What is it like to volunteer for a vaccine against covid-19 10:03
(CNN) -
Almost six months have passed since Covid-19 was declared a pandemic in the United States.
For all that researchers have learned, there is still much more to understand.
The key to moving forward is understanding where Covid-19 has spread around the country and what the science tells us about what to do next.
What lessons can be applied in schools and universities?
What can cities and counties learn from what others have already suffered?
Where are we looking for treatments and a possible vaccine?
This is what is clear so far about who is affected by the virus, how the virus has been controlled, and where the global race for treatments and vaccines is at.
Who has been affected?
The human cost of the virus has risen in ways many could not imagine.
When the pandemic began, little was known about who would be affected and what factors could make people vulnerable.
Those answers have changed over time.
Where things are:
As of Monday, at least 183,000 people have died in the United States and more than 6 million have been infected, according to data compiled by Johns Hopkins University.
According to the CDC's best estimate, the average person has a less than 1% chance of dying from coronavirus.
In the months since the pandemic began, public health experts have learned some key things about who is most likely to get seriously ill.
If infected, people aged 85 and over are 20 times more likely to die than people in their 50s and 60 times more likely to die than people in their 40s.
The underlying conditions have a great impact on more serious cases or deaths.
People with diabetes are three times more likely to be hospitalized.
Obese people have a three to four times higher risk of death compared to people of normal weight.
The people most likely to be hospitalized with COVID-19 are minorities: Blacks, Hispanics, and Native Americans.
In the largest review to date, 13% of people with cancer and Covid-19 died within a month.
Younger people are not immune to this disease.
More than 60% of new infections in the United States now occur in people under the age of 50.
People from 18 to 29 years old represent 22.3% of the cases;
ages 30 to 39 represent 17.1% of cases and ages 40 to 49 represent 15.7% of cases.
Pediatric cases increased 90% in July, according to the American Academy of Pediatrics.
And health departments in many states have reported cases of excessive inflammation in youth, possibly in reaction to coronavirus infection.
This rare complication is known as MIS-C or multisystem inflammatory syndrome in children.
Why It Matters:
Leaders at all levels need to know who to protect and how best to protect them.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has repeatedly repeated that there are five things people can do to help stop the spread of the virus: wear a mask, all the time, consistently, when you are outside and can be exposed;
maintain physical distance;
avoid bars or, if possible, close them;
stay away from crowds or congregations;
maintain hand hygiene.
We continue to see states struggling to contain continued outbreaks of cases.
As some states control their outbreaks, cases have increased in others.
That is, in part, a factor of whether proper action is being taken and whether people are following the guide.
To address this infection, the focus must be twofold: protecting the populations most at risk and ensuring that the very young understand the impact they have in preventing the disease from spreading.
Reducing transmission among all groups, including children and young adults, who are less likely to become seriously ill, can have a huge impact on protecting the most vulnerable populations.
7-year-old boy dies from covid-19;
cases are increasing 1:17
The state of the evidence
Where things are: The
United States has come a long way since its first problems with covid-19 testing, but that doesn't mean there isn't a long way to go yet.
While some of the major bottlenecks have been cleared, the rapid and proper tests that many public health officials say are necessary to stay on top of this virus do not yet exist.
To diagnose covid-19, there are two key types of tests available.
PCR
tests
:
Molecular diagnostic tests, also called PCR tests, are the most common tests in the US for coronavirus.
The tests look for the genetic material of the virus, a sign of active infection.
The shortage of some components of the PCR test has caused bottlenecks throughout the process since the onset of the pandemic, frustrating patients, physicians, and public health experts alike.
Antigen
testing
: Antigen
testing does not require complicated chemicals, viral transport media, or RNA extraction kits.
They do not necessarily require appointments in specialized laboratories, highly trained technicians, or certain machines.
And they can provide an answer in minutes, rather than hours or days.
They are usually cheaper.
They do not analyze the complete genetic code of the virus, but a part of it.
That may mean that they are not as reliable as PCR tests.
Why it matters:
There are still outbreaks in cities, counties and states or events superspreading.
Rapid and effective tests are needed so that public health officials can isolate, track, and stop transmission of the virus.
For many Americans, getting tested for coronavirus has meant waiting several days, often too many days to be worth it, according to public health experts.
Waiting too long can mean that you have missed an opportunity to isolate someone and prevent them from spreading the virus at its peak of infection.
Rapid tests are one of the key tools South Korea used to help stop the spread of the virus so quickly.
This is why rapid tests, even if they are not as accurate, are so important.
Experts say that being able to run quick tests more often makes up for the fact that they aren't as accurate.
For colleges to reopen, for example, students may need to take exams every two or three days and be able to get quick results in minutes or hours, and that's in addition to still wearing masks, washing their hands, and staying away from others.
According to data from the Covid Tracking Project, the US conducted just over 4.7 million tests last week.
