Worse ahead; don’t stop fight, urge health leaders

NEW YORK — With a covid-19 vaccine poised to roll out as early as this week in the U.S., top health officials warned Americans that this is no time to let their guard down, as the current surge of virus cases is expected to worsen.

“The vaccine’s critical,” Dr. Deborah Birx, the White House coronavirus response coordinator, said on NBC’s “Meet the Press.” “But it’s not going to save us from this current surge. Only we can save us from this current surge.”

A Food and Drug Administration advisory panel is scheduled to take up a request Thursday to authorize emergency use of Pfizer’s vaccine. Vaccinations could begin just days later, though initial supplies will be rationed, and shots are not expected to become widely available until the spring.

The Centers for Disease Control and Prevention is recommending that health care workers and nursing home patients get priority when the first shots become available.

Both Pfizer’s vaccine and a Moderna vaccine that will also be reviewed by the FDA later this month require two doses a few weeks apart. Current estimates project that a combined total of no more than 40 million doses will be available by the end of the year. The plan is to use those to fully vaccinate 20 million people.

Meanwhile, some U. S. health experts are urging President-elect Joe Biden’s administration to put in place a comprehensive national testing strategy once he takes office.

With the U.S. facing what could be a catastrophic winter, top government officials warned Americans anew to wear masks, practice social distancing and follow other basic measures — precautions that President Donald Trump and other members of the administration have often disdained.

“I hear community members parroting back those situations — parroting back that masks don’t work, parroting back that we should work towards herd immunity, parroting back that gatherings don’t result in super-spreading events,” Birx said. “And I think our job is to constantly say those are myths, they are wrong and you can see the evidence base.”

The virus is blamed for over 282,000 deaths and more than 14.7 million confirmed infections in the U.S. New cases per day have rocketed to an all-time high of more than 190,000 on average.

Deaths per day have surged to an average of more than 2,160, a level last seen during the dark days in April, when the outbreak was centered around New York. The number of Americans in the hospital with the coronavirus topped 100,000 for the first time over the past few days.

Dr. Scott Gottlieb, a former FDA commissioner, warned on CBS’ “Face the Nation” that the U.S. death toll could be approaching 400,000 by the end of January.

“As bad as things are right now,” he said, “they’re going to get a lot worse.”

Dr. Moncef Slaoui, head of Operation Warp Speed, the government’s vaccine development program, suggested on CBS that using those 40 million doses more broadly to reach 40 million people right away would be too risky, because of the possibility of manufacturing delays that could hold up the necessary second doses.

“It would be inappropriate to partially immunize large numbers of people and not complete their immunization,” he said.

But Gottlieb said he would push out as many doses as possible, taking “a little bit of a risk” that the supply would catch up in time for people to get a second dose.

During his interview on “Face the Nation,” Slaoui said vaccinations may start to have an impact on infection counts for “the most susceptible people” in January and February.

In a separate interview on CNN’s “State of the Union,” he predicted that most of the “highly susceptible population,” about 100 million people, could be covered by vaccines by the middle of March.

“I am hopeful that, by the end of the month of January, we should already see quite a significant decrease in the mortality and severe morbidity associated in the elderly population,” he said on CNN. “There are, of course, many other people, unfortunately, that have co-morbidities that live outside of care facilities, that it will take more time to immunize them.”

Slaoui also countered recent criticism from Biden that the Trump administration doesn’t appear to have a detailed distribution plan for the vaccine.

He said Biden’s transition team has not yet been briefed on all plans.

“We haven’t had any meetings yet,” he said on Face the Nation.” “I know we have a meeting this coming week, and we really look forward to it because actually things have been really very appropriately planned.”

Slaoui also praised Biden’s plan to ask Americans to commit to wearing masks for the first 100 days after he enters the White House.

“I think it’s a good idea, it’s never too late. This pandemic is ravaging the country,” he said. “We all need to take our precaution, wear our masks, wash our hands, keep our distance, remain aware that this virus is a killer.”

Slaoui added that there is “light at the end of the tunnel, but we will not all have the vaccine in our arms before May or June, so we need to be very cautious and vigilant.”

CALL FOR TESTING PLAN

As the coronavirus epidemic worsens, health experts are urging the Biden administration to put in place a comprehensive national testing strategy that could systematically check more people for infections and spot surges before they take off.

Some experts say the lack of such a system is one reason for the current national explosion in cases, hospitalizations and deaths.

