Trust Me, It’s Raining.

Well, this was supposed to be about the economy, but that’ll come later.
While each of these *can* be read independently, it’s best when read together: First Article, and Second Article.

With the release of the C.D.C.’s new updated Mask recommendations and the reactions from cities and the W.H.O. over the past few weeks, it’s about time we actually see a scientific approach to mask guidance and a bit about boosters and how this all works together in your toolbox of dealing with the pandemic.

 First, let’s talk about the title of the article, “Trust me, it’s raining.” We’re diving into the importance of public trust in agencies and how, unfortunately, science isn’t always the driver of a decision as much as we’d like to think it is. Because in May, the C.D.C. and the Biden Administration’s messaging was akin to pissing on our shoes and telling us it was raining. Unfortunately for us, when it rains, it pours.

 It’s also meant as an analogy we’ll talk about later when it comes to preparing the tools in your intervention toolbox, how they layer, and how to think about daily covid protection, more like weather, or well, rain.

A few weeks ago, amid the new mask rules, the C.D.C. also acknowledged that transmission has been occurring among the vaccinated population. For some reason, this tidbit seems to be very misleading among folks, from advancing concerns about the effectiveness of the vaccine vs. the new fears of Delta/V.O.C.s… but this reality makes their previous guidance seem suspect.

Because in terms of the data and Literature at the time, it was. It was a political decision to not simply repeal the mask guidance prematurely, but to encourage abandonment of interventions once vaccinated… Public Health experts have been beside themselves this entire time. When vaccination rates scuttled, the hope that F.O.M.O. would encourage folks to get vaccinated not only fell flat but helped encourage cases to spread.

In my previous articles, I’ve explained the reality reservoirs play when large groups of folks refuse to abide by interventions designed to decrease the incidence of COVID19. Those being mask-wearing, physical distancing, increased hygiene/handwashing, and of course vaccination when medically reasonable.

Before we dive into why the new C.D.C. guidance makes sense and how we should incorporate the new “covid weather map” into our daily lives, let’s talk about that last intervention.

The vaccines are solid, they work well, and are unlikely to require a booster any time soon. In November/December, that may change. (although the WHO, taking a political knee and saying please stall until September for boosters to the developed countries pushing boosters) It’s important that the target for vaccination should be the most folks getting fully vaccinated before boosters become common in developed countries, if we want to eliminate the global recurrence of new VOCS at the rapid pace we’ve seen. “In the context of ongoing global vaccine supply constraints, administration of booster doses will exacerbate inequities by driving up demand and consuming scarce supply while priority populations in some countries, or subnational settings, have not yet received a primary vaccination series.  The focus for the time being remains on increasing global vaccination coverage with the primary series (either one or two doses for current EUL vaccines).” as stated by the W.H.O.

That being said, if our current V.O.C. trend continues, sometime next year, a booster would likely help the more vulnerable populations and may be indicated for everyone should the virus find new footholds. The science behind boosters is sound, and the data reflects the protective quality of the vaccine. We have always known that the vaccine likely protects to a certain degree against infection but that it does not always prevent transmission.

All my pencils just say Drugs now

 Our current messaging on the pandemic is, well… bad. It’s exclusive, shame-inducing, and it’s basically the same strategy we always use: shame, aka peer pressure. Does it work? To a degree, but it has a weak range of effectiveness, it always has; Project D.A.R.E. is ineffective(West, 2004). If you suspect it works, I D.A.R.E. you to consider other similar strategies met with bucking shame and tribalism like the “War on Drugs” and, well, Condom use.

When we hear messaging on vaccination, it blames the unvaxxed for all the problems we’re experiencing, as if they are the source of the new problems. Which while partially accurate regarding V.O.C.s, it’s also important to remember that this is a virus. And no one is at fault here.

 Leaders who use their platform to spread misinformation or disincentivize folks from taking the vaccine or following other interventions do bear a degree of blame for which society should interpret sooner rather than later.

It’s important to consider the US CDC messaging isn’t happening in a vacuum, it’s happening in a world where 20-30% of the population cannot afford the vaccine under the current conditions, and somewhere around 20% are struggling to access for a lot of different reasons, but mostly to do with cost or the convenient opportunity to commit genocide with less potential blame. Currently, about 30.4% of the world is at least partially vaccinated, only 15.8 are fully vaccinated, and the U.S. just passed the 50% mark on fully vaccinated (two weeks after the last jab.) Pandemic is global, an important reminder here is that V.O.C.s have come from other countries, as well as being amplified in the U.S. Importation of cases will constantly be an issue when states like Florida are a hot-bed for the circumstance due likely in part to DeSantis political ambitions overweighing safety for the American people. Between instituting a mask-less requirement for all Florida schools and threatening district leadership with pay cuts if they try anything(and now that pushback), I don’t think we’ve yet seen the worst of his policies, as they continue to ignore evidence and enjoy cherry-picking data.

