With 5 Million Confirmed Cases, Is a Vaccine the Best Hope?

John Whyte, MD, MPH; William Schaffner, MD


August 10, 2020

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  • The United States has reached 5 million confirmed cases of COVID-19 — more than the population of Los Angeles. The real number is probably much higher.

  • A safe and effective vaccine is needed, along with a delivery process that is efficient, clear, transparent, and equitable.

  • Diagnostic tests are working better but still need improvements in accuracy, reliability, and availability.

  • Early results of vaccine trials are encouraging. Some Americans are concerned about the "rush" to a vaccine, however, and may take a wait-and-see approach toward getting vaccinated.

  • More than one vaccine may become available at some point. Health officials will need to be clear and transparent about each vaccine's effectiveness and which populations the vaccines target.

This transcript has been edited for clarity.

John Whyte, MD, MPH: You're watching Coronavirus in Context. I'm Dr John Whyte, chief medical officer at WebMD. Today marks a serious milestone: 5 million confirmed [COVID-19] cases here in the United States. To put that in perspective, that's more people than are in the city of Los Angeles.

To help provide some insights, and also to give us guidance as to how not to reach another 5 million confirmed cases, I've asked a frequent guest to return: Dr William Schaffner. He's a professor of preventive medicine and professor of medicine in infectious diseases at Vanderbilt University. Dr Schaffner, thanks for joining me again.

William Schaffner, MD: Good to be with you, John, always — even on this sad occasion.

Whyte: Yeah, 5 million cases. Five million confirmed cases, because we know we're at more than 5 million cases in the United States. What's the significance of this milestone?

Schaffner: Well, it certainly is a testimony to how small we are in the world. This is a virus that appeared on the scene as a human pathogen just a few months ago. It's spread all around the world. I think it has hit every continent on the globe, except maybe Antarctica. And it's caused an enormous amount of illness and, of course, many, many deaths. A huge amount of medical care resources have been devoted to this infection all around the world. It's halted economies. It's halted travel. It's had profound social and economic effects. It's enormous.

Whyte: What's your guess in terms of how many cases we actually have here in the United States? As I mentioned, we know it's not at 5 million. That's 5 million confirmed cases — people who had tested, came back positive, and reported. Do you think it's 30 million, 40 million? What's your best guess?

Schaffner: I don't have a real best guess, but it's some multiple of 5 million, that's for sure.

Whyte: How do we make sure we don't get to another 5 million confirmed cases? As you've talked about, we're not on the right place on the curve. I hope we're not talking to you in 3 months and we're at 10 million confirmed cases.

Schaffner: Well, John, you're asking me what my best hope for that is. And, of course, my best hope is for a vaccine — a vaccine that's safe and effective and for which we can create a delivery mechanism that is efficient, clear, transparent, and equitable, getting to all of the populations here in the United States and then around the world.

Whyte: Are you more optimistic today than when we talked a few weeks ago, and even a few months ago, about the availability of a vaccine next year?

Schaffner: I'm more optimistic about a vaccine, that's for sure, because we have several candidates that are in trials, and I think we'll get those results. And the early results are indeed encouraging, I would say.

One of the things that doesn't make me optimistic is that the behavioral interventions — all the social distancing, the mask wearing, and the like — haven't gone nearly as rigorously in our country as I think it ought to have. And I think the public health leadership has been put aside, and it's our political leaders that have led this campaign, but we should have left it to public health.

Whyte: Do you think there is an element of fatigue? You know — "How long is this going to go on? How long do people have to wear masks? How long do we have to socially distance?" In many ways, people have just stopped doing it.

Schaffner: Yeah, John. It's a marathon; it's not a sprint. And I think our population was not prepared. When we did lockdown, folks weren't told that once we opened up carefully, the "carefully" part would have to go on for a long time. That is the mask wearing and the social distancing.

I think our population was not prepared for that at all. And they have, as it were, thrown off the traces. Many of them, not everyone. But there is a lot of non–social distancing going on, if you will — or social nondistancing, I should say.

Whyte: Are we fixing the issues of diagnostic testing in terms of the availability of the tests, getting the tests back sooner? As you know, that's been a big challenge. It doesn't help that you have to wait 7-10 days or longer to get back a test.

Schaffner: That's been going on a step at a time. And yes, we are improving, but we're nowhere near where we ought to be. New tests are becoming available. We'll see if they're sufficiently rigorous, because some of them have the prospect of providing very, very quick — and, I hope, accurate — results.

Whyte: But remember when we talked early on with point-of-care testing? We had lots of challenges, both in diagnostic and antibody testing in terms of the accuracy and reliability of the tests. Have we learned from our past mistakes in addressing this pandemic?

Schaffner: I think we've learned lots of lessons. We haven't always been able to apply all of those lessons comprehensively across the country, I'm afraid.

Whyte: I want to come back to the vaccine issue and the optimism toward a vaccine. For the sake of argument, I'm going to say, okay, there is a vaccine early next year. But there have been a lot of studies, including one that we did recently on WebMD, that talked about a large percentage of people saying that they're not going to get the vaccine or they're not going to get the vaccine in the first couple of months.

It's "I'm going to wait and see. I'm going to wait and see how you do, Dr Schaffner, with the vaccine, and then I'm going to decide." It's these concerns, particularly about safety, when they feel something is being rushed. So how do we address that? Because there is a real concern that, just like masks have become, it's becoming politicized.

Schaffner: Well, we've made some mistakes. We've emphasized too much how quickly we're moving. And what the general public — or many people in the general public — are concerned about is that we're moving too quickly, that we're cutting corners.

We've tried to reassure people that we haven't cut corners, and we will have to continue to do that. We'll have to be very transparent about exactly how effective the vaccines are. And they may differ in their effectiveness if we have several vaccines. We'll have to be very clear about which populations the vaccines target and when, because we'll have to start with a priority list.

As to safety, that will be very important. After all, these are new vaccines using new technologies against a new virus that's not really completely understood. So a degree of skepticism is appropriate.

Whyte: Is 7-9 months a sufficient amount of time to really determine safety?

Schaffner: I think the large clinical trials — and they will be large — will provide a great deal of reassurance in that regard. And we'll have to communicate our own degree of assurance and demonstrate that, as we and our families get the vaccine, we think this vaccine is safe for the average person in this country.

Whyte: What's your advice to viewers who are watching and simply just want to get back to their lives? What do we tell them at this point?

Schaffner: Tell them my heart is with them, but my brain says we have to keep up with the social distancing and the mask wearing for a while yet while we get ready for the vaccine.

Whyte: What's been the most difficult part of these public health strategies for you and your family?

Schaffner: For us, it's the remove from friends. We've wanted to get together, go out to dinner, have a little party at our house. But all of us with a little bit of gray hair have been very cautious about that. We've gotten together with some family members, but even when we're together inside, we wear the masks and keep socially distancing. It's been a hug-free zone for us.

Whyte: Dr Schaffner, I want to thank you again for taking the time to share your insights. And, as you point out, hopefully we will not get to another 5 million confirmed cases. Thank you.

Schaffner: Thanks, John.

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