COVID-19 - Dr. Jim Halverson

Ask Dr. Halverson: Our epidemic is improving, but the pandemic is not

web 4 17 Halverson photo
By Dr. Jim Halverson 
The news from India regarding COVID-19 is very troubling to me.
There have been more than 20 million cases reported thus far, behind only the United States, which has reported more than 32 million cases. India has had more than 300,000 new cases per day for more than 10 straight days and more than 3,000 deaths daily. 
Experts believe there have been more than the 215,000 reported total deaths. Indian hospitals, morgues and crematoriums have been overwhelmed. Many families have been left on their own to scramble for medicines and oxygen. Many Indian states have imposed some forms of restrictions and a national lockdown may soon occur.
Many other countries have similar issues. Brazil has more than 400,000 deaths, second only to the United States, which has reported slightly more than 570,000. Several European countries are experiencing another surge in cases. The COVID-19 pandemic continues to be overwhelming in many parts of the world.
Yet, in the United States we are appropriately reopening and lessening restrictions. New Centers for Disease Control guidelines regarding masks have given significant freedoms for fully vaccinated people and also slightly lessened restrictions for those still unvaccinated. California plans to fully reopen by June 15 if case counts continue to drop and vaccination rates continue to be strong.
Understanding the difference between an epidemic and pandemic is very important, not just for semantics, but also for the future of COVID-19 infections both nationally and globally. 
First, let’s consider the semantics. An epidemic is a disease that affects a large number of people within a community, population or region. Several years ago, after an unusually high number of measles cases were reported in a short time in the Los Angeles area, many people appropriately received the measles vaccine and an epidemic in Southern California was prevented. Often, in the winter, we hear the phrase that influenza is reaching “epidemic proportions” in a community or region in the United States.
A pandemic is an epidemic that has spread to multiple countries or continents across the world. Virtually every country has reported cases of COVID-19 and in early March of 2020 the World Health Organization declared COVID-19 a pandemic. It WILL NOT be over soon. A likely scenario over the next one to two years is that we will see the United States, Europe and a few other countries in reasonably good shape, responding to outbreaks in regional areas with the reinstitution of mitigation measures such as masking, while other countries in the world may be suffering with high infection rates. This is not a future that any one of us would want. It is correct to say that we are hopeful that the COVID-19 epidemic is coming to an end in many areas of the United States. It is incorrect to say that the pandemic is ending.
There are many reasons this pandemic will continue in many areas of the world. Poverty, poor health, overcrowding, lack of information or, in many countries, an abundance of misinformation are all to blame for the continued high rate of cases, hospitalizations and deaths.
I firmly believe the greatest reason that the pandemic is far from over is the lack of accessibility to COVID-19 vaccines in countries worldwide. We are so fortunate that the United States has a tremendous supply of available COVID-19 vaccines, with everyone 16 and over now eligible to be vaccinated. At current vaccination rates, all individuals who wish to be vaccinated can be by mid-summer. As a result, case numbers, hospitalizations and deaths should continue to drop substantially.
Sadly, this is not the case worldwide. India has the second-largest population in the world, with more than 1.3 billion people. Only China has a larger population, with nearly 1.4 billion people. By comparison, the United States has 330 million people. To date, only 2.9% of the population in India are fully vaccinated against COVID-19.  The United States has partially vaccinated 54% of its population 18 and over, with 37% fully vaccinated. 
India simply does not have adequate access to enough vaccine at the current time. It is not due to lack of belief in the effectiveness of vaccines. Due to an incredible effort by many in India and the Global Polio Eradication Initiative, billions of doses of polio vaccine were given to children in India over the past several decades, and polio has been eradicated completely from that country since 2011. Hopefully, when India has an adequate number of COVID-19 vaccines available, it will have similar success in decreasing coronavirus disease and death. 
Recently, a major milestone for COVID-19 vaccination was reached when it was announced that the one-billionth dose had been administered worldwide. That is an incredible number. The population of the world age 16 and over is approximately 5.5 billion. The number of fully vaccinated people is closer to 500 million, which means that only approximately 10% of the eligible world population is fully vaccinated. Clearly, there is a long way to go to get adequate distribution of vaccines to most of the world.
 Why are significant COVID-19 cases worldwide relevant to us locally? Traveling to and from many of these countries will continue to be limited. Continuing viral mutations worldwide may lead to more highly contagious or deadly variants with less vaccine susceptibility. This could lead to recurrent outbreaks in the United States due to new variants that we may not be as well protected from.
What can we do now? If you are vaccine-hesitant, I hope that knowing 1 billion doses have now been given with significant effectiveness and safety is reassuring. If you are not planning on being vaccinated, please follow the CDC guidelines for unvaccinated people to help prevent yourself and others from becoming infected. If you have been fully vaccinated, I encourage you to stay informed about how long your vaccine will be effective. Immunity is still strong for at least six months and likely longer. Try to avoid situations that are not yet safe. Be a positive advocate for getting the vaccine. Stay aware of the   reports regarding COVID-19 internationally and stay hopeful that supplies of current vaccines and approval of new vaccines in the near future will enable our entire world to have the opportunity to have access to the vaccine in the very near future.
Together, whether we are vaccinated or not, there is reason for continuing optimism regarding control of COVID-19 locally. If we continue to follow the guidelines that have been so thoughtfully developed, I believe we can look forward to a summer of increasing freedom to spend time with others and enjoy many activities that we have been unable to do since early 2020. 
Stay properly informed, follow the guidelines, stay hopeful, stay safe and stay well!


— Dr. Jim Halverson is a longtime Ojai physician who writes a weekly column on COVID-19 for the Ojai Valley News.