As many of you who regularly visit CNN.com know, on occasion throughout the pandemic, I have talked about the United States as if it were my patient.
I was there when the country first developed mild symptoms, and then tested positive for a new mysterious disease. I worried as the disease spread and I watched as the patient progressively worsened, needed ICU care and at times became unstable. Even as the country was eventually transferred to a general care floor and then to recovery, I stayed at its bedside. And, I am still there.
So, on this Fourth of July — the country’s second pandemic birthday — I thought it might be a good time to once again check in on the patient and take the pulse of the country.
When I looked at America’s chart on its last birthday, I wrote that the patient was not doing well at all: infection hot spots were cropping up around the country yet the patient hadn’t been following basic doctors’ orders to wear masks, socially distance and stay home as much as possible.
I was frustrated because I thought I, as a doctor, would be having a different conversation. Instead of celebrating the patient’s progress, I was worried about the sickness growing within. Even though the patient was getting the best care and best advice from specialists and experts across the land, America was not heeding it; instead, the patient was stopping treatment too soon, reopening too quickly, tossing aside masks and gathering at events both large and small.
By the time I wrote the next essay in early December the patient was in intensive care, in pure crisis mode with infections and deaths skyrocketing well above the spring 2020 peaks, with the worst still yet to come.
One thing is certain: a lot has changed since this time last year — but a lot has also remained the same.
How the patient is doing now
The very good news is that the patient now appears fully on the road to recovery, at least physical recovery. (The mental and emotional recovery will probably take a lot longer.) And that’s almost completely due to vaccines, a Hail Mary pass thrown at the start of the pandemic that was miraculously caught and run into the end zone right before the end of 2020 with the US Food and Drug Administration authorization of the first two candidates.
The vaccines — and massive vaccination effort surrounding them — have pushed down infection and deaths rates since the start of 2021. But it’s important to remember the patient isn’t entirely healed and back to normal yet, no matter how much it would like to think it is.
As wonderful and effective as the vaccines are, their uptake has slowed greatly, from more than 3 million shots a day at their peak in April to around 1 million a day more recently.
Although the country has gotten close, President Joe Biden’s goal of having 70% of American adults with at least one shot in the arm by July 4 doesn’t look like it’s going to be met. We’re currently at 66.7% — two thirds — of Americans adults with at least one dose. (Seventeen individual states have met Biden’s goal.)
And this slowdown of the vaccination effort is hampering the patient’s overall recovery effort. Experts warn we could see outbreaks in pockets of the country with the lowest vaccination rates — such as Mississippi, Alabama, Arkansas, Wyoming, and Louisiana — each of which has less than 36% of its total population fully vaccinated (compared to more than 47% for the country as a whole).
Biden’s chief medical adviser, Dr. Anthony Fauci, said earlier this week he’s “very concerned” about the disparity in vaccination rates, which he feels could lead to there soon being “two Americas” — one where most people are vaccinated, and therefore safe, and another where low vaccination rates could lead to case spikes.
Not only that, but pockets of low vaccination rates create the perfect conditions for dangerous variants to arise: They allow the virus to spread and possibly mutate into something more transmissible, or more dangerous, or more resistant to the tools we have against it — including our vaccines and the medicines we currently have at our disposal to fight Covid-19.
In other words, the patient, who still has an infection, needs to finish taking all of their medicine, even if they’re feeling better. It’s like finishing a course of antibiotics: If you don’t take the full course, the medicine only kills the weakest bacteria — leaving the strongest to multiply, ultimately creating an antibiotic-resistant infection. In this case, vaccines are the medicine — and a full course means as many of us as possible need to get all the necessary doses.
Vaccine versus variants
Speaking of variants, there is much concern is over the newer Delta variant, first identified in India, which is more transmissible and may be linked to more serious disease than the original SARS-CoV-2 virus; it is now in all 50 states and Washington DC and is estimated to make up more than 25% of all new infections in the country. The Delta variant is predominantly infecting unvaccinated individuals, including adolescents and young adults, who now make up about a third of all those hospitalized with Covid-19.
