HOPE on the Horizon

By Elizabeth Morse Read

We see it non-stop on TV, our cell phones, in magazines, and even in our dreams. It’s the screensaver from hell: a swarm of golf balls studded with cocktail toothpicks ending in red bubbles. Those cocktail toothpicks surround the golf ball like a crown (corona) and those “bubbles” are the COVID-19 virus’ “spike proteins,” which latch onto our cells and allow the virus to enter and infect us with a plague of Biblical proportions. And whether you call it SARS-CoV-2, coronavirus, or COVID-19, it has overwhelmed the world’s population, health systems, and economies.

In less than a year, COVID-19 has become the leading cause of death in the US, leapfrogging over cancer and heart disease. And almost every 30 seconds, another American dies of it. We are on the cusp of a catastrophe.

What’s wrong with this picture?

The United States represents less than 5% of the global population, yet we have almost 25% of the world’s COVID-19 infections and deaths – more than any other nation. How is it that the entire continent of Africa, with its 1.3 billion people, has recorded 52,000 deaths compared to the staggering totals here?

Both South Korea and the US reported its first case of COVID-19 on January 21, 2020 – yet, South Korea had reported fewer than 600 total deaths, compared to the projected 362,000 American deaths by January 1. In early December, the US first recorded 200,000 confirmed new cases in a single day, more than all cases ever recorded in Japan, a country of 127 million people, since the beginning of the pandemic.

But the daily “confirmed” cases don’t tell the whole story. The US Centers for Disease Control and Prevention (CDC) estimates that, due to a lack of widespread testing and tracing in 2020, only one in eight infections have actually been identified. In addition, the CDC believes that as many as 40% of infected people are asymptomatic “silent spreaders” responsible for causing at least half of all other known infections.

After so many Americans ignored public health warnings about not traveling or gathering for Thanksgiving, the national surge increased exponentially in December: over 100,000 hospitalized, and the highest daily death toll since the pandemic began – 3,100. That’s more than Japan’s ten-month total of 2,161 deaths, more than all who died on 9/11, and more than all who perished at Pearl Harbor. And Dr. Anthony Fauci warned that a similar surge after Christmas and New Year’s Eve would bring the country “to a really dark time” by mid-January.

It took 98 days from the first reported infection in the US to reach one million confirmed cases. Four million new infections were recorded in November alone (double that of October) and another million new cases were confirmed in just the first five days of December, the next million in just three days. Confirmed cases could reach 20+ million by early January. And if this explosion is not tamped down, some experts predict there could be more than half a million Americans dead by April.

The facts are mind-numbing and soul-crushing. We need a miracle.

The race for a cure

In December 2019, the Chinese government first reported a localized outbreak of severe flu-like cases to the World Health Organization (WHO). Identifying it as a novel “coronavirus,” the Chinese shared the new virus’ genetic sequence on January 12 with the global scientific community.

This new respiratory virus quickly proved to be both highly contagious and exceptionally lethal, especially among the elderly population – 40% of all US deaths have been residents of nursing homes. Scientists and public health officials were terrified that this virus could be as deadly as the Spanish flu pandemic of 1918-19, which killed 675,000 Americans and 500 million worldwide – almost a third of the world’s population at that time.

In an unprecedented move, governments across the globe cooperated in finding a cure, researching dozens of potential vaccines in a race against time. Within just a few months, promising vaccines began clinical trials on humans, a timeline that previously took years – and two vaccines based on a never-before-used genetic technology emerged so breathtakingly safe and effective that they will revolutionize medicine as profoundly as did the discovery of penicillin [see sidebar].

Just eight months after receiving the new virus’ genome, pharmaceutical giant Pfizer and biotech start-up Moderna applied for Emergency Use Authorization (EUA) from the US Food and Drug Administration (FDA) for distribution of their radically new vaccines based on messenger RNA (mRNA) technology. After completion of Phase III clinical trials, both Pfizer’s and Moderna’s vaccines proved to be 95% effective in preventing infection, far exceeding the FDA’s minimal 50% efficacy rate, and Moderna’s vaccine also proved to be 100% effective in preventing serious illness and hospitalization in trial participants who did contract the virus.

There is finally light at the end of the very long and very dark tunnel we called 2020.

Starting with Jenner’s smallpox vaccine in the late 18th century, traditional vaccines introduce microscopic bits of weakened or inactivated viruses into a person’s body, alerting the immune system to start making virus-neutralizing antibodies against any future detection of that virus. Life expectancy for the average American has nearly doubled in the past 100 years, largely due to the development of vaccines. Most childhood illness vaccines are 90-99% effective: the most effective have been for measles, tetanus, polio, and smallpox. In fact, smallpox has been eradicated worldwide due to massive World Health Organization (WHO) vaccination programs – the last case was reported in 1977. But scientists are constantly tweaking vaccines in order to improve effectiveness. For example, the Zostavax vaccine, developed to prevent shingles (herpes zoster), used a live virus platform, but turned out to be only 51% effective. The newer Shingrix vaccine, which uses an inactivated virus platform, has proved to be 90-97% effective. On the other hand, after 30 years of research, scientists have yet to find a successful vaccine for the HIV virus.

