There is a radical difference in how the 4th wave of Covid is being experienced—between those with immunity vs. those without immunity.
1. Those without immunity are 20 times more likely to get Covid (using the statistic that the vaccines are 95% effective)
But 20 times is very conservative. Only about 0.1% of the people who have been vaccinated in the U.S, have had a symptomatic breakthrough case of Covid. Very few of those who have had Covid are being reinfected, so most all the cases in June and July occurred among those without immunity.
2. Those without immunity are about 100 times more likely to have a really serious illness when they get Covid, compared to a similar population.
An Associated Press analysis from May suggested that “breakthrough” infections in fully vaccinated people accounted for fewer than 1,200 of the more than 107,000 COVID-19 hospitalizations. That’s about 1.1%. During this time period, about half of the adults in the U.S. were fully vaccinated, so these two numbers come from roughly equal population size groups. If you included those with immunity from having Covid in the numbers, the dangers to those with no immunity would be much higher.
3. Those without immunity who are relatively healthy are many hundreds of times more likely to die from Covid than a similar population who have immunity.
Only about 150 of the more than 18,000 COVID-19 deaths in May occurred among vaccinated people, about 0.8% of all Covid deaths. But almost all those 150 had compromised immune systems before they were vaccinated. An exact analysis of the health of these 150 is not available, but it is clear that a person who is relatively healthy has almost no chance of dying from Covid after full immunity. Those who are unvaccinated and have not already had Covid are perhaps 1000 times more likely to die of Covid than a person with immunity who does not have a compromised immune system. Just one small example: In Tennessee in June, there were 130 deaths from Covid among the unvaccinated. There were none, zero, among the vaccinated.
The good news
The above estimates are not exact, of course. There are too many variables to be precise. Nonetheless, they are in the ballpark. The most dramatic and obvious observation about Covid today is that those without immunity are driving this new outbreak. The numbers of new cases among the vaccinated and those who already have had Covid are dramatically below the threshold that would cause an outbreak, so this wave is caused entirely by the large number who have no immunity.
It did not have to be this way. If more people had been vaccinated when they had the chance, this 4th wave would not have taken hold. “There is a clear message that is coming through,” said CDC director Dr. Rochelle Walensky, “This is becoming a pandemic of the unvaccinated.”
The good news is that the main vaccines used in the U.S. are quite effective, even against the new Delta variant. They might not be as effective as they were against the original Covid viruses, but they are quite effective against Delta. The bad news is that not enough people have immunity. Of those over 12 years of age in the U.S., 58% are fully vaccinated. Approximately 100 million have probably had Covid and acquired immunity in that way. There is a great deal of overlap in these groups, of course, so perhaps 67% in the United Sates have immunity now. We are close to reaching herd immunity.
But we were not close enough at the beginning of July to stop the current outbreak. The reason is made vividly clear by the fact that the outbreaks are mostly in places that have the lowest vaccination rates. As a result, millions of people are getting sick, tens of thousands are being hospitalized, many will have long-term Covid, and thousands more will die. This wave will not be as bad as the last, and it will subside as more people are vaccinated and as millions more suffer through the disease. But this combination of new immunities from vaccines and from having Covid suggests this wave will pass over us in a couple of months.
Vaccination versus having Covid
Most all the studies being done today compare results between vaccinated and unvaccinated populations, such as the ones cited above. But immunity can be acquired either by having the Covid virus or through vaccination, and the degree of immunity seems to be roughly the same. And, dramatically important, both kinds of immunity are preventing serious illness from new infections.
This means that to truly understand the dangers those who have no immunity face, we need to recognize that perhaps half of those in the “unvaccinated” category have immunity from having had Covid. This suggests that the dangers of not being vaccinated—if you have not had Covid—are much greater than they seem. You are perhaps in twice the danger most studies show if you have no immunity, because the studies do not account for the immunity provided by having had Covid.
