Although COVID-19 science has raced forward, the pandemic is likely to have an enormous impact on our lives deep into 2021, even with a vaccine on the horizon next year, two top UC Davis Health experts said this week on UC Davis LIVE: COVID-19.

“I don’t think we’re going to hit normal anytime soon,” said Allison Brashear, dean of the School of Medicine. “People are expecting that one day they’ll wake up and everything will be back to normal. That’s not going to happen, even with a vaccine.”

Brashear and Dean Blumberg, chief of pediatric infectious diseases at UC Davis Children’s Hospital, provided a state of the pandemic overview Thursday (Sept. 24) as they answered questions on what we’ve learned in the six months of COVID-19.

Among the major takeaways

• They are hopeful a vaccine will be developed by 2021, possibly early in the year, but they don’t see it happening sooner safely. “There is an intensive worldwide effort,” Blumberg said. “Still, by the time you get the data meticulously analyzed, presented to the FDA, have the FDA meticulously go over the data, then manufacture the vaccine and distribute it, I just don’t see it being available before next year.”
• A vaccine will not mean flipping a switch and making the coronavirus disappear. It will be more like turning the corner toward “normal,” with months more of precautions against COVID-19 transmission. “I don’t see a wave of the wand and we go back to how life was,” Brashear said. “But the ability to get close to normal is in our power if we’re consistent about wearing masks and social distancing. We need to take responsibility for our own health and for the health of our community.”
• Both experts are confident the current promising vaccine trials are being run safely, and they are hopeful the trials will produce a vaccine that will be effective across all communities and populations.
• Researchers are still learning about how COVID-19 is transmitted, but science has proven that wearing masks and social distancing are the most effective ways to protect yourself and each other.

How far COVID-19 science has evolved

“We started from zero,” Blumberg said. “A lot of the advice we gave was wrong. Remember, initially we were saying don’t wear a mask, if you can believe that. We’ve learned masks work. That’s a scientific fact.”

Despite early concerns about touching contaminated surfaces and research that showed the virus could survive for hours or days on some materials, that is not a major source of transmission, Blumberg said.

“We were worried about touching our mail or our groceries,” he said. “We’ve seen businesses do a lot of ‘deep cleaning,’ but a lot of that is for PR purposes to reassure the public they’re a safe place to go.”

But now research has shown the primary source of infections is respiratory, and that droplets — which only travel about six feet before gravity pulls them down — are the major carrier.

“That’s why we mask and distance,” Blumberg said. “It’s still important to wash your hands and carry sanitizer, but that’s more effective against staph infections and other issues. We don’t think that’s effective against COVID-19.”

Other advances include understanding how to treat the disease. That includes the use of remdesivir — a treatment UC Davis Health helped pioneer — and steroids, if given at the correct time. Providers have also learned much more about what supportive care is most effective, he said.

The state of the COVID-19 pandemic

“I consider this the relative calm before the storm,” Blumberg said.

As people have gotten more consistent about masking and social distancing, coronavirus transmissions have generally been reduced, but only after huge summer spikes in California and across the nation when many people eased up their cautions. Some regions outside California are still increasing, but generally the trend is downward. For now.

“But we’re entering the winter respiratory virus season,” Blumberg said. “We do expect an increase in cases through the month of October and a real increase during November. That’s what we’re worried about.”

He said cold weather drives people indoors, where they are usually closer together and the air flow is more limited.

“Outdoors, there is basically an unlimited amount of air and that dilutes the virus,” Blumberg said. “Plus, in winter, the temperature and humidity favor survival of the virus, so you can have enhanced transmissions.”

Flu season and COVID-19

Because this coronavirus is so new, there is limited research on COVID-19 and the flu, which has experts nervous.

“That’s why it’s so important that people get their flu shot this year,” Brashear said. “Both are respiratory diseases. It’s going to be difficult to tell them apart.”

Blumberg said recent research in the United Kingdom showed that patients who had COVID-19 and the flu at the same time had a significantly higher risk of dying than patients who had COVID-19 only.

The window for getting a flu shot lasts through October, and infectious disease experts do not have one ideal date to get a flu shot, but both Brashear and Blumberg said there is no real reason to wait.

“Once you get the shot, it takes about two weeks to develop full immunity,” Blumberg said. “Trying to predict the exact flu season is like trying to play the stock market. I would say get your shot in October at the latest because you don’t want to risk missing when flu season starts.”

“If you can get it, get it now,” Brashear said. “We are having everybody at all the UCs get vaccinated now. That says a lot.”

Progress on COVID-19 vaccine trials

Both said they have been impressed with the safety and comprehensive approaches of the vaccine trials, and are proud that UC Davis Health is one of the partners in a trial headed by Pfizer Inc. and BioNTech involving 30,000 people across the United States.

“We had over 3,500 individuals sign up to possibly be one of our 200 people in that trial,” Brashear said. “They represented a diverse population across California.”

She cited a couple of the demographics from UC’s participation: about 30 percent Latinx and 12 percent Black.

“This is unheard of in clinical trials in having such a diverse population,” she said. “It’s really a demonstration of the strength of UC Davis’s connection to the community and of how much everybody in the community wants to participate.”

Diversity in trials is crucial

A diverse group of trial participants is crucial for making sure the vaccine will be safe and effective for all populations, especially Latinx and Black communities, which have been hardest hit by COVID-19.

“We want clinical trials to represent the diversity of our country,” Brashear said. “We want to be sure the vaccine works for everyone.”

Trials like these require a large pool of participants, in part because that can speed up the timetable, and because researchers need to be certain about the results. Participants get either a vaccine candidate or a placebo, then go about their lives. They are not intentionally exposed to the coronavirus.

“That’s why we need really large numbers,” Brashear said. “We watch people as they go to the grocery store and go to work in the natural course of their lives. If they happen to get COVID-19, then we look at their blood and at them carefully.”

Blumberg said that is also why the trials are spread across the country. “They need to be in areas where the virus is being transmitted,” he said. “The researchers have to be confident that the numbers are statistically relevant.”

He said researchers and regulators need total confidence the vaccine is safe, that it works and that it doesn’t cause even a rare serious side effect.

“Remember, we’re going to give this vaccine to everyone,” Blumberg said. “We want to be sure we don’t make healthy people sick.”

The status of other COVID-19 knowledge

• Over-the-counter treatments — “I’m not aware of any evidence that over-the-counter supplements or treatments are effective in either prevention or treatment,” Blumberg said.
• The safety of airplane travel — “I think most airlines are following the health guidelines,” Blumberg said. “I’ve even started considering flying again, if there were anywhere to go on vacation. I think it’s relatively safe. But it’s still safer to drive.” Added Brashear: “The bigger risk is being in a small room with 20 people not wearing a mask who are eating and talking loudly — like in a bar or restaurant.”
• Aerosol virus transmission — “The scientific evidence isn’t 100 percent clear on aerosol transmission,” Blumberg said. “The primary transmission is droplets, but if it were only droplets, then wearing a mask and social distancing would be effective 100 percent of the time, and we know that doesn’t work 100 percent. However, focusing on droplets is still by far the most effective action.”

The long view

“As a country, we haven’t been really aware or supportive of public health,” Brashear said. “Now, public health is front and center. COVID-19 has brought science to the forefront and we’ve come to understand how much we depend on science to be healthy.

“If there is a good thing to come out of all this terribleness,” she said, “it’s that we’ve come to realize that our survival depends on staying ahead with science and partnering with science.”

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