Correction: On July 30, the state said an automation error caused approximately 225 deaths to be incorrectly added to the overall death count; a subsequent quality check by Department of State Health Services epidemiologists revealed COVID-19 was not the direct cause of death in these cases. The numbers and charts in this story have been updated to account for this error and are current as of July 30.
Texas southernmost county, Cameron, is home to just 1.5% of the states population, but it accounts for nearly 5% of its known COVID-19 fatalities.
Cameron County where 89% of residents are Hispanic and nearly a third live below the poverty line stands out as just one stark example of widespread disparities in COVID-19 outcomes. Across Texas and the nation, the novel coronavirus is deadlier for communities of color and low-income communities.
These disparities, and a wealth of other demographic information, became more apparent this week when new tallying methods at the state health agency revealed a more complete picture of who has died in Texas and where. Trends showing that Black and Hispanic individuals had been disproportionately hit by the virus were clear nationally and apparent in local snapshots, but until earlier this week, the Texas Department of State Health Services limited demographic data had clouded the picture of those disparities statewide.
Hispanic Texans make up about 40% of the states population, but they account for 49% of its known COVID-19 fatalities. Black Texans also appear slightly overrepresented in the fatality toll, representing 14% of fatalities but just 12% of the state population. Texas reported a total of 6,274 fatalities Thursday evening.
By contrast, white and Asian Texans died at lower rates relative to their share of the states population.
Sometimes called the great equalizer, the novel coronavirus has been anything but a deadly reality in a state like Texas, where the Hispanic population is expected to become the largest group in the state by mid-2021.
The disparities should not have been a surprise, said Jamboor Vishwanatha, director of the Texas Center for Health Disparities at the University of North Texas Health Science Center.
What COVID did is essentially shined a bright light on existing disparities, Vishwanatha said, citing disparities in rates of preexisting conditions like diabetes and cardiovascular issues, as well as social factors like income inequality and access to health care. You would expect something like this to happen.
Research has found that higher-paid employees are more likely to have the option to work from home, and that Black and Hispanic employees are less likely to be able to work remotely. In Texas and across the country, front-line employees like janitors, grocery clerks and transit workers are more likely to be women and people of color, an Associated Press analysis of U.S. Census Bureau data revealed.
Thats forced low-income workers and people of color to risk their health at work, exposing them to the virus while others earn a paycheck from home.
Many of these folks, particularly early on, were exposed to the disease, Dr. Georges Benjamin, executive director of the American Public Health Association, said Wednesday at an event put on by The Academy of Medicine, Engineering and Science of Texas.
Benjamin said a higher prevalence of chronic illnesses like hypertension and heart disease is contributing to disparities.
Geography has also played a role. Many of Texas deadliest hot spots have emerged in communities of color: among immigrant workforces at the meatpacking plants in the Panhandle; in Houston, one of the countrys most diverse cities; and in the Rio Grande Valley, where the population is majority Hispanic.
In general, most deaths have been recorded where most Texans live in big cities like Houston, Dallas, San Antonio, El Paso and Austin. But some counties, like Cameron and Hidalgo in the Rio Grande Valley, are mourning an outsized number of people relative to their population. Both counties are about 90% Hispanic.
Even in bigger urban areas, some whiter, wealthier counties seem to be faring better than poorer counties with more diverse populations. Travis County has some 400,000 more residents than El Paso County but fewer deaths, according to state data. According to census data, Travis County is about half white and a third Hispanic, with a median household income around $76,000 annually; El Paso County is 83% Hispanic, with a median household income around $44,000 annually.
And the virus true death toll is almost certainly higher than reported; for experts, the question is by how much.
The state may be showing a particular undercount in Hidalgo, a majority-Hispanic county in the Rio Grande Valley that is being ravaged by COVID-19. County health officials, using local medical records, report 576 deaths; the state, now relying on death certificates, revised its tally for the county down from over 450 to 312. Local officials said the difference is caused by delays in the issuance of death certificates.
Meanwhile, Vishwanatha said, access to testing has been more limited in communities of color.
Pointing to local data from North Texas, Vishwanatha said there is a disparity between communities of color and white groups not only in chance of getting infected but also in chance of dying from the disease. The gulf is even wider for mortality rate than it is for infection rate.