We do not know the exact differences in immunity provided by vaccination versus having had Covid, and we do not know how long either immunity will last. But immunity for this kind of disease often fades over time, and this is a crucial question to be answered. One recent study, however, suggested that a single dose of either the Pfizer or Moderna vaccine a few months after having had Covid boosted immunity to 99% against further infection. Since there does not seem to be any serious downside from getting one of these vaccines if you have had Covid, and there is reason to believe the increased immunity will last longer—this is a very good argument for getting at least one dose of a Pfizer or Moderna a few months after having had Covid.
If you do not know for sure if you have had Covid, and have not been vaccinated, the message in vividly clear: Get the test to see if you have had Covid. If you have not, get the vaccine as soon as possible. Otherwise, you are in serious danger.
(The situation is different for those under 12 years old. There is much less evidence concerning the vaccines with this age group. Plus, when they do get Covid, they seldom get very sick. Then they have immunity. Whether parents should have children vaccinated at this point is an open question.)
Who should sacrifice?
Even after this 4th wave has passed, we will not be free from Covid. It will be with us for years. The crucial issue, then, is how to escape the fear-based communal life many have been living. In considering this question, it is important to realize that Covid is no more dangerous than the flu for those who have immunity. Those who have a compromised immune system have greater risk from Covid than the average healthy person, even if vaccinated, but this is also true of every other disease.
As with every pandemic in human history involving a highly contagious disease, this one will end with herd immunity. The difference this time is that effective vaccines have been created fast enough to become a major factor in ending the initial ravages of the disease. But this does not change how the pandemic will end—the fierce outbreaks will end in each country when enough people have immunity.
The least destructive way for this to happen is that a high enough percentage of people will be vaccinated to provide the tipping point. The other alternative is that, over the next year or two, a lot more of the unvaccinated will become infected with Covid and acquire immunity that way. The problem with this path is that many more people will die, many more will be hospitalized, and many more will have long-term Covid.
The other dramatic consequence of waiting for a sufficient number of the unvaccinated to have the disease and acquire immunity in that way is that those who have tried to do their part by being vaccinated are having to make new sacrifices because others are refusing to do what they can to protect their neighbors. Events are being cancelled, businesses are beginning to suffer again, jobs are being lost, and lots of people are having to reconsider visits with elderly and sick loved ones—because of the refusal of so many to be vaccinated.
We must work together
To live in a community means one must take actions to help make the community successful. Being vaccinated for Covid is one of those actions. It should not be required by the government, but many organizations can and should do their part to protect employees, customers, their families, the elderly, and the health-compromised among us.
Further, it is wrong to penalize those who have been vaccinated, and limiting their activities does just that. Forcing them to wear masks is not only unfair, but unwise. There is little to no evidence that this pandemic will be affected by requiring those who have been vaccinated to wear masks. It is possible for the vaccinated to spread Covid, but it is rare. As Dr. Leana S. Wen, the former Public Health Commissioner for the City of Baltimore, wrote recently: “The vaccinated are not a major source of spread. Even if every vaccinated person puts on a mask, that’s not going to solve things when the vast majority of transmission is by the unvaccinated.”
Yet mandatory masks are being reintroduced in some areas. Dr. Wen says this is because health experts “want to get the unvaccinated to put on masks in indoor spaces.” They are using indoor mask mandates for everyone “not because the vaccinated are suddenly a problem, but because we don’t trust the unvaccinated to voluntarily do the right thing. It’s not a commentary about the effectiveness of the vaccine, or even the trickiness of the delta variant, but rather about the failure of unvaccinated Americans to fulfill their societal obligation to act in the interest of everyone’s health.”
Mask mandates will not stop this 4th wave. Rebellions against mask wearing were widespread months ago. If new mask mandates are put into place, the vaccinated are the ones who will wear them, while many of the unvaccinated will not—so the disease will keep spreading. It is only those who are unvaccinated that need to wear masks, yet there is no way to check to see who is vaccinated in most public situations, so if masks are required in a widespread way, it will be mostly the vaccinated who wear them. Is this fair, or even wise?
