COVID-19 vaccines have arrived, but winning the war is still more a matter of behavior

By Martin L. Jacobs

Nurse Eunice Lee gives Matthew Dartt, Assistant Director of Respiratory Therapy, the Pfizer-BioNTech COVID-19 vaccine on December 16 at Ronald Reagan UCLA Medical Center in Westwood.
Photos courtesy UCLA Media Relations

The Pfizer/BioNTech COVID-19 vaccine, administered to front-line workers at the Ronald Reagan UCLA Medical Center and many other Southern California hospitals last week, brings with it a longed-for sense of truly turning the corner in this worldwide battle that may prove to be the defining event of this still young century.

But for those patiently waiting to exhale sans the P95 mask, the best advice from experts is to keep on keeping on. That is, this vaccine and the Moderna/NIH version, approved for emergency authorization later in the same week, may serve as the heavy artillery in this battle, but that doesn’t mean the infantry gets to pack up and go home.

As Dr. Karin Michels of the UCLA Fielding School of Public Health and chair of the Department of Epidemiology cautions, “The vaccine is a big step forward. However, it will be several months until it will manifest in a real change in numbers.”

To relax and ease up now with amplified confidence would be a critical error. Dr. Anthony Fauci, director of the National Institute of Allergies and Infectious Diseases, has signaled repeatedly that January will likely be the most devastating month in the war to date, largely due to the imminent Christmas surge being superimposed on the Thanksgiving surge we are currently contending with.

UCLA’s best vaccinating UCLA’s best

The fact that masks and distancing protocols must be observed religiously well into next year doesn’t diminish the beauty and hope of what occurred last week when a group of neonatal ICU nurses at Ronald Reagan UCLA Medical Center volunteered to administer the new Pfizer/BioNTech vaccine to their counterpart adult ICU nurses, doctors, respiratory therapists and other health care professionals who spend their days in harm’s way caring for highly contagious COVID-19 patients.

In the hospital’s basement, 10 immunization stations were set up early on the morning of December 16, and the first batch of doses thawed from their frozen state and diluted with saline by the pharmacy department in preparation for use. Health care workers had signed up to receive the first of the two-part vaccines at specific time slots, with about five people getting through every 10 minutes.

Several hospital administrators and computer technologists were present to manage the logs and streamline the charting data entry. More than 400 vaccinations were administered the first day. For the sake of full disclosure and with some pride, I say that my spouse was among those NICU nurses giving the painless injections. The event was a show of strength, of science and of love. There was palpable excitement in the air and heavy media coverage, leading some to consider: is this the beginning of the end?

Emergency physician Medell Briggs-Malonson was the first person at UCLA Medical Center to receive the vaccine. “I had a couple of butterflies, but then actually coming down and realizing this was going to be the first shot and the first vaccine, and then we can hopefully start to return to normalcy,” she says. “It took all the flutters away…I’m incredibly excited, I’m very optimistic.”

There were even occasional moments of levity on both sides of the syringe. One nurse conveyed that she vaccinated a hospital surgeon that showed a surprising shyness for needles. The hospital, as of this writing, is treating 138 COVID-19 patients, more than at any other time during the pandemic.

The advanced design of the facility allows, technically, hundreds more patient rooms in the building to be configured as ICU rooms, provided the specialized equipment can be sourced and ICU personnel are available to man them. Some estimates indicate that a single COVID-19 patient in an ICU can require six hospital staff to provide the 24/7 care required.

How do the Pfizer and Moderna vaccines work?

Both vaccines use an entirely new technology, and that is in part why they and similar vaccines now in the pipeline can be developed and mass produced on such a compressed timeline. Instead of traditional methods that use weakened or dead virus to stimulate the immune system, these vaccines use fragments of messenger RNA (a massive biomolecule, like DNA, whose function is to create, store and encode information) encapsulated in a tiny protective ball of fat.

Once injected, the mRNA then “infects” some healthy cells and uses those cells to produce the signature “spike protein” of the coronavirus. These “infected” cells, however, are just stand-ins and are not harmful to us. Their only purpose is to elicit our body’s complex immune system response to the telltale spike proteins, thereby thwarting efforts by the real coronavirus to use its spike proteins to gain access to healthy cells.

The vaccine isn’t a no-brainer for some

In the months leading up to the vaccine’s emergency use approval on December 11, a survey of nurses and other health care professionals by Dr. Anne Rimoin, a professor of epidemiology at the UCLA Fielding School of Public Health, indicated that roughly two-thirds of them would opt out of the vaccine or delay getting it.

Far apart from the whole anti-vaxxer and aluminum foil headwear crowd, there is genuine concern about a vaccine that made it from a pitch meeting to non-laboratory deltoids in less than a year. But these are not ordinary times, are they?

With the infection numbers increasing logarithmically and hospital ICUs nearing capacity, a leap of faith and a faith in science may be required. That’s a hard ask when one considers how science has been undermined, belittled and often entirely bypassed for the last four years by a White House that not only propagates conspiracy theories in lieu of science, but has weaponized them for political leverage.

