Saturday, August 14, 2021

How the COVID Delta Variant Changes the Stakes

 As I tend to do when I'm worried about something, I've been reading up about the Delta variant of COVID-19. What does the emergence of this variant, which is outperforming all others today in terms of spread, mean for us? I have drawn two chief lessons. I share them here in case they are helpful.

LESSON 1: Not If but When.

The high transmissibility of the Delta variant means it is largely no longer a question of if you will get infected with COVID, but when. The remaining question is this: When you are infected, will your immune system be primed to fight off the disease quickly and efficiently—likely so quickly and efficiently that the virus is licked without you ever realizing you were sick? 

 It you are vaccinated, then the answer will be yes. If not, then the first time the virus enters your body, your immune system will be scrambling to figure out how to fight it. It may succeed--or, as has happened to too many people, it may flounder and go haywire in ways that jeopardize your life.

You will meet the Delta variant sooner or later. Its spectacular transmissibility pretty much guarantees that.

This means we are now in the situation of comparing head-to-head the health risks associated with getting the vaccine with the health risks of getting COVID. That didn’t used to be the case, at least not quite. Before the Delta variant came along, someone could reasonably say, “If I get the vaccine, I’m sure to face the risks associated with that. But if I don’t, I might never get COVID and so never face the risks associated with either one.” 

That is no longer true, unless you are capable of total isolation.

Of course, no vaccine is totally risk-free, but in a head-to-head comparison of vaccine vs. COVID risk, there really is no comparison. Both have been intensely studied by medical experts. For ordinary citizens, the chances of serious health complications from the vaccine is one in millions. The chance of serious health complications from COVID, if you're unvaccinated, is one in hundreds.

Put simply, from a health-risk standpoint getting COVID is many thousands of times worse.

There are few medical decisions these days where the difference between the options is so stark—similar in clarity to the choice between whether to have ice cream or someone else’s vomit for dessert. The only difference is that in the case of the ice cream vs. vomit, we don’t currently see loads of people playing up the risks of lactose intolerance while trying to make the vomit more appetizing by sprinkling hydrochloroquinine over it.

LESSON 2. We Mitigate Through Mandates or Face a Health Care System in Crisis

You might ask, if the Delta variant is so transmissible that everyone will be exposed eventually, why slow down the inevitable with mitigation measures like social distancing and mask-use? 

There are two answers. First, slowing down the rate at which people are exposed gives us more time to get more people vaccinated. It gives us more time to convince the vaccine-hesitant to get the shot before exposure—something that may save their lives. And it gives us more time to finish researching the impact of the vaccine on children under 12—potentially enabling us to protect our children with safe and effective vaccines before they catch COVID.

Second, given just how transmissible Delta is, if we do not collectively and consistently pursue mitigation measures in settings where transmission is likely--something that will likely only happen if we implement mandates on mask-use and social-distancing wherever transmission rates are significant--the virus will sweep through the vulnerable (that is, unvaccinated) population so quickly that we risk completely overwhelming our healthcare system. 

Delta spreads a LOT faster than earlier variants. A substantial vaccinated population--even as low as 50%--might have slowed the spread of other variants down enough to keep hospitals from being overwhelmed. But Delta is a different animal. Unless we take active steps to mitigate spread, it will find the unvaccinated quickly. It will spread among the unvaccinated quickly--especially if we bring bunches of them together in one place (such as grade schools where all the kids are under 12 and so cannot be vaccinated). The most vulnerable among them will need to be hospitalized. Some will need ICU care. Some will die. 

In states that actively preclude mitigation mandates, like Texas and Florida and Oklahoma, ICU beds (including pediatric ICU beds) are already at or near capacity. And that’s before the impact of the school year starting up (here in Stillwater, public schools started up two days ago and the university starts on Monday). Once schools are back in session, if we don’t implement mitigation measures like mask mandates things will get a lot worse a lot more quickly. 

And if you think mask-use will be extensive  and consistent if it is done on a wholly voluntary basis, without mandates, you might want to look around here in Stillwater, Oklahoma, today--and compare what you see with how things looked back before the mask mandates expired in May. Despite efforts to get the word out about the Delta variant and the new CDC guidance, mask use is...spotty.

Spotty masking won't do much good--especially if there is significant overlap between the unvaccinated and the unmasked. Remember, Delta is sweeping through the unvaccinated population, sickening the unvaccinated population, hospitalizing the unvaccinated population, killing the unvaccinated population. Those who are vaccinated can carry Delta to others...but are far less likely to. They can get seriously ill...but are far less likely to. 

Here's the problem. We've got two classes of people: those who take the pandemic seriously and trust the medical experts; and those who either don't take the pandemic seriously, don't trust the medical experts, or both. The former are very likely to have already been vaccinated--and they are very likely to take seriously a strong CDC recommendation to begin masking up in indoor public spaces. But it's the latter who, being unvaccinated, are vulnerable to the current wave of the pandemic--and hence the ones we really need to mask up to avoid a health care crisis. Unfortunately, it is also the latter group that is least likely to mask up voluntarily based on guidance from medical experts--because, for whatever reason, they don't trust those experts.

Of course, some of that latter group will resist mask use even if it is mandated. But mandates still have an effect. Last academic year, all my students wore masks in class, even those who didn't believe it was necessary. They wore the masks because that was the rule. Mandates increase mask-use, and widespread and consistent mask-use--especially among those who are unvaccinated--is a crucial tool in slowing the spread of Delta through unvaccinated populations and thus keeping hospitals from becoming overwhelmed.

An overwhelmed health care system means everyone has less access to lifesaving treatment—whether they’re sick with COVID or something else. An overwhelmed health care system means that doctors and nurses who are already overworked and emotionally exhausted find themselves pushed past the break point.

We’re talking about a health care system in which the human beings who are called to fight this war suffer such serious burnout they can’t continue. And like a kind of feedback loop, an already overburdened system becomes even more overburdened as people burn out and the weight falls heavier on those who remain.

This was a risk before the Delta variant came along, and was a major basis for the decision to shut the country down. Now the Delta variant is in play, with viral loads a thousand times higher than earlier strains and transmissibility rates many times higher. Unless we mandate mitigation measures like indoor mask-use, we will quickly reach a healthcare crisis once Delta starts to spread in schools. 

If the crisis gets bad enough, we won't be talking about mandating masks in schools. We'll be talking another shutdown. And we'll be burying too many beloved dead.

Love your unvaccinated neighbors--by getting vaccinated and wearing a mask.

Love your local health care workers--by getting vaccinated and wearing a mask.

Love yourself--by getting vaccinated and wearing a mask.

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