While most Americans believe a vaccine for COVID-19 will be available in 2021, only around half say they’ll get vaccinated according to a recent study.
A leading infectious disease expert at UAB worries, however, that there’s no guarantee researchers can create a safe, effective vaccine for the virus at all, and that if a vaccine does make it to market, making enough doses to protect those in the U.S., and people worldwide, could take some time, and that without a vigilant public, the virus could infect and kill millions more in the U.S.
“Seemingly, a large number of our population doesn’t quite comprehend the power of this pandemic,” said Dr. Michael Saag, an infectious disease expert at UAB and prominent HIV/AIDs researcher, speaking to APR on Wednesday. “They certainly have heard enough information about it. They’re aware of it. They just haven’t translated that awareness into the meaning.”
Saag said the impact of many people in Alabama getting the virus at one time “is where we’re headed, unfortunately.” Saag cited APR’s reporting Tuesday that shows the number of new confirmed cases statewide have been rising since April 30, and show no sign of slowing.
In a nationwide poll of more than 1,000 Americans conducted May 14-18 and released Wednesday, pollsters found that just 49 percent said they’d get vaccinated, while 20 percent said they would not. The remaining 31 percent said they were unsure. Older Americans were much more likely to say they’d get vaccinated than those under aged 60.
Saag said he worries that if and when a vaccine is available, many who aren’t taking coronavirus seriously, because it hasn’t yet infected them or someone they know, might be less likely to get vaccinated.
“Why would I want a vaccine for something that isn’t real, or isn’t a major thing in my life?” Saag said. “And the second thing is, I think appropriately, is that we don’t know if we’re going to have a vaccine, but if we do, what is the safety profile of that vaccine? And that won’t be known until the large scale efficacy studies are done.”
A majority of those who said they wouldn’t get vaccinated, or 70 percent, said they’d avoid doing so over concerns about side-effects.
“That’s a manageable concern, that the details will matter there,” Saag said.
President Donald Trump’s Operation Warp Speed program, announced May 15, aims to supply the U.S. with 300 million doses of a COVID-19 vaccine by January 2021, which is quicker than any vaccine has been developed and sent into market. There’s been no details from the White House as to how all those doses, if created, would be given to Americans.
“President Trump’s vision for a vaccine by January 2021 will be one of the greatest scientific and humanitarian accomplishments in history, and this is the team that can get it done,” said U.S. Department of Health and Human Services Secretary Alex Azar in a statement.
National Institutes of Health Director Francis Collins told the Associated Press last week that at least four or five vaccines being developed look promising, and one or two will be ready for large-scale testing by July.
“I’m not still 100 percent confident we’re going to have a vaccine,” Saag told APR on Wednesday. “I’m pretty sure we’re not going to have it in 2020.”
Saag said the best we can hope for is that we have data that shows a vaccine for COVID-19 works by the end of 2020.
“But think about the transition from knowing that something works to getting it scaled up in production, to a level where you have to have 300 million to 600 million vaccines available, just for the United States,” Saag said. “And this is a global pandemic so we’re talking about billions of doses of vaccine. I don’t think we’ve ever done anything like that before.”
Traditional vaccines, which use either a weakened version of a virus or proteins taken from the virus, require much effort to produce, Saag said, which is why we sometimes see shortages in vaccines for the common flu.
“But the vaccines that I think are showing promise here are brand new, or brand new approaches to vaccines,” Saag said.
These new vaccines use messenger RNA (mRNA), which are genetic components of the virus that are then injected into a person and can produce the protective proteins that can create immunity, Saag explained.
“The bottom line is the mRNA vaccines will be much, much easier to mass produce,” Saag said. “So I think there’s some hope, if we do have something by the end of this year, that we could in the next year ramp it up, with the right kind of commitment and resources, which will be motivated to do.”
Without a vaccine, the picture becomes much more dire, he explained. To get the epidemic under control we’ll need at least 70 percent of the population to have immunity, Saag said.
“That’s the so-called herd immunity that you hear so much about,” he said. “For us to get to that point without a vaccine is going to take a lot of pain.”
Deaths in the U.S. from COVID-19 were approaching 100,000 on Wednesday, and the number of confirmed infections were at 1.6 million.
For the U.S. to get to 70 percent immunity around 210 million people would have to have been infected with COVID-19, Saag said.
“And when you translate that into deaths, even if the death rate is 1 percent, we’re dealing with over 2 million people who will have died,” Saag said.
Saag said what’s important for the public to understand is that “this epidemic does not go away unless we get enough people immune. Unless and until we get herd immunity.”
