Too many people are dying right now.
A few weeks ago, in a back-of-the-envelope calculation during an interview with Eric Topol of Scripps, I suggested that because of widespread vaccination of the most vulnerable elderly, we may have reduced overall mortality risk in the country by 90 percent. Topol thought that was a little high, but agreed that vaccines were delivering great protection against death and hospitalization, and while we would likely see some of each during the Delta wave, “it won’t be like the monster third wave.” More recently, the Dartmouth economist Andrew Levin, who early in the pandemic did major work calculating mortality risk by age, estimated in an interview with my brother that the effect was probably 75 percent — that given the same number of cases, we’d probably see about one quarter as many deaths as we would’ve seen a year ago, without vaccines.
The U.S. numbers are a bit wobbly these days, and there are huge variations state to state, reflecting disparities in vaccination rates, among other things. But at the national level, at least for the moment, the reduction of mortality risk seems to be considerably smaller. In the worst of the winter surge, the country was registering 250,000 new cases per day; at its peak, that surge was killing roughly 3,000 Americans each day (often a bit above, but with a few dips below). Today, we have a bit more than 100,000 new cases each day, though the numbers are still rising as part of the Delta wave. If we had reduced mortality risk by 75 percent, that would mean about 300 daily deaths. If we had reduced it by 90 percent, it would mean 120. Instead, in our seven-day average, we just passed 500.
That’s from David Wallace Wells. And unless you have a good strong drink in your hand, you do not want to read the rest. It’s and interview with Topol on the current state of affairs. It’s the most pessimistic thing I’ve read about this surge for vaccinated people.
And it makes me livid.
Just one bit:
These numbers are disorientingly grim to me. How are you thinking about what’s going on?
Well, I’m trying to use the other countries that have been through this already, or are concurrently going through it as a reference or an anchor. And I think our rate of rise of hospitalizations is really alarming. We saw quite a bit of hospitalization increase in the U.K. But this is so far worse than that. And many of those people are going to die.Just looking at the U.K. and Israel, which had been our guideposts, I thought we would keep the hospitalizations pretty darn low — maybe a fourth of where we’d been in prior waves. And deaths 10 percent of prior waves. But we’re not doing that at all. If you look at the log charts of the U.S. and the U.K, you’re starting to see some real separation for death. It’s certainly going in the wrong direction, and it had been tracking incredibly closely, until recently.
Now, we are under-testing, too, compared with those other countries. That might be giving us a distorted picture of what’s happening here. But I just don’t know where we’re headed.
What I just can’t understand is why all three things are all moving up together so rapidly. Given everything we’ve seen in other countries and everything we think we know about the vaccines, even if cases rose dramatically, we’d expect much lower rates of hospitalization and death. But we’re not.
It’s like we didn’t have vaccines. Or worse. I was just putting this talk together and I made the same observation. I’m looking at the four waves, and, as you know, in the monster wave, we got to 250,000 cases per day. And at that time we had 120,000 plus hospitalizations [per day]. About half. What’s amazing is, we’re at about 120,000 cases now, and we’re over 60,000 hospitalizations.It’s the same ratio.
Yeah. So when I look at that, I say, what happened to the vaccines?Now, the rate of rise is being driven by several states, as you well know, not the whole country. And I guess the real issue here is, I don’t know if what is going so bad in places like Louisiana and Florida is going to become a diffused pattern, throughout the country. But there are some indicators that it might be.
[…]
But holding all else equal, if vaccines were still doing a good job preventing severe disease but a considerably worse job preventing spread, wouldn’t that drive the gap wider between cases and hospitalizations, or cases and deaths?
Yeah. But —It’s a lot to hold equal.
What I’m hearing — and I’ve been helping with a bunch of patients — is that people who are breaking through are getting very sick. They’re getting Regeneron antibodies.There may be something to this waning immunity story. It’s fuzzy, but the people who are getting hit are more apt to be people who were vaccinated very early. I had a patient in recent days, who’s in her 70s. She got vaccinated in January. And, I mean, she almost died. I mean, it’s just terrible. I think — I hope — the monoclonals are going to save her life. But she was a healthy 70-year-old lady, and just following her case was illuminating — she thought she was protected, but she also wore masks everywhere. She was on guard and still got infected and desperately ill.
Most people aren’t being that careful.
The vaccinated — who are now a very slight majority — those people just think the pandemic’s over. There’s still this sense that if you’re vaccinated, you’re good to go. I mean, I’ve even seen on television, you know, some of our leading house experts, tell people it’s perfectly okay to have indoor gatherings among vaccinated people. Well, it’s not true. So we’re getting bad advice.This booster thing is yet another issue, because we don’t even know if they’re going to protect against a Delta. I mean, everybody’s assuming it, but there’s no data. You know, there’s some neutralizing antibodies from the Pfizer report in 23 people and there’s an Israeli pre-print, it says there’s waning immunity without any neutralizing antibodies. So we’ll see. But these are just classic spike-protein boosters. There’s nothing special about them to handle Delta. So I don’t know. I mean, I suspect they’re going to provide some protection, but I’m not sure I’m so confident it’s going to be great.
There’s more … unfortunately.