “Vax-a-Million” lottery campaign, which helped boost week-to-week vaccination numbers 53 percent.
The lotteries appear to be part of a growing trend of states and officials offering cash prizes or other incentives to combat slumping vaccination rates. The country’s seven-day average for daily vaccinations has dropped to around 1.8 million, down from a peak of nearly 3.4 million in mid-April.
In a White House COVID-19 press briefing Friday, Senior White House Advisor Andy Slavitt said that, based on the data the administration has seen, the lotteries “appear to be working.”
As COVID-19 vaccination efforts continue across the United States, many are wondering how long protection from the shots might last. And if protection is relatively short-lived, what does that mean for the years ahead? Will we need boosters? Will COVID-19 vaccines become an annual jab like the seasonal flu shot?
In back-to-back public interviews, top infectious disease expert Anthony Fauci provided the current outlook based on the latest data. Boosters are looking likely, but it’s still unclear when we’ll need them, with current speculation landing in the range of a year or so after the previous vaccination. Whether we’ll need them every year seems, for now, dependent on how many people get vaccinated this year.
Speaking at an Axios virtual event Wednesday, Dr. Fauci emphasized that “we don’t know exactly when” a booster will be required. We know that the current vaccines remain protective for at least six months—“and likely considerably more,” Fauci added.
The US Food and Drug Administration on Wednesday announced a big change in the way doses of Pfizer-BioNTech’s COVID-19 vaccine can be handled. From now on, undiluted vials of the mRNA vaccine can stay at normal refrigerator temperatures for up to a month rather than the previous limit of just five days.
The change has the potential to significantly ease storage issues and promote the use of the highly effective vaccine, which has been hindered in some settings by its ultra-cold storage requirements.
For long-term storage, the vaccine still requires ultra-cold freezer temperatures—between -80°C to -60°C (-112°F to -76°F). But the vials can be transported and temporarily stored at normal freezer temperatures—between -25°C to -15°C (-13°F to 5°F)—for up to two weeks. According to yesterday’s update, the undiluted vials can then be thawed and kept at normal refrigerator temperatures—between 2°C to 8°C (35°F to 46°F)—for up to a month. Once the vials are diluted and ready for use, they must be used within six hours, according to the FDA’s detailed handling guide.
The Centers for Disease Control and Prevention is undergoing a shake-up amid criticism over its guidance for fully vaccinated adults, according to reporting by Politico. So far, two high-profile officials have announced their departure from the agency during the ongoing changes.
On May 7, Dr. Nancy Messonnier, the CDC’s top respiratory disease scientist who helped lead the agency’s response to the pandemic, announced her resignation effective May 14. Messonnier announced her departure just two weeks after new CDC director Rochelle Walensky restructured the CDC’s COVID-19 vaccine task force, which Messonnier had headed.
According to Politico, the restructuring meant Messonnier, who had been operating semi-autonomously, would now have to report to CDC’s incident response team overseen by Henry Walke, director of the agency’s Division of Preparedness and Emerging Infections. (Dr. Walke, in turn, reports to Walensky.) Amid the change, Messonnier took an “unplanned vacation” from the agency before announcing her resignation.
President Joe Biden announced on Monday that the United States will share at least 20 million doses of Pfizer-BioNTech, Moderna, and Johnson & Johnson COVID-19 vaccines with other countries over the next six weeks.
The pledged doses will be in addition to 60 million stockpiled doses of AstraZeneca’s vaccine the administration has previously said it will donate after they’re cleared by the Food and Drug Administration.
The announcement comes amid mounting pressure for the US and other rich nations to share doses with low- and middle-income countries, some of which are struggling with COVID-19 surges amid a dearth of doses. It also comes as the US has a glut of vaccine doses and is now struggling to convince a vaccine-hesitant portion of the population to take the available shots.
Criticism and confusion have erupted following the Centers for Disease Control and Prevention’s abrupt recommendation last Thursday that fully vaccinated people can immediately shed masks in most settings. The agency is yet again on the defense over its mask guidance.
