HJAR Nov/Dec 2020

HEALTHCARE JOURNAL OF ARKANSAS I  NOV / DEC 2020 11 between 60 to 70 percent of the popula- tion that needs to be immune. If you take into consideration that these vaccines, the FDA set as a low point 50 percent efficacy, so a vaccine that has 50 percent or 60 per- cent efficacy will need to be administered to many more people in order to achieve herd immunity. That’s one thing. The other thing is that there is a lot of (you can hear it in public, you can see it in the press) vaccine doubt. Depending on the population, as many as 30 percent of indi- viduals say they will not take the vaccine if available at this time. So that’s all going to factor into this. It does us no good to have four vaccines but nobody willing to take it. That’s why I can’t give you an answer as to when we will have the herd immunity. But until then, we will be living with these neces- sities—that is the facial coverings, the social distancing and the hand-washing, which are so essential to mitigating against this virus. Editor According to the last governor’s conference, over 70,000 Arkansans, that we know of, have recovered from COVID- 19. Do you believe they can get the disease twice? Romero I suspect that there will be individu- als who get the virus twice. They can get it after a period of time and get it again. We know that that happens. That happens with the flu. It’s unusual, but it does happen. It happens with a number of other viruses, where infection doesn’t confer lifelong immunity. The issue really revolves around the duration of immunity. How long does the immunity last? And you asked what we have learned about this virus, well this is one of the things we’ve just learned about this virus, which is that not everybody develops immunity to the virus after infection. Not everybody has high viral titers after the infection, and not everybody has a long survival of those antibodies in the body. Some people lose them very, very quickly. And so, those are the novel things that we’re learning about this virus, and until we understand those, until more people are infected, and we have more data on how they will fare in the future, we really can’t predict how many people are able to be reinfected. I suspect we will see individu- als that are reinfected, but I don’t know if it will be three months after the infection, nine months after the infection or many years after the initial infection. Those are things that we will have to learn over time. Editor So, if you’re one of the recovered, should you still wear a mask to protect others? Romero I think that that would be prudent at this time. One of the things that we will be discussing in that group that I chair, the ACIP, is what about vaccine for individuals that have recently had the infection. Should we recommend that vaccine for them?Will they get any benefit from the vaccine? If I had a COVID infection a month ago, is it bet- ter to take that dose of vaccine if I do have immunity [and give it to someone who has not been infected] and don’t need a vacci- nation at this point? Those are issues that we are going to have to discuss and try to come to a consensus about what’s best to do. Editor Knowing what you know, what would you say to those healthy folks, including some healthcare workers, who advocate a COVID-19 party to get the sick- ness over with so they can stop living in fear? Dr. José R. Romero in conversation with former Secretary of Health Dr. Nate Smith