Will People Get the Coronavirus Vaccine?

an interview that aired during last night’s Aspen Ideas Festival broadcast, Dr. Anthony Fauci expressed doubt that the United States would achieve herd immunity if a coronavirus vaccine became available. A major reason is the alarming number of Americans who oppose vaccination.

A coronavirus vaccine isn’t available yet, but three are in phase 3 clinical trials and more than 125 are in development. There’s no guarantee, however, that any of them will be effective in 100% of people who get it — the best humans have accomplished is 97% to 98%, with the measles vaccine. In the interview, Fauci, a member of the White House coronavirus task force, said he’d “settle” for a coronavirus vaccine that was only 70% to 75% effective, which he said would bring us to the “herd immunity level.”

A population achieves herd immunity when the proportion of people who are immune to a disease passes a certain threshold, making it extremely difficult for the disease to spread even if it is reintroduced. The threshold is different for every disease, but as Tara Haelle wrote in Elemental, experts estimate that it’s about 60% to 80% for Covid-19.

Herd immunity can be achieved in two ways: Either everyone gets vaccinated, or enough people get infected with Covid-19 and — crucially — manage to recover. Since Covid-19 can be fatal, the latter is not a great option. Widespread vaccination is a safe way to establish herd immunity that doesn’t involve the risk of people dying — it has succeeded for measles, mumps, polio, and chickenpox — but it’s only going to work if enough people actually get vaccinated.

Unfortunately, anti-vaccination sentiment is strong in the United States and has seen a surge during the pandemic.

A CNN poll conducted in May showed that one-third of Americans would not get a coronavirus vaccine if it was available. It also revealed that 81% of Democrats and 64% of independent voters polled would try to get a vaccine if it existed, while only 51% of Republicans would do the same. Regular polls conducted by the CUNY Graduate School of Public Health and Health Policy have shown similar trends: The latest data, from May, showed that 31% of those polled would immediately get a vaccine, while 12% would reject a vaccine outright, according to The BMJIn California, a hotbed of vaccine opposition, anti-vaccination advocates have staged regular protests at the state capitol, at which Judy Mikovits, the discredited doctor and anti-vaccination activist behind the widely debunked Plandemic conspiracy documentary, has been a guest speaker.

In the interview on Sunday, Fauci expressed his often-repeated concerns about anti-vaccination in the United States. “There is a general anti-science, anti-authority, anti-vaccine feeling among some people in this country — an alarmingly large percentage of people, relatively speaking,” he said.

Anti-vaccination advocates make up a small but very vocal minority around the world, including in AustraliaCanada, and the U.K. Suspicions about racism in vaccination trials have been stoked by the clinical trials of a new coronavirus vaccine in South Africa, adding a layer of complexity to the opposition to vaccines.

In an interview last week, Stanford University law professor Michelle Mello pointed out that it will not “be immediately salient that [anti-vaxxers are] not willing to be vaccinated,” pointing to the likelihood that a limited number of doses will be available at first. “Because so many people will want vaccines when they become available,” she says, “the question in the near to medium term is not must everyone get them, but who gets to access them?” In May, Emily Mullin wrote in OneZero about the ways in which the government might have to triage its distribution of the vaccine.

Fauci, for his part, said he was “cautiously optimistic” that a vaccine will be available by the end of this year or the beginning of 2021. He pointed out that several vaccine companies have said that hundreds of millions of doses could be available by the beginning of 2021, and up to a billion doses could be made available by 2022. Though triaging will likely have to happen early on, eventually there could be more than enough doses for every American to have one.

Herd immunity is possible and could protect everyone in the United States — if the vast majority of people choose to cooperate. But as long as we are divided along ideological lines, we remain vulnerable to the spread of what could, eventually, become a preventable disease.

Coronavirus Has Made Me a Better Physician

you only have five minutes with a patient, what questions do you ask and what physical exam maneuvers do you perform? If you can only order one laboratory test, what should it be? If the MRI or CT scanner is unavailable, are you still confident in your diagnosis?

These are questions that we resident physicians ask ourselves daily as part of a critical thinking exercise. They help us stay grounded and able to practice medicine without relying on the luxuries of expensive or advanced testing.

Theory becomes reality

When Covid-19 engulfed our state and hospital, this critical thinking exercise took on new meaning by becoming a daily reality. I found myself increasingly working in a resource-limited environment, in which every patient encounter and test was scrutinized for necessity. It wasn’t easy to completely upend my usual practice — yet I suspect that facing constant limitations may have made me a better physician.

Coronavirus has prompted me to relearn the fundamentals of medicine, triage appropriately, and adapt to a virtual visit model — all of which may mean I’m providing increased care.

Because covid precautions demand limited patient encounters, I am forced to think carefully through the minimum necessary steps, exam findings, and testing to clinch the diagnosis.

