Category: COVID-19

Categories
2021 COVID-19 Ethics Science Vaccine

When We Lose Trust

There is a crisis of trust in America.  One manifestation is in healthcare.  For a century, the trust among Americans, their physicians, and institutions of public health built the most reliable healthcare system in history.  Today that trust is being undermined, and the entire system is in danger of collapse.  If we do not restore trust, we will suffer the reversal of a century’s gains in medicine. 

The Youngest Science, a collection of essays by Dr. Lewis Thomas, traces medicine’s journey from pre-twentieth century practices into the evidence-based practices of today.  Before this transformation, medicine was an unreliable mixture of traditional treatments like blood-letting and fanciful concoctions like snake oil tonic.  Transparency, empirical evidence, and patient collaboration were absent.  

Although there were many well intentioned physicians before the twentieth century, greedy hucksters and evil-doers thrived in this environment.  Quacks with phony credentials wagoned into town hawking the one-and-only genuine medicinal potion that promised to cure whatever ailed you, often accompanied by craftily staged demonstrations.  After selling as many worthless “cures” as possible, these predators escaped at night, leaving townsfolk poorer but in no better health.   People naturally feared being duped again.  Medicine could not progress in this environment.

In the twentieth century, trust changed all this.  Beginning in 1906 with the Pure Food and Drug Act, the federal government developed institutions like the FDA, CDC and NIH to assure the safety and effectiveness of drugs and treatments.  State governments licensed physicians and established standards of medical practice.  Physicians organized, creating boards to prevent frauds from entering their ranks and abusing the trust of their profession.  By the end of the last century, healthcare providers were among the most trusted professions in the nation.  So much so that people were willing share intimate personal details with a stranger, as long as that stranger was a doctor or a nurse. 

Now we see an erosion in the trust at the foundation of the youngest science.  When trusted institutions like the CDC and FDA give incomplete or misleading statements, physicians lose a resource for reliable information.  This quickly translates to a loss of the trust that bonds patients and physicians.  As employers and political leaders displace physicians by claiming to be health experts, people are unsure who to believe.  We’re back in the nineteenth century again.

It didn’t have to be this way.  We could have leveraged medicine’s abundance of trust to lead us to recovery.   Our trusted institutions could have given physicians the tools needed to make meaningful risk-benefit calculations for patients.  But this would have required the acknowledgement that natural immunity is at least as good as vaccination in some COVID survivors, that vaccination is harmful to some individuals, and that vaccination does not prevent the spread of disease.  We could have determined which groups receive the greatest benefit from vaccination, and which groups are most likely to suffer adverse effects.  We could have guidance on measurable markers of immunity—what are the minimum protective antibody concentrations, and what levels are toxic—so that those at greatest risk of death from COVID-19 can determine whether they will benefit from vaccination or booster.  We could have real data on adverse effects of vaccines by age and health status, and we could have balancing data on risk of death by SARS-CoV-2 infections.  We are 18 months into the pandemic; we should have this information by now.  Instead, our public health institutions have adopted an incredulously monolithic policy, saying universal vaccination is our only way out, even though we know this policy violates the oath of my profession: Do no harm.

Our trusted health institutions, like our trusted political institutions, have failed to communicate a clear, achievable objective for the pandemic.  They have failed to demonstrate a connection between their policies and the achievement of this goal.  As a result, we’ve lost trust.  This crisis of trust has created a crisis of healthcare.

We must restore trust, together.  The health of our nation is at stake.

Categories
2021 COVID-19 Science Vaccine

How We Got Here

It was a scary time.  When the first wave of COVID-19 swept through the nation in the spring of 2020, infection rates, hospitalization rates, and death rates climbed rapidly, and we didn’t know how high they would go.  Nursing homes were especially ravaged.  Once infected, more than 40% of people over 75 years old died.  We were focused on keeping people alive, and we were committed to making sure that the sick had the resources for their best chance at survival.  As hospitals filled up, our greatest fear was that people would die waiting for a ventilator.  We determined to decrease the height of the wave by stretching out the time it would take to pass over us.  Whether you agreed with the policy then, whether you agree with it now, that’s why we locked down, masked, and social distanced.  We thought it was the best way to accomplish our objective of keeping people alive.

