SPECIAL REPORT: COVID Realities

Health in America, like almost everything else, has become politicized.” –The Lonely Realist

Instead of being a “United” States of the vaccinated and COVID-recovered, America is suffering through a new wave of infections, hospitalizations and deaths. Importantly, although COVID-19’s Delta variant is increasingly disrupting Blue States, it is aggressively rampaging through Red States where residents inexplicably reject the success of President Trump’s Operation Warp Speed vaccination initiative.

Viruses mutate. That’s what they do. That’s what the COVID-19 virus has done and what it will continue to do. High numbers of COVID-19 infections led to the emergence of the Alpha variant in the UK, Beta in Africa, Gamma in Brazil, Epsilon in California, Iota in New York, Kappa in India, and, notably, Delta in India. It would be delusional to believe that additional, more potent mutations will not emerge. Whatever the future may bring, Delta is the current, dominant strain. It is significantly more virulent than the others, with a 50% higher transmission rate than the Alpha strain (which, itself, was 50% more transmissible than the original COVID-19 strain). It is now estimated to be 225% more transmissible, which should raise the alarm among everyone who lived through the 2020 pandemic crisis when the original strain required a global shutdown to prevent a health catastrophe. Delta now accounts for 58% – or, say other experts, 83% – of new infections in the US. Although there is insufficient data on hospitalizations and deaths from the Delta variant, preliminary numbers from the UK indicate that it may be 85% more deadly for unvaccinated patients and less effective in preventing hospitalization among those already vaccinated (88% versus 98%).

Not surprisingly, the Delta variant is preying almost entirely on the unvaccinated. In the UK, 14% of unvaccinated people over 50 end up in the hospital. Nearly 4% have died, 4x higher than those under 50. In the US, hotspots closely correlate with States and counties that voted Republican in the 2020 election:

    • Alabama and Mississippi: 34% fully vaccinated
    • Arkansas, Wyoming, and Louisiana: 35% fully vaccinated
    • West Virginia, Oklahoma, and Tennessee: 39% fully vaccinated [the backlash against COVID vaccination in Tennessee has been so severe that it resulted in the halting of all vaccination outreach for teenagers and children, including measles, mumps, and other illnesses]
    • Missouri: 40% fully vaccinated
    • Florida: 48% fully vaccinated

Experts believe that herd immunity from the Delta variant would require that total vaccinations and infections equal between 70% and 85% of Americans. Thus far, that percentage is less than 60%. Moreover, 30% of Americans have reported that they will refuse vaccination outright.

The current Delta Wave of infections is likely to be exacerbated by two seasonal factors. First, a typical flu season will create localized ambulatory and hospital crises and COVID complications, with consequent agitation for mask mandates and mandatory social distancing/occupancy restrictions, and increased economic and work-from-home pressures. More significantly, the return to school in September will accelerate the infection rate. Children under the age of 12 are still not eligible to be vaccinated, and barely one-third of teenagers in America between ages 12 and 17 have had even a first dose. There is no State masking requirement in the US for teachers or students (although some localities, including New York City, require students in public schools, but not their teachers, to wear masks). Schools, especially those in areas with low vaccination rates, are therefore likely to become super-spreader locations, which in turn could lead teachers’ unions to take labor action and parents to embrace home-schooling and work-from-home schedules. Both outcomes could have a long-term impact on the educational preparedness of American children and America’s economic well-being.

State and local governments will be unlikely to reimpose lockdowns to protect those who choose not to get vaccinated. Moreover, in the absence of a mutation that nullifies current antibody immunity, there is only a very slight possibility of government-imposed mobility restrictions … even in the Blue States. Florida, which accounts for almost 20% of recent Delta infections, has led the way in a return to economic normalcy and provides the most likely template for the future trajectory of Delta and for ongoing variant infection rates, foretelling a potentially grim Fall and Winter health (and potentially economic) season. 

