POST 250. May 11, 2022. CORONAVIRUS. Herd Immunity Déjà vu. “Not so long ago, the world was clinging to the hope of herd immunity—to the notion that the population would eventually reach some communal level of protection sufficient to quash the outbreak for good. Maybe, experts posited many months back, once 60 to 90 percent of people had been infected or vaccinated or both, the virus would run out of viable hosts, and simply fizzle out. Now it’s clear that “that’s too simplistic…”

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“The Biden administration is issuing a new warning that the US could potentially see 100 million Covid-19 infections this fall and winter, as officials publicly stress the need for more funding from Congress to prepare the nation.

The projection of 100 million potential infections is an estimate based on a range of outside models that are being closely tracked by the administration and would include both the fall and winter, a senior administration official told CNN. Officials say this estimate is based on an underlying assumption of no additional resources or extra mitigation measures being taken, including new Covid-19 funding from Congress, or dramatic new variants.

The White House is sharing these estimates as officials renew their push to get Congress to approve additional funding to combat the virus and as the nation approaches a coronavirus death toll of 1 million. Officials have said the White House will commemorate the moment when the US surpasses 1 million deaths from Covid-19.

The Biden administration has been sounding the alarm for weeks that additional funding is needed to continue the federal Covid-19 response, even as it seeks a return to “normal” with many pandemic-era restrictions lifting.

CNN has reported that the Biden administration requested $22.5 billion in supplemental Covid-19 relief funding in March in a massive government funding package but it was stripped from the bill. That request included funding for testing, treatments, therapeutics and preventing future outbreaks. Negotiators were able to reach an agreement on a scaled-back $10 billion package, but Congress left Washington in April without passing that bipartisan bill amid a disagreement over the Title 42 immigration policy — a pandemic-era rule that allowed migrants to be returned immediately to their home countries, citing a public health emergency.” (A)

“Last week, Anthony Fauci, President Joe Biden’s chief medical adviser, told several news outlets that America had exited “the full-blown explosive pandemic phase,” and was transitioning toward a “more controlled” chapter of the crisis. But if that pivot sounds nice and neat and tidy, it shouldn’t. Cases are still rising, to levels likely undercounted, and are still meeting numbers that the nation hit during the early parts of last summer’s devastating Delta surge. Other countries are also battling gargantuan swells in cases, and new branches of Omicron’s lineage are circumventing the defenses left behind by the last. The pandemic is very much gunning.

Not so long ago, the world was clinging to the hope of herd immunity—to the notion that the population would eventually reach some communal level of protection sufficient to quash the outbreak for good. Maybe, experts posited many months back, once 60 to 90 percent of people had been infected or vaccinated or both, the virus would run out of viable hosts, and simply fizzle out. Now it’s clear that “that’s too simplistic,” says Sarah Cobey, an infectious-disease modeler at the University of Chicago. Immunity against the most serious forms of COVID has decent staying power, especially if laid down by vaccines. But our defensive shields aren’t strong or durable enough to block transmission long-term; the virus keeps finding the holes in our blockades.

That doesn’t make the protection we do have useless. The types of immunity more relevant to the current pandemic era blunt the frequency and severity of future waves, rather than obliterate them. If classic herd immunity was a silencer, then we’ve had to trade it in for herd immunity lite—a muffler, whose effects accumulate gradually, and can still strengthen with effort and time. There is no pandemic off switch. So we must instead work to maintain incremental gains: In this universe, 60 percent of people infected is mostly meaningful in that 60 is higher than 50, and 40, and anything below. It might translate into some level of heightened population resilience, but it is not a guarantee that the virus’s threat is gone…

Some people who have banked multiple and recent exposures—three shots and an Omicron infection, say—are quite far along the spectrum of immune protection. Others very much aren’t, because they still have no experience with the virus or vaccines at all, or have logged those encounters so far in their past that they’re likely quite easy to infect or reinfect. And for some people the safeguards of shots struggle to properly take, or fade faster because of age or underlying health conditions. To make matters more complex still, no one knows exactly where they fall along the spectrum of protection; many people can’t even say for sure whether they’ve had the virus or not, given how disastrous America’s testing infrastructure has been, and how tough it can be to detect virus-elicited antibodies in blood. “We’re in this position where we have a poor understanding of how different levels of immunity map to reductions in infectiousness,” Cobey told me.

All of this leaves the country in a troubling spot, a time when the coronavirus is still very much on the move. Cases are once again ticking upward nationwide, pulling the sick out of work and school, and straining a health-care system that’s been stretched past breaking for years.” (B)

“Covid cases surged during the last two winters and are likely to again this year — unless the country can prepare and act, White House Covid-19 response coordinator Ashish Jha said Sunday morning.

“If we don’t get ahead of this thing, we’ll have a lot of waning immunity, this virus continues to evolve and we may see a pretty sizable wave of infections, hospitalizations and deaths this fall and winter,” Jha said on ABC’s “This Week.”

Congress needs to provide resources, Jha said, specifically $22.5 billion, a number that will help with a vaccine supply that’s dwindling. In March, White House Coronavirus Response Coordinator Jeff Zients said: “If the science shows that fourth doses are needed for the general population later this year, we will not have the supply necessary to ensure shots are available.”