Vaccine development normally takes up to ten years, but with this new mRNA technology, it took only 63 days from gene sequencing to the first human trials. EUA was granted just a year after the coronavirus first emerged in China, and supervised vaccination of American healthcare workers and nursing home residents began before Christmas.

How mRNA vaccines work

Imagine if it were possible to instruct our bodies to make the therapeutic drug we needed to either cure a disease or to prevent becoming infected by a disease. What if scientists could manufacture an “imposter” protein that would trigger the same immune response without risking an actual viral infection? That is the genius of mRNA vaccines – they mimic the genetic sequence of the COVID-19 spike protein, tricking our own immune system into thinking that the real virus is present.

The mRNA vaccines use synthetic genetic material to stimulate our cells into producing a harmless viral protein that our immune system learns to attack, triggering production of neutralizing antibodies without ever exposing people to the actual virus. In other words, an mRNA vaccine turns the body into both an antigen- and an antibody-producing laboratory.

Unlike traditional vaccines, mRNA vaccines can be produced rapidly in a laboratory. It took Moderna researchers only two days to design the new synthetic mRNA spike protein after receiving the genetic code on a Microsoft Word file from the Chinese. Even if a virus mutates, scientists can tweak the genetic sequence to produce updated vaccines quickly, or else create a cocktail of proteins to target several strains.

The mRNA vaccines work like an Operating System on a computer, allowing scientists to insert genetic code from a virus – like an app – to easily create a customized vaccine. In order to survive its journey through our bloodstream, the synthetic mRNA protein is protected, encapsulated in a biodegradable bubble of lipid (fats) nanoparticles (LNP).

The importance of mass immunization

A recent Gallup poll showed that almost 60% of Americans were willing to be vaccinated. But it is crucial that at least 70% of the population be vaccinated in order for herd immunity to kick in so that life can return to some version of “normal” again [see sidebar]. There will need to be a massive public education effort to convince people that the vaccines are both safe and effective – a big sell to a skeptical public, given the barrage of chaos and quackery that came out of Washington during 2020. On top of that, there is a long-held resistance among some sectors of the population who don’t trust scientists, pharmaceutical companies or the federal government itself when it comes to vaccines.

Fewer than 20% of Black Americans believe that the new vaccines are safe and effective, a resistance linked to past unethical medical programs like the US government’s Tuskegee Experiment. Likewise, a growing body of “antivaxxers,” parents who refuse to vaccinate their children due to a baseless fear of their developing autism, join many citizens who resist any government effort that infringes on their freedom to choose what they do with their lives – like being forced to wear masks in public.

In an effort to further bolster a hesitant public’s confidence in the vaccines, many states have set up review committees to further vet for the safety and efficacy alongside the FDA’s rigorous evaluation processes. Also, the private sector plans to persuade people to get vaccinated. The Ad Council, a nonprofit advertising group, is planning a $50 million ad campaign, similar to its push in the 1950s urging people to get the polio vaccine.

Former Democratic presidential candidate John Delaney proposed that anyone receiving the vaccine be given a $1,500 incentive payment, seeing as no new stimulus checks have been forthcoming. As outrageous as that might seem, cash payments were given to parents in India to increase childhood vaccinations – and they increased a whopping 600% as a result.

CVS, Stop & Shop, Walmart, and Walgreens have partnered with the CDC to provide free vaccinations throughout the country as supplies become available. In a pilot program, Rhode Island will be one of four states to receive early supplies. CVS projected that it would deliver the Pfizer and Moderna vaccines to skilled nursing facilities, front-line workers, and medical professionals by the end of December, with a second shot 21-28 days later. Other traditional vaccines [see sidebar], like those still in clinical trials at Johnson & Johnson, AstaZeneca, and Novavax, will become available by springtime. By June, anyone who wants to get a vaccination should be able to do so.

But until vaccines have been widely distributed, Americans must continue to follow public health guidelines: wear a mask, keep socially distanced, wash hands frequently, and avoid crowds, especially indoors.

Personal freedom vs. The public good

So, as we say goodbye (and good riddance!) to 2020, we have a personal choice to make. Will we each become part of the solution in this race to eradicate COVID-19, or will be part of the problem, refusing to get vaccinated or even to wear a mask?

