Mental Health Impact of COVID-19: A Survey of 59 Countries

By Shlomo Maital   

  We are approaching almost a year of the coronavirus pandemic – and in virtually every country (except perhaps New Zealand, where fans are filling stadiums to watch the All-Blacks), it is beginning to wear people down.  Here are the results of  large-scale study of the mental health impact, based on a sample of 6,882 individuals in 59 countries. *

  • Elisabet Alzueta et al., “How the COVID-19 Pandemic has changed our lives: A study of psychological correlates across 59 countries”.  J. of Clinical Psychology 2020: 1-15.

Of the nearly 7,000 participants, 25.4 % reported moderate-to-severe depression,  while 19.5% reported anxiety symptoms. 

  What caused the depression?  A variety of factors:  Among them,

*  the country’s income level (higher income correlated with higher depression),  * exposure to COVID-19 (e.g. unconfirmed symptoms), * government lockdowns, * life changes (e.g. working from home); and * conflicts with other adults at home.  However, all these factors ‘explained’ (in a statistical sense) only about one-fifth of the variance in depression.

A major battle is underway between the “the cure (of the pandemic) is worse than the disease, let’s open at once” camp,  and the “you cannot heal the economy until you stamp out the damned virus” camp.  I think the latter are more right – better to severely lock down, like taking a very bitter medicine to cure an illness, to shorten the prolonged impact on mental health by failing to do so.

  It is surreal that American voters are basically being asked to choose between these two camps, Trump vs. Biden —  when the issue is really rooted in complex epidemiology and shrouded in massive uncertainty.   It is clear, however, that the science and the scientists overwhelmingly favor the “end the virus first, clamp down hard” policy. 

Post-Pandemic Youth: Tired But Hopeful

By Shlomo Maital  

    A great many hard words have been said and written about GenY and GenZ, the young generations – who are tired of lockdown and perhaps spread virus to vulnerable elderly. 

     Here is a different take, based on a survey of 1,300 full-time college students in the US, UK and Canada, published in Harvard Business Review.*

  • A. Whillans, L.M.Giurga, L. Macchia and A. Yemisoigil, “Why a Covid-19 World Feels Both Tiring and Hopeful for College Students”.  Harvard Business Review, August 3, 2020.

The main finding, is this:

“Many students also demonstrated a heightened concern for helping others and hoped to find work that fulfilled a greater purpose. Specifically, students reported a heightened interest in pursuing careers that were useful to society and that helped other people. The single highest job priority for the college students we studied was “to have a job that allowed them to help other people.” In light of the economic recession, perhaps unsurprisingly, students’ desire to have a purposeful career was followed closely by “having a job that resulted in high income” and “job security.” Perhaps most interesting was the fact that prosocial and economic-based career motivations were stronger in this student sample than opportunities for advancement, job flexibility, and free time: three motivations which typically dominate career interests among this age group.

The pandemic has taken a terrible of lives and sickness, among millions.  But in a way, it has also been a global alarm clock, a wake-up call.  And perhaps, according to this Harvard study, it has resonated especially with younger people.  This is crucial, because it is they who will “Build Back Better”.    Older generations sometimes teach the younger ones – but perhaps, today, it is the elderly who can learn from the young.

  The authors conclude:

We are all exhausted and stressed. Perhaps more than any other group, students are especially concerned with what the future holds. Yet, we can all learn something from our data and this moment. Using this present as a chance to reflect about life’s meaning, and our own desired legacy, can increase our resilience in facing our unknown challenges. In becoming more resilient and reflective, we will not only reduce our own personal stress, but also become more focused on helping our families, our communities, and our country.

COVID-19 Immunity: Is It Short-Lived?

By Shlomo Maital

    One crucial fact we need to know and understand about COVID-19 —  for those who have had it, and survived – are they immune?  For how long?

    Now comes a study from England, that is not good news at all.  According to Nicola Davis, writing in The Guardian:

The proportion of people in England with coronavirus antibodies dropped by more than a quarter in the space of three months, researchers have revealed, fueling concerns over reinfection.  The findings come from the React-2 study, which is based on home finger-prick antibody test results from random participants across all 314 local authorities.  The first results, based on data from 100,000 people, were released in August, revealing that about 6% of the population of England had the antibodies – protective proteins produced in response to an infection – although the team say that could be a slight underestimate.   The new work – not yet peer-reviewed – extends this with more testing in two fresh cohorts, each yielding results from more than 100,000 adults.  The results reveal that just 4.4% of those tested in the most recent round, between 15 and 28 September, had detectable coronavirus antibodies.