As the first wave passed, we relaxed a bit and found ways to feel normal again.  We all stocked up on toilet paper.  We tested small gatherings on Memorial Day and Independence Day.  Those of us who survived (regrettably not all of us did) became convinced we could survive again.  As the second wave of COVID-19 swept over us in the summer, we had new tools—tests, convalescent plasma, and drugs.  And we had the promise of vaccines.  If we could just hold on until the vaccines arrived, we would have a lifeboat that would save us from the virus and make things normal again.  We all wished it would be so; it was not to be.

The second wave was devastating, infecting more people, and lasting longer than the first.  Again, the elderly, the obese, and the diabetics were hardest hit, but more people survived infection this time.  Mortality rates for those over 75 years old were cut in half—still too high, but better than before.  

As the second wave passed and we entered the calm of fall, we began to see our vaccine saviors on the horizon.  Applications were submitted to the FDA.  But by now, the virus had mutated, and the more infectious alpha variant headed our way.  This third wave, the largest and broadest of the three, proved that we had learned how to handle the virus.  Death rates for infected individuals older than 75 dropped to 15%, about the same as Russian roulette.  Still, more Americans died in the third wave than in the previous two combined.  

As the alpha wave headed towards its crest, Pfizer-BioNTech received an EUA for its vaccine.  People clambered for vaccination, especially the elderly and front-line health care workers.  Moderna was authorized, then Janssen.  Local health departments organized waiting lists, and people skipped work when they got the call for their turn.  Operation Warp Speed put vaccines into arms in record time.  And the alpha wave began to subside.  There seemed to be an inverse correlation between vaccination rates and infection rates.  

It was about this time, as lifeboats appeared on the horizon, that we lost our way.  We stopped focusing on helping people survive, and we put our energy into pulling people into the lifeboats.  We didn’t recognize that the boats were leaky, and that some people were better off where they were.  We believed that vaccination would lead to eradication which would lead to freedom and our pre-pandemic lives again, but it wasn’t true.  Even as the alpha wave receded, it became clear that the virus would be here to stay.  

Yet we clung to the fantasy.  We abandoned our initial objective of helping people live.  Instead, we believed in the make-believe of universal vaccination—if we could just vaccinate everybody, the virus would leave earth.  Nevermind that the vaccinated can pass the virus to others; at least they won’t be infectious for as long.  Nevermind that the vaccinated get sick; at least they won’t die.  Nevermind that some vaccinated died; their deaths are clearly the fault of the unvaccinated.  Nevermind that vaccination doesn’t last very long, doesn’t prevent severe disease, and isn’t as good as natural immunity.  Vaccinate!  Vaccinate!  And vaccinate again, with unauthorized boosters!  Afterall, it’s a pandemic of the unvaccinated.

As the delta wave washes over us now, we must have the courage to believe what we see.  Our vaccines are leaky, and they will not eradicate the virus.  We cannot vaccinate our way back to our pre-pandemic lives.  It’s time to change the paradigm.

We must return to our original objective of keeping people alive, and we must measure our actions, our public health policies, and our pandemic response against this objective.  When we stop following the fairytale of universal vaccination, we can use vaccination as a tool to further our true objective of survival.  We must develop other tools, prophylactics, and early treatments, and we must see whether any old tools can be repurposed to accomplish our objective.

We can defeat this pandemic if we change course, but the window of opportunity is closing.  We must change course now.

Categories
2021 COVID-19

Quick Chart on Covid Mortality

This chart on Covid mortality provides perspective during the current spread of the delta variant.  The CDC COVID Data Tracker shows weekly rates per 100,000 population for COVID-19 cases (CDC’s term for infections) and deaths since the outbreak of the pandemic.  Selecting the dates corresponding to the peak death rate for each viral surge in the United States, I divided deaths by cases to approximate risk by age group:

While neither a comprehensive statistical analysis nor an entirely accurate calculation, this chart gives an idea of relative risk at important points in the pandemic.  The delta wave has not peaked, so we may have not seen the highest death rates from the present surge.  The risk of death for the elderly is consistently higher than for younger individuals, and, with few exceptions, age adjusted death rates have decreased in successive waves of the virus.  Maximizing survival should be our objective as the pandemic continues.

