POLICY BRIEFING – WEEK IN REVIEW

After first being detected in the United Kingdom in September, the B.1.1.7 mutation of the SARS-CoV-2 virus has been capturing headlines, especially given concerns that it might evade defenses that children are thought to have. 

The variant has been spreading more rapidly, though possibly less symptomatically, than its counterparts, and the mutations it encompasses are focused on changes to the virus's surface spike protein—which is also the target for all of the major vaccines for which phase III trial data is currently available. 

This week, the first confirmed case in the United States was announced in a national guardsman in Colorado. Amidst the resulting media furor, the Centers for Disease Control and Prevention (CDC) released a statement that, in part given the patient's lack of travel, this new strain has likely been spreading undetected in the United States for an extended period of time.

Given the importance of the spike proteins in developing immunity, a logical question on many peoples' minds has been what effect this variant will have on the existing vaccines. Dr. Anthony Fauci, head of the National Institute of Allergies and Infectious Diseases (NIAID) has said that all of the data coming from the UK shows the vaccines in use here remain effective, but that the United States will conduct its own confirmatory studies. 

To keep the public informed, the CDC has updated its page on all known coronavirus mutations and ongoing efforts to sequence and understand their implications.

As covered in Brief19, mutations are a natural part of a virus's development over time. While SARS-CoV-2 is statistically expected to mutate every couple of weeks, most of the resulting changes to the viral structure (and therefore its "behavior") are minimal. Some other viruses, like HIV, are far more likely to have meaningful mutations on a regular basis, which is the main reason a vaccine against that virus has been so elusive. Various. 1 January 2021.

The final guidance from the National Academies of Sciences, Engineering, and Medicine (NASEM) listed people with significant underlying comorbidities as the second-highest priority for the newly authorized coronavirus vaccines, coming after only frontline healthcare workers and first responders. But initial statements from both Pfizer and BioNtech stated that, while authorized for this patient population, the available data on the efficacy for them remains limited.

Over the weekend, and in part due to news stories reporting adverse reactions, the US Centers for Disease Control and Prevention (CDC) released new recommendations to clarify who should and should not proceed with inoculation.

• Patients with weakened immune systems: regardless of whether due to chronic disease or resulting from immune-system compromising medication (such as anti-rejection drugs for organ transplant recipients), the increased risk of a serious covid-19 infection for these patients should prompt them to receive the vaccine.
• A history Guillain-Barré Syndrome: No confirmed cases of Guillain-Barré Syndrome (a neurological disorder that can cause muscle weakness or even paralysis) have been reported during coronavirus vaccine clinical trials and in general the Advisory Committee on Immunization Practices (ACIP) does not list a history of Guillain-Barré Syndrome as a general vaccination precaution.
• A history of Bell's Palsy: While cases of Bell's Palsy (paralysis of one of the nerves of the face—which is usually temporary) were reported during the clinical trials, the US Food and Drug Administration (FDA) does not consider the proportion to be above that expected in the general community. In other words, the number of cases that occurred during the trial is similar to that which would have occurred anyway.

As part of the initial guidance from the vaccine manufacturers, it was recommended that pregnant women or those who intend to become pregnant in three months should not get the vaccine due to lack of their inclusion in the studies. But the American College of Obstetricians and Gynecologists (ACOG) has since released a statement supporting vaccination for both pregnant and breastfeeding mothers, in accordance with ACIP's prioritization plan.

In short, the only people who should not receive the vaccine are those who are allergic to any of its ingredients, which is a cutoff that holds true for every single medical product. Various. 30 December 2020.

The United States Congress has essentially been deadlocked on a new round of coronavirus stimulus since July, when the Republican-controlled Senate passed its version that was just slightly smaller than the Democrat-controlled House-proposed package (the $2 trillion difference may sound like a lot, but in the context of the US economy and the pandemic's effect on economic productivity, even that amount of money almost amounts to a rounding error). The drama ended on Sunday evening.

In recent weeks the sides appeared to be working towards reconciliation, with compromises resulting in unemployment benefits and stimulus checks ($300 and $1200, respectively) favored by the Democrats as well as protections for large businesses championed by the Republicans. As this process approached finalization, however, President Trump began tweeting his desire for larger stimulus checks, to the tune of $2000 over the opposition of many of his Republican allies trying to balance fiscal restraint with the needs of the moment.

A strange alliance began to brew. Democrat lawmakers quickly got on board with Trump's request, drafting an amendment to the bill with new language to reflect the increased disbursement. On Thursday, Democrats were unsuccessful in an attempt to pass the changes by "unanimous consent."

Speaker Pelosi set a formal vote for the measure on Monday in the Democrat-controlled House, while Republican senators largely remained silent on the issue. Complicating matters was the fact that Trump is at once a lame-duck president with less than a month remaining in office, all the while embodying what has become of the modern Republican party. He is at his weakest point—and yet the specter of a 2024 run likely remains on the minds of his allies and foes alike.

Amidst this new delay, millions of Americans reliant on Pandemic Unemployment Assistance and Pandemic Emergency Unemployment Compensation saw those benefits expire over the weekend. Even with renewal, required re-enrolling may result in weeks of delays as the application process once again goes into gear.

With an impasse developing, President Trump unexpectedly backed down on Sunday night. He signed the original text with the lower stimulus checks in place, passing it into law. Various. 28 December 2020.