Oklahoma residents can take their choice of color-coded systems that gauge COVID-19 conditions for each county, with each one having a distinctly different view of the hazard.
A weekly White House task force report paints one-third of the state as experiencing high levels of spread, while the governor’s weekly alert system depicts moderate risk or less across the entirety of Oklahoma.
State health officials acknowledged Sept. 4 in a meeting with journalists that moderate risk is essentially the upper limit on the state’s alert system for public use, so new normal (green), low (yellow) and moderate (orange) are the levels with corresponding guidance.
Interim Health Commissioner Lance Frye referred to the high-risk (red) category as a warning sign for state health officials to use to inform Gov. Kevin Stitt that he might want to take additional action if reached.
However, that wasn’t how the alert system originally was pitched to Oklahomans.
At the map’s unveiling on July 9, Frye described it as similar to a county-level weather warning system to guide behaviors. He said the risk assessment map would empower people to make wise decisions and provide a tool for local leaders to use.
So is the governor’s COVID-19 Alert System more for the state government or for residents of Oklahoma?
“We developed it initially for people to use in communities, but it’s a great tool for us to use, as well,” Frye said. “So that’s why we came up with that red piece from the very beginning. We’ve had it all along, but that was really for us to try to use as a warning system for us.”
Previously, public health officials in Oklahoma had called the state’s alert system unhelpful in part because it failed to use local or regional hospital data to pair with the county new case rates for its high-risk designation.
The state on Friday launched a portion of its revamped COVID-19 alert map that now relies on regional rather than statewide hospital data as the gate for a county to enter the red, or high-risk, category. The map’s legend contains the updated trigger points, but the map itself remains defined by county and not hospital region.
All other colors of the map are based on each individual county’s seven-day rolling average of new cases per capita.
The White House Coronavirus Task Force has privately produced weekly state-level reports since June 29 that assess COVID-19 spread in each county.
In contrast to the state’s risk map, the task force’s most recent report places 24 counties and seven metro areas in the red zone for high levels of virus spread. The yellow zone, for moderate spread, has 26 counties and 10 municipalities.
The latest report continues to recommend that bars be closed and that indoor dining be restricted to 25% of capacity in red zones and 50% of capacity in yellow zones.
The state didn’t share the task force reports with local government or public heath leaders and didn’t post them publicly until Aug. 24 after fielding questions about them when the nonprofit newsroom Center for Public Integrity publicly released some it had acquired.
The Sept. 6 report lists Oklahoma as No. 4 in the country for highest test-positivity rate, as well ninth highest for new weekly cases per capita.
Oklahoma has been in the task force’s red zone since July 14, whereas no county has reached the red level on Stitt’s map since its inception.
A third option for schools
The Oklahoma State Board of Education built its own county-level map to inform school districts, deviating in multiple respects from the governor’s COVID-19 Alert System.
The board uses only each county’s new-case rate to determine the county’s threat level, not any regional or state metrics. Additionally, the orange level was split into two shades to denote a moderate level and moderate-plus level.
The new-case rate is the seven-day rolling average for each county, which is the same calculation the state’s alert system uses for its green, yellow and orange categories.
A look at the COVID-19 vaccine: How it’s progressing, and when it can be expected
Is there time for any vaccine to complete the clinical trials?
Partly it depends on whether the coronavirus is spreading rapidly in communities where vaccines are being tested against placebo.
The two vaccines that are farthest along are made by Pfizer and Moderna. Both require two doses, given three or four weeks apart.
Recently, Pfizer said it is “on track” to seek regulatory review by late October. On July 27, Moderna announced it had started the pivotal phase 3 clinical trial.
What’s an Emergency Use Authorization?
The EUA program, established in 2004, gives the U.S. Food and Drug Administration the power to grant temporary, accelerated approval to a medical drug or device needed in a public health emergency. The EUA review process is less rigorous than a regular approval.
