“It’s kind of like people dying in a war after the peace treaty has been signed.” Dr. Sanjay Gupta, CNN, July 14, 2021

“This is like the moment in the horror movie when you think the horror is over and the credits are about to roll. And it all starts back up again.” Rep. Jamie Raskin (D, Maryland), July 22, 2021

“Folks are supposed to have common sense. But it’s time to start blaming the unvaccinated folks, not the regular folks. It’s the unvaccinated folks that are letting us down.” Alabama Gov. Kay Ivey, July 23, 2021

“Political division, disinformation and, frankly, stupidity are costing lives. It is not authoritarian to mandate vaccines in America.” Ian Bremmer, President, Eurasia Group, July 26, 2021

“Sometimes praying isn’t enough. I yell at Jesus if I need to.” Laurie Douglas, COVID-19 care nurse, CNN July 31, 2021

“I wish I could snap so many people out of their selfish stupor but I can’t, so I get to watch instead as people learn the hard way; with a tube down your throat. With a ‘code blue, code blue!’ and the crack of a sternum.” Kathryn Ivey, COVID ICU nurse, August 2, 2021

“We are seeing more and more pediatric patients coming in with COVID-19… I would love everyone to look within themselves and do what is right for their family, for our children, for our community… But if people aren’t going to use common sense, then unfortunately mandates may be important and necessary.”  Dr. Kelechi Iheagwara, Medical Director of the Pediatric ICU, Our Lady of the Lake Children’s Hospital, Baton Rouge, Louisiana, August 14, 2021

 

Dear Students,

I have not written an update since Juneteenth, by far the longest I have gone without writing. I have to say that I have been too discouraged. I realized that I could pretty much compose a new update with quotes from my updates over the whole tragic period since early 2020. I use the word “tragic” advisedly. What is tragedy after all but a catastrophe that was avoidable except for some profound human flaw? Why keep writing about it? Because some students and other readers tell me they trust the way I sift through vast amounts of bewildering information and say clearly what I think.

Since it’s my first update since Juneteenth, I want to start by showing you the chart on the right (from a recent article in Health Affairs; FPL means Federal Poverty Level), which shows more strongly than anything how we as a society have failed African-Americans. It really is astounding. It has been said that a civilized person can look at a page of numbers and weep. This chart should bring tears to your eyes. I wrote on Juneteenth, “2.9 is the odds ratio of blacks vs. whites being hospitalized with COVID-19, and 2.0” is their relative risk of dying.” This chart shows that no matter your insurance status, family income, or type of work, you were far more likely to die during this pandemic if you were black than if you were any other kind of person. This is systemic racism, an extension of slavery and Jim Crow, and it is our failure as a nation.

So what I am going to say about vaccine resistance (different from vaccine “hesitancy”), and opposition to masking pretty much exempts black people—let’s call it the Tuskegee exemption—although the chart  tragically shows they would benefit most from vaccination. (The Rand Corporation conducted a study of vaccine hesitancy in black communities last December.) Also exempt, of course, are the small number of people who have legitimate medical reasons for not being vaccinated.

I am talking about white people who carry placards lying about vaccines and masks. I am talking about white governors who repeat the lies or ban mask mandates. I am talking about TV personalities and social media “influencers” who are leaders in the lying. They are, all of them, not just liars but killers, spreading highly deadly disinformation.

I am tired of people who repeat self-serving lies, and I am tired of people who coddle them, who want to make nice-nice with them and help them come around to abandoning their lies. I don’t have time for such psychotherapy. If it’s someone you love, persuade them if you can. But don’t expect the rest of us to wait and see if your persuasion works.

Here is what I want to say to them:

You have bad breath. You have foul, diseased, deadly breath, both when you are spewing your lies and when you are breathing on me, and my children, and my grandchildren, who have done everything humanly possible to fight off this virus, while you have done everything possible to give aid to the enemy. You are traitors to the United States and to the human race. Soon you will be ostracized by widespread mandates, because coercion is all you understand. You will not be forced to accept a vaccine or wear a mask, you will simply be excluded from places where your obstinacy and stupidity can hurt people who have more common sense and more respect for others than you do.