We are currently facing a critical situation where some of our communities are really suffering. We need to do everything to overcome these disparities. But hopefully this COVID situation has brought out something that we should have been tackling all along how to overcome these chronic health disparities that our communities suffer, Vishwanatha said.
Disclosure: The UNT Health Science Center has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.
Doris Crippen, 73, said she had come down with what she thought was the flu in May. Due to how weak it made her, she ended up falling and breaking her arm, sending her to the emergency room and eventually down memory lane.
It turned out she had coronavirus and had to spend almost 30 days in the hospital recovering, Crippen said. After she was released, Crippen went to Fremont Methodist Health's Dunklau Gardens to get rehab on her arm.
It was there that she encountered a wonderful surprise.
Bev Boro, 53, has been a medication aide at Dunklau Gardens in Fremont for 22 years and when she came across Crippen's name on a patient board she immediately recognized it.
"I couldn't believe it," Boro said at a July 22 news conference. "I thought, 'Oh my God, I think this is my sister.'"
The two women have the same father but different mothers, and they have not seem each other in 53 years, when Boro was a baby. Crippen lived with her mother, but Boro and four of their 14 siblings were separated by the state and put up for adoption when she was 6 months old.
On June 27, Boro decided to take a chance and confirm that Crippen was who she thought she was. Since, Crippen is hard of hearing, Boro went into her room with a white board and wrote their father's name. Crippen confirmed that was her dad.
"I pointed at myself... and said, "That's mine too!"... I have our dad's eyes," Boro said.
"I about fell out of my chair and I just burst into tears," Crippen said. "It was just a happy feeling to find my sister. It's been 53 years since she was a baby and I held her."
Crippen had tried to find her siblings several times over the years, but d failed.
"It's amazing ... really overwhelming, after so many years," Crippen said. "I never thought I'd find her again."
Boro on the other hand had tracked down most of their siblings, and now she gets to reunite Crippen with the family members Crippen thought she had lost. They are now trying to plan a family reunion.
"It was the Lord's blessing that I got sent here," to the rehab center, "because if I hadn't been sent here, I wouldn't have found her," Crippen said.
The media will reportedly not be allowed to witness Donald Trumps formal renomination as the Republican partys choice for president at its national convention later this month.
Citing coronavirus-related health concerns, a convention spokesperson told the Associated Press that media members would be turned away in order to assure compliance with state and local guidelines regarding the number of people who can attend events.
The announcement was highly unusual and would represent a historic departure from convention practices in modern times. An Arkansas newspaper, the Democrat Gazette, first reported the news. The Republican national committee, which organizes the convention, could not immediately be reached for comment.
Held once every four years, the national conventions represent occasions for party officials and operatives to come together to strategize, renew contacts, share excitement and ultimately formally nominate the partys candidate for president.
The official nomination is typically covered with a wall-to-wall media blitz including cheering crowds decked out in party swag and a live broadcast of the nominees acceptance speech. The exposure typically results in a bounce of a few points for the nominee in approval polls.
But this year the Republican party appears intent on repeating its nomination of Trump, whose dismal performance in handling the coronavirus pandemic has dragged his popularity to historic lows, with no cameras present, in subversion of the presidents own instinct for spectacle and obsession with TV ratings.
Given the health restrictions and limitations in place within the state of North Carolina, we are planning for the Charlotte activities to be closed [to] press Friday, August 21Monday, August 24, a convention spokeswoman told the AP.
We are happy to let you know if this changes, but we are working within the parameters set before us by state and local guidelines regarding the number of people who can attend events.
It was not clear how the convention could move forward in compliance with state guidelines, which have been a sticking point between Republicans and the states Democratic governor for months. North Carolina currently has set an official limit of 10 people for indoor gatherings and 25 people outdoors.
The Republican national party has announced that 336 officials will attend the convention.
Confronted with earlier expressions of concern by the state about the crowds, the Republican party abruptly announced the relocation of key convention activities to Florida, which has a strongly pro-Trump Republican governor.
But Trump had to call off the public components of the convention in Florida last month, citing spiking cases of the virus across the country.
The convention was once expected to bring 15,000 journalists to Charlotte, but the spread of coronavirus this spring upended those plans.
