The Winter Wave Is Already Here
Cases are no longer declining due to rising waves in New England and the Midwest. While winter will bring more cases, vaccines will prevent the worst of last year's death tolls.
The Counterpoint is a free newsletter that uses both analytic and holistic thinking to examine the wider world. My goal is that you find it ‘worth reading’ rather than it necessarily ‘being right.’ Expect regular updates on the SARS-CoV-2 pandemic as well as essays on a variety of topics. I appreciate any and all sharing or subscriptions.
Winter Waves
Despite society’s efforts to move past COVID-19, SARS-CoV-2 is still very much with us. Since August 1st, an additional 149,772 Americans have died from COVID-19.
It simply takes time for any virus to work it’s way through the human population. Check the listed dates on the Spanish influenza pandemic’s Wikipedia: “February 1918 – April 1920.” With modern medical and public health tools, the global health community has contained novel pathogens, for example, multiple Ebola virus outbreaks and the two previous novel coronaviruses, SARS-CoV-1 and MERS. But each of these viruses is different from SARS-CoV-2. Ebola is only spread through direct contact, SARS-CoV-1 is only contagious when symptomatic, and MERS doesn’t display community transmission (i.e. it’s rare to spread between people).
Once asymptomatic and community transmission of a novel respiratory virus was confirmed (spring 2020), a two year timeline should’ve been clear and repeatedly explained by political and public health officials.
The reality is that we are still within that two year window and winter weather promotes viral transmission. Scientists and researchers were already discussing this way back in March 2020(!), for example “Temperature, Humidity and Latitude Analysis to Predict Potential Spread and Seasonality for COVID-19,” a paper that this newsletter discussed. Since then, it has become crystal clear that SARS-CoV-2, just like the other endemic human coronaviruses, is seasonal, and that we should expect and increased number of cases this winter, something I’ve tried to hammer home in recent newsletters, see September 18th and October 24th.
That winter wave of cases is now here.
It’s not quite detectable in the national graph yet (below). After continued declines, the United States has been stuck in a plateau, with the seven-day average of cases being in the 70,000s since Oct 20th. But time and time again, the national data obscures what is happening underneath (the most famous example of this is former Vice President Mike Pence’s WSJ op-ed, “There Isn’t a Coronavirus Second Wave”).
Graphed below are five states in New England and five states in the Great Lakes region. Each of these states had a ‘Delta’ wave that either never subsided or has picked back up again.
And to be clear, this isn’t just the United States, the more-northern Europe has been experiencing a growing wave for some time now.
Vaccines Prevent Cases
Not perfectly! We are all aware of “breakthrough cases.” But all scientific and real-world evidence points to high vaccination rates preventing community spread, just like the vaccines for polio, measles, mumps, etc., do.
But isn’t the European Union more vaccinated that the United States? It is. And isn’t New England the most vaccinated part of the United States? It is. Then why are they having waves?
Vaccines, while highly effective at preventing transmission, aren’t perfect and should only be considered one tool in the toolbox for preventing COVID-19. Vaccines need to be combined with cost-effective policies such as masks, rapid testing1, and ventilation. Measures such as sanitizing surfaces2, stay-at-home orders, and business closures are no longer only viable options from controlling COVID-19.
But ultimately, this is another example of aggregate data obscuring something important: we can solve this pandemic through vaccination alone3. The problem is that, in the United States and most other places, we aren’t anywhere near that threshold.
The European Union is experiencing a large wave of cases. But different countries are experiencing different magnitudes of waves. Graphed below are daily cases for Spain, Italy, France, and Germany.
Compare this graph to the percent of each total population fully vaccinated: Spain 80.6%, France 77.7%, Italy 74.8%, and Germany 67.6%.
Given the evolution of the hyper-infectious Delta strain and the continued removal of public health measures, a population needs to be at least 75-80% fully vaccinated in order to prevent large winter waves.
The United States is 58.7% fully vaccinated. Our most vaccinated state, Vermont, is only 72.0% fully vaccinated.
Simply put, because we’ve failed at vaccinated ourselves, the majority of the United States should expect a moderate-to-large winter wave of cases.
Shooting Ourselves In the Foot
The United States subpar vaccination rate isn’t because of a lack of supply. In fact, we’ve never had more vaccines available, with nearly 115 million vaccines in reserve.
This is ~84 days of supply at the current vaccination rate, which, with both booster shots and the approval of childhood vaccinations, has increased from the summer lows. The seven-day average of daily vaccinations stands at 1,370,279.
Despite these increases, the United States has an unacceptably low vaccination rate. Only 68.1% of the total population is partially vaccinated, 58.7% fully vaccinated, and only 14.7% of the fully vaccinated have been boosted (below, top). Each of these numbers is lower than every other first-world nation (below, bottom).
How To Proceed
The hard reality is that the United States’ low vaccination will not change anytime soon. This winter will have a moderate-to-large number of cases to many states. Honestly, regardless of your vaccination status, SARS-CoV-2 is endemic, and you will probably be infected at some point in the near or medium future. The outcome from that infection will be heavily dependent on your age, the date of your last vaccination/booster, and any co-morbidities that you have.
At the community level, the data is definitive that high vaccination rate plus other non-pharmaceutical interventions can damper or outright prevent a wave of cases. If you care about public health, these are concrete steps you can take:
Schedule your next vaccination today, regardless if it’s your 1st, 2nd, or 3rd shot. It is monetarily free and should only take 15 minutes in the clinic. There are plenty of vaccines; you will not be taking someone else’s.
Upgrade your cloth masks to KN95 masks and continue to wear them when in public. Masks reduce the spread of viral droplets and aerosols in the air. If already in the air, they prevent inhalation of those droplets and aerosols.
If feeling unwell, please stay at home. Keep a handful of rapid tests and take one if you have any symptoms. Bonus points if you take a rapid test before attending a large gathering, even if asymptomatic.
Make ventilation a political issue. Air pollutions kills millions of people per year. Ask your local schools, hospitals, businesses, and government offices to upgrade their ventilation systems. Lobby political and public health officials to start grant programs to provide money for any upgrades.
We are twenty months into this pandemic. Nearly one million Americans have died. I know that we are all “over this,” but more than 1,000 Americans are dying per day from a preventable disease. Each and every one of us can be part of the solution. Together, we can limit the worst of the current and coming wave. Please, do your part and let’s beat this virus.
If you have an hesitancy around vaccinations, or any questions whatsoever, please do not hesitate to reach out. There really are no stupid questions. Please contact PatrickHeizer[AT]gmail[DOTCOM].
Rapid tests need to both cheap and widely available, something the United States continues to fail at.
Great for other pathogens, but not SARS-CoV-2.
As other issues of this newsletter have discussed, SARS-CoV-2 is endemic and will never be ‘solved’ as in eliminated, only effectively managed into something like our annual influenza waves.
Vaccines haven't prevented death for all though Patrick, my concern is that many are still dying because of the vaccine, especially the athletes, I hope there is another way to deal with this societal crisis.