    “As a whole, these data suggest the possibility that decreasing population immunity will lead to an increased risk of reinfection as detectable antibodies decline in the population,” said Graham Cooke, co-author of the report and professor of infectious diseases at Imperial College London.

 Apparently, too, the elderly lose immunity faster than do the young. 

 This does NOT mean that a  COVID-19 vaccine will be ineffective.  “… the new results do not necessarily mean that immunity arising from vaccination would be short-lived. A good vaccine may well be better than natural immunity.

 So what do the British results imply, for ordinary citizens?  I think they mean —  hunker down, everyone, this novel coronavirus is going to be with us for a long time, and we are going to have to learn to co-exist with it.   Masks, some social distancing, etc.  We are resilient. We CAN live with it. 

    The crucial point is,  to live with it, not die with it.  Those who scorn what science and public health tell us to do, are potentially guilty of “negligent homicide”, a well-defined crime in criminal law.   

China – Newest Global Growth Engine?

By Shlomo Maital

    source: Bloomberg

Once, when the world economy was in trouble, there was a locomotive to pull it out of stagnation – the US economy.  After World War II, when the rest of the world was destroyed, the US supplied purchasing power through its imports.  With frequent global recessions, again the US appetite for consumer goods supplied badly-needed demand for the world.

      Today?  With an incompetent xenophobic addled President (at least for the next 13 days, or 92 days until the Inauguration), and the pandemic worsening in the US in up to two-thirds of all states —  the United States is not the locomotive but in fact the quicksand.

       Enter China,  vilified by Trump, but arguably emerging fastest and strongest from the pandemic.  China’s quarterly GDP growth rate annualized, is nearly 5%….   and that means demand for imports, especially from the Asian ecosystem at which China is at the center.   China can be at least a regional locomotive, and the effects will spread more widely.

       Why has China’s economy done a “V-shaped” recovery, when the US recovery, and that of the EU,  are far more likely to be flat-bottomed U-shaped?  

       China’s local authorities have poured easy credit and infrastructure projects into the economy; lockdown has virtually ended, and when the virus rears its head, China rapidly tests millions of people, to gain control.  

        It is possible to admire China’s economic resilience, while fiercely criticizing its flawed civil rights.  Why cannot every nation learn from other nations, embracing the good, rejecting the bad?   

        Bloomberg News shows regularly how the US economy is lagging – and the conclusion is,  you cannot jumpstart an economy without gaining nearly-full control of the virus.  The failed US administration – not just the President, but the incompetent Cabinet and advisors he has appointed, including Dr. Atlas, who espouses ‘herd immunity’ and denigrates masks —  will go down in history as one that outdid Calvin Coolidge (1928-32) in failing to see what was clearly written on the wall.

Blockchain Chicken Farms: Can High-Tech Empower Poor Farmers?

By Shlomo Maital

  My country Israel has grown wealthy largely through high-tech.  Small correction: SOME people in Israel, about one in twelve, have done well through technology-intensive startups (the high-tech sector is 8% of the labor force pre-pandemic).  So it has bothered me for many years, that the benefits of technology have not been more widely dispersed throughout the economy and population, to enhance general wellbeing.

    In a new book BLOCKCHAIN CHICKEN FARM And Other Stories of Tech in China’s Countryside, by Xiaowei Wang, we learn about how high-tech is being brought to many of China’s remote farms and their poor farmers. 

     You ask, how can blockchain make a Chinese chicken farmer wealthy?  Here’s the answer – from Clive Thompson’s New York Times book review:

    Raising free-range chickens isn’t easy, a Chinese farmer named Jiang tells Xiaowei Wang in a fascinating new book, “Blockchain Chicken Farm.” Why? “Chickens aren’t very smart,” he notes; if you leave lights on, they’ll cluster around “and they overcrowd each other, killing each other. A kind of chicken stampede.”

Each chicken has a QR code on its leg.  Those who buy the chicken can scan it and observe the chicken’s entire lifespan, on a free range, and verify it. 

 Even if you get the chickens safely grown in their sunny, free-range yards, you have a new problem: You have to convince your finicky customers, in far-off cities, that you’re telling the truth about how the chickens were raised.   So Jiang turned to high-tech chicken surveillance. He outfitted his chickens with wearable legbands that record their movements — “a chicken Fitbit of sorts” — and worked with a tech start-up to record the data on a blockchain.

