Responding to
COVID-19

"You never know how close you are to turning the corner
until you turn the corner.
Keep moving forward, one step at a time.
You will get there."
Fawn Germer
Is it too early to say we're turning the corner? Maybe.

The end of the pandemic means different things to different people. For some, it means that people are no longer getting sick from COVID-19. For others, it means that people are no longer dying from COVID-19. And for others, it means that they have stopped worrying about COVID-19 and have gone back to their pre-pandemic lives, perhaps because they've received their vaccinations or because they've simply chosen to go back to their pre-pandemic lives.

The World Health Organization termed the spread of the coronavirus a "public health emergency of international concern" in January 2020. It wasn't until mid-March that they changed their terminology to "pandemic." Regardless of what it's called, how individuals behave is what ultimately matters.

Fully eliminating transmission of the coronavirus, the most straight-forward definition of the pandemic's end, probably won't happen anytime soon, if ever. “This would require very high levels of vaccination coverage,” according to Celine Gounder, an infectious-disease specialist at New York University. And the United States will probably never reach high enough vaccination rates to do so. Nor will the rest of the world, for that matter.

So, perhaps the answer to the question rests on when we have the virus sufficiently under control. And that's a numbers game. According to Paul Offit, Director of the Vaccine Education Center and an expert in virology and immunology at the Children’s Hospital of Philadelphia, “the doors will open” when the country gets to fewer than 5,000 new cases per day, and fewer than 100 deaths per day. To put that in context, the flu kills 20,000 to 50,000 Americans annually, averaging out to between 55 and 140 deaths per day. “This risk is largely considered acceptable by the public,” observes Joseph Eisenberg, an epidemiologist at the University of Michigan. “The end to the emergency portion of the pandemic in the United States should be heralded . . . by the curtailing of severe illness, hospitalizations, and deaths from COVID-19,” suggests Monica Gandhi, an infectious-disease specialist at the University of California San Francisco. “Fewer than 100 deaths a day, to mirror the typical mortality of influenza in the U.S. over a typical year, is an appropriate goal.”

The comparison between flu deaths and COVID-19 deaths isn't perfect, however. Deaths attributed to COVID-19 are directly reported to public health authorities, while deaths from seasonal flu are CDC estimates based on national surveillance data that have been fed into statistical models. And testing for flu doesn't occur with nearly the same frequency as testing for the coronavirus. Additionally, neither count takes into consideration underlying factors. But the 100 deaths per day is a standard people can understand and so it will likely be the standard by which we measure the end of the pandemic.

It will likely take months for the number of daily COVID-19 deaths to fall below 100. Which means that, for some people, the pandemic will feel like it will never end. For others, it will feel that it’s over long before it actually is. That’s why public health experts continue to urge all of us to hold firm even as the pandemic seems to be receding. “We’re lifting mitigation measures too soon,” cautions Dr. Gounder. “We’re taking our foot off the brake before putting the car into park.” She warns that, if too many people ignore that message and decide the pandemic is "over" for them, it may very well put off the moment when we can say that the pandemic is over for everyone.
Will being vaccinated stop the spread of COVID-19?

Many scientists are reluctant to say with certainty that the vaccines currently being administered will prevent transmission of the coronavirus from one person to another. Unfortunately, for many people, this is interpreted as an admission that the vaccines don't work. That’s not the case. The vaccines prevent disease.

Limited data are beginning to suggest the vaccines will at least partly reduce transmission. Known as "sterilizing immunity," two recent studies show some pretty favorable results. One from the UK found that two doses of the Pfizer vaccine cut down a person's chance of transmitting the virus by 86 percent. The other, from Israel, found an 89.4 percent reduction in transmissibility. Johns Hopkins epidemiologists M. Kate Grabowski and Justin Lessler argue, “We are confident vaccination against COVID-19 reduces the chances of transmitting the virus.”

Until the data are confirmed, however, we won't know with certainty how well vaccines prevent infection. And as other vaccines come to market, such as the newly authorized one from Johnson & Johnson, more research will be critical. Viral variants will also complicate things.

Adding a bit of confusion to the complexity is the fact that the terms "COVID-19" (the disease) and "coronavirus" (the infection) are often used interchangeably. "You can’t have the disease without the virus, but you can have the virus without the disease, as many asymptomatic people already know," writes Dr. Angela Rasmussen, a virologist at the Center for Global Health Science and Security at Georgetown University Medical Center. That's why it remains important to continue masking and distancing in the presence of unvaccinated people.

The race to create vaccines against the disease caused by the coronavirus meant that clinical trials needed to focus on something easily observable - symptoms of COVID-19. Put simply, it was faster to identify participants who developed symptoms of COVID and then confirm infection with the virus, than it was to determine whether participants became infected with the virus but remained asymptomatic.

Vaccines often protect against diseases but not the viruses that cause them. Those of us of a certain age know that vaccines that don't prevent infection can still stop epidemics. The polio vaccine, developed by Dr. Jonas Salk, doesn't provide sterilizing immunity, but it did result in the rapid elimination of polio in the United States beginning in the 1950s. The Salk vaccine was highly protective against the disease and reduced the spread of polio because so many people were vaccinated early and could clear their infection.

Yogi Berra once commented, "it ain't over till it's over." He was talking about the 1973 National League pennant race. The same is true of the pandemic. It doesn't matter how we feel about our own risk of exposure, we need to respect the risk others may be facing. Until the numbers reflect a sustained reduction in spread, we haven't turned the corner. Please, continue to do everything you can to keep yourself and those around you safe and healthy.

I remain forever grateful for all that you do.
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Thank you for your vigilance. We want you to stay safe,
healthy, and informed.