I say to you: Breathe on each other, not on us. Spit on each other if you like, it amounts to the same thing. Keep your filthy, disgusting, sickening breath and other excretions to yourselves and others like you. Stay away from me and those I love.

Polls show that the great majority of all unvaccinated people state that they will not or probably will not get a vaccine. This is not lack of access, this is opposition. Every minute of every day we use laws, rules, mandates, and other forms of coercion to protect ourselves from human obstinacy and stupidity. We have to stop coddling the obstinate and stupid. We have used a lot of carrots, and they don’t work nearly well enough. We need sticks too.

Mandates (laws, punishment, coercion) have been an integral part of public health for centuries and have saved millions of lives.

This includes, but is not limited to, isolating people arriving in fourteenth-century Florence during the Black Death for 40 days (where our word “quarantine” comes from);  mandatory vaccination against smallpox in 1850s Britain, while some religious leaders inveighed against it as un-Godly; shutting off public water supplies carrying cholera (John Snow, 1854); outlawing spitting in public places in New York in the 1890s, when it was extremely widespread, to stop TB; forced quarantine of Typhoid Mary; mask mandates in the flu pandemic of 1918-20; mandatory childhood vaccinations for pertussis, diphtheria, measles, mumps, rubella, polio, etc. or you don’t go to school; mandatory meningitis vaccination or you don’t go to college; closing of bathhouses in the HIV epidemic; arresting and jailing people who deliberately spread HIV; severe restriction of smoking in public places and punitive taxation of tobacco products; infant car seats, seat belts, shoulder belts, and airbags; and cracking down hard on drunk driving.

All these coercions (“sticks”) and many more have stood up to legal, ethical, and historical scrutiny and have saved countless millions of lives. More and more institutions, governments, businesses, and schools will soon be mandating proof of vaccination and masking as the price of admission. You don’t want to do that, fine, you’re free to show me your back. And if you don’t, I’ll be free to call the police to keep you off my premises. And rest assured I will. In the end you will have to take your bad breath somewhere else.

On September 5, 2020, I wrote, “TETRIS [Testing, Tracing, and Isolation] is dead. So is the CDC. And the FDA. And 188,000 Americans.” (What a paltry number that seems now. If only we hadn’t insisted on more than tripling—and soon perhaps quadrupling—it.) I had high hopes for the new government in Washington. But a successful spring vaccination campaign had petered out by summer and, though daily jabs are rising again, they will not suffice.

On May 9th I wrote, “The country has fought the virus to a standstill on a hill some feared we couldn’t hold, and we fought it down the hill. If we can fight it down further off the high plateau, we might just win the war. As always of course, this involves not just vaccinations but other precautions, especially those against swapping air. But the situation in India is heart-breakingly bad and worsening by the day.”

Around that time, the CDC announced that vaccinated people could be unmasked indoors. They unraveled a year of education only to reverse themselves in July. While not as disastrous as last year’s CDC, this one is sending mixed messages that cost lives. If they had just looked at India and the U.K. in May, they would have known better than to ease up on masking.

But this is America. We don’t learn from other countries. So we now have the highest number of new cases in the world.

On the July 4th weekend, our new president took the opportunity to pretty much declare our independence from the virus. How very premature that was. As the second chart shows, we were just getting into the fourth, possibly worst wave.

As for the FDA, it’s also not dead, but some experts I trust say it’s moving far too slowly on full approval of vaccines that have been given to scores of millions of people with minimal safety concerns. The American Academy of Pediatrics has said the same about emergency use approval for children under 12.

If this is not an emergency, I don’t know what would be.

