From left to right: Nirav R. Shah, MD, MPH, Senior Scholar, Stanford University’s School of Medicine; Dr. Kim Rhoads, UCSF; Dr. Daniel Turner-Lloveras; Dr. Dali Fan, Health Science Clinical Professor, UC Davis
Also available in Spanish.
The B117 mutant variant, more contagious and virulent than its predecessor, could become the dominant strain by summer. Can the U.S. achieve herd immunity before it prevails?
By: Jenny Manrique
The race to achieve herd immunity before new strains of the coronavirus prevail among the population, continues to run into one of the biggest bottlenecks in vaccination efforts: reaching minorities.
Latinos, African Americans, and homebound seniors, who have suffered the highest rates of COVID-19 infections, still account for the lowest vaccination rates nationwide.
“Minority communities are being left out of the telehealth boom and far behind in the race to sign up for vaccines,” said Dr. Daniel Turner Lloveras, founding member of the Latino Coalition Against COVID-19, during a media briefing hosted by Ethnic Media Services on March 19th.
“Unless we do something about it, they will continue to be left out and thus contributing to the inequitable distribution of COVID-19 vaccines.”
Turner Lloveras created the “Digital Compañero” program, an initiative to address digital literacy among the Latino community, especially affected by the transition to virtuality during the pandemic.
According to a survey by the Pew Research Center, before the pandemic only 57% of Latino families owned a desktop computer compared to 82% of white families.
And while society was forced to move to remote work and education due to COVID-19, nearly 40% of Hispanic households didn’t have internet access, which caused scenes of children trying to connect to free Wi-Fi in the parking lots of McDonalds to do their homework.
“Our bilingual volunteers reach out by telephones to latinos eldelry not able or comfortable to use the internet or the computer, or to immigrants who don’t have a digital literacy to get online and sign up for the vaccine,” explained Dr. Turner Lloveras about his initiative, that also uses text messages and WhatsApp, and door-to-door visits to improve digital skills among the community.
Not only to access health services, but also job opportunities, financial information, and government programs.
“Another component (of the program) is to address the vaccine hesitancy that has been very confusing during the past several months,” said Turner Lloveras. Through virtual town halls, health care workers have debunked myths about the dangers of the vaccine spread by social media, encouraging many to get their shot.
A similar experience takes place in Oakland, where Umoja Health, a group of about 30 community associations, partnered with the University of California, San Francisco and the Alameda County, to engage the African-American community in raising awareness about COVID-19, having tests and vaccinations.
“We did a mass testing in Bay Hunters and Sunnyvale and found a very low infection rate among blacks: out of 400 people, none tested positive (for COVID),” said Dr. Kim Rhoads, associate professor of epidemiology & biostatistics at UC San Francisco’s School of Medicine, who is leading the project.
“The community developed a very rapid trust in us. They call us when a community member tests positive, and we bring him personal protective equipment (PPE) and groceries, so we break the change of transmission.”
As a community based organization, Umoja became the official vaccine provider in Alameda County using a model of pop-up clinics to reach neighborhoods and streets where African Americans live, with the help of volunteers.
“One of our collaborators described that in a pop-up clinic, black people were running to be vaccinated … the (alleged) hesitancy in the community is a pretext for explaining the (access) inequities that we are inevitably going to see,” she said.
Contagious strains
The United States has already exceeded the goal of 100 million vaccines promised by President Joe Biden, who announced that by May 1, any adult over 18 in the country will be able to get vaccinated.
But the fast-paced campaign is leaving out not only Latinos and African Americans, but 22 million older Americans who do not have internet access at home to sign up for a vaccine, and represent 42% of adults over 65 years, population at higher risk of complications from COVID-19.
19 million of them live alone.
“The rate of vaccination among the homebound elderly was only 20%,” said Dr. Nirav Shah, adjunct professor of medicine and primary care and population health at Stanford University.
“We need to achieve herd immunity to help those not protected by the vaccine even for immune reasons or because they are vulnerable populations such as the homebound elderly,” he added.
Herd immunity is achieved when 70% of the population is resistant to the virus and has developed immunological protection against its potential genetic variants. In recent months these mutations have appeared in places like the UK, Brazil, and California, and it only takes a small change in the spike protein for the new strains to be more contagious and letal and become the dominant variant, Shah explained.
Scientists study the variants in three categories: interest (early stage), concern (more contagious), and high consequences (those for which there are no medical countermeasures yet).
Among the variants of concern tracked by the Centers for Disease Control (CDC) is the B117 strain, which according to a study published in the science journal Nature, it transmits from one person to the next 50% faster compared to some of the original strains, and can also lead to increase death up to 70%.
“With these variants, the therapies developed tend to be less effective, and vaccines can be less effective … People who had one strain of COVID might be infected with a new strain that is a variant of concern,” said Shah.
Although the Pfizer, Moderna and Astrazeneca vaccines antibody responses are a little bit less with the B117 strain, it is known that the doses from these laboratories approved by the Food and Drug Administration (FDA) are enough or now.
“It is a race on how fast we get people protected, meaning fully vaccinated vs. the level of disease in the community and how much we see transmision going on,” Shah said.
J&J single dose
Experts consider it inconvenient that over a dozen states, including Texas and Minnesota, have decided to reopen the economy and relax public health measures such as the mandatory use of masks, in moments where these new variants are appearing.
But the hope relies on the development and approval of new vaccines such as Johnson and Johnson’s and clinical trials in children, that promise that minor modifications in the vaccines can match the evolution of the viruses.
The fact that the J&J vaccine requires a single dose and can be transported and stored for up to three months in temperatures between 2 and 8°C, makes it easy for it to be distributed “not only in large cities, but in places that do not have freezer capacity such as rural areas, mobile vaccination sites and pop-up clinics,” said Dr. Dali Fan, UC Davis health science clinical professor.
J&J vaccine prevents moderate and severe COVID cases by 67% and in clinical trials it was effective against hospitalization in 93% of cases and against death in 75%.
“None of the vaccines have had serious side effects in the short term among the 100 million people vaccinated,” Dr. Fan said. “We don’t know (the effects) in 5 or 10 years time, those things you can’t guess, but they are very safe now,” he concluded.