If you have not been vaccinated, put yourself in the place of those who did not want to be vaccinated but did so anyway—to do their part to protect others. Imagine their feelings if they are required to close their businesses or have fewer customers because of vaccine holdouts. Imagine the feelings of those who are having events they were looking forward to cancelled, or visits with elderly loved ones prevented because of this outbreak among unvaccinated people.
We should not be severely limiting the freedom of those who have been vaccinated, asking them once again to stop their normal lives because some of their neighbors are not willing to do their part to stop this pandemic. That is like a group of people declaring they do not recognize speed limits and driving any speed they like whenever they like. They might kill themselves, but they will also kill and injure a lot of innocent people. In a pandemic, getting a vaccine is like obeying speed limits agreed upon by the communal processes in the place one lives.
Comparing dangers
Of course, some people who get vaccinated for Covid do have problems with the vaccine. This is true for any medication. But the Pfizer and Moderna vaccines are turning out to be the safest vaccines ever developed. And they have had the biggest trial in human history—almost 4 billion doses of all vaccines have been given, with well over a billion of Pfizer and Moderna. And the serious side effects have been amazingly small for those two vaccines.
More than 340 million doses of those vaccines have been administered in the U.S. alone, and there have been only 674 reports of Myocarditis and pericarditis (0.000005 percent). Crucially, some of these would have happened to those same people if they had not taken the vaccine (there is no way to know that number, except by percentages, and it is too early to make that calculation). But of great importance, almost all recovered.
There have also been several hundred reports of severe allergic reactions to these vaccines, but rapid medical intervention has mitigated almost all these reactions quickly, with no lasting negative consequences.
Looking at the overall picture, the number of deaths among those receiving those two vaccines is almost exactly the same as would have been expected among the same population in a similar time period in a normal year. In stark contrast, the number of deaths among the unvaccinated in the U.S. during the Covid pandemic is approaching 800,000 (the excess mortality calculation).
As the 4th wave rolls on, and as Covid percolates through the population in coming years, there will be many more excess deaths among the unvaccinated—and almost none among the vaccinated. The vaccines have the potential to save many lives. Well over 99% of the deaths from Covid are now occurring among the unvaccinated and those with compromised immune systems. Crucially, deaths among the vaccinated are not enough to increase the number beyond that which would be expected in a normal year among that population. In other words, excess mortality is not increasing among the vaccinated.
We do not know, of course, the long-term risks of the vaccines, but the exact same thing is true for the long-term effects of having Covid. All we have to go on now is a year and a half of results for Covid and 8 months for the vaccines. In this time period, the long-term risks are dramatically in favor of vaccines. Getting sick with Covid is, so far, 1000 times more likely to cause long term problems than taking the Pfizer or Moderna vaccines. Those are pretty good odds.
Could more problems with the vaccines show up later? Sure, but the same is true for all those who will get Covid. The evidence suggests that the dangers from long-term problems from Covid are dramatically greater than from being vaccinated. Comparing what we know about the small likelihood of long-term reactions to the vaccines to the certain fact that millions of people who do not get vaccinated will have long-term Covid—which might last for years—any risk analysis comes out highly in favor of being vaccinated.
More about the odds
More than 630,000 people have died from Covid in the United States alone, and perhaps as many as 10 million have had lingering symptoms that could turn into long-term Covid. If only 25 percent of those over 12 without immunity get Covid in the next 2 years, that will mean perhaps 100,000 more deaths, and a million cases of long-term Covid. If you do not have immunity, your odds right now of getting very sick from Covid are perhaps 5%, and of dying from Covid, around 1%. In comparison, the odds of getting really sick from a vaccine are almost zero, and of dying from the Pfizer or Moderna vaccines, zero.
