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Why Utah health officials call future COVID-19 vaccine best path to herd immunity

10 more coronavirus deaths reported Tuesday, 448 new cases

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University of Utah Health’s Dakota Silva, left, and Ashley Cameron work together as they test people for COVID-19 during the University of Utah’s Wellness Bus drive-thru testing event at Centennial Park in West Valley City on Monday, July 6, 2020.

Steve Griffin, Deseret News

SALT LAKE CITY — As a small but vocal chorus of Utahns continue to applaud rising COVID-19 infection rates for the sake of herd immunity, health officials and experts say that route to herd immunity isn’t the answer.

Herd immunity means enough people become immune to a disease to make spread unlikely. The percentage of a community that needs to become immune differs by disease, and is currently unknown for COVID-19. Polio is an example of a disease that was eradicated in the U.S. due to herd immunity reached through immunization.

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The Beehive State won’t reach it until a vaccine becomes available, Dr. Angela Dunn, epidemiologist with the Utah Department of Health, and others have repeatedly said during the course of the pandemic.

But will a vaccine really lead to herd immunity — and why is it the best answer, according to experts?

“In most cases, vaccines actually provide a more stable and better immune response than the disease itself. And it seems to be for COVID, especially in those individuals who are asymptomatic or have very mild disease, they’re not mounting a very large antibody response. And those antibodies, the counts drop pretty dramatically within two to three months,” said Dr. Tamara Sheffield, medical director for community health and prevention at Intermountain Healthcare.

It’s been found with many other infections that vaccines mount a “better and long-lasting” immune response, she said. Those who have had the disease already may not have experienced enough of an immune response to prevent them from getting the disease again, or from spreading it to others.

Of 100 people who contract the disease, 14 will become severely ill, five of whom will require intensive care, Sheffield noted. Death rates between 1% and 2% is also “unheard of for individuals in terms of an illness,” she said.

“This is a bad actor. And so if we’re waiting for people to all become immune without the vaccine, that means that you’re going to have to say a whole large portion of the population is going to have to be severely ill,” she explained.

Health officials currently believe a 70% immunization rate might be needed to gain herd immunity for the novel coronavirus, but that remains under investigation as the disease is still so new, Sheffield said.

Herd immunity is “somewhat a calculation of the incubation period, so between your exposure and when you start showing signs of a disease or an illness, that actually determines somewhat how high of an immunization rate you have to have to have herd immunity. So the longer the incubation period, the more people that have to be immune to prevent spread,” she said.

That’s why for measles, 90% to 96% of the population needs immunity to prevent an outbreak because the disease has a two-week incubation period. The more asymptomatic people who are out spreading the disease, the higher the immunization rate needed to prevent spread, she said.

Vaccine hesitancy

One concern that could impede Utah reaching herd immunity, however, is the state’s rate of those hesitant about vaccines.

“We have those in our community who have concerns about vaccines. And ... we want to make sure that we are respectful of their concerns, that we understand them, and that we can respond to them,” Sheffield said.

She said communities with a high rate of residents who are either vaccine-hesitant or do not believe in vaccinations can lead to outbreaks, as has been seen recently with measles.

“When you have pockets of people in a community or school that get a high enough number of individuals that don’t vaccinate, as you start dropping below 96% of your population for measles in that school or in that community, you can have outbreaks. And once the outbreak happens there, it can spread in a wide area,” Sheffield said.

Audrey Stevenson, director of the Family Health Division of the Salt Lake County Health Department, believes the success of vaccines has led to some hesitancy. Now, most have never known someone who experienced polio or whooping cough, she noted, and they’ve become more fearful of the vaccines than the diseases themselves.

Low flu vaccination rates in Utah — and low immunization rates at some Salt Lake County schools, where many parents take philosophical exemptions that allow them to not get their kids vaccinated — show that there’s a “swell of distrust” in manufacturers and often health officials, Stevenson said.

Utah also sees lower-than-average numbers of HPV vaccinations.

“I think some of the hesitancy around HPV vaccination that we may also find with the COVID vaccine is hesitancy around the belief that the HPV vaccine is a new vaccine. However, it’s not a new vaccine. It’s been around since 2006, but I think we may see some of that with a COVID vaccine. And people want to know that a vaccine has a strong safety record,” said Deanna Kepka, investigator with Huntsman Cancer Institute.

And often on social media, where misinformation circulates regarding vaccines, “people will misrepresent the information from the studies or from the original article to support their needs or to support their contention on both sides of the fence,” Stevenson said.

Transparency on the part of health officials, doctors and the government will be needed when a COVID-19 vaccine becomes available, Stevenson and Kepka both said.

