The Covid Vaccines are Great…*and* We’re Still Looking at a 4th Wave

We’re in a very awkward time in the covid pandemic. If you’re following some of the most accurate voices talking about the science and reality of the pandemic right now you know their mood is both thrilled and deeply concerned. Yes, both.

The Vaccines Are Truly Outstanding

The reason to be thrilled is the superb effectiveness of vaccines from Pfizer, Moderna, and, soon, Johnson & Johnson. The first two have truly remarkable efficacy, ~95% in preventing the development of covid and even better and preventing severe cases. The J&J vaccine currently at the FDA for emergeisn’t quite as amazingly effective at preventing covid overall, but equally as effective at preventing hospitalizations and deaths. It’s a great vaccine.

One of the biggest challenges with these vaccines is scaling up manufacturing for the huge numbers of doses needed to vaccinate America (and the world). That’s one of the biggest reasons our nation’s vaccination effort is of to a slow & rocky start. But, hope is on the way.

How good are the vaccines? This chart of results from vaccines in the pipeline, shared by the Dean of the School of Public Health at Brown University says a lot.

The covid vaccines currently available and in the pipeline are phenomenal.

The 3rd Wave of Covid is Receding

Also in the good category: the current trajectory of the pandemic is very positive. Now that we’re past the holidays where people were foolishly gathering indoors without masks, creating a massive spike in cases, every trend line for the pandemic is on a downward trajectory (albeit from upsetting, painful highs). Cases numbers are down…

hospitalizations are down…

and deaths will trend down soon too. 

Source: https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

That’s a good trend. For now.

The Problem on the Horizon

All else being equal, we’re in a race to vaccinate as many people as possible as fast as possible to keep the trend going, including given the now very American pattern of getting tired of restrictions, people doing stupid shit, the pandemic spiking again…lather, rinse, repeat. The vaccine won’t be available to any adult who wants it until late spring/early summer.

Now comes the curveball, and it’s a big one. If you’re a close follower of covid news you know there are emerging variants of covid that are deeply problematic. Viruses like coronavirus naturally mutate, especially when allowed to infect lots of people. Some mutations don’t mean much difference practically. But, sometimes mutations result in less potent version…or more potent versions. The more potent versions is what’s happening now with covid.

There are variants in particular that were first found in the UK, South Africa, and Brazil. The UK variant spread quickly through the UK and Ireland, leading to severe outbreaks. The variant spreads roughly 50% easier than the main coronavirus strains that have previously been spreading worldwide. It may also increase instances of death, but even if not, dramatically a much more contagious version of the virus in and of itself is obviously a problem Example: up until recently, Portugal had one of the best pandemic responses in Western Europe. Then the UK variant exploded there and things got ugly, fast in January. Like the UK and Ireland, it took rapid lockdowns to turndown contain.

Source: https://www.worldometers.info/coronavirus/country/portugal/

The variants found in South Africa Brazil need more study, but the South African variant shows significant indications of evading at least some antibodies from the previously dominant form of coronavirus during this pandemic. That has clear implications for managing the pandemic if people can be re-infected, plus current vaccines may well require a booster to fully combat the South Africa strain (though early studies of the vaccines cites above show still good, if reduced, protection against it).

The Brazil variant is potentially even more troublesome. It appears to evade previous antibodies *and* potentially spread more easily. It ripped through the city of Manaus with the ferocity of spread and death that is more akin to the horrific 1918 pandemic than covid thus far. That’s after Manaus had an outbreak last year so bad it was estimated 50-75% of the populace had antibodies before the latest outbreak.

For now, the UK variant is a more immediate risk based on the number of cases of it found across the United States already (especially California and Florida), which indicates community spread is real. Add it all up and you can see why we’re in an awkward phase:

  •  Vaccines are great news
  •  The 3rd wave is receding in America
  •  New covid variants are a major potential problem at risk of exploding before we vaccinate enough of the populace

All meaning, as current numbers trend down and vaccine distribution continues, people  will inevitably be tempted to let down their covid guard. Same for states & localities who will either be under pressure to ease restrictions and/or won’t pay enough heed to the risk of the new covid variants. The threat of a 4th wave ripping through parts of the country before vaccinations are widely available in late spring or summer, especially in areas of the country not taking covid restrictions and guidelines seriously, is quite real.

