As reminders…

Alpha–Variant first identified in the UK

Beta–Variant first identified in South Africa

Gamma–Variant first identified in Brazil

Delta–Variant first identified in India

–Around the horn, cases are rising in the US, and there is plenty of headline chatter about reinstating mask rules and lockdowns. We’ll get to that in a second. First, the facts. Epiforecasts has the Ro pegged somewhere around 1.4. As a reminder, anything over 1 is a virus expanding its infections in the population. This is sustained high transmission, and Delta (now 70-80% of cases in the US) is going to be a bit of a wave into next month. Per capita activity is highest in the Ozark area (Missouri and Arkansas), where, indeed, vaccination rates trail the US average. But there is plenty of activity in vaccinated areas as well.

Interestingly, at least in Indiana, activity is lowest in Indianapolis and its major suburbs, as well as the counties in the northwest that are basically extensions of Chicago. These have a combination of high disease activity in all prior waves AND higher vaccination rates. I suspect this trend will hold nationally.

Basically, as we said, Delta is going to burn through as much of the tinder as is left, in terms of people with no natural resistance (due to prior infection, now recovered) and vaccination.

That finer point is being lost a bit in the headlines. For example, Indianapolis itself (Marion county) doesn’t even fall in the top 10 most vaccinated counties in Indiana on a per capita basis. But I would be willing to lay money it has a top 10 per capita previous infection rate.

The current wave is not so much a vaccinated versus unvaccinated story–that’s only part of it. It’s really a “how much herd immunity do you really have story”. That equation breaks out like this:

herd immunity = complete vaccinations + recovered patients with natural immunity

Indy is holding strong against Delta so far, despite being back to work, despite having no mask restrictions on the unvaccinated, and despite a noticeable increase in traffic in and out these past couple weeks, because it is, per capita probably heavier on the right side.

Meanwhile, the suburbs of Indy are top 5 per capita vaccination rate counties. Heavier on the left side than the right–hence, they too, are resisting Delta a bit better.

The Ozark area of Missouri and Arkansas is a little lower on the left, and, being more rural, I would suspect a little lower on the right than average.

–That said, even with rampant Delta activity in EVERY state, hospitals are holding strong. This is the week we should be starting to see a major push in hospitalizations. So far, hospitalization rates remain pretty flat. This is partly due to a number of Delta cases being “breakthrough”–very mild cases or only detected in screening in patients who were previously vaccinated. Like several high profile cases in the US government right now.

Again, I want to stress that your chances of getting any symptomatic infection from SARS-CoV-2 drop like a rock after complete vaccination. Further, your chances of hospitalization or worse with COVID (again, its MAIN PANDEMIC THREAT) drop to 0.003% per the CDC’s data.

The vaccines do work. The breakthrough cases are news because there is A) so much Delta going around right now and B) a lot of people were vaccinated, so by sheer force of numbers “breakthrough” is happening.

I promise you some of it is also “breakthrough” mild cases in people who got over COVID already, including some who were asymptomatic or not symptomatic enough to get tested the first time around. Again, from last week, the Israeli data suggests that people who get SARS-CoV-2 infection the second time around are 6-7 fold less likely than even the vaccinated to have hospital-serious disease.

–And thus far, case velocity looks very similar to the Alpha outbreak in Feb-April earlier this year. Just with noticeably less uptick in hospitalizations. Recall Alpha is a more contagious variant too, and vaccinations were just getting off the ground for most people.

–I expect a similar trajectory. I also expect hospitalizations remain muted relative to the size of new cases (don’t expect that to make the lede; they will bury that in the article). And that, my friends, is the medical end of the pandemic. If COVID, even the extra contagious Delta variant, cannot meaningfully occupy my hospital beds to threaten all cause mortality, and the most at risk demographics are largely already vaccinated, the pandemic threat is gone.

–So, do we need masks again? Bluntly, I don’t think it matters. I don’t think those orders will be enforceable for enough of the adult population to make a difference.

