Ari Armstrong, Coronavirus, Exclusives

Armstrong: Learning to live with Covid

“There is no Covid zero.” But, through vaccines and better treatments, we can learn to live with the virus. So argues Amesh Adalja, an infectious disease specialist at Johns Hopkins and one of the most consistent and reasonable voices through the pandemic.

Right now, though, Colorado is getting crushed by the Fifth Wave of the Pandemic. Measured by daily cases or daily hospitalizations, this wave threatened to become the state’s worst into the holiday season, according to a November 3 modeling report from the Anschutz Colorado School of Public Health. (See also my summary.) That report estimates the true number of cases, far higher than the number of positive tests. The strain on hospitals prompted the state to institute crisis standards of care regarding staffing and to consider further emergency measures.

Covid-related deaths also spiked in this Fifth Wave, although the total deaths during the wave remain far below those of the brutal Third Wave, which peaked on December 9 with 80 deaths in a single day. That one wave accounts for around 4,000 deaths, nearly half of the total.

As Adalja points out, better treatments have helped reduce the death toll. Doctors found that better oxygen management, dexamethasone (a steroid), remdesivir (an antiviral), and monoclonal antibodies can help. Both Merck and Pfizer are working on new antivirals that hopefully will prove to be game-changers. Britain already has ordered hundreds of thousands of doses, Reuters reports.

And vaccines have proved highly (not perfectly) effective against infection, hospitalization, and death. As of November 12, 81% of people hospitalized for Covid at that time were unvaccinated, even though the unvaccinated made up less than 30% of the population. Based on data from September and October that compared vaccinated and unvaccinated populations, the unvaccinated were 3.8 times as likely to test positive for Covid, 9.7 times as likely to be hospitalized with Covid, and 12.4 times as likely to die from the disease.

As the Anschutz report shows, vaccinations also benefit others. The report splits Colorado into eleven regions and charts Covid hospital admissions per hundred-thousand people against percent of the population in the region vaccinated. It then does the same for Covid deaths per million. Two facts clearly emerge: The unvaccinated are at substantially higher risk, and more-heavily vaccinated regions better-protect everyone.

In the report’s words: “The toll of [the virus] SARS-CoV-2 is most severe in regions where vaccination rates are low and among unvaccinated populations. Vaccinated individuals in high-vaccination regions have the lowest hospital and mortality rates in the state. Conversely, unvaccinated individuals in low-vaccination regions have the highest hospital and mortality rates in the state. Notably, unvaccinated individuals in high-vaccination regions have lower hospitalization and mortality rates than unvaccinated individuals in low-vaccination regions, suggesting that vaccination is protecting not only the vaccinated, but reducing transmission risk in regions with high vaccination coverage.”

True, immunity gained from vaccines, as well as immunity gained from infection, wanes somewhat over time. And “antibody levels vary widely from one individual to another after an infection,” notes the Washington Post based on a CDC report. It’s clear that getting vaccinated after an infection increases immunity; it’s safe to say that being exposed to the virus after getting vaccinated does the same. (My wife had mild Covid symptoms for a few days after being exposed to our test-positive son, having previously gotten the Johnson and Johnson shot.)

Waning immunity prompted Governor Polis to declare on November 11 that the entirety of Colorado is a “high-risk setting,” enabling anyone over 18 to get a booster shot.

So why did Colorado get hit so hard with this wave? Eric Topol Tweeted a map of U.S. hotspots. On August 7, the southeast, including Florida, was hard hit. On November 7, the northwest, including Colorado, was. A good explanation I’ve heard is that, as the weather cooled, more people went outside in the southeast but inside in the northwest. And of course the virus spreads easier indoors. The Anschutz report isn’t sure of that, though, saying, “The extent to which weather is driving the current surge is unclear.”

That report does find, “Population movement is at or beyond pre-pandemic levels.” Increasingly, people are out living their lives normally.

Interestingly, the Anschutz report also finds, “We examined mask-wearing patterns using public survey data. Facebook survey data do not show a sharp downturn in reported use of masks coincident with the timing of the surge. In fact, there is a gradual increase in mask wearing, particularly in Boulder and Larimer counties, which recently implemented mask mandates, which may explain why Colorado’s increase in SARS-CoV-2 spread has been more gradual than other states. We do not see evidence that a decrease in mask wearing is driving the current surge.”

Eventually this wave will quiet down, but right now it’s severe. The way I look at it, at this point, people who don’t get vaccinated who end up in the hospital or in the morgue are, for the most part, victims of their own choices. The people I most worry about are the relative few number of vaccinated people who get a serious breakthrough case, the people who have a harder time getting medical care for non-Covid problems, and the healthcare professionals working with Covid patients who have faced an absolutely punishing couple of years.

Covid ain’t going away. But its damage to our lives will lessen with time. Through our prudent choices we can mitigate the damage of this wave and help make Covid a low-level background disease. And that will be victory enough.

Ari Armstrong writes regularly for Complete Colorado and is the author of books about Ayn Rand, Harry Potter, and classical liberalism.  He can be reached at ari at ariarmstrong dot com.

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