Fall 2021: Where I Am At
We’re slowly inching towards the new normal and I thought I’d give you my perspective on where I’m at and where I think the Bay Area’s at with COVID-19.
Slide from UCSF presentation to the Latino Task Force on Monday October 24th which shows the clear effectiveness of booster shots in Israel at keeping people from getting COVID-19 and keeping them out of the hospital if they do get COVID-19.
Booster Shots- Flu Shot Analogy
Before the pandemic, I would get a flu shot most years because it was convenient, my doctors told me to do it, and others around me were getting their flu shot. It is only through the pandemic that I really thought about the reasons for getting the flu shot.
It reduced my chance of getting the flu.
It meant I had a milder case if I did get the flu.
It lowered the spread of the flu to keep it away from more vulnerable people.
However it probably wasn’t needed to keep me out of the hospital and / or to keep me from dying.
It feels to me like COVID-19 vaccines are on their way to becoming similar to flu vaccines. There is excellent data out of Israel that indicates that COVID-19 booster shots help keep people from getting sick with COVID-19. Israel’s vaccination rates were much higher months earlier than ours and so the course of their pandemic is many months ahead of ours. Like flu vaccines, COVID-19 boosters help to limit the spread of COVID-19 which helps to keep it from reaching vulnerable people like Colin Powell. Additionally COVID-19 boosters seem to help make breakthrough cases more mild if they do happen.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02249-2/fulltext
I’m guessing that I’ll seek out a booster shot some time in the next six months. I don’t expect that there will be an urgency to getting a booster for most of us who aren’t vulnerable. Changes in immunity of vaccinated people and our susceptibility will happen at a slow enough rate that we should be able to see any need for booster shots approaching clearly. Perhaps a more aggressive rollout of booster shots will happen with the next surge.
I do not want the rollout of booster shots in wealthy countries to slow down the rollout of vaccines to poorer countries, but I think I would tackle this problem as a supply chain issue rather than trying to work on the demand side of the equation. I would look to tackle any supply issues by getting additional factories running in alternate locations like in the southern hemisphere. And as a last resort if the big pharma wasn’t acting in good faith I would threaten to take away their patent rights. (Its not like they haven’t made a vast amount of money on the vaccines so far.)
I Still Like Masks- Indoors
I saw a play at my daughter’s high school and for the first time in the course of the pandemic I found myself wanting people to take off their masks. I’m not talking about the audience. I really appreciated that everyone in the audience was still wearing a mask even though most of them were probably vaccinated. I wished the performers weren’t wearing masks which seemed like it could be reasonable to do given that they’re a stable cohort of students and probably all fully vaccinated. Additionally for almost all of the play they were well away from the audience. Unfortunately masking rules and masking guidance is so broad brush that its hard for health authorities to make small fine grained levels of change that could speak to micro decisions like having performers go unmasked while audience members remain masked. I want masks to be able to come off in places where it really makes a difference while encouraging them to remain on in most indoor situations so that we can continue to keep COVID-19 at bay. This leads me to my next point.
(BTW the performers were miked well and changed their masks in fun ways with the costumes so their masks didn’t undermine the play much.)
The Pandemic Doesn’t End with a Governmental Declaration. It ends with a Long Slow Petering Out and perhaps additional small waves.
All of that to say that declarations by governments that the pandemic is over is foolish and seems to backfire every time. It backfired on California after June 15th. It is currently backfiring on Britain which has encouraged people to go mask-less and now has got another surge. It backfired on India back in January. These declarations are counter-productive because they get lots of people to change their behavior abruptly. If conservative social behavior prior to the declaration was keeping the virus in check, then after the declaration you’ve got the makings of a surge on your hands.
It’s much better to just let everyone slowly slowly decide for themselves that they’re going to loosen this or that restriction in their personal lives. I would prefer to see masking mandates persist for a longer period of time with less and less enforcement, analogous to speed limits today. Just wait and eventually remove the mandates quietly and gradually without a lot of noise.
I would love to see some data from San Francisco on any outbreaks in workplaces and gyms and other places where SF has allowed people who are fully vaccinated to doff their masks.
We’ll probably see additional surges and I would not be surprised to see a surge this Winter. I hope that each surge will be smaller than the last.
What makes me upbeat and what brings me down.
Upbeat: Children 5-11 getting vaccinated. Getting another large chuck of our population vaccinated will add another cushion to the Bay Area’s already high vaccination rates. Getting this cohort vaccinated really makes it that much harder for COVID-19 to spread and that will moderate future waves.
Downbeat: There’s a surge in Britain. Generally Britain has been ahead of us in the pandemic and so I’m a little worried that they’ve got a surge going on over there. I’m hoping that their wave is just because they’ve stopped using masks and foolishly and prematurely declared themselves “fully open.”
Upbeat: Hospitalizations in San Francisco are still heading down. They’re going down slowly but they are heading down.
Downbeat: Cases in many Bay Area counties, including San Francisco, have stopped dropping and are plateauing.
Downbeat: We’re heading into Winter. Unfortunately COVID-19 really seems to like spreading during Winter. (During our summer you could clearly see COVID-19 surges in the southern hemisphere.)