 The U.S. C.D.C. messaging creates a specific narrative that does not help to eliminate the pandemic.

 The current C.D.C. messaging focuses on pressuring the unvaccinated as the cause of V.O.C.S. and the reason for our current surges, which is a half-truth. The vaccinated, are, unfortunately, also spreading SARS-CoV-2, as much, if not MORE, than unvaccinated due to their larger numbers and similar lack of adherence to interventions; the difference is in how far that spread goes. The evidence regarding vaccinated folks carrying the virus has been known for some time; the initial SARS-CoV-2 virus had been shown to be transmissible among vaccinated, but far less than typical. We also suspected V.O.C.S. might change the game up. On March 10th, J.A.M.A. Viewpoint from the C.D.C. “A growing body of evidence suggests that fully vaccinated people are less likely to have asymptomatic infection and potentially less likely to transmit SARS-CoV-2 to others. However, further investigation is ongoing.” (Christie, 2021)

“The risks of SARS-CoV-2 infection in fully vaccinated people cannot be completely eliminated as long as there is continued community transmission of the virus. Vaccinated people could potentially still get COVID-19 and spread it to others. However, the benefits of relaxing some measures, such as quarantine requirements, and reducing social isolation may outweigh the residual risk of fully vaccinated people becoming ill with COVID-19 or transmitting the virus to others.” (Christie, 2021)

This is from a paper the C.D.C. director co-authored; the tone was already being set for the shift in messaging; however, what’s certain, was that we should not discourage interventions but relax measures according to regional outbreaks. California’s tier system successfully allowed counties to better control their circumstances; the lessons learned would have been easily translated, as they more recently have been in the new C.D.C. guidance.

But…following the strange shift to ENCOURAGING vaccinated folks to resume all activities without consideration for interventions was at the very least reckless. The medical blog site The Conversation echoed how most Public Health folks felt about this strange messaging. “Vaccines can be great at preventing you from getting sick, while at the same time not necessarily stopping you from getting infected or spreading the germ.” (Mishra, 2021) 

We knew caution was essential to maintain because many suspected immune escape and viruses to continue to create potentially new V.O.C.s when the subvariants affect one another. We knew immune escape was a potential problem, we suspected increased transmissibility of new V.O.C.s, and yet not until weeks after Biden’s celebration regarding successfully not reaching 70% by July 4th and more information coming out about Delta did the messaging shift. 

 For those of you who are interested in high-value content regarding accurate information about COVID-19, might I suggest https://www.covidhealth.com/  and https://www.unbiasedscipod.com/ They put out lots of well-designed graphics and sharables like the one below.

from Unbiased Science Podcast

 Important regarding the Delta V.O.C., The increased transmissibility is roughly twice as potent as the original strain, increasing viral load early on by as much as a thousand times higher. This not only indicates significantly more pre-symptomatic transmission, but importantly it improves the sensitivity of our PCR tests. Previously, PCR tests had a false negative rate which decreased to near nil close to day 5, but due to the increased viral load, Delta is detectable earlier than the original strain. Overall potentially improving test sensitivity by upwards of 10-15% due to the smaller windows of false negatives.

 People were grossly unaware of the reality of the problem partly because the news doesn’t understand public health. Occasionally the NYT has been helpful regarding their data; however, their interpretations, opinions, and articles vary immensely based on its author.

 This discourse was confusing for the general public because of media trash like this.

 Made more confusing by choices like this from the C.D.C.: As explained in my previous article, the C.D.C. isn’t really looking for breakthrough cases, although the states are recording data on their own. Given the political climate, this *seems* not well thought through. It’s also important to note that breakthrough cases are defined by two weeks following vaccination, which puts partially vaccinated folks into the general lump. DEBLASIO, DID YOU READ THAT? Why the Capslock? Because the Mayor of New York City’s strange vaccine I.D. requirements only need one dose to count and may repeat the Springsteen debacle of vaccine nationalism, because what vaccinations count? L.A. reinstituted a mask requirement, which is…well…easier, more inclusive, and pisses off people who don’t want cloth on their face. The LA requirement also has no teeth, so most folks will and have likely ignored it to a degree, which we’ve been seeing alongside growing tourism likely importing cases.

