The State of the Pandemic – The New York Times

astead herndon

From The New York Times, I’m Astead Herndon in for Michael Barbaro. This is The Daily.

As Covid cases continue to drop in much of the country, I spoke with my colleague, Apoorva Mandavilli, about what to expect this fall and what we know about booster shots and the possible new treatment for the virus. It’s Thursday, October 7.

OK, so before we get too far into the Covid questions, can you tell me the landscape? Where are we at in terms of cases in the United States right now?

apoorva mandavilli

This is the one time that I can give you some good news. The cases are actually going down. And hospitalizations, deaths— we’re seeing decreases across the board. And that’s really welcome news, because we had been seeing these numbers go up for weeks and weeks. And it seems like we’ve finally turned the corner. I don’t want to speak too soon and say that we’re going to go all the way down. We may plateau. Other countries have done that. But at the moment, it’s looking pretty good.

There are some states still that are seeing some high numbers and increases— Maine, New Hampshire, Minnesota. And things are pretty bad still in some places like Alaska. But for the most part, most states, including the Southern ones that had really big waves are seeing a downturn.

astead herndon

When you say down, what do we mean specifically? What are those numbers?

apoorva mandavilli

So across the United States, we are seeing something like 100,000 cases a day. And that’s about a 25 percent drop from a couple of weeks ago. So that’s really good. And hospitalizations are down, too. They’re down about 20 percent.

And the best part I think, is that the deaths have gone down. We were at a high of something like 2,200. And we’re now at 1,800, which is still a lot. But it is on the decrease. So that’s really nice to see.

astead herndon

Yeah. Yeah. I feel like I’ll take all the Covid good news I can get.

apoorva mandavilli

Exactly, right?

astead herndon

You know, I’m soaking this in. Is this just because of vaccinations? Is it just more Americans are getting vaccinated, therefore cases are going down? Is this just one-to-one causation or is there something else happening here?

apoorva mandavilli

Yeah, so this is a very interesting and very complicated question. Why are the cases going down? I don’t think we really know. The virus seems to go up and down in these waves. A lot of the time, though those are in two or three-month cycles. Sometimes they’re longer.

There are a lot of different explanations that I think probably contribute. Like almost everything else in this kind of science, it’s not one thing, right? Maybe it’s that people change their behavior when they see the cases going up, and they hear about packed hospitals and I.C.U. units. Maybe people start being more careful when they know that their kids are going back to school.

We also don’t know as much about the virus as we think we do. There’s something about the Delta variant and about this virus in general, where it seems to need a certain number of people to infect before it really takes off. And maybe it’s that it doesn’t find quite as many people, and so it dies out, and then comes back again later when people stop being careful. So all these things have to sort of play together for the virus to go up or down.

astead herndon

Do we know anything more about the Delta variant now? Have we learned anything about how it operates?

apoorva mandavilli

We’re learning more about how this virus operates in general and about how some of the newer variants seem to be working. So recently, there were these couple of studies that were super interesting. They basically said that the virus seems to be evolving to be better at airborne transmission. And I want to be careful when I say the word evolve. I don’t mean that the virus is smart and knows what it’s doing and is heading towards something. It’s more that when there’s a variant that is very good at something, there’s a higher chance that that will get selected and become the dominant variant. And it seems like with Alpha, the scientists were able to show that Alpha is much better at being transported through these tiny little aerosols, which is what keeps the virus afloat for a long time in indoor spaces.

And they think that Delta may be even better at that. And what that means is basically, we should all be wearing better masks in certain situations, especially in sort of crowded, indoor spaces. This study looked at different kinds of masks. And it said a thin cloth mask or a surgical mask only cuts the virus levels by about half. So at least in some crowded indoor spaces, we might need to be wearing something a little bit better than that, like an N95 that will really filter out almost all of the virus in order to stay safe.

astead herndon

I’ll probably have to drop my favorite fashion mask based on this new understanding.

apoorva mandavilli

They do have some very fashionable masks with filters in them. Those work very well, too.

astead herndon

Oh, maybe my outfits are back on. OK, another question I had was to seek some updates on the tools we’ve been using to combat the virus. Last week, it seemed, from my very unscientific, untrained eye, that we got some good news about a potential pill that you could take to treat infections. Can you tell me more about it?

apoorva mandavilli

Yeah, this is a pill from the company Merck. And it’s an antiviral, meaning unlike the vaccine, it’s for people who already have Covid. And early an infection, if they take this pill, it really cuts down their risk of getting severely sick. The name of the pill— I’m not even going to really try to pronounce. It sort of molnupiravir. But the cool thing about it—

astead herndon

A for effort. I appreciate it.

apoorva mandavilli

I tried. But the cool thing about it is that it’s named for the hammer that’s wielded by Thor, the Norse God.

astead herndon

Oh.

apoorva mandavilli

So they were really going for some symbolism here. And I think that in that way, it actually is a game changer. It’s the first of these antiviral pills that we’re going to see that will really change the way that Covid is treated, especially in parts of the world where the vaccine hasn’t really made it yet.

astead herndon

So this is the first treatment that has shown promise in terms of mitigating Covid infections once someone gets sick that’s in a pill form?

apoorva mandavilli

Right. It cuts down their risk of both hospitalization and death by half, but when given to high-risk people. And it has to be given early an infection. So there are some caveats. But you know, those are usually the people who end up in the hospital. So it just gives them another option.

