This post tries to communicate a few related points:
- This is no longer a pandemic of the unvaccinated. The majority of new cases are among vaccinated individuals.
- And yet, only the unvaccinated remain at high risk of hospitalization and death.
- As a result, the apparent severity of the average new case has fallen. That’s not because “the virus is getting weaker”. It’s because new cases are increasingly occurring among the vaccinated who, by and large, won’t die from it.
- But now, nothing stops chains of infection. Not vaccination, because efficacy against any Omicron infection is low. Not masks, because the overwhelming majority of the population faces little risk of serious illness, and they’re not going to mask up merely to protect others.
- As a result, this is a really bad time to be an unvaccinated elderly person. Plausibly, the worst since the start of the pandemic.
In my prior post, I noted our current bout of pandemic agnosticism. One year ago, anything like the current new case rate and increase would have led to prayers for divine relief. Now, we just shrug it off.
This is mostly rational, I think. Assuming that people act in their narrow self-interest.
There are still only about 300 deaths a day attributed to COVID (based on the CDC COVID data tracker). All the breathless headlines you read about how COVID-19 deaths are doing this-or-that are therefore mostly nonsense. When you get down to an average of six deaths / state / day, with new case loads shifting rapidly across states, anybody who thinks they can parse out the fine points of time trends is kidding you. And likely kidding themselves.
(As a point of reference, a typical U.S. flu season results in maybe 37,500 deaths, mainly over a five-month period, or an average seasonal flu death rate of about 250 deaths a day.)
And we still haven’t hit 3,000 new hospital admissions per day. Nor are there any states where the hospital system is stressed by the COVID-19 case load (as measured by more than 30% of ICU beds devoted to COVID-19 patients.)
(Again as a point of reference, a typical flu season results in about 380,000 hospitalizations, or about 2500 a day during a (say) five-month flu season. The whole flu-versus-COVID writeup starts with Post #1400, part 3. Note that in both cases, if you’re vaccinated, your risks are far lower than the risks you would face from seasonal flu, as the unvaccinated disproportionately account for COVID-19 deaths and hospitalizations.)
I attribute both of those to the peculiar way in which the vaccinated (and possibly those with prior infections) are losing immunity against the BA.1.12.1. As shown in yesterday’s post, vaccines still provide good protection against severe disease. But at this point, they appear to provide little protection against getting infected. As a matter of arithmetic, then, as immunity against any infection fades, a higher proportion of all infections is occurring among the vaccinated. And so, occurring in a population for whom infections are far less likely to proceed to hospitalization and death.
Six months ago, this was truly a pandemic of the unvaccinated: The overwhelming majority of cases (and hospitalizations, and deaths) were among the unvaccinated. Here’s Virginia as of September 2021. This chart is a little extreme, but not atypical for that time period.
Here’s the same chart, with the most recent data from Virginia.
Source: Calculated from Virginia Department of Health, COVID-19 cases by vaccination status, accessed 5-12-2022.
It’s no longer true that this is a pandemic of the un-vaccinated. Not in terms of new cases. That’s in small part because the number of vaccinated persons has increased. But it’s in much larger part because the efficacy of the vaccine against any infection (from BA.2 or BA.2.1.12) has fallen. As a result, depending on the week, in Virginia, the unvaccinated account for the bare majority of cases (or, in weeks just prior, were actually the minority of new cases).
But in terms of deaths and hospitalizations, sure, this is still a pandemic of the unvaccinated. As of February, COVID-19 still had a 2 percent case mortality rate among the unvaccinated. One-in-50 of those formally diagnosed with it died from it. Regardless of the new monoclonal-this-and-that now available to treat it.
You see a lot of popular-press and social-media mis-reporting of this phenomenon. Despite any significant change in the virus, people are reporting this as if the virus itself has somehow magically become weaker. Independent of its relatively stable genome. And those who report that, and repeat that, never stop to consider the literal impossibility of that, absent major change in the virus’ genes.
This “virus has gotten weaker” meme simply isn’t true. Omicron (BA.2) is the same now as it was five months ago. It’s just that the vaccinated are getting infections at a high rate now, and those infections by-and-large do not progress to serious illness.
There’s an odd consequence of this, in that the U.S. population now splits into a vast majority that really has nothing major to worry about from COVID. And a small minority — call it the unvaccinated elderly — who remain at high risk of death, if they should become infected.
If this new-case growth keeps up, it’s going to be a really bad time to be an older person who is unvaccinated. Why? Because at this point, there’s no way to stop the chains of infection. Sure, almost nobody is dying from it, or even being hospitalized for it. But on the flip side, almost nobody is maintaining COVID-19 hygiene in any form. And a mostly-vaccinated population now provides almost no barrier to circulation of the disease.
Back when vaccination provided good immunity against any infection, a mostly-vaccinated retirement community / assisted living facility / nursing home provided pretty good protection for those who refused (or could not undergo) vaccination. The vaccine holdouts lived within an infection-resistant herd.
But now? As of February, vaccination provided only scant protection against infection. It appeared to cut your odds of any infection in half. By now, it’s probably less.
The upshot is that for the unvaccinated at-risk (e.g., elderly), this is a new phase of the pandemic. New-case rates are higher than they have been for most of the pandemic. But now, in terms of disease transmission, it’s almost as if vaccines and masks don’t exist. Vaccines, because they no longer protect (much) against any infection, masks because most won’t wear them now.
And, as icing on the cake, we have a popular press telling those vaccine holdouts that it’s OK, “the virus is getting weaker”. When that’s simply not true, and the case mortality rate for the unvaccinated remains at 2 percent.
And so this most recent wave of the U.S. pandemic is devolving into an odd sort of inadvertent Darwin test. We’re not merely back to the point where nothing will materially prevent the spread of infection. We’re at the point where most people see no reason to engage in any COVID-19 hygiene either. And then we have a small fraction of the at-risk population who won’t get vaccinated and so remain at risk of serious illness from COVID-19.
And so, we approach a sort of rational no-golden-rule equilibrium. Sure, all of us can spread it now, but few of us face significant risk from it. For the unvaccinated who have not yet been infected, arguably, a given level of daily new cases puts them at higher risk now than it did at any prior time in the pandemic.
Source: CDC COVID data tracker, accessed 5/12/2022