During the coronavirus pandemic, the FDA has granted EUAs to hundreds of tests and two treatments. But the only immunization ever approved for emergency use was against anthrax, in 2005.
The FDA has said the decision to grant an EUA to a COVID-19 vaccine before final testing is completed “would be made on a case-by-case basis” considering factors including “the totality of the available scientific evidence.”
Philadelphia Health Commissioner Thomas Farley said he likely would not recommend the vaccine for everyone without final data.
How good would a vaccine have to be to get full approval?
A COVID-19 vaccine would need to prevent or decrease the severity of the disease by 50% or more, according to FDA guidelines. FDA Commissioner Stephen Hahn has repeatedly stressed that the agency won’t cut corners.
Is this political?
The United States has had an estimated 6.1 million cases of COVID-19 and 186,000 deaths. The Trump administration, which has invested heavily in vaccine development, could use a preelection win.
Paul Offit, director of the vaccine education center at Children’s Hospital of Philadelphia, who serves on the FDA’s vaccine advisory board, worries that the FDA will cave to pressure. He pointed to two controversial EUAs of COVID-19 treatments — for the drug hydroxychloroquine and convalescent plasma — that FDA officials initially opposed because studies had not shown them to work.
“Those two EUAs were, to me, warning signs,” Offit said.
Why is hesitancy a concern?
In this country, vaccine “hesitancy” — skepticism about vaccines that have been huge public health successes — is a growing problem, so there is concern that rushing a COVID-19 vaccine will add to distrust, said Jose Romero, who chairs the CDC’s Advisory Committee on Immunization Practices (ACIP), a group that will help the government decide who gets priority access to new coronavirus vaccines.
In meetings between CDC staff and the Philadelphia Department of Public Health, public perceptions have come up. “If people don’t have faith in this vaccine, it is going to make our job impossible,” James Garrow, a department spokesman, told CDC employees.
Offit said that even if a vaccine now in development proves to be 75% effective — which public health officials would consider fantastic — many people would still be at risk of infection. That means people would still need to wear masks and comply with social distancing.
“That will be a hard sell,” he said.
Who gets the vaccine first?
Two groups, ACIP and a newly formed panel from the National Academies of Sciences, Engineering and Medicine, are working on how to prioritize vaccines, because doses are expected to be limited at first. The academies committee released its draft recommendations earlier this week and ACIP’s may come later this month. It is not clear who will make the final decision on who gets initial doses.
Both groups are suggesting prioritizing health-care workers because they are at high risk of exposure to the virus and of spreading it. The academies proposal includes nursing home employees, and first responders such as police and firefighters.
Both groups are likely to give special consideration to people at high risk of serious illness and death, including older people and those with chronic health conditions.
Can states start distributing vaccine in November?
Farley said it makes sense to prepare now even if a vaccine isn’t ready right away. “Sooner or later we’re going to have to distribute a vaccine,” he said.
Nate Wardle, a spokesman for the Pennsylvania Health Department, said the state has a team that is always preparing for big vaccination efforts. “Our current planning includes multiple pathways to provide vaccine to the public and high-risk groups, including working with doctors’ offices, pharmacies, and other locations where other vaccinations are readily available.
Philadelphia, along with four states, was asked in August to prepare a distribution plan that could be used as a model for other places by Oct. 1, Wardle said. Now, he said, it appears that the CDC has asked all states to come up with their own plans.
One big challenge will be vaccine storage. The Pfizer vaccine must be stored at minus-70 degrees Celsius, requiring special freezers usually found only at large hospitals. Moderna’s vaccine needs minus-20 degrees. Another is making sure people get both doses, properly spaced.
Garrow, with the city health department, also cited the challenge of data. Both the Moderna and Pfizer vaccines require two doses, three or four weeks apart. The timing of each dose must be tracked, and patients must be reminded to get the second dose.
A big remaining question is whether a person can get doses in different hospitals, cities or states.