Mask usage has been one of the most contentious issues throughout the pandemic—and that seems unlikely to change anytime soon. Just last Tuesday, CDC Director Rochelle Walensky faced a grilling from Senate Republicans, who suggested that the agency was being too slow and too conservative in its health guidance, particularly on the issue of outdoor mask use.
At the time, the agency recommended that fully vaccinated people should continue to wear masks in many uncrowded indoor settings as well as in crowded outdoor settings. “We will continue to recommend this until widespread vaccination is achieved,” Walensky said in an April 27 briefing. On that day, around 29 percent of the US population was fully vaccinated.
As part of an ongoing press conference, the Centers for Disease Control and Prevention responded to recent data on the effectiveness of vaccines and updated its guidance on mask use and physical distancing. Under the new guidance, anyone who is fully vaccinated (meaning two weeks after the final dose of their vaccine) can now skip mask use and social distancing both indoors and outdoors.
“Anyone who is fully vaccinated can participate in indoor and outdoor activities—large or small—without wearing a mask or physical distancing,” said CDC Director Rochelle Walensky. There are some exceptions; vaccinated people should still mask up in places like hospitals, airplanes, and other forms of public transport. But for the most part, people who have been vaccinated can return to normal activities.
The press conference is ongoing, and we’ll update this story once it’s over.
States will not receive shipments of Johnson & Johnson’s one-shot COVID-19 vaccine next week, according to a report by Politico.
White House officials told governors in a call Tuesday that there are no new doses available for order. It’s unclear if the federal government will be able to distribute doses through other channels, such as those that provide vaccines directly to pharmacies and community health centers.
The dried-up supply is just the latest trouble for Johnson & Johnson, which has consistently struggled to produce its vaccine in the US.
Charity Dean has been in the national spotlight lately because she was among a group of doctors, scientists and tech entrepreneurs who sounded the pandemic alarm early last year and who are featured in a new book by Michael Lewis about the U.S. response, called The Premonition.
It’s no wonder the press (and, seemingly moviemakers, too) are interested in Dean. Surgery is her first love, but she also studied tropical diseases and not only applied what she knows about outbreaks on the front lines last year, but also came to appreciate an opportunity that only someone in her position could see. Indeed, after the pandemic laid bare just how few tools were available to help the U.S. government to track how the virus was moving and mutating, she helped develop a model that has since been turned into subscription software to (hopefully) prevent, detect, and contain costly disease outbreaks in the future.
It’s tech that companies with global operations might want to understand better. It has also attracted $8 million in seed funding Venrock, Alphabet’s Verily unit, and Sweat Equity Ventures. We talked late last week with Dean about her now 20-person outfit, called The Public Health Company, and why she thinks disease-focused risk management will be as crucial for companies going forward as cybersecurity software. Our chat has been edited for length; you can also listen to it here.
TC: You went to medical school but you also have a master’s degree in public health and tropical medicine. Why was the latter an area of interest for you?
CD: Neither of my parents had college degrees. I grew up in very modest setting in rural Oregon. We were poor and by the grace of a full ride scholarship to college I got to be premed. When I was a little girl some missionaries came to our church and talked about disease outbreaks in Africa. I was seven years old, and driving home that evening with my parents, I said, ‘I’m going to be a doctor, and I’m going to study disease.’ It was outrageous because we were poor. My parents didn’t have college degrees. I didn’t know a single person with a college degree. But I was too young to know that there would be hurdles and blockers. My heart was set on that, and it never deviated from it.
TC: How do you wind up at the Santa Barbara County Public Health Department, instead of in private practice?
CD: It’s funny, when I was finishing up my residency, which I started doing general surgery — surgery is my first love — then I pivoted into internal medicine, I had a number of different doctors’ private practices come to me and recruit me because of the shortage of women physicians.