Categories
2021 COVID-19 Vaccine

Leaky Vaccines

A perfect vaccine protects like a child’s immunity after chicken pox.  It prevents future disease, prevents transmissions to others, and lasts for a very long time.  Anything less is called a leaky vaccine.  Let’s see how our current COVID vaccines stand up to each of these points:

  • Prevent Future Disease.  COVID vaccines don’t connect on this standard, and there are any number of reports that can show this.  Just to pick one we haven’t discussed before, read the MMWR Early Release for August 24, 2021 which shows vaccine effectiveness dropped from 91% to 66% since the arrival of the delta variant, suggesting that vaccine is less protective against delta than pre-delta strains.  But this data also shows that vaccine protection from disease was less than perfect even before delta.  A perfect vaccine has effectiveness of 100%; our COVID vaccines never have.
  • Prevent Transmission of Virus to Others.  Another swing and a miss.  To drive this point home, we need go no further than the CDC’s Recommendations for Fully Vaccinated Individuals, which states, “Preliminary evidence suggests that fully vaccinated people who do become infected with the Delta variant can be infectious and can spread the virus to others.”  Still not convinced?  A recent pre-print study from Vietnam demonstrates transmission between vaccinated healthcare workers.  A perfect vaccine would prevent infection between vaccinated individuals; our COVID vaccines do not.
  • Lasts for a Long Time.  Strike three.  Even though the vaccines have been available for less than a year, emerging data from Israel suggests that their effectiveness is already waning.  My own antibodies lasted for less than five months.  Vaccine-induced immunity doesn’t last very long.

Our COVID vaccines are leaky.  So what?  Just take a booster.  And another.  And another.

There are several problems with this reasoning.  Here are three:

First, a false perception of protection leads to risky behavior.  Maybe you’re young, and it doesn’t matter if you get a SARS-CoV-2 infection.   Maybe you’re pregnant or elderly, and it does.  When you believe that your vaccination protects you from future infection, you are more likely to ignore precautions that might protect your life, or the lives of others.   

Second, leaky vaccines may stimulate the formation of more dangerous variants.  The theory goes like this.  The virus seeks a host.  If vaccination reduces but doesn’t eliminate the available hosts, the virus feels evolutionary pressure to mutate into a form that will infect more people.  Not everyone agrees with this idea, but there is enough evidence to at least consider this possibility.

Finally, leaky vaccines will not eradicate SARS-CoV-2, no matter how many boosters you take.  Vaccination has eradicated exactly one human viral pathogen from the earth: smallpox.  The smallpox vaccine was a perfect example of a perfect vaccine.  It prevented disease.  It prevented transmission.  It lasted a lifetime. It eradicated the virus from the earth.  And it took nearly 200 years.  We cannot expect a leaky vaccine to produce the same results.

Maybe future vaccines won’t be as leaky as the ones we have now.  Maybe we’ll even have a perfect COVID vaccine someday.  We can hope.  But until then, eradication is a pipedream.  Instead, we must do all we can to protect the lives, the health, and the wellbeing of people while the virus is among us.  We must learn to live with the virus. 

Categories
2021 COVID-19 Vaccine

RSV

Respiratory Syncytial Virus (RSV) is a highly infectious virus that can lead to serious disease in children.  The virus emerges each year roughly at the time school starts in the fall and subsides later in the spring.  Midsummer RSV is unusual.  Last year we did not see the typical rise in RSV, but this year the RSV surge started much earlier and is of much greater magnitude than normal.  Our COVD-19 response has unintentionally increased children’s risk from RSV infection.

Respiratory syncytial virus, named because of the unique appearance of infected cells under the microscope.

Lock downs, social distancing, and masking, whether voluntary or mandated, changed the rhythm of upper respiratory infections like RSV and Flu.  Flu has yet to return; the last infection diagnosed in my practice was in May, 2020, at the tail of the 2019-2020 season.  But RSV has returned with a vengeance, all over the world.  To illustrate, look at this graph of RSV infections in Tokyo for the years 2017-2021.  And this year’s cases are more severe than before.   According to CDC, “Due to the reduced circulation of RSV during the winter months of 2020–2021, older infants and toddlers might now be at increased risk of severe RSV-associated illness since they have likely not had typical levels of exposure to RSV during the past 15 months.”  You read that right.  Anti-COVID measures, regardless how well-intentioned or how necessary, will cause more severe RSV disease in our children this year.

