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Covid vaccines promise, but it will take time to return to normal

Returning to many of our old familiar ways will take time and how long remains unclear. The answers await more research on vaccines, how they can be distributed and how many people are willing to receive them.

“The vaccine will not be immediately available to everyone,” said Arthur Reinhold, a professor of epidemiology at the University of California, Berkeley School of Public Health. He also chairs the California COVID-19 Scientific Safety Review Working Group, which will evaluate the safety and efficacy of covid-1

9 vaccines.

“It will probably take four to six months,” he said. “What he tells me is that people will have to continue wearing masks at least until spring. We will not be in a magically different situation until February or March. I don’t see how this can happen. “

Equally important are those unknown to the vaccines themselves. Scientists still don’t know how long the protection caused by a vaccine will last, for example, or whether inoculations can block the actual infection or just prevent the disease from occurring. If the latter turns out to be the case, which means that vaccines protect us from disease but not infection, we can still be contagious to others. Until we find out, don’t throw these masks in the trash.

“The bottom line is that while an effective vaccine will certainly significantly reduce the relative risk of transmission, we should not yet completely abandon basic public health measures, including wearing masks,” said Anthony S. Fauci, director of the National Institute of Public Health. allergies and infectious diseases, the email said.

In a recent JAMA report, he and colleagues stressed the need for continued vigilance, saying that precautions such as wearing masks would be “essential” during the initial release of the vaccine.

Robert T. Schully, a specialist in infectious diseases at the University of California, San Diego, said that although vaccines would provide a different level of protection, the virus would not go away and would exist for many years.

“But until we know more about how long protection lasts and how well people are protected,” he says, “it’s important to keep using all the tools we have to keep the virus under control, and that means masks. social distancing and ventilation. “

These precautions will guarantee against transmission if vaccines fail to prevent infection, says William Schaffner, a professor of preventive medicine at Vanderbilt University. He urges people to be patient.

“The average person wants answers yesterday,” he said. “But try to keep in mind that I’m still moving at rocket speed.”

Next summer

Some experts say they hope for a level of protection by next summer that will allow us to resume certain activities. “I’m not sure about mass rallies, like baseball games, but that’s believable,” Reinhold said. “Time will tell.”

Andrew Badley, an immunologist who heads the Mayo Clinic’s covid-19 task force, says the return of any normal activity depends on a number of factors, including how many people are vaccinated.

“The only way to normalize life by the summer is if the majority of the population receives the vaccines by then and early efficacy data are confirmed in ongoing studies,” he said. However, he added: “I think it is unlikely that we will be able to vaccinate the majority of the population by then.”

Schaffner expects a “significant improvement” by the summer, although it’s probably not a full return to our previous lives. But he added, “The next Thanksgiving could be back to near normal.”

The two leading vaccine candidates were developed by Moderna Therapeutics, which reports 94.5% efficacy, and Pfizer, in partnership with German company BioNTech, which demonstrated 95% success, including 94% among those aged 65 and over.

Both vaccines include a new and promising technique based on messenger RNA, or messenger ribonucleic acid (mRNA), which uses a synthetic form of RNA to trick human cells into making the virus’s distinctive “spike” protein by boosting the immune system. to generate antibodies in response.

Preliminary findings on their effectiveness are based on the number of people who have become ill, not on whether vaccines prevent infection.

“Although [preventing infection] it could be the end result, we don’t know that at the moment, “said Fauci, the country’s most recognized pandemic expert. “The primary endpoint [in these studies] was the prevention of symptomatic infection. So it is possible to say that the vaccine will protect you from a clinical disease, but it does not necessarily protect you from infection. “

Schooley expects that additional tests will examine participants’ blood to see if their antibodies are a response to the vaccine or to a natural infection with the virus, or both.

Vaccines generate antibodies to a single viral protein – the “jump” – while natural infection produces antibodies against multiple viral proteins.

“If you find someone who has antibodies only against the protein, it means they came from the vaccine,” he explains. “If they have this, plus other viral antibodies, they may have been vaccinated – but they have also been infected,” he said. “This will tell us whether the vaccine, in addition to reducing the disease, also reduces the infection. Furthermore, we do not yet know the longevity “, referring to how long the protection will last” or the level of protection of different subgroups of people at risk “, such as the elderly or those with concomitant medical conditions.

