The Michael Myers Phenomenon: How COVID-19 Came Back
Filmmaker John Carpenter has built an entire career around the 10-film Halloween franchise, the central character of which is a seemingly unstoppable serial killer named Michael Myers. Various cinematic incarnations of that horrific character have been stabbed, shot, burned and even decapitated, but Michael Myers keeps coming back, again and again, his unceasing mindless bloodlust driving him to kill innocent people again and again, without the faintest shred of remorse.
So here we find ourselves rapidly approaching two years of COVID-19—and SARS CoV-2, the virus that caused it all, has pulled its Michael Myers act, roaring back to life after being pronounced dead once again, dashing hopes of a any imminent return to “normal,” whatever that really means these days.
In mid-June, Savannah hit a landmark in the fight against COVID-19: Zero COVID-infected inpatients in our three area hospitals’ ICUs, and single-digit numbers of hospitalized COVID patients overall. Given that the Savannah hospitals are the ICU resource for most of coastal Georgia and the nearby parts of South Carolina (a catchment area of over a million people), the dearth of hospitalized COVID patients was significant—the lowest such numbers since the pandemic first spread into our area in March 2020.
But there were signs of trouble ahead. Vaccination efforts, both nationally and locally, had been robust in April—but they were stalling out by June, with many vaccination centers closing out of a lack of interest. The state of Georgia has only fully vaccinated 40% of its total population—one of the lowest percentages in the country (the national average is 57% of those 12 and up). Chatham County is only slightly better, at 42% fully vaccinated; Effingham County is far worse, at only 30% (https://experience.arcgis.com/experience/3d8eea39f5c1443db1743a4cb8948a9c/ ). The rapid emergence of the Delta variant, which is up to 6 times more contagious than the original COVID strains that this country first saw in March 2020, was also worrisome. This variant, which now constitutes 83% of new COVID-19 cases in the U.S., had previously led to severe recent COVID outbreaks in India and in the U.K. (https://apple.news/AHM22bQehQOqOy7a8cUPdpw ). Studies from the U.K. showed that the delta variant was twice as likely as the previously-dominant alpha variant to result in hospitalization. One positive aspect: Studies in England showed that the Pfizer vaccine, one of the three COVID vaccines approved for Emergency Use Authorization (EUA) in the U.S., is 96% effective against hospitalization with the delta variant after two doses (https://www.gov.uk/government/news/vaccines-highly-effective-against-hospitalisation-from-delta-variant ). Other studies have shown similar efficacy for the Moderna and J&J vaccines, the other two COVID vaccines authorized for U.S. use (https://www.healthline.com/health-news/heres-how-well-covid-19-vaccines-work-against-the-delta-variant ). It has been shown that the vaccines are quite effective in preventing both serious disease from COVID requiring hospitalization (96%) and death (94%) (https://www.medscape.com/viewarticle/955761 ).
But vaccines cannot be helpful if they are not being used.
As of last week, the number of COVID-19 inpatients in Savannah’s hospitals had jumped to over 100—a far cry from the 190 inpatients we saw here in January 2021, but a dramatic upward trend. The community transmission index of COVID-19 in Chatham County has skyrocketed from 43 cases per 100,000 residents in late June to 404 cases per 100,000 residents as of July 30 (https://covid19.gachd.org/chatham-county-covid-19-data/ ). Both of these numbers are the highest we have seen locally since mid-February. Nationally, COVID-19 cases are up 145%, particularly in the Deep South, where vaccination levels are lowest. Cases in Louisiana are up 307%; in Mississippi, they are up 274% (https://www.cnn.com/2021/07/31/us/new-orleans-covid-19-surge/index.html ). South Carolina (248% increase), Alabama (217% increase) and Georgia (208% increase) are right behind them.
In the health care industry, the recent trends have been striking. As over 95% of our local over-65 population has been vaccinated, most of the people we are hospitalizing now are under 50 years of age. I have personally seen several people under the age of 40 die of COVID during the past few weeks. In Savannah, the average age of the hospitalized COVID patient last week was 51. This trend is also being seen nationally, as the age range of the average hospitalized COVID patient has shifted downward into the younger unvaccinated population (https://www.wsj.com/articles/young-americans-arent-getting-vaccinated-jeopardizing-covid-19-fight-11625995802 ). Two new game-changing emerging trends with the hyper-contagious Delta variant have become evident, prompting the CDC to recommend universal masking indoors even among vaccinated individuals in so-called “high-transmission areas” (and yes, we emphatically qualify) (https://www.washingtonpost.com/context/cdc-breakthrough-infections/94390e3a-5e45-44a5-ac40-2744e4e25f2e/ ). First, the number of “breakthrough infections” (symptomatic COVID infections of fully-vaccinated persons) is on the rise (https://www.latimes.com/science/story/2021-07-21/rare-breakthrough-covid-cases-are-causing-alarm-confusion ). Second, it has been shown that asymptomatic vaccinated persons exposed to the Delta strain may unwittingly transmit COVID-19 to other individuals, who can then become sick and die. This is something that was not thought to be the case before (https://apple.news/AGgVqTlDsSCSsXJ_FgGvh8A ). And Pfizer just came out with data showing that its vaccine efficacy began to wane after six months, falling from 96% protection to 84%, although it was still highly effective at preventing hospitalization and death. Interestingly, a second study showed that a third “booster” dose of the Pfizer vaccine increased antibody levels against the Delta variant up to five times over levels after a second dose in people aged 18-55, and even higher levels in older individuals (https://www.mdedge.com/internalmedicine/article/243572/coronavirus-updates/pfizer-vaccine-protection-wanes-after-6-months ). This information sets the stage for booster vaccinations to be administered to at-risk populations in the near future.
