The coronavirus has done a lot of damage. Although we continue to receive messages from visitors to this website who maintain it is all a hoax, a lot of people have died from this disease. At last count, well over 170,000 people in the U.S. are no longer with us because of COVID-19. That means this virus is now the number 3 cause of mortality in the United States, just after heart disease and cancer. After looking at data from the CDC, we offer the following COVID-19 update: Deaths now exceed those from stroke, Alzheimer’s disease, diabetes, accidents, influenza and pneumonia.
Is There Some Good News in this Otherwise Grim Story?
In this COVID-19 update, we can report that we are starting to see declines in new cases in many states. Alabama, Arizona, Florida, Louisiana and South Carolina were especially hard him. But over the last couple of weeks these states have seen decreasing new cases (New York Times, August 20, 2020). Sixteen other states are also seeing fewer cases on a weekly basis.
There is more good news from states that are staying stable after significant declines. New York, New Jersey and Connecticut were early hot zones. We saw rapid increases in cases and tremendous challenges for health care workers. But then new cases dropped dramatically and have stayed down. The curves flattened, to use the current jargon. Nineteen other states are also “mostly the same” as they have been. That’s good news in this COVID-19 update.
Cases are increasing in the Dakotas, Hawaii, Kansas, Illinois, Delaware and Wyoming. Deaths are increasing in Nevada, Louisiana, Tennessee, Iowa and Oklahoma. But deaths are a lagging indicator. I am hopeful that we will see improvement in some of these states over the coming weeks.
The Wild Card in this COVID-19 Update:
Schools are the wild card in the COVID-19 update. They are just now beginning to open around the country. No sooner did the University of North Carolina at Chapel Hill welcome students back, then the University had to rethink the plan. Clusters of COVID-19 cases began cropping up in fraternities, sororities and residence halls. The student newspaper, The Daily Tar Heel, ran an editorial under the headline “UNC has a clusterf**k on its hands.” A lot of people were likely scandalized by the play on the word cluster.
Not long after the decision to shut down in-person classes at UNC, other universities followed suit. The University of Notre Dame is temporarily moving to online instruction. Michigan State, Drexel and the University of San Diego, have also abandoned in-person teaching. We suspect that as clusters crop up, more colleges will abandon in-person campus teaching.
Let’s not forget elementary, middle and high schools. These programs are reopening all across the country. The unanswered question is whether children will rapidly catch and spread the coronavirus amongst themselves, pass it to teachers and bring it home to parents and grandparents. What we cannot predict is whether this will start a so-called second or third wave. If so, how long it will last?
Can We Achieve Herd Immunity vs. COVID-19?
How long will it take to reach herd immunity? Public health authorities don’t know exactly what proportion of the population needs to be vaccinated or recovered to slow or stop viral spread. Some have suggested that it will take about 60 to 70 percent of the population, but others think it might be lower—maybe as few as 40 percent.
In some places that have been hit hard by COVID-19, herd immunity may be close. Some neighborhoods in Mumbai, London or even Brooklyn, New York, appear to have a significant proportion of people with antibodies to the coronavirus.
In certain Brooklyn neighborhoods, 80 percent of those tested showed antibodies, though the proportion in the borough overall is nowhere near that. Likewise, some crowded areas of Mumbai had 57 percent with antibodies. In the rest of the city, the rate of positive antibodies is between 10 and 20 percent.
The conventional way of thinking is that level of seroprevalence (antibody formation) will not get us close to herd immunity. Some models suggest that we would end up with 3 million deaths if we relied on the 60% threshold of exposure to the virus. But what if there were a less obvious, hard-to-test form of immunity?
T Cells and COVID-19 Immunity:
You have no doubt heard about antibodies. It takes the body awhile to start churning out antibodies to fight off an invader like SARS-CoV-2. They may not represent the best way to test for COVID-19 immune responses.
There is growing suspicion that standard antibody testing may not tell the whole story about COVID-19 immunity. New research suggests that people who have had mild infections could develop something called virus-specific T-cell immunity (Cell, August 14, 2020).
Even after antibodies disappear, T cells can retain their memory of the coronavirus for months, if not years. Exposed to it again, they would alert the immune system to fight it off.
A Different Hypothesis About Herd Immunity:
Some scientists speculate that a percentage of the population already has some degree of immunity against the coronavirus that causes COVID-19. These are not people who have been exposed to the virus responsible for this pandemic.
They may have caught a cold or some other coronavirus a few years ago. The T cells that were generated by that immune response may provide partial protection against SARS-CoV-2. That could be why so many people remain asymptomatic after exposure to this virus.
Others produce T-cell immunity as soon as they come into contact with the new coronavirus that causes COVID-19. A robust T-cell immunity could lead to mild symptoms and less mortality. Some places may be much closer to the 40% immunity than our testing reveals. That’s largely because we do not have good tests for T-cell immune reactions.
How To Explain COVID-19 Curves?
One of the puzzles about the coronavirus has to do with the death curves. If you look at COVID-19 curves for Belgium, Canada and Taiwan, it looks like they have made good progress (Our Word in Data as of August 20, 2020). These countries have mortality curves that look a lot like mountains. On one side, there is a steep slope to the peak and then a pretty impressive decline to a flattening.
Then there are other countries, like Japan and Israel, that did very well for awhile. Now the curves are going up again. Even the Netherlands is seeing an upswing in deaths in the latest COVID-19 update.
New York, on the other hand, has seen dramatic drops in both cases and deaths. Can NYC and the state of NY maintain this progress? Or will we see flares as they now have in Spain, New Zealand and Australia? By the way, it is winter down under, so the land of Oz may predict a second wave that so many people are concerned about in the US come cold weather. And remember, we have yet to determine the impact of school openings on cases.
Final Words:
There is so much we do not yet know about the coronavirus. Can we achieve herd immunity over the next few months through natural immune reactions? Are tens of millions already protected because they have partial or complete T-cell immunity to COVID-19? Will we have to wait for a vaccine to achieve herd immunity?
Sadly, we must wait for more data to begin to answer these questions. Stay tuned for the latest COVID-19 update here at The People’s Pharmacy. We will do our best to keep you informed about vaccines.
You may want to listen to our syndicated public radio show at 7:00 am this Saturday morning EDT. We will be interviewing one of the world’s foremost authorities on vaccines for COVID-19. He will tell you how long he thinks it will take to have vaccines in the clinic. You can hear Dr. Paul Offit by listening to the live streaming audio from WUNC-FM at this link. If 7:00 am is too early for you on Saturday, you can listen to the podcast on Monday morning. Just click on the podcast tab at the top of the home page.
