5. FA24 COVID-19 and Pandemic Management-2
.pptx
School
University of Illinois, Urbana Champaign**We aren't endorsed by this school
Course
IB 230
Subject
Medicine
Date
Dec 15, 2024
Pages
28
Uploaded by BarristerCrown11611
Lecture 5: COVID-19 and Pandemic Management
What are the major avenues for controlling a pandemic in the 21stCentury?•Medical Intervention•Testing•Vaccination•Treatment•Social Distancing•6 ft of space in general (or more if exercising) •Quarantine/Lock downs•Travel restrictions•Personal Protective Equipment (PPE)•Masks•Face shields•Glasses/goggles•CO2monitors •We breathe out CO2, so these measure the amount of exhaled breath in the room, which correlates with risk•Hygiene•Hand washing/sanitizer•Cleaning/wiping down surfaces•Air purifiersThis lecture will focus on vaccination and large-scale population movement restrictionsAdam Maida
COVID-19 VaccinesProgress in one yearLast updateVaccines are a powerful pandemic control tactic. As bad as the numbers looked in last week’s lecture, without these vaccines, both the case and death count would be exponentially higher.
Vaccine Trial ProcessPhase 3 efficacy trials for the COVID-19 vaccines took place in COVID-19 hotspots to ensure an accurate picture of how well the vaccine worked to prevent illness
Types of VaccinesMost used COVID-19 Vaccines: Pfizer-BioNTech (mRNA), Moderna (mRNA), Oxford/AstraZeneca (viral vector), Johnson & Johnson (viral vector), Sinopharm (whole microbe-inactivated), Sinovac (whole microbe-inactivated), COVAXIN (whole microbe-inactivated), Covovax (protein subunit), CanSino Biologics (protein subunit)Other types of vaccines:-Whole microbe: either live attenuated (weakened) or inactivated (killed), works similarly to subunit proteins, but includes the whole pathogen -Toxoid: target a toxin produced by the pathogen instead of the pathogen itself
COVID-19 mRNA Vaccines•In December 2020, two “genetic vaccines” using mRNA were approved for emergency use following phase 3 trials indicating higher than 90% efficacy•The first mRNA vaccines approved for use in humans, both proved highly effective and incredibly safe•New tech can breed doubt as there is not a long record of safety. However, a lot of new tech has actually been worked on in animal models for much longer. mRNA tech has been studied since the 1990s.•Part of why mRNA COVID-19 vaccines were able to be developed so quickly is that there were already prototypes for mRNA vaccines underway.•mRNA vaccines are considered by many to be the best vaccines developed by science as they are very safe and are highly immunogenic (produce an immune response)Contain a synthetic snippet of the coronavirus’s genetic material, called messenger RNA or mRNA, that the vaccine delivers into our cells. The cells read the mRNA and make spike proteins that provoke an immune response.(no longer updating) https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.htmlThe spike protein is what SARS-CoV-2 uses to attach to the host cell
15 years1 yearFactors that allowed the process to move faster:•mRNA vaccines were already in development•Due to urgency, steps were overlapped instead of doing each step in order. For example: infrastructure for vaccine production was built prior to approval. This allowed for immediate production rather than 4 or more years of building first.Main takeaway: The COVID-19 vaccines still needed to go through every step of the approval process, it just moved much faster, and a lot of bureaucratic steps were greased.https://www.nytimes.com/interactive/2020/04/30/opinion/coronavirus-covid-vaccine.html?searchResultPosition=8
A previously under recognized science hero: Katalin Kariko•“The development of the Pfizer-BioNTech coronavirus vaccine, the first approved jab in the West, is the crowning achievement of decades of work for Hungarian biochemist Dr. Katalin Kariko, who fled to the US from communist rule in the 1980s.”•At the time, DNA was the big story, and RNA was under studied and not seen as important research•Dr. Kariko actually didn’t receive tenure from the University where she developed this work and was demoted several times•Luckily, she didn’t switch research topics despite significant career setbacks and transitioned out of academia and into industry•This led to her work being recognized as a potential game changer within industry and the potential for mRNA vaccines really took offDr. Kariko was recently awarded the Nobel Prize in Medicine!!!
