State of Covid, August 2021
Simplistic solutions to complex problems are rarely correct. “Get vaccinated and wear the mask” is not an exception to the rule.
Douglas County is experiencing the reality of the delta variant, with further viral mutations on the horizon. Mandates of vaccination, without exceptions, and outdoor masking won’t change that. If messaging and actions were designed to divide, they could not be more effective. Opinions expressed in public forums and social media serve as a thermometer of the heat and blaming in our community.
Some have advocated the hospital not admit ill patients who are unvaccinated. Those who have chosen to be vaccinated blame the unvaccinated for immune escape of the variant. It is likely just the opposite. But the blaming and divisions, at the very time we need to come together, is most harmful. Is there no good news?
Well, there is good news.
1. Herd immunity for the alpha strain is here. Dr. Marty Makary, Professor at the Johns Hopkins School of Medicine and Bloomberg School of Public Health writes in the Wall Street Journal that 80-85% of American adults are immune to this version of the virus. Over 64% have received at least one vaccine dose and, of those who haven’t, roughly half have natural immunity from prior infection.
2. There is ample scientific evidence that natural immunity is effective and durable. This immunity also is likely to protect against variants (Emory University study). Researchers from Washington University in St. Louis reported last month that 11 months after a mild infection, immune cells were still capable of producing protective antibodies. We have more follow-up data on the duration of natural immunity than on vaccinated immunity. Some scientists suggest natural immunity is probably lifelong.
3. Globally, the survival rate for COVID 19 is 99.8%. Under the age of 70, the survival rate is 99.97%. This is on par with many influenza seasons. The average age of death from COVID is 78. The average life expectancy in America is 78. The survival rate in children is 99.995%.
4. Early outpatient treatment works. At Evergreen Family Medicine, we are aggressive in those stratified to be at risk in this early phase. We believe Regeneron, Ivermectin, anticoagulation, and judicious use of steroids and active monitoring is keeping patients out of the hospital.
5. There is little, if any, spread of COVID from asymptomatic persons. Like other viral infections, if you are sick, you should stay home. There is no need to quarantine the asymptomatic healthy.
And there is concerning news:
1. Immune escape is real. More and more breakthrough infections are occurring. Israel’s experience is instructive. In that country, only one person in 15 did not receive at least one vaccine. Nearly 90% of adults over 30 are fully vaccinated. Well above the range experts state would provide herd immunity. And a significant number of those older unvaccinated people are simply too sick to tolerate the vaccine. Which makes them also at higher risk with Covid. Ability and propensity to be vaccinated is likely a marker for overall health. This is known to be true of the influenza vaccine.
What is concerning is the rate of cases in Israel has risen 12-fold in the last month. Covid cases quadrupled in 20 days. And rates of serious illness among the vaccinated are now as high as they were among the unvaccinated only 2 weeks ago.
2. Antibody Dependent Enhancement may be happening. What is new in our approach to Covid 19 is mass vaccination in the face of an active pandemic. With this, we are seeing the impact of immune and evolutionary pressures on a virus already adept at mutation.
The delta virus is more infectious, and affecting younger patients, than the alpha strain. And 99% of the current Covid expression is the Delta variant.
3. There are risks entailed with the mRNA vaccines which exceed all other vaccinations we have broadly employed. The VAERS reporting system now has over 10,000 deaths (EU 20,000 deaths) reported after receiving the vaccine. I understand this is passively reported data, not considered proven to be true. Neither has it been proven untrue. This is far more deaths than associated with any other vaccine in history, using the same reporting mechanism. That merits our attention. Other adverse reactions include anaphylaxis, blood clots with pulmonary embolus and stroke, myocardial infarction, pericarditis, etc. Informed consent requires an honest acknowledgment of risks.
At age 71, I have chosen to be vaccinated. I accept the known and unknown risk. For young healthy adults and children, who are at minimal risk of Covid disease, that risk-benefit equation may produce a different answer.
4. The mRNA vaccines are not 95% effective as touted. Efficacy is likely closer to 40-70 %. And falling. More data is needed. Whether booster injections of the same vaccine that did not work very well the first time will be helpful remains to be seen.
5. Meanwhile Institutions, companies and government agencies are removing individual treatment choice, at the same time dissenting data and expert informed messages are censored and suppressed. Trust and credibility of these same organizations is in rapid decline. At a time, it is vital we be able to trust these organizations, such as the FDA and CDC.
This is my belief and hope for America:
1. US citizens can preserve the freedom to choose our medical treatments and not be persecuted for that choice.
2. The futility of contact tracing in an aerosolized virus with the transmissibility of chicken pox will be recognized. We do not need to quarantine the asymptomatic healthy. People and public health have no way of knowing where exposure occurred.
3. The value of naturally acquired immunity will be acknowledged. Broad based immunity of natural disease exposure may be more durable and offer better protection from variants than the specific T spike protein immunity incurred with vaccination. Mandating vaccinations or boosters, to people with proven disease mediated immunity, by using a vaccine with as low as 40% efficacy, imposes a risk with no benefit. This is counter to any science based or ethical decision matrix.
4. Children need to return to school Without masks. Without vaccination. Covid 19 will not go away. Instead, we are transitioning now from a pandemic to endemic status. Children have more chance of dying in a car wreck, unintentional drug overdose, or influence than from Covid. And children rarely spread the virus.
5. Focused protection is key. We should resist further attempts at lockdowns or mask mandates, as neither have worked. We know exactly whom to protect – the elderly and those with chronic health problems. We know how to do that. This is where we should concentrate our energies.
6. I hope the epidemiologist and public policy makers will listen to those on the front line treating Covid. The jet pilot does not design his own plane. But the engineer that does better talk to him. Physicians treating Covid, including the Front Line Covid-19 Critical Care Alliance, and including our own EFM Urgent Care seeing 250 patients daily, have important firsthand experience that is worth listening to. This includes the value of risk stratification and aggressive early intervention based on phase of the disease.
We have listened to the academics and central policy planners. Some directives are helpful. Some would clearly benefit from listening to those closest to the problem. It’s our turn to talk.