The money, once allocated, would go toward Covid vaccine supply and coronavirus testing.

“If Congress doesn’t step up and fund these, I think, urgent and emergent priorities … they can’t wait until the fall, it will be too late,” Jha said.

And the proof is in the jab. With cases increasing in the Northeast, deaths remain low because of high vaccination rates.

“That’s not true for the whole country,” Jha said.

With enough resources to get more people vaccinated and more therapeutics in place, he said, “I do think we can get through this winter without a lot of suffering and death.”” (C)

“After dropping substantially after the winter Omicron surge, new confirmed U.S. cases have been rising again. As of Friday, the average of new U.S. cases had reached about 70,200 a day, an increase of 52 percent over the past two weeks, according to a New York Times database, though infections are thought to be undercounted, especially with access to at-home testing. Hospitalizations are also climbing nationally, with an average of more than 18,400 people with the coronavirus in U.S. hospitals, an increase of 20 percent from two weeks ago. And deaths, a lagging indicator, ticked up for the first time in weeks, inching upward by 1 percent, to an average of 371 a day.” (D)

“A devastating virus was laying waste to nations that lacked medicines available to Americans. The pills were patented and pricey. Poor countries lacked refrigeration to store them, the thinking went, and patients would not be able to follow the complex dosing regimen.

The year was 2002, the virus was H.I.V., and the president, George W. Bush, secretly sent his top health advisers to Africa to investigate what activists were calling “medical apartheid.” In the 20 years since, the United States has led the way in building a global infrastructure for H.I.V. testing and treatment, saving an estimated 21 million lives.

Now, with that history in mind, global health agencies and the Biden administration are working to bring coronavirus tests and expensive antiviral pills to low- and middle-income nations. This week, President Biden will emphasize “global test to treat” at his second international Covid-19 summit, a virtual gathering of world leaders aimed at injecting new energy into the international pandemic response.

Until now, the response has been focused largely on vaccinations, which remain a high priority. But Mr. Biden will also use the summit to call on wealthy nations to donate $2 billion to purchase Covid treatments and $1 billion to purchase oxygen supplies for low- and middle-income countries, according to a senior administration official involved with the planning.

In the United States, where antiviral pills to combat Covid are widely available, Mr. Biden’s “test to treat” initiative lets many patients go to pharmacies, get tested for Covid and receive a free prescription on the spot if they test positive. In low- and middle-income nations, such efforts will most likely be much more limited until generic pills arrive, probably in 2023.

But the global effort faces some of the same obstacles and inequities that existed two decades ago.

Rich nations, including the United States, have gobbled up much of the supply. Global health agencies do not have the money to buy the antivirals or tests, which are crucial because the medication needs to be started early in the course of infection. Drug companies, trying to protect their patents, are limiting the supply of generic alternatives in many middle-income countries, including an entire swath of Latin America.

All of this is playing out against the infectious disease equivalent of a ticking time bomb.

“We all expect a major new surge from Omicron or a new variant in the global south from June to September, and if that happens, we are not going to be ready with test and treat,” said Dr. Bill Rodriguez, who runs the testing arm of the ACT Accelerator, the Geneva-based consortium coordinating the global response. “It feels extremely similar — painfully, ironically, tragically similar — to what happened with H.I.V.”..

One of the biggest hurdles is the rapid decline of Covid testing around the world. The W.H.O.-backed consortium recently reported that just 20 percent of the 5.7 billion tests conducted globally have been in low- and middle-income nations. Low-income countries accounted for less than 1 percent of the testing. The reasons are twofold: Countries lack money to buy the tests, and demand has dropped in regions where Covid rates are now low…

Paxlovid, the more powerful of the two Covid antiviral pills approved by the Food and Drug Administration, is so plentiful in the United States that pharmacies are struggling to use up their supplies. The Biden administration has committed to purchasing 20 million treatment courses for Americans.

The W.H.O. recently issued a “strong recommendation” that Paxlovid, which is made by Pfizer, be given to patients at high risk of hospitalization and called for its “wide geographic distribution.” The W.H.O. has given a far weaker “conditional recommendation” to the other drug, molnupiravir, which is made by Merck and is not nearly as in demand.” (E)

“For the first time in two years last Saturday and amid no shortage of hand-wringing, the White House Correspondents’ Dinner returned. Now, days later, perhaps most unsurprisingly, it appears a growing number of attendees, from journalists to members of President Joe Biden’s cabinet, are discovering they took home a sign-of-the-times souvenir from their weekend of schmoozing in Washington.

