Seasonality, vaccines, variants, caseloads—the country is in a confusing place right now. I spoke with ⁦ @michaelmina_lab⁩, probably the most incisive epidemiological thinker in this pandemic, about all of it. A thread of his many observations (1/x). https://nymag.com/intelligencer/2021/02/harvards-michael-mina-on-covid-seasonality-vaccines.html

“My personal feeling is we are seeing the benefits of seasonality hit, which I know some of my colleagues don’t agree with.” The conventional wisdom is that seasonality wouldn’t abate before the spring, but “it’s not uncommon for coronaviruses to essentially start dropping now.”

“Most of the known coronaviruses have something on the order of a three-month window where they’re really infectious — when they’re really transmitting.” We may be leaving that window behind now.

The effect of sunlight and vitamin D may play some role in that. “The winter — it’s a real thing! But we don’t fully understand why. And vitamin D and sunlight could certainly play a role.”

We may have wasted weeks of vaccine rollout, @michaelmina_lab says, by prioritizing health workers. “We spent weeks vaccinating health-care workers we could’ve spent vaccinating the most vulnerable.”

“In the hospitals, they were vaccinating 20-year-olds who are sitting behind a computer and don’t even see patients. And there are patients in the same hospitals who are 65 years old at very high risk of getting COVID who have to wait.”

This is especially frustrating, he says, “considering the mantra for so long has been that doctors don’t even need to get tested regularly, PPE is working, don’t worry. Then the moment the vaccine comes out, it’s doctors are at extremely high risk and need vaccines immediately.”

Given vaccines, he says, pursuing a “zero COVID” elimination strategy is not the right goal. “We’re going to see the most vulnerable people who make up the majority of deaths become vaccinated. At that point, do we keep society shut down just to stop a small number of deaths?”

“People will still talk about long-haulers, long COVID and children getting severe disease. But we have to recognize that, especially in younger people, these are fairly rare events, especially in kids.”

“I do think we should take the summer and do what we didn’t do last year, which was squander the summer and did nothing to prepare for the fall,” he says. “I think we could take this summer and say, ‘Okay, let’s get all the pieces in place. Let’s get rapid testing ready.’”

“It doesn’t mean people have to rapid test all the time, but if you start to see an outbreak occur, then you get a text message that says, ‘Hey, start rapid testing again.’”

“We can really set ourselves up as a country to be adaptive, to be able to combat an outbreak when it starts, so that we’re not always playing catch-up after it does. That could allow us to both simultaneously get back to work and get back to school with minimal risk.”

He had some critical words about the development and testing of vaccines, as well—which many see as the lone American bright spot in the pandemic. “The entire evaluation process was based on symptomatic disease. The major trials didn’t even consider transmission.”

“They didn’t even consider, do we need two doses or one, and what would it mean if we actually could get by for six months between doses, what would that mean for the globe? Does that mean we could actually vaccinate an extra billion people in a year?”

Instead, “we just followed the regular playbook we’ve always used, which is to do a phase three trial, accelerated a little bit.”

“Why did we not swab people’s noses during those trials, to allow us to ask the basic question, will these vaccines inhibit transmission? That would have massive implications for who we vaccinate first. And we still don’t know the answer.”

And because we never deployed large scale serological testing, we have no clear picture of who’s been sick, which means that while in theory we could add vaccination immunity on top of ~100m cases of natural immunity, in practice it’ll be impossible to keep those groups separate.

“Another issue: All of the major vaccines that we are building all present the exact same spike protein. They’re all clones of each other — no difference for the most part. Nobody ever took a step back to say, what if this virus mutates?”

“The U.S. could’ve said, ‘Okay, we’re going to back two vaccines that are against the spike protein only,’ and then maybe try to figure out some other vaccines, like multi-protein vaccines, multi-peptide vaccines, live attenuated vaccines, killed vaccines — all different sorts.”

“And now we very well might find ourselves totally screwed in a few months, because we have no vaccines that will work as well as we need against a mutant that might arise still, or the ones that have already risen.”

We’re also flying blind, in responding to the new variants, because we’re doing so little genetic surveillance of the disease. “We’d much rather just wait and then blame South America and blame the U.K,” he says.

“Meanwhile, we’re probably getting the identical variants here—not just because they’re being brought in by travelers, but because they are probably being built right here in the U.S. through mutation and viral evolution. But now we can blame it on South America or South Africa.”

And while there has been some movement on rapid testing, there is still maddening resistance, he says. “I’ve been so angry at people like @mtosterholm saying the only approach is to lock everything down. We have other solutions, we just haven’t used them.”

“We could’ve at least tried, back in May, to get these rapid tests out. We didn’t do it in May. We didn’t do it in August, November, December. We still haven’t done it, but it is one of the only tools that could have actually allowed us to open up safely and gather safely.”

“People talk about COVID fatigue, but then they say, yeah, there’s COVID fatigue, but we need to lock down anyway, because we need to control the virus.”

Public health messaging that testing is insufficient for safe socializing has been counterproductive, he says. “People are treating these tests like they don’t work, but, you know what? They do work. But from certain public-health figures you hear this constant refrain...”

“...if there is any risk whatsoever, then don’t do it. Somehow these same people are failing to recognize that we have massive risks around us every day, because cases have been completely out of control.”

“In my opinion, you would actually be safer going in and having a party with people, indoors, if everyone tested right before that party, than you would be going about your regular environment out in the world.”

“In my opinion, you would actually be safer going in and having a party with people, indoors, if everyone tested right before that party, than you would be going about your regular environment out in the world.”

We do not have to wait for large-scale data about how vaccines will perform against the variants, @michaelmina_lab says. “This is one of the more recent things that I kind of have gotten in arguments with some other scientists about....”

“I said, ‘If the variants are not as susceptible to immunity acquired by natural infection, then there’s no reason to think that the vaccine would be any different than the natural infection-acquired immunity.’”

“And so many people say, ‘Well, we haven’t seen the data for that, we need to actually see that vaccine-derived immunity is not performing as well for the variants before we can possibly say that, because it would be too scary to say it.’”

“But, like, use immunology and biology 101. We created the vaccines to look exactly like the natural virus. We don’t need the data.”

“We don’t actually need it to be able to say, if there are natural strains that are coming about that are evading one version of this virus, then they would also evade the immunity derived by the vaccine.”

And while manufacturers are now working on tweaking vaccines to address the new variants, the stated timelines are dispiritingly slow. “Why would it be a multiyear timeline to get a new version of the vaccine out? That doesn’t make any sense.”

“It’s just like people breaking the five-minute mile or the four-minute mile and things like that. People think, Oh, you’ll never do faster than that. It’s like, well, actually you can break it by leaps and bounds more.”

“It’s all just been so sad to me, this unwillingness to look to the future and say, in the midst of all of what’s happening today, ‘What can we do to set us up for down the road?’”

“Let’s stop that ridiculous thinking and say, ‘What do we need to do today to set us up for one year from today, so that one year from today we’re looking back and we’re saying, Thank you, prior self, I’m happy you did that.’” (X/x)