“I think we need a message from more than one angle. We need it from public health, we need it from the media, we need it from our educational institutions, we need it from our health care systems,” Kepka said.

“If people don’t take a vaccine seriously, we’re not going to be much better off than we are right now, which is living in this crazy new world where we’re all at risk in any sort of public environment. And it’s scary, and it’s a change of lifestyle I’m sure not a lot of us are loving,” she noted.

It will also fall on individuals to use their best judgment when deciding whether to get vaccinated when a vaccine becomes available to the public.

“We also have to remember with regard to vaccine hesitancy and anti-vaccine movement, there’s many decisions that are emotional,” Stevenson said. When there’s a story of someone who died of a vaccine or had a bad experience, “we’re making an emotional decision, and we don’t always take the time to weigh the pros and cons,” Stevenson said

“We’re going to have to weigh the pros and cons with a vaccine in determining: Are we willing as individuals within a community to take this vaccine and take it on good faith that it’s been tested adequately, and that it’s going to be safe and it’s going to be protected?” Stevenson explained.

Tuesday numbers

In Utah, 10 more deaths were reported Tuesday from the novel coronavirus.

Confirmed cases of COVID-19 rose by 448 — a smaller number than the previous several days — as 6,186 test results were reported, with a 7.2% positive rate, according to the Utah Department of Health. They bring the state’s total cases to 30,478 of 424,521 tests recorded, for an overall positive rate of about 7.2%.

The previous seven days brought Utah a daily average of more than 600 new cases.

Hospitalizations also fell on Tuesday to 176 from 207 on Monday. Intensive care units in Utah are now 64.8% full, and non-ICUs are 44.9% full.

Six of the deaths added to the state’s total on Tuesday occurred in San Juan County, where three men over age 84 staying in a long-term care facility died. The facility, the Four Corners Regional Care Center, has been experiencing an outbreak, officials have said.

The other three deaths in San Juan County occurred previously but hadn’t been determined to be Utah residents until now — a woman older than 85 who died in May, a man between 65 and 84 who died in June, and a woman between 65 and 84 who died in July, according to the San Juan County Health Department.

The delay in reporting them occurred because many of the county’s deaths occur out of state, said Kirk Benge, San Juan health director. Local health officials then need to request the patient’s medical records from that state — a process that can take time.

The four other deaths were a Cache County woman between the ages of 65 and 84 who was a long-term care resident; an Iron County woman older than 85 who was hospitalized when she died; a Weber County man between 45-64 who was also a long-term resident and who was hospitalized when he died; and a Utah County man between 65-84 whose hospitalization status was unknown.

The Utah Senate and House Democratic caucuses on Tuesday called on Gov. Gary Herbert to issue a statewide mask mandate, joining the chorus of the state’s biggest hospital systems. Last week, Herbert declined to implement one and instead said if the state doesn’t decrease its daily case count by August, more restrictions could occur.

“Nearly half of the deaths so far in Utah have been people in long-term care facilities, and two-thirds of Utah’s long-term care centers have experienced a coronavirus case,” the legislators said in a letter to the governor.

Because staff members in those facilities aren’t required to wear face masks, “your leadership is sorely needed,” the legislators wrote, pointing to the deaths in the San Juan County care center.

“We have already seen that when you acted with stronger, clearer guidelines, more Utahns responded. Continuing that type of leadership will allow fewer to be sickened and die, and our state to recover with more speed and vitality. Please, our state needs your leadership now more than ever,” the legislators said.

The latest breakdown of Utah cases, hospitalizations and deaths by health district:

  • Salt Lake County, 15,083; 1,013 hospitalized; 130 deaths.
  • Utah County, 5,560; 280 hospitalized; 29 deaths.
  • Southwest Utah, 2,140; 125 hospitalized; 19 deaths.
  • Davis County, 1,976; 120 hospitalized; 6 deaths.
  • Bear River (Box Elder, Cache, Rich), 1,806; 70 hospitalized; 4 deaths.
  • Weber-Morgan, 1,608; 109 hospitalized; 16 deaths.
  • Summit County, 596; 49 hospitalized; 1 death.
  • San Juan County, 481; 61 hospitalized; 17 deaths.
  • Wasatch County, 464; 20 hospitalized; 4 deaths.
  • Tooele County, 364; 16 hospitalized; 0 deaths.
  • Central Utah, 273; 17 hospitalized; 0 deaths.
  • TriCounty (Uinta Basin), 73; 6 hospitalized; 0 deaths.
  • Southeast Utah, 54; 2 hospitalized; 0 deaths.