The seven-day average for confirmed new Covid-19 cases in North Carolina climbed steadily before breaking the 2,000 barrier last month. The state has recorded almost 2,000 deaths from coronavirus since the start of the pandemic. Face masks are required in public in the state per executive order.
Privately, some GOP delegations have raised logistical issues with traveling to Charlotte, citing the increasing number of jurisdictions imposing mandatory quarantine orders on travellers returning from states experiencing surges in the virus.
The subset of delegates in Charlotte will be casting proxy votes on behalf of the more than 2,500 official delegates to the convention. Alternate delegates and guests have already been prohibited.
The Democrats have planned a mostly virtual convention to nominate Joe Biden to be held in Milwaukee, Wisconsin, from 17-20 August.
North Carolinas Democratic governor Roy Cooper said last week that the state would welcome Trump if he decided to attend the convention.
Hes welcome to come, but nothing has changed about our resolved to keep health and safety first, Cooper said. Obviously we would have concerns about people coming in and about a large crowd, but well continue to keep health and safety number one in this process.
Trump indicated in an interview at the White House last month that he would travel to Charlotte to accept the nomination.
Well be doing a speech on Thursday the main speech, the primary speech, Trump told reporters. Charlotte, they will be doing the nominating on Monday. Thats a different period, a different thing happening, but theyll be doing nominations on Monday. I speak on Thursday.
Trump last month announced cancellation of three days of events set for Florida. I looked at my team and I said the timing for this event is not right. Its just not right, Trump said at the White House. To have a big convention, its not the right time.
At-home testing could transform the fight against the novel coronavirus. USA TODAY
As Leon county surpasses 55,000 locally-administered COVID-19 tests, at least six Big Bend residents died because of the coronavirus over the weekend, according to the Florida Department of Health.
Leon County gained 105 confirmed cases of COVID-19 Sunday, bringing its total to 4,387 positive tests. Among the new cases are two 4-year-old girls, a 6-year-old boy, an8-year-old boy and five teenagers between ages 13 and 19. The youngest of Leon's new cases is a boy listed as "zero" years old. The oldest is a 91-year-old woman.
In Gadsden County, a 77-year-old man and a 61-year-old manhave died because of COVID-19, the state health department reports. So far, Gadsden County has had 20 fatalities associated with the virus.
The free COVID-19 testing site at Bragg Memorial Stadium on the FAMU campus Tuesday, May 12, 2020, has a steady stream of patients, but plenty of space to keep them all socially distant.(Photo: Randi Atwood/Tallahassee Democrat)
An 80-year-old Franklin County woman also has died because of COVID-19. She is the second coronavirus-related fatality in Franklin County, according to the health department.
In Jackson County, a92-year-old woman and an 87-year-old man have died because of the novel virus. The health department verified the 87-year-old man's death on Saturday and confirmed the 92-year-old woman's death on Sunday.
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A 60-year-old woman in Wakulla County also has died because of the virus. She is the fourth Wakulla resident to die because of COVID-19, according to the state health department. The department confirmed her death Saturday.
The health department does not provide further details about the individuals, except that they were all Florida residents.
Jefferson Correctional Institution in Monticello had 99 more inmates test positive for COVID-19, according to the Florida Department of Corrections.
The facility now has 174 inmates and 38 staff members who have tested positive. On Sunday, 225 inmate tests were pending, according to the state corrections department.
Franklin Correctional Institution in Carrabelle has had 17 more inmates test positive for COVID-19, the state corrections department reports. The Franklin facility has 888 pending inmate tests, according to the department.
Gadsden Re-Entry Center in Havana had 15 more inmates test positive for COVID-19, according to the corrections department. In total, the facility has had 16inmates and seven staff members test positive so far. The facilityhas333 pending inmate tests, the corrections department reports.
Casey Chapter is the news editor of the FSView & Florida Flambeau. Reach her at CChapter@Tallahassee.com or follow her on Twitter @CaseyChapter.
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New York invested $750,000 in Rheonix, an Ithaca-based manufacturer, to build lab instruments and make reagent kits, which are now being used for thousands of tests daily. States should tap their local manufacturing companies to compensate for international shortages, and Congress should allocate funding for businesses that fill these needs.