[At the same time] the medical director from the county public health department came and found me and he said, Hey, I hear you have a master’s in tropical medicine.’ And he said, ‘Would you consider coming to work as the deputy health officer, and communicable disease controller, and tuberculosis controller, and [oversee the] HIV clinic and homeless clinic?’ And . . . it was, for me, a fairly easy choice.
TC: Because there was so little attention being paid to these other issues?
CD: What caught my attention is when he said communicable disease controller, and tuberculosis controller. I had lived in Africa [for a time] and learned a lot about HIV, AIDS, tuberculosis, vaccine-preventable diseases, things you don’t see in the United States. [And the job] was so lockstep with who I was because it’s the safety net. [These afflicted individuals] don’t have health insurance. Many are undocumented. Many have nowhere else to go for health care, and the county clinic truly serves the communities that I cared about, and that’s where I wanted to be.
TC: Over the course of that job — and later at the California Department of Public Health — you developed a deep expertise in multi-drug-resistant tuberculosis. Was your understanding of how it is transmitted — and how the symptoms present differently — what made you so attuned to what was headed for the U.S. early last year?
CD: It was probably the single biggest contributor to my thinking. When we have a novel pathogen as a doctor, or as a communicable disease controller, you know, our mind thinks in terms of buckets of pathogen: some are airborne, some are spread on surfaces, some are spread through fecal material or through water. In January [of last year], as I was watching the news reports emerge out of China, it became clear to me that this was potentially a perfect pathogen. What does that mean? It would mean it had some of the attributes of things like tuberculosis or measles or influenza — that it had the ability to spread from person to person, likely through the air, that it made people sick enough that China was standing up hospitals in two weeks, and that it moved fast enough through the population to grow exponentially.
TC: You are credited with helping to convince California Governor Gavin Newsom to issue lock-down orders when he did.
CD: Everything I’ve done is as part of a team. In March, some amazing heroes parachuted in from the private sector, including [former U.S Chief Technology Officer] Todd Park, [famed data scientist] DJ Patil, [and Venrock’s] Bob Kocher, to help the state of California develop a modeling effort that would actually show, through computer-generated models, in what direction the pandemic was headed.
TC: How did those efforts and thinking lead you to form The Public Health Company?
CD: What we are doing at The Public Health Company is incorporating the genomic variant analysis — or the fingerprint of the virus of COVID virus as it mutates and as it moves through a population — with epidemiology investigations and [porting these with] the kind of traditional data you might have from a local public health officer into a platform to make those tools readily available and easy to use to inform decision makers. You don’t have to have a mathematician and a data scientist and an infectious disease doctor standing next to you to make a decision; we make those tools automated and readily available.
TC: Who are your customers? The U.S. government? Foreign governments?
CD: Are the tools that we’re developing useful for government? Absolutely. We’re engaged in a number of different partnerships where this is of incredible service to governments. But they’re as useful, if not even more useful, to the private sector because they haven’t had these tools. They don’t have a disease control capability at their fingertips and many of them have had to essentially stand up their own internal public health department, and figure it out on the fly, and the feedback that we’re seeing from private sector businesses has been incredible.
TC: I could see hedge funds and insurance companies gravitating quickly to this. What are some customers or types of customers that might surprise readers?
CD: One bucket that might not occur to people is in the risk management space of a large enterprise that has global operations like a warehouse or a factory in different places. The risk management of COVID-19 is going to look very different in each one of those locations based on: how the virus is mutating in that location, the demographics of their employees, the type of activities they’re doing, [and] the ventilation system in their facility. Trying to grapple with all of those different factors . . .is something that we can do for them through a combination of our tech-enabled service, the expertise we have, the modeling, and the genetic analysis.
I don’t know that risk management in terms of disease control has been a big part of private sector conversations, [but] we think of it similar to cyber security in that after a number of high-profile cyber security attacks, it became clear to every insurance agency or private sector business that risk management had to include cyber security they had to stand up. We very much believe that disease control in risk management for continuity of operations is going to be incredibly important moving forward in a way that I couldn’t have explained before COVID. They see it now and they understand it’s an existential threat.