There have three deaths linked to blood clots after people got the J&J vaccine. But none with Pfizer or Moderna. 6,207 people who received one of those vaccines have died, but those deaths, upon investigation, were due to other causes. Crucially, 6,207 is almost exactly the number of deaths that would have been expected in this population without the Covid pandemic. In other words, this is the number of expected deaths from other causes in this population—so there have been no excess deaths among the vaccinated. In comparison, among unvaccinated people in the U.S., there have been almost 800,000 excess deaths—that many more deaths than would be expected without Covid.
The big picture
Covid will be with us for years. Once a pandemic gets established, if it is highly contagious (as this one is), it will be present in the world and infecting people for a long time. Crucially, each new infection serves as a breeding ground for a new variant that could be resistant to the vaccines and end up killing millions more.
Thus, our country and the world are in the midst of a dire crises. One recent estimate is that almost 8 million have died worldwide from Covid. Thousands more are dying each day. With every new infection, the risk of a new variant goes up, and one of those new variants might be more deadly, and the next one might even be totally resistant to the current vaccines. Any person who has not had Covid and does not get vaccinated is like a soldier on the battlefield who decides to go to a bar when assigned to guard the perimeter against an enemy sneak attack. That soldier is giving a deadly enemy a good opportunity to get behind the lines.
What is effective?
Another issue as the current wave crosses this country is deciding which strategies are effective in mitigating Covid.
Very effective:
Vaccines, especially Pfizer and Moderna
Effective:
Social distancing
Staying out of crowded indoor spaces
Spending time outdoors and in well-ventilated spaces
Practicing personal hygiene
Those who have any symptoms of a cold, flu, or Covid staying away from other people
If someone has any symptoms at all, and must interact with others, wear a mask
Minor effectiveness:
Wearing a mask to protect yourself if you are vaccinated, except if you are forced into a crowded room or have to interact with someone who is sick, then masks are worthwhile
Little effectiveness:
Wearing a mask outdoors, in uncrowded spaces, or when interacting with those who are vaccinated or have recovered from Covid
What we don’t know
I come to the above conclusions from reading many reports and articles, and from following the outliers in dealing with the pandemic. For instance:
Sweden was widely condemned because they did not require masks, and instead of mandates, used thoughtful, self-selected social distancing. Their schools mostly remained open throughout the pandemic, as did their businesses. They maintained their economy and their way of life better than most any other country. They have not had the societal problems many other countries have had.
Belgium had a very strict mask policy for a long time, and they shut down more than most countries in Europe.
United States The response varied all over the country, but was, on average, more strict than Sweden, but less than Belgium.
Consider, then, as of August 1, 2021, the number of deaths attributed to Covid-19:
Deaths from Covid per 100,000 people:
Belgium 217
U.S. 189
Sweden 144
Another important factor: In some countries death is more likely to be attributed to Covid than in others. Some deaths in the elderly and sick would have occurred soon in any case. Further, there have been numerous deaths in some countries that have been caused by the measures taken to prevent Covid, whereas in others there have been few. This means that “excess deaths” is an important indicator for deciding which countries found the best approach. Here are the numbers of those who have died from all causes in excess of the number that would have been expected to die during the same time frame without Covid:
Excess Deaths per 100,000 people since Covid began—as of late June 2021:
U.S. 218
Belgium 168
Sweden 98
A final factor to note is that Sweden in not suffering a 4th wave of Covid at this point, as are the United States and Belgium, so Sweden’s position in terms of having better death outcomes will improve in the coming months.
Another set of numbers to consider are the differences between states. Connecticut has had one of the most severe mask and shutdown policies, and Florida one of the loosest. Tennessee was in-between. Consider these numbers as of August 1, 2021:
Deaths from Covid per 100,000 people:
Connecticut 233
Tennessee 187
Florida 182
Conclusions
The main conclusions I draw from all this is that we don’t know that much about how to prevent the spread of Covid, except the flood of evidence that vaccinations work, especially the Pfizer and Moderna vaccines.
This pandemic will end when enough people have immunity, either through vaccination or having had Covid. The amount of additional suffering and death we will go through until that time depends on whether those without immunity do their part.