Invest in innovative solutions. The Food and Drug Administration recently approved pooled testing, where multiple samples are run at once, increasing capacity and saving lab supplies. But for one national lab, the approved pool size is just four samples. In Wuhan, China, up to 10 specimens were pooled, allowing the city to increase its capacity to 1.5 million tests daily, up from 46,000 tests daily.
The federal government should direct research money so that labs can increase their pool size, while ensuring accuracy. With flu season on the way, Congress and federal agencies should also invest in developing widely available single tests that can detect multiple respiratory viruses, including the coronavirus and different types of influenza.
Congress should also invest in developing more tests that can give results in minutes and that can be administered at workplaces, not just labs. The F.D.A. has approved only a handful of these devices, and they are not widely available.
Fund all necessary testing. Currently, under federal rules, medically necessary testing is free for those with Covid-19 symptoms, as well as asymptomatic people who have been exposed to the virus.
But states should be able to conduct broad community screening 40 percent of infected people are asymptomatic to detect the virus and control its spread. For example, Congress should ensure testing is free for individuals who attend mass gatherings, regularly ride public transportation or interact with members of the public at work.
New York is proof that a real testing strategy can control Covid-19. But our future success depends on other states to do the same a virus anywhere is a virus everywhere.
Estimated infected people arriving in the first week
+ -
Pod of 10
School of 100
School of 500
School of 1,000
Source: Lauren Ancel Meyers and Spencer Fox, the University of Texas at Austin; Michael Lachmann, Santa Fe Institute
Millions of families face an excruciating choice this fall: Should their children attend if local schools reopen their classrooms, and risk being exposed to the coronavirus? Or should they stay home and lose out on in-person instruction?
No single factor can settle such a fraught decision. But new estimates provide a rough gauge of the risk that students and educators could encounter at school in each county in the United States.
The estimates, from researchers at the University of Texas at Austin, range from sobering to surprisingly reassuring, depending on the area and the size of the school.
Based on current infection rates, more than 80 percent of Americans live in a county where at least one infected person would be expected to show up to a school of 500 students and staff in the first week, if school started today.
In the highest-risk areas including Miami, Fort Lauderdale, Nashville and Las Vegas at least five students or staff would be expected to show up infected with the virus at a school of 500 people.
The high numbers reflect the rapid spread of the virus in those areas, where more than 1 in 70 people are estimated to be currently infected.
At the same time, smaller, isolated groups of students face a much lower risk. Some schools are considering narrowing classes down to small pods, with students who mainly come in contact with their teacher and each other. While the chance of having an infected person at the school would stay the same, the risk of exposure within those pods would be much lower.
If they remain isolated from the rest of the school a tall order 10-person pods in every part of the country would be unlikely to include an infected person in that first week.
Note: Estimates show potential infected people arriving during the first week of instruction. A zero indicates a low probability that an infected person will show up in the school or pod during that week.
Education experts and disease researchers said information that reflects local conditions could be critical in shaping decisions by parents, teachers, administrators and political leaders.
Its meant to guide schools so they can anticipate when it might be safe, or easier, to open and bring kids in, said Lauren Ancel Meyers, an epidemiologist at the University of Texas at Austin who led the research team.
The projections are rough guidelines based on the estimated prevalence of the virus in each county, which is drawn from a New York Times database of cases, and estimates that five people may be infected for each known case. Those estimates reflect current levels of infection around the country and are likely to change, improving or worsening in individual communities over the next weeks and months.
The estimates assume that children are as likely to carry and transmit the virus as adults a large assumption, given the unknowns about children, said Spencer Fox, a member of the research team.
This is meant to be a rough guide, a first step, Dr. Fox said.
Some preliminary studies have suggested that children are infected less often, or that young ones do not transmit the disease as readily, which could reduce the risk, said Carl T. Bergstrom, a professor of biology at the University of Washington. But those questions remain unresolved, he said.
Still, the information really helps put things into context for parents, Dr. Bergstrom said. Anything that could help you do that both helps you make better decisions and offers a level of comfort and assurance.
Many districts will start the school year remotely. Those that do open buildings will hedge the risks by taking various measures, such as requiring masks and social distancing, holding classes outside when possible or bringing students to school on alternating schedules.
