Why Is the CDC Delaying Its Vaccine Guidelines?

Policy

A nurse injects a boost dose during a coronavirus community vaccination event in Martinsburg, W.Va., February 25, 2021. (Kevin Lamarque/Reuters)

On the menu today: The CDC delays the release of its guidelines for vaccinated Americans, raising tough questions about what’s triggering its hesitation; the evidence that vaccination helps cut down on transmission a lot; and why far too many journalists have impeded a serious discussion about the trade-offs involved in quarantine restrictions. Oh, and the joys of Amazon reader reviews.

Is the CDC Afraid to Tell Americans that Vaccinated People Can Socialize Normally?

What is up with this?

The Centers for Disease Control and Prevention will not be releasing its guidance for vaccinated Americans on Thursday as originally planned, according to two senior administration officials with knowledge of the situation.

After a series of meetings and calls with senior officials on the White House’s Covid-19 task force and the Department of Health and Human Services over the last two days, the CDC was told to “hold off on releasing” the recommendations, one of those sources said. The reason is still unclear but one senior administration official said the guidelines were still being finalized . . .

There is no evidence to suggest that the Biden White House is trying to suppress the CDC guidelines or override the judgement of CDC scientists.

Okay, we’ll take them on their word on that. But does it seem a little ridiculous for the CDC to not have guidelines for vaccinated Americans, eleven weeks into vaccinations? More than 80 million shots have been jabbed into arms, 8 percent of U.S. adults have both shots, and another 8 percent have one shot. We’re finally averaging more than 2 million shots per day. A lot of people out there really want to know how much they can go back to normal, fellas!

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The description of the dispute sounds like another case of scientists and health experts seeing good news in the data but being afraid of what the general public will do if it hears good news:

The CDC’s guidelines for vaccinated people, as described to POLITICO earlier this week, were supposed to say that those who had received a full course of vaccine could socialize with other vaccinated people in small groups in the home without masks. But the guidelines said that vaccinated individuals should continue to adhere to mask and social distancing guidance in public.

Is the CDC afraid of how the public will react to the guidelines? You may recall that Dr. Anthony Fauci admitted in December that he had slowly and steadily changed his assessments about herd immunity, based upon what he thought the public could handle hearing.

In the pandemic’s early days, Dr. Fauci tended to cite the same 60 to 70 percent estimate that most experts did. About a month ago, he began saying “70, 75 percent” in television interviews. And last week, in an interview with CNBC News, he said “75, 80, 85 percent” and “75 to 80-plus percent.

In a telephone interview the next day, Dr. Fauci acknowledged that he had slowly but deliberately been moving the goal posts. He is doing so, he said, partly based on new science, and partly on his gut feeling that the country is finally ready to hear what he really thinks.

Hard as it may be to hear, he said, he believes that it may take close to 90 percent immunity to bring the virus to a halt — almost as much as is needed to stop a measles outbreak.

“When polls said only about half of all Americans would take a vaccine, I was saying herd immunity would take 70 to 75 percent,” Dr. Fauci said. “Then, when newer surveys said 60 percent or more would take it, I thought, ‘I can nudge this up a bit,’ so I went to 80, 85.

“We need to have some humility here,” he added. “We really don’t know what the real number is. I think the real range is somewhere between 70 to 90 percent. But, I’m not going to say 90 percent.”

(Irony alert: Fauci made those comment in an interview with Donald McNeil Jr., who is now considered by the New York Times newsroom to be the most dangerous man in the world and one of history’s greatest monsters.)

This came after public-health experts initially insisted masks didn’t work because they didn’t want to see a rush on masks. It is really hard to tell people to “trust the science” when the top scientists admit their public statements aren’t fully honest because they don’t think the public can handle the whole truth, or they think people will behave recklessly if they hear news that is too bad or too good.

The publicly available data we have suggest that the vaccines not only make you unlikely to need hospitalization or to succumb to the virus, but also makes you much less likely to transmit it others.

The American Association of Medical Colleges recently spotlighted the assessment of Dr. Monica Gandhi, professor of medicine and associate division chief of the Division of HIV, Infectious Diseases, and Global Medicine at the University of California, San Francisco:

First, when the vaccines were studied in macaque monkeys (during preclinical testing), they did eliminate asymptomatic infection — researchers swabbed the vaccinated macaques’ noses and found little or no virus. Second, the types of antibodies that are stimulated by most systemic vaccines (IgG and IgA) do tend to block viral infection in the nose (and no viral load in the nose most likely translates to no transmission). Finally, when monoclonal antibodies are given to COVID-19 patients, those antibodies reduce the viral load throughout the respiratory tract, including the nose.

The most convincing evidence, though, is just starting to emerge among real-world data. In Israel, where more than 90% of those age 60 and over have been vaccinated, “cases have plummeted in this population,” Gandhi notes. “Not just hospitalizations, which we expected, but cases [asymptomatic infection] as well.” Moreover, data from vaccinated health care workers recently published in the Lancet and preprint servers show reduced rates of asymptomatic infection and low viral loads in the nose when swabbing after vaccination.