Just how severe is RSV?  RSV is a major viral cause of death in children 5 years of age and younger, with mortality rates estimated between 0.5 and 1.7% in healthy U.S. children, but devastatingly higher in immunosuppressed children and in the children of the developing world.  By comparison, the mortality risk for infants and children infected by SARS-CoV-2 is under 0.03%.  RSV is a more serious risk to our kids than COVID.

There is no vaccine for RSV, and there is no treatment other than supportive care.  Severe cases require ventilator support in a pediatric ICU.  Most patients survive.  According to the American Academy of Pediatrics Red Book, most kids are exposed to RSV by the age of 2, and reinfection is common. 

Which brings us to the point.  Even though RSV can cause a serious and deadly viral respiratory illness, the virus circulates among children.  Children live with this virus.  RSV prevention measures are targeted toward those at highest risk of death from the virus.  Eradication of RSV is not the objective, and, as our experience in 2020 and 2021 suggests, may not even be desirable. The disruption of the seasonal viral pattern by implementation of COVID-19 precautions has increased the risk of sickness and death by RSV this year.  Children derive benefits from natural exposure to RSV that may be important to their future survival.

We need to be aware that our actions during this pandemic can have consequences beyond what is in view.  Homelessness, suicide, drug overdose, and now increased RSV–all unintended consequences of our public health policies.  With this in mind, and the possibility of other unknown variables, we need to target our prevention efforts toward those at greatest danger. We must agree on a clear, sensible, and attainable objective.  We must learn to live with the virus.

Categories
2021 COVID-19 Science Testing Vaccine

Vaccination Card Folly

Do Vaccination Cards Keep Us Safe?

Before I answer that question, I’d like to tell a personal story.  I took a single dose Janssen vaccine March 15, 2021.  I measured my spike protein antibodies on May 20 to make sure that the vaccine worked; my test was positive with an index level of 1.4.  Last Thursday, August 12, I measured my antibodies again.  They were negative.  I have a vaccination card that I can use to sit in a New York City restaurant, attend a concert at SFJAZZ, live on a university campus, or work at a hospital that has mandated vaccines.  Even if H.R. 4980 becomes law, I will be able to travel on an airplane in the United States.  Yet not even five months since my vaccination, there is no longer evidence of antibody-based immunity in my blood.

My story is another example of the folly of making universal vaccination the primary objective of the pandemic response.  Vaccine mandates by restaurants, employers, airlines, colleges, and entertainment venues are based on the flawed assumption that vaccinated people are safe, clean, and not dangerous to others.  There is undeniable evidence that breakthrough infections occur, that the vaccinated can spread the disease, and that vaccinated individuals can die of the disease.  It’s becoming clear that eradication is no longer possible.  

There is also mounting evidence that vaccines are associated with significant side effects that affect the health and wellbeing of individuals.  Expect more evidence to emerge.  We do not yet know the whole story.

I don’t have all the answers—nobody does.  Our understanding of both the virus and the vaccines are so far from complete that it’s impossible for anyone to make sweeping recommendations, no matter their position, no matter their intelligence.  But there is one thing we know for sure.  Clear objectives drive sound decisions.  Before we can win this war, we must agree on a sensible objective.

Our desired outcome should be keeping as many people alive as possible.  The life, health, and wellbeing of all individuals are paramount.  When we give primacy to vaccination status, we lose sight of our noble objective, and we divide people into uncooperating groups.   To the extent that vaccines further our objective, we should use them.  To the extent that early treatments further this objective, we should use them.  To the extent that therapies and treatment protocols have not been fully studied by science, we should fund studies publicly.  Although we can count on the free market to sponsor research when there’s the prospect of a large profit, wouldn’t it be a shame to overlook regimens that can keep people alive just because there’s no money to be made?  But we should never confuse any of these tools with our primary objective. We must allow people to make choices, and we must allow doctors to make personalized decisions in the best interest of individual patients.