After herd immunity has been reached, we will have to learn to live with Covid just as we have learned to live with the flu and other diseases. Here are some questions to be answered:
How long does immunity last from each vaccine, and from having had Covid? (There is some new evidence coming in that immunity might not last as long as was hoped.)
Which leads to—when is another dose of a vaccine advisable?
How do we prepare for the possibility of a vaccine resistance variant?
How long will it take to end the pandemic in other parts of the world? (To do so is in everyone’s’ vital intertest, for as long as this disease is rampant anywhere in the world, it will continue to blow back on all.)
One thing is clear: we must return to a less fear-based way of living as soon as possible, and this will not happen because there is no danger from Covid. We will probably never be 100% safe from Covid. But life isn’t !00% safe. If you stay away from other people completely and wear a mask the rest of your life if you get within 10 feet of others, you will probably never have another cold, the flu, or Covid. But this is not the way I choose to live. If your life is about safety only, you will never get in another automobile or airplane.
Today, if you have been vaccinated and do not have a compromised immune system, Covid is no more dangerous than the flu, or riding in a car. Staying away from those who have been vaccinated or who have recovered from Covid is not the way forward. We will have Covid with us for years, so we need to return to a life that is not consumed with safety. Vaccinations are the way to do that. We need to encourage everyone without immunity to be vaccinated, and reward those who do.
To close with the good news again. We have the means at hand to end this pandemic, both in the United States and in the world. It only requires that each person who is unvaccinated and has not had Covid do their part to protect us all. Plus, it requires that the wealthier nations make the vaccines available as quickly as possible to the poorer ones who need it most. Unlike many problems in our world, we now have the means to solve this one. Let’s do it!
And let’s all begin to find
an improved life together
in this fragile world.
David
P.S. I just read this article by Andrew Sullivan on his Weekly Dish platform:
Some excepts:
Do we really want to get back to living? I do. So, take the rational precautions—a solid vaccine—and go about your business as you always did. Yes, I’ll wear a mask indoors if I’m legally required or politely asked. But I don’t really see why anyone should. In a free society, once everyone has access to a vaccine that overwhelmingly prevents serious sickness and death, there is no reason to enforce lockdowns again, or mask mandates, or social distancing any longer. In fact, there’s every reason not to.
We are at a stage in this pandemic when we are trying to persuade the hold-outs to get vaccinated. How do we best do this? Coercion is not an option in a free country. Forcing all the responsible people to go back to constraining their everyday lives for the sake of the vaccine-averse is both unfair and actually weakens the incentive to get a vaccine.
Mounting sickness and rising deaths will concentrate the minds of among the recalcitrant. Let reality persuade the delusional and deranged. It has a pretty solid record of doing just that.
The government cannot be held responsible for sickness and death it has already provided the means to avoid. People are responsible for their own lives. The most potent incentive for vaccination will be a sharp rise in mortality rates. The more people who know someone who has suffered and died the likelier they will see the logic of taking measures to avoid the same fate. In other words: if people recklessly refuse to face reality, their bluff will be called.
The one silver lining of plagues in the past is that, at some point, they blew themselves out by creating herd immunity. Now that we have several vaccines, and can adjust them from time to time, and the healthcare system is not on the verge of collapse, the logic for lockdowns and masking has completely disappeared.
Living with a virus—rather than defeating it—is not emotionally satisfying. It does not, in our minds, remove the threat. But the truth is: humans have no choice but to live with viruses. We always have.
These viruses challenge the psyche, and the trick, it seems to me, is not to deny their power and danger, but to see past them to the real goal: the living of your life. If you are not careful, this one viral threat can crowd out all other perspectives, distort your judgment of risk, and cause you to be paralyzed by excessive caution and fear. But defeating a virus often does mean living with it. We already do this with the flu. There’s no reason we can’t do it with Covid as well.
Those who live in denial, who have somehow convinced themselves that the virus is a hoax or a deep-state plot or a function of white supremacy or whatever, will experience what everyone in denial eventually experiences: reality. And reality is the most tenacious influencer I know.