But now the C.D.C. finally is on board with an actual solution, and of course, folks are doubting the agency…again. Do they deserve the doubt? Yeah, I’d say they tarnished the trust with the U.S., now multiple times over masks, so this was an epic fail on the part of the C.D.C. to do this, in this fashion.

But now that we do have reasonable guidance, let’s talk about how we should live with this pandemic.

We’ll get into the nitty-gritty of just why the C.D.C. messaging is so bad after this analogy.  

Gritty is a mascot and the logo are owned by The Philadelphia Flyers

 IT’S RAINING, MEN.

However you consider the Coronavirus/SARS-CoV-2/COVID-19/’Rona Pandemic, its essential to consider how a public health body should explain preparation for everyday folks.

 We should think of SARS-CoV-2 like we do precipitation. Now, with better testing, better maps, integrated map tools into Google Maps, this type of analogy can make a lot more sense.

First, we have to look locally because that’s where the problem lies. A Pandemic in this sense is considered by its millions of regional outbreaks. So we can think of it as a massive Global super-Hurricane capable of producing all weather phenomenon. 

 Does it sound potentially terrifying? It should. Our toolbox of protection against rain may be raincoats, umbrellas, boots, maybe a towel by the door. For snow, we might need a snow shovel, salt, thicker coats, snow boots, etc.. We prepare for a pandemic in the same fashion, it’s just a little harder for some folks to initially see this because it’s a generally invisible threat.

 The prevention toolboxes listed above are for an individual, and there are more for the community, and the State, should the weather become too burdensome on the individual. There are also toolboxes for response, maintenance/long term, and importantly for the future, meta-analysis, but let’s focus on what you can do, and maybe a bit about what some stuff around you can do.

 These are the tools in our toolbox for an individual by importance: 

 1. Getting the Vaccine, in terms of rain( SAR-Cov-2), It’s like having a scotch guard bubble, one’s feet might get wet, and the bubble gets scratched up as it encounters things like hail(V.O.C.s). 

 2. Wearing a mask is like an umbrella, so if any water does get in, one is still dry to a degree, but one’s feet still get wet. (benefit is an umbrella can reduce the rain for others nearby, but don’t share masks)

 3. Interactions are a combination of physical distancing and time. These are the boots, and how they’re used determines what type of boots they are and to what they’re resistant. The less time an interaction requires, the stronger those boots are, the greater the distance the interaction requires, the more protective those boots are. E.G., If an Interaction takes 15 minutes, and someone can keep a distance of 6-8 feet, that interaction previously ran a low risk but now runs a low but higher risk with Delta. It would be like wearing boots with worn soles a small hole in moderate rain; socks likely will get wet the longer the stay, and with random hail(V.O.C.s), it’s making the water splash about getting the bottoms of pants wet.

 4. Airflow, often this can be considered Inside Vs. Outside. There are lots of ways to improve or increase airflow, opening windows, using air purifiers, increasing the cubic footage (typically heightening a room), adding negative pressure or exhaust fans. Each of them, like every intervention, mentioned, layers to add protection against SARS-CoV-2 and its V.O.C.S.

5. Hygiene isn’t just washing your hands. In this case, it’s cleaning your hands after you interact with things in new buildings or commonly touched items outside. It’s avoiding touching the face, nose, and eyes while not in the home. It’s the analysis of our washing routines to make sure we enter our homes clean, which can mean taking a shower after a long day at work if work is in a public or shared space with lots of people. Hygiene also reduces our risk of getting multiple illnesses. Some folks might wear lycra gloves to avoid constant handwashing, but they should rotate through sets as they go from location to location.

 6. What? There are more tools?! What else can we do? Vote for political candidates who aren’t actively telling others not to or disable their ability to do any of the above. Really. This is by no means an endorsement of any political group; it’s just common-sense Public Health. Leaders who broadcast and elect to enact policy making an outbreak easier are objectively a bad choice during a pandemic.

7. Hah! There’s even another one, because the Internet. Correct misinformation to the best of your ability, even your own. The Scientific Literature is constantly growing and correcting itself, and when agencies interpret this, once an Administration is involved, it has to consider what obligations or national temperament may require. This is part of why C.D.C. Director Walensky removed the mask requirement because it would release tension regarding intervention compliance, giving a break, for what she would have likely suspected, was a wave coming in the Fall. The likely additional guidance by the White House to disregard all interventions once vaccinated was likely weighed with the unknown of Delta. The Literature expanding to include the significantly higher transmissibility put pressure on the C.D.C. to install the current system, one which always should have been the guidance. But Literature doesn’t guide every government decision; there are a lot of data to consider, including compliance with interventions. So government agencies have a degree of fallibility here. But it’s crucial that when we correct misinformation, we shouldn’t be a dick about it, speak honestly, but withhold that new Government Encouraged Outrage.