Eradication is no longer possible, but survival is.  We must learn to live with the virus.  Have faith.  Have courage.

Categories
2021 COVID-19 Vaccine

Common Sense

As SARS-CoV-2 infections are increasing and some parts of the country are experiencing their highest rates of the pandemic, we face a medical shortage.  In Texas, the supply of staffed hospital beds is shrinking, and some communities are out of ICU beds.  Staffing shortages are becoming critical.  Is this the time to fire doctors, nurses, and other healthcare professionals for refusing a COVID vaccine?

Many people feel sick after a COVID vaccination, and some of those people won’t be able to come to work.  The Janssen vaccine isn’t fully effective for two weeks after the shot.  It takes five weeks for Pfizer and six for Moderna.   Meanwhile, hospitals are short on beds, and even shorter on staff.  Which will save more lives—fully vaccinated healthcare workers or staffed hospital beds?

The healthcare community has managed COVID surges without vaccine before, and we can do it again.  The universal vaccination of healthcare workers achieves no benefit that justifies the violation of individual liberty required to achieve this goal.  You may disagree with me.  We should have that debate.

But right now, those of us who work at hospitals have our hands full taking care of COVID patients.  Can we talk about this later?

Categories
2021 COVID-19 Statistics Vaccine

Updates, Questions, Present, and Future

A lot changed in pandemic landscape last week.  This blog outlines those changes and highlights important unanswered questions.

  • The surge of delta virus infections continues across the country.  Several weeks ago, I announced that the pandemic is over.  That statement requires revision.  Maybe the pandemic of alpha virus was over then, but the epidemic of delta virus is here now.  Delta virus is the overwhelming variant in the U.S. with parts of the country (Florida, Hawaii, and Louisiana) experiencing their highest cases of the entire pandemic.  
  • Deaths are up, but still low.  Unfortunately, it’s no longer the case that deaths are at the lowest level of the pandemic.  Deaths have increased with the current surge of delta virus.  Although even one death is too many, it is reassuring to see that deaths are not at levels seen during the winter surge, and that deaths have increased at a lower rate than infections during the current surge.  As with the previous two surges, older individuals are at great risk than younger individuals.  Based on data from the CDC COVID Data Tracker, COVID-19 deaths per ten million Americans during the week of July 24, 2021, were:  
    • 2 for individuals between 18 and 29 years-old
    • 5 for individuals between 30 and 39 years-old
    • 14 for individuals between 40 and 49 years-old
    • 22 for individuals between 50 and 64 years-old
    • 39 for individuals between 65 and 74 years-old
    • 101 for individuals aged 75 years and older.
  • New testing recommendations for COVID vaccinated individuals.  The CDC has changed its testing recommendations for vaccinated individuals who have had an exposure to someone with SARS-CoV-2 infection.  An exposure is still defined as contact of less than 6 feet for more than 15 minutes when one or both individuals are not wearing a mask.  Before this change, COVID vaccinated individuals were asked to test only if symptoms developed.  Now a SARS-CoV-2 test is recommended for COVID vaccinated individuals 3 to 5 days after the exposure, and the exposed individual should wear a mask indoors for up to 14 days until a negative result is obtained.

As individuals decide how to mitigate personal risk of death from COVID-19, the following information on the CDC COVID Data Tracker would help people make better decisions:

  • Reinfection rates and deaths among previously infected individuals.  Contrary to CDC recommendations, I believe vaccination of COVID survivors is a risk without benefit.  We could know the answer for sure if cases and deaths in the CDC COVID Data Tracker were stratified by previous infection status.  If unvaccinated people with previous infections have low infection and death rates, we could conclude that previous infection provides protection from COVID-19. 
  • Infection rates and deaths among previously vaccinated individuals.  This data exists, but not on the CDC COVID Data Tracker.   We could have a better understanding of the risk of breakthrough and serious disease if the CDC compiled and published this information beside the other important and helpful information on its website.
  • Vaccination complication rates by age and severity.  This information is essential to a risk/benefit analysis of COVID vaccination, but this data is especially difficult to compile for several reasons.  First, not all adverse effects report on VAERS are truly vaccine related.  Second, not all vaccine related adverse effects are reported on VAERS.  Finally, not all adverse effects caused by vaccine are recognized as such.  Delayed effects may never be flagged as vaccine related.  It may take years to ever sort out this problem.  The best we can do now is look at the vaccine warnings (see Pfizer, Moderna, Janssen), including the warning that “additional adverse reactions, some of which may be serious, may become apparent with more widespread use”.  We must continue to expect unknown consequences.