Both Pfizer and Moderna announced that they soon would be applying for emergency use authorization for booster doses of their vaccines, citing unpublished internal evidence that the efficacy of their vaccines is waning over time. In response, the FDA and the CDC jointly announced that individuals do not currently need a booster shot. Because there is as yet no extrinsic evidence that a booster is either necessary or appropriate, a skeptic might infer that the announcements by Pfizer and Moderna were motivated as much by a financial interest as a health one – data on both sides is sadly lacking. Vaccine failures arise from one of two primary mechanisms: immune system memory lapse; and mutation. Memory lapses are easier to detect and repair. However, as COVID-19 has been around for barely 20 months and vaccine use for less than 12, there is insufficient data concerning antibody decay among those infected, let alone among those who have received the various vaccines. Naturally acquired immunity among those infected has been shown to last at least 9 months and could last far longer. However, naturally acquired immunity appears weaker than vaccine immunity because B and T cells obtained by vaccination also participate in the immune response and create germinal centers containing memory cells. Naturally acquired immunity also varies widely among individuals, while vaccine immunity is more consistent. Nevertheless, it is worth noting that the more recent variants have demonstrated more substantial vaccine resistance in both lab and field studies.

COVID is a worldwide pandemic. It would be a mistake to view COVID-19 and its variants myopically as an American problem. The Coronavirus will remain a global health crisis for years to come. The developed economies of America, Europe, the UK, and parts of Asia are not about to return to lockdown. Lockdowns in emerging and frontier economies are not going to be effective in preventing COVID spread. Cases therefore will continue to spiral. Unless governments worldwide adopt policies that seal borders and severely restrict global travel (steps no government is likely to take because they would bankrupt too many essential industries), COVID variants will proliferate …, presaging significant changes in human behavior, work practices, business operations, supply chains, education, and employment. Governments will have little ability to control their consequences.

Finally (from a good friend)

1 Comment
  • jeffcsiegel
    Posted at 10:39h, 23 July

    Dealing with COVID, and now the “Delta” variant has shown the irrationality of human understanding of probability and risk. The Media and Governments have used people’s inherent poor understanding of risk to grow their influence.

    Simply put COVID isn’t Ebola.

    In the US different mitigations haven’t changed anything. Florida with an older (more at risk) population and one of the less mitigation-focused government policies has a similar death rate as big blue mitigation states. Is New Jersey’s 277 deaths per 100K, California 166, or Florida’s 170 meaningfully different? People in California could hardly leave their houses at one time. Did that help?
    https://www.statista.com/statistics/1109011/coronavirus-covid19-death-rates-us-by-state/
    World-wide apart from a very few isolated outliers we’ve seen the same. Government isn’t the answer.

    For the overwhelming percent of people COVID is survivable and not the highest mortality risk they face in life. Take kids, where most of the Delta is happening today. Kids are 7 times more likely to die with a typically seasonal flu, than with COVID. They are 40 times more likely to drown in a pool than with COVID. While at the same time COVID mitigation is doing immense harm to their mental health. Punishing children to protect the elderly is simply moral wrong. Almost all kids should never wear a mask, and if they get COVID it will in all likelihood be net benefit to them, as getting the Chicken Pox was in the past.

    People who haven’t gotten vaccinated aren’t stupid and irrational. Many of the people I know who did not get a vaccine have already had COVID. This is certainly over 100 Million Americans and likely more. If you have had COVID, the probability of getting it again (even with a variant) is extremely small. True its not zero, but it is quite small. Another large group in South who haven’t got vaccinate are Blacks who are both more likely to be higher risk obese and tend to fear government experiments. (Not your assumed Blue state demographic.)

    And let us take the last group, people who don’t want to the vaccine and haven’t had COVID. By all means offer them the vaccine, but as someone who thinks freedom vital, I believe they get to make their own choices in life. It is not government’s role to control everyone’s behavior. Perhaps they are at slightly more risk and die because of their decision? That is their choice, and they will have to suffer the consequences.

    For about a few early months, we didn’t understand the COVID, and our health system was in danger of being overwhelmed by it. That is no longer the case. It is time to rationally put this in perspective and treat is more like “acceptable” flu, cancer, accident, overdose, and suicide deaths. The UK is taking this perspective now, and we should too.

    Jeff

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