For a moment, to see how the messaging is doing to improve vaccinations, let’s return to the K.F.F. Vaccine Monitor to see what stalwarts likely remain, besides those of us with chronic conditions who require the timing to figure out when to vaccinate or who simply cannot given the current guidance with their doctor. We should assume that the vast majority of them would likely answer “Wait and See” and a few as “Definitely Not”, but not enough to break 4-5% and 1-2% respectively of the whole. So about 20% of Americans still leaves many folks who aren’t interested in vaccine-induced immunity for whatever reason.

But the most compelling thing from this month’s K.F.F. Vaccine Monitor was this unsurprising comparison “News Of Coronavirus Variants Has Caused Some Adults To Change Behavior, Two In Ten Unvaccinated Adults Say It Has Made The More Likely To Get Vaccinated” vs “A Majority Of Vaccinated Adults Say News About The Possibility Of A Booster For The COVID-19 Vaccine Hasn’t Caused Them To Worry About COVID-19 Protection, Black And Hispanic Adults Slightly More Concerned.”

These data illuminate that the white house messaging DARING folks to get vaccinated to avoid creating V.O.C.S. and blaming them for the new surges aren’t having the desired effect of increasing demand for vaccination.

So it’s time to consider what’s next. The increased vaccine employer requirements are absolutely squeezing the “only if required” crowd down to zero. Still, the remaining potentially 15% by the end of this year who will be Choice Unvaccinated might be enough to continue this nonsense for another year yet, instead of going from mitigation to control like in New Zealand or Taiwan

 How do we convince the stalwarts? Talking to them helps, but only when it’s productive and informed.

 A big thing, though, is honestly, ignore the big fluffing. The thought-leaders encouraging anti-vax thrive on being the underdog and defending their position, don’t give them clicks, just brush it off like the nonsense it is, and also don’t feed the hating on them, ya know, like the U.S. C.D.C. messaging inadvertently does.

 It’s important that we all agree on something here, though, that no one deserves COVID-19. Leaders do bear some responsibility; however, that doesn’t mean someone deserves a life-threatening condition that could result in a chronic illness or death. If we want to get through this pandemic, the only way we can is together. 

 By considering the Interventions relative to the danger around us, much like we do with weather every day, we can best take caution to protect ourselves and our communities. We may not always need to wear a mask all the time, but when the risk is high, we should take as many precautions as possible and use as many tools as we can carry.

Get Vaccinated when/if you can. Wear a Mask indoors, in crowds, and in mass transit. Also, consider the other tools as the situation demands.

References

Christie A, Mbaeyi SA, Walensky RP. C.D.C. Interim Recommendations for Fully Vaccinated People: An Important First Step. J.A.M.A. 2021;325(15):1501–1502. doi:10.1001/jama.2021.4367

Lazarevic I, Pravica V, Miljanovic D, Cupic M. Immune Evasion of SARS-CoV-2 Emerging Variants: What Have We Learnt So Far? Viruses. 2021; 13(7):1192. https://doi.org/10.3390/v13071192

 Levine-Tiefenbrun, M., Yelin, I., Katz, R. et al. Initial report of decreased SARS-CoV-2 viral load after inoculation with the BNT162b2 vaccine. Nat Med 27, 790–792 (2021). https://doi.org/10.1038/s41591-021-01316-7

Mishra, S. (2021, July 29th). Can people vaccinated against Covid-19 still spread the coronavirus? The Conversation. https://theconversation.com/can-people-vaccinated-against-covid-19-still-spread-the-coronavirus-161166.

West, S. L., & O’Neal, K. K. (2004). Project D.A.R.E. outcome effectiveness revisited. American journal of public health94(6), 1027–1029. https://doi.org/10.2105/ajph.94.6.1027

The Impotence of Patients or the Importance of Patience

If you’re reading this first, check out my initial article in our COVID-19 series. This is the second article in the series. I’m an Infectious Disease researcher and MPH working with ending epidemics. I also happen to work in Workforce Development/Life Sciences and have a background in Economics, PoliSci, History, Law, Policy, Healthcare, Counseling, Advocacy, and Marketing. 

