Reassessing COVID-19 Vaccine Deployment in Anticipation of a US B.1.1.7 Surge: Stay the Course or Pivot?

 Michael Osterholm, PhD, MPH Angela Ulrich, PhD, MPH Cory Anderson, MPH Eric Topol, MD Bruce Gellin, MD, MPH Ruth Berkelman, MD Marc Lipsitch, DPhil Kristine Moore, MD, MPH

COVID-19: The CIDRAP Viewpoint 

February 23, 2021

Introduction 

The SARS-CoV-2 B.1.1.7 variant, which is more transmissible and virulent than previously circulating strains, threatens to reverse the current downward COVID-19 trends in the United States (US) and could lead to a significant surge in cases in the next 4 to 12 weeks (CDC 2021a)(PHE 2021a)(Walensky et al 2021). Whether the surge will occur in the US remains uncertain; however, evidence from countries such as Ireland, Israel, Portugal, and the United Kingdom (UK) suggest surges driven by the B.1.1.7 variant occur when initial widespread transmission of the variant is documented throughout a country. Since the B.1.1.7 variant is now widespread in the US and the proportion of COVID-19 cases caused by this variant are increasing rapidly in areas such as Florida and California, a major peak in cases, hospitalizations, and deaths in the near future remains a strong possibility. In the US, the variant is 35% to 45% more transmissible, and its frequency is doubling every week and a half (Washington et al 2021). According to a model from the Centers for Disease Control and Prevention (CDC), B.1.1.7 is expected to become the dominant variant in many states in March 2021 (Galloway et al 2021). If the US experiences a surge similar to that seen in the UK, one could expect to see unprecedented healthcare demand of 175,000 to 193,000 hospitalizations per day (COVID Tracking Project 2021)(PHE 2021b)—far surpassing the US peak of 132,474 individuals hospitalized with COVID-19 set in early January. Thus, the immediate goal of public health policy should be to reduce the likelihood of a significant escalation in severe COVID-19 infections, hospitalizations, and intensive care that could compromise the ability of the healthcare system to provide adequate healthcare services and to minimize preventable suffering and deaths. While we need to continue to strive for equity in our vaccination program, we also recognize that above all, age is the strongest risk factor for COVID-19–related severe disease, hospitalization, and death. Adults 65 years Report 7: Reassessing COVID-19 Vaccine Deployment in Anticipation of a US B.1.1.7 Surge: Stay the Course or Pivot? 3 and older constitute a risk group with significant morbidity and mortality and produce the greatest COVID-19 burden on the healthcare system. In the event of a surge in cases, the vast majority of hospitalizations and deaths will occur in this age-group. In the US, nearly half of all COVID-19 hospitalizations and 80% of COVID-19 deaths are among those 65 and older (CDC 2021b)(CDC 2021c). Compared with 5- to 17-year-olds, older individuals had a 35-fold, 55-fold, and 80-fold increase in hospitalizations among individuals ranging from 65 to 74 years, 75 to 84 years, and 85 years and older, respectively, and a 1,100-fold, 2,800-fold, and 7,900-fold increase in deaths (CDC 2021d). While the current US distribution of vaccines is a critical development in preventing and controlling COVID-19, doses will be limited for the next several months. Supply will likely remain limited throughout some, if not all, of a B.1.1.7-related surge. To date, approximately 43 million people in the US have received at least one dose of vaccine (CDC 2021e). Even with the nearly 84 million Americans who have had COVID-19 (CDC 2021b), we are far short from reaching a herd immunity threshold, with an estimated 65% of the US population remaining susceptible to infection. To maintain healthcare capacity during a B.1.1.7 surge, we have a time-limited period to strategically target vaccination to those at highest risk of hospitalization and death before the surge arrives.

https://www.cidrap.umn.edu/sites/default/files/public/downloads/cidrap-covid19-viewpoint-report7.pdf