 December 7, 2020 |
An informed guide to the pandemic, with the latest developments and expert advice about prevention and treatment. |
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Who should get the vaccine second? |
The coronavirus vaccination campaign is expected to begin in the United States within the next month, and the debate about when different groups of Americans should receive doses is heating up. The Centers for Disease Control and Prevention has recommended that health care workers and the oldest, most vulnerable people should be first in line. Who should go next? |
Experts are divided. Some argue that the country should prioritize people over 65 and those with serious medical conditions, who are dying of the virus at the highest rates. Others say the next doses should to be given to essential workers, an expansive group that has borne the greatest risk of infection. |
My colleagues Abby Goodnough and Jan Hoffman write that, in the end, the debate is really over what should take the higher priority: preventing death or returning to some semblance of normalcy. |
In a meeting last month, the committee members who advise the C.D.C. on immunization practices signaled their support for putting essential workers ahead of people at risk because of age or medical conditions. That advice runs counter to the framework proposed by the World Health Organization. |
But the pandemic has laid bare entrenched inequality in the United States, and the C.D.C. committee members are also considering social justice concerns alongside scientific evidence to inform their decisions. The essential worker category, for instance, includes a high proportion of minority and low-income workers, who have been disproportionately affected by the virus. |
There’s also the tricky matter of priority within the essential work force — a group that, according to the C.D.C., makes up nearly 70 percent of American workers. |
In the end, the decision will be up to officials from each state to determine which groups will get the vaccine first, and we’re already seeing variations in the plans. Louisiana, for example, puts prison guards and food processing workers ahead of teachers and grocery employees, while Nevada prioritizes education and public transit workers. |
But perhaps the biggest unknown is how many people in the early groups will actually take the vaccine. |
“If a high proportion of essential workers decline to get the vaccine, states will have to quickly move onto the next group anyway,” said Lisa A. Prosser, a professor of health policy and decision sciences at the University of Michigan. “Because once the vaccines arrive, they will have to be used in a certain amount of time before they degrade.” |
When will I get a vaccine? The Times Opinion section put together a tool to help you find where you may stand in the vaccine line. |
Q. and A. on vaccine immunity |
The United Kingdom will begin administering its first vaccines tomorrow, marking the start of the immunization campaign in the Western world. With the shots come many questions about the immunity conferred by vaccines. Our colleague Apoorva Mandavilli spoke to experts about some of the questions that are top of mind. |
Q. Which produces a stronger immune response: a natural infection or a vaccine? |
A. We don’t know, but early evidence suggests that Covid-19 vaccines may induce better immunity than natural infection. Volunteers who received the Moderna shot had more antibodies — one marker of immune response — in their blood than did people who had been sick with Covid-19. While natural immunity from the coronavirus is strong, it varies widely among people and can wane within a few months in those who had only a mild infection. |
Q. I’m young, healthy and at low risk of Covid. Why not take my chances with that rather than get a rushed vaccine? |
A. The experts were unanimous in their answer: Covid-19 is by far the more dangerous option. On average, the virus seems to be less risky for younger people, but that is a broad generalization. For example, in a study of more than 3,000 people, ages 18 to 34, who were hospitalized for Covid, 20 percent required intensive care and 3 percent died. Covid vaccines, in contrast, carry little known risk. They have been tested in tens of thousands of people with no serious side effects — at least so far. |
Q. I had Covid. Is it safe for me to get a vaccine? If so, when can I get one? |
A. Experts said that it’s safe, and probably even beneficial, for anyone who has had Covid to get the vaccine at some point. But if you’ve already had Covid-19, you can afford to wait awhile for the vaccine. Studies have shown that people who have had Covid have some level of protection during the first few months after infection. Because there is so little vaccine available at the moment, some experts think that those who have had Covid should not be in the front of the line. |
The Swiss cheese model |
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Lately, in the continuing conversation about how to defeat the coronavirus, experts have made reference to the “Swiss cheese model” of pandemic defense. |
The metaphor is easy enough to grasp: Multiple layers of protection, imagined as cheese slices, block the spread of the virus. No one layer is perfect. Each has holes, but several layers combined — social distancing, and mask wearing, and hand-washing, as well as testing and tracing, and ventilation, and government messaging — significantly reduce the overall risk. |
Ian M. Mackay, a virologist at the University of Queensland, in Brisbane, Australia, saw a version of the model on Twitter, but he thought that the visual would be better with more slices and more information. He created, with collaborators, the “Swiss Cheese Respiratory Pandemic Defense,” an infographic that has been translated into more than two dozen languages. |
Resurgences |
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What else we’re following |
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