Coronavirus 5: Let the Vaccination Begin

[clueliss]

Trying to post about Springfield MO, board eating things.   TThey are out of vents.

[Black Aliss]

I'm starting to think we are doomed. This, from writer Sharon Astyk (disclaimer: I'm only halfway through fact checking all of her assertions but so far she's scoring 100%) Cliff's Notes version:

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So the data out of Israel this week is really important, because it is impossible to ignore. Pay attention folks, this shows where we are headed.

In May, I told everyone to enjoy late spring and early summer because I thought Delta would hit us hard by mid-July. A bit later I revised my estimate to suggest it would hit in early July. I don't see any reason to think I was wrong, unfortunately - and I see a lot of reasons, many of them coming from Israel, why those who think that this is only going to be a red state problem are very, very wrong.

In case you don't want to read the whole thing, I'm going to give you the essential bullet points right now, that everyone needs to know. I've explained how and why we know these things at length below, but what's important is that the data is coming out of a lot of countries, and is remarkably consistent across the globe and in countries like the UK and Israel that are more or similarly vaccinated to us. If you don't have time to read the whole thing, you can stick with the numbered points.

1. Delta is clearly 4xs more transmissible. That's a lot. It is airborn, and can linger in the air for hours, so 6' doesn't matter. Also, the old 15 minutes rule is irrelevant - Australia can clearly document Delta variant spreading in seconds. None of this is up for debate. 4xs more transmissible means that vaccines have to be more effective to stop spread.

2. The vaccines, even the mRNA ones, work substantially less well with Delta - they are about 65-70% effective according to two Israeli studies in real life. Israel has similar vaccination rates to most of the most highly vaccinated US states and much higher than the US as a whole. 2 doses are still more effective at stopping hospitalization and death, but more like 80-85% and less good the older you are. One dose of mRNA is only 30% effective. Johnson and Johnson is about 60% effective, but that's in very small studies of only 8 people and in vitro, rather than in real life. It is probably lower for J & J in actuality.

3. Delta circulates heavily in children, and children are infecting their vaccinated relatives. Delta also makes children sicker, with 1 in 100 identified cases in children ending up hospitalized. Dozens of countries have had large school and daycare outbreaks, many of them with 100% secondary attack rates even among the vaccinated.

4. Vaccinated people are transmitting Delta - to one another and to unvaccinated people. So you can infect your grandkids. Or your immune compromised neighbor. Or your elderly mother. Vaccinated people and children can and do get long covid.

5. Hospitalizations and deaths are going up in places that are as vaccinated as your state is. And not only among the unvaccinated. 40% of Israeli hospitalizations are among the 2 dose vaccinated. Again, older people are more at risk.

6. With a 4xs greater transmissibility, and lower vaccine effectiveness, vaccine induced HERD IMMUNITY CANNOT BE ACHIEVED. Period. We already knew you can't get there by natural infection. Unless we are willing to create a police state, and forcibly vaccinate our population (which I'm not willing to do) including infants and children, we will not be able to control Delta with vaccination alone.

You can reduce PERSONAL AND INDIVIDUAL risks and risks of hospitalization, and reduce stress on the health care system. Vaccination is a really good idea. But we use vaccination ALONE at the cost of allowing the virus to circulate and form new variants that will be more dangerous later. ONLY a combination of public health measures and vaccination can control covid. Nations that rely on either one alone cannot control Delta.

7. Delta is about to blow open in the US. It already has in some states, including Florida, Missouri, and Nevada, but even highly vaccinated states are about to see or are already seeing substantial rises. If you care about your own health, and your children's and grandchildren's, you need to go back to the way it was last December. No eating in restaurants. Masks indoors - preferrably N95 or KN95. No high capacity events. Cloth masks outdoors. For kids too. Remember, we've simultaneously been lowering spread at the same time it is starting to go up - that masks growth. But pretty soon we won't be able to mask it.

Living in a high-vaccination rate Blue State with currently low caseloads does NOT mean that you or your family is not at risk of Delta. Israeli vaccination rates are similar to MA and Hawaii, and only slightly lower than Vermont. If they can have an outbreak, so can you.

8. This is a huge political problem for the United States. Yesterday's national celebrations focused on freedom from restrictions. From January, Joe Biden has focused on the fourth of July as the end point of restrictions, and the CDC has declined to reinstitute masking or other public health measures. This is going to bite them hard, and it is going to be a political disaster. We are not going to control the pandemic. We are going to keep up our rhetoric of "if you get covid it is your own fault." We are going to lie, as we are lying right now, and say it is not dangerous to the vaccinated. And the price will be paid in lives. And it will be paid in the length of the pandemic.

