A Pfizer Covid vaccine syringe seen in Jerusalem, Dec. 10, 2020. (Photo/JTA-Olivier Fitoussi-Flash90)
A Pfizer Covid vaccine syringe seen in Jerusalem, Dec. 10, 2020. (Photo/JTA-Olivier Fitoussi-Flash90)

‘There is no magic bullet.’ Bay Area Covid experts offer reality check

Dr. Arthur Reingold, head of epidemiology at the UC Berkeley School of Public Health, thinks people need to get rid of the idea that there is one, single solution to ending the pandemic. The reality is just too complicated.

“With something like this virus, there is no single magic bullet,” he told J. in an interview. “The vaccine is not a perfect magic bullet, masks are not a perfect magic bullet, social distancing, etc. We really need to think more in terms of a collection of strategies to try and keep people safe.”

In recent conversations with J., two medical experts weighed in on some of the knotty questions that remain top of mind as the pandemic drags on, and the Jewish community braves another pandemic-era High Holiday season, spurred by the highly infectious delta variant.

Reingold, for his part, has been studying infectious diseases for more than 40 years, focusing on vaccine-preventable diseases and respiratory infections. That made him the perfect person to chair the state’s Scientific Safety Review Workgroup in 2020, which reviewed vaccine data on safety and efficacy before Covid-19 inoculations were rolled out across the state.

It also made him the perfect person to answer the question: What’s the deal with vaccine boosters? Answer: It’s complicated.

Dr. Arthur Reingold
Dr. Arthur Reingold

Reingold said that despite the announcement by President Joe Biden that, starting Sept. 20,  most Americans can get boosters eight months after their last shot, the verdict is still out among scientists whether boosters are needed, and whether they should be the same vaccine or tweaked for the delta variant that now makes up the bulk of cases in California. But he expected there to be agreement soon.

“The question of whether to give a third dose in the general population, I would say, in the U.S., is probably going to get resolved within the next few weeks — frankly, [I expect it to go] in the direction of recommending [a third dose] because of the delta variant and concerns about reining it in,” he said.

Israel has taken the lead on offering boosters to any vaccinated person from ages 12 up. Gernany and France also started offering third shots. But it’s not a unanimously popular idea on the world stage, he said.

“The controversy, if you will — beyond ‘How important are they?’ and ‘When should they be given?’ — relates to global equity concerns,” Reingold said. “If we’re busy giving booster doses to everybody in rich countries, there’s less vaccine for first doses in poor countries. And so that is a contentious issue.”

Dr. Jonathan Blum, a recently retired infectious disease specialist at Kaiser Permanente in Santa Clara, doesn’t think boosters are necessarily the main priority.

“The greatest need is to vaccinate the many people who are eligible but have not gotten the initial vaccine,” he said. “So it’s all fine, go get your booster when it’s your turn. But the real gap in coverage for our population is the people who have not done anything yet.”

He’s encountered vaccine hesitancy and said sometimes it’s ideological, but sometimes it’s just fear.

“I think when people get worried, sometimes they get paralyzed,” Blum said. “It’s getting close to a year since we started vaccinating, [which is] effective and studied in hundreds of millions of people. And yet, I still hear from people, ‘I’m waiting to see. I’m doing my research.’ The research is done. We’ve seen the results.”

Dr. Jonathan Blum
Dr. Jonathan Blum

The very pace of Covid-19 research — boosted by immense funding from the federal government — has a downside, Reingold said. New results are published every day, but the constant onslaught of information can be confusing for the general public and even for those in the medical field. While research results are a good thing, it’s hard to keep up with information that seems to change day by day.

“It creates a problem for people in public health who are trying to create accurate messages to guide the public without confusing them,” Reingold said. “And when the message seems to change, or does change, then that can create confusion for people.”

That makes it crucial to rely on the right sources for information, Blum said.

“In immunology, in particular, it’s very easy to make gibberish sound good. I call it ‘the right words in the wrong order,’” he said. “Being alert for that is difficult, because it’s hard for a non-expert to sort through this stuff. Actually, it’s hard for an expert to sort through this stuff!”

With schools reopening and some already facing virus outbreaks spurred by the delta variant, J. asked Reingold whether Covid-19 vaccines for children will make a big difference.

According to Reingold, expanding vaccination to children under 12 — something expected in October at the earliest — will curb community transmission significantly only if it’s done widely. This would require the kind of state mandate schools currently have for measles vaccinations, for example. Without that, he said, it may not help that much.

“If only 10 or 20 percent of kids get vaccinated, it’s probably not going to make much of a difference in what we see,” he said. “On the other hand, if 95 percent of kids get vaccinated, it easily could.”

While California had been known for having fairly strict vaccination policies for its schoolchildren (the state won’t let kids go to public school without vaccines, and parents can no longer choose not to vaccinate because of religious or personal beliefs), Reingold doesn’t expect all states in the U.S. to jump on a Covid-19 vaccine requirement.

“We will have parents and educators and others who think it’s a good idea to make sure that all kids are vaccinated for school, and other people who are horrified at being forced to vaccinate their children,” he said. “So whatever one does, there will be enormous controversy, and litigation.”

As to what we’ll see from the ever-mutating Covid-19 virus in upcoming months, Reingold said it’s hard to predict.

“There will always be variants developing as long as the virus is circulating in humans,” Reingold said. “The concern for us is: Are any of the variants more transmissible or more likely to get you really sick if you get them? And if you’re vaccinated with one vaccine made against a particular variant, do one or more of the new variants escape vaccine-induced protection? So there are important issues, and the reality is, for most of those issues, people would be guessing.”

According to Blum, the majority of experts don’t expect the virus to be eradicated. But most diseases aren’t.

“What’s more likely,” but not certain, “is that it will follow a course something like what happened after the 1917-18 influenza pandemic, where a combination of population immunity and viral evolution combined to convert the virus from this pandemic influenza into what we call endemic influenza, which is the seasonal flu we all know and hate,” he explained.

With no certainty for how the pandemic will play out the rest of this year and next, Blum offered a list of the most important things people need to do.

“The first one is: Get your vaccine. The second one is: Get your vaccine. The third one is: Get your vaccine. OK, so those are the top three. Easy,” he said. “The fourth one is: Wear a mask. The fifth one is: Wear a mask. And then the sixth one, which is more complicated, is adjust your activities to reduce risk. And I can’t tell any person what they have to do. There’s no such thing as no risk in life, and people will have to decide for themselves.”

Reingold agrees. He was getting ready to go see his grandchild in another state and said he didn’t mind flying, masked and vaccinated, because he was comfortable with the risk. At the same time, some of his public health colleagues are more conservative, he said.

But, he added, there’s a caveat in all of this: It might be your own choice to risk your health, but playing fast and loose with Covid safety could risk the lives of others.

“I think that the difference is — because I elected to be vaccinated, and wear a mask, and behave myself when I’m doing these things — I like to think I’m at least not posing a risk to other people.”

Maya Mirsky
Maya Mirsky

Maya Mirsky is a J. Staff Writer based in Oakland.