    A blockchain is a type of software, most famously used to create Bitcoin, that can make nearly tamper-proof digital records. When customers buy the chicken, they don’t need to take Jiang’s word that his birds strolled around in the sunshine. They can trust the implacable math. Blockchain in this case is a clever tech solution that also happens to have a bleak libertarian philosophy behind it. As Wang notes, some blockchain coders are fond of citing Thomas Hobbes’s dismal view of human nature: Nobody can trust anyone else.  

     It’s a weird, delightful and unsettling tableau. In “Blockchain Chicken Farm,” Wang introduces us to dozens of such quixotic figures, hopscotching across the country on a mission: to document how technology is transforming the lives of China’s rural poor.

      And yes – there is a Trump lesson here, as Thompson observes:

     It’s good to turn on the klieg lights here. Rural China is a part of the world Americans likely ponder very little, despite being economically entwined with it. To the extent China looms in the American imagination, it’s mostly as an economic adversary, a land that has mercilessly stolen American manufacturing jobs by offering dirt-cheap labor in gleaming factories. (At least, that’s the message the White House has hammered for years now.) \

     It’s certainly true that the country’s manufacturing explosion has helped create a much wealthier China. But it has also produced a rural-urban economic schism that neatly mirrors that of the United States itself. While the cities have gotten rich, the countryside has been left behind, with higher infant mortality, lower life expectancy and markedly lower educational attainment.

So, China is trying to use technology to find remedies for the rural poor?  Is America? Is Israel?

   In an ideal world, technology spreads widely to benefit everyone, including those who are not expert in understanding it. (Xiaowei Wang asked the Chinese farmer, how he enjoyed using blockchain, and the farmer responded, what is blockchain?  You don’t need an M.Sc. to implement technologies invented by geniuses).

   Startup entrepreneurs?  Are you at least aware that some of you are benefitting a fairly small sliver of society — and that what you know nad do can benefit a whole lot of people currently shut out of the modern world?  And do you care?

by Shlomo Maital

Today’s Jerusalem Post reports on a fascinating Israel-India collaboration, to develop something the world has needed for a very long time, since the start of the pandemic: a quick (instant) test!

One of the key implications of a 30-second test is that air travellers will be able to confirm they are virus-free instantly — and board without hassle. This could save civil aviation, which is in a desperate crisis — in the US alone, some 130,000 civil aviation employees face permanent layoffs.

Here is the report by Maayan Jaffee-Hoffman:

A 30-second coronavirus detection test being developed by India and Israel should be ready in “a matter of days,” Israeli Ambassador to India Ron Malka told the Indian news agency PTI on Friday. “All the thresholds have been passed.”

The operation has been dubbed “Open Skies,” and Malka said he believes the testing kit will enable the world to begin opening the skies, since the technology simply requires a person to blow into a tube and the results become available in less than a minute. It is also very cheap to carry out, as the results are delivered locally without the logistics and cost of sending the sample to a lab.

by Shlomo Maital

    Policy begins with measurement.  If you measure wrongly, you act wrongly.  Result: Fiasco.

    My country Israel is deep in a COVID-19 second wave, far worse than the first, with 7,000 and more new cases daily, for a small country of some 9 million people.  There are nearly 900 people in intensive care – stretching ICU capacity to the limit.  Medical staff, working non-stop since February, are crushed under the burden. And now, a country-wide severe lockdown, closing businesses and schools, closing everything.

    So why is this a fiasco?  It is explained clearly in this article:  “This Overlooked Variable Is the Key to the Pandemic. It’s not R0.”  ZEYNEP TUFEKCI.   SEPTEMBER 30, 2020    The Atlantic. 

    This is a very long blog.  So here is a brief summary.  Political leaders, guided by public health experts, are focused on R0 – this is the AVERAGE number of people infected by one person already infected.  R0 bigger than one:  exponential spread.  R0 less than one:  negative exponential decline.  So the goal is: Get R0 down.

    Here is the problem. R0 is an average.  Misleading.  Why?  Consider a group of two. One is a millionaire.  One is a pauper.  There average income is $500,000.  So – all is well?