U.S. Vaccination Rates•Once one of the global leaders in COVID-19 vaccination, now the U.S. is plummeting in ranking of %vaccinatedhttps://coronavirus.jhu.edu/vaccines/international
U.S. Vaccination Rates•The CDC still recommends getting your COVID-19 booster for 2024-2025 cold and flu season•U.S. now has 17% of it’s population boosted, highest in the elderly population•Flu vaccinations are about 50% for all ages •Lack of booster dose uptake is often because: •Some doctors won’t suggest the booster unless they are elderly or immunocompromised. •Many healthy people don’t feel that COVID-19 is a big risk anymore
The Vulnerable Unvaccinatedhttps://www.nytimes.com/interactive/2023/us/covid-cases.html•Being unvaccinated puts people at higher risk for:•COVID-19 infection (3x risk)•Severe COVID-19 infection requiring hospitalization (2-6x risk- depends on age/general risk profile)•Death from COVID-19 (4x risk)
Inequity in the Global Vaccine Distribution(last updated March 2023) https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html>5.5 billion people- at least one dose•Early on in vaccine development, wealthy countries like the US, Canada, Australia, and some countries in Europe made deals with vaccine manufacturers to provide them with more vaccines than they needed before distributing to other countries. This left poorer countries without.•India and China are major vaccine producers and so were able to supply their own countries.•Wealthy countries were criticized for hoarding vaccines when pandemic management necessitates a global, rather than national, approach.•In response, wealthy nations, after they received their vaccine distributions, agreed to cooperate to provide vaccines to poorer countries•The U.S. is currently ranked 6th(adjusted for pop size and GDP) in vaccine donations
When we stop tracking and testing•Many organizations that previously tracked COVID-19 pandemic metrics (tests, cases, hospitalizations, deaths, vaccination status, etc.) stopped reporting long before the WHO declared an end to the pandemicHow could this be a problem?Not tracking and testing means we don’t have an accurate picture of COVID-19 community spread. Most people do not report positive COVID-19 cases from at-home tests. This means that estimates of community disease load are often tracked more by hospitalizations and deaths, when it is often too late to stop a wave in the community. This makes it harder for people to make decisions about how to protect themselves and others.
Herd Immunity and COVID-19•“Herd Immunity” refers to the protection offered to unimmunized individuals in a population by a high percentage of immunized individuals•Due to age or medical conditions, some people are unable to be vaccinated, or unable to produce a vaccine response•Two ways to achieve herd immunity: vaccine-derived or naturally-acquired immunity from infection (if protective)•Generally, requires immunity rates of 75-95%•Due to new variants, the Mayo Clinic estimates we will require over 94%immunity to achieve herd immunity for COVID-19Proportion ImmuneDisease Prevalence0100
Is “natural” immunity better than vaccine-induced immunity?•Complicated, but the answer for many reasons is NO•1/3 of natural infections do not produce an effective antibody response•Successful natural immunity from COVID is also not long lasting, leading to higher risks of re-infection•Risk of complications and death from COVID far outweigh risks of complication and death from vaccination even for young people•People who got COVID and then were vaccinated were 5x more protected against reinfection than those who had COVID and then were not vaccinated•However, natural infection PLUS vaccination is more protective than either alone in otherwise healthy adults for the amount of time that natural immunity lasts (not long).All that being said, repeated COVID infections have their own risks even when vaccinated and should be avoided.
