I’m going to give the conclusion to this diary at the start, and then work my way through the reasons. The conclusion is simple:
Vaccinations must be “mandated” (more on that later) STAT.
I can’t describe how demoralizing and depressing watching the news every morning actually is for me. I suspect it’s the same for many others — and what makes it especially frustrating is knowing that the decisions being made and the information being communicated by this administration is adding fuel to the fire.
Let’s get out of the way the fact that the vaccine rollout was masterful — it was. I imagine I would be even more impressed with that rollout if I had been a fly on the wall for what Biden and his team inherited from TFG. But the glow of that competence wore off for me months ago. Below are my observations about where we’ve screwed this up and what needs to happen.
Ludicrous masking guideline rollbacks
It started on May 13th 2021 when the CDC issued guidance that fully vaccinated persons could largely stop masking in indoor public spaces. WTF? I have commented on this ad nauseum ad infitum here on Daily Kos, but mainly from the perspective of encouraging even the vaccinated to continue masking in indoor public spaces. I’m going to take a different approach to this here, however
I remembered first reading about the rise of Delta globally on April 2nd via the UK’s Wales NHS website. The first reporting on Delta occurred as far back as October 2020 based on alarming data coming out of India. The WHO declared Delta a variant of concern (VOC) on May 31st 2021. The CDC only followed suit a little more than two weeks later on June 15th 2021. A 16-day lag may not seem that substantial out of context, but think about how quickly Delta has overtaken infections here in the US, exponentially overtaking all other strains.
You can see the US there. But more instructive: Look at the lines for the other countries that saw an exponential rise in infections due to Delta. India started its devastating rise back in February. The UK started its rise in April. What has happened here in the US was foreseeable, predictable, and — most important — preventable. The CDC issued its ludicrous revised May guidelines with all the information they needed to know that a) Delta was bad; b) Delta was already bad in other countries before the CDC issued the revised May guidelines, and c) that it was just a matter of time before the US followed the trajectory of India and the UK (it did). I’m having a difficult time excusing not only that guidance — which was foolish — but also the revised guidance. More on that below.
CDC’s revised masking guidance
Just last week, the CDC issued updated masking and public health guidance in the face of the (entirely predictable) rise of the Delta variant. My general overall impression of this revision was that it was entirely too soft. But my blood started boiling again when I saw this:
Wear a mask in public indoor settings if they are in an area of substantial or high transmission.
Let’s set aside that finding the definition of “substantial” (50 to 100 cases per 100K or positivity rate of 8% and 10%) and “high” (100 or more cases per 100K or positivity rate of 10% or higher) was ridiculously difficult for a moment. Here’s what the “heat map” from the CDC’s link in the quote above says today:
Basically, if you’re red or orange, the CDC says to consider returning to masking indoors for all persons regardless of vaccination status. If you’re seeing what I’m seeing above, it’s a sea of red/orange in the US. Also (I can’t believe I have to point this out, but we are where we are), last time I checked, if you live in a substantial or high transmission area, you are NOT precluded from traveling outside of that area. So all the red people — even those who are vaccinated since studies show vaccinated people carry the same viral load of Delta as unvaccinated people — are all “Pandemic’s over!” and travelling and spreading around the country. It’s stupid guidance, it’s weak, and I predict that in two week’s time (if we’re lucky), we’re barely going to be able to pick out non-red and non-orange areas of that map.
Let’s look at the heat map for Virginia, by way of example:
That little yellow area outlined in gray is my county. Note that it’s surrounded by orange counties that are almost completely surrounded by red counties. How long do you think my county will remain yellow? Yeah. Not long. If we wanted to stay yellow or even improve to blue, we should ALL be masking in indoor public spaces at a minimum no exceptions.
“70% of people with at least one shot”
As I’ve been typing this, I’ve literally heard the news report that we’ve finally achieved Biden’s “70% of people with at least one shot” milestone. I mean… Yay? I’ll cut the administration a bit of slack here in that that goal was set in late January/early February and, at the time, it was a good goal but ONLY if other more contagious and virulent strains didn’t arise. The reality is that one shot of either of the mRNA vaccines is not enough when confronted with Delta. Even if inadvertently, the administration reinforced in the public psyche the idea that one shot was “good enough”. It’s not. Stop reinforcing the idea that it is.
Another argument I have with this is that the language here is carefully curated. From the linked CDC website above, that 70% figure is of adults with at least one shot. If you factor in all vaccine eligible persons (aged 12+) , the figure is 67.9%. If you factor in ALL persons, the figure is 57.8%. Last time I checked, children under 12 are still people and count towards the goal of herd immunity (more on THAT in a moment). The point being, continuing to report on this carefully defined and articulated magical 70% has lead to a dangerous and foolish false sense of security.
[Just as an aside to what I’m ranting about in this section, the percentage of fully vaccinated persons as a percentage of the total population is 49.7%. Abysmal.]