An effective oral antiviral drug, if researchers can produce one, could be used very early in the course of a COVID-19 infection, Saag said, which could have an impact on outcomes for COVID-19 patients.
“That would abort the progression to more severe disease,” Saag said of an oral antiviral drug.
The giant pharmaceutical company Merck and Miami-based Ridgeback Biotherapeutics on Tuesday announced the two companies had entered into an agreement to develop the antiviral drug EIDD-2801, which is in early clinical development to treat COVID-19 patients, according to Businesswire.
“I think that that would be the other solution, if we don’t get a vaccine, and I think it’s, I don’t know, a 50 percent chance we’ll get one that works and is safe,” Saag said.
Vaccines are hard to develop, Saag said, adding that for 35 years researchers have been trying to develop a vaccine for HIV.
“Respiratory Syncytial Virus, which is the number one cause of childhood breathing trouble, we’ve tried for 20 years. We’re close on that one but we haven’t got it yet,” Saag said.
“I think this particular virus has a profile that gives me some hope, unlike HIV, which is much more difficult, but I think while we’re waiting for a vaccine the development of effective antiviral therapy may be our bridge,” Saag said. “Without either of those, frankly, we’re in for a long haul with this virus. I’m talking, potentially years of dealing with this virus.”
UAB continues to study and treat some COVID-19 patients with the antiviral drug Remdesivir, the only such antiviral drug approved by the U.S. Food and Drug Administration on an emergency basis to treat coronavirus patients. Physicians at UAB have said patients have been administered the drug intravenously improve 31 percent faster, but there are limitations with the drug’s use.
Dr. Racheal Lee, a UAB Hospital epidemiologist, in a press briefing on Wednesday said Remdesivir can’t be given to patients who have liver problems and may be less effective for patients who are so sick that they require a ventilator.
“I think we still are waiting to tease out some of these side effects from the medicine, but overall, it appears to be fairly well tolerated, at least based on the initial trial,” Lee said.
“So I’m very hopeful about all the work that has been done on vaccine research,” Lee said, but she warned that there are other complications.
“It will be very difficult though, in terms of getting everybody in the world vaccinated in a particular time frame and also to manufacture those vaccines,” Lee said. “So I think that we as Americans need to be prepared, that we may see another way of infections in the fall, and potentially be prepared that we may have to shelter in place again, if that’s necessary.”
As researchers work to find a vaccine and additional treatments for COVID-19, Saag said it’s up to the public to act in a way that keeps themselves and others safe.
Gov. Kay Ivey’s decision last week to loosen more restrictions on state businesses and public social life has prompted concern from health experts worried that more confirmed cases and deaths could be the result.
“So this increase that we’re seeing is concerning to me,” said Lee, speaking of the state’s rising new confirmed cases over the past week. “And part of that may be due to relaxing some restrictions. Part of it may be not wearing masks in public or having larger events, which is what we would be concerned about on Memorial Day weekend.”
We could go back to a more restrictive “stay-at-home” order, Sagg said, and that would likely work, but said we’ve got to find other ways forward.
“Two simple things. One. Avoid any large crowd of more than 10 people, and two. Always wear a mask when you’re around anybody else,” Saag said.
Despite much disagreement in the public sphere, cloth masks do work very well to slow the spread of coronavirus, Saag said. Up to 90 percent of the virus’s transmission happens through the aerosol route when someone infected breaths, speaks, sings or shouts, he said.
Saag said people are correct when they question whether a cloth mask that doesn’t fit tightly would protect them from contracting the virus, but said “the answer is, partially” and that wearing a mask can slow the spread in another, important way.
“It will help a little bit, but the reason to wear it is in case I have the infection and don’t know it, and I’m spreading the virus unwittingly, and that protects the people around me,” Saag said.
Lee said what she and many others want to do is be able to send their kids to school safely and go to work safely, but asked what that might look like.
“Does that mean masks? Yes. Does that mean continuing social distancing? Yes. So all of those things have to be part of our planning for the future,” Lee said.
Country star Amanda Shires to donate funds from single to Yellowhammer Fund
Grammy-winning country musician Amanda Shires will donate all proceeds from a new single to the Yellowhammer Fund, a nonprofit that provides assistance with abortions in Alabama.
Shires and her musician husband, Jason Isbell, partnered on the single “The Problem,” which is set to be released Sept. 28, according to a press release from the Yellowhammer Fund.
The song can be purchased here.