What Should You Do Now?

Be cautious. Leading public health experts are as concerned about these new variants based on what they’re seeing as they were right before covid exploded last spring. And we know how that turned out. So, what to do:

Get vaccinated when you’re eligible. While vaccine clinical studies are primarily focused on proving prevention of the covid as a disease, vaccination will inevitably help reduce transmission of the coronavirus, even if it doesn’t eliminate that spread.

Understand covid is airborne. That requires changing how many people have acted in recent months. Our initial scientific understanding of the emerging virus last spring was that it spread via respiratory droplets from coughing, sneezing, and the like that could also be spread by touching your face then shaking hands or touching a surface, where the virus would linger and others could catch it. We’ve since learned (it’s called a “novel” coronavirus for a reason) spread is primarily airborne. 

Airborne — or in more scientific terms, aerosol — means more tiny droplets we emit when breathing, coughing, laughing, singing, and the like, not the larger droplets from coughing and sneezing, are the key vehicle for covid spread. Think of the difference between throwing a handful of gravel in the air versus throwing a handful of fine dirt in the air. Gravel hits the ground quickly. You’re not going to experience it in the air unless you’re right nearby. The dirt becomes dust and lingers in the air much longer. Pretty easy to walk through that dust for a while after and breath it in. Here’s a good visual of the difference between spread via coughing vs. spread via talking:

Which is exactly why indoor gatherings, without masks, with poor ventilation to clear the air, is the worst possible environment. The larger the gathering, the larger the risk…including because the majority of covid spread comes from people who aren’t yet showing symptoms (or never show them). It’s why we should be talking about ventilation much more than cleaning for indoor environments. 

Our “hygiene theater,” with so many guidelines and businesses focused on cleaning and sanitizing and hand washing, has missed the mark. Those steps don’t hurt, but since covid is airborne, businesses should be telling you a lot more about how they’ve improved ventilation (open windows, fans, improved HVAC airflow and filters, etc.) than how often they’re cleaning. The difference between ventilating well and not is pretty clear:

And, sorry, that’s exactly why indoor dining and other large indoor gatherings without masks are the highest risk environments…and why we had a huge spike in the US during the holidays because people insisted on having holiday gatherings, indoors, without masks.

One of the first documented super-spreader events in the US was a choir practice in Mount Vernon, WA where people singing in an enclosed space resulted in dozens of covid cases (and some deaths). That’s why indoor religious services, especially with singing, are bad news absent masks and a whole heckuva lot of distancing (though to be honest 6 feet isn’t enough when indoors without masks)…unless you enjoy sharing covid with your fellow worshippers. 

Public officials, elected or otherwise, have been truly terrible about explaining the issue of airborne spread to the public. They’ve been much better about saying restrictions are in place than saying why those restrictions are in place. It’s part of why people didn’t see the problem with indoor holiday gatherings.

Since covid is airborne, wear a mask. Mask wearing is one of the best ways to both protect others and protect yourself…especially with the UK variant that spreads much easier becoming more dominant in America. I’ve seen people joke about the idea of wearing 2 masks, and, well…either get a high quality, multi-layer mask (like a KN-95, easy to buy on Amazon, for example) or throw a disposable mask over a cloth one. More protection against a more contagious variant of an airborne, pandemic virus is not a joke, it’s serious. Wearing masks has been proven to reduce the spread of covid.

Hold out hope. All this talk of new covid variants is not fun, on top of everything else the covid pandemic has brought us. At the same time the high quality of covid vaccines should be an incredible source of optimism. They will be widely available in the coming weeks and months. I’m incredibly positive on what the vaccine means for us. I’m less positive about how patient many Americans will be until a big swath of the populace is vaccinated.

The weeks ahead until enough Americans get vaccinated may well get rough (the issue of whether enough Americans will choose to be vaccinated is a separate, giant question mark). Maybe we’ll dodge a 4th wave, but our entire pandemic experience as a nation indicates otherwise.

Be smart. Get a vaccine. Wear a mask. Stay the hell away from indoor gatherings, especially without masks. And have some empathy for each other because this whole pandemic has been hard on all of us.

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