 As a patient advocate for over ten years now, when I look back at the majority of my moments as a patient, I look back at my powerlessness. For the vast majority of patients, powerlessness is an overwhelming reality when it takes hold. It can be from the initial diagnosis. It can be when certain symptoms begin or often when they find out that there are no treatments, even on the horizon. In my case, I was lucky that treatments were developed in my lifetime to cure my of my lifelong battle with Hepatitis C. But those fears, that impotence, is very real and very common, at least for some time in many patients. 

Norovirus is relatively harmless for most folks with healthy immune systems. Still, for the elderly or folks with hampered immune systems, it can be a significant challenge. In rare instances, death can occur. On cruise ships over the past decades, Noroviruses have become so common that most cruise ships have enhanced safety requirements to protect passengers and staff. The CDC has managed these cases and provided guidance in this arena for as long. The CDC does this through the Vessel Sanitation Program, since 1975 when it was created. The CDC indicates its specific jurisdiction of cruise ships carrying more than 13 passengers and a foreign itinerary in US ports.

WAIT, I THOUGHT THIS ARTICLE WAS GONNA BE ABOUT COVID AND MASKS AND VACCINE IMMUNITY.

 It is, and it isn’t; it’s also about the legal stuff and vaccine “passports” as well as a spiritual continuation of When Captors Masquerade as Allies. Let’s talk about the state, which will likely be a consistent reservoir for COVID-19 and new Variants Of Concern, Florida. And has led the country in growing VOCs, having the highest amount of VOCs in April prior to the new COVID-19 dashboard, and currently as of July 2 , maintains 2,381 over the two week period, vs. 2,598 in CA, a state with twice its population and equally a destination state for tourism. Florida in April had double the cases of any other State among VOCs, and that trend seems to be continuing with DeSantis’ policies standing in ignorant defiance of how infectious disease works.

 Aside: my previous article centered on the CDC’s failing of removing mask requirements prematurely and charging ahead, ignoring evidence of transmission among vaccinated populations amid rise in VOCs. While the vaccine does appear to significantly reduce transmission, it does not appear to eliminate it, as even the CDC states. What I didn’t mention in the previous article was a likely important factor, that in part, the decision was made in favor of reaching political benchmarks and having big fundraising efforts. Memorial Day is traditionally the beginning of summer, and BBQs bring in local and national political dollars. But there are a dozen awful factors in this choice, none of which are scientific in the least. The logic of doing this to encourage FOMO for the vaccine is disturbingly reminiscent of Lt. Gov Dan Patrick’s choice statements regarding sacrificing the elderly for the economy. But intent isn’t so easy to assume, so now let’s focus on an area the CDC has been doing well on but has a different political fight.

Would you, could you on a boat?

So the CDC’s VSP has always been the only one with jurisdiction here. Cruise ships have a very specific carve-out due to the health hazards historically associated with Cruise ships. So why do I care about Cruise ships? I don’t really; my personal experiences leave much to be desired, but this situation in Florida is problematic at best, because it can easily lead to higher importation of cases when not monitored properly.

A Florida judge sided with DeSantis on an incredibly weak premise. The basis of the lawsuit is a fundamental loss of tax revenues due to the conditional sailing order given by the CDC. 

 Here’s where the DeSantis Magic happens, though: One of the underpinning components of their comparison is that the CDC’s order fails to recognize the prevalence of vaccines. DeSantis created a policy that fines cruise ship operators $5000 for each customer who is asked to provide proof of vaccination

 DeSantis is arguing on one hand that the CDC’s sailing limits restrict Florida’s revenues while claiming that vaccine prevalence is so widespread, so much so, he’s willing to punish the industry he’s claiming to protect. What’s even weirder here, both cruise ship passengers and companies seem pretty happy with the enhanced protections, something DeSantis doesn’t seem to be considering in his stand against reasonable and basic public health measures.

As we consider these interactions on a national level and see how inconsistent actions among people with authority wielding these clubs against one another. Where a disagreement between federal marshalls who refuse to disclose vaccination status meets a judge who demands to see it while refusing masks in his courtroom. This interaction showcases the challenges when political intention creeps into our bureaucracy; both parties seem to be acting on partial information. The Judge, being in a public court, should hold that all people inside are wearing masks when vaccination status is unknown, while the Marshalls should have known to comply with the court, providing the documentation. The CDC and Circuit courts generally agree on the following: 


In courtrooms, if only vaccinated people are in the courtroom, masks will not be required. If anyone is unvaccinated or the vaccination status is unknown, masks will be required unless the presiding Judge permits otherwise.