While that may sound like a lot, that still adds up to less than 20 million tests per month, and it's far less than the million tests per day that some public health experts say we should do.
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Treatments and vaccines
Where things are:
There have been incremental advances with coronavirus therapies.
Three are approved and there were at least 270 active trials and 570 in the planning stages for treatments as of Aug. 31, according to the FDA.
The
remdesivir
, an antiviral, has been approved by the FDA to treat hospitalized patients with severe covid-19.
The drug must be administered intravenously.
It has been found that
dexamethasone
, a widely available steroid, helps inpatients with covid.
One study found it could help the sickest in hospitals who require ventilation or oxygen.
A 10-day low-dose regimen was found to reduce the risk of death by one third among those using ventilators or oxygen.
The
convalescent plasma
is the treatment of covid-19 to the latest FDA authorization granted emergency use.
It uses blood donated by people who have recovered from coronavirus infections.
There is hope for this treatment, it has been used to treat other deadly coronaviruses, but many health experts said more studies are needed to prove its benefits.
Much of the publicly available data does not include randomized controlled trials, the gold standard in research.
The data that has been shared shows that those treated with plasma were often treated with other drugs as well, making it difficult to know the impact of plasma.
Currently, several companies are studying
monoclonal antibodies
as a possible treatment for patients infected with COVID-19 and as prevention.
Monoclonal antibodies are proteins of the immune system that specifically target a single target.
In the coronavirus, they are targeted at a single structure in the body of the virus.
The hope is to slow, or even prevent, the infection.
However, the treatments can be expensive and difficult to manufacture.
As for the vaccines, 33 are in human trials worldwide as of Aug. 31, according to the World Health Organization.
The US government's vaccine development effort "Operation Warp Speed" supports eight vaccines, six of which have been announced.
The goal of the operation is to have 300 million doses of a vaccine that is safe and effective by January 2021.
Moderna:
The vaccine developed by Moderna and the National Institute of Allergy and Infectious Diseases began phase 3 trials in the United States in late July.
The first results of the mRNA-1273 vaccine studies showed that it elicited an immune response and a T-cell response in all age groups, which is what the researchers wanted to see.
The higher the dose, the greater the immune response in people who got it, but the side effects were worse, too.
More than half of the participants experienced side effects, such as fatigue, chills, headache, muscle pain, and pain at the injection site.
Pfizer / BioNTech:
A vaccine developed by Pfizer and BioNTech also began phase 3 trials in the United States in late July.
The companies went into a combined phase 2/3 trial with their vaccine candidate, called BNT162b2.
In the combined phase 1/2 trial, the vaccine also induced a T-cell and antibody response, a "double-arm" effect that companies hope will provide longer protection.
Preliminary data from the phase 1/2 trial showed "a favorable overall tolerability profile" for the vaccine, Pfizer said in a news release, "with generally mild to moderate side effects" lasting one to two days, "such as fever, fatigue and chills and no serious adverse effects. '
AstraZeneca:
A vaccine manufactured by AstraZeneca and the University of Oxford launched its phase 3 trial in the United States on Monday.
Results from the first previously published trials showed that the vaccine elicited an antibody response in 28 days and a T-cell response in 14 days.
Neutralizing antibodies, so named because they can neutralize the virus, were detected in most participants after one injection and in all after two.
There were no serious adverse events related to the vaccine;
fatigue and headache were the most frequently reported reactions.
More vaccines in the works:
Johnson & Johnson's vaccine is expected to begin phase 3 trials in the US in mid-September.
The Novavax vaccine is expected to begin phase 3 trials in the US in late September, and Sanofi / GlaxoSmithKline is expected to begin phase 3 later this year.
What does it mean for a vaccine to be in phase 3?
1:25
Why They're Important:
Until a vaccine is approved, it's important to keep in mind that of the available treatments, most will be used in patients who are sick in the hospital.
That leaves out many people who are very sick with this disease, but perhaps not the sickest of all.
In an ideal scenario, doctors would like to have treatments that can be used in all settings: for the sickest in the hospital, but also a treatment for people at home.
Think about flu season and how an option like Tamiflu is offered to those who test positive.
It can be taken at home and help reduce symptoms and reduce the need to be in a hospital.
Such a drug would also help Americans feel more comfortable "resuming normal life."
But so far, treatments have been limited to the sickest in hospitals, or those currently using oxygen or ventilation.
These treatments are the bridge or a temporary solution until a vaccine is developed.
And that probably won't be until spring 2021, according to most public health experts.
A vaccine must first and foremost be safe, but it must also protect a wide swath of the population.
This is why it is so important to have trials that include older patients and minorities.
There has been a discussion about the importance and difficulty of recruiting both groups.
And that is cause for concern.
The good news is that there have been data from Moderna's vaccine showing an immune response at all ages and no differences in symptoms between ages.
Pandemic