About that herd immunity thing… I’m not going to misrepresent the concept of herd immunity here as a simple thing. LOTS of factors go into trying to estimate that magical goal. But let me try to give an example here. The simplest calculation of herd immunity is as follows:
1 — (1/R0)
You don’t have to be particularly good at math to understand that the R0 (r-naught), the reproductive rate of any virus against which you are trying to achieve herd immunity, is pretty critical here. For the sake of comparison, let’s track the various R0 values for each of the major COVID-19 outbreaks:
- Original Wuhan strain: 2.4 — 2.6
- Alpha strain: 4.0 — 5.0
- Delta strain: 5.0 — 8.0
(source)
Now — let’s do math! Here’s what the simple formula for herd immunity yields for each strain:
- Original Wuhan strain: 58.3% — 61.5%
- Alpha strain: 75% — 80%
- Delta strain: 80% — 87.5%
Important to note: although it’s difficult to discern, I believe the R0 figures provided for each strain above was the reproductive rate with no mitigation (i.e., no vaccines, masking, social distancing etc.). Also interesting to note — the R0 for smallpox was 3.5% — 4.5% in the 1970s. Delta is more contagious than smallpox, FFS.
So a few things about this. Even with good intentions, a 70% vaccination figure was always meaningless. I mean — it’s good to have goals, but based on what we knew about alpha, the dominant US variant at the time the whole 70% thing arose, it was woefully below threshold. Thanks to the administration’s desire to offer a “you can drop your masks!” carrot to a population largely unswayed by the carrot, we are now looking at a higher herd immunity percentage needed to finally bring this shit to heel. Bonus points for managing to also piss off many of the vaccinated as we lurch from crisis to crisis. Jesus.
”This is a pandemic of the unvaccinated”
NO. Stop saying that. You stop it, the news needs to stop it, and certainly the administration needs to stop it. Is it largely the unvaccinated that are disproportionately affected by severe disease right now? Yes. But see — that’s the funny thing about viruses. The concept of natural selection applies here, but not to the humans. It applies to the virus.
COVID-19 is a coronavirus. Coronaviruses are RNA viruses. As RNA viruses, they are less stable and more prone to mutation. As an example, the seasonal flu virus is also an RNA virus, and as we all know, it mutates requiring an updated seasonal flu shot each year. Some viruses mutate and become less deadly, and some do so and become more deadly. It’s too early here in the US to evaluate the totality of Delta’s real life effects — i.e., is it more deadly or simply more contagious? What we DO know is that high levels of transmission and infection dramatically increase the probability of virus mutation, which is also correlated (at least at this time) to lowered overall vaccine efficacy.
Those of you who can think back to the ancient history of late last calendar year remember all the data and figures showing the high efficacy of the two mRNA vaccines against the original and alpha COVID strains even with only one dose. Yet a recent study has documented the erosion of that efficacy with the Delta variant. It drops first-dose effectiveness to 30.7%. For fully vaccinated persons with either of the mRNA vaccines, efficacy went from 95% to 88% of contracting any kind of symptomatic COVID as of the authoring of the study itself.
So yes — right now, the majority of severe COVID are among the unvaccinated. But the incidences of fully vaccinated persons winding up in the hospital is increasing, and as this shit rages on through the slightly over 50% of US persons who are unvaccinated, expect to see those hospitalizations go up.
And frankly — accuracy matters. Transparency matters. Giving accurate information matters. We just lived through four years of misinformation, and I’m not suggesting that that’s what the Biden administration is doing, that it’s their intent, but honestly, the end result is the same. It’s confusion, and confusion breeds opportunity for the GQP and its mouthpieces to foment even more doubt about the vaccines.
My final entry in “shit the administration has mishandled is as follows:
Social science and public health are inextricably intertwined.
Biden et al can’t “carrot” their way out of the cycle of badness we are in. I truly believe — with the best of intentions — that Biden believed that the “drop your masks if you’re fully vaccinated” thing would encourage more people to get vaccinated. And on the margins, that may be the case. But the margins were not enough to prevent what we’re seeing right now, and certainly won’t be enough to help us get out of it. We just barely fell over the line of 70% of adults with 1 dose of vaccine today. When we hit July 4th, the original aspirational date for that threshold (and we’ve established that the threshold was largely mental, rather than anything that would have a substantive impact on public health), 67% of American adults had one dose of vaccine, and 47% of adults had been fully vaccinated (source). That means that in the past month, we have increased the percentage of fully vaccinated people by 2.7% to 49.7% as of this week.
We should embrace ANY increase in full vaccination rate, but this is nowhere near what’s needed. Those who are disposed to get vaccinated aren’t being convinced by carrots — and this is having the opposite effect of essentially pissing off the vaccinated people. Even worse — if our minimum herd immunity threshold for Delta as it currently exists is 80%, it’s going to take another eleven months at the current full vaccination rate of increase to get us over the line. Remember where we were last September? That was 11 months ago. Now think about what new level of nastiness might emerge in the next 11 months.
