COVID-19 Weekly Newsletter: Leaders Ponder Return to Normalcy

With significant headway in the vaccine distribution and certain states already lifting COVID-19 restrictions, U.S. leaders are beginning to contemplate when we might return to some semblance of normalcy. 

Two Million Vaccinations a Day

Since vaccine distribution started on December 14 in the U.S., 80 million doses have been administered, reaching 15.9% of the total population, according to the Centers for Disease Control and Prevention (CDC). However, states say the CDC numbers underestimate their efforts and the number is much higher, and the CDC acknowledges that its data has a reporting lag of up to five days. If this supply and rate of vaccination continues, 75% of the U.S. population, the threshold required to attain herd immunity, will receive a vaccine dose by the end of summer. According to Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases (NIAID) and President Biden’s chief medical adviser, “if 70% to 80% of Americans are vaccinated by the end of summer, the country could experience ‘a degree of normality’ by the fall.” However, there are many unknowns that could impact this timeline: increase in vaccine supply with new vaccines receiving Food and Drug Administration (FDA) authorization; uncertainty about the duration for which people who were infected with the virus and survived have a level of immunity; and potential challenges to school openings, as none of the vaccines being distributed are available to children.

COVID-19 Vaccines: Questions Answered, Myths Busted

With several different vaccines now available to more and more people (and more vaccine types are on the way), countries are pondering the road to full re-openings. But new variants of SARS-CoV-2 are also spreading in the population, raising many practical questions for those who have received or are considering receiving a vaccine. The Association of American Medical Colleges (AAMC), a nonprofit organization established in 1876, has published a helpful guide to frequently asked questions related to current vaccines that provides fact-based guidance and debunks a few common myths surrounding vaccines. The Infectious Diseases Society of America also published an authoritative and regularly updated resource on COVID-19 vaccines and related scientific questions. For those with some extra time and interest, further reliable information is available as free lectures presented by an eminent Columbia University professor. These Virology 2021 lectures could even be watched and discussed on “family movie nights” or viewed as introductory material by students with interest in biology. The Animation Lab at the University of Utah/School of Medicine/Department of Biochemistry also created a SARS-CoV-2-specific explanatory visual tool based on the latest science. 

Senate Advances COVID-19 Relief Legislation

The U.S. Senate is working Friday and over the weekend to advance President Biden’s first legislative priority, the American Rescue Plan. The $1.9 trillion COVID-19 relief legislation passed the House of Representatives last month with no Republican support. Republicans oppose the measure, in part, because of the price tag and its inclusion of non-COVID funding and policies. Yesterday, the Senate voted along party lines, 51-50, to proceed with discussions on the COVID-19 relief package. Friday, the Senate began working through a marathon (often referred to as “vote-a-rama”) as the legislative body considers numerous amendments to the relief package. Senate Majority Leader Chuck Schumer (D-NY) stated that the Senate is “going to power through and finish this bill however long it takes,” hinting that it will push toward a final vote on the measure possibly as early as this weekend. Republicans will do their best to stall the package by offering a significant number of amendments. This follows the reading of the bill, which took about 11 hours, that was requested by Sen. Ron Johnson (R-WI). Given the 50-50 Senate, Democrats will need to keep their entire caucus together on final passage, a goal that seems attainable at present. The amendment process may cause some tough votes for some lawmakers, particularly those facing voters in 2022. Senate Budget Chairman Bernie Sanders (I-VT) has indicated that he will force an amendment vote on a $15 phased-in minimum wage after the parliamentarian struck the provision raising the minimum wage for federal employees.

CDC Studies Reiterate the Importance of Tight-Fitting Masks

The importance of wearing masks, especially in closed spaces, was highlighted by several recently published case studies — including one in Chicago and one in Hawaii — of COVID-19 outbreaks among gym goers who used masks inconsistently or not at all. Correct use of masks also requires a tight fit around the face.

The CDC also recently studied the effectiveness of masks for protecting the wearer. To prevent aerosols such as those carrying SARS-CoV-2 virus particles from reaching the wearer’s airways, it is important to close up all the gaps between the mask and the face. To improve the fit, plastic “fitters” could be worn over a regular face mask, or a length of sheer hosiery could be worn around the neck and pulled over the facemask. The New York City Health Department is already recommending double-masking to improve fit — for example, a cloth mask over a disposable one (but not two identical masks, as that does not improve the overall fit).

