Most Republican voters don't vote for Republican candidates or policies. They vote *against* imaginary Democrats, who they are told multiple times a day, every day, hate America & want it to be destroyed. These people, in other words.
Tuesday, July 06, 2021
Saturday, June 19, 2021
It's not over
Remarkably effective vaccines that prevent serious illness and death from Covid have been available to all Americans since April 16, two months ago. First shot + second shot + 2 weeks for the body to develop full immunity = 6 weeks.
Those spreading false Information about the vaccine, causing people to be afraid to protect themselves against a deadly virus are going to be responsible for almost all of the deaths from Covid from here on.
I only say "almost all" instead of all because no vaccine ever made is perfect. And people who are severely immune compromised may not to be able to make a sufficient immune response even when vaccinated.
Although he death rate has plummeted since the vaccines became available, there are still hundreds of Americans – wives, fathers, daughters, brothers, best friends, neighbors – dying every day from Covid. Except for a literal handful of the immune compromised, all were unvaccinated and all of their deaths did not have to happen, all of their deaths were preventable.
But this is what we'll be seeing for some time:
Manatee County, in the Tampa suburb of Bradenton, Florida –
"On Monday, June 18, 2021, more than two months after the vaccine became available to everyone, one of four IT staffers, who had been hospitalized with COVID-19 died, according to County Administrator Scott Hopes. A fifth IT staffer who went to the doctor on Wednesday, died at home Thursday from COVID-19.
The one staffer in the department who worked closely with the other five, but who did not contract the coronavirus, was vaccinated.
'These were not elderly employees,' Hopes said. Both staffer who died, a man and a woman, were in their 50's. Those who were hospitalized were as young as their late 30's, according to Hopes, causing him concern that we could be seeing one of the stronger variants in these cases."
06/18/21—The Manatee County Administration Building is closed until Monday after several people reportedly contracted COVID-19. Several weeks ago the county commission voted to lift the mask requirements inside the building
Monday, June 14, 2021
Dr Bob Wachter
Bob Wachter reports, June 13, 2021
I know everybody’s sick of playing 3-dimensional Covid chess. Sorry, but the Delta variant forces us back to the chess board. Ergo, this.
If you’re fully vaxxed, I wouldn’t be too worried, especially if you’re in a highly vaxxed region.
If you’re not vaccinated: I’d be afraid. Maybe even very afraid.
Why? Let’s start with the things that we know about the current situation, then layer in new information about the Delta (aka, Indian) variant, B.1.617.2 Then we’ll end with what I’d suggest you, and we, do.
Current U.S. situation is good. Cases, hospitalizations, & deaths are falling fast, largely due to our fabulous vaccines. In San Francisco, with 70% of people over age 12 fully vaccinated – we’re nearly in a post-Covid world. Everybody’s opening up, including (on Tues) California. That’s fine…for now.
Sadly, about 50% of the U.S. (older than age 12) remains unvaccinated, and in certain states (mostly southern), it’s more like 2/3rds are unvaccinated. We know that a small number of vaccinated people will get breakthrough infections, but they’ll rarely get very sick and will almost never die of Covid.
washingtonpost.com/opinions/2021/…
Unvaccinated people remain at high risk of getting Covid... if they’re exposed to it. In April, I argued that this is the most dangerous time for unvaccinated people (without prior Covid), since their bodies are no better at fighting the virus than they were in 2019, and the virus they’re likely to come in contact with (back then, it was Alpha [UK] variant) is better at infecting people. But unvaccinated folks had 2 advantages: 1) they tend to be younger, so less likely to get sick, and 2) they were less likely to be exposed to virus since community rates had fallen so much (due to kindness of vaccinated strangers). This remains true, which is why unvaccinated folks may do OK for a while, probably through summer.
But fall/winter now scares me a lot, much more than it did 2 weeks ago.
Reason: Delta.
From the start, we said the 3 things to know about variants are: a) are they more infectious? b) are they more serious? (ie, are you likelier to get very sick) and are they vaccine (or prior Covid-based immunity) resistant? Alpha was about 40% more infectious.
There’s still debate over whether Alpha is more serious (some studies say yes, others no). But there’s no question that the vaccines (at least the 3 approved in the U.S.) work just fine against it. This meant that – even though it became the dominant virus in Israel, the UK & now the U.S. (here, it’s 69% of current cases covid.cdc.gov/covid-data-tra…), relatively high vaccination rates in these countries prevented it from becoming much of a problem (although unvaccinated people ARE at higher risk of catching it and dying).