Vaccine Hesitancy•Defined by WHO as a “delay in acceptance or refusal of vaccines despite availability of vaccination services”•Reported in more than 90% of countries•Although GLOBAL maps of vaccine hesitancy and vaccine access do not match up, indicating that vaccine hesitancy isn’t driving the lack of vaccination in these areas, it’s the lack of access•Threatens the historical achievements made in reducing the burden of infectious diseases
Vaccine Hesitancyhttps://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-10/COVID-Cohn.pdfVaccine hesitancy is often conflated with being an anti-vaxxer. There are many reasons people have doubts about vaccination, some of them are valid concerns. We have to address these without judgement in order to alleviate fears. Strong negative reactions are why many vaccine hesitant people never get the answers they need to feel safe. Reasons for vaccine hesitancy:•Inequity in access to healthcare and knowledge about health•Lack of effective public messaging •Structural racism within the healthcare and research fields•Poor access to information about vaccines (lack of computer or internet, etc.)•Unclear expectations of the vaccine experience•Barriers to accessing vaccine (may not be totally anti, but may work or need to care for children during times vaccine appointments are available, or may not be able to take off work if the vaccine makes them feel sick)
Vaccine Hesitancy and Structural RacismThe medical and research fields have a long history of unethical, exploitative, and cruel experiments on minority communities. This has led to a valid distrust based on community and self-preservation. These are a few of the experiments, but there are many many more. These communities continue to lack adequate access, treatment, and care, as the medical system is not set up to help them (ex. most doctors are trained in how different diseases show up on white skin, which can lead to misdiagnosis)•The father of gynecology•Many techniques currently used are based on experiments that J. Marion Sims conducted on enslaved African women during the 1800s•The Tuskegee Experiments 1932-1972•Infected 399 Black men with syphilis (and didn’t tell them)•When antibiotics emerged as an incredibly effective treatment, the men were not told and were used as a “control”•28 died from syphilis, 100 died from complications, 40 wives were infected, and 19 children were born with congenital syphilis •Radiation experiments (1960-1971)•Exposed 88 cancer patients, mostly Black, to high levels of radiation in the guise of “treatment”•In reality the study was funded by the pentagon to assess radiation fears brought on by the cold war. •A quarter of the participants died from radiation poisoning.•Forced sterilizations•In the 1970s, thousands of Indigenous women in the US were sterilized without their consent or knowledge•Estimates are that about 25% of Indigenous women were sterilized, but are thought to be higher•Pharmaceutical company malfeasance: Pfizer’s own history•In order to get around new IRB and other review boards for medical experimentation, many companies “outsourced” medication efficacy testing to poorer countries•In 1996, Pfizer tested medications on 100-200 children in Nigeria without parental consent. 11 died and more suffered cognitive effects. •Pfizer was sued, and in 2011 settled with some of the children’s families
Vaccine Hesitancy and Unclear ExpectationsKnowing what to expect from a medication, procedure, experience, etc. prepares people and makes them feel safer when they experience side effects.•Unmentioned side effects•The intensity of the mRNA vaccines•Many people did not expect the side effects of the COVID-19 vaccines to make them feel so sick (particularly the mRNA vaccines)•Feeling sicker than expected made some people think they were reacting unusually or having a bad reaction•Because the knowledge of these side effects often came from community rather than medical professionals, this bred distrust •Menstrual disruption•Menstrual disruption occurred in many female patients after receiving the COVID-19 vaccines•The most likely response was heavier periods, or unusual spotting.•Menstruation is an important indicator of overall health, so disruptions cause increased fear.•Menstrual disruptions were not included as a side effect as they were not assessed during the efficacy trials •Not being listed as a known side effect led to many people being dismissed by their medical providers when they mentioned their symptoms•The misinformation campaign around the COVID-19 vaccines latched onto this symptom to drum up fear of miscarriage and decreased fertility•There is no increased risk of miscarriage or effect on fertility•This is ongoing research in the Clancy Lab at UIUC!