Plans announced by some of the nations largest school systems already show the range of choices in play. Districts in San Diego and Los Angeles, citing the risk of crowded classrooms, said they would operate online in the fall, as will the vast majority of schools in California under guidelines issued by the state. New York City, though, is planning a partial reopening, allowing classroom attendance one to three times a week.
But decisions on remote learning come with their own concerns, said Greg J. Duncan, an education professor at the University of California, Irvine. Studies have shown that younger children and those in lower-income districts do not learn as well online as they do in person. For lower-income children, that gap in learning can persist, he said.
Wealthy families, which have more resources and workarounds, will be far more risk-averse than others, Dr. Duncan said.
One infection is too many will likely be the refrain of wealthier families, he said. Any slight chance that their child is going to be infected is probably going to get them to jump to a decision more quickly than lower-income families.
Although the risk varies by school size, in the hardest-hit areas of the country, even small schools face significant risks.
In eight states, most people live in counties where even a school of only 100 people would probably see an infected person in the first week if school started today, the estimates say: Louisiana, Alabama, Mississippi, Florida, Nevada, Tennessee, Arizona and Georgia.
The list is even longer for schools of 500 people: The vast majority of people in 19 states, including California, Texas and Illinois, live in counties where at least one infected person would likely show up to school in the first week if in-person classes were held. Many of those areas have elected to hold classes online for now.
Many parents are consumed with the question of returning to school, and there is hunger for solid guidance, said Annette Campbell Anderson, deputy director of the Johns Hopkins Center for Safe and Healthy Schools.
They want to see the data to make them feel that they have a model that they can trust, Dr. Anderson said. And we need it. We need this kind of data.
At least 20 Boston researchers, technologists and science enthusiasts have tried a DIY vaccine developed by a group called the Rapid Deployment Vaccine Collaborative, or Radvac, according to the MIT Technology Review.
The scientists, many of whom are connected to Harvard University and MIT, include George Church, a celebrity geneticist from Harvard. While Church has not left his home in five months, he believes that the vaccine is extremely safe, as one of the developers is Preston Estep, a former graduate student of his at Harvard.
"I think we are at much bigger risk from COVID considering how many ways you can get it, and how highly variable the consequences are," said Church, according to the MIT Technology Review. "I think that people are highly underestimating this disease."
Radvac was formed in March, when Estep emailed a number of acquaintances wondering if a DIY project could develop a vaccine more quickly than ongoing projects, as he felt that "already sufficient information" had been published about the virus in order to guide an independent project.
We established a core group, most of them [from] my go-to posse for citizen science, though we have never done anything quite like this, explained Estep, a cofounder of Veritas Genetics, a DNA sequencing company.
The Radvac team went through reports on vaccines against SARS and MERS and worked in borrowed labs with mail-order ingredients in order to develop the vaccine. The team was looking for "a simple formula that you could make with readily available materials, Estep told the MIT Technology Review. That narrowed things down to a small number of possibilities.
A white paper detailing the vaccine was published by Radvac in early July for anyone to copy, with four authors named on the document and a dozen initials of participants who chose to remain anonymous.
The DIY vaccine is a "subunit" vaccine consisting of fragments of the virus. Radvacs virus is made from peptides, short bits of protein that match part of the coronavirus but can cause the disease itself. Subunit vaccines are used for some other diseases including hepatitis B and human papillomavirus (HPV). Novavax, a biotechnology company, is also working on a subunit vaccine for the coronavirus, and has secured a $1.6 billion contract from the Trump Administration's Operation Warp Speed.
The peptides in Radvac's vaccine were mixed with chitosan, a substance from shrimp shells, which coats the peptides in a nanoparticle which can pass the mucous membrane.
Nasal vaccines are easier to administer than injected ones, but only five out of about 199 COVID-19 vaccines are using nasal delivery.
A nasal vaccine could also create mucosal immunity, or immune cells present in the tissues of the airway, which could be important for defending against SARS-CoV-2. Mucosal immunity is harder to detect than antibodies that appear in the blood, however, and may require a biopsy to identify, according to the MIT Technology Review.
George Siber, the former head of vaccines at Wyeth, told Estep that short, simple peptides often don't cause much of an immune response and that he hasn't heard of any subunit vaccine delivered nasally. Siber also asked Estep if Radvac had considered a dangerous side effect, called enhancement, in which a vaccine can actually worsen the disease.
