When a vaccine for COVID-19 is developed, manufactured and distributed, the final decisions on its delivery into Americans’ biceps will be influenced largely by state and local officials.
“The missing piece is who the states will prioritize who will be vaccinated first,” Dr. Deborah Birx, response coordinator for the White House coronavirus task force, told a session at NCSL Base Camp 2020.
“Every legislator will know the unique aspects of the people they serve,” she said, adding that the Centers for Disease Control and Prevention just released a playbook for state response to COVID-19.
“We know the populations uniquely at high risk,” she said. “Each state will know how many Native Americans will need to be served, how many people who are Hispanic, African Americans and white who have significant co-morbidities and really understand who they want to immunize first. That will determine how that vaccine will be utilized on a state-by-state level.
“It will come down to a question of do you prioritize those in elderly or high-risk populations first or do you prioritize those most likely to be exposed to the virus but may not have as deadly an outcome like hospital workers. That’s a really important decision state by state. That’s the right thing because (state and local officials) know who is at highest need. They track those hospitalizations as well as we do and they know how they would effectively roll out vaccines.”
Testing, Birx said, plays an increasing role in combating the virus and it needs to be both more wide-spread and more targeted.
Over the last few weeks, with decreased hospitalization and emergency visits, the U.S. is seeing a continual decline in testing.
“I want to call on all Americans that if you did something over Labor Day that may have involved not physical distancing, we want to get the message out that testing is available and if they think they may have done something that may have caused them to be infected, please go get tested so you have confidence that you are not infected and asymptomatic,” she said.
Birx said she wants to see testing rates (now estimated at just under 2 million per week) rise to 800,000 per day.
“With the new antigen testing coming available there can be a remarkable increase in day-over-day testing. New platforms that started being developed in March are finally being realized,” she said.
What is critical in testing and contact tracing is that you are testing the right people where the virus is circulating. As we see people become ill, go into those neighborhoods and provide testing. —Dr. Deborah Birx
Testing isn’t just a matter of numbers, she said, citing the increased availability of drive-through and walk-up testing.
“What is happening with testing is we’re not providing the level of counseling we would normally provide. We’re getting it to the community but not in the typical provider way. We’ve cut out our nurses, practitioners, physicians, assistants to not only test but ask why they think they need it. Who’s in their household, if they are positive how they need to protect others in the household, giving them extra face covering.
“I want to see testing getting into more of our traditional service providers at the same time providing options like drive-through and walkup. What is critical in testing and contact tracing is that you are testing the right people where the virus is circulating. As we see people become ill, go into those neighborhoods and provide testing.
“We want to see much more surveillance testing out there. Using sentinel surveillance, whether it’s nursing home staff, prison staff, even k-12 teachers to have eyes on whether the virus is circulating in an asymptomatic way. That’s what we saw this summer (when people returned from vacations). By the time you had people coming to the ER the virus had already spread significantly in their state.
“We need eyes on where that virus is in their communities so we can see both the symptomatic and asymptomatic cases.“
Birx said people closest to vaccine development are confident they will have early data from trials by the end of October. The timetable has been accelerated, she said, because the trials are over-enrolled, thus giving researchers more data than in a normal trial.
As cooler weather approaches, Birx stressed that fall “will be determined by what we do as Americans.”
“Masks, physical distancing, washing hands. You don’t have that birthday party with family members who have come from across the state or across the neighborhood. You can’t tell who has COVID. The majority of the spread since July has come from community, local family and neighborhood events.”
“Fall can look the way we want it to look based on our behaviors,” she said.
And that, she added, “is both empowering and frightening.”
Mark Wolf is the editor of the NCSL Blog.
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