“I don’t want to live like this, but I don’t want to die”

From the song Harmony Hall, by Vampire Weekend

I heard this song over the weekend, and though the release of this music predated the pandemic, it pretty much sums up life over the last year. The good news is that we likely will not have to “live like this” for much longer. Almost 250 million vaccines have been administered in the US, and of these 100 million people are fully vaccinated. There is of course, bad news, which is that of the remaining unvaccinated population, some have no intention of getting the vaccine. Recent polling suggests that 18% of the adult population votes “Maybe” on the vaccine, that is, they are considering getting it.

Twenty two percent are an absolute “No” on the vaccine and will not likely be convinced. These numbers do not reflect the unvaccinated population of children under 16 who are not yet eligible for the vaccine.

“Vaccine hesitancy” is a term which describes several distinct groups of people who do not plan on getting the vaccine, at least any time soon. There is a group that is suspicious of the vaccine, possibly because they feel like guinea pigs taking a vaccine that was developed rather quickly. There is another group that is sure that they do not need the vaccine because they are young and healthy, and after all have never gotten the flu, so why worry about Covid. There is a group that is concerned that a conspiracy is under way; Bill Gates probably put a microchip in the vaccine to make them buy more Microsoft products or some such nonsense.

If any of you are in one of the above groups, let me try to appeal to your altruistic impulses. The vaccine is not just about you, it’s about everyone else on the planet. When you are vaccinated, you become a “dead end host” for the virus. If you are exposed to the virus when you are vaccinated, it cannot move on and be transmitted to anyone else. You are doing your part to end the pandemic, not just protect yourself. So take one for the team.

So how does this all shake out over the next few months? Most experts believe that we are in for a good summer. Vaccinations will continue but will slow down as demand ebbs. Warm weather and outdoor gatherings tend to leave the coronavirus high and dry, as it did last summer. It is likely, that by the middle of the summer, we will see only double-digit cases per day in Maryland, and very few deaths from Covid. The behavior of the virus in the fall is entirely dependent on the penetration of the vaccine into the Maybe and No Way portion of the population. It is also dependent on the vaccination of children, who are going back to school, even if it means certain death.  (Parents have had enough). It is impossible to imagine, with the backstop of a large percentage of the population vaccinated, that we will see a surge of cases in the fall and winter like in 2020. But we will likely see some increase in cases after Thanksgiving.

So, what does this mean to you? If you have not ventured out to get the vaccine, it’s time to get the Cadillac out of the garage and drive to your local drugstore. Chances are, you won’t even have to wait. Doses, as predicted, are now in abundance. It’s like a catered outdoor wedding that was suddenly rained out – there are plenty of extra doses waiting, like soggy crab balls and pigs in the blanket sitting in aluminum tins. You can take your pick.

Which brings us to the Johnson and Johnson affair. Most of you have heard that the J&J vaccine was “paused” for about 10 days and then reinstated with the warning that it may cause unusual blood clots. The blood clots were rare, (about 15 cases reported out of 7 million doses) but were dangerous. All occurred in central veins in the brain. (Believe me, you would rather have one in your leg.)  So far, the reporting suggests that all of the cases occurred in young women, under age 50. This would imply that estrogen may be playing a role, but this is still unknown.

Should you get the J&J vaccine? If you lived in a country where it was the only choice, I would say yes. The benefits clearly outweigh the risks. But in the United States you can have it your way, even at the Burger King. I would opt for either of the other two approved vaccines from Pfizer or Moderna. The track records of these vaccines locally and worldwide suggest they are safer and more effective. In my opinion, I would not advise young women to get the J&J vaccine, even if it means waiting for one of the other two. (The CDC has not made this recommendation, so keep in mind this is only my opinion.)

And what about the rest of the world? For any of you who planned a trip to India or Brazil this summer, the above ground pool in the backyard with a floating pink flamingo is a better bet. Due to crowded living conditions, lack of vaccine availability, emergence of variants, and in the case of Brazil poor governance, many unnecessary deaths will occur in these countries, where medical facilities are filled to capacity. For any of you who still believe that we overreacted to this sucker, take a look at the scenes outside of hospitals in India, where people are dying waiting for treatment.

There is concern that the rapidly propagating virus in the developing world will lead to rapidly emerging variants that will evade the vaccine. This would suggest that as we achieve herd immunity in the US, travel bans should be put in place to avoid new more dangerous variants circulating here. But maybe not. Dr. Scott Gottlieb, who has been on target on his predictions for the progression of the pandemic, had this to say on CBS Face the Nation today:

“You’re getting what we call convergent evolution with the same mutations that are arising in other parts of the world are also arising here spontaneously. There’s probably a finite number of ways that this virus is going to try to mutate to evade our immunity. And it’s testing us everywhere in the world. So the same mutations that are arising in other parts of the world are arising here as well. They just haven’t gotten a foothold here, in part because we’ve been vaccinating our public.”

So it’s possible that travel restrictions will not be helpful, because the virus may be mutating here the same way it is mutating everywhere. We will learn more about this in the coming months.

And finally, on May 2, 2001, I saw the first patient in my new practice, then located on Ritchie Highway. Two decades have elapsed since then, and during that time events changed the world: 9/11, wars in the Middle East, Anthrax, the Washington Sniper, the first African American President, the iPhone, the Great Recession, the Trump years, (no comment) and of course, the Jonas Brothers. Looking back, I have occasionally provided some important medical advice to my patients, but what stands out is the camaraderie, the laughter, the dedication of our great staff, and all that I have learned about medicine and life from each of you. Thanks, sincerely.

And get vaccinated, really.