We are in our second year of the pandemic, and we have some experience to help us understand what’s coming.  The U.S. is experiencing its third surge of SARS-CoV-2 infections.  The first surge was associated with the original form of the virus.  The second surge coincided with the replacement of the original form by alpha variant.  The current surge began as the wave of delta variant replaced alpha.  Will it be the case that a surge will be experienced time a more infectious variant replaces its predecessor?  Could be.

Categories
2021 COVID-19 Vaccine

Staying Alive

If anything is sacred, the human body is sacred.

― Walt Whitman

How should we define victory in the war on the pandemic?  My vision may surprise you.  I think our objective should be not dying.  Death rates should be our success metric, and the preservation of our institutions and freedoms our goal.  We can accomplish this by making smart individual decisions, not sweeping collective ones.  We cannot allow our society to be fractured into camps of the vaccinated and unvaccinated.

The universal vaccination mandates sweeping across our nation now are more dangerous than the current wave of SARS-CoV-2 infections.  Don’t believe me?  Check out the CDC’s COVID Data Tracker.  Deaths from COVID-19 are at their lowest levels since the pandemic began.  Yet on pain of job loss, we are pushing vaccines into the arms of our young who have the most to lose and least to gain.

Don’t get me wrong.  Vaccination is an important tool in our effort to save people from dying of COVID-19.  Those at greatest risk—the old, the obese, the diabetics—should strongly consider vaccination for their own safety.  Vaccines also reduce the spread of COVID-19 within a community.  When vaccines became available in late December, community infection rates declined as vaccination rates went up.  But that doesn’t mean that vaccination is in the best interest of every individual.

Wait, I hear you say, we must vaccinate everybody to contain breakthrough and stop the spread of the virus.  Especially hospital workers—I want to know that people taking care of me are vaccinated so they won’t make me sick.  Nice theory, but where’s the data that supports the idea that vaccinated people can’t make you sick, that vaccines contain breakthrough and stop the spread of the disease?  I’ve looked; I can’t find it.  If you have it, please share it with me.

I see data that supports the opposite theory.  In last Friday’s Morbidity and Mortality Weekly Report (MMWR), the CDC reported a SARS-CoV-2 outbreak in a highly vaccinated community.  Some were shocked to learn that three-quarters of these cases occurred in fully vaccinated individuals, that the viral loads between vaccinated and unvaccinated individuals were identical, and that four out of five patients sick enough to be hospitalized were fully vaccinated.  This report supports one of the points made last week: vaccination doesn’t prevent COVID-19.  Breakthrough cases occur, and the vaccinated can spread the virus.  Universal vaccination will fail as a containment strategy.

But, you persist, we have to vaccinate everybody before new variants emerge that will be even more dangerous.  After all, you say, 90% of the virus in the reported outbreak were delta variant.  True, this outbreak was mostly delta variant, but delta variant is now the dominant variant in the U. S. because of its higher transmissibility, just like alpha variant replaced original SARS-CoV-2 earlier in the year.  Where is the evidence that universal vaccination prevents formation of more dangerous variants?  Again, I’ve looked, and I don’t find it.  If you have it, please share it with me.

Infectious disease orthodoxy says the opposite.  Indiscriminate use of anti-biologic agents pressure pathogens to mutate, increasing their virulence.  Doctors are reprimanded for treating viral illnesses with antibacterial agents (“antibiotics”) because they have potential for more harm than good.  The same is true for vaccines designed to prevent infections by viruses that easily mutate. That’s one reason we don’t have vaccines for the common cold—the target moves too quickly, and infection is not that dangerous to most people.  Universal vaccination will fail to prevent emergence of variants.

