COVID-19 Update: July 30th, 2021

It feels heavy today, so if you need to wait to read it - please do.

Let's chat about break through infections, masking again, and viral shedding.

1. The CDC has not "changed their minds" about masking, they changed the guidance. That is not the same thing. The situation is fluid, therefore the guidance too must be rather fluid. To be fair, if I ruled the world (what a scary and yet exhilarating prospect) I too would have reinstituted masking. Honestly, I probably would have done it a week or so ago. The reasoning for reinstituting masking is built off of several things:

a. Viral shedding of the vaccinated. This is a thing and it is not a new thing. Remember the chat we had about three key functions of vaccinations. The first and most important job of a vaccine is to prevent serious illness and death. That is their purpose. Many of them also prevent mild to moderate illness. And finally a few, prevent the vaccinated person from shedding the disease. Some vaccines do this (prevent viral shedding) but many many do not. Polio is a great example of a vaccine does not prevent viral shedding of those who are vaccinated. New evidence seems to say that some, or all, of our vaccines do not prevent viral shedding. While we continue to study this, masking is smart.

b. Variants. If you are vaccinated, you received a vaccine built off of the original COVID. While they are still working against the variants, the vaccine wasn't designed specifically for the variants. So the effectiveness is lower. Still very good (about 84-86%) but eventually, the vaccines may fail if variants continue. The thing is, that day won't come with a big alarm bell. It will just happen. So taking some precautions, is wise.

c. Break through infections. You recall that some people will get vaccinated but never develop immunity. This is true of all vaccines and all natural exposure to a disease. A small percentage of people simply do not develop significant enough immunity to protect them. The only way to know if this you, is to be tested. So if you, and your friend are vaccinated - but your friend didn't develop immunity, they are still at risk, but they think they are protected.

Remember, the vaccines are not 100% effective. So even if you are vaccinated, you still have a small risk. The thing is, the vaccines are really really good at doing their job, preventing serious illness and death. Anything else they do is just the cream on top. Take the outbreak in Cape Cod as an example. Over 300 people who were fully vaccinated got sick with COVID. Here are the numbers from that outbreak, "Among the 469 cases in Massachusetts residents, 346 (74%) occurred in persons who were fully vaccinated; of these, 301 (87%) were male, with a median age of 42 years. Vaccine products received by persons experiencing breakthrough infections were Pfizer-BioNTech (159; 46%), Moderna (131; 38%), and Janssen (56; 16%)" But check this out, among persons with breakthrough infection, 274 (79%) reported signs or symptoms, (so they got sick) but only four were hospitalized and ZERO died. Zero. That is a vaccine doing its job.

d. Greater transmissibility of the virus. The Delta variant is more transmissible than the original version of COVID. It replicates in the body faster, causes illness sooner, and leads to more severe illness. I have seen estimates of 225% more transmissible up to 1,000% more transmissible. This is determined by the viral load of people known to have the variant. You may have seen the leaked story supposedly saying the Delta variant is as transmissible as the measles. I hope that is not correct because the measles is one of the most contagious diseases there is with an R0 of 18 - meaning for each person who gets the measles, they spread it to 18 other people. So let's hope that that leaked document has been taken out of context or is not correct.

e. Herd immunity. We have not reached it, we aren't even close. Just under 50% of the total US population has been fully vaccinated according to the last numbers I saw. When you go to the store and you look around you, are 50% of people wearing masks? Not in most places. In my area, maybe 5% are masking. So something about "if you are vaccinated you don't have to mask, but if you are not vaccinated you still should mask" didn't quite work out.

The facts are, our numbers are growing too quickly. We are headed into the fall and we are not positioned well. I have included a chart for your review. You can see that we are back up to about the same place we were in July of last year. We could be in for a very rough fall and winter.

FINAL THOUGHTS: Trust me when I tell you that I totally understand that no one wants to mask again. No one wants to distance. No one wants to "do" COVID anymore. I completely understand because I don't want to either. I want it to be over. I did all the things I should - I masked, I distanced, I stayed home, I vaccinated, I told my children "no" over and over and over. I don't want to do that again. None of it. I feel frustrated and exasperated and a little angry at this entire thing. School is about to start and decisions need to be made and a sense of dread is swooping in. So I get it.

But today, I sat at the pharmacy with my daughters while we did the 15 minutes post vaccine wait, and we chatted with a Vietnam Veteran who happened to be there too. He shared a small sliver of his story with me. A story that was heart breaking and beautiful and inspiring. He has shrapnel in his spine and little by little his body is failing him. He told me he was trying to maintain the use of his legs but everyday he lost a little bit more and a little bit more. And yet, he persisted. He knew he would eventually lose and end up in a wheelchair. But he wasn't there today. Today, with cane in hand, and a slow pace, he was walking. Not far, not fast, but he was walking. He shared stories of his life, fascinating stories of a man who had truly lived. Stories of love and loss. Stories of shame and fear. Stories of redemption and kindness and joy. But most of all, stories of hope. He had hope and joy despite the trials and challenges.

And so today, as we face what may be a very difficult fall - we walk together. We haven't lost to COVID. Perhaps one day we will, but this isn't that day. On this day, we persist. We muster our remaining hope. We dig deep and find our kindness. We take a deep breath and remind ourselves of all we have accomplished. Today, we harness those last fragments of humanity and cling tightly to them. Today, with cane in hand, at a slow pace, we walk together.

PS. I will be off the grid for a bit so if I am slow in responding just know it is because I don't have internet.