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.