Listen to what Pope Francis had to say in a recent New York Times editorial: “Most governments acted responsibly, imposing strict measures to contain the outbreak. Yet some groups protested, refusing to keep their distance, marching against travel restrictions – as if measures that governments must impose for the good of their people constitute some kind of political assault on autonomy or personal freedom! Looking to the common good is much more than the sum of what is good for individuals. It means having a regard for all citizens and seeking to respond effectively to the needs of the least fortunate.”

Make your New Year’s resolution now – get vaccinated. Happy 2021!

Sidebar 1: How traditional vaccines work

Starting with Jenner’s smallpox vaccine in the late 18th century, traditional vaccines introduce microscopic bits of weakened or inactivated viruses into a person’s body, alerting the immune system to start making virus-neutralizing antibodies against any future detection of that virus.

Life expectancy for the average American has nearly doubled in the past 100 years, largely due to the development of vaccines. Most childhood illness vaccines are 90-99% effective: the most effective have been for measles, tetanus, polio, and smallpox. In fact, smallpox has been eradicated worldwide due to massive World Health Organization (WHO) vaccination programs – the last case was reported in 1977.

But scientists are constantly tweaking vaccines in order to improve effectiveness. For example, the Zostavax vaccine, developed to prevent shingles (herpes zoster), used a live virus platform, but turned out to be only 51% effective. The newer Shingrix vaccine, which uses an inactivated virus platform, has proved to be 90-97% effective. On the other hand, after 30 years of research, scientists have yet to find a successful vaccine for the HIV virus.

Annually, flu shots are anywhere from 40-70% effective, depending upon which inactivated flu strains were included in the mix. Yet less than half of all US adults get an annual flu shot, many claiming that they “felt sick” after getting one. After any vaccination, you may experience mild side effects like fatigue, fever, or minor body aches for a day or so – but this does not mean that you’ve been infected with the virus. Such inflammatory symptoms are actually a sign that your immune system has revved up in reaction to the presence of a weakened or inactivated virus.

Sidebar 2: Future applications of mRNA technology

Much like a computer operating system, mRNA therapies instruct your body to produce its own “medicine.” Along with CRISPR gene-editing technology, which can replace a missing gene or remove a defective gene, the breakthrough mRNA technology is being investigated for treatment of cystic fibrosis, rare genetic metabolic disorders, rabies, hemophilia, melanoma, aggressive breast cancers, autoimmune disorders, and many disorders where transplantation and lifelong immunosuppression is the only treatment. It is also being researched as a way to regenerate damaged heart tissue after a heart attack. Amazingly, mRNA drugs can even be injected directly into the spinal cord, allowing them to enter the brain by bypassing the “blood-brain barrier,” a membrane that protects the brain but also makes it difficult to treat brain diseases.

Sidebar 3: Herd immunity and the “Swedish Model”

When COVID-19 first flared up in the spring, most countries took aggressive action to “flatten the curve” – stay-at-home orders, mandatory mask-wearing, social distancing, bans on large gatherings, shutting down bars, restaurants, and non-essential businesses. In large part, such strict measures did slow down the spread of contagion, but one western country, Sweden, decided to follow a different path. Instead, they chose a relaxed approach that relied on people using common sense to avoid exposure, allowing life and business to carry on as usual. As a result, the nation’s nursing homes were ravaged, and by the time the second surge hit Europe this fall, Sweden was recording nearly 6,000 new infections each day, and 20% of the citizens were testing positive for the virus. They have since imposed strict lockdown measures similar to its European neighbors.

But right-wing and libertarian politicians in the US hailed “the Swedish model” as a template for achieving herd immunity without crippling the economy. They promoted an alternative risk-based approach to the pandemic which provided “focused protection” for high-risk individuals while avoiding the social and economic damage created by lockdowns and behavioral restrictions. They claimed that, by allowing lower-risk individuals to resume their normal daily lives, an increase of immunity in the population would eventually protect those at higher risk. They believe that, by allowing the virus to circulate and “healthy” people to become infected, the greater population would reach “herd immunity” – and then the virus would die out.

But as of now, only about 10% of the world’s population has been infected with the coronavirus, so many more people would need to become infected in order to achieve herd immunity through natural infection alone – and many, many would die unnecessarily along the way. Without a vaccine and public health mandates, scientists predict that at least 1,000,000 Americans would die before herd immunity was reached.

Widespread immunization, rather than letting a virus run rampant, is a far better strategy in achieving herd immunity. And the number of people who need to be vaccinated depends upon the disease – in the case of measles (the most contagious disease in the world), it’s 95%; for polio, it’s 80%; and the best estimates suggest that for COVID-19, at least 70% need to be vaccinated. That means that at least 160,000,000 Americans would need to be vaccinated (or else immune due to previous infection) in order to reach that 70% threshold for herd immunity.