US Vaccine-Only Focus •The US has chosen a primarily vaccine only approach to pandemic control. •There is an insistence that we MUST return to a “new normal”•This emphasizes:•Return to in-person activities/work/education•Stop masking•Economic concerns driving health decisions•There has been a large push that the reason we must return to this “new normal” is that our economy must be protected.•There is validity to economic fears. Economic recessions can drastically affect standard of living, especially for those most vulnerable, and can even lead to government instability.•However, the mortality we have seen with COVID-19 has disproportionately affected essential, or front-line, workers. •These front-line workers are majority low-wage occupations, indicating that a vaccine only plan that sees COVID-19 transmission as inevitable, is already affecting the most vulnerable people in our society•Rates of COVID-19 infection have led to complications within the healthcare field•Waves of COVID-19 infections place a burden on medical facilities, leading to crowded or unavailable hospital space•This leads people to die from preventable causes because there are not available beds, or surgeries must be delayed•Death rates among healthcare workers are some of the highest (nurses especially as they have high patient contact)
US Vaccine-Only Focus Mental health•The impact of the pandemic, and ensuing isolation, should not be taken lightly. There are estimates that the mental damage of the pandemic will last for decades. •Since the start of the pandemic, there has been a 25% rise in depression and anxiety across the globe•Mental health effects from the pandemic are highest in young people•Up to 70% of college students now report struggling with their mental health•Humans have always lived in groups and need human contact to thrive. This is especially true for children/adolescents who need socialization for development (both behavior and cognitive)•Who is left behind in a “return to normal”? Two affected groups are disabled/chronically-ill people and medical workers.•Many people in these categories have elevated risk profiles (health and exposure status)•One-sided mask wearing is much less safe than everyone masking•Medical workers are over-worked and understaffed due to the high rate of medical provider deaths from COVID-19•This is both mentally and physically taxing. •There is limited ability to track community spread and therefore preparing for waves is difficult.•This has led to a lot of hurt and frustration within the medical community as they feel detached from their communities•Minimal masking and lack of ability to track community spread effectively leads to many disabled/chronically-ill people being unable to engage in normal activities as they cannot exist safely in public (from socializing to grocery shopping).•This often includes not being able to travel over longer distances because they cannot take planes, trains, or buses because enclosed spaces increase risk. This can interfere with necessary medical appointments and treatments.•This has led to a lot of frustrations among disabled/chronically-ill people as they feel that not only is their mental health not as important, but that their communities don’t care if they die.How do we balance our need for human contact with limiting COVID-19 transmission (without leaving people behind)? What do you think?
Population Movement ControlTravel Bans•This term is used regularly to refer to large scale population movement i.e. planes and inter-country travel•At the beginning of the pandemic, this was a major step to combat the spread of COVID-19 and most international travel was locked down•Later studies found banning entry into a country only delayed the arrival of COVID-19, but had little effect on outcome (with exceptions)•There is variation in travel bans/restrictions. Some countries banned ALL incoming traffic, others restricted based on case load, vaccination status, proof of negative COVID test, and/or with a quarantine period upon arrival•Current travel restrictions have mostly been removed with limited exceptions:•Djibouti, Niger, and Republic of the Congo all require proof of negative COVID test for entry•East Timor requires proof of negative COVID test and quarantine upon arrival•Nauru, Turkmenistan, and Western Sahara are still closed to all outside travelWithin-Country Movement Restrictions•Quarantine•There are two avenues for quarantine- from positive exposure or presumption of exposure due to travel•Different countries have different standards for how long to quarantine after a positive exposure. We know from last week that you can take up to 14 days to show symptoms. The current CDC recommendation is only 5 days largely due to political pressure.•Lock down•Lock downs mean no movement of people. This is separate from travel bans, as this restricts movement within a country, city, or location. People are generally required to stay where they have been locked down (not necessarily at home) until the lock down is lifted.•This is not a common strategy employed in the fight against COVID-19, largely because it requires a centralized power structure that can make decisions and move quickly, and a somewhat militarized enforcement policy.