Its not the best idea especially in this case, you could make things worse, warned Siber. You really need to know what you are doing here.
Arthur Caplan, a bioethicist at New York University Langone Medical Center, called Radvac "off-the-charts loony," according to the MIT Technology Review, warning of a high "potential for harm" and "ill-founded enthusiasm."
Radvac still can't say whether or not the vaccine works. Church said that some studies are underway in his Harvard lab to see if the vaccine leads to antibodies against the virus and Estep hopes that mainstream immunologists will help the group. Concerning immune responses so far, Estep told the MIT Technology Review that its a little bit complicated, and we are not ready to report it.
Estep has continued to deliver the vaccine to a number of friends and colleagues. The materials for the vaccine have been delivered to 70 people, but since the vaccine must be mixed by the recipients, they're unsure about how many have actually taken it.
The US Food and Drug Administration requires authorization to test novel drugs in the form of an investigational new drug approval. Radvac did not request approval from the FDA and has not had any ethics board sign off on the vaccine plan.
Estep stated that he feels that Radvac is not subject to oversight because the group mixes and administers the vaccine themselves without any exchange of money. If you are just making it and taking it yourself, the FDA cant stop you, said Estep.
Estep explained that the group did seek legal advice and the white paper begins with extensive disclaimers, including that anyone who uses the vaccine takes "full responsibility" and must be at least 18-years-old.
What the FDA really wants to crack down on is anything big, which makes claims, or makes money. And this is none of those, said Church. As soon as we do any of those things, they would justifiably crack down. Also, things that get attention. But we havent had any so far.
Siber explained that self-experimentation with COVID-19 vaccines would never win ethics approval at any US university, but admitted that many vaccinologists had injected themselves as a quick and cheap way to get data. Siber himself has even done so, although not recently.
Rammensee said that he self-injected to avoid red tape and get preliminary results about a vaccine being developed at the university, adding that it was acceptable to do so because he is an expert in the field and understood the risks and implications.
"If someone like me who knows what he is doing [does it], its fine, but it would be a crime for a professor to tell a postdoc to take it, explained Rammensee.
Alex Hoekstra, a data analyst with training in molecular biology who previously volunteered on the Personal Genome Project staff, explained that the virus changed how he moved through the world, according to the MIT Technology Review.
I am not licking doorknobs, said Hoekstra. But its an amazingly surreal experience knowing that I may have an immunity to this constant danger [and] that my continued existence through this pandemic will be a useful data set. It lends a level of meaning and purpose.
U.S. President Donald Trump delivers a speech during a visit to the Fujifilm Diosynth Biotechnologies' Innovation Center, a pharmaceutical manufacturing plant where components for a potential coronavirus disease (COVID-19) vaccine candidate are being developed, in Morrrisville, North Carolina, U.S., July 27, 2020.
Carlos Barria | Reuters
The hunt is on for a vaccine for Covid-19, which has killed more than 600,000 people.
The current frontrunners include an mRNA vaccine from Moderna; a candidate vaccine from AstraZeneca and Oxford University; a Chinese vaccine from the military and biotech company CanSigo Biologisc; and an mRNA-based vaccine from German company BioNTech and Pfizer.
While a candidate could be approved this year, it remains to be seen whether the vaccine will confer temporary or long-term immunity, or how many doses will be required, as doubling the number of jabs could complicate worldwide immunization efforts.
But bioethicists and public health experts all agree that manufacturing doses for 8 billion people quickly is an insurmountable challenge.
So someone will have to decide who should get the vaccine first and why.
In the United States, committees have begun to form to discuss this tricky issue.An advisory committee of external health experts is advising the Centers for Centers for Disease Control and Prevention on an equitable framework. The National Academies of Medicine announced earlier this month that its committee will "develop an overarching framework to assist policymakers in the U.S. and global health communities."
Some of the most challenging questions they face include whether pregnant women (normally the last to get a vaccine) should be higher up on the list, or whether Black and Latino people who have been disproportionately affected by the virus should get access to the vaccine before the rest of the population.
Then there are the global considerations. Task forces have formedto come up with a "fair and equitable" framework to distribute the vaccine between countries, but face numerous practical challenges.