If universal vaccination becomes our objective in the war against the pandemic, deaths may increase, surges may continue, and more dangerous variants may emerge, but won’t we feel good about our vaccination rates?  The pandemic has an enemy; it’s not the unvaccinated.

There is another way.  Allow doctors to make individualized decisions for treatment and vaccination in the best interest of each patient.  If we do all we can to help those at risk, deaths will continue to go down.  The virus may never go away, but we can learn to live with it.  We can also preserve our institutions and freedoms, and we can stop dividing people.  We can stay alive.

Categories
2021 COVID-19 Science Vaccine

A Pandemic of the Unvaccinated?

During a White House press briefing last week, Dr. Rochelle Walensky, the director of the CDC, declared, “This is becoming a pandemic of the unvaccinated.”  She continued, “And our biggest concern is that we are going to continue to see preventable cases, hospitalizations, and, sadly, deaths among the unvaccinated.”  Is there a rational basis to allow our war against the pandemic to devolve into a fight between vaccinated and unvaccinated citizens?  In this blog, I will use data found at the CDC’s website to outline what we know and what we don’t about vaccinations, infections, disease, and death.

What we know:

  • SARS-CoV-2 infections have increased recently.  It’s easy to see this point from the CDC’s COVID Data Tracker.  Play with the graph a little.  By clicking any of the boxes (sex, age, ethnicity) under “Cases” on the upper left, you’ll see case trends of the entire pandemic.  Pass your cursor along the horizontal axis, and you’ll see the rate of cases each week of the pandemic.  The number of cases bumped up in the first two weeks of July.  But the recent increase is not yet close to levels of the surge last winter.   
  • Deaths from COVID-19 are still going down.  Using the same graph, click on any of the boxes under “Deaths” on the upper right.  The last week deaths increased was May 8, and then only by a little bit.  There has not been a spike in COVID deaths since the winter surge.  Even as infections increased recently, deaths have not.
  • Risk of death from COVID-19 increases with age.  Now look specifically at deaths by age.  Move your cursor along the horizontal axis and pay attention to the death rate as age increases.  It’s the old who die from COVID-19, not the young.   
  • Vaccination rates are highest among those at greatest risk of death from COVID-19.  Now study another chart from the CDC’s COVID Data Tracker.  Notice that in increasing age groups, more and more people are at least partially vaccinated, more than 90% among 65–74 year-olds.  The old, who have the greatest risk of death from COVID-19, also have the highest vaccination rates.  
  • Vaccination does not prevent COVID-19.  Breakthrough cases occur, and vaccinated individuals can spread the disease.  This last point is well known by everyone who follows Texas politics.
  • Community vaccination rates correlate with reduction in COVID-19 spread.  For this point, study the CDC’s vaccination vs. covid heat map, showing lower rates of COVID-19 where vaccination rates are higher and vice versa.  This is the data Dr. Walensky points to when saying “This is becoming a pandemic of the unvaccinated.”  However, unless she has private data not on the website, I do not see a similar correlation between deaths or even hospitalizations.  Death rates continue to decline, even among the unvaccinated.

There are some things we don’t know, and we don’t know them because we don’t yet have good data.  For example, the CDC tracks COVID-19 deaths by sex, age, and ethnicity, but not by vaccination status.  That information would be very helpful to individuals deciding whether to take a vaccine.  So would age-adjusted vaccine complication rates.  The absence of such data makes it difficult-to-impossible for young people to determine their personal risk-benefit ratios for vaccination.  The VAERS website is good for its intended purpose as a reporting site for adverse events, but the data must be mined and analyzed to be meaningful.  

Good data is simply hard to come by.  Last week, Sir Patrick Vallance said in a press conference that 60% of hospitalized COVID-19 patients in the UK are fully vaccinated.  Later, he tweeted a correction, saying exactly the opposite.  The trouble is that it’s impossible to validate either statement with reliable, publicly available data.  

Science is a process, not a product.  For science to work, conventional wisdom must be questioned.  It is always okay to ask, “Why should I believe this?”  Dissent is a natural byproduct of science.  But dogmatism, coercion, ridicule, hyperbole, and fearmongering have no place among real scientists.  Not even the director of the CDC.