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National COVID- 19 positivity rates are falling and more vaccine doses could be on their way soon, said Adm. Brett Giroir, MD, assistant secretary for health in the Department of Health and Human Services, during a call with reporters on Thursday.

"Right now we remain in a critical and dangerous time in the pandemic, but we are just starting to see reductions in national positivity rates," Giroir said.

He cited declining numbers of cases, hospitalizations, and deaths in the Midwest, Northern plains, and the "Heartland" as driving the national reduction. But numbers are still rising on the coasts -- especially in California -- and in parts of the deep South, he said.

Giroir also said the government was prepared to ship 7.9 million doses -- 2 million of Pfizer/BioNTech's vaccine and 5.9 million of Moderna's vaccine, if authorized for emergency use, which appears imminent.

An FDA advisory committee meeting Thursday voted unanimously (with one abstention) to recommend authorization of the Moderna product. Quick emergency use authorization by the FDA is considered likely, perhaps as soon as Thursday night.

In the long term, Giroir said, vaccines will help the nation achieve herd immunity, if 75%-80% of Americans agree to be immunized.

"This will essentially end the pandemic, as we know it," he said, though such predictions presuppose that the vaccines will reduce infection and transmission over long periods, benefits that have yet to be demonstrated. The current products' trials only examined efficacy against clinical illness, and only for two months after dosing.

Giroir did acknowledge that "pockets" of the country with low immunization rates "could still incubate virus, like we have seen with measles."

In the short term, Giroir said, vaccines can have an "immediate clinical impact" by achieving "life-sparing results" and helping to reduce hospital overloads.

Other Measures

He also urged states and counties to keep schools open, arguing that that schools are not sources of community spread; a new CDC report indicated that schools generally run safely when "reasonable mitigation" measures are followed. Giroir also noted that "serial testing" among college students has been shown to reduce cases on campus and in the community.

Additionally, he warned states that closing outdoor dining has no effect on transmission of the virus, since large groups will simply take meals into their own homes to eat together. Giroir said families should minimize groups meeting indoors; it's better to eat outdoors, keep homes ventilated, and physically distance within a residence.

Giroir announced that, as of this week, 102 million of Abbott's BinaxNOW rapid antigen tests for healthcare use have been shipped, with 66.6 million going to states and the rest designated for use with "vulnerable populations."

While there have been questions about the reliability of such tests, Giroir defended the products.

"We have increasing and, I would say, definitive evidence from multiple academic and other sources that Binax tests, in particular, are highly sensitive and specific for both symptomatic and asymptomatic individuals and for both adults and children," Giroir said.

Additionally, Giroir said that the government has supplied states and other partners with 184 million swabs and 202 million tubes of transport media and there has been "no deficit in states for months."

The total number of available tests in December is expected to be about 183 million (without pooling) including 111 point-of-care antigen tests and 8 million point-of-care molecular tests.

Giroir also explained that the federal government will continue to supply swabs and media to states "at least through March and likely longer," as contracts, which ended in December are extended.

In addition, a contract for 150 million BinaxNOW tests was to end in early January, but the federal government has extended it in order to obtain an additional 30 million tests. These will be distributed at 10 million per month for 3 months and targeted to vulnerable populations such as long-term care facilities and assisted living as well as historically Black colleges and universities, tribes, and "similar populations," Giroir said.

Direct shipment to governors will then be paused, though states, territories, and tribes can order the tests directly for the same cost, $5 per test, he said. The government will also allow "a portion" of the Binax tests to be sold commercially, making them available to businesses, healthcare systems, and others not on the priority list, Giroir said. He did not specify whether this might include the .

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