Bad News

1. The Delta variant—which is so different that I’m inclined to call it “The Delta Virus,” although that’s technically wrong—now accounts for well over 90% of US cases. It is much more contagious than earlier strains (each infected person infects 5-10 others, as opposed to 1-2), makes people sicker, is easily contracted by vaccinated people (although it rarely sends them to the hospital or kills them), and affects young people, including children, more than earlier strains did. It will result in millions of cases of long COVID, which will burden our nation’s health for years, maybe decades, to come. As of today, Delta is the story.
2. In states with low vaccination rates (and some have killer governors), Delta is overwhelming hospital systems. Georgia is one of the worst states. Children’s wards are filling up fast, and many children are very sick. Nurses are quitting, citing “compassion fatigue.” Don’t have a heart attack, an auto accident, or appendicitis in these states right now. There’s a likelihood that no one will be there for you. On January 5th, when there were a mere 350,000 American COVID deaths, I wrote about overwhelmed health care workers, “We will kick them until they are dead.” This seemed hyperbolic, but we did kill many, some by their own hand. We are about to do it again.
3. No children are vaccinated, and children are getting COVID-19 in unprecedented numbers, around 100,000 in the past week (that we know of). Of these, roughly 1-2,000 will be hospitalized, and some 300 will die. An unknown number, somewhere between 2,000 and 20,000, will experience long COVID. As Dr. Daniel Griffin said in his latest podcast, if no adults got the virus we would consider this an extremely serious childhood illness. But many people still think it doesn’t affect children all that much because it affects adults more. Schools are opening across the land. CDC Director Wilensky keeps saying, “We know how to protect our children.” Sure, and if you gave each school a couple of million dollars they could implement the protections. Unless of course your governor forbids you to do that. Closures for quarantine are already occurring. And yes, I do get that children need to be in school; but I also get that their health needs protecting.
4. This virus is evolving. Delta is not the last new variant we will see. Read my “interviews” with the virus (here and here) to learn more about “Sarsie’s” ongoing quest to follow the steps laid out by his Uncle Charlie Darwin, in order to advance his species in its struggle against ours. And heed the warning of Dr. Andrew Pekosz of Johns Hopkins University, which I quoted last time: by have a large unvaccinated population side by side with the vaccinated, we allow the virus to go back and forth and evolve new strains to overcome vaccine protection. It’s essentially the same way Pekosz creates—evolves—new strains of viruses in his laboratory. And of course, the world at large is mostly unvaccinated. We have imported new, increasingly contagious and/or virulent strains of SARS-CoV2 from several other countries, and we will continue to do so until we vaccinate the world.

Good News

1. Daily vaccination rates are going up again, although they are still a small fraction of the numbers we saw in April and May. Still, we are slowly chipping away at the numbers of unvaccinated people, at least the minority of them who had access problems or who were persuadable. Slightly more than half of Americans are now fully vaccinated. The FDA says it may give full approval (as opposed to Emergency Use Approval) to some vaccines in September.
2. There are plenty of vaccine supplies for our country, so in the not too distant future a third booster dose will be available. We already approved the third dose for immunocompromised people (around 3% of Americans), and Israel, Germany, and some other countries are already offering it to all older people. This will protect us as vaccine immunity inevitably wanes, on an unknown timetable.
3. Monoclonal antibodies save many lives if administered to outpatients in the first ten days or so of an infection, although they are much less effective in hospitalized patients. They have kept many thousands of people out of the hospital. If you or a loved one has been exposed and is showing symptoms of COVID-19, get a test, and if you test positive, call your doctor or go to an emergency room to inquire about this treatment right away.
4. Here is the best news of all, but be wary of it because it is a speculative projection. The Delta wave could go away as fast as it surged. This has happened in India and the UK, two extremely different countries in everything from vaccination to sanitation. Nobody knows why, but it is just possible that the same will happen here. Right now, though, we are very much in the rising portion of the surge, and that means rising cases, hospitalizations, and deaths, including children. Don’t become a statistic, or turn your loved ones into statistics, while we are waiting and hoping for the surge to peak. And remember Uncle Charlie Darwin; the virus has more tricks to play on us after the Delta surge is over.

We have vaccines. Many people refuse them, and masks as well. They have a deadly movement. They are not just ignorant, they combine ignorance with arrogance. They deny they have COVID while they are in the ICU dying of it, and while endangering the people taking care of them. After a year and a half, if some of those brilliant, brave caregivers walk off the wards and don’t come back, you won’t see them getting blame from me.

As for anti-vaxxers and anti-maskers: Keep your foul breath to yourself in your own dirty places. Blow it on your friends and relatives if they will stand for it. But keep away from decent Americans who care about our country and each other.

As  for the rest of us, rewind last year’s horror movie. We are watching it—no, we are in it—again.

Stay safe, and keep your loved ones safe. I will see some of you soon.

Dr. K