Case Studies: New ZealandNew Zealand (pop. 5.228 million)•Deaths from COVID-19: 3,445 •2.4 million cases total•Reasons for success:•Island- this is an exception to the travel ban rule. Islands are better able to regulate incoming traffic and are therefore better able to screen people.•Required quarantine and testing upon arrival•As of October 2022, all restrictions have been rescinded. This led to an increase in cases throughout the country, up to a 30% increase in some areas.•Communication- the government prioritized public health messaging to ALL communities, listened to scientists, and engaged in transparent communication with the public
Case Studies: ChinaChina (pop. 1.425 billion)•Deaths from COVID-19: 121,790 •Over 99 million cases•Reasons for success:•China had a very strict zero COVID policy until Dec. 2022•Waiting until vaccines had been administered to drop restrictions meant the overall spread and death toll was lower•Centralized control with government allows for fast decision making as only a small group of people are making those calls. •Electronic monitoring- allows for centralized data collection and communication•Lock downs- China made widespread use of lock downs to control COVID-19 transmission, often with little warning.•These lock downs happening so abruptly means that people can be left without access to medical care or food. There are reported deaths due to these lock downs and they have been criticized for restricting the human rights of their citizens.There were several lock downs at theme parks like Shanghai Disneyland, where patrons could not leave until they tested negative
Case Studies: PortugalPortugal(pop. 10.247 million)•Deaths from COVID-19: 27,630 •5.63 million cases•Reasons for success:•Enacted an immediate “worst-case scenario” and went into lockdown before cases rose•Called on the morality and responsibility of citizens to protect the country•Put a military figure in charge of the vaccination program, who resisted politics and framed it as Portugal vs COVID•Reversal of policies in 2021/2022 led to a massive rise in cases, but death toll remained lower due to vaccinesWhat do you think the U.S. could have done differently to prevent the spread and mortality of COVID-19?“The first thing is to make this thing a war,” Admiral Gouveia e Melo said in an interview, recalling how he approached the job. “I use not only the language of war, but military language.”
COVID-19 MisinformationCOVID-19 misinformation has been rampant throughout the pandemic•Misinformation contributes to:•Anti-vax sentiments •(microchip, kills fertility, poison)•Ineffective testing methods •(hold your breath for 10 seconds)•Unsafe or ineffective treatments •(horse antiparasitic, drinking methanol or bleach, etc.)•Unsafe or ineffective preventative measures •(using cocaine, heating sinuses with a blow-dryer, various oils/tinctures, etc.)•Inaccurate information about the virus itself•(will be killed by winter cold, “just the flu”, natural immunity is better)•Social media and misinformation:•Many people, especially young people, now get most of their news or information about the world from social media (estimates range from 30-70%). With COVID-19, this led to wildfire misinformation campaigns as there is very little fact checking on social media. •Several social media companies responded by attaching a disclaimer to posts about COVID-19, but this does not stop the information from traveling.•The problem with “do your own research”•Algorithm bias•Internet algorithms (like Google, YouTube, and any For You page) is based on your activity, and so suggests things it thinks you want to see.•The Google algorithm has been found to have bias separate from user bias that suppresses content •Not everyone has the scientific background to evaluate medical information, leads to misinterpretation and confusion
The End of the Pandemic as We Know ItThe WHO declared the end of the global emergency of COVID-19 on May 5, 2023President Biden declared the public health emergency of COVID-19 was over on May 11, 2023•COVID-19 is here to stay- are we at the endemic stage yet?•Governments say yes, medical professionals say it’s not that simple•We haven’t solidified seasonality of COVID-19 surges yet, and are still experiencing unexpected waves•Compare to the flu where there are very easily to predict patterns in disease burden (in normal flu years, not 1918)•Why does classification as a “pandemic” or “global emergency” matter?•There is concern that downgrading the emergency level will mean there will be less motivation/pressure on wealthier nations to share vaccines and other resources, which could lead to new variants•Access to resources may be more difficult as pandemic era policies end, but pandemic era pressures remain•Increased apathy and misinformation when precautions are still warranted
The End of the Pandemic as We Know ItAn article published in Nature in April 2022, “ An equitable roadmap for ending the COVID-19 pandemic”, have outlined three suggestions for how to end the pandemic while protecting the vulnerable.1.Increase production of vaccines, make them affordable and readily available to all countries across the world. They state the vaccine donations from wealthy countries are not enough to ensure everyone is vaccinated. They promote the use of emergency intellectual property waivers to ensure optimal and expedient vaccine production.2.Governments should develop a public health plan based in science to surveil disease burden, flexible reintroduction of PPE, support for health services burdened by the pandemic, and work to rebuild trust.3.Protect the vulnerable. This includes the massive burden on healthcare workers, both mental and physical. They suggest occupational and mental health programs as well as ensuring adequate staffing to prevent burnout. Better research funding for long-COVID is also included, as well as making sure policies do not leave immunocompromised/otherwise at-risk people behind. Mukaigawara et al. 2022