The people who will continue to refuse to get vaccinated are numerous enough to deny us even the lower threshold of herd immunity as it stands today. No carrot is going to get them there, and our leadership needs to stop fooling themselves into thinking that it will. We are WAY past the time where we need to wield the stick.
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Ok. So that was a whole bunch of bummer shoved in your face through many paragraphs, links and a lot of words. So let’s return to where I started this diary, with the conclusion:
Vaccinations must be “mandated”
I put “mandated” in quotes for a reason. Do I think on sheer manpower alone that we have what we need to dispatch an army of vaccinators out there to physically force people to get vaccinated? No, I don’t. But Biden and the Federal government can implement policies that effectively bar the willfully unvaccinated (those without a valid medical reason for not receiving the vaccine) from every meaningful life activity like working, shopping, or going anywhere around others who are not their immediate family.
He’s taken a half-step there with the idea that Federal workers either get vaccinated to return to the office OR undergo as-yet undefined testing protocols. Although this is strictly anecdotal, I am a Federal contractor and I can tell you that my clients would do a happy dance for any excuse not to have to return to their offices. The half-step isn’t going to get us where we need to be. So here are my ideas — I’m sure there are many more good recommendations, but these are mine.
1. Biden needs to mandate the vaccine for anyone returning to a Federal office. AND he needs to mandate a return to the office for all Federal workers. AND he needs to require this of any contractor entering a Federal facility. The Feds can still have flexible work schedules, but they can require 1-2 days in the office to maintain employment (which is what they did in even the most flexible Federal office environments) and that to meet those mandatory in-office days, you have to be vaccinated.
2. Biden needs to mandate the same for visitors to Federal facilities. This includes all national parks and any facility/service controlled by the Federal government. This would include getting on airplanes.
3. Biden/Democrats need to provide incentives to businesses for creating a “vaccinated workplace”. It could be a tax incentive, frankly, that provides substantial incentives for businesses that make vaccination a term of getting hired or maintaining employment. This could be bifurcated, with tax incentives to large businesses and/or grants to small businesses to accomplish the goal. This could be further segmented for public-facing businesses who guarantee that patrons are vaccinated.
4. Settle on and fund a definitive vaccine passport app. A whole bunch of these already exist. The administration needs to give these apps the hooks they need to a definitive data source to easily verify vaccination status. The vaccine cards aren’t going to suffice — they are easily faked.
5. Get tough with states. Pass a law that says municipalities can’t mandate mask wearing in schools (for example)? Say goodbye to your education grants. Pass a law that says municipalities can’t issue masking requirements? Say goodbye to your public health funding. Pass a law that says businesses can’t require proof of vaccination (the Florida ban against cruise lines requiring proof of vaccination comes to mind)? Say goodbye to your transportation funding. The point is — there are MANY lucrative levers that the Federal government can pull to pressure states into compliance.
6. Start working with health insurance providers now. I’d like to think this is already happening — but the administration can pave the way for insurance providers to treat the unvaccinated the same way they treat smokers, for example. You pay a higher premium if you’re a smoker, and in some cases, you can be denied treatment for smoking-related diseases. This would have the side-benefit of also further incentivizing those businesses that provide healthcare benefits to also require vaccination. Talent acquisition and retention is key to competitiveness among businesses, and benefits are a big component of that. Guaranteeing a vaccinated workplace and workforce will enable businesses to lower their premiums and provide better comprehensive health benefits. This would also apply to individuals who don’t get their insurance from employers.
7. Pay people to get vaccinated. This would probably need to be a tax rebate construct, as I don’t think they could get a new stimulus-like bill through the current House/Senate. But what better way to reward behavior that benefits the public health AND gives people some extra cash? It should be retroactive with no income limits as well.
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In conclusion: Vaccinations MUST be “mandated”. The administration and the CDC need to stop curating their figures (intentional or not, it’s misleading) and they need to tell the truth about what’s happening and what that means for the future if we continue like this. If Delta subsides, there are a host of variants of interest (VOIs) waiting to shoot us backward again, causing more death and privation in their wakes. We have over 100 years of virology under our belt to know that we are going to be in this constant wash, rinse, repeat cycle if we don’t start dishing some honesty and requiring people to do ALL the things in the public interest.
I took my vaccinations (Pfizer) for myself and for others about equally. But now, I want to see this action mostly for my own benefit. I’m sick to death of worrying about this, especially since all common sense shows the path to getting out of it. I know it’s risky — but we elected Biden in part because of his humanity, and our belief that he would do what was right, not just what was politically convenient. We need to reward “risky” choices that make us all safer and shove us demonstrably forward towards getting out of this.
Yep — that was along. I start every day pissed off about this. We all know where this is going — so why are we waiting to get there? Is there some magical number of deaths that signals “oh hey — NOW is the time to get tough” like you see with traffic lights only going in at intersections after a certain number of deaths? No. We’re better than that — we know what the data is saying, and we know we’re never going to get out of this without requiring vaccinations. Let’s just rip the band-aid off and get to it already.
Enough.