I recently saw a 23-year-old woman in the emergency department for a severe headache. She was in significant pain and could not provide much of a history, which meant we were unable to rule her out for Covid-19. She also had a low-grade fever, flagging concern about meningitis, a deadly brain infection.

I abbreviated my exam to look for two things: neck stiffness and trouble with eye movements. She had both, indicating a likely deadly infection, with early signs of increased intracranial pressure. The patient needed prompt antibiotics, urgent head imaging, and a spinal puncture. This type of “emergency neurology” workup is normally frowned upon, as there may be subtle things that are missed in a rapid encounter. However, because Covid precautions demand limited patient encounters, I am forced to think carefully through the minimum necessary steps, exam findings, and testing to clinch the diagnosis.

Tests become risks

In today’s climate, the stakes are higher for any scan I might order. A brain MRI, for instance, will potentially expose the patient’s nurseemergency room physician, transport team, radiology technologist, radiologist, environmental services team, and administrative staff to the virus — if the patient has it. Likewise, the patient will also be exposed to all of these individuals who might be carrying it.

With this in mind, I am frequently forced to reconsider my recommendations. Obtaining unnecessary imaging is a dangerous practice. Incidentalomas, unexpected incidental findings, occur in as much as 10% of patients. These findings can lead to increased worry, stress, and unnecessary interventions. This is in addition to the harmful radiation or intravenous contrast, which may cause anaphylaxis or kidney damage, that a scan might entail.

We now have to be absolutely sure about every test we order.

Because of this particular patient’s abnormal eye movements and neck stiffness, she needed imaging despite the risks of exposure.While at times it has been daunting to practice medicine without the guaranteed safety net of advanced testing, it has been refreshing to place new emphasis on our clinical skills and knowledge.

Caring for patients at home

This type of risk-averse thinking and triage has impacted our outpatient management as well. We now ask ourselves on a regular basis: Does this patient need to be in the hospital? We have started to triage small strokes for expedited follow-up, completing the work-up over a few days in an outpatient setting. Likewise, we have been doing our best to keep our immunocompromised patients, including those with brain tumors on chemotherapy or with multiple sclerosis on immunosuppression, out of the hospital. We have done this by increasing our number of virtual visits.

Initially, I was hesitant to move toward telemedicine. My training has always prioritized physically seeing patients and testing all parts of their nervous system — including strength, sensation, and coordination. However, while virtual visits are not perfect substitutes for in-person interactions, they offer tremendous value when it comes to increasing access to care.

Many neurologists are clustered in certain regions of the country. This has led to disparate access, particularly in rural and urban areas. Someone in rural Alaska or Maine may live hundreds of miles away from the nearest medical facility. Even living in a city with an abundance of medical specialists does not guarantee access to care. Transportation costs may be prohibitive and time consuming, ultimately contributing to health care disparities.

This pandemic has provided us with the unique opportunity to improve our telehealth system. Previously, these systems were clunky and outdated — requiring expensive technology or complex interfaces. Now, most virtual visits can be conducted using a cell phone. Even though these systems are still in their infancy, there is untold potential in increasing access to care, particularly to our most vulnerable populations. While telemedicine is not perfect and cannot fully substitute for a face-to-face visit, possibilities abound when it comes to providing medical care via telemedicine to traditionally underserved communities.

Covid-19 has undoubtedly changed the practice of medicine. And not all of these changes are negative. When this pandemic is finally over, we should not be so quick to revert back to the status quo, but rather try to integrate these changes to continue to improve health care for all.

Pakistan Reports 1st Case of Coronavirus Reinfection

A case of reinfection of Coronavirus has emerged in Pakistan, General Secretary of Young Doctors Association (YDA), Salman Kazmi, has confirmed.

The reinfected patient is exhibiting more severe symptoms now in comparison to the symptoms at the time of the first diagnosis, suggesting the existence of more than one strain of SARS-COV-2, the Coronavirus which causes COVID-19 disease.

In a Facebook post, Kazmi penned:

Just seen a case of reinfection from COVID-19 with more severe symptoms. This shows we have more than one strain around as we don’t have the capacity to test strains. So please be careful and always take precautions. This is the first case I have seen with proper symptoms of reinfection.

The reinfected patient, who is a doctor at Mayo Hospital Lahore, had initially contracted the disease 3 months ago while tending to Coronavirus patients. The doctor made a complete recovery and was discharged from the isolation center after testing negative.

However, the doctor recently developed more severe symptoms of Coronavirus once again and tested positive for the disease.

Kazmi has urged the public to exercise caution as the antibodies produced against the Coronavirus through the plasma therapy does not offer long term protection. These antibodies can only protect recovered patients for three months only after which there are high chances of reinfection.