What does it look like until we all get the vaccine?
In my last newsletter, I wrote about how incredible the vaccine data looks.
The Pfizer/BioNTech vaccine is starting to be shipped across the country. Millions of doses will be given over the next few weeks, with many times more over the next 6 months.
This is unequivocally good news and a real reason to have some optimism.
But we aren’t out of the woods yet. Lots of hurdles remain and the logistics for mass distribution are daunting. After all, this is a vaccine that requires 2 doses spread over a period of 3 weeks and needs to be kept at the temperature of dry ice. So even though it’s easy to scale up manufacturing of an mRNA vaccine, that doesn’t mean vaccinating people is easy.
Demand for dry ice has skyrocketed. Supply chain challenges have led to Pfizer revising down their estimates for vaccine delivery.
Always remember, there’s a difference between a vaccine and vaccination. So having an efficacious vaccine is only the first step and there are still hurdles to overcome.
Meanwhile, the pandemic is spiraling out of control
I’m incredulous about the nature of the our current trajectory.
Being in the hospital now feels pretty similar to the beginning of the pandemic. I spend my days wearing an N95 and come home everyday with mask marks all over my face. Our admitted patient numbers go up because new COVID cases are coming in faster than we can discharge the old ones. We’ve had enough false negatives and patients coughing in our faces that we’re all constantly on edge.
Look at the numbers in the Johns Hopkins state-by-state tracker. These numbers are almost unbelievably bad. I wrote a few weeks about how the testing metric that may be the best crystal ball for the next few weeks is the percent positive test rate.
This is the metric that experts use to make recommendations about increasing or decreasing public health restrictions.
Higher numbers suggest more community transmission with more undetected cases and more rapid spread. When this number creeps over 5%, it’s bad news.
Take a look at that tracker again. The numbers are awful.
Washington DC, Hawaii, Maine, and Vermont are the only areas in the country with a percent positive under 5%. Most states are WAY above the 5% mark. That means that the current level of spread is bad and it’s going to get much worse.
Unfortunately, there’s a lot of confusion about what to do until we get better vaccine distribution.
Why is this confusing? It’s because public health messaging has been really bad
I don’t just mean Trump here.
Poor public health messaging started at the beginning of the pandemic and hasn’t gotten all that much better overall.
It’s easy to remember the bad advice of Jerome Adams, the Surgeon General, about masks back in February:
But you should also think about what’s going on in California to understand what I mean about the messaging problems.
In Los Angeles, they just closed outdoor parks to the public before an outcry led to revision of those restrictions. But when you’re outside, you still need to wear a mask no matter how far away you are from others.
Restaurants are closed to the public, but the Governor of California is having fancy indoor dinners with lobbyists at the French Laundry. The Mayor of San Francisco is doing the same thing, having a private indoor dining event at a restaurant that costs $300 per person without drinks or tip.
It’s easy to get angry about politicians denying COVID or refusing to implement any restrictions.
But I’m just as angry at leaders who are practicing 'restrictions for thee but not for me,’ because these are the types of actions that make people lose trust in public health messaging.
The public messaging should have been easy, because this isn’t that complicated.
There are a handful of important things to keep in mind about this virus.
The majority of spread is from aerosolized particles. This means that close proximity to respiratory droplets is how the virus gets spread. So masks, physical distance, and avoiding confined spaces with poor ventilation are the hallmarks of staying safe.
A lot of transmission is asymptomatic, so rapid, frequent testing will identify outbreaks early and help to prioritize who needs to stay home and who doesn’t.
Superspreader events account for the majority of transmission. Any crowded indoor space has the potential to lead to a big outbreak.
Risk of spread is much less outdoors than indoors. Mandating mask wearing when you’re alone in a park is the type of nonsensical public message that makes folks question the sensible restrictions.
We are in this together, but we aren’t all equally sharing risk. And risk doesn’t just mean risk of infection.
The first 4 are the straightforward pieces of information that our public officials should have been messaging over and over. There’s been a lack of clarity because they haven’t stayed focused. And going to a fancy indoor dinner basically flouts all of these messages, including making it clear that we aren’t actually all in this together.
Despite this, I think many people have gotten the idea that risk exists on a spectrum and that indoor spaces that are crowded with people who aren’t wearing masks are uniquely dangerous.
But the risk here isn’t all related to getting COVID. The unintended consequences of trying to reduce viral spread are real and getting worse.
Not all risk is medical
People are struggling during the pandemic even when they’re not getting sick with COVID.
I think about this similarly to how I think about the risk of infection. Just because we all can get infected, it doesn’t mean that the infection affects us all the same. And just because all of our lives have been changed doesn’t mean that impact is the same for all of us.
Everyday, I see patients who describe the intense stress that they’re experiencing from job loss or a business shutting down. They’re miserable from what the social isolation has done to them. People are gaining weight, getting sick, missing their families. Lives are being screwed up in a lot of ways.
Kids, especially poor and minority kids, are getting screwed. This is a really big deal. Their development and education have not been prioritized by society, and the aftereffects will be felt for a long time.
The next few months are going to be really bad in terms of the numbers of hospitalized and deaths from COVID, but they’re also going to be really bad for the many folks among us who are already suffering because of the way that their lives have been turned upside down by the pandemic.
So until we get wide distribution of a vaccine, I suspect that the next few months are going to feel like the previous year but a bit more intense. That means more infections, more hospitalizations, more stress, and more suffering. And much more inequality.
But there is a light at the end of the tunnel.
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