“‘The Problem’ is a song that showcases what loving support looks like through what is often an emotional time,” Shires said in a statement. “The Yellowhammer Fund offers a similar type of support to Alabamians and the Deep South. The fund provides safe options for people in a segment of America where reproductive health is very often at high risk of government interference. Everyone has the freedom to choose how to care for their own body. Individual health care decisions are difficult enough without the added pressure of stigma and ever-changing legal hurdles.”
Laurie Bertram Roberts, executive director of Yellowhammer Fund, said the nonprofit is thankful for Shires help, which comes at a critical time.
“Here in the Deep South, abortion is already incredibly difficult to access, even before a new president is elected or another Supreme Court Justice is appointed,” Roberts said in a statement. “As a fellow southerner, Shires understands those difficulties as well as the negative stigma surrounding abortion. We are thankful that she wrote this song and is telling a story that’s rarely heard.”
“It feels natural to align this song with The Yellowhammer Fund,” Shires said. “Having someone in your corner, offering unconditional support when you’re making hard choices is invaluable. Together, I know we can help make a difference.”
Roberts said at this point the best actions we can take are to go vote, donate to a local abortion fund, and stay active in the fight for reproductive justice.
“Our abortion rights are always on the line — regardless of who is in office — and we must continue the battle to expand access to everyone, no matter what rulings or laws may be in our future,” Roberts said.
Coronavirus task force’s Dr. Deborah Birx says Alabama should extend statewide mask order
Dr. Deborah Birx, coordinator of the White House’s coronavirus task force, said Thursday that Gov. Kay Ivey should extend her statewide mask order, set to expire on Oct. 2. She also responded to a CNN report that cited those close to her as saying she’s “distressed” with the direction the White House coronavirus task force is taking and is unhappy with what she sees as her diminished role in the group.
Birx, speaking at Auburn University, said she met with Ivey and Alabama State Health Officer Dr. Scott Harris earlier in the day to discuss COVID-19 and how the state is responding.
“So we really talked about the importance of continuing mitigation,” Birx said of her talk with Ivey and state officials earlier on Thursday, adding that Ivey was one of the first governors in the South to enact a statewide mask mandate, which she said clearly decreased the spread of the disease.
Birx pointed to numbers, such as the test positivity rate, that have improved since July, but said “we’ve got to do even more.” Asked if the statewide mask mandate was one of the mitigation efforts she suggests continuing into the fall, Birx said she does. “Because if you look at what happened within two weeks of the mask mandate you can see the dramatic decline in cases here in Alabama,” Birx said.
Birx said that when she last visited Alabama in July, the state was suffering from too many new cases of COVID-19.
“I think when I was last here at the beginning of July, it was a very difficult time in general for Alabama. We saw nearly 95 to 100 percent of every county in Alabama, rural or urban, that had more than 10 percent test positivity to COVID-19,” Birx said, adding that today, around 20 percent of the state’s counties have positivity rates above 10 percent.
Public health experts believe positivity rates above 5 percent mean that there isn’t enough COVID-19 testing being done and cases are likely going undetected.
In a statement to APR on Thursday, a spokeswoman for Ivey said Ivey and Dr. Scott Harris would provide an update on the statewide mask order ahead of its Oct. 2 expiration date.
“It is evident that Alabamians are doing considerably well in modifying their behaviors to take the COVID-19 pandemic seriously, and we all remain optimistic that a successful vaccine will be coming soon,” said Gina Maiola, Ivey’s press secretary, in a statement to APR on Thursday. “Our state’s success is largely in part to Alabamians stepping up to the plate when it comes to cooperating with the mask ordinance.”
Maiola said Ivey is leading the way on several fronts “including getting students and teachers back in the classroom, college students returning to campus and businesses remaining open — in fact, Alabama has one of the country’s lowest unemployment rates.”
“This success is a reality because Alabamians are wearing their masks and maintaining social distancing precautions. Governor Ivey and Dr. Scott Harris will continue closely monitoring our progress and provide an update ahead of the October 2nd expiration,” Maiola continued.
Speaking to reporters at Auburn, Birx was also asked about a CNN report on Wednesday that cited sources close to Birx as saying she is unhappy with what she sees as her diminished role on the White House coronavirus task force, that she’s not certain how long she can serve in her position and that she is “distressed” with the direction the task force is taking.
CNN also reported that Birx, who is no longer a fixture at White House coronavirus briefings, views Dr. Scott Atlas, a recent addition to the task force, as an unhealthy influence on President Donald Trump.
Atlas, a neuroradiologist with little experience in public health or epidemiology, has expressed support for the so-called herd immunity “strategy,” which infectious disease expert roundly dismiss as unattainable and a move that would cost millions more lives.
Instead of being a regular presence at White House coronavirus briefings, Birx has spent recent months traveling the country and speaking with governors and university administrators about coronavirus.