Those who went did so knowing they’d be at increased risk for contracting COVID-19, despite whatever precautions organizers said they were committed to taking (measures that, as the Washington Post reported prior to the event, some White House officials and health experts feared were insufficient). That 2,600 people nevertheless took that chance was fodder for Daily Show host Trevor Noah, this year’s comedic host, who coined the evening “the nation’s most distinguished super-spreader event.” After all, as Noah noted, this dinner came just weeks after the Gridiron dinner, another politerati-type gathering, at which a reported 72 people who attended tested positive for Covid-19. “What are you doing here?” Noah asked Saturday night. Some in the tightly-packed room, where few wore masks and ventilation was poor, were perhaps asking themselves the same—or, in Post reporter Jada Yuan’s case, asking too late:

Later in his remarks, Noah thanked White House press secretary Jen Psaki for being willing to “risk getting COVID for, like, what, the tenth time?” Psaki has yet to announce a positive test since attending, but Secretary of State Antony Blinken has, along with reporters and staffers from outlets that reportedly include CNN, ABC News, NBC News, CBS News, Politico, and others. Among them is ABC’s Jon Karl, who sat next to Kim Kardashian and shook hands with Biden, as Politico reported, and Voice of America chief national correspondent Steve Herman, who announced his diagnosis on Twitter Tuesday.

“We worked hard to publicize our protocols and encouraged those eligible to get booster shots in the weeks leading up to the dinner. Our event implemented protocols that went beyond any guidance or regulation issued by the CDC or the DC health department,” CBS News Radio’s Steven Portnoy, the president of the White House Correspondents’ Association, said in a statement. “We wish anyone who may not be feeling well a speedy recovery.”

The WHCD required proof of vaccination (as did the Gridiron) and a same-day negative test for entry (unlike the Gridiron). Protocol aside, CNN noted the nature of the two events is fundamentally different: the Gridiron is a singular dinner, whereas the WHCD is part of a weekend of events in Washington—receptions and parties where COVID precautions were varied and outside the purview of the WHCA, as Portnoy noted in an email Tuesday. “Nothing we implement to protect the ballroom can reach the many social events other organizers throw around our dinner,” he wrote, according to the New York Times. “Bear that in mind.”

Indeed, attendees could have contracted the virus at any point in the weekend (and some who have said they’d participated in other social gatherings). But it doesn’t help that party organizers were reportedly “hesitant to install devices that disinfect the air using ultraviolet light because of concerns the devices might interfere with the program,” according to the Post. Portnoy told the paper that the offer from Don Milton, a prominent coronavirus expert who has advised the White House, to install such technology—at no charge—came too late in their planning. “We just aren’t in a position, with less than a week to go, to more fully understand the benefits or potential risks of what appears to be an experimental technology,” Portnoy said. Milton noted there is “really good data going back many decades” and that the White House recently acknowledged its credibility.” (F)

“George Cheeks, the president and chief executive of CBS, tested positive for the coronavirus on Thursday, just days after sitting beside President Biden at the White House Correspondents’ Dinner, the network confirmed on Friday.

Mr. Cheeks is fully vaccinated and has received a booster shot, according to CBS, and tested negative before the dinner on Saturday, and on Monday, Tuesday and Wednesday.

“He is feeling fine and working from home,” the company said in a statement.

Mr. Cheeks is one of several people who attended the White House Correspondents’ Dinner only to later test positive for coronavirus, including Antony J. Blinken, the secretary of state, and several journalists, such as Jonathan Karl, ABC News’s chief Washington correspondent, who shook hands with Mr. Biden during the dinner, and Steve Herman, the chief national correspondent at Voice of America.

As of Friday night, it was unclear how many cases had been confirmed among people who attended the dinner or related events. The dinner required proof of vaccination and a same-day negative test, and boosters were strongly encouraged; the associated events set their own policies.

At the dinner, Mr. Cheeks sat between President Biden and Jill Biden, the first lady, all three unmasked.”  (G)

• A.Coronavirus wave this fall and winter could potentially infect 100 million, White House warns, by Kaitlan Collins, https://www.cnn.com/2022/05/06/politics/white-house-covid-fall-wave/index.html
• B.America Is Starting to See What COVID Immunity Really Looks Like, By Katherine J. Wu, https://www.theatlantic.com/health/archive/2022/05/omicron-covid-transmission-herd-immunity/629758/
• C.White House warns of Covid surges in the winter,By HANNAH FARROW, https://www.politico.com/news/2022/05/08/white-house-warns-of-covid-surges-this-winter-00030901
• D.The White House, warning of a fall surge, plans for how to provide vaccines if there’s no more Covid aid., By Sheryl Gay Stolberg, https://www.nytimes.com/2022/05/06/us/politics/covid-aid-vaccines-white-house.html?referringSource=articleShare
• E.As Poor Nations Seek Covid Pills, Officials Fear Repeat of AIDS Crisis, By Sheryl Gay Stolberg, https://www.nytimes.com/2022/05/08/us/politics/covid-pills-global-aids-hiv.html?referringSource=articleShare
• F.White House Correspondents’ Association Wishes Nerd Prom Guests a “Speedy Recovery” from COVID, BY CHARLOTTE KLEIN, https://www.vanityfair.com/news/2022/05/white-house-correspondents-association-wishes-nerd-prom-guests-a-speedy-recovery-from-covid
• G.George Cheeks, the president of CBS, tests positive for coronavirus after attending the White House Correspondents’ Dinner, By Jesus Jiménez, https://www.nytimes.com/2022/05/06/world/george-cheeks-covid-positive-biden.html?referringSource=articleShare
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