Arthur Caplan, professor of bioethics at New York University Langone Medical Center, thinks some countries will have vaccines to spare, while others won't have access to many at all. Some nations could use their leverage over vaccines as a way to curry favor or to negotiate trade deals. Enforcing safety and efficacy is another sticking point because not every country has the same quality-control processes.
"Internationally, there's a lot of talk about how every life is valuable," he said. "But that doesn't address what you do in practical terms if there's a shortage."
Caplan is also concerned about the rise of black markets, which might allow rich people in certain countries to jump the line and buy vaccines for themselves and their families.
Other bio-ethicists note complicated questions around responsibility and need. For instance, countries like New Zealand have done a very good job at flattening the curve, while others like Brazil are struggling to contain active outbreaks. So should the countries that have largely stamped out Covid-19 vaccinate their populations last?
"We need to think through how to distribute vaccines to reduce harm internationally," saidEzekiel Emanuel, an oncologist and senior fellow at the Center for American Progress. "And some countries are really suffering more than others."
Within the U.S., bioethicists hope that vaccines are distributed in a centralized and coordinated way. Back in April and May, the lack of coordination from the federal government meant that states had to compete for supplies, including ventilators, and manufacturers were confused about where to send equipment.
"I'm worried that there will not be the kind of national leadership on the issue that we need to avoid fights from breaking out as people jockey to get access," said Michelle Mello, professor of law and medicine at Stanford University.
Even if the federal government steps up, there isn't yet consensus on who should get access to the vaccines first.
Most of the experts had a set of categories in mind.Lawrence Gostin,a professor of global health law and director of the O'Neill Institute for National and Global Health Law at Georgetown, helped draft policy papers on the issue for the Obama administration during the H1N1 crisis of 2009.
His strategy would be using the vaccine first to prevent further spread of the virus.
"That is, we might need a kind of ring vaccination strategy for major clusters of cases that don't we want to spread to other other cities or states," he said.
Next, he would prioritize health workers on the front lines of the pandemic. Once they're vaccinated inside hospitals, he would turn his attention to other essential workers, including police, sanitation workers, and workers who are critical to maintaining our food supply. Then he'd select the most vulnerable, including the elderly or marginalized populations or those with pre-existing conditions.
Other experts have different ideas.
Nisarg Patel, a surgeon at UC San Francisco and a co-author of an op-ed on the topic, would start with the people at highest risk, including health workers, essential municipal workers, vulnerable groups and the elderly.
But given that nearly half of Americans have at least one chronic illness, there might need to be some consideration about who gets prioritized within that group. For instance, should immunocompromised patients in the midst of cancer treatment get access to the vaccine before tens of millions of people with Type 2 diabetes?
"The way you think through them is to think through the outcomes," said Mello, although she notes the evidence is still accumulating on that. She also points out, however, that it might be the case that not everyone will want the vaccine immediately - so some might wait and see what happens with the first cohort.
Even then, it's not that simple.
Bioethicists point out that some of these decisions can only really be made once the specifics of the vaccine are better understood.
Vulnerable populations including the frail and elderly might not mount a robust immune response to the vaccine, for instance. The data on that from clinical trials is still limited. And health care workers might not get first dibs if they have sufficient PPE to protect themselves. The first round might be limited to those who treat Covid-19 patients specifically.
"A lot will depend on the vaccine, but also the modeling that we do," said Emanuel. "We might even find that the best way to reduce the spread of the virus is to vaccinate the most common transmitters, like grocery store workers or policemen," he said.
Another question that will need to be determined by committees: If sufficient people aren't willing to volunteer for a vaccine, should governments require that certain groups get vaccinated?
"Voluntary is always better," said Emanuel. "It's never the first option to mandate it, but it may be a necessary one."
Caplan agrees that discussions should be underway on this issue, as a lot of people might be reluctant to get vaccinated. Anti-vaccination sentiment is far from limited to the United States, he points out. In countries like France, surveys have shown that 1 in 3 people do not feel that vaccines are safe.