Asked Thursday about CNN’s reporting, Birx pushed back.
“Because they wrote that without even speaking to me,” Birx said. “Do I look like a person that’s diminished?”
CNN reported Wednesday that Birx had not responded to requests for comment on the story.
“Yes, I have been on the road. I’ve been on the road not as a spokesperson, but on the road to really understand what’s happening across the country, to be in deep dialogue with mayors, with communities, with governors, with administration school and faculty,” Birx said.
“I’m asked here because I am supposed to be here,” Birx said. “I haven’t been in Washington, and nor was I asked about that, but I’ve actually never been called diminished.”
Asked if she was planning to leave the task force, Birx said, “I have strong tenacity, and I’m very resilient, and we’re in the middle of a pandemic that’s affecting Americans, and as an American, I think I can do the best service to my country right now by serving in this role, working across the agencies, because that’s the experience that I have.”
Asked to clarify whether she planned to step down from the task force, Birx said “no.”
Asked if she was distressed about the direction the task force is taking, Birx said, “well that would be on me, if I was distressed, right, because I’m supposed to be coordinating the groups.”
“So that would be an indication that I’m not doing my job, and I believe that I do my job pretty well every day. I can always learn to do better,” Birx said.
UAB doctor urges public get flu vaccine as COVID-19 continues to spread
As the flu season nears, Alabama health care providers are encouraging the public to get flu vaccines to prevent stressing hospitals, which continue to care for COVID-19 patients.
“We just are really encouraging everyone to go ahead and get vaccinated,” said Dr. Erin DeLaney, assistant professor in the department of family and community medicine at UAB’s School of Medicine, speaking to reporters on Thursday.
DeLaney said physicians are encouraging flu vaccinations, regular hand washing and social distancing because they’re not sure what flu and COVID could look like together.
“We know that there are other respiratory pathogens that together, combined with the influenza virus, can have poor outcomes,” DeLaney said. “And we know that the flu and COVID separately can have poor outcomes, so we’re hoping to protect as many people as we can.”
DeLaney also discussed what will likely be the challenge for the public in attempting to determine whether they have the flu or COVID-19, which would prompt them to seek coronavirus testing.
“Unfortunately, coronavirus and influenza, they will share a lot of the same symptoms,” DeLaney said. “The only thing that’s going to be completely different would be the loss of sense of taste and smell, is specific to COVID.”
DeLaney said the medical community will have to rely on testing to determine between a case of influenza or COVID-19, and recommended that if a person isn’t able to get a coronavirus test they should assume they have COVID-19 and self-quarantine for 14 days.
Taking a clue from areas of the world that have already seen the start of the flu season, DeLaney said it appears that the spread of flu in those areas has been lighter this year, most likely because of what’s being done to protect people from COVID-19, including the wearing of masks, social distancing and regularly washing hands.
“We are hopeful that would also be our same experience as we enter our flu season — that if people are vigilant with COVID that it would protect us from not only the flu but other respiratory pathogens as well,” DeLaney said.
Speaking about the upcoming Halloween holiday, DeLaney said if families decide to go door-to-door with their children, eager for candy, masks should be worn. Masks that come with costumes do not provide protection, however, and DeLaney said they don’t recommend placing cloth masks over costume masks either. Medical providers are encouraging kids to wear Halloween-themed cloth masks instead.
The Centers for Disease Control and Prevention encourages families giving out candy on Halloween not to put the candy in a bowl for children to reach into, but instead suggest placing candy into separate bags and to place the bags outside the home.
She also recommended other outdoor activities in lieu of door-to-door candy gathering.
“So an outdoor pumpkin carving. Playing some Halloween music outside or having different types of activities where people are not going to be gathering closely, or not all touching the same things, would be ideal,” DeLaney said.
There have been 148,206 confirmed cases of COVID-19 in Alabama as of Thursday, when the state added 1,052 new cases, according to the Alabama Department of Public Health. As of Thursday, 2,506 people have died in Alabama from COVID-19, 18 of which were added on Thursday.
Alabama declines to release COVID-19 data associated with child care centers
APR has asked for that data and whether ADPH was aware of the number of cases associated with child care centers statewide.
It was unclear Tuesday the number of confirmed cases of COVID-19 there have been among staff, children and relatives associated with child care facilities in Alabama, because the Alabama Department of Public Health declined to release that data.
“All cases of COVID-19 are required to be reported to the Alabama Department of Public Health under notifiable disease laws. ADPH is aware of cases in entities such as child care but does not report separately from other data,” said Dr. Karen Landers, assistant state health officer, in a message to APR on Tuesday.