–What about schools, particularly kids too young to get the vaccine? We should have vaccine data in that demographic shortly. Until then, not going to argue–and many school systems are already saying the back to school plan will include masks. Rumors from a Biden presser yesterday that CDC may make a statement to this effect soon too. I can say the masks don’t seem to bother my kids any, and I expect the “all clear” to drop the masks will come sometime in the next school year anyways. Key thing is they are back in school, as a number of reports and studies have suggested that last year was a lost year for a sizeable percentage of kids with remote learning. It just doesn’t seem to be viable in terms of education quality for about 30% or so of students (at a minimum) from elementary through high school. Can the motivated college student pull it off? Yeah, maybe, but that is likely all due to their socialization and brain development being already complete by 18-22.

–Lockdowns? I’m too lazy to link to all the times I have flogged this dead horse. Suffice to say that the evidence on their efficacy is mixed. In fact, still going around the horn, countries that were lauded for the severity and lengths of their lockdowns in Asia, ranging from Thailand, to Vietnam, to Indonesia, to South Korea, and Australia (who has been in and out of lockdowns so often they would make a boomerang dizzy), are -all- exploding with a large delta variant wave.

The lesson from the Black Death, and the lesson we all should take from this pandemic too, is the Choose Your Own Adventure. Once it’s out, it’s out. The pandemic is gonna’ pandemic. And it will find it’s way to you eventually, no matter which adventure you choose.

The best argument for a lockdown is the initial stage–to slow transmission enough to get testing and hospital capacity up.

We have sufficient testing and hospital capacity right now. In fact, Abbott and Roche in the last three weeks have laid off over 10,000 people in their COVID diagnostics units because there is so much excess testing capacity right now.

Yes, even with the current Delta wave.

Justification for another lockdown is a high scientific and political threshold right now. Do I think there are politicians around the world willing to try though?

Wouldn’t put it past them…

–Also worth noting that the CDC released data this week showing that opioid deaths increased by 30% 2020 versus 2019. Additionally, headlines over the last couple days have covered the decrease in US life expectancy. The majority of that is the all cause COVID drag, but unintentional injuries made a big leap, followed by small increases in homicide, diabetes and chronic liver disease.

“Unintentional injuries” includes drug overdoses in the CDC classification.

One would hope that potential losses due to “deaths of despair” would be weighed against potential losses to COVID among a more resistant population in the decision to attempt further lockdowns.

One would hope…

–Interestingly, cancer mortality took a big fall in the CDC’s data–so at least there is a silver lining for improved treatments there.

–Finishing up around the horn, cases are on the downslope a bit in both the UK and South Africa. Calling out the reserves appears to have settled most of the violent rioting in the latter, although reports suggest there are still protests in pockets, and police are currently investigating at least 168 homicides during the unrest. The causes of that unrest are complex, and mostly socioeconomic (with the arrest of Zuma for obstruction merely the most proximal cause, and probably not the main cause). And will likely continue to be a struggle for the country for awhile at least.

And again, they will not be alone. With grocery store CEO’s in the news today suggesting that prices might be 10-15% higher by October in the US alone, food price pressure is not going away, and that pressure will fall disproportionately on the world’s poor. South Africa will not be the last country to have simmering socioeconomic problems and inequalities bubble over in that kind of environment.

–And yes, it was hard to find coverage on South Africa riots as soon as they settled down this past week. Yes, to read headlines, South Africa last week goes from “nation on the brink,” “unfolding disaster”, “utter collapse”… you know, this:

…to just falling off the face of the news altogether, with some serious DuckDuckGo work to find out that yes, indeed, the looting, violence, and arson had pretty much ceased.

