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https://www.cnn.com/2021/07/14/health/covid-vaccine-solution-not-problem-gupta/index.html
Dr. Sanjay Gupta: The importance of being vaccinated
By Dr. Sanjay Gupta, CNN Chief Medical Correspondent
Updated 2:04 PM ET, Wed July 14, 2021
00:02/05:00
(CNN)We've all heard it said over and over again: We're now in the phase of the pandemic when it's a race between vaccinations and the variants.
It has been neck and neck for a while, and honestly, I was ready to cheer a vaccine victory. We nearly dropped to an average of fewer than 10,000 new cases a day, an important number because, according to President Joe Biden's chief medical adviser Dr. Anthony Fauci, that number moves the country into "containment" -- a time when we would finally get our arms around the spread. We came tantalizingly close: 11,299 cases in late June.
But, then the variants caught some speed, and the vaccine started to fall behind; we are now at an average of 23,472 new cases a day as of Tuesday, and all indications point to that number rising. There are many countries around the world that now are seeing case rates increase against a backdrop of sparse vaccine supply. Here in the United States, we have plenty of vaccine available, a precious commodity almost every country around the world wishes they had. We have the means to distribute vaccines and have even made them totally free of charge.
I believe most of us also fundamentally understand the best way to get a handle on the pandemic and return fully to life as we know it is to vaccinate enough people. What we are lacking is the will.
It may be that some parts of the country really haven't gotten the memo on the importance of vaccines -- or even worse, they are receiving another far more insidious message: that it's the vaccines themselves that are the problem.
They aren't the problem. They are our best shot at being rescued from this ongoing pandemic. Research from the Commonwealth Fund estimates the Covid-19 vaccines have already saved about 280,000 lives and averted up to 1.25 million hospitalizations in the United States. A vaccine protects not only the person getting it but those around them as well -- including children under the age of 12, for whom the current coronavirus vaccines are not yet authorized, or those who have weakened immune systems that prevent their bodies from generating a strong immune response after vaccination.
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That is the very definition of herd immunity: providing a ring of protection around the vulnerable. In order to get there, around 70% of people need to be fully vaccinated. That level of immunity will make it so that we are no longer such willing hosts to the virus and put us on a path to eventually run it out of town.
The vaccines also directly protect us from future variants; mutated versions of the virus that emerge in infected people and can be more contagious than the original strain. Right now, it's the Delta variant that is wreaking havoc in the United States and elsewhere, but the more the virus spreads, the higher the chances another variant of concern will take its place. Vaccinations slow these mutations from happening because if a person doesn't get infected in the first place, their body can't possibly become a breeding ground for a mutation.
A look at the numbers
President Joe Biden set what initially appeared to be an attainable goal: have 70% of the adult population with at least one Covid-19 vaccine shot by July 4th. But after months of steady vaccine progress, the numbers began to dwindle and the goal was missed.
Currently about 59% of the US population has at least one dose and 48% is fully vaccinated, according to the US Centers for Disease Control and Prevention. But that doesn't tell the full story. The United States cannot be painted with a single brush stroke, and nowhere is that more true than with this pandemic. As things stand now, the top five states have 60% or more of their population fully vaccinated versus less than 36% for the bottom five states.
According to a CNN analysis of data from Johns Hopkins University and the CDC, states that have fully vaccinated more than half of their residents reported an average of 2.8 new Covid-19 cases per 100,000 people each day last week, compared to an average of about 7.8 cases per 100,000 people each day in states that have vaccinated fewer than half of their residents. That's almost a three-fold difference. It's in those states with the highest vaccination rates where you can see the vaccines truly work their magic. It's not just cases decreasing, but more importantly, hospitalizations and deaths plummeting as well. The vaccines accomplished exactly what they were designed to do.
Early data from a number of states suggests that 99.5% of those Covid-19 deaths during the first six months of the year have been in unvaccinated people. Just consider that if a patient in the United States is hospitalized or dies of Covid, 99 times out of 100 they are unvaccinated. Dying at this stage in the pandemic is almost like a soldier dying after a peace treaty has been signed. Heartbreaking and largely preventable.
CDC Director Dr. Rochelle Walensky called any suffering or death from Covid-19 "tragic," and noted that available vaccines mean that "the suffering and loss we are now seeing is nearly entirely avoidable."
"We have seen the successes of our vaccination program over the last eight months with cases, hospitalizations and deaths far lower than the peaks we saw in January," she said. "And yet on the other hand, we are starting to see some new and concerning trends."
One of those trends is the falling rate of vaccination. An average of 282,143 people are reaching "fully vaccinated" status each day -- one of the lowest daily rates since the end of January, when vaccination efforts were just picking up steam. And it's almost a 50% drop from last week, when an average of about 535,000 people became fully vaccinated each day. At our peak in mid-April, an average of nearly 1.8 million people -- more than six times as many -- were becoming fully vaccinated every day.
The wrath of Delta
Another new and concerning trend involves the rise of the Delta variant, which is believed to be much more contagious; it now makes up more than 50% of Covid-19 cases in the US -- and in some places, that number tops 80%. Its dominance is making the vaccination issue even more pressing.
Fauci called it "a real bad actor virus" on CBS earlier this week.
