| I send warm wishes to you and your families during this extraordinary Thanksgiving season. I sincerely hope that you are staying safe, and healthy despite the gloom of the season. While the news for hospitalizations and deaths from COVID-19 are tragically setting new records in this and other countries, there are some bright spots that, if we focus on, will help us get through this long winter. First, it appears that there will be a resolution of the post-election political impasse soon, with progress towards a Biden-Harris transition team that will need to address both the economic and health crises. Second, the incoming COVID-19 team is packed with scientists who have a strong track record of fighting pandemics, and can build on what has been done by Drs. Fauci, Adams, and Birx. Third, substantial progress has been made in vaccine development with the results of 3 Phase III trials showing surprisingly good safety results and efficacy rates between 70% (Astra-Zeneca/Oxford University) and 95% (Moderna and Pfizer). The next challenge will be in the logistics of deployment, which represents the single largest mobilization of health resources in history. Recall that vaccine “effectiveness” within a population is a function of “efficacy” and delivery. Not only do some of these vaccines require extreme refrigeration, but 40-50% of the American population have expressed reservations about accepting them.
So what can we do as neurologists to reassure our patients, especially those from vulnerable populations, using immunomodulatory agents, or with comorbidities that increase the mortality rates from COVID-19 ? First, we have a duty to rapidly educate ourselves on the vaccines, which will begin deployment for health care workers and individuals at high risk for severe COVID-19. The CDC will set the timetable, but we will certainly be asked by our patients whether, when, and how they should receive the vaccine. Second, we have a responsibility to lead by example, both with regard to social distancing and masking, but also by getting vaccinated ourselves, and being open about this. Our hope for this winter is that the surge of COVID-19 will not be as severe as anticipated, and that vaccine deployment helps us establish herd immunity by late 2021. We should remind ourselves, and our patients, however, that even this will not guarantee return to normalcy in our lives. Viral immunity, whether from natural infection or a vaccine is likely to be short-lived given our experience with SARS-CoV-1 antibody responses. Continued vigilance for this and future pandemics will be required by strengthening the global infrastructure that has been assembled to allow for the rapid detection and treatment of novel infections. Warm regards, Justin C. McArthur, MBBS, MPH |