But it gets very tricky when the CDC stops holding the bar up for the country regarding actions for public health safety. State courts, even county courts (this site lists them all out), all have different rules regarding vaccination, status, and masks during the pandemic.

 One central theme, though during all of this pandemic, has been folks blatantly defying public health orders for a surprising number of reasons. Reasons varying from political free speech, their freedom to breathe, believing it’s worse for your health, believing they don’t work, to just not wanting to. 

woman looking at sea while sitting on beach
Photo by Pixabay on Pexels.com

These actions bear responsibility for facilitating the spread of the virus. As a person who lived with Hep C nearly all my life, I was constantly aware of the very real potential jail time which could come into play if I intentionally hid my positive status with a sexual partner even though Hep C isnt’ an STD, and they were to be infected. These rules regarding STDs disproportionately affected the LGBTQ community, and thankfully these laws are being revisited. So there are circumstances where we can see exceptions, like for folks who are vulnerable and could not wear a mask. But here, what we’re seeing is closer to intentionally infecting others, the goals of anti-maskers are wide, but some do want to naturally create herd immunity(which would make more VOCS just like Manaus), in spite of how little we know. (side note the Unbiased Science folks helped this one, it’s a solid article.)


The trouble again comes before with anti-maskers, and soon with the maskueraders, their actions likely add not only to further spread of the virus but also strain community relationships and introduce stress and tension into environments.

 This is why it’s unfortunate that a state with a historically slow clemency process and a governor who continued this has been so blatantly political as to pardon violators of covid-19 recommendations in Florida.

 Actions like these are willful defiance of a uniform strategy for public health, something essential for any public health strategy: unity. To encourage maskueraders by pardoning their crimes of willful defiance of public health orders during a national emergency, his actions also discourage trust in the CDC and public health institutions. 

The importance of patience is essential to our survival as a nation. 

It is important that we learn from what has happened and to move forward, saving as many lives as possible while Building Back Better™.  COVID-19 ranks third regarding death in 2020, destroying 5.5 million years of life. With over 600,000 dead, there should be no insertion of politics into this ongoing global natural disaster. Moving forward together, with friends, family, neighbors, our communities, countries, and the world as a whole. In contributing to covax and other projects which share resources for fighting COVID-19, we ensure our mutual success, however, vaccine equity seems further off. Some countries outright refuse the vaccine; others, like Brazil, likely intentionally stalled.

There is a considerable race to vaccinate and protect as many people as possible, as new variants of concern pop up, which have increased transmissibility or immune escape. On a global scale considering India and Australia’s recent surges, our premature revelry in the US will likely lead to unnecessary deaths. Thankfully Australia has mechanisms acting in unity which may help them considerably in containing Sars-CoV-2 in Australia. But importantly, from the Australia case, just as in many circumstances in the US, the overwhelming majority of cases occur among unvaccinated individuals and are increasingly VOCs

Image of viruses from DW

As the Delta variant displaces its progenitor rapidly, more and more public health officials are encouraging mask use, including the WHO,   Los Angeles and more recently, Sacramento. Folks who are immunized should likely wear a mask indoors, in crowds, or in mass transit for the duration of the pandemic.

 It’s good that there is something we can do about this, but that doesn’t make its spread any more unnerving. And more recently, a new variation of Delta has arrived, as Delta Plus. 

 VOCs like Delta and Delta Plus throw a big wrench in the reality of data being presented. In the US, an overwhelming majority, almost 99% of severe cases, occur in folks who have yet to get vaccinated. So let’s focus on those who are vaccinated but test positive for covid-19, Breakthrough infections/cases as they’re called. 

 An important consideration: Breakthrough Infections, bottom line, does everyone need a test?

 Breakthrough Infections are complicated, and while early on, the majority were asymptomatic, about 10% of the 10,262 breakthrough cases as of April 30,2021, were hospitalized, and 2%(160) died. The median age being 82, indicates that in the rare cases of breakthrough infection, death trends skewed towards older; perhaps importantly, 64% of hospitalized cases were VOCs. It’s also important to note that there are likely significantly more asymptomatic cases of COVID-19 among the vaccinated population. However, their infection may never be noticed or included in data, due in part to the lack of priority on testing among vaccinated individuals at this time. Deprioritizing testing among a population can cause testing bias in the system, which may impact the data.