And it may also be an option for people who have been vaccinated already, have a breakthrough infection, and ended up in the hospital again because they are much older, or they have weak immune systems. This gives them another option beyond monoclonal antibodies, which is the thing that we’ve all known about for months. That one is a little harder to give to people. You have to be hooked up to an IV. And this is a pill, so that makes a big difference.

astead herndon

So when will we know if this pill will be approved? And when will it actually be available for doctors to give to patients who have Covid?

apoorva mandavilli

Well, so these are just the clinical trial results that Merck announced last week. And so Merck still has to apply to the F.D.A. for emergency use authorization. And then once the F.D.A. authorizes it, it can start to be prescribed.

Most countries are not waiting for that. The U.S. has already put in an order for 1.7 million doses. And Australia has bought a bunch of doses. And Thailand has bought a bunch of doses. There’s kind of a mad scramble to buy as many of these doses, even before the drug has gone through the approval process.

But this is really just another tool for us. You know, this is mainly also for high-risk people who might get really sick. It’s not that anybody who gets Covid is immediately going to be able to go get a pill. It may not do much for them.

And you also have to get it pretty early on in the illness. So there are some caveats.

And vaccination is still really the best long-term strategy for any person, or for any whole society to keep this virus at Bay.

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astead herndon

We’ll be right back.

Apoorva, let’s talk about booster shots. What’s the status of the F.D.A.‘s approval on booster shots? And who qualifies for the extra jab right now?

apoorva mandavilli

Right now, the only booster that is authorized is Pfizer. And it is only authorized for certain groups of people, so older adults, people who have high-risk conditions one kind or another, and for people who are in certain high-risk jobs, like if the job puts them at heavy exposure of the virus.

What is not yet authorized is the Moderna booster or the J&J booster. So for people who got Moderna or J&J the first time around, the C.D.C. has asked them to wait, but not for long. Moderna and J&J have both applied to the F.D.A. for authorization. And those conversations are happening next week. So it’s possible that if everything goes well, those boosters will be authorized within a week or so. And then, people who got Moderna and Johnson & Johnson can also go get a booster.

But the other thing that’s happening next week that I think is really interesting is that the F.D.A. advisors are going to hear results of some studies that the N.I.H. did on what it looks like when people mix and match vaccines. So like, if somebody’s got Pfizer the first time around, and now they want to go and get Moderna, or they got J&J the first time, and now they want a Pfizer booster— next week, they’re going to discuss these new results. And it’ll be really interesting to see what they say. There is some evidence that mixing and matching vaccines might actually be a good idea.

astead herndon

I feel like we have heard so consistently about just the different types of vaccines. And I’ve heard very little about that question of mixing and matching. You’re saying it’s a real possibility that when it comes to these booster shots, someone who got Pfizer could get a Moderna booster, or someone who got a Moderna could get a Johnson & Johnson booster?

apoorva mandavilli

It’s a real possibility. I mean, we don’t know what these results look like next week. But you know, it’s already happening in the U.K. and in some countries in Europe, where they gave AstraZeneca to begin with. They are now authorizing Pfizer boosters, so people who got AstraZeneca are getting Pfizer.

And there’s reason to think that that works well. There was a study that looked at what happens when you combine Pfizer and AstraZeneca. And people did very well. And we’ll find out next week when we look at what it looks like when you mix Pfizer with J&J, or J&J and Moderna, and all those combinations that we have here in the United States.

astead herndon

OK, so we’ve been talking about vaccinations and booster shots for adults. But there’s a big chunk of the population that haven’t gotten vaccinated, which is kids 12 years old and under. What is happening on that front? And where are we in the process of getting full approval for kids to take the vaccine?

apoorva mandavilli

We will get emergency authorization for the Pfizer vaccine for kids 5 through 11 probably in a few weeks. Pfizer already came out and announced that the results look really good. And usually, it takes a few weeks after that for the F.D.A. to look at all the data and make a ruling. So we will probably see something fairly soon. For kids even younger than that, it’s probably going to be later this year, maybe even early next year for us to see vaccines.

astead herndon

Will kids need to get two shots like adults do?

apoorva mandavilli

Kids may need to get two shots like adults do, yeah. That’s the plan at the moment. There are countries that are offering just one dose to kids 12 and older. And the thinking there is that they want to wait and see what the safety data look like a little bit longer term for the second dose.

