From left to right: Dr. Tung Nguyen, Professor of Medicine at UCSF; Dr. Nirav Shah, Senior Scholar at Stanford University’s Clinical Excellence Research Center; Dr. Ashish Jha, Professor of Global Health at the Harvard School of Public Health
With the prospect of an effective vaccine in the second half of next year, difficult times are to come in terms of infections, but also hopeful times if disparities exacerbated by the pandemic are taken on.
By: Jenny Manrique
With a total of 39 vaccines in different phases of development worldwide, the rest of this year promises to be a time of scientific experimentation in the battle against COVID-19. However, for the testing to be reliable, at least 30,000 volunteers prone to the coronavirus are needed, and racial disparities and side effects must be taken into account.
As Dr. Nirav R. Shah, head researcher at Stanford University’s Clinical Excellence Research Center explained in a Zoom video conference organized by Ethnic Media Services, “Science is moving rapidly, but a vaccine will not be generally available until the latter part of next year, because these tests are difficult to coordinate.”
The vaccine testing done on a few dozen healthy adult volunteers don’t say anything about their effectiveness on large vulnerable populations, “which are the ones we need to protect first,” said Shah, who is an elected member of the National Academy of Medicine. Then it will be necessary to solve the shortage of doses in a pandemic situation.
Faced with the lack of an effective quarantine and isolation policy, Shah said there are a number of applicable strategies to control the pandemic and a “false dilemma” has been established in this country between life and the means for living, because “people can still be saved and kept working.” As he sees it, the solution is not the so-called “herd immunity” applied in countries like Brazil and Sweden, where the virus has been allowed to expand uncontrollably, because that will only increase the number of deaths.
A practical early detection system is the distribution of 1.5 million smart thermometers equipped to predict whether the fever is a flu or is related to other symptoms of COVID, data for immediately identifying high fever hotspots in the country. “While people are dying because they have to wait up to 18 days for their test results, this would be a leading indicator that could identify the communities where there is COVID before people end up in intensive care units and die,” assured Shah.
These molecular COVID tests that are used today in the United States are not only costly (up to $100), but also the results take weeks, time when the virus has already spread. A more efficient test would be the antigen test that has a lower cost (between $5 and $15), a very low risk of false positives, and results are available in 15 minutes, the expert explained.
To date 169 treatments in various stages of development have been identified, and there are some, like steroids, that have shown to be economic and effective even reducing the number of deaths by up to 50% in certain sectors of the population.
But despite the availability of this scientific knowledge, Shah noted the discrepancy in the statistics between the Center for Disease Control and the Department of Health and Human Services has made it impossible to have a proper strategy. “The number of daily cases, rates of infection, positive cases, and hospitalizations are the minimums needed to make decisions,” he asserted.
Worse than less developed countries
This data is relevant in this time when the United States is the country most affected by the pandemic in the world, dangerously close to 200,000 deaths, and almost 5.5 million infections that have gone up by 66% in the last few weeks, according to CDC data. The states of California, Texas and Florida have all surpassed 500,000 cases, while 295 counties are considered hotspots but only 79 of them have racial statistics. Hispanics are the most affected in 59 of those hotspots.
These rates of infection are higher than less developed countries in Eastern Europe and South Asia.
And even though there is the theory that the authoritarianism of certain countries (strict controls and quarantines) or the culture (for example, the extensive use of face masks in Asian countries) are sufficient reasons to explain why some countries have had better control of the pandemic, it is not so clear as to those being the motives.
“While political leaders refuse to use science as a guide and ignore biology or mathematics, it is not going to go well,” said Dr. Ashish Jha, Director of the Harvard Global Health Institute and Professor of Global Health at that university.
“There are four or five ways to deal with the virus and if countries decide to use one very effectively and the others as a supplement, there will be success. In the United States simply using a face mask has become a political issue, and here public policies are not based on science,” he insisted.
In poor countries like Vietnam, for example, it has gone better because they limited trips to China at an early stage, monitored visitors and tracked contacts. In South Korea they test massively, in Japan they have set up the universal use of face masks and in New Zealand there are strict quarantines.
By comparison, in the U.S. there are 50 different responses to the pandemic amid a global crisis since the free movement over internal borders has made governors battle with 50 “inadequate responses”.
“We have been underfunding the public health infrastructure… it is a model in which the state decides and the federal government supports, but with an absent federal government, the state response has been very weak,” said Jha.
Suicidal thoughts
As if that were not enough, the repercussions of the pandemic on the mental health of people in the United States are alarming In a survey by the CDC among 5,000 participants in June, 40% of them reported mental health problems. Among young people age 18 to 24, that rate was much higher, reaching 75%.
In the same survey, 52% of the Latinos reported between one and four major mental health problems, 18% had suicidal thoughts and 21% starting using some substance to deal with the stress and anxiety caused by the pandemic. Twenty-two per cent of the essential workers also thought about taking their own lives.
“This shows us that the COVID-19 pandemic is more than a simple illness caused by only one virus,” said Dr. Tung Nguyen, Professor of Medicine at the University of California, San Francisco (UCSF) and Director of the Asian American Research Center on Health.
“We are seeing the beginning of a social mental health epidemic and a terrible effect on the social determinants of health, like income, employment and housing.”
For Nguyen the U.S. health system has failed to produce enough face masks, ventilators and personal protection equipment (PPE) accentuating the disparities. “Since we will not have an effective vaccine until 2021, people will continue to suffer unnecessarily,” he observed.
Despite the numbers and the dark outlook, experts assure that there is a ray of hope in the future. “At times like these people cannot pretend things are fine. We will have a cultural change and I’m sure a variety of dynamics will change and we will come out of this even stronger,” said Nguyen.
For Shah even if “we never go back to normal, with any luck we will have learned about infection rates and how to do things in a future pandemic.”
Dr. Jha showed the most optimism. He said that the protests of the Black Lives Matter movement and the COVID-19 pandemic are not disconnected phenomena, but rather have magnified systemic racism that reflect how African Americans are the most affected by the virus, next to Hispanics.
“I think we will come out of this pandemic with a strong desire to take on these racial inequalities to move ahead… I hope we progress because it is a long-standing debt,” he concluded.
