It’s officially spring, and we have the weather now to prove it: bright and sunny one day, gray and rainy the next. Moreover, removing any lingering doubt, the ducks have returned to the fountain near Caspary auditorium! In fact, we had them on the roof of the president’s house this morning, contemplating a nest in the back garden, it appeared (which would be challenging, given our dog!). I hope you are all finding time to get outdoors for some R&R (apparently, we can use it: A small study published last week in JAMA, based on data collected from Bluetooth-connected smart scales, found that Americans under shelter-in-place orders gained an average of ~1.5 pounds per month).
The number of people infected with COVID each day in the U.S. has plateaued, but at a level about 80% lower than the peak in January, with roughly 17 new cases per day per 100,000 population, with similar reductions in hospitalizations and deaths. New York City continues to be at the epicenter of the highest infection rates in the U.S., with ~48 new cases per 100,000 per day. This level is essentially unchanged from the end of February and is only ~40% lower than the January peak. There was confusion on this point in the press this week owing to incomplete data reported by the city, then published each day in the New York Times as though it were complete, giving the false impression that levels were rapidly declining. The NYC data is now back up to date and reiterates that new case numbers are largely unchanged since late February and are at rates that are near the highest in the nation, matched or exceeded primarily by surrounding counties in NY and NJ, with these two states the highest in the nation in cases per capita.
Limiting this high infection rate is the successful scale-up of vaccination, which nationally has increased to 2.5 million shots per day, with 26% of the US population having received at least one dose of vaccine and 14% being fully vaccinated, including vaccination of 70% of those over age 65, who account for 80% of the deaths from COVID-19. As a result, nationally the fraction of hospitalizations and deaths among those over 65, and particularly those over 85, has been plummeting. This provides good evidence that the vaccines are having their intended effect to protect those most vulnerable to the virus. Nonetheless, we are not seeing similarly brisk reductions in hospitalizations and deaths in NYC due to the persistently high case levels, and a lower fraction of vaccinations among the elderly (for example, only 41% of New Yorkers over 85 have received at least one dose of vaccine). In particular, more needs to be done to get vaccines administered to people of color, as Black and Latino people in NYC are getting vaccinated at only about 60% of the rate of white and Asian individuals, likely significantly attributable to access issues. At the current vaccination rate, it’s projected that 70% of the national population will have had at least one dose of vaccine by the second half of June, and 90% by the end of July.
A significant threat to reaching herd immunity at these high vaccination numbers is the emergence of viruses with variant sequences in the spike protein that are more infectious and might be less effectively neutralized by antibodies generated in response to vaccination with the spike protein from the initial viral strain. In this regard, about two thirds of new infections in NYC are with a variant (called B.1.526) that appeared in NY last fall and the ‘UK’ variant B.1.1.7. Half of the ‘NY’ variants also have the E484K mutation found in predominant viruses in South Africa and Brazil; this variant inhibits binding of a class of neutralizing antibodies directed against the spike protein and almost surely increases risk of infection. These variant viruses are likely significant contributors to the persistently high infection rates in the NYC area.
At Rockefeller, over the last two weeks 12 new cases of COVID-19 have been diagnosed. These are widely distributed across departments and none appear to be attributable to on-campus infection; none have led to hospitalization. Of particular note, two members of our community have been infected after completing vaccination, one each with the Moderna and Pfizer vaccine. Sequencing the virus in both cases showed variant viruses. Consistent with the expectation that vaccination will still provide strong protection from severe disease for people with these ‘breakthrough’ infections, both individuals had very mild clinical courses and have fully recovered.
My takeaways regarding the current state of the pandemic are that NYC remains a/the national hot spot for virus, and our situation is further compounded by the high levels of viruses that likely have greater virulence. Given this circumstance, everyone needs to continue to take strong precautions to prevent infection as we have for the last year. Based on recent experience, this includes wearing masks, even after vaccination. In my view, which is supported by most experts in this field, this really is no time to be maskless indoors at restaurants, bars or gyms. Please continue to take all precautions to protect yourself, your families and Rockefeller colleagues.
Another takeaway is that more than 85 million Americans have received at least one dose of vaccine, and the vaccines are very safe. Among the >500 Rockefeller community members who have been vaccinated, the most common report is an ache for a day at the vaccination site. The vaccines are also highly effective in preventing serious disease and death from COVID-19. Given the persistently high infection rate in NYC, resulting in significant numbers of patients with severe disease and death, or with persistent symptoms long after infection, the risk-benefit ratio strongly argues in favor of getting vaccinated, and I urge everyone to get vaccinated with any approved vaccine as soon as possible.
That brings me to our new opportunity to get vaccinated on/near campus, which was announced earlier this week. Through a partnership with the Hospital for Special Surgery, starting next week we will start vaccinating all Rockefeller employees (including on-site contractors and HHMI personnel) who meet any of the state eligibility criteria. The vaccine will be administered by HSS personnel, and we anticipate having enough appointments available to serve our entire eligible community within two to three weeks. Currently, all Rockefeller employees (including on-site employees of contractors and HHMI personnel) coming to campus at least once per week are eligible for vaccination as public-facing employees of an essential employer. Additionally, everyone over age 50, regardless of health conditions, is eligible, as is everyone regardless of age who has specific health conditions. Next week these vaccinations will occur at the HSS Belaire Courtyard at 525 East 71st St. (between York Ave and the FDR Drive), and thereafter will occur on the Rockefeller campus at the Kellen BioLink. Watch for emails from Occupational Health Services for announcements of availability of new blocks of time, and schedule your appointment online here. Many thanks to Tim O’Connor, Deborah Yeoh, Ann Campbell and everyone else who helped organize this arrangement with HSS, and of course to our HSS colleagues who will provide both the shots and the staffing! I urge everyone to get vaccinated as soon as you can!
Lastly, I have conveyed my concerns about the state of the pandemic in the NYC area to federal officials, with particular exhortation to preferentially scale up vaccine delivery in the region to prevent unnecessary deaths and attenuate the spread of the B.1.526 variant with the E484K mutation across the country.
Please stay safe, be well, and continue to take care of one another.
With best wishes,
Richard P. Lifton, M.D., Ph.D.
Carson Family Professor
Laboratory of Human Genetics and Genomics
The Rockefeller University