It’s hard to accept the daily reported numbers

They become meaningless abstractions—and perhaps that’s healthier. To fully grasp the amount of human suffering and death the world has endured this year could overwhelm the best of us: almost 1.7 million souls have perished thus far. Horrifying, but still a long way from the death toll of the 1918 influenza epidemic that took between 17 and 100 million lives.

We have already long surpassed the original, at the time almost unthinkable estimate of 100,000 to 200,000 US deaths that Dr. Fauci made back in March. With over 3,000 new cases in the US reported each day this week, the graph of infection rates from May to December looks more or less like a ski jump.

LA County is up to 581,000 cases: that’s a 155% increase over the last 14 days, and many Southern California hospital ICUs are nearing capacity. It’s a math problem and a behavioral problem; the slow, steady progress of vaccinations will be the downward curve to be summed with the opposing upward curve of new infections.

The question of how soon that sum equals zero is very dependent on the behavior of all of us Angelenos. Can we maintain the discipline to push the numbers downward? Can we withstand the economic damage? It’s a math problem, but the units are human lives: people we love, our mothers and fathers, our aunts and uncles. And the pesky mythology of freedom isn’t helping; Americans don’t like being told what to do.

We see it everywhere and it’s pretty awkward, sometimes even dangerous, to speak up. Every weekend I drive past nearby Penmar Park in Venice to see large baseball games in progress, the bleachers full of families. I see nice cleats, expensive gloves and very few masks.

Who is dying?

Basking in the bright sun and relative comfort of the Westside of LA, it can all seem far away, someone else’s problem. And in an indirect way, money can buy immunity. Wealth provides better health care. And wealthy people have financial cushions. They don’t have the same urgency to provide basic necessities for their families as do working class or impoverished people. When you have no savings you have to go to work, risk or no risk. It’s not really a choice.

According to CDC data, American Indians are four times more likely to be hospitalized with a COVID-19 infection, and 2.6 times more likely to die from that infection than White, non-Hispanic persons. African Americans are 3.7 times as likely to be hospitalized, and 2.8 times as likely to die, and Hispanics are 4.1 times as likely to be hospitalized, and 2.8 times as likely to die than their White counterparts.

A medical professional I know recently overheard a nurse who works in an LA hospital’s COVID-19 unit lamenting, “It’s all Latinos in there.” A sobering assessment. Why is this so? Pre-existing conditions such as high blood pressure and diabetes are part of it, as is education and access to quality health care.

But there’s a cultural factor, too. I asked Dr. Michels about this. She points out the social aspects and traditions: “Each ethnic group has their own lifestyle and culture. Among them the tradition of big families and being together in groups, meeting family and friends on the weekend. They have way more social contacts and the social distancing is much more difficult for them.”

In other words, all that bonding and closeness that provides a strong social fabric is now a front-of-the-line pass to the hospital. It all seems far away until it hits close to home, or at home. On December 14, a dear friend of mine, Alan Decker, an accomplished sound mixer at Technicolor Sound, died of COVID-19. I had spoken to him on Thanksgiving just a few weeks before. He felt ill in the days that followed and tested positive on November 30. He seemed to get better, but then got suddenly worse and was admitted to the hospital. He died just over a week later.

A battle against misinformation

In many ways, our current battle against COVID-19 is as much an information war as an immunological one. Where you get your information about COVID-19 and what you believe dictates how you behave, what precautions you take, and what rules you adhere to. Spend the 90 minutes that you aren’t spending at a holiday gathering and watch the mind-blowing Netflix documentary “The Social Dilemma” to get primed for some big picture thinking.

Even with the arrival of life-saving COVID-19 vaccines this month, about half of Americans might not want to get it. A Langer research study released in late November found that only 51% of Americans said they would opt for a first generation
COVID-19 vaccine. The number went up to 66% when the conditions include that it is “proven safe and effective by public health officials…and more than 90% effective.”

A National Public Radio story by Shannon Bond, “The Perfect Storm: How Vaccine Misinformation Spread to the Mainstream,” describes how “baseless claims that the virus was planned and that vaccines will be used to track or control people rank among the most mentioned pieces of misinformation this year, according to Zignal Labs, a media analytics company.”

Also in the story, Imran Ahmed, CEO of the Center for Countering Digital Hate, which tracks online misinformation, concludes that the twin pandemics amplify each other. “One being biological and one being social, [they] are working in concert to really undermine our capacity to contain COVID-19.”

2020: the year that sucked on so many levels

A common sense caution: faith in science, God or whatever force you believe turns the wheels of our existence on this planet may be necessary in the coming weeks if things get as bad as Dr. Fauci suggests, but we will get past it. We Americans, and Angelenos in particular, are a scrappy lot; adaptable, clever and determined. The day will come when COVID-19 is just a T-shirt, a bumper sticker and a story we tell our grandkids.

Writer Martin L. Jacobs can be reached at martin@scriturra.com

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