Caplan doesn't have a clear solution for hardline anti-vaxxers, who might never be willing to get the vaccine. But he does think that a lot can be done to sway those who are reluctant or hesitant by showing data from the first group that gets vaccinated. In the United States, he would message to the public that vaccination is required for certain freedoms, like travel or sending their kids to school. Emanuel suggests that public health workers might even consider teaming up with celebrities and influencers to help spread the word.
These challenges and many more surrounding vaccine allocation are surmountable with the right planning and coordination, Emanuel stresses.
"We shouldn't give up," he said.
Bruce Horovitz, Kaiser Health News Published 6:00 a.m. ET Aug. 1, 2020 | Updated 11:27 a.m. ET Aug. 2, 2020
The US recently topped 4 million confirmed COVID-19 cases and now has reached another unenviable milestone. USA TODAY
Imagine this scenario, perhaps a year or two in the future: An effective COVID-19 vaccine is routinely available and the world is moving forward. Life, however, will likely never be the same particularly for people over 60.
That is the conclusion of geriatric medical doctors, experts on aging, futurists and industry specialists. Experts say that in the aftermath of the pandemic, everything will change, from the way older folks receive health care to how they travel and shop. Also overturned: their work life and relationships with one another.
In the past few months, the entire world has had a near-death experience, said Ken Dychtwald, CEO of Age Wave, a think tank on aging around the world. Weve been forced to stop and think: I could die or someone I love could die. When those events happen, people think about what matters and what they will do differently.
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Older adults are uniquely vulnerable because their immune systems tend to deteriorate with age, making it much harder for them to battle not just COVID-19 but all infectious diseases. They are also more likely to suffer other health conditions, like heart and respiratory diseases, that make it tougher to fight or recover from illness. So its no surprise that even in the future, when a COVID-19 vaccine is widely available and widely used most seniors will be taking additional precautions.
Residents of the Dr. Sarphati House nursing home in Amsterdam, The Netherlands, sit in front of a same size version of the famous painting 'The Night Watch' by Dutch painter Rembrandt van Rijn, in Amsterdam on July 20, 2020. - This summer, the Rijksmuseum brings a version of the world-famous painting by Rembrandt to thirty nursing and care homes and senior complexes. Outings to cultural institutions are not possible for many elderly people due to the coronavirus crisis.(Photo: ROBIN VAN LONKHUIJSEN, ANP/AFP via Getty Images)
Before COVID-19, baby boomers those born after 1945 but before 1965 felt reassured that with all the benefits of modern medicine, they could live for years and years, said Dr. Mehrdad Ayati, who teaches geriatric medicine at Stanford University School of Medicine and advises the U.S. Senate Special Committee on Aging. What we never calculated was that a pandemic could totally change the dialogue.
It has. Hereare predictions for what a post-vaccine life looks like for older Americans:
KHN (Kaiser Health News) is a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation) that is not affiliated with Kaiser Permanente.
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Merck was purposely cautious during the start of the pandemic when it came to vaccine development but is now slowly but surely ramping up its efforts into the clinic.
The U.S. Big Pharma, which has good form in creating a new vaccine against a sweeping threat after gaining approval for its Ebola vaccine, said in its second-quarter update that, via its recent buyout of Themis, its plotting a third-quarter start for human testing of its thus preclinical V591.
While behind the likes of AstraZeneca, Moderna, Pfizer/BioNTech and CureVac, Merck hopes its expertise and slightly different MOA may prove a tortoise over the hare victory.
The Themis/Merck vaccine works by tapping a measles virus vector platform based on a vector originally developed by scientists at the Institut Pasteur, a world-leading European vaccine research institute, and licensed exclusively to Themis.
And this is not the only shot on goal, as Merck has also teamed up with IAVI for another vaccine candidate,V590, that uses a recombinant vesicular stomatitis virus platform.
This is the same platform that was used for Mercks approved Ebola vaccine, making it more of a known entity; human studies are planned to start this year. This also dovetails with a series of antivirals the company is working on, already in clinical testing.
Mercks CEO Ken Frazier said: This pandemic underscores the essential role of Merck and the biopharmaceutical industry in addressing the worlds greatest health challenges and underscores the importance of a health care ecosystem that incentivizes risk-taking and innovation. Ultimately, scientific and medical knowledge will help overcome this ongoing global pandemic, and that is why we must continue to trust and invest in breakthrough science.