The situation is being made worse by the fact that young adults are one of the very groups lagging when it comes to vaccinations.
Even though case numbers have declined dramatically since the start of 2021, cases have plateaued and even ticked slightly upward in recent days. The US Centers for Disease Control and Prevention reported on Wednesday the seven-day average climbed to almost 15,000 new cases, from about 12,500 the week before.
“While this is a 95% decrease, lower from our peak into early January, it does also reflect a 10% increase in the seven-day average from last week,” CDC head Dr. Rochelle Walensky said Thursday, during a virtual White House briefing.
The question now is: Will we also soon see an uptick in hospitalizations and deaths?
The Biden administration is so concerned about the double-whammy of variants and low vaccination rates, it is planning to deploy response teams across the country to areas with a high spread of the Delta variant to offer surge testing, support staff for vaccination sites and medicines such as monoclonal antibodies that have been shown to help people avoid getting very sick.
Masks make a comeback
As a sign of how troubling the Delta variant is — Fauci called it the “greatest threat” to progress against Covid-19 in the United States — consider that masks are once again inching onto the stage, both here and abroad.
The World Health Organization, whose mandate is to safeguard global health, never stopped encouraging indoor masking (even among the vaccinated), probably because much of the world remains unvaccinated. But even Israel, a country with very high vaccination rates, returned recently to mandatory indoor masking, specifically to combat the spread of the Delta variant.
In this country, the CDC is so far sticking by its guidance, which it changed back in mid May, stating that fully vaccinated people can choose to not wear masks both indoors and out, in most situations. It was a decision that surprised many of us caring for this patient at the time, as if the CDC were allowing the patient to run before it could fully walk — especially because it came so quickly and without warning, leaving many people, businesses, organizations unprepared.
But the tide is turning in some localities, especially places that are seeing a high number of cases due to the Delta variant, like Los Angeles County, which urged everyone, even those who are vaccinated, to wear masks in public indoor spaces. In Illinois, Gov. JB Pritzker this week also encouraged people to wear masks indoors even if they are vaccinated due to spread of Delta variant. And New Jersey Gov. Phil Murphy said that while the state will not reinstate masks for students in the fall, that could change if things get worse.
Walensky agrees that mask guidance should be flexible. “We are still seeing uptick in cases in areas of low vaccination, and in that situation we are suggesting that policies be made at the local level. And those masking policies are really intended to protect the unvaccinated,” she said. “The vaccinated, we believe, still are safe.”
Recovery is a rollercoaster ride
I find it encouraging that local authorities are stepping in and making good sound decisions based on science and what is going on in their communities. It’s become pretty clear that we’re never going to be completely rid of SARS-CoV-2: All signs point to it circulating among us for the foreseeable future.
While we can’t eradicate it, we can manage it, especially with the tools we have at our disposal right now, like vaccines and even mask-wearing. And until there’s a vaccine for the entire population, we can protect children and others by getting vaccinated ourselves, wearing masks and keeping them away from big crowds and risky situations.
We have to be flexible and nimble, adapting to all the curve balls that the virus throws our way. But we should never let our guard down, nor should we make unforced errors.
For the patient, our country, that means recovery may look less like a straight line and more like a roller coaster, with highs followed by dips.
As a doctor, I want to remind America that it is not 100% healed yet; I strongly urge the country to take it slowly, to finish taking all of its medicine. By that, I mean get vaccinated, get your second shot if you haven’t already and get your kids vaccinated when they become eligible.
What’s heartbreaking to me as a doctor is that throughout the pandemic, my patient didn’t do very well. And while things are certainly much better, America is still not where it could be. There is a seven-day average of well over 10,000 new infections a day; a portion of those people will need to be hospitalized, and another portion will struggle with long-haul Covid. And we can’t forget that every single day, an average of more than 250 people are still dying of Covid-19. At this point, almost all these are preventable deaths.
I am convinced the patient will recover, but now it is just a question of how long it will take and what the human and economic cost will be of letting the infection smolder too long.
Going forward the patient must do better; we must do better. Because as I keep on saying, we’re still all in this together.
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