CDC’s home for COVID-19 data. Visualizations, graphs, and data in one easy-to-use website.
https://covid.cdc.gov/covid-data-tracker/#variant-proportions
Why is Delta scarier? First, it appears to be even more infectious than the Alpha variant, probably by a similar amount (~40% more infectious than Alpha.)(h/t @EricTopol for @BBC table below) This means the same exposure that a person might have had last year is now about twice as likely to result in Covid. Second, it's looking like it is more serious, though we need more data to be sure. Third – and this is the big one – it does appear to be somewhat immune resistant. Before getting too freaked out about this, it’s worth noting that the data are reassuring, in a way: the efficacy of 2-doses of Pfizer is 88%, only a smidge lower than the 95% we’re used to, and still great.
Vaccines highly effective against B.1.617.2 variant after 2 doses
https://www.gov.uk/government/news/vaccines-highly-effective-against-b-1-617-2-variant-after-2-doses
But the first dose data is concerning. Normally, a few weeks after dose 1, you’re about 80% protected (this was the argument for delaying 2nd doses when jabs were scarce). But for Delta, Pfizer dose 1 is only ~33% protective. gov.uk/government/new… This creates 2 problems: 1) People stay vulnerable until after shot 2 (& many let guard down earlier); 2) Loss in efficacy for dose 1 points to some degree of vaccine/immune escape. And – though this isn’t proven – I’d worry that a fully vaccinated elder, or someone whose immunity stems from an infection >12 months ago, won’t be sufficiently protected over time, if immunity falls below a threshold needed to thwart Delta.
Delta variant makes up 6% of US COVID-19 cases
https://www.cidrap.umn.edu/news-perspective/2021/06/delta-variant-makes-6-us-covid-19-cases
What to do? For a vaccinated person, watch the Delta % in your region (currently ~6% in the U.S. & rising) & Covid cases in your community. cidrap.umn.edu/news-perspecti… If you’re seeing more cases & more Delta, I’d restore some precautions (esp. if you're high risk) – at least indoor mask wearing (if you’ve stopped; BTW, I haven’t) in places w/ unvaxxed/unmasked folks.
If you’re unvaxxed, get your shots! You may be reassured by a low a local case rate , but don’t be: it may be due to summer plus the still-low Delta fraction. Both will change.
As you can see, Delta has made me nervous: I’ll now bet we’ll see significant (incl. many hospitalizations/deaths) surges this fall in low-vaccine populations due to combo of seasonality, Delta’s nastiness, & “back to normal” behavior. If you’re unvaxxed, you’ve made a bet that Covid is yesterday's news, & that now seems like an awful bet. Moreover, I worry that a right-leaning Governor who opened up early & proudly (& has gotten away with it so far) will be stubbornly unwilling to reverse course, even in the face of surging cases & deaths.
And there’s the matter of timing. If your strategy was “I’ll consider a shot if I see an uptick in cases,” that’s also a loser, since once a surge begins, you won’t be well protected against Delta for 4-6 weeks after shot #1. By that time, you may be very sick, or dead.
Is the threat real? UK has been a step ahead of U.S. on vaccinations, & cases/deaths have fallen faster in UK than in U.S. But look at recent UK case # s – they’ve doubled in past 2 wks, as Delta became dominant strain (now 91% of UK cases). Reassuringly, deaths remain low since unvaxxed are mostly younger & less likely to get sick. But don’t be surprised if we see upticks in hospitalizations/deaths, esp. if Delta proves to be more serious (it’s looking that way), and if it begins to dodge immunity in those with low or waning protection.
We’ve been lulled by the amazing efficacy of the vaccines & by fact that prior variants haven’t been all that nasty (esp. w/ regard to immune escape). Delta should ring the alarm & spur action. We need FDA to fully authorize our vaccines, to step up research on boosters, & faster approvals for kids. We also need > outreach to unvaxxed (incl. info on Delta) & vaccine mandates in risky settings (healthcare, nursing homes).
For me, Delta adds to my resolve to keep mask on indoors when unvaxxed/unmasked people may be around. And I'm getting psychologically prepped for some restrictions to return in fall (tho highly vaxxed places like SF will likely do fine). Nobody wants that, but the virus doesn’t care what we want.
Robert M. Wachter, MD is Professor and Chair of the Department of Medicine at the University of California, San Francisco (UCSF). In 2021-22, the Department was ranked the best internal medicine department in the nation by U.S. News & World Report. Wachter is author of 300 articles and 6 books. He is past president of the Society of Hospital Medicine and past chair of the American Board of Internal Medicine. He has written two books on safety and quality, including Understanding Patient Safety, the world’s top selling safety primer. In 2004, he received the John M. Eisenberg Award, the nation’s top honor in patient safety. Thirteen times, Modern Healthcare magazine has ranked him as one of the 50 most influential physician-executives in the U.S.; he was #1 on the list in 2015. He is a Master of the American College of Physicians and an elected member of the National Academy of Medicine. In 2020-21, his tweets on Covid-19 were viewed over 200 million times by 170,000 followers and served as a trusted source of information on the clinical, public health, and policy issues surrounding the pandemic.
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