Some things to consider here: “In Israel, where 57.1 percent population is fully vaccinated, about half of Delta variant infections occurred among those fully vaccinated with the Pfizer shots. This prompted Israel to reinstate wearing masks indoors.” Much like the WHO, mask requirements are as simple as I laid them out at the end of the first part of this article series.

Important note: Vaccination does the best job in preventing severe symptoms and death regarding COVID-19 despite what clickbait headlines from leading newspapers might suggest.

Without the CDC holding the bar on what mask and vaccine standards we should maintain, we end up with more chaos than needed during a very wild economic time. A hospital in Texas is fighting for its ability to ensure that its employees are vaccinated, facing a lawsuit from 117 employees who did not want to get the vaccine. Cases like this will come about across the country; however, there is no standing, so it is unlikely many will succeed. Without proper guidance from the CDC as to best practices, at the very least, states all have incredibly different policies, which will likely only further expand reservoirs, as mentioned in my previous article. Reservoirs naturally encourage new VOCS if they have a high enough population of unvaccinated folks. It’s also important to know that now the Delta variant accounts for the majority of new infected cases. All the more reason to get vaccinated to reduce the potential for VOCs.

Drake Meme encouraging vaccination to reduce VOCs

On safeguards towards containment efforts, yes, Taiwan has shown us, it can be contained, so long as the will to do so exists.

 Here’s something which may or may surprise you: I’m not for vaccine passports, but I’m also not necessarily opposed to them, as they don’t actually impede on privacy or health status information. 

Vaccine passports are complicated, and honestly, privacy is the least important aspect. Accessibility, equity, and vaccine nationalism make the conversation not as cut and dry as one might expect. You might be surprised to find that the WHO isn’t for vaccine passports. They are building a kind of neutral digital certificate and architecture, however, but it’s not really the same thing as an individualized passport.

 California is attempting something similar, but still uniquely Californian, in that, it only applies to places you have to pay for. Conceptually, it limits the ID requirement to systems that need to know the information due to increased risk and a cost barrier, and who knows when it will actually be instituted, or how it may yet change.

 Different but related, just on more economic, legal matters regarding COVID-19, more lawsuits are going forward against governments for loss of revenue. A reasonable consideration for small and medium-sized businesses who suffer(ed) or discontinued during the pandemic. We’ll take a deeper dive into the economics of all of this in the next article: When the Economic Flywheel Isn’t Flying.

These solutions to vaccine status awareness may prove helpful in time if there is social acceptance. But again, this harkens back to an earlier message: unity. Public Health efforts, when not unified, fluster and have significant holes. Public health efforts require immense trust, buy-in, and consideration from each community involved. Without all of walking the same route of protection, it weakens any potential defense. So, however, we move forward with vaccination identification, we should hope and encourage equitable solutions.

 Unfortunately, a pandemic affects the world, which also means that as VOCs spread around the world, we are gravely affected by each other misdeeds, misconceptions, or misunderstandings regarding COVID-19. It also means that vaccination efforts be universal across the globe to ensure the eradication of the threat of COVID-19, much as we’ve done for Smallpox and Polio, rather than as we’ve done for Malaria, HIV or Viral Hepatitis, which run rampant around the world, killing millions each year while the US has significantly reduced death counts comparatively. Smallpox and Polio had global vaccination efforts with few restrictions on patents, while HIV and Viral Hepatitis face patent restrictions (which create temporary monopolistic pricing for the patent holders), among dozens of other potential barriers. There are a handful of efforts to like COVAX and #FreeTheVaccine, which are trying different ways to encourage the sharing of the vaccine to rid the world of this problem. 

 It’s important to remember that Polio was solved here in the US so quickly because of the refusal of Dr. Jonas Salk to patent the Polio Vaccine. In his famous words: “Could you patent the Sun?” A comment not only inspires parable but an essential legal reference to the reality of products of nature. Obviously, when a product like mRNA comes into play, it’s a lot more removed than a more typical product of nature, so the logic here is more complicated. Here, we look at the result required for global stability: universal vaccine availability and seek to understand solutions to that complex problem. While the United States has held that patents in this specific circumstance would benefit from flexibility, Germany, has strictly opposed such patent sharing. Mind you, in the US, multinational pharma companies are still fighting this stance. So it’s unlikely that patent sharing, waiving, or other exceptions will pass without obstacles.

 This gets even more complicated when Belt and Road and China’s vax effort is considered, but that’s for next time. Vaccine Nationalism gets weird after all, even within the “the special relationship.”

