In the United States, the number of cases and deaths that had been rising to a peak for almost a year have been flattening out, thanks, in large part, to COVID-19 vaccinations that began in December. As the weeks pass, more reports have been coming out about the effectiveness of the vaccines that are in use and the potential of those still in development. So, how do they differ?
It’s important to keep up, but it’s also a daunting task, given the flood of information (and misinformation) coming at us from so many directions.
Vaccines from Pfizer-BioNTech, Moderna, and Johnson & Johnson are being administered in the U.S. right now, and others are on track to do the same.
We mapped out a comparison of the most prominent COVID-19 vaccines.
Author(s): Kathy Katella
Publication Date: 1 July 2021 (originally published February 2021, updated)
Somewhere in PHE’s data pipeline, someone had used the wrong Excel file format, XLS rather than the more recent XLSX. And XLS spreadsheets simply don’t have that many rows: 2 to the power of 16, about 64,000. This meant that during some automated process, cases had vanished off the bottom of the spreadsheet, and nobody had noticed.
The idea of simply running out of space to put the numbers was darkly amusing. A few weeks after the data-loss scandal, I found myself able to ask Bill Gates himself about what had happened. Gates no longer runs Microsoft, and I was interviewing him about vaccines for a BBC program called How to Vaccinate The World. But the opportunity to have a bit of fun quizzing him about XLS and XLSX was too good to pass up.
I expressed the question in the nerdiest way possible, and Gates’s response was so strait-laced I had to smile: “I guess… they overran the 64,000 limit, which is not there in the new format, so…” Well, indeed. Gates then added, “It’s good to have people double-check things, and I’m sorry that happened.”
Exactly how the outdated XLS format came to be used is unclear. PHE sent me an explanation, but it was rather vague. I didn’t understand it, so I showed it to some members of Eusprig, the European Spreadsheet Risks Group. They spend their lives analyzing what happens when spreadsheets go rogue. They’re my kind of people. But they didn’t understand what PHE had told me, either. It was all a little light on detail.
AT A PRESS conference at the White House on June 22nd Anthony Fauci, the director of America’s National Institute of Allergy and Infectious Diseases, issued a warning. The delta variant of the SARS-CoV-2 virus, first identified in India in February, was spreading in America—and quickly. “The delta variant is currently the greatest threat in the US to our attempt to eliminate covid-19,” declared Dr Fauci. Boris Johnson, Britain’s prime minister, issued a similar warning a week earlier. To contain the rapid spread of the variant, European countries and Hong Kong have tightened controls on travellers from Britain.
According to GISAID, a data-sharing initiative for corona- and influenza-virus sequences, the delta variant has been identified in 78 countries (see chart). The mutation is thought to be perhaps two or three times more transmissible than the original virus first spotted in Wuhan in China in 2019. It is rapidly gaining dominance over others. According to GISAID’s latest four-week average, it represents more than 85% of sequenced viruses in Bangladesh, Britain, India, Indonesia and Russia. It may soon be the most prevalent strain in America, France, Germany, Italy, Mexico, South Africa, Spain and Sweden. (GISAID does not, in its summary data, distinguish between delta, B.1.617.2, and the “delta plus” mutation, AY.1, AY.2.)
India has officially recorded more than 390,000 coronavirus deaths, but families who have lost loved ones, health experts and statisticians say that vastly undercounts the true toll. Families like Mrs. Singh’s have been left struggling to get compensation that some states have set up for Covid-19 victims.
India’s undercount has also left a huge gap in the world’s understanding of the impact of the Delta variant, which health experts believe helped drive one of the world’s worst Covid-19 surges in April and May. India was the first to detect the highly infectious variant, which has hopscotched around the world. It is fueling a surge in the U.K., and is expected to become the dominant variant in the U.S.
The undercounting of infections and deaths is a problem world-wide, even in countries with widespread testing. The World Health Organization said last month that the global Covid-19 death toll could be two or three times the official number. The problem, however, is particularly acute in the developing world, where access to healthcare and coronavirus testing is often more limited.
….. To qualify for its Covid-19 compensation payment of 400,000 rupees, equivalent to about $5,400, the state requires a report from a certified lab, which at the time were taking days to process.The family got a test strip from the lab indicating that Mrs. Singh was positive and rushed to a doctor. …… Health experts say many Covid-19 deaths have gone uncounted among India’s vast population of rural poor, who have little access to healthcare or Covid-19 testing.