“I think that in a few months, we are going to be able to say with certainty that these vaccines not only protect you, they also protect those around you,” Ranney says.

The link above goes to a study published in The Lancet examining the results of vaccination efforts at Sheba Medical Centre, Israel’s largest hospital. A separate Israeli study of vaccinations run by Maccabi Healthcare Services concluded, “the viral load is reduced 4-fold for infections occurring 12-28 days after the first dose of vaccine. These reduced viral loads hint to lower infectiousness, further contributing to vaccine impact on virus spread.”

Now, notice that these studies aren’t saying that the vaccinated have no viral load, no infectiousness, and no risk of getting infected asymptomatically and inadvertently spreading the virus to others.

But as far as vaccines go, we’ve won the lottery. Our society can function easily, and with minimal or no restrictions, if SARS-CoV-2 no longer gets severe enough to require hospitalization, can’t kill you, and spreads at just a quarter of the rate that it currently does. (We should probably keep that frequent hand-washing habit and ubiquitous hand-sanitizer stations.)

This suggests that we can largely go back to “normal life” once we’re fully vaccinated. “Fully vaccinated” is considered two weeks after the second Pfizer and Moderna shots. The Johnson & Johnson vaccine builds up your system’s ability to fight off the virus gradually — with some effectiveness after two weeks and close to full effectiveness after a month.

There is one compelling and one not-so-compelling argument against telling Americans (and the world) that they can go back to normal once they’re fully vaccinated. First, we want to avoid becoming a two-tiered society where the fully vaccinated can enjoy rights and privileges that those still waiting for vaccination cannot. You can imagine what would happen if authorities announced that church services, hockey and basketball games, or concerts could be enjoyed unmasked by the vaccinated but not the vaccinated. We don’t want store employees, ushers, cops, or anyone else demanding to see people’s vaccination cards. Under this thinking, businesses and localities should require masks for the vaccinated in public for a brief period in the name of social equality. But this approach will only make sense while there is a shortage of vaccines. The moment there’s enough for everyone and those who are unvaccinated are unvaccinated by choice, the masks are coming off and you’re on your own, anti-vaxxers.

The not-so-compelling argument is that a lot of pandemic restrictions have turned into a partisan football, and the CDC doesn’t want to offer any assessment that might contradict President Biden’s assertion that Texas and Mississippi’s decision to end mask mandates this week represents “Neanderthal thinking.”

Every restriction enacted since the start of the pandemic represents a sacrifice with real consequences. That’s somebody’s job you’re eliminating, somebody’s business you’re pushing to bankruptcy, somebody’s much-needed human contact you’re denying them, somebody’s education you’re setting back significantly. Quarantine restrictions that made sense in March 2020 will not necessarily be justifiable in March 2021. And we’ve seen so many examples of elected officials breaking their own restrictions, that it’s clear some of the people enacting these rules haven’t really thought through how they’ve impeded and harmed the lives of those living under them — or maybe they just don’t care.

Every one of these restrictions represents a trade-off between a public-health benefit and an economic, social, psychological, and in some cases, public-health cost. It would be nice to have a grown-up conversation about these trade-offs, instead of having our national discussion dominated by axe-grinding journalists characterizing every decision taken by a Republican governor as “an experiment in human sacrifice.” (Ten months after that infamous headline, Georgia ranks sixth in total cases, eighth in total deaths, 19th in cases per million residents, and 20th in deaths per million residents.)

Maybe Texas’s recent mask decision will be come to be widely seen as inexplicably reckless. But as I noted yesterday, the Lone Star State has gone a long way toward vaccinating the most vulnerable — so at minimum, we shouldn’t see a surge of deaths in the coming weeks. (And Texas is right in the middle of the pack in cases and deaths per million residents, ranking 24th in both.)

But few things in this pandemic have been easily predictable. That assessment could turn out to be wrong.

Yesterday, according to Worldometers, Texas had 7,620 new cases and 266 new deaths — down from more than 20,000 new cases per day and more than 400 new deaths per day in January. Let’s check back in two weeks and a month and see what those numbers are.

ADDENDUM: I’m never quite sure how to respond to a book review such as this one: “I bought this book without expecting it to be very good but really enjoyed it.” Uh . . . thanks? Maybe it’s safe to raise your expectations of me now?

Meanwhile, another reader panned Hunting Four Horsemen, concluding, “When the two main characters change due to emotional impact from, not the actually contracting of the COVID . . . you lost me.

Uh . . . he read far enough to learn about the two major supporting characters who died from the virus in between books, right? One protagonist’s brother having lingering health issues, the isolated elderly parents, the old neighborhoods that have permanently changed? None of that seems like it could leave lingering emotional and psychological issues in the characters?

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