 Another organization is attempting a different strategy; the Global Immunization Action Network Team (GIANT) is a global resolve to improve global public health outcomes by combating vaccine hesitancy through effective, sensitive, science-based communication and education. Vaccine Hesitancy is a complicated demon to face. The other side of vaccine availability and equitable access is the desire to understand vaccination’s safety benefits. GIANT isn’t focused on COVID-19 specifically, but it encompasses it; but for those like myself working with End The Epidemics and No Hep 2030, among other elimination initiatives, comorbidity is a big target we’re focusing on. Comorbidity is having multiple infectious diseases or conditions. Comorbidity just amplifies the problem at hand, whatever the condition. COVID-19, being so widespread, has complicated life for folks with chronic conditions looking to avoid additional comorbidity because that could mean death. So GIANT’s approach towards messaging and education are critical while figuring out how to make the vaccine more accessible.

 Okay, again, this is terrible! Infighting, and confusion, lawsuits galore! What can anyone do?

If you can, get vaccinated, Me, getting vaccinated July 5th.

As a transplant recipient , I’ve been eligible for the vaccine in CA, since February. But in the heat of my MPH, learning my chair had an adverse reaction to the vaccine reminded me of the importance of timing. Timing for side effects is something folks with chronic conditions have to figure out with treatments, vaccines, and other health procedures. I’ve personally had to plan 6 Hep C Treatments, thankfully. The new ones aren’t so bad as far as side effects, But the old pegylated interferon and Ribavirin are an awful experience. Months of exhaustion, mood swings, skin issues, and significant blood loss were important to time these in my life. I injected on Fridays to have the weekend to take the brunt of each interferon injection, which felt like the nights of a thousand flus. Between my MPH Thesis, new caretaking needs for a family member, some personal health concerns, and other serious projects, I wanted to make sure that if the vaccine had any serious side effects, that it would be on my time, that it wouldn’t be too much of an additional burden.


I also was watching several studies on liver transplant patients to see if the outcomes were different. (As a transplant recipient, according to a recent study, mortality is about 20% with COVID-19, but with the vaccine currently, there have been no reported deaths due to COVID-19 among transplant recipients, so although we don’t know how well the vaccine confers immunity in transplant patients due to their immunosuppression, we can tell the outcomes.) Importantly, I also note that I don’t have any allergies, so I knew I could pop over to Vons and take it. If I had more common allergies, I personally would have taken it at a clinic, JIC. So I arrived at yesterday, at a local Vons. For those who can vaccinate, please do, and encourage folks around you to do so as well. Important note: There are hundreds of thousands of folks in my situation who planned when and how to vaccinate because for us, it’s not as simple as walking in. There are plenty of folks with chronic conditions who decided, “you know what, I’m just going to go for it,” and we appreciate their choice to lead us through the crisis. But the choice of when to vaccinate can be complicated. So it’s essential when we talk about vaccination with our close friends and family that we also keep this in mind. It’s also important to remember that among all the revelry, this pandemic isn’t over.

FF Meme about family and getting vaccinated

Honestly, if you are not in a position of power to be able to help folks, improve messaging, finance, research, or otherwise seal holes in our global vaccine response. Then there is not a whole heck of a lot you can do, but… there is still something pretty big.

 First, you can get the vaccine if it’s available and you are physically able to tolerate it. Regardless of vaccination status, wearing a mask indoors, in groups, and in mass transit helps decrease spread and thus the potential for VOCs. For folks who are still unvaccinated, wearing a mask, maintaining six feet of physical distance, preferring outside interactions, and reducing interaction time, can be helpful.

 If you still want to do more, you can. Talk with your friends and family, make sure everyone who can vaccinate is vaccinated. Chat about how important mask use still is while indoors, in groups, or in mass transit.

 Important note: as vaccination rates rise and cases decline, it’s also essential to consider the positivity percentage of COVID-19 regionally. The lower the number of cases and positivity percentage on a regional dashboard, the safer it can be without interventions for those who are vaccinated; however, it is critical to consider your own personal health circumstances. If there is no dashboard available, then, much like the court case mentioned previously, the best practice would be to wear masks.

We haven’t even talked about Long COVID, the chronic condition resulting from COVID-19. A condition that plagues asymptomatic and severely symptomatic alike, nor its impact on our public health system, but we’ll get there next time, in the next article: When the Economic Flywheel Isn’t Flying.

This series will take as long as needed. 

Read it for as long as you can/would like; I appreciate your ears/eyes and hope to also hear/read your considerations.