Mr. Banaji, the mathematician, says the central government has tended to praise states with low death counts and castigate those with higher counts as incompetent. “This narrative of success and failure centered on fatality numbers is very dangerous,” he said.
Life expectancy in the United States between 2018 and 2020 decreased by 1.87 years (to 76.87 years), which is 8.5 times the average decrease in other high-income nations. What’s more, decreases in life expectancy among Hispanic and non-Hispanic Black people were about two to three times greater than in the non-Hispanic White population, reversing years of progress in reducing racial and ethnic disparities. The life expectancy of Black men (67.73 years) is the lowest since 1998.
Those are key findings of a study conducted by researchers at the Virginia Commonwealth University School of Medicine, the University of Colorado Population Center and the Urban Institute in Washington, D.C., and published in The BMJ — a peer-reviewed medical trade journal of the British Medical Association.
Chan started emailing authors and journals to get the raw data she needed to more fully analyze what they had done. Making such data available is usually a condition of publication, but it can still be hard to obtain. After what she calls months of stonewalling, Chan finally lost her cool and blasted an accusation out from her browser. “I need the scientists + editors who are directly or indirectly covering up severe research integrity issues surrounding some of the key SARS-2-like viruses to stop and think for a bit,” she posted to Twitter. “If your actions obscure SARS2 origins, you’re playing a hand in the death of millions of people.”
Eddie Holmes, a prominent Australian virologist and coauthor of one of those papers (as well as “Proximal Origins”), called the tweet “one of most despicable things I read on the origins issue.” He felt accused, but he wondered what he was being accused of, since his paper had correctly accounted for its pangolin data sources. Holmes then circulated an intricate time line prepared by Chan of the publication dates and past connections between the authors. The chart’s dense web of arrows and connections bore an unmistakable resemblance to an obsessive’s cork board covered with red string and thumbtacks.
Results Between 2010 and 2018, the gap in life expectancy between the US and the peer country average increased from 1.88 years (78.66 v 80.54 years, respectively) to 3.05 years (78.74 v 81.78 years). Between 2018 and 2020, life expectancy in the US decreased by 1.87 years (to 76.87 years), 8.5 times the average decrease in peer countries (0.22 years), widening the gap to 4.69 years. Life expectancy in the US decreased disproportionately among racial and ethnic minority groups between 2018 and 2020, declining by 3.88, 3.25, and 1.36 years in Hispanic, non-Hispanic Black, and non-Hispanic White populations, respectively. In Hispanic and non-Hispanic Black populations, reductions in life expectancy were 18 and 15 times the average in peer countries, respectively. Progress since 2010 in reducing the gap in life expectancy in the US between Black and White people was erased in 2018-20; life expectancy in Black men reached its lowest level since 1998 (67.73 years), and the longstanding Hispanic life expectancy advantage almost disappeared.
Conclusions The US had a much larger decrease in life expectancy between 2018 and 2020 than other high income nations, with pronounced losses among the Hispanic and non-Hispanic Black populations. A longstanding and widening US health disadvantage, high death rates in 2020, and continued inequitable effects on racial and ethnic minority groups are likely the products of longstanding policy choices and systemic racism.
Indeed, new research published Wednesday in the BMJ shows just how wide that gap has grown. Life expectancy across the country plummeted by nearly two years from 2018 to 2020, the largest decline since 1943, when American troops were dying in World War II, according to the study. But while white Americans lost 1.36 years, Black Americans lost 3.25 years and Hispanic Americans lost 3.88 years. Given that life expectancy typically varies only by a month or two from year to year, losses of this magnitude are “pretty catastrophic,” said Dr. Steven Woolf, a professor at Virginia Commonwealth University and lead author of the study.
Over the two years included in the study, the average loss of life expectancy in the U.S. was nearly nine times greater than the average in 16 other developed nations, whose residents can now expect to live 4.7 years longer than Americans. Compared with their peers in other countries, Americans died not only in greater numbers but at younger ages during this period.
The U.S. mortality rate spiked by nearly 23% in 2020, when there were roughly 522,000 more deaths than normally would be expected. Not all of these deaths were directly attributable to covid-19. Fatal heart attacks and strokes both increased in 2020, at least partly fueled by delayed treatment or lack of access to medical care, Woolf said. More than 40% of Americans put off treatment during the early months of the pandemic, when hospitals were stretched thin and going into a medical facility seemed risky. Without prompt medical attention, heart attacks can cause congestive heart failure; delaying treatment of strokes raises the risk of long-term disability.
