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Tuesday, July 20, 2021

More covid lessons from Israel and Houston Wedding

 Recent data from Israel. Of 61 patients hospitalized because of covid , 24 were unvaccinated  and 37 were fully vaccinated, Of the 37- 36 were over age 60 and one was in their fifties.

Clearly being fully vaccinated does not provide 100% protection against being seriously ill. Older people are not immune to developing serious covid 19 illness even after 2 sots of the mRNA vaccines.

Earlier the Israeli Health Ministry released the following summary without the detailed data on which the conclusions were made:

 The effectiveness of the Pfizer vaccine for prevention of disease was said to be 64% and the effectiveness as regards prevention of serious disease was 93% . Both values were in in the 90s from the randomized clinical trials for Pfizer.  

Why are they so different. Perhaps the antibody levels induced by the vaccine have decreased over time to a point at which the disease protection ability has also decreased. The other likely explanation is increasing number of cases due to the Delta variant.

From the Houston wedding case report we have to conclude that serious covid 19 disease can occur with spread of the virus from vaccinated person to another vaccinated person. 

An important question is:

1)Can a fully vaccinated person transmit the virus to another person? The Houston wedding  story makes it apparent that the answer is yes. While we do not know with a solid level of certainty the chain(s) of transmission in that spreader event  it seems most likely that at least one fully vaccinated person gave it to at least one other fully vaccinated  person.For that conclusion to be valid we have to assume there were no unvaccinated individuals, perhaps a service  person or a valet parking attendant  who could have transmitted the virus to all six of the infected attendees. 

Those type epidemiologic details would be important because if the fully vaccinated can transit the disease to the fully vaccinated and of course to the unvaccinated than the CDC advice for the vaccinated to do whatever they were doing before the pandemic without masks needs to be revisited and revised particularly as the Delta variant spreads

Further if vaccinated persons can spread the virus and since we know there can be asymptomatic spread and we know that there is aerosol spread then vaccinated persons should not go mask less in congregate settings such as grocery stores and churches to mainly protect others as well as themselves.

What about protection of children too young to be eligible for vaccination? Vaccinated parents should wear masks in public to minimize the risk of bring a covid virus home to infect the child.The vaccinated parents are very unlikely to get seriously ill from the Delta variant but are able to transmit the virus to their unvaccinated child. 

Mask wearing became a political issue earlier on in 2020 and when the discussion turns to why do folks oppose mask reading one purposed reason is "libertarian thought".

There is nothing libertarian about the vaccinated tossing the masks away if there is asymptomatic spread even among the vaccinated. One does not have the right to put others at risk. The foundational libertarian principle is that of non aggression i.e. one does not have the right to initiate force against another, Libertarian thinking is sometimes blamed for mask aversion but if someone believes he can spread a potential fatal disease to others  and if he does not wear a mask that is not libertarian exercise of a right  but rather a hostile act. 

So what are the lessons from recent Israel data and the Houston wedding story.

1) If and when the Delta variant is increasing in a community ( particularly  in a community with low level of complete vaccination ) people who have been vaccinated should not believe themselves to immune to covid They can spread the disease and there are break through cases..The CDC proclamation was poorly understood  or taken to mean to be no mask at all under most all circumstances. More troublesome is the obvious fact that everyone who is mask less is not fully vaccinated. Less than 50% of residents of Harris county Texas,home of Houston, have been vaccinated but try and find more than one or two people with masks when a crowd shot is shown at a Astros home game.Further, one shot of either of the two mRNA vaccines does not protect against the Delta variant.

2)Vaccinated people can get seriously ill from Covid and  some will  die.

3)With the increasing spread of a many time more contagious everyone should wear a mask in congregate setting to as was true in the beginning of the pandemic to protect others and yourself.

 The CDC said that masks may still have to be worn when government regulation (Federal or state or local) so indicates. Unfortunately in some states the legislature and or the governor have decreed that business may not demand a "vaccine passport" and/or that public school cannot mandate vaccination or masks regardless of what the level of risk may be.

As cases again begin to spike, CDC needs to revise its mask guidelines and when a virus is on the ascending limb of spread time is of the essence.


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