A recent Gallup poll showed that while 76% of Americans are either vaccinated or plan to be, over half of the remaining 24% say that they are “not likely at all” to get vaccinated under any circumstance (https://news.gallup.com/poll/350720/covid-vaccine-reluctant-likely-stay.aspx). Yet it is that very same stubborn vaccine resistance which has gotten us into the mess we are presently in. Viruses mutate when they are replicating—and they can only replicate inside a living host. If there are no infected persons, variant strains such as Delta cannot emerge. Our failure to contain the original strains of COVID-19 with an effective, safe series of vaccines is precisely what has allowed variants like Delta to emerge—and this trend may continue if we don’t get control of the situation. Recognition of that fact is what is now prompting the federal government, local municipalities and employers like Google, Disney, Walmart and Facebook to mandate vaccination among their employees. The American Medical Association and the American Nurses Association also recently called for mandatory COVID vaccination of health care workers (https://www.nytimes.com/2021/07/26/health/health-care-workers-vaccine-requirement.html?referringSource=articleShare ). Moreover, such mandates are legal, and in no way constitute a violation of HIPAA laws (https://www.nytimes.com/2021/06/09/business/covid-vaccine-employer-rules.html?referringSource=articleShare ).
There has been a great deal of vaccine misinformation circulated on social media. This misinformation has been an impediment to our ability to get control of the COVID-19 pandemic in this country and has directly led to the current disease resurgence. Here are the facts about the three COVID vaccines (Pfizer, Moderna and Johnson and Johnson) currently in use in this country:
· The vaccines are very effective in the prevention of symptomatic disease, even against the Delta variant, as noted above.
· The vaccines are extremely effective at preventing serious COVID-related illness resulting in hospitalization and death. As noted previously, 95% of the recently hospitalized patients with COVID and 96% of the deaths have been among the unvaccinated.
· The vaccines are very safe. Anaphylaxis, a treatable allergic reaction, occurs in 2-5 vaccinated persons out of every million and almost always occurs within 15 minutes after administration. Thrombosis with thrombocytopenia syndrome (TTS), the condition which prompted a pause of the J&J vaccine earlier this year, has only been seen in 39 cases out of over 13 million J&J vaccine recipients in this country. Myocarditis and pericarditis are very rare (699 cases out of 342 million vaccine doses administered in the U.S.). Death after COVID vaccination from any cause is extremely rare (0.0019% as of July 26, 2021) (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html).
Unfortunately, appears likely that COVID-19, in one form or another, is here to stay, at least for a while. The Delta variant-fueled surge is likely to continue well into the fall. The huge negative economic impact of another lockdown makes that strategy unlikely. Similarly, another year or remote learning in schools would be extremely detrimental to school-age children, many of whom have already fallen way off the educational curve. For now, social distancing, avoiding indoor crowds, universal mask-wearing and—most importantly—vaccination appear to be our best tools to mitigate the effects of the COVID-19 pandemic.
I have seen numerous persons declaring that it is their “right” not to be vaccinated, and that no government mask mandate should be able to impinge upon their “freedom.” But nobody trumpets the “right” of an individual to operate a motor vehicle while intoxicated. You would not want your airline pilot to take off while high on cocaine. A food worker spreading typhoid to her customers does not have the “right” to continue to serve meals to unsuspecting individuals. The fact is, matters of general public welfare supersede anyone’s individual rights. Vaccination, mask-wearing and social distancing are a small price to pay for saving the lives and health of our friends, neighbors and loved ones.
Over 35 million Americans are documented to have had COVID-19 thus far, with 613,000 deaths. Nearly 21,000 Georgians have died from the disease. Those numbers will inevitably worsen. Our COVID-19 response must be treated as a matter of public health, with decisions being made on the basis of scientific data. Politics, which have unfortunately driven a lot of the decision-making, have no place here. If we can limit the spread of disease to at-risk individuals and come even reasonably close to universal vaccination, we will eventually get through this.
If we cannot, God help us.