Interesting, no? It’s like there is a predilection, what we would statistically call a “bias”, towards reports that emphasize the worst outcomes (often without context for actual risk of those outcomes), and generate feelings of anxiety, worry and fear. The moment it is clear the worst outcome is past (South Africa did NOT descend into a “Mad Max” landscape this past week, or become a failed state as of this past Wednesday), all mention disappears from the headlines. The next thing to worry about, or be tribally outraged about, starts to crop up instead.

And the cycle begins anew.

–Wonder if there is any correlation to the steady drumbeat of fear, worry, and outrage seeking headlines and articles (optimized by algorithms to maximize return on attention for their profit) and the increase in “deaths of despair”–like overdoses? Or the reports of increased feelings of disconnection with churches, jobs, communities? Or why everyone is waiting for the next apocalypse to confront us? Or the reports out just yesterday about increased feelings of loneliness among teenagers?

–Another possible correlation… Could the obesity epidemic also be at least partially explained by people self-medicating the anxiety, not only of life in general, but the added anxiety from modern news consumption, social media etc., with the sweet, sweet dopamine hit that comes from eating high fat, high sugar, high calorie, low satiety foods?

–Anyways. Getting off topic now…

Rounding out the last major news stories…

1. No opinion on Fauci vs. Ryan and NIH funding of the Wuhan lab for gain of function research. I think I have made my stance on Dr. Fauci clear already, and frankly, the whole kabuki is just grist for the news cycle mill. Changes nothing from a pandemic management, vaccines/masks/lockdowns/Delta waves, perspective.
2. Monkeypox. Yes, and thank you to the readers who forwarded the article. Guy on a plane to Texas turns out to have contracted monkeypox during his stay in Africa. Oops. The CDC is now monitoring the other 200 or so people on the plane and close contacts (from the sounds of it) in something like 27 states. Monkeypox is in the same virus family with smallpox, but, as you can gather from the name, mostly affects monkeys. You only really get it from close contact with monkeys, possibly rodents in among the monkeys (there is debate about the actual reservoir). It’s rare everywhere except the Democratic Republic of the Congo, where, yes, our old friend the DRC has reported more than 1,000 cases of monkeypox every year since 2005. If you like exotic infectious disease, my friends, the DRC is indeed the place for you. Monkeypox looks like a mild case of smallpox, with fever, headache, backache, chills etc. turning into a rash 1-3 days after the fever with the characteristic “pox” look. Typically resolves within 2-4 weeks. That said, monkeypox can be fatal in up to 1 in 10 cases; treatment is mostly supportive, although you can try providing antibodies to the same inactivated cousin that is the smallpox vaccine. Human to human transmission only occurs through direct contact with the lesions, or prolonged (CDC’s words) respiratory contact. Since everyone had to wear a mask on the flight, chances of human to human spread of monkeypox in the US are pretty low. We will not be following this, unless this turns out to be a bioengineered strain released by the Army of Bioterrorist Monkeys or causes more than the 1 case here.
3. One of the largest and most cited studies of ivermectin in the treatment of COVID has been retracted due to significant problems with the data. I won’t go into all of them here, but just to give an example, when other researchers dug into the raw data behind the study, they found that most of the patients listed as dying during the study were admitted to the hospital and died before June 8th, 2020. That is a bit of a problem for a study that supposedly did not start enrolling patients until after June 8th, 2020. What they published for deaths in the ivermectin group and control group did not match their actual data, and always in a direction that would make ivermectin work better. In short, turns out the paper was a hot mess and needed to be pulled, since the conclusions in no way match the raw data, and at this point, it’s not clear what reliable data they actually have. Again, jury is still out on ivermectin as a treatment for acute COVID.

–Your chances of catching COVID this week are equivalent to the chances that I get sent several reports of the monkeypox case by readers, yet no one sends the story of the rampaging monkey in India that broke into a liquor store, and, to assert its dominance, downed an entire bottle of Kaluha while staring down the hapless owner.

At least it didn’t get into the good stuff.

And that’s your chances of catching coronavirus this week.

<Paladin>