Covid Epi Weekly: Public Health Waking Up From Politics-Induced Coma
Unfortunately, Covid cases, hospitalizations, and deaths continue to worsen. Vaccination is coming, so let’s make sure as many of us as possible are still around when it’s our turn. We must double down on protection protocols. Together, we’re stronger and safer.
We’re seeing the highest case and hospitalization rates ever in the US. Although cases are cresting in much of the Midwest, they’re still at a very high level. Some of the decrease in the past week can be explained by less testing and care over the holiday. My father, who ran intensive care units, used to comment, “Only very sick people come in on Thanksgiving and Christmas.”
When I say “cresting” though, that doesn’t mean case levels are low. They’re lower — sky high, but not quite as sky high. 1 in 3 South Dakotans has now been infected with Covid. Stunning. By January 20, if it were a country, South Dakota would have the highest death rate in the world: approximately 1 of every 60 people over age 70 will have been killed by a preventable infection.
We must share information on how hard it’s raining Covid in every county, every week. Real-time data empowers people to know their risk, and community leaders to take steps to reduce that risk through nuanced closures — or circuit-breaker stay-at-home times. Great to see that the CDC’s data is ever-improving.
Most of the US is experiencing explosive spread of Covid — and that’s before the post-Thanksgiving surge, which hasn’t shown up yet in the data. 251 cases per 100,000 a week is orders of magnitude higher than levels where it’s plausible to do contact tracing well. We all have to assume we’re exposed. Here’s a site showing risk levels by state, county, and Congressional district.
Positivity rates are still probably the best single metric to track spread, but the data needs to be more consistent. Standardizing how percent positivity is measured and reported should be a high priority for the federal government.
The hospital overload is coming. With it, decreased survival rates of Covid patients, more infections and deaths among health care workers, and more illness and death from non-Covid conditions among people who don’t receive the necessary care. They keep having to add colors to this map.
Another stunning figure: there have only been 17 positive flu cultures in all sentinel sites in the country. SEVENTEEN. But flu can still come, so make sure to get your flu shot.
It’s great to see CDC scientists speaking directly to the public again, after a hiatus of 9 months. We’re all safer when we can hear about the facts as they’re being uncovered. The agency published some good guidance on how to get through the holidays more safely.
Vaccines are coming, but they won’t be here soon enough. In the meantime, we must double down on protection protocols. I outline in the Wall Street Journal what we don’t yet know about vaccines and what we need to do now to save lives and restore economic and educational growth.
The new guidance last week from the Advisory Committee on Immunization Practices (ACIP) is appropriate and sensible. And no one should be able to jump the line. It will be months before a vaccine is widely available. Because it’s a 2-dose series, it will take another month or two for immunity to kick in. We’re many months away from being out of the woods.
I’m appalled at how Operation Warp Speed has discussed vaccination. To hear them, it’s a math problem and the process sounds like delivering groceries: right temperature, prompt restocking. That’s a formula for failure. Change happens at the speed of trust — of clinicians, communities, and patients. A vaccination campaign must build trust or it won’t succeed.
There are science- and fact-based ways to increase vaccine uptake. A WHO group led by my friend (and squash legend) Cass Sunstein published a good report on this. Make vaccination the easy, default action, supported by social norms, and increase motivation.
We can learn from our history. Ben Franklin’s favorite son died of smallpox after Franklin decided not to vaccinate him. Franklin then made sure Washington’s troops were vaccinated, which may have made the difference and won the war. Always avoid anticipated regret. (Thanks Alex Howard for finding the quote below.)
Vaccination will be a bumpy road. People who think Covid isn’t serious won’t be eager to get a vaccine. People who fear “that Trump vaccine” may not take it. Vaccination is our best way forward. The more information we share openly, the sooner we’ll get toward normal.
The more we mask up, the safer we all are. The more we keep distance, the safer we all are. The less we all travel, the safer we all are. The more, eventually, we get vaccinated, the sooner we can end the pandemic. We’re all connected.
The greatest hope for this pandemic is that we recognize and act on our connectedness. The greatest risk is that we become inured to suffering — one death is a tragedy, a million deaths a statistic.
A quote to remember from John Donne:
Any death diminishes me. And therefore never send to know for whom the bells tolls; it tolls for thee.