The Delta variant, first identified in India, is likely behind the current uptick in cases. The US is now averaging more than 23,000 new Covid-19 cases each day, according to Johns Hopkins University, almost double two weeks ago. The average number of daily cases is rising in 46 states. And we're seeing 261 new Covid-19 deaths each day -- a 21% increase from last week. Again, deaths that are largely preventable.
How contagious is the Delta variant? If you remember back to the start of the pandemic, we measured how infectious a communicable disease is using a mathematical term called R0 (R-nought), also called the reproduction number. It basically estimates the average number of people one infected individual will go on to infect. If the R0 number falls below 1, the disease eventually dies out.
According to estimates, the original virus found in Wuhan, China had an R0 between 2.4 and 2.6. The Alpha variant, which had been the dominant variant and was first identified in the United Kingdom, was between 4 and 5. The Delta variant's reproduction number is estimated to be somewhere between 5 and 8.
That means the Delta variant is estimated to be two to three times more contagious than the original virus first seen in Wuhan, Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, said via email.
What does that look like in real life? Unforgiving. A remarkable look at CCTV footage from Australia revealed a simple encounter between two people passing each other at an indoor shopping area that resulted in two separate instances of transmission. The encounter was brief. The premier of New South Wales, where the incidents occurred, even called it "scarily fleeting."
That is why the rise of the Delta variant coupled with low vaccination areas is really worrying public health experts, just as they were ready to start looking at Covid in the rear view mirror.
A new data analysis by researchers at Georgetown University has now identified 30 clusters of counties with low vaccination rates and significant population sizes that are vulnerable to surges in Covid-19 cases and could become breeding grounds for even more deadly Covid-19 variants. The five most significant clusters are sprawled across large swaths of the southeastern United States and a smaller portion in the Midwest. No surprise, most are already seeing increases in Covid-19 cases.
"We can't have it both ways; we can't be both unmasked and unvaccinated. That won't work," Dr. Jonathan Reiner, a CNN medical analyst and professor of medicine and surgery at George Washington University, said Monday.
Or as Dr. Barney Graham, deputy director of the Vaccine Research Center at the NIAID and one of the developers of the Moderna vaccine, told me: The country will no longer be split into vaccinated and unvaccinated; it will simply be split into vaccinated and infected.
That's where this road leads.
How to unstick the stuck vax rate
The simple answer is: Get vaccinated. You know that by now, and again, most people do. The doctors, nurses and health care teams recommending this are not political, but I can understand why you might think otherwise lately.
During the Conservative Political Action Conference's summer gathering in Dallas last weekend, attendees cheered author Alex Berenson when he pointed out that the Biden administration fell short of its vaccination goal.
At least 34 states as of June have introduced bills that would limit requiring someone to demonstrate their vaccination status or immunity against Covid-19 in certain areas such as workplaces or government buildings, according to the National Conference of State Legislatures; 13 of those bills have passed into law. That includes at least seven states -- Alabama, Arkansas, Florida, Indiana, Montana, Oklahoma and Utah -- that enacted legislation this year that would restrict public schools from requiring either coronavirus vaccinations or documentation of vaccination status.
And in Tennessee Dr. Michelle Fiscus, a pediatrician who has served as the state's medical director of the vaccine-preventable diseases and immunization for two years, says she was fired after she shared information about a decades-old state policy that allowed some teens to be immunized without parental consent.
Vaccine benefits outweigh risks
It's true that there have been a few concerning possible side effects associated with the vaccines. They include reports of a rare neurological condition called Guillain-Barré syndrome developing in some who received the Johnson & Johnson's vaccine as well as reports of rare blood clots in others; and heart inflammation in a small number of people who received Pfizer/BioNTech or Moderna vaccines.
While these are all serious conditions, it's important to remember these events are very, very rare occurrences out of the almost 185 million people who have received at least one shot in this country. And it's reassuring to know that in the vast majority of cases, those who developed these side effects recovered. The same can't be said for Covid-19, which has killed more than 607,000 people in this country, caused almost 34 million infections, and can cause symptoms that linger long after the person has "recovered."
It's also true there have been breakthrough cases of Covid-19 among the fully vaccinated, but that is to be expected. Even if an infection occurs, the important thing to remember is that the vaccines offer excellent protection against severe disease and death -- the two most important outcomes. And that's true even for the Delta variant, according to recent data from Israel and the United Kingdom.
Some progress is being made. A new poll released Tuesday by the Kaiser Family Foundation found that about 20% of Americans who were initially hesitant about or squarely against getting the Covid-19 vaccine have since gotten their shots. Of course, seen from the glass-half-empty perspective, that means 80% haven't.
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Convincing most unvaccinated Americans to get their shots will take more time than initial phases of vaccinations, White House Covid-19 chief Jeff Zients told reporters at a Covid-19 response team briefing earlier in the month.
"Each person in this phase will take longer to reach, but that makes them no less important. And the spread of the Delta variant, which poses a particular threat to our young people, only strengthens our resolve to reach everyone," he said.
That's an effort I am 100% behind.
Andrea Kane, Jacqueline Howard, Deidre McPhillips, Elizabeth Cohen, John Bonifield and Naomi Thomas contributed to this report.
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