Rest of the article under spoiler: 

Spoiler

How do we know this? For those who haven't been paying attention, Israel, which dropped its mask mandates after the US did (despite much higher vaccination rates with 2 dose mRNA vaccines, mostly Pfizer), has a significant, uncontrolled Delta outbreak.

It started and spread among unvaccinated school children (similar pattern to the UK and many European countries) and then spread to their vaccinated relatives. Almost half of all their detected cases are among vaccinated adults at this point. 40% of hospitalizations are among fully vaccinated adults. Their cases, hospitalizations and deaths are still rising, despite rapid reimplementation of their mask mandate (within days of the outbreak.) And remember, Israel had much stricter public health protocols than we do to be begin with, and retained many of them even after they dropped the mask mandate - they reported only six deaths in June from cases before the Delta outbreak.

More importantly, where people have managed to dismiss or ignore data from, say Singapore or the UK, attributing all differences to differerences in vaccines or vaccine protocols, Israel cannot be ignored. There is basically no way in which Israel's protocols aren't better than ours by a lot. And the percentage of Israelis vaccinated is significantly higher than in the US - Israel's adult vaccination rate is similar to blue states like Massachusetts or Vermont currently having record low case loads (remember, three weeks ago so did Israel.)

Two studies, one based on real world infections in Israel and another from Hebrew University both show very consistent results. The real world data from Israel shows that in may, the dose mRNA vaccines prevented 94.5% of all infections, and in June, with Delta, they prevented 64% of all infections. They were still fairly effective at keeping people out of the hospital and alive, but because those are lagging indicators, the data is not reliable.

The Hebrew University study also showed Pfizer vaccine effectiveness at between 60-80% at preventing transmission, and with a lowered, but not clear effectiveness at preventing severe disease and death. This is down from 95% against previous strains. Let us also note that until about 10 days ago, vaccinated Israelis were not advised to test after exposure, travel or crowded spaces, so this data probably understates the number of breakthrough infections in vaccinated individuals.

Also important out of Israel - we had confirmation from Singapore and the UK that vaccinated individuals were transmitting the virus to both vaccinated and unvaccinated people (Singapore contact tracing shows this very clearly), but again, Israel is the closest US parallel in type and consistency of vaccination, and the news reports, among other vaccinated-to-vaccinated transmissions in the current outbreak, was a case where a British visitor to Israel transmitted Delta (fully vaccinated and tested at entry) to a equally fully vaccinated relative, who transmitted it to *75* high school students. So the transmission chain is vaccinated person to vaccinated person to unvaccinated kids, as well as unvaccinated kids transmitting to their vaccinated adult relatives. That is, your kids and grandkids are at risk from you.

Reports of vaccinated people getting Delta show that even if they don't have severe disease (remember, mild to moderate means "don't need supplemental oxygen or hospitalization") they are having significant symptoms in breakthrough cases and getting ill enough to require medical attention. In Israel, while it was still not mandatory for vaccinated people to be tested if they were exposed or travelled, 50% of their identified cases were in vaccinated people. That means those were SYMPTOMATIC cases, people experiencing enough disease to seek testing even though they didn't need to.

Breakthrough deaths are overwhelmingly in the elderly. We have no idea whether breakthrough cases of Delta will cause long covid at the same rates as previously in vaccinated individuals, but we do know that Long Covid does happen in people who are fully vaccinated, so the default assumption should be that you can get Long Covid from Delta, either with a breakthrough symptomatic or asymptomatic case you don't even know you have. Remember, about 20% of Long Covid cases had no symptoms, may not even have known they had the disease.

Hospitalizations and deaths are lagging indicators - it takes 2 weeks minimum to see hospitalizations rise and at least 3 before deaths start. But both are rising week over week in Israel, up from historic lows.

So what we're seeing is very consistent data - consistent data from Israel's outbreak, which is the closest parallel to the US in vaccines, and very close to the highest vaccination rate blue states in level of vaccination. And it is consistent with experiences globally - here are the consistent, universal outcomes of Delta. We now know it is not the differences in vaccines or vaccination policy that matter here - Delta is just dangerous, and while is substantially LESS dangerous to the vaccinated, American pro-vaccine rhetoric that implies that if you get covid, it is your own damned fault is not going to be helpful.

Remember, Delta makes kids who are too young to be vaccinated sicker. It may cause higher rates of MISC, and it definitely has a 1% hospitalization rate for children in many countries. That's much higher than the flu, and really concerning. Moreover, somewhere between 8 and 12% of all kids have symptoms five months later, ie, long covid, and it is 20% in severe cases, which are disproportionally non-white kids in the US.

In every country where Delta is currently a problem (and at this point that's basically every country) it spreads heavily in schools, daycares and children's programs. In both Israel and the UK, rates in school children were HIGHER than the general population. So if the story that children don't transmit was very true, it is over. And we still have no idea if children who get covid develop normally - they can't always tell us if they have brain fog or lower muscle tone. We won't know for years. But we have been playing Russian roulette with our kids.

