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The United States has spent months trying to vaccinate those most at risk for serious illness from Covid-19, from health care providers and the elderly to essential workers and those with other underlying medical conditions.
In the coming weeks, data on Covid hospitalizations and deaths will show whether this strategy works.
Increases where the numbers usually translated weeks later into increasing hospitalizations and deaths, a dynamic that should decline after the most vulnerable are immunized. Although there are early signs that occur in places such as nursing homes, it remains to be seen whether it will be valid for other at-risk groups and for younger people. And the moment of truth comes just like infections growing again in many states.
“It will be a test of the effectiveness of our vaccination campaigns to reach at-risk populations,” said Josh Michaud, associate director for global health policy at the Kaiser Family Foundation, an independent nonprofit. All states have made at least those aged 65 and over eligible, which means that “eliminate something like 80% of the population at greatest risk of death.”
The growing share of Americans who received Covid-19 vaccines – about 26%, or more than 87 million people, got at least a dose – represents a turning point in the trajectory of the pandemic and an important moment for the USA, where the virus made at least 30 million sick and killed over 547,000.
However, most people in the United States are not yet protected. And there are significant obstacles in the US race to staying ahead of the virus, including hesitation in the vaccine and barriers to access, declining testing and the emergence of more contagious variants.
While the number of new cases, hospitalizations and deaths will remain important indicators of the state of the pandemic, there is a clear need for more accurate ways to measure Covid-19, say public health experts.
“Knowing where we have a problem depending on the community and the source is very important to deal with the pandemic as we move forward,” he said. Ali Mokdad, a professor at the Institute for Health Metrics and Evaluation in Seattle, who produces influential Covid-19 projections. “Otherwise, we fly blind.”
Shift Younger
At least for some groups, Covid vaccines reach their target audience and do what they should. Of those aged 65 and over, an early demographic group to qualify for inoculation, about 71% received at least one dose, according to the Centers for Disease Control and Prevention. date.
In nursing homes, where residents were also prioritized for shootings earlier, Covid cases among residents fell by nearly 98 percent since mid-December and deaths by 88 percent, according to the CDC. data, something industry officials have linked to immunizations.
What this means is that new Covid cases are likely to occur in younger age groups. This has happened in Israel, where infections have recently flattened, despite the world’s leading immunization program. It turned out that the cases among young people increased, even if the infections decreased in the crowd of 50 years and older.
Younger people, although believed to be less likely to show symptoms, can spread the virus and contract severe cases themselves. In a handful of states, for example, those with underlying medical conditions do not yet qualify for shooting.
Vaccines work
Nursing home residents see declining Covid-19 infections, deaths
Source: CDC National Health Safety Network
While it is “extremely good news that the rate of our deaths is declining in those who have been vaccinated, there is still a mortality rate among those over the age of 20,” CDC Director Rochelle Walensky told a briefing from the White House this week. “As these cases continue to grow in that population, we will see the mortality rate in that population.”
These risks are top notch in West Virginia, which expanded eligibility this week in an effort to stop the spread of the virus among young people.
“We think that will save us more time,” said Clay Marsh, Covid-19 coordinator in West Virginia and executive dean for health sciences at the University of West Virginia. “We would like to keep the options at bay and try to vaccinate the rest of the population.”
In Michigan, where Covid infections are rising again, the ratio of hospitalizations to cases is significantly lower than in October, the last time the state saw such a large increase. About 69% of its cohort aged 65 and over – which usually accounted for half of all Covid hospitalizations and about 4 in 5 deaths – now had at least one dose of vaccine.
However, The Michigan Health & Hospital Association has sounded alarms this week about growing hospitalizations among younger age groups: Since early March, they have risen 633% among 30-year-olds and 800% among 30-year-olds. 40 years. The data show that Covid-19 vaccines work, but also “the fact that adults of all ages are vulnerable to complications of the disease,” the group said.
Blunt instrument
While expanding vaccination coverage is key to the US recovery, it also threatens to further split an already fractured national pandemic response.
Take, for example, test levels, which are how cases in the US are identified and counted. In recent months, these levels have stagnated and even recently begun to decline.
“We have completely shifted our focus to vaccines at the expense of testing,” with states even turning test facilities to administer vaccines, said Jennifer Nuzzo, a senior researcher at the Johns Hopkins Center for Health Security. the virus and where it is not and how fast it spreads ”.
And while there are other ways to monitor Covid trends, known as surveillance, such as conducting more specific tests in places like travel centers, nursing homes, or prisons that have never started in the United States, said Nuzzo.
This is important because as vaccination coverage expands, outbreaks of the virus may become more widespread.
“People would be surprised to see the number of people still unvaccinated, especially among vulnerable groups,” said David Rubin, a physician and director of PolicyLab at the Children’s Hospital of Philadelphia, which modeled the spread of Covid-19.
CDC epidemiologist Adam MacNeil said in an interview that the agency is setting up surveillance systems to track Covid-19 reinfections and cases of people who have been immunized to become infected, to accompany long-term efforts to track and model infection levels. .
Federal and state officials have made virus data available to the public at the county level, but more accurate views of those affected are often missing, Mokdad IHME and others said. Data for cases and hospitalizations by age and race or ethnicity, for example, are scarce and inconsistently available at the county level, according to Rubin of PolicyLab.
“We don’t even have that, a year after the pandemic,” he said.
– With the assistance of Jonathan Levin and Jill R Shah