    Most people infected with COVID-19 do not spread it.  A few spread it as super-spreaders.  Why not focus on the super-spreaders?  Why shut down everything, just to catch that handful of super-spreaders?   “K” is a statistical measure of “dispersion” or “scatter” – do many people infect many others, or do a very few infect many others?  Because, if it is the latter – then if we can find the super-spreaders, we can halt the spread, without disastrously shutting down the whole world!

   And – how do you find the super-spreaders?   Backward tracing.  Conventionally, we trace forward.  You have COVID-19?  OK – with whom did you associate? And with whom did each of those associate?

    Backward tracing means:  Take a thousand persons infected in a given place.  Work backward, to see who was it and where was it and when was it that they were infected?  With the goal of finding that COVID-19 Mary – that super-spreader!   

     For example:  At the Rose Garden ceremony introducing Judge Amy Barrett – who in the front row infected so many people, including the President, Hope Hicks, the campaign manager, and so many others?   And most important – shut down mass events – like bars, weddings, and Trump rallies – that super-spread virus.

    And now, the whole story.

= = = = =

     The R mentioned in the daily press briefings represents an average of the whole country or region, involving millions of people. But its single value hides many differences between individuals and their impact on virus transmission.

      Rather than assuming that every infected person and every contact they make follows the same pattern (as with the R number), scientists working on epidemic models allow for the number of new cases caused by each infected person to vary randomly.  Some people might have high viral loads or might simply cough more and hence spread the virus more effectively.   Many people, although ill and highly infectious, don’t show any symptoms. They might make many contacts without realising they pose a danger to others. An example from history is the infamous Mary Mallon (“Typhoid Mary”), a cook in New York City in the early 1900s. Although she carried typhoid bacteria, she didn’t show any symptoms and is believed to have infected more than 50 people over seven years.

   Here is what Zeynep Tufekci writes:

  “…. averages aren’t always useful for understanding the distribution of a phenomenon, especially if it has widely varying behavior. If Amazon’s CEO, Jeff Bezos, walks into a bar with 100 regular people in it, the average wealth in that bar suddenly exceeds $1 billion. If I also walk into that bar, not much will change. Clearly, the average is not that useful a number to understand the distribution of wealth in that bar, or how to change it. Sometimes, the mean is not the message. Meanwhile, if the bar has a person infected with COVID-19, and if it is also poorly ventilated and loud, causing people to speak loudly at close range, almost everyone in the room could potentially be infected—a pattern that’s been observed many times since the pandemic begin, and that is similarly not captured by R. That’s where the dispersion comes in.    There are COVID-19 incidents in which a single person likely infected 80 percent or more of the people in the room in just a few hours. But, at other times, COVID-19 can be surprisingly much less contagious. Overdispersion and super-spreading of this virus are found in research across the globe. A growing number of studies estimate that a majority of infected people may not infect a single other person. A recent paper found that in Hong Kong, which had extensive testing and contact tracing, about 19 percent of cases were responsible for 80 percent of transmission, while 69 percent of cases did not infect another person. This finding is not rare: Multiple studies from the beginning have suggested that as few as 10 to 20 percent of infected people may be responsible for as much as 80 to 90 percent of transmission, and that many people barely transmit it.”

     Notice this:  It is the 80/20 rules so well known in management.  20% of the people do 80% of the work.  19% of the cases cause 80% of the transmission.  So the goal has to be not R0  but K:  FIND THOSE 19%!!!  STOP THOSE MASS EVENT WHERE THE 19% ARE SPREADING VIRUS!.

    OK.  Prove it.    So here is Japan’s approach based on “K”.

“Hitoshi Oshitani, a member of the National COVID-19 Cluster Taskforce at Japan’s Ministry of Health, Labour and Welfare and a professor at Tohoku University who told me that Japan focused on the overdispersion impact from early on, likens his country’s approach to looking at a forest and trying to find the clusters, not the trees. Meanwhile, he believes, the Western world was getting distracted by the trees, and got lost among them. To fight a super-spreading disease effectively, policy makers need to figure out why super-spreading happens, and they need to understand how it affects everything, including our contact-tracing methods and our testing regimes.

“In study after study, we see that super-spreading clusters of COVID-19 almost overwhelmingly occur in poorly ventilated, indoor environments where many people congregate over time—weddings, churches, choirs, gyms, funerals, restaurants, and such—especially when there is loud talking or singing without masks.”

   And now – my country Israel.  28% of Ultra-Orthodox tested for coronavirus proved positive.  Their lifestyle focuses on community prayer and celebration.  Some 40% of all new cases come from this community, which is only a small fraction of the population.