A close fit around the nose is particularly important, as nasal mucosa has been identified as a primary entry point for SARS-CoV-2 infection by many studies, including the following:

• SARS-CoV-2 Entry Factors Are Highly Expressed in Nasal Epithelial Cells Together With Innate Immune Genes
• ACE2: Evidence of Role as Entry Receptor for SARS-CoV-2 and Implications in Comorbidities
• Key Nose Cells Identified as Likely COVID-19 Virus Entry Points
• New Evidence That Cells in the Nose Are Key Entry Point for SARS CoV-2 / COVID-19

States Lifting COVID-19 Restrictions

This week, a few states announced they will be lifting most, if not all, COVID-19 capacity restrictions and mask mandates. Many businesses, including CVS, Starbucks and Target, just to name a few, will still require patrons and employees to wear face coverings regardless.

Timescale of SARS-CoV-2 Infection

The SARS-CoV-2 infection is a complex process that plays out at a number of levels — from molecular to full-organism, with different timescales characteristic for specific events. For example, the “eclipse” phase — which is the time between a virus’s attachment to a cell’s membrane and the appearance of the viral progeny inside the infected cell — is about 10 hours for SARS-CoV-2. Then there is a lag between the virus’ proliferation inside the body and the first signs of “illness.” Most recent research into the dynamic of viral replication in COVID-19 patients indicates that the peak viral load occurs one day before the onset of symptoms. The immune responses are mounted over the course of days and weeks. One of the components of the immune system — the so-called memory B-cells — continue evolving their response to SARS-CoV-2 for as long as six months. In cases of serious disease, the accumulated evidence suggests that the COVID-19 illness progresses in two phases. The shorter first phase affects primarily respiratory and gastrointestinal systems. The longer second phase is characterized by major pathologies in the cardiovascular and central nervous systems. Unfortunately, even people who initially had only mild or moderate COVID-19 symptoms may go on to develop a “long COVID” syndrome. Because “long COVID” takes months to manifest itself, it is starting to get wider recognition and attention only now.  Last fall, the estimates for the incidence of long COVID were “1 in 20," or about 5%.  By now, it is said to occur in “1 in 3”, or a third of COVID-19 cases. Much about the mechanisms is still unclear, and that’s why the National Institutes of Health (NIH) just announced its plans to study “long COVID.” Here are some other informative sources about this condition:

• Clinicians Struggle to Make Sense of 'Long COVID'
• COVID-19 (Coronavirus): Long-term Effects 
• Patients, Clinicians Seek Answers to the Mystery of 'Long COVID'
• The Tragedy of Long COVID
• Post COVID / Long COVID
• What to Know About Long COVID
• Long Haulers: Why Some People Experience Long-term Coronavirus Symptoms
• The Lasting Misery of Coronavirus Long-haulers
• The Problem of ‘Long Haul’ COVID

Frequent Testing With Fast Results Can Prevent COVID-19 Outbreaks Even if Test Sensitivity Is Modest

When it comes to preventing COVID-19 outbreaks in facilities where people necessarily congregate for long periods of time, such as nursing homes, frequent testing with fast turnaround times (and isolating individuals who test positive) can be a game-changer even if test sensitivity is not very high. For example, a mathematical modeling study based on published infection parameters showed that daily testing with immediate results combined with other infection-control measures can prevent the spread of the SARS-CoV-2 infection even when the test sensitivity is only 50%.

High Dose of Vitamin D3 Does Not Reduce Length of Hospital Stay for COVID-19 Patients

A recent study of the vitamin D₃ effects on the course of severe and moderate COVID-19 sampled 240 patients across multiple centers, with some receiving a single dose of 200 000 IU of vitamin D₃ and others receiving a placebo in a randomized, double-blinded fashion. Both groups of patients were found to have statistically similar length of hospital stay, in-hospital mortality, rates of transference to intensive care units, and need for mechanical ventilation.

NSAIDs Are Safe With COVID-19

Early in the pandemic, reports surfaced that some of the common painkillers were associated with worse COVID-19 outcomes. In a recently published, very large study conducted in England between March and mid-June 2020, that putative association was rigorously tested and disproven. One of the cohorts, the use of non-steroidal anti-inflammatory drugs (NSAIDs), was even associated with lower rates of COVID-related mortality.

Additional Resources

Global COVID-19-Related Patent Office Status and Deadline Extension Updates
Information regarding the status of each foreign patent office and the availability of extensions of time in each jurisdiction.

Government Actions: COVID-19
Tracking executive orders, legislation, and other government actions related to COVID-19 by state and major locality across the U.S.

Tracking Fraud Related to the COVID-19 Pandemic
Tracking federal and state law enforcement and regulatory actions taken against bad actors who have exploited the COVID-19 emergency to defraud consumers and payers.

Faegre Drinker’s Coronavirus Resource Center is available to help you understand and assess the legal, regulatory and commercial implications of COVID-19.