September 4, 2021 - Surging Thoughts -

We’ve got doctors out there like Kimberly Manning (@gradydoctor), tirelessly listening to the concerns of the vaccine-hesitant, and oftentimes getting them past those concerns, with great respect and gentleness.  We’ve got people out there like the Dean of my cathedral, making the case for getting the vaccine as an act of caring for others, as we ought. (I commend to you 40 satifsying seconds, starting here).

And then we’ve got Wendy Molyneux, offering either catharsis for the annoyed, or evidence that ONE person still cares enough to argue with the vaccine-obdurate.  I doubt even Wendy M can change the obdurate. But I am all for catharsis, and I liked her image of soft pretzels, so I’m sharing this gloriously obscene and even more satisfying selection, for those who might want to vent.

I haven’t written much about COVID since May, when I discovered I didn’t understand the math around what vaccine efficacy actually measures. A medical friend sent me an article about it, and I read it, and then I asked a different friend, a former high school science teacher, to help me check my understanding (thank you, Keith, I owe you).

But the answer was so counter-intuitive that I a) lost heart, b) started collecting examples proving that other people didn’t understand it either (SEE?!?!) and c) found myself with follow-up questions, and a not-unfounded fear that I would wear out my exhausted medical pals if I asked for more explanations. So, enough. If I never quite grasp some stuff, that won’t be the worst thing that ever happens to me.  

Also, like many others, I thought maybe COVID was going to recede, and maybe there weren’t too many more numbers I needed to understand.

But now I’m wrestling with the Delta surge. Something in Oregon rose 990% recently, and I couldn’t envision what that percentage even meant. It’s fierce. Hospitals around the state are overwhelmed, morgues are overflowing, and my brain and heart clutch when I look at the charts or listen to news stories and hear health care workers crying.  

Some of us are having trouble weighting disparate facts: YES, being vaccinated almost always prevents death and lessens the severity of an infection and also, YES, the virus will probably be with us for the foreseeable future, and so YES, we need to find workable ways to go on with our lives and/but also YES, this is a HUGE surge, we are back to the very early days when “flatten the curve” meant Do Not Overwhelm the Hospitals, and we’re failing, and also, HEY, I for one don’t want even a mild-to-moderate case, thanks, and also - maybe the hardest nubbin - YES, a modest percentage of a very big number can be a very big number.

The question is, essentially, what to do right NOW? Go to the game, masked, knowing everybody there will be vaccinated or tested negative? Or stay home? (Easy one for me, since I’ve never gone to a game before and don’t want to go now. But I hear 50,000 other people went today.) We’re back to that weighing-our-decisions place of just a few months ago.

There are some numbers, if numbers are your thing. The Oregon Health Authority has built new dashboards on breakthrough cases.

(The OHA website gets better all the time.)

Last week, the ratio of unvaccinated cases to breakthrough cases in Oregon was 5 to 1. The median age for breakthrough cases (in the six weeks they’ve been tracking) is 48 years.  

But we care much more about severe cases than mild ones. Illness severity for breakthrough cases is vastly lower than for unvaccinated cases. According to the OHA chart, there were zero breakthrough hospitalizations, and zero breakthrough deaths, for many months. The recent growth in hospitalizations and deaths might reflect the explosion in all cases, or waning immunity amongst those first vaccinated, or both. Cumulatively, less than five per cent of breakthrough cases have been hospitalized. Cumulatively, less than 1 per cent of breakthrough cases (113 cases) have resulted in death. The median age of those who suffered a breakthrough death was 81.   

The numbers help. But I doubt I’ll ever get all my questions cleared up. For instance:

The Trends and Projections section of the OHA site models two scenarios for the near future, both of which “assume recent vaccination levels will continue in the upcoming weeks. These scenarios assume that school reopening will not cause an increase in cases or hospitalizations in our state….”  Do they make that assumption because evidence shows it’s valid? Or do they have no data on how much school reopening usually changes case rates, so they just left that out of the model?

(The scenarios they do model are increased mask wearing versus no increase in mask wearing. Bottom line: if mask wearing increases, and all the other assumptions hold, we might peak about September 21.) 

I suppose, like everything else with COVID, time will tell.

Anyway, I’m not alone in struggling to weigh risks given the surge, as I wasn’t alone with my efficacy-rate confusion. I saw a buddy two weeks ago who had implemented very strict safety protocols in response to the surge. I spoke to her again yesterday and asked what her protocols are now. She said they change hourly. Sounds about right.