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VOL. 45 | NO. 29 | Friday, July 16, 2021

‘Great unknown’ of COVID still lingers

Health officials wait, worry as public brushes aside continuing risks

By Kathy Carlson

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It’s been more than two months since the federal Centers for Disease Control relaxed its recommendations on masking for the fully vaccinated and since Metro Nashville lifted its own restrictions on masking and gathering. Since then, many have ditched the masks and resumed most, if not all, of their favorite pre-pandemic activities.

So, is the COVID-19 pandemic over and done with? Are we back to normal? It depends on how the virus that causes COVID-19 mutates, how many people become vaccinated against it, and on the interplay between those two factors.

“We are seeing regionally and nationally that the pandemic in our country is slowing,” says Dr. Randy Wykoff, dean of the College of Public Health at East Tennessee State University. “What we don’t know is whether the slowdown will continue until (COVID-19) extinguishes itself or (whether we will see) another spike.

“The great unknown right now,” he continues, “is whether we have enough immunity from vaccinations and from nature (natural immunity in people who had and recovered from COVID-19) to change the sawtooth pattern (spikes and declines in the disease over time) that we saw historically.”

There’s a bit of an “on one hand, but on the other hand” feel to what has been going on with the pandemic in Tennessee.

Looking at the past several weeks, reported new cases of COVID-19 have been a fraction of what they were this time last year. They’re also way down from the peaks of December 2020, when more than 214,000 people came down with COVID-19 in Tennessee.

For the first eight days of July, new statewide case numbers have ranged from less than 200 to 572 on July 8. Meanwhile, vaccination rates have declined both in Tennessee and across the country. Rates in Tennessee, moreover, lag national rates, although there’s considerable variance among the state’s counties.

“We continue to see a steady decline of COVID-19 cases in the state,” Tennessee Department of Health spokeswoman Sarah Tanksley says. “New infections are primarily among unvaccinated individuals, which is why it is important to continue to educate on the benefits of the vaccine and address misinformation concerning the vaccines.”

Vaccines against COVID-19 are “our best defense against the continued spread of the virus,” she adds.

“The higher we can put the vaccination rate, the more people will be protected as an interconnected society of humans,” says Dr. Robert Carnahan, associate professor of pediatrics, pediatric infectious diseases, at Vanderbilt University Medical Center. He also is director of the Vanderbilt Antibody and Protein Resource and holds a Ph.D. in cell biology from Vanderbilt.

Deciding not to get vaccinated, Carnahan says, is a gamble that the SARS-CoV-2 virus causing COVID-19 won’t mutate in a way that could make a person really sick. Think of going to a casino and gambling, he says.

“The more times we gamble, the greater the likelihood that we’re going to hit 7 red,” he says, adding seven red could be a new, dangerous iteration of SARS-CoV-2.

About 90,000 people receive vaccines each week in Tennessee, Tanksley says. That’s roughly 386,000 doses a month.

By comparison, more than 1.3 million doses a month were administered in Tennessee in March and April. Vaccinations dropped to 788,000 in May and 429,000-plus in June.

Nashville’s drop in COVID-19 cases this summer reflects the effect of the vaccines, Davidson County Department of Health spokesman Brian Todd says.

“We’re already seeing the effects of vaccines on the spread of COVID in our community and other moderately to highly vaccinated communities around the world. Cases are declining as more vaccines are administered,” Todd explains.

“While Nashville-Davidson County is not even at 50% vaccine coverage yet, we will continue to see cases since we haven’t reached the percent of vaccine coverage estimated for herd immunity. However, the number of people protected with vaccines plus immunity from a large number of previous infections is contributing to keeping COVID much more in control now than last summer,” he adds. “This could change, though, so people should remain vigilant and anyone who is not vaccinated should do so since these vaccines are safe and highly effective.”

As of July 4, 43.7% of Tennessee’s population had received at least one dose of a COVID-19 vaccine, and 38.6% were fully vaccinated. Both measures are below the U.S. average of 55% of people being given at least one shot, and 47% fully vaccinated, the New York Times reports.

What the Tennessee averages don’t show, however, is a great divide between the vaccinated and unvaccinated.

Of Tennessee’s 95 counties, only a dozen are at or above the state average for people with at least one dose of a COVID-19 vaccine. Sixteen counties meet or exceed the state average for percentage of population fully vaccinated, including Davidson, Hamilton and Knox. Most counties don’t reach the state average, and the rates in some counties are below 30%. Much of Tennessee is rural, and vaccination rates tend to be low in rural areas.

“There may well be parts of the state where the virus continues to smolder,” says Dr. William Schaffner, professor of preventive medicine in the department of health policy and professor of medicine in the division of infectious diseases at the Vanderbilt University School of Medicine. On the other hand, he says, the lower population density in rural areas may cut down on outbreaks.

“We could have an occasional superspreader event” such as a religious or school event attended by a lot of unvaccinated people, as well as someone who “happens to be a very contagious person,” he says.

Many people in rural areas are saying the vaccine is not for us, says Dr. Donald Alcendor, associate professor of microbiology and immunology and a medical virologist at Meharry Medical College. Among those declining vaccines are white males with Republican political affiliation, he says. “They’re simply not interested (in getting vaccinated); they’re hard set against it.”

Other vaccine-hesitant people are in the black and brown communities, he says. And then there are those who aren’t yet eligible to be vaccinated, children 11 years old and younger. Vaccine-hesitant parents will be hesitant to have their children vaccinated, he says, adding that even vaccinated parents may be reluctant to have a young child vaccinated.

Also, vaccine-hesitant people most likely are not masking, he adds. That will increase the possibility of COVID continuing to spread.

“There is great concern for me. All you need is for the virus to continue to transmit. There will likely be spikes and increased hospitalizations,” Alcendor says, and eventually, if enough people are infected, there’s a possibility of future shutdowns. Governors and mayors across the US would prefer not to shut down; they really can’t do it” economically, he says.

The Delta variant of COVID-19 poses yet another threat to unvaccinated populations in that it’s more transmissible. It’s not yet known if it causes more severe disease.

As of July 8, there were 125 cases of Delta variant in Tennessee, the state’s most recent report of critical indicators for COVID-19. Nationally, it’s responsible for half of the new cases of COVID-19, the Johns Hopkins University COVID-19 Situation Report for July 9 said, citing a CDC projection.

“Because it is so very contagious it might well produce substantial disease in our very under-vaccinated state,” Schaffner says. “This now is the third time that a variant from an international source has come here and become prominent. The first was the original COVID from China, then the Alpha variant from Britain and now Delta from India. This emphasizes that we need to strengthen our international perspective. This is a pandemic and what occurs far away ‘over there’ can rapidly come here.”

What’s more, Vanderbilt’s Carnahan says it appears the Delta variant is “getting better at hitting young people. The more times we gamble at this table, the more likely we are to hit something bad” that threatens people in addition to the frail elderly who were hit hard in the early days of COVID-19.

“This virus is not going to disappear," Schaffner says. "There’s confusion; when we talk about the pandemic going away, we don’t mean that the virus is gone. It will be smoldering along. Just as the flu comes back each year, we’re going to have to deal with COVID like the flu.”

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