    Yet the whole country is locked down by the Prime Minister and cabinet. Why?  To focus on the Ultra-Orthodox would be discriminatory,  racist, anti-Semitic – and worst of all, politically damaging to the Prime Minister, who needs their votes and support, in his coalition.

     So Israel’s “K” is small.  We have superspreaders. But because of politics, we manage our policies based on R0.     When Israel’s Project Manager for COVID-19 control, Dr. Roni Gamzu, mentioned the Ultra-Orthodox as super-spreaders, based on medical evidence, he was violently attacked and forced to apologize.


   So let us give  Tufekci the last word – a word of hope.  “Could we get back to a much more normal life by focusing on limiting the conditions for super-spreading events, aggressively engaging in cluster-busting, and deploying cheap, rapid mass tests—that is, once we get our case numbers down to low enough numbers to carry out such a strategy? (Many places with low community transmission could start immediately.) Once we look for and see the forest, it becomes easier to find our way out.”

Why Rwanda Is Far Smarter Than the US –

Dealing with COVID-19

By Shlomo Maital

   Consider Rwanda. This small African country in south-central Africa, landlocked, has about 12 million people, with GDP per capita of about $2,600. This is only 4% of America’s per capita GDP. So Americans are 25 times wealthier than Rwandans…. But – is the US leader as smart as Rwanda’s, Paul Kagame?   4% as smart?

   Rwanda has struggled to move beyond the terrible massacre/genocide that occurred between April and July 1994, which killed between half a million and a million Tutsi – 70% of the total Tutsi population in Rwanda.

   Here is how Jason Beaubien, National Public Radio, described Rwanda’s success in controlling COVID-19. First the numbers:







Now Beaubien:

   “A robot introduces itself to patients in Kigali, Rwanda. The robots, used in Rwanda’s treatment centers, can screen people for COVID-19 and deliver food and medication, among other tasks. The robots were donated by the United Nations Development Program and the Rwanda Ministry of ICT and Innovation.

     “In some places in the world right now, getting tested for COVID-19 remains difficult or nearly impossible. In Rwanda, you might just get tested randomly as you’re going down the street.

     “So whenever someone is driving a vehicle, bicycle, motorcycle or even walking, everyone is asked if you wish to get tested,” says Sabin Nsanzimana, director general of the Rwanda Biomedical Center, which is the arm of the ministry of health that’s in charge of tackling COVID-19. Health officials in personal protective equipment administer the test. Nsanzimana says the testing is voluntary, although some others say refusal is frowned upon.

“The sample collection — from a swab up the nose — and filling out the contact information paperwork takes about five minutes.

“All these samples are sent that day to the lab,” Nsanzimana says. “We have a big lab here in Kigali. We have also six other labs in the other provinces.”

   “Despite being classified by the World Bank as a low-income country, and despite its limited resources, Rwanda has vowed to identify every coronavirus case. Anyone who tests positive is immediately quarantined at a dedicated COVID-19 clinic. Any contacts of that case who are deemed at high risk are also quarantined, either at a clinic or at home, until they can be tested.

     Kagame is controversial; he is accused of being dictatorial and anti-democratic. That may be.   But he and his country have done much much better than the wealthy United States, in protecting its citizens.

     Remember what President Trump called some African countries?   In 2018?   S???hole countries? Hmmm.  

SARS-COV-2 Has One Big Trick – Have We Just Discovered It?

By Shlomo Maital

   According to the India Times’ Economic Times:   SARS-COV-2 virus has one big trick – and it may be that scientists have just figured out what it is.

   “It looks like this virus has one big trick,” said Shane Crotty, a professor in the Center for Infectious Disease and Vaccine Research at the La Jolla Institute for Immunology in California. “That big trick is to avoid the initial innate immune response for a significant period of time and, in particular, avoid an early type-1 interferon response.”

   According to the India Times: The work highlights the potential for interferon-based therapies to enlarge a slowly accumulating range of Covid-19 treatments. These include Gilead Sciences’ remdesivir and convalescent plasma, a component of the blood of recovered patients that may contain beneficial immune factors.  These treatments provide limited benefit and are typically used in very sick, hospitalized patients. The possibility that interferon may help some people is enticing because it appears most efficacious in the early stages of infection when life-threatening respiratory failure could still be averted. Dozens of studies of interferon treatment are now recruiting Covid-19 patients.