APR has asked for that data and whether ADPH was aware of the number of cases associated with child care centers statewide.
Landers noted that ADPH does provide the percentage of cases among age ranges, however. There had been approximately 2,628 confirmed COVID-19 cases among Alabama children 4-years-old and younger as of Monday, according to ADPH’s dashboard, but the department doesn’t specify which of those cases are associated with child care centers, and it was unclear how many cases there have been among relatives or workers connected to child care centers.
While children 10-years-old and older can efficiently transmit COVID-19 to others, the Centers for Disease Control and Prevention in a recent report note that “limited data are available on SARS-CoV-2 transmission from young children, particularly in child care settings.”
The Sept, 18 CDC report looked at three COVID-19 outbreaks in child care facilities in Salt Lake County, Utah, during April 1 through July 10, and found that the 12 children who contracted the disease spread it to at least 12 others outside the centers, and one parent was hospitalized with coronavirus.
In one facility, researchers confirmed five cases among workers and two among children. One of those children, aged 8 months, transmitted COVID-19 to both parents, the report notes. Many of the children had mild symptoms or none at all, researchers found.
“COVID-19 is less severe in children than it is in adults, but children can still play a role in transmission,” the report reads. “The infected children exposed at these three facilities had mild to no symptoms. Two of three asymptomatic children likely transmitted SARS-CoV-2 to their parents and possibly to their teachers.”
While Alabama’s Department of Public Health isn’t releasing data on cases associated with child care centers, many other states are, including Texas, South Carolina, North Carolina, California, Minnesota and Massachusetts.
There have been 332 confirmed cases, two deaths and 14 separate outbreaks associated with child care centers in North Carolina, according to the North Carolina Department of Health and Human Services.
Health officials in California’s Sonoma County traced 30 cases of coronavirus to one child at a child-care center in the county, where 16 students, 11 relatives and three workers tested positive, according to The Los Angeles Times. In addition to that outbreak, there have been 62 other cases at 13 child-care facilities in the county, including 27 family members, 10 workers and 25 students, with 381 cases of children younger than 17 still under investigation, the newspaper reported on Sept. 21.
Reopening child care centers can be done safely, according to an Aug. 28 report by the Centers for Disease Control and Prevention, which that found that in Rhode Island, which reopened child care centers on June 1, there were just 52 confirmed and probable cases among staff, children and relatives across 29 centers between June 1 and July 31.
The report noted that Rhode Island at first limited centers to 12 or fewer students, required staff and students to not move between groups in centers and “universal use of masks for adults, daily symptom screening of adults and children, and enhanced cleaning and disinfection according to CDC guidelines.”
Alabama State Health Officer Dr. Scott Harris on March 19 issued an order closing child care centers through April 5, with exceptions for facilities that provided services to first responders and other workers deemed essential. Harris on March 27 issued a supplemental order allowing centers that cared for 11 or fewer children to reopen.
The Alabama Department of Public Health on Monday published a press release touting the number of open child care centers across Alabama. According to the department, 76 percent of all child care facilities in Alabama are open.
“Alabama is well on our way to reopening the necessary number of child care facilities to enable parents to return to work and resume a more normal schedule,” said Alabama DHR commissioner Nancy Buckner, in a statement. “This is the sixth survey we have conducted and each one has shown tremendous growth in the numbers of open facilities. We have worked hard to encourage child care providers to open by providing support in the form of grants and supplies.”
Asked whether the department is aware of the number of COVID-19 cases among children, staff or relatives associated with child care centers, a DHR spokesperson responded in a message to APR on Monday that “We don’t track that.”
While child care plays a critical role for working parents across the country, the pandemic and subsequent shutdowns have put a strain on the businesses, according to a July 13 study by the National Association for the Education of Young Children, which surveyed more than 5,000 child care facilities in every state.
Among the child care centers surveyed, two out of five said they would have to close without more public assistance, while half of the minority-owned centers said they have to close without more aid, according to the report. A quarter of child care workers said they’d applied for or received unemployment benefits, and 73 percent of centers said they have or will begin laying off workers and/or make pay cuts.
An Aug. 26 study by the Washington D.C.-based nonprofit Bipartisan Policy Center found that 32 percent of parents polled said their child care centers were closed, 14 percent of them permanently, and 22 percent of the parents said they could not return to work in person without childcare.
Even when child care is available to parents, many are worried about sending their children back while COVID-19 continues to spread. Of those asked, 77 percent of parents said they were concerned that sending their kids back would increase the risk of exposing their family to COVID-19.