“The vaccine is the weapon that will end the war, but it won’t hit critical mass until June, September or even December. If we float along relying solely on the vaccine, the way many states are, we are looking at months of shutdowns and the economic, mental, and spiritual hardship they bring.…We can’t do that. We just can’t let that happen. We can’t float along, watching the pain, the hardship and the inequality grow around us. That’s not what we do in New York. We must take control of our destiny.” Gov. Andrew Cuomo, State of the State Address, January 12, 2021

     “If quick action isn’t taken, then the highly infectious B.1.1.7 variant of COVID-19 will become the main variant in the United States by March, further burdening our already overburdened health care system.” Frank Diamond, Infection Control Today, reporting on Centers for Disease Control warning, January 18, 2021

Dear Students,

My wife Ann and I got our first dose of the Pfizer vaccine on Friday, and while we’re not changing our precautions at all yet, it’s a huge relief to have gotten started. We’re both over 65, which puts us in priority Group 1A in Georgia, but there was a lovely personal touch as one of my former students who is in practice in Atlanta reached out to us and said her office had vaccine. She was sitting right where you are around 15 or 20 years ago. Slightly sore arms were the only side effect.

Since today is the holiday honoring the Rev. Dr. Martin Luther King, Jr.’s great legacy, it behooves us to remember that of the 400,000 Americans killed by the virus so far, a greatly disproportionate number are black. African Americans have also borne a disproportionate share of the economic devastation. I have written about this before, but I am emphasizing it again today. In 1963, two days before my 17th birthday, I was present in Washington for Dr. King’s “I Have a Dream” speech. We have come a long way since then, but we still have a long way to go.

Case in point: the insurrection that took place in the same city on January 6th was overwhelmingly white, and many among them were avowed white supremacists. Nobody thinks that if the rioters had been black they would have been allowed to get as far as they did in taking over our government.

Two days from now the same huge mall that I stood on with two hundred thousand others on that day in 1963 will be decidedly empty, despite the fact that President Biden will be inaugurated.

One reason it will be empty is the virus of course, which Biden has so much more knowledge of, and so much more appropriate caution about, than his predecessor. But the twenty thousand National Guard troops deployed to D.C. this week are not there to defend against the virus. They are there to defend against another right-wing insurrection.

The attempted coup on January 6th at the Capitol, designed to prevent the transfer of power to a duly elected new president, was also a superspreader event. Very few of the rioting revolutionists were wearing masks, and they certainly weren’t observing any kind of social distancing.

More surprising perhaps, some members of Congress who were hiding from them also did not wear masks, despite being crowded into rooms where they were sheltering from violence. Some of them mocked their colleagues and their official physician who were wearing and distributing masks. These members of Congress were Republicans.

Since the pandemic began, 62 members of Congress have contracted COVID-19, 44 Republicans and 18 Democrats. At least 7 have tested positive since the insurrection, most likely because of mask refusal by Republicans. Looking at the course of the American epidemic, blue states were affected first but controlled the spread better, and red states have had a much worse fall and winter surge, especially after controlling for rural and urban populations.

I try not to get too political in these updates, but these are the facts.

Some students have asked me what will be different after President Biden is inaugurated at noon on Wednesday. My answer is: a lot. First, we have to get there, and the possibility of further disruption by Trump supporters both before and after Wednesday is real.

But here is the good news:

1. Biden has already appointed the most competent and experienced physicians and scientists to deal with the pandemic. There is a world of difference between them and the people they are replacing. This includes the heads of the CDC, FDA, HHS, the Coronavirus Task Force, and many other positions, starting with Dr. Anthony Fauci, who will finally have the ear of the president and the ability to speak directly to the American people.
2. Biden has a detailed national plan for rectifying the dismal failure of the vaccine rollout, with an attainable goal of having 100 million doses delivered in the first 100 days of his presidency. Far from abandoning the states to their own floundering, he will work closely with the states and their governors to properly organize distribution and injection.
3. Similar national plans for huge expansion of testing will be implemented, giving America its first detailed knowledge of who has and who is spreading COVID-19. Ditto (see #2 above) on working with the states.
4. Public health education for preventive measures against the virus (masking, social distancing, etc.) at a national level will be hugely improved, along with increased mandates where possible, and the standards and models set by people in national government will be positive instead of negative.
5. President Biden will invoke the Defense Production Act much more extensively than his predecessor, giving manufacturers well-compensated mandates to produce more vaccine, vials, syringes, freezers, protective personal equipment, and many other sorely needed products to fight the war we are in, as has happened in previous wars, but so far very inadequately in this great war against the pandemic.
6. While the Senate is only narrowly controlled by Democrats, Biden, like Lyndon Johnson before him, is a ‘man of the Senate.’ He spent most of his life there, knows the institution and its ways, and is friends with many sitting senators. He may not get 100 percent of the funding he wants to fight the virus, but he will know how to compromise and he will get a lot.

The bad news is:

1. Political opposition to all of the above will continue. That includes resistance to public health measures, vaccine refusal, and pretty much everything else the new administration wants to do. The same people who brought you 400,000 deaths will do all they can to bring you at least a couple of hundred thousand more. Continuing insurrection will make all this worse.
2. New variants of the virus, especially the B.1.1.7 strain first identified in England, are spreading fast in the United States. This is partly because they spread at least 50 percent more efficiently, and partly because our precautionary measures have been so inadequate and the vaccine rollout such a failure. Continuing insurrection will make this worse too.
3. 100 million doses of vaccine in the first 100 days (i.e. by the end of April) will get us nowhere near the herd immunity that all vaccination campaigns aim for. Even with the (probably) soon-to-be-approved one-dose vaccine from Johnson & Johnson added to our current options, we will still have protected only a fraction of Americans.
4. And probably the worst news of all is that we could easily have a late spring and summer surge in the new variants, given the laxity of proper precautionary measures, and the slowness of even a greatly improved vaccine rollout. The dual graph comes from the new CDC paper on this. On the left is a reasonable model of what will happen with vaccination but without strict precautionary measures. On the right, a likely result of vaccination with masking, social distancing, and so on.

So, due entirely to our own failures, the overall pandemic will likely be with us through the summer and possibly into the fall of this new year and beyond. But it won’t be as bad as it is now, it just won’t yet be normal. Of course, we could change all that if we did the right thing.

Stay safe,

Dr. K

PS: Please don’t rely just on me. The best resource on what is happening specifically in the state of Georgia is Dr. Amber Schmidtke’s Daily Digest. More generally, I recommend the following: The Bill & Melinda Gates Foundation COVID-19 Update, aka The Optimist; for the science of viruses, especially the new coronavirus, This Week in Virology (TWiV) podcast; Dr. Sanjay Gupta’s podcast, Coronavirus: Fact vs. Fiction; COVID-19 UpToDate for medical professionals; and for the current numbers: Johns Hopkins University (JHU); Institute for Health Metrics and Evaluation (IHME); Our World in Data (OWiD); The New York Times Coronavirus Resource Center (NYT). For uncannily accurate warnings, follow @Laurie_Garrett on Twitter. I also recommend this COVID-19 Forecast Hub, which aggregates the data from dozens of mathematical models, and this integrative model based on machine learning. For an antidote to my gloom, check out the updates of Dr. Lucy McBride, who doesn’t see different facts but accentuates the positive. For an up-to-date account of the clinical facts by the marvelous front-line doc Daniel Griffin, listen to TWiV episode 701, a marvelously clear step-by-step from exposure to recovery in 39 minutes.