Covid Epi Weekly: Immunizing Against Herd Stupidity

It’s been a bad week in the fight against Covid. We’ve seen reopenings without sufficient care. Failure by infected people to isolate. Failure to communicate consistently, effectively, respectfully, empathically. A dangerously misguided theory on immunity. Throughout the country, cases are increasing. This will inevitably be followed by increased hospitalizations, and then by increasing death rates.

Test positivity increased for the first time in a month (to 5.4%), but positivity is now more difficult to interpret due to new antigen tests and a lack of consistent definitions and reporting. Hospitalization data is concerning, though in the crazy world of US health economics supply creates demand.

In the past two weeks, 21 states reported their highest Covid rates ever, including in most of the Midwest and much of the West. As predicted, we’ve surpassed 50,000 reported cases per day. The White House cluster is up to 40 known cases and hundreds remain untested. Only two states—Maine and Vermont—are still encouraging.

More information on long-haulers is emerging. We must better understand and care for people who are suffering from the persistent effects of Covid for months after their infection. This excellent article by the incomparable Jane Brody lays out what we know and what we’re trying to find out.

Some people have shamefully misrepresented a recent CDC study which found restaurants, bars, and close contact with Covid patients associated with illness. It’s infuriating to see this kind of misrepresentation, and it’s on par with Wakefield’s fraud on vaccines.  

Here’s some great new data on self-reported mask-wearing. More masks → less illness. Masks are a low-cost, effective way to reduce spread.

No place where more than 90% of people said they regularly wear masks had more than 20% of people say they know someone who’s sick. On the other hand, no place where less than 85% of people said they regularly wear masks had less than 20% say they know someone who’s sick. How in the world did masks become political? They’re only against a virus, not a party or person. There’s only one enemy here, and that enemy is the virus that causes Covid.

Three pieces of bad news from this past week:

  1. Remdesivir doesn’t appear to reduce death. 

  2. The US continues to fail at contact and source case tracing. This is complex, important, high-skill, high-empathy work. 

  3. The dangerously misguided concept of herd immunity through natural infection is spreading.

The reality is that we’re all connected. Infections in healthy people lead to infections in others. “Protecting the vulnerable” requires reducing the risk of infection in everyone. Although the more people who are immune, the slower virus spreads, every infection is a setback, not a step forward. This is not a complicated idea: The way to protect the vulnerable is to have fewer infections, not more infections.

Now three pieces of good news: 

  1. At least 199 out of 200 people with the infection recover. Covid is NOT the zombie apocalypse. 

  2. Dexamethasone and other steroids—cheap, available meds—reduce the likelihood of death by as much as a third. 

  3. Lots of safer social and economic activity is possible.

With Halloween and Thanksgiving coming, we CAN have some safer connections. I shared some ideas on how Halloween can happen without increasing the spread of Covid. For Thanksgiving, I’d suggest that all family members adhere to a strict two week quarantine before any get-together, and only plan to gather if travel can be done safely. That’s what my family is doing.

Let’s not get ahead of ourselves on vaccines. They are our best tool, but just one of many. We don’t know if they will be effective, safe, accessible, trusted. We don’t know how well they will work, how safe they will be, and for how long they will protect people. And even if they are safe, effective, accessible, and trusted, they won’t end the pandemic, and rare, serious adverse reactions may occur. Even if only 1 in a million people, or 1 in 100,000 people have a bad reaction, that’s a lot of people for a vaccine which billions of people may take. It’s always better to underpromise and overdeliver.

Simple measures such as ensuring paid sick leave are also very important. An interesting new analysis found that there was “roughly 1 prevented COVID-19 case per day per 1300 workers who newly gained the option to take up to two weeks of paid sick leave.” This is so important, and would have so many benefits. Should be high on the priority list of all governments.

We in public health must do better understanding and empathizing with the social and economic pain of the pandemic. In the US, there are at least 30 times more people who have lost their job because of the pandemic than have lost their life. 

But it’s important to remember, as Ghana President Nana Akufo-Addo said, “We know how to bring the economy back to life. What we do not know is how to bring people back to life.”

Covid is here to stay. We must live fully now, taking steps to protect ourselves and our loved ones. 

“The present moment is the only moment available to us, and it is the door to all other moments.” -Thich Nhat Hanh