Covid 2.0

Editor’s note: This previously unpublished post is seeing the light of day today, 3 Dec 2021, as the Omicron variant has begun to sicken Americans, sending the covid epidemic into a third distinct phase.  The basic distinction made here, in the divergent risks the virus poses to the vaccinated and unvaccinated, remains as salient today as in September, when this piece was composed.

Instead of continuing to wane. the pestilence known as COVID is surging, and a nasty new phase of the pandemic lies ahead.  Since the more contagious delta variant arrived from overseas, it has moved into areas previously left untouched.  More Americans in out-of-the-way places are getting sick.  Delta is spreading over the South and other “red” regions where a fatalistic or defiant attitude toward preventive measures reigns.

At the same time, delta confounds the simple narrative of “victory through vaccination” that federal officials and the scientific community have been telling.  Two starkly different fates await the vaccinated and unvaccinated, but, unfortunately, even vaccinated people are still contracting and transmitting the disease.

The unvaccinated are at far greater risk of developing serious illness, though.  Because their bodies are unprepared to fight off the virus, they are many times more likely than the vaccinated population to require hospitalization or to die.  Hospitals say that the unvaccinated make up the vast majority of the cases they are treating.  The patients are notably younger than the ones hospitals saw before delta struck.  In May, late-night comedian Jimmy Kimmel branded the unvaccinated as freeloaders, in that they demand society’s care even while shirking their part in combating the disease.

Meanwhile, the fully vaccinated find they still risk being infected with covid, due to delta’s greater infectiousness and the waning power of the vaccines over time.  A Mayo Clinic survey of 50,000 people found that the efficacy of the COVID19 vaccine (especially Pfizer) has dropped since the spring.  The Moderna vaccine, which was 86% effective against COVID earlier in the year, had dropped to 76% effectiveness by July.  In the same period, the Pfizer vaccine’s effectiveness dropped from 76% to 42%.

So-called “breakthrough infections” are likeliest to occur where covid is most prevalent and vaccinations are scant.  In such circumstances, vaccinated people end up with more cumulative exposure.  This is particularly true now that the delta variant is dominant.  In an interview with the PBS Newshour, Dr. Alex Huffman, an aerosol scientist and professor at the University of Denver, reported that people infected with the delta variant “produce a thousand times greater viral load than seen from the original COVID-19 strain.”

A fully vaccinated person can transmit the delta variant as easily as an unvaccinated one.  On July 30, the CDC released data on an instance of community transmission in Massachusetts in which three-quarters of those infected were vaccinated.  Before delta became dominant, vaccinated people did not need to worry about being “silent spreaders,” but they do now.  Vaccinated and unvaccinated persons carry similar viral loads.  Vaccinated people appear to be infectious for a shorter period, though.

All together, these developments have officials scrambling to adjust their messaging about public-health aims.  The public is disillusioned, because, despite the hype, vaccination is not a “silver bullet” that stops COVID dead.  None of the vaccines provide foolproof protection against the delta variant.  They limit, but don’t completely stop, the disease’s spread.  Moreover, they don’t obviate the need for other preventive measures, such as masking and distancing, that many of us had hoped vaccination would free us from.

Yet, the vaccines lessen the worst outcomes from the disease (i.e., serious illness, hospitalization, and death), which is the de facto (if not always bluntly expressed) goal at this stage of the plague.   In the tiny nation of Singapore, where vaccination rates are among the highest in the world, vaccinated people make up three-quarters of the nation’s covid caseload.  Most cases are mild, though, which is a “success” in keeping with the government’s goal of mitigation.

Similarly, the goal of keeping the American population “safe” from COVID (by stamping it out) has given way to more realistic aims.  Since the US lost the early battle to contain COVID, the disease has had the run of an extensive territory, and it isn’t going to be beaten back any time soon.  The American population may be slow to grasp this, but our main goal must be to limit the number of victims: to minimize acute suffering, chronic illness, and death.  So far, a significant portion of the American population has proved deficient in the understanding and great public spirit needed to reach this recalibrated aim.