Vaccinations are likely to come in waves, with initial inoculations expected before the end of the year, with first health workers and emergency services receiving the first doses, followed by the most vulnerable, including the elderly, especially those in nursing homes, and people with medical conditions. conditions, and then younger, healthier people. Participants in the placebo trials may also receive the vaccine early. Those who are ill and have recovered from covid-19 are also likely to receive vaccinations, as it is not yet clear how long natural immunity will last – although they are likely to come at the end of the line, experts say.

Two shots are needed at intervals each month. As it is not yet clear how long the protection will last, public health officials do not know whether boosters will be needed and, if so, how often.

Patience can be difficult for many Americans who long to see their children and grandchildren and are exhausted by the fear and effort of dealing with a pandemic. I told Fauci about a recent phone conversation I had with my older son, who – although he understands the need for distance – is unhappy that we can’t see and hug at the moment. Fauci offered both caution and hope, saying the danger could be greatly reduced once we are both vaccinated.

“Since all the risks are relative, I would think that if you were vaccinated with a 95 percent effective vaccine and your son was also vaccinated, the relative risk of you or your son getting infected or infecting each other would be so low.” [although] not zero so you can feel relatively comfortable hugging your son, ”he says. “You could probably start doing things you haven’t done before,” which means being able to enjoy other social activities that have been limited.

Optimism about the vaccine

Microbiologist Peter Palais, an RNA virus expert who heads the microbiology department at Ican Medical School in Mount Sinai, is optimistic that these vaccines will be effective against both infection and disease. He and his wife volunteered for the Pfizer study, and while he received a medically useless placebo, she got the real thing.

Palese says she has produced many times higher levels of antibodies than their 48-year-old son, a doctor who fell ill and recovered. He is enthusiastic about the new approach, saying it will change the development of future vaccines as well as the current pandemic.

“Messenger RNA is extraordinary,” says Palese. “It’s an incredible breakthrough that will change the face of this plague.”

Others are more cautious.

“The biggest danger is that people will think we’re done with this, but we’re dealing with two studies with the results of the first two months, when vaccines look best,” Schooley said. “There may be some loss of protection over time and people need to pay attention to them in the long run.”

But even if vaccines are fully effective, they won’t do much to limit the spread of infection and disease if people refuse to take pictures.

Surveys show that 40 percent or more of Americans will not receive the covid-19 vaccine, a statistic that worries public health officials about the prospects for developing herd immunity. This leads after the majority of the population has achieved protection, giving the virus far fewer people to infect, thus reducing transmission and disease.

However, it is uncertain what we need in terms of the scope of vaccines for this to happen.

“We still don’t know if we need to vaccinate 50 percent or 90 percent of the population to see the positive impact of vaccines on community transmission,” Badley said.

“There’s a lot of hesitation in the vaccine,” Reingold said. “There is a spectrum in this country in terms of attitudes towards vaccination. The world is not neatly divided into yes or no. It’s much more complicated. There are people who are skeptical about what we know about these vaccines right now, and would prefer to wait and stay home and take a risk. There are also many people who can be vaccinated eventually. And there are others at the end of the spectrum who say: never. “

Fauci says that the sooner the country reaches herd immunity, the sooner everyone’s life will return to normal.

“As for reopening society, economically and otherwise, it will depend on taking the vaccine,” Fauci said. “Even with a highly effective vaccine, if only half of the population is vaccinated, protection at the community level would not be adequate and certainly not optimal.”

In short, life in the world after the vaccine remains a complicated scenario for now.

“It’s possible that the more people get vaccinated, the lower the risk of infection,” says Schooley. “People who are at risk of dying if they become infected may want to wear a mask for a really long time – remember that people who are older and have major illnesses and are at greatest risk of get sick – may be the least likely to respond stably to the vaccine. We will learn more when more data comes out. Certainly the more people get vaccinated, the better. “

Badley, who chairs the Mayo Clinic’s working group at Clinic 19, is optimistic that more and more people will roll up their sleeves as researchers learn more about the safety and efficacy of vaccines and successfully pass this information on to the public.

“Smallpox is the only infectious disease eradicated by the vaccine and it has taken almost 200 years since the disease was discovered,” he said. “We have come a stunningly long way in a short period of time, and if the trajectory continues, we must have good control of the pandemic in the coming months and years.”

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