“If we’d had a more robust approach and testing was scaled up as one of the tools, I think much of this third surge would would have been avoidable,” said Dr. Grant Colfax, director of the San Francisco Department of Public Health.

There are differing opinions on what such a strategy should look like, but many experts say rapid and at-home tests should be used so Americans can check themselves and stay away from others if they test positive.

Biden has endorsed that strategy, called for making testing free for all Americans, and said government experts at the CDC and other agencies should be empowered to coordinate the entire effort.

“The reality is we’re not testing enough today,” Dr. Marcella Nunez-Smith, cochair of Biden’s coronavirus advisory board, told The Associated Press last week.

His transition team so far has not gone into further detail.

EARLY MISTAKES

Testing was one of the first stumbles in the federal government’s response to the coronavirus epidemic that hit the nation early this year.

In February, the CDC distributed test kits to public health laboratories that initially were faulty. U.S. officials worked with companies to expand testing, but shortages of chemicals, materials and protective equipment meant fewer tests were available than what experts said was necessary.

Worse, some experts say, states and cities competed against each other to buy limited testing services and materials, and with little guidance or training on how to best use the tests.

In April, Trump declared governors were responsible for testing. Amid complaints about shortages and delays, the federal government began sourcing and shipping key testing supplies to states, beginning with swabs.

In the latest phase, Trump officials are sending more than 100 million rapid, pointof-care tests to states. The government said the first shipments went out in early October.

Administration officials say they are proud of the current state of testing. Last month, Vice President Mike Pence celebrated that 170 million tests have been completed, and that an expanding array of tests are available.

But the focus should be less on numbers and more on action, said Dr. Ali Khan, dean of the University of Nebraska College of Public Health.

“It shouldn’t be anybody who needs a test can get a test,” Khan said. “It should be anybody who has a positive test immediately gets isolated” and the people they were in contact with checked and placed in quarantine.

He was echoed by NunezSmith, the Biden coronavirus adviser.

“Testing is only useful when we can act on the test,” said Nunez- Smith, a Yale health equity researcher.

The nation may be weeks away from coronavirus vaccines becoming available, but that won’t erase the need for testing, said the Rockefeller Foundation’s Eileen O’Connor.

“We’re not going to get everybody vaccinated right away. And we still don’t know how long that immunity will last,” she said. So testing will still be needed to monitor where the infection is active and to see if infections are occurring in vaccinated people.

During an appearance on NBC’s “Meet the Press,” Dr. Anthony Fauci of the National Institutes of Health said Americans should have easy tests they can do in their own homes.

“We don’t have that,” he said. “We should have that.”

Versions of such an approach have been tried in some places, including Slovakia and Minnesota. But some experts note there is little precedent for screening tens of millions of people with cheap, rapid tests—which would generate a significant portion of false results. It’s also unclear whether people who test themselves at home will follow instructions to quarantine.

Nearly all experts agree that more data and coordination is needed.

“Having every state do its own thing without guidance from the federal level — from CDC in particular — I think has really hampered us,” said Scott Becker, the chief executive of the Association of Public Health Laboratories. “It is a federal response as much as it is a state response, but it’s a shared responsibility. We need to work together.”

CALIFORNIA LOCKDOWN

Separately, California enacted the first statewide lockdown since last spring, issuing new stay-at-home orders that took effect Sunday night in Southern California, much of the San Francisco Bay area and other areas.

The new rules in the state of 40 million people prohibit residents from gathering with those outside their household. Retailers including supermarkets and shopping centers can operate with just 20% capacity, while restaurant dining, hair salons, movie theaters, museums and playgrounds must shut down.

Hospitals in California are seeing space in intensive care units dwindle amid a surge in infections. California health authorities imposed the order after ICU capacity fell below a 15% threshold in some regions.

Some law enforcement officials, though, said they don’t plan to enforce the rules, and some business owners are warning that they could go under after a year of on-andoff closings and other restrictions.

California Gov. Gavin Newsom said he hopes the new lockdown order is the last one he has to issue, declaring the vaccine offers “light at the end of the tunnel.”

Information for this article was contributed by Mike Stobbe, Matthew Perrone, Carla K. Johnson, Stephen Groves, Adam Beam, Kathleen Ronayne, Amy Taxin and Hope Yen of The Associated Press; and by Paulina Firozi, Jeanne Whalen, Felicia Sonmez, Lena H. Sun and Laurie McGinley of The Washington Post.