   How did the scientists figure this out? Here is the story:

      When two brothers fell critically ill with Covid-19 around the same time in March, their doctors were baffled. Both were young — 29 and 31 years old — and healthy. Yet within days they couldn’t breathe on their own and, tragically, one of them died. Two weeks later, when a second pair of Covid-stricken brothers, both in their 20s, also appeared in the Netherlands, geneticists were called in to investigate. What they uncovered was a path leading from severe cases, genetic variations and gender differences to a loss of immune function that may ultimately yield a new approach to treating thousands of coronavirus patients.   The common thread in the research is the lack of a substance called interferon that helps orchestrate the body’s defence against viral pathogens and can be infused to treat conditions such as infectious hepatitis. Now, increasing evidence suggests that some Covid-19 patients get very ill because of an impaired interferon response. Landmark studies published on Thursday in the journal Science showed that insufficient interferon may lurk at a dangerous turning point in SARS-CoV-2 infections.

See also:

“Impaired type I interferon activity and inflammatory responses in severe COVID-19 patients”   Science 07 Aug 2020: Vol. 369, Issue 6504, pp. 718-724


COVID-19 Vaccines: What We Know

By Shlomo Maital

   In my country Israel, there are more new daily cases per million population than anywhere in the world. Europe too is undergoing a second wave; and many states in the United States are also seeing increasing morbidity. So – everywhere, we await a vaccine.

   Over a hundred different efforts are underway to create, produce and administer COVID-19 vaccines.   Here is what we know so far, based on a very clear, lucid website sponsored by the Children’s Hospital of Philadelphia. This vaccine effort is an amazing global effort, led by the top scientific minds, trying a wide variety of creative approaches, some tried and true, some radical and innovative. One or more of them will save humanity!

     What types of vaccine are being tested?


   * Inactivated vaccine — The whole virus is killed with a chemical and used to make the vaccine. This is the same approach that is used to make the inactivated polio (shot), hepatitis A and rabies vaccines;

 *Subunit vaccine — A piece of the virus that is important for immunity, like the spike protein of COVID-19, is used to make the vaccine. This is the same approach that is used to make the hepatitis and human papillomavirus vaccines.

* Weakened, live viral vaccine — The virus is grown in the lab in cells different from those it infects in people. As the virus gets better at growing in the lab, it becomes less capable of reproducing in people. The weakened virus is then used to make the vaccine. When the weakened virus is given to people, it can reproduce enough to generate an immune response, but not enough to make the person sick. This is the same approach that is used to make the measles, mumps, rubella, chickenpox and one of the rotavirus vaccines.

   * Replicating viral vector vaccine — In this case, scientists take a virus that doesn’t cause disease in people (called a vector virus) and add a gene that codes for, in this case, the coronavirus spike protein. Genes are blueprints that tell cells how to make proteins. The spike protein of COVID-19 is important because it attaches the virus to cells. When the vaccine is given, the vector virus reproduces in cells and the immune system makes antibodies against its proteins, which now includes the COVID-19 spike protein. As a result, the antibodies directed against the spike protein will prevent COVID-19 from binding to cells, and, therefore, prevent infection. This is the same approach that was used to make the Ebola virus vaccine.

   * Non-replicating viral vector vaccine — Similar to replicating viral vector vaccines, a gene is inserted into a vector virus, but the vector virus does not reproduce in the vaccine recipient. Although the virus can’t make all of the proteins it needs to reproduce itself, it can make some proteins, including the COVID-19 spike protein. No currently licensed vaccines use this approach.

   * DNA vaccine — The gene that codes for the COVID-19 spike protein is inserted into a small, circular piece of DNA, called a plasmid. The plasmids are then injected as the vaccine. No currently licensed vaccines use this approach.

* mRNA vaccine — In this approach, the vaccine contains messenger RNA, called mRNA. mRNA is processed in cells to make proteins. Once the proteins are produced, the immune system will make a response against them to create immunity. In this case, the protein produced is the COVID-19 spike protein. No currently licensed vaccines use this approach.

Which type of COVID-19 vaccine is most likely to work?

       It is likely that more than one of these approaches will work, but until large clinical trials are completed, we won’t know for sure. Likewise, the different approaches may have different strengths and weaknesses. For example, mRNA or DNA vaccines are much faster to produce, but neither has been used to successfully make a vaccine that has been used in people.  On the other hand, killed viral vaccines and live, weakened viral vaccines have been used in people safely and effectively for many years, but they take longer to produce.