Moreover, we are seeing Zero Covid nations lose control of the pandemic - this has basically never happened before. So countries that relied heavily on controlling the disease through very strict public health measures, including mandated quarantines, contact tracing and testing but have low vaccination rates, are struggling to contain delta. These include Vietnam, Taiwan and Australia.

Simultaneously, nations like the UK, Chile, Seychelles and Israel that relied heavily on vaccination, and relaxed public health measures are also unable to contain Delta, even when . The global picture is very, very clear - because Delta is four times more transmissible than wild strain Covid, neither single strategy will work.

In order to contain covid with vaccination alone, given the increased transmissibilty of Delta variant covid, and the reduced effectiveness of the vaccines, we would need to vaccinate 90-96% of the population. Meanwhile a Pew study came out this week that showed that 29% of American adults have no intention of being vaccinated, and 20% of those would never, ever take the vaccines.

Moreover, concerns about cardiac inflamation and the death of a Michigan teenager make it possible that we will not see emergency authorization of vaccines for children at all this fall. Which means despite America's powerful incentive to deny it, the "unvaccinated" aren't selfish, they are children. We cannot achieve herd immunity from Delta - or from the next dominant variant and the one after by vaccination alone.

While nations like Australia and Taiwan are recognizing how urgently they need to vaccinate their populations to supplement their zero-covid strategy, vaccine-primary states are finding out that they cannot relax public health measures without disaster. The only viable way to contain Delta (remember, you are not just saving your own life, but you are preventing further vaccine evasions from developing by dropping spread) is with BOTH strategies - mask mandates, test and trace, air cleaning and ventilation, and mandatory quarantines, reducing capacities, plus vaccination. It just doesn't work any other way. We have all the evidence we need on this from all over the globe, and it is remarkably consistent.

The problem is that the US is not equipped to return to masking and lower capacities. This is, bluntly, the fault of the CDC and of Joe Biden's administration. It cannot be blamed anywhere else. Biden has doubled and tripled down on the idea of making yesterday's fourth of July celebration a celebration of freedom from restriction. He has promised no lockdowns. The CDC dropped the mask mandate in May, even though experts overwhelmingly hoped to keep it in place through fall and winter. Without CDC guidance recommending masks, even places that want to keep them in place are struggling with lawsuits and pressure. Moreover, the framing again of freedom as "freedom from restrictions that protected you" rather than "freedom to gather safely" is going to bite this administration in the ass.

Meawhile, case were rising in the US before the holiday weekend (many states don't report data over holiday weekends and many test sites are closed, so it will probably be the end of the week before we see if those increases continue . States like New York, which are among the highest vaccinated in the US are seeing substantial case jumps, although the holiday weekend will probably mean that the data doesn't clearly demonstrate what's going on until the end of the week.

Florida cases are up 50% week over week, Nevada more than 100%. Hospitalizations and deaths are still comparatively low, but remember the term lagging indicator. More importantly, whereas in the first waves of covid the only goal was to avoid overwhelming the hospitals, now there are other goals too - not disabling a large portion of our population, and ceasing to fuel variants that will come back for us next year. Or at least, those should be our goals.

Which means people who cannot afford to get covid due to medical problems, parents and the elderly are on their own again. While the current administration won't have the "let them eat cake" attitude of Trump and the Republicans, their investment in vaccines as the sole necessary solution is in some ways almost as damaging. They'll have two choices politically - walk it back and pay the huge political price for telling the country covid was over for vaccinated people or do what the Trump administration did - hope it goes away and do nothing. If Biden is the mand that I hope and suspect he is, eventually he'll do the former, but can't see how that could help the Democrats in the midterms.

In the meantime - wear your masks. Stop engaging indoor unnecessary activities. Build up supplies and resources. Donate to anti-poverty groups. Because this one is going to be a bumpy ride. And if we don't get it together, it is going to be a rollercoaster we don't get off for many years.

 

 

[Smash!]

20 minutes ago, Black Aliss said:

I'm starting to think we are doomed. This, from writer Sharon Astyk (disclaimer: I'm only halfway through fact checking all of her assertions but so far she's scoring 100%) Cliff's Notes version:

We are not doomed. Moderna and I’m sure Pfizer are already working on a booster shot that’s more effective against Delta. And the government's need to step up: Restrictions, mask mandates and making it mandatory being vaccinated in places where it hurts many people. Oh and fully acknowledging that Covid is airborne in making schools and public spaces safer. It is possible but sometimes I have a feeling many elected officials  aren‘t interested in protecting the health of their constituents. That is probably the main issue.

[Coconut Flan]

Carry on here: