Will the Pfizer and Merck pills move COVID-19 into endemic status?

From my inbox this morning:

Pfizer’s pill is the second to show significant effectiveness against COVID-19; Merck also has one that’s waiting for authorization from the FDA. Are these pills the next step toward moving COVID-19 from pandemic to endemic status?

A quick definition of our terms might be useful here:

  • A pandemic is a widespread outbreak of a disease, affecting multiple countries and their populations. The growth of the disease is exponential and there are few, if any, known preventive measures that can be taken against it.
  • An epidemic is an unexpected increase in disease cases in a specific geographic region. Epidemic diseases don’t have to be contagious; obesity and other health-related behaviors, such as smoking, can also be considered to be epidemic.
  • An endemic disease is one that is consistently present (like measles or influenza); in other words, it isn’t fully (or nearly fully) eradicated. There may be flare-ups in specific regions occasionally, but overall, the disease can be managed with existing preventative measures (as simple as effective hand-washing but also including the use of vaccines) or palliative measures (such as pharmaceuticals designed to alleviate the effects of the disease after it was contracted).

COVID-19 remains a pandemic. We have preventative measures, specifically several vaccines, that are proven to greatly reduce the chance of contracting the coronavirus that causes COVID-19. And those same vaccines also greatly reduce the severity of the illness, including nearly eliminating the chance of hospitalization and death, if someone gets COVID-19 in a “breakthrough” infection. To reach endemic status, as many people as possible need to be vaccinated or develop enough resistance to future infections from already having a COVID-19 infection (which doesn’t happen in every case, making getting a vaccination even after having COVID important).

Vaccinations have plateaued in the United States. According to CNN Health, the U.S. is 57.0% fully vaccinated, with an additional 9.1% having at least one dose administered to them. Among the G-20 nations that report overall vaccination percentages, the U.S. is twelfth, just behind Turkey and ahead of Mexico. (The table doesn’t include the European Union, which is the 20th G-20 member; or Brazil and China, which don’t report vaccination percentages for their populations.)

RankCountryFully vaccinatedOne-dose onlyTotal at least partially vaccinated
1South Korea76.2%4.5%80.7%
2Canada74.6%3.9%78.5%
3Japan73.4%4.7%78.1%
4Italy71.8%5.5%77.3%
5France68.1%7.8%75.9%
6United Kingdom67.1%6.4%73.5%
7Germany66.3%2.6%68.9%
8Australia66.0%8.5%74.5%
9Saudi Arabia61.4%7.3%68.7%
10Argentina57.8%18.5%76.3%
11Turkey57.6%7.7%65.3%
12United States57.0%9.1%66.1%
13Mexico46.6%10.7%57.3%
14Russia33.8%5.7%39.5%
15Indonesia27.8%16.7%44.5%
16India24.2%28.8%53.0%
17South Africa21.0%4.9%25.9%
COVID-19 vaccination rates for G-20 countries (Source: CNN Health)

Considering the enormous advantage the U.S. when vaccines first became available last winter, it’s frustrating to see how far behind we are in getting people vaccinated. But is that really unusual? Leaving aside politics (admittedly a difficult thing to do these days), we’re historically averse to getting vaccines that aren’t required by law: in 2019-20, just as we were becoming aware of COVID-19, only 51.8% of Americans six months and older got that year’s readily-available influenza vaccine, according to CDC data. Our current COVID-19 vaccine rate of 57% is just slightly higher than that figure.

COVID-19 has declined again across most of the U.S. As of November 3, there are hotspots in Minnesota, Colorado, Arizona, New Mexico, and parts of Maine, New York, Michigan, and Alabama. But it’s nothing like early September, when infections were rising nearly everywhere. While the college where I’m employed requires masks inside campus buildings, in the rest of town it’s very rare to see anyone wearing a mask in a restaurant, grocery store, or other retail business. Yet our numbers remain low, including the Rt number I’ve discussed before.

If the pills from Pfizer and Merck can be rolled out and the costs aren’t prohibitive (not a safe assumption, unfortunately), we might reach a place where, like the flu, at least a slight majority of people have chosen to get a vaccine and those who don’t have a simple, effective remedy. At that point, the realistic goal of turning COVID-19 from a pandemic to an endemic disease could be in sight.

And now, some good news

As we stumble through the last weeks of 2020, there’s some good news:

  • The Pfizer/BioNTech COVID-19 vaccine is being distributed in the U.K., will start to be distributed next week in the U.S., and other countries will soon follow. Other vaccines are also close to approval, either full or emergency authorizations, and should continue to expand the vaccination of humanity against the cause of the biggest social upheaval in the last century. The vaccines are highly effective, have few side effects, and while there will be significant challenges ahead in the logistics of getting people vaccinated, there’s definitely a light at the end of the tunnel. One of the biggest remaining hurdles is getting people who are skeptical or who have bought into disinformation about the vaccines to actually get the shots. Unfortunately, a lot of the people who say they will refuse to get vaccinated are the same ones who won’t wear masks and won’t follow social distancing guidelines.
  • In the long run, the “miracle” development of the various COVID-19 vaccines bodes well for the future. As this article in New York magazine explains, the Moderna vaccine actually only took a weekend to develop back in January, even before we started to see how disruptive COVID-19 would be. This is the product of incredible advances in the understanding of how viruses work, but it’s as much a result of sheer computing power. Scientists can now model, in three dimensions and in real time, the structure and behavior of viruses, and can try out theories and hypotheses in days instead of months or years. The vaccines against COVID-19 have their basis in work that was done on other coronavirus infections, including Severe Acute Respiratory Syndrome (SARS) in 2003 and Middle East Respiratory Syndrome (MERS) in 2012. This has positive implications for our ability to combat future viruses and also other diseases and illnesses, including cancer.
  • The U.S. Supreme Court refused – twice – to play ball with the Trump campaign’s ongoing attempt to overturn the results of the 2020 presidential election with nuisance lawsuits. On the 8th, the court refused to stop Pennsylvania from certifying the results of the election, issuing a single sentence response to the request from Republicans in that state. And late Friday, they also refused to consider the ridiculous lawsuit brought by the state of Texas that sought to invalidate the results in four key battleground states that went to Biden, based on alleged irregularities in the voting, including mail-in balloting. (Of course, similar “irregularities” happened in a number of states that went for Trump, but apparently those are okay.) The justices, in a 7-2 decision that included Trump appointees Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett voting with the majority, determined that Texas didn’t have standing to bring the case in the first place, so they didn’t actually make any judgment on the merits of the case, but it seems to bring to a conclusion any legal recourse the Trump campaign has.
  • Finally, the Lions have a new leader in coaching winning percentage, at least until tomorrow’s game with Green Bay. Darrell Bevell won his first game as a head coach last Sunday when his squad came back from behind to beat the Bears, 34-30. That gives Bevell a perfect 1.000 winning percentage. If the Lions somehow beat the Packers tomorrow, he might be on his way to taking the “interim” tag off his title, though I’d prefer that the team come up a with a long-term plan before rushing into that decision.

Enjoy the good news, and have a great week!

The will to work together to solve an epidemic: Polio in 1952

The disease had been known for many years. When it made an appearance in a town or county, schools closed and children were kept away from each other, because catching this disease could mean debilitating long-term consequences and even death.

In the worst outbreak of the disease, over 58,000 cases were reported in the United States, mostly children though a third of the cases were in patients at least 15 years old. 36% of those who contracted the disease that year – over 21,000 – were left with permanent physical problems, including mild to complete paralysis. If the paralysis was focused on the chest muscles, patients could suffocate unless an apparatus to assist breathing, an iron lung, was available.

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