   In addition to differences in how long it takes to make different types of vaccines, each type may also cause the immune system to respond differently. Understanding the immune responses that are generated will be important for determining whether additional (booster) doses will be needed, how long vaccine recipients will be protected, and if one type offers benefits over another.

Is one of the COVID-19 vaccines expected be more effective for the elderly population?

     It is likely that COVID-19 vaccines could have different levels of effectiveness in various subgroups of people. Because the elderly generally do not respond as well to vaccines, one or more COVID-19 vaccines may not work well for them, which is concerning given their higher risk of severe disease. The large phase III studies may not include people over a certain age. But, the manufacturers have been encouraged to include older people, so that we have this type of information earlier in the process than may usually occur. We will have to wait and see what the data show to know which vaccine(s) work best in the older population.

How many doses of a COVID-19 vaccine will be needed? Will a booster dose be needed?

     The number of doses of a COVID-19 vaccine that will be needed has not yet been determined. The coronavirus vaccines being studied are evaluating one or two doses. When giving two doses, they are usually given one or two months apart. We will need to wait for the results of the clinical trials to have more information about how many doses will be needed.

How long will vaccine immunity last?

Since we do not yet know how long immunity after infection lasts, immunity following vaccination will also have to be determined. Likewise, immunity following vaccination will depend in part on which types of vaccines are licensed, what part of the immune system responds to the vaccine, and the level of immunity that is generated by the vaccine.

If more than one vaccine becomes available, could taking two different vaccines boost the effectiveness?

While it is likely that more than one COVID-19 vaccine will become available, we probably won’t have a good answer to this question until vaccines are actually licensed and we know more about them. Three scenarios can occur if a person is vaccinated with two versions of vaccines against the same disease, particularly close in time:

— They get a stronger immune response. An example of this was when children got inactivated polio vaccine and later got oral polio vaccine.

—- The second vaccine causes immunity that would be similar to receiving a second dose of the original vaccine. Using a different brand of hepatitis B vaccine for one or more doses would be an example of this.

— The immune response generated by the first vaccine interferes with components of the response to the second vaccine, in some cases causing lower immunity. For example, when people got a pneumococcal polysaccharide vaccine (PPSV) followed by a pneumococcal polysaccharide vaccine with a harmless helper protein attached to it, called pneumococcal conjugate vaccine (PCV), they had lower antibody responses to one part of the PCV vaccine than people who got the two vaccines in the opposite order (PCV followed by PPSV).

For these reasons, studies will need to be done to determine the effects of getting a second type of COVID-19 vaccine shortly after receiving a different one. If, however, we find that COVID-19 vaccines are like influenza vaccines and we need to get vaccinated annually, concerns about switching types from one year to the next are less likely to be an issue.

Will a coronavirus vaccine need to be given annually?

   When a vaccine is licensed, we will only have information about length of immunity for as long as we are from the trials. For example, if the first people in the study were vaccinated in July 2020 and the vaccine is licensed in December 2020, we will only have information about the immune response up to 5 months after vaccination. The vaccine manufacturer will likely continue to monitor vaccine recipients for several months or more, so that over time, we will continue to get a better picture of the durability of immunity. With this information, we will be better able to understand whether vaccines against COVID-19 will require annual dosing like influenza.

Is a coronavirus vaccine necessary?

   SARS-CoV-2 infections can be a minor hindrance or lead to severe disease or even death. While hygiene measures such as social distancing, handwashing, and wearing masks offer some help, the best way to stop this virus is to generate SARS-CoV-2-specific immunity. This specific immunity can be achieved in one of two ways — through illness or vaccination. Since illness could lead to severe disease or death, vaccination is a better alternative as long as safe and effective vaccines can be developed.

How long before a coronavirus vaccine takes effect?

   Generally speaking, it takes a week or two for immunity to develop following vaccination, but the specific timeline for any coronavirus vaccine will depend to some extent on which type of vaccine is licensed. For example, a live, weakened vaccine requires time to reproduce in the body, whereas an inactivated vaccine is given at a dose that will generate immunity. On the other hand, because the live, weakened vaccine reproduces to generate immunity, it might provide a more robust immune response than an inactivated vaccine

Blog entries written by Prof. Shlomo Maital

Shlomo Maital