So, it’s March 31st and I was anticipating that by this time, we would be celebrating the beginning of the end of the pandemic. And while that may in fact be true, several pesky facts are spoiling the party. Cases and hospitalizations are going up in a slew of states, including Michigan and New York. A larger proportion of younger people are being hospitalized than in the earlier waves of illness. Evidence is mounting that the predominant strains of virus in many states are variants, including the B117 strain from the United Kingdom. Cases in our practice have suddenly spiked. The reproduction number of the virus or R value, which indicates the likelihood of future spread, is now greater than 1 in more than half the states, indicating a higher likelihood of community spread is coming. This number was below 1 in 49 out of 50 states a few weeks ago.
How can this be happening? We are vaccinating the hell out of everyone who will hold still to get a needle in their arm. People, by my observations, seem to be adhering to wearing masks and distancing about as much as they did earlier in the pandemic. States that have opened up and reduced restrictions don’t seem to be doing much worse than the states that have remained clamped down. What is going on? Another round of pandemic will devastate my bourbon supply which I was not planning to replenish until at least Thanksgiving.
Well, the short answer is, it is not clear what is happening. The most likely explanation is that this is a confluence of events. My suspicion is that we are now dealing with a nastier, more contagious form of the virus that does not respect our usual mitigation measures. The same precautions that slowed this down previously may not be working now. Cell phone data indicate that people are far more mobile than they were a year or even a month ago, which may be ginning up the spread as well.
If you add up the numbers of everyone who should be immune to the virus at this point, either by contracting the disease and recovering, or receiving a vaccination, you would think that it does not have many places left to set up shop. Over ninety million people in the US have received at least one shot of vaccine and likely 100 million people have been infected previously, making them poor hosts. There is overlap in these two groups, but it is a good assumption that 50-60% of the population in the US has functional immunity to the virus.
We can learn what might be happening by looking overseas. The United Kingdom and the European Union have roughly the same variant profile, with over 50% of cases likely to be caused by the UK variant. England has vaccinated close to 50% of the population to date and is seeing a plateau and reduction in cases. The EU currently has vaccinated 10% of their population and is having a surge in cases across the continent. Israel, which is approaching a 70% vaccination rate looks like they are seeing the end of the current pandemic.
The new improved coronavirus may not respect mitigation measures as much as our old friend from a year ago. But data as above suggest the vaccine is very effective against the new nuclear form of the virus. So, it is my personal belief that the only way out of this is to vaccinate, vaccinate, vaccinate. If you are questioning whether to get vaccinated, it’s time to come to Jesus (after all Easter is upon us) and get the damn thing. If you have to drive to Berlin or Waldorf or Westminster, who cares? Do it. Bring a ham sandwich and an Alman Brothers CD and hit the road. If you think the vaccine will make you infertile or grow a Unicorn spike, feel free to believe that. But get the vaccine anyway. Think of the attention you will get from the horn growing out of your forehead.
Moving on. Patients have been asking. “If I get the vaccine, can I still spread the virus?” The CDC has been reluctant to clarify this. A letter printed this week in the New England Journal, from the medical centers at University of California in Los Angeles and San Diego, sheds some light on this question.
The California Hospitals managed to vaccinate a high percentage of their 35,000 employees by the end of January. Concurrently, all employees, vaccinated or not, got weekly PCR tests for the coronavirus. After the vaccinations were complete, less than 1% of the employees tested positive for the virus on their weekly test, with a tendency of decreasing positivity as weeks since the completion of the vaccine accrued. This is a good indication that we will not transmit the current virus after vaccination.
So right now, the vaccine, and it doesn’t matter which one, is our little Easter Miracle. It is Baby Jesus, Baby Moses, and Buddha all wrapped into one. It is 100% effective at keeping you from getting sick enough to be hospitalized or dying from coronavirus. It is likely 99% effective at keeping you from spreading it to others. And it is free. It is the best deal of your lifetime and the length of your lifetime and mine may depend on getting it. So, if you come to the office and tell me you are ambivalent about getting it, I am going to give you endless, and I mean endless grief.
Our office will be closed for the Easter Holiday, this Friday. We hope all of you have a great holiday. If you and your loved ones have been vaccinated, and appropriate time has elapsed, you can party like it’s 1999. If you have not gotten the vaccine, stay home and make a TV dinner, and watch I Love Lucy reruns. Better days are ahead.