You may have heard that some people seem to have heart problems after getting the second dose of the vaccine. It’s super, super rare. But it’s been seen mostly in young men. And so what these countries are saying is, we don’t have very high rates of Covid right now. And we don’t think that our kids are at very high risk of Covid. And so we’re going to give them one dose, which still gives some protection. And we’ll wait to see about the second one.

Obviously, the situation is very different here in the U.S., because we’ve had very high rates of Covid. And we’ve had a lot of kids get infected. And we’ve had 500 kids die of Covid.

The C.D.C. looked at all of the available data couple of months ago and decided that the benefit far outweighs the risk. And the risk of getting heart problems from Covid is a lot higher. So here, I think the C.D.C. will probably still come down on the side of, for us, two doses is the safest option. And a couple of experts I talked to also pointed out that we don’t really know that the one dose does a lot— that it is effective, or how long that protection lasts.

astead herndon

While we’re peppering you with questions that have been on our minds about Covid, I wanted to ask about the upcoming flu season. Last year, there was talk about a “twindemic,” that you could have the double whammy of flu and Covid hitting the country at the same time. And that never really transpired. We had a pretty mild flu season. What’s the expectation for this year?

apoorva mandavilli

We might not be so lucky this year.

astead herndon

Hmm, why’s that?

apoorva mandavilli

So we didn’t really see a “twindemic” last year, because a lot of us were still social distancing, not really going out, wearing masks, really terrified of the virus. But this year, that’s different. A lot more people are vaccinated. We are back to being much more social. A lot more people are going back into work, and schools are open.

So all of those things mean that the flu virus also has more chances to spread. And so the doctors that I’ve spoken to are all recommending that people do go and get the flu vaccine this year.

astead herndon

So Apoorva, with all of these developments, we are still going into the winter— a time when people are indoors more, and the time that I know inspires a lot of fear among some public health officials— what can we expect over the next few months?

apoorva mandavilli

I know you guys always want me to predict on this show. And I really can never do it. What I will say is that we shouldn’t be so excited about these numbers going down that we think this is the end of Covid for us. We’ve done that so many times, and we’ve been wrong every time.

We still have something like 70 million people who are unvaccinated in this country. So there is plenty of room for the virus to still get around. And if we stop being careful, if we move indoors, we stop wearing masks, we start socializing heavily again, the virus will probably come back. A lot of experts I’ve spoken to have said we should expect to see the numbers go up in the winter like we did last year, although of course, the peaks hopefully, will not be anywhere near as high as what we saw last year.

astead herndon

But if you are in an area that has high vaccination rates, low case rates, and you are vaccinated, can you sort of go on with your lives as is? It seems like in some places, there is a real moment of respite from the virus.

apoorva mandavilli

And I think that’s real. You know, that respite is justified. If you are vaccinated, and you’re wearing a mask in crowded indoor spaces, you’ll probably be OK. And as we’ve seen for most people, the vaccines are still really powerful for preventing hospitalization or death.

So unless you are in a very high-risk category, there’s no reason to go back to the way we were living last year. But I would just say we probably still need to continue to be careful in some places, continue to wear a mask in some situations, continue to meet people outdoors as much as possible. Just do these little things that we know go a long way towards keeping ourselves and everyone around us safe.

astead herndon

Thank you. I appreciate your time.

apoorva mandavilli

Thanks.

astead herndon

We’ll be right back.

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Here’s what else you need to know today.

archived recording

As some of you may know, I started my career as a malaria researcher. And I longed for the day that we would have an effective vaccine against this ancient and terrible disease. And today is that day, an historic day.

astead herndon

On Wednesday, the director general of the World Health Organization announced the approval of the first malaria vaccine, a long-awaited breakthrough in the fight against the disease.

archived recording

Using this vaccine in addition to existing tools to prevent malaria could save tens of thousands of young lives each year.

astead herndon

Malaria kills about half a million people each year, most of them in sub-Saharan Africa. And among them, 260,000 children under the age of five. The W.H.O.‘s endorsement is the first step to worldwide distribution of the vaccine.

archived recording

We still have a very long road to travel. But this is a long slide down that road.

astead herndon

And congressional Democrats and Republicans are working on an agreement to temporarily raise the debt ceiling to avert a high-stakes fight over the country’s ability to pay its debts. Democrats received an offer from Republican Senate Leader Mitch McConnell to pass a short-term increase of the debt ceiling into December, delaying the deadline for the U.S. to default on its debt.

The deal gives Democrats more time to focus on passing President Biden’s ambitious agenda before finding a permanent solution for the debt ceiling. Economists warn that if the U.S. is unable to pay its debts, there will be dramatic consequences for the global and domestic markets.

Today’s episode was produced by Jessica Cheung, Rachelle Bonja and Eric Krupke. It was edited by M.J. Davis Lin and Lisa Chow and engineered by Chris Wood and contains original music by Dan Powell and Marion Lozano. Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly.

That’s it for The Daily. I’m Astead Herndon. See you tomorrow.

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