In the midst of the uncertainty, Epic, a private electronic health record giant and a key purveyor of American health data, accelerated the deployment of a clinical prediction tool called the Deterioration Index. Built with a type of artificial intelligence called machine learning and in use at some hospitals prior to the pandemic, the index is designed to help physicians decide when to move a patient into or out of intensive care, and is influenced by factors like breathing rate and blood potassium level. Epic had been tinkering with the index for years but expanded its use during the pandemic. At hundreds of hospitals, including those in which we both work, a Deterioration Index score is prominently displayed on the chart of every patient admitted to the hospital.
The Deterioration Index is poised to upend a key cultural practice in medicine: triage. Loosely speaking, triage is an act of determining how sick a patient is at any given moment to prioritize treatment and limited resources. In the past, physicians have performed this task by rapidly interpreting a patient’s vital signs, physical exam findings, test results, and other data points, using heuristics learned through years of on-the-job medical training.
Ostensibly, the core assumption of the Deterioration Index is that traditional triage can be augmented, or perhaps replaced entirely, by machine learning and big data. Indeed, a study of 392 Covid-19 patients admitted to Michigan Medicine that the index was moderately successful at discriminating between low-risk patients and those who were at high-risk of being transferred to an ICU, getting placed on a ventilator, or dying while admitted to the hospital. But last year’s hurried rollout of the Deterioration Index also sets a worrisome precedent, and it illustrates the potential for such decision-support tools to propagate biases in medicine and change the ways in which doctors think about their patients.
But most people with COVID-19 are never ill enough to be hospitalized. The best way to assess the prevalence of long COVID is to follow a representative group of people who have tested positive for the virus. The UK Office of National Statistics (ONS) has done just that, by following more than 20,000 people who have tested positive since April 2020 (see ‘Uncertain endpoint’). In its most recent analyses, published on 1 April, the ONS found that 13.7% still reported symptoms after at least 12 weeks (there is no widely agreed definition of long COVID, but the ONS considers it to be COVID-19 symptoms that last more than 4 weeks).
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In other words, more than one in 10 people who became infected with SARS-CoV-2 have gone on to get long COVID. If the UK prevalence is applicable elsewhere, that’s more than 16 million people worldwide.
The condition seems to be more common in women than in men. In another ONS analysis, 23% of women and 19% of men still had symptoms 5 weeks after infection. That is “striking”, says Rachael Evans, a clinician scientist at the University of Leicester, UK, and a member of the Post-Hospitalisation COVID-19 study (PHOSP-COVID). “If you’re male and get COVID, you’re more likely to go to hospital and you’re more likely to die. Yet if you survive, actually it’s females that are much more likely to get the ongoing symptoms.”
The Utah Department of Health reported 462 new cases of COVID-19, one new death and 7,412 new vaccinations administered in Utah Thursday.
It also released a new dataset for the first time that shows the number of “breakthrough” cases, hospitalizations and deaths for those who aren’t vaccinated account for a vast majority of recent trends. It also shows rate of new COVID-19 vaccinations is very slowly rising.
Utah’s rolling seven-day average for new positive cases in the state is now at 324, which is a slight increase from 312 Wednesday. The number of new cases is still well below any of the previous increases experienced since March 2020.
Millions of Americans are immunosuppressed or immune-compromised. That is, they take drugs to make sure that a transplanted organ is not rejected or to tamp down the overactive immunity that produces rheumatoid arthritis and lupus; or, alternatively, they have illnesses that undermine their ability to defend against pathogens. A handful of research papers published over the past few months all find the same result: When these patients receive Covid vaccines, their bodies don’t create as many defensive antibodies as those of healthy people. Some have contracted the disease despite being fully vaccinated—meaning that, to protect themselves, they must continue to behave as though their vaccinations never occurred.
As a result, some are seeking extra vaccinations, arranging for third doses that they hope will act like booster shots. A study published Monday in the Annals of Internal Medicine by a team at Johns Hopkins University School of Medicine documents the experience of 30 people living with organ transplants who sought out a third shot in hopes of boosting their immune responses. After their second shots, none of the 30 had high antibody levels; in fact, only six showed any antibody response at all. After the third shot, 14 out of 30 saw some improvement, and 12 of 30 had antibody levels that the researchers considered protective.
