The Weekly Sift

Ever since the Delta variant of Covid-19 emerged as the most virulent strain yet, public health officials have been talking about a race between the vaccines and the virus. In the US, the vaccines have been winning that race since the post-holiday-season peak in mid-January, which, conveniently for President Biden, coincided almost exactly with his inauguration.

But then the tide started to turn again. Cases began trending upward. New cases per day hit a low around 11,000 in mid-June, but now are back up to 19,000.

The usual pattern in Covid surges has been that hospitalizations and deaths lag a little, but eventually follow the case-number trends. (That makes intuitive sense when you think about how a Covid death plays out: First you get sick, then you are hospitalized, then you die.) Now hospitalizations have turned (up 11% in the past two weeks), though deaths are still (for now) trending downward. As treatments improve, we might hope to see a less solid link between hospitalizations and deaths, but we won’t know for another week or two which way the death trend will go.

It’s not hard to see why the graphs turned. Initially, vaccination was a logistics problem. Large numbers of people, like me, were eager to get vaccinated, and it was just a matter of producing and distributing enough doses. I would happily have taken my first shot in January, but (being just below the age-65 cutoff) I ended up waiting until April. Vaccinations increased as the logistics problems were handled, and peaked at over four million doses per day in early April.

But then they started to fall, as the number of eager unvaccinated people dwindled. Around half a million shots are still being given every day, but the Biden administration fell just short of its 70%-by-July-4 goal, and it’s not clear how much above 70% we’ll ever get.

Politics and risk. Like masks and other public health measures that would have been nonpartisan in previous eras, vaccines have become political. Former President Trump himself may be vaccinated, and may even mildly encourage his followers to get vaccinated, but Trump Country has become the center of vaccine resistance, which Trump Media actively promotes. The result is a wide divergence of vaccinations by state. Blue states like Vermont (66%) and Massachusetts (62%) have the largest percentages of their populations fully vaccinated, while red states like Alabama (33%) and Mississippi (33%) the least. (These numbers are not directly comparable to Biden’s 70% goal, which was a percentage of adults getting at least one shot, not the percentage of the whole population fully vaccinated.)

Unvaccinated people are like dry tinder to the virus: The fire doesn’t start until a spark comes, and the exact spot where that will happen is unpredictable. The center of the current outbreak is along the Arkansas/Missouri border.

the rise in cases seemed to be caused by three factors: the area’s low vaccination rate, the arrival of the Delta variant and Springfield [Missouri]’s recent decision to lift its mask mandate. Ninety percent of Covid patients at Cox Medical Center South in Springfield have the Delta variant, and they are trending younger

Taney County, Missouri is the site of the Branson tourist-resort area. It currently has 26% of its people fully vaccinated and only 30% with at least one dose. It is averaging 84 new cases per day per 100,000 people, compared to the national average of 6.

Over the last 16 months, we’ve seen numerous news reports about hospitals overwhelmed by Covid patients. The current ones are coming from Springfield — the first city up US 65 from Branson.

Many other counties are just as vulnerable, but have lesser outbreaks. The list of states where cases have doubled in the past two weeks is: Tennessee, Arkansas, Alabama, Kansas, Louisiana, South Carolina, Florida, and Mississippi. All are Trump states with low vaccination rates. (In fairness, Florida is just slightly below average: 47% fully vaccinated compared to 48% nationally.)

Delta and the vaccines. One part of the story of the recent surge is that the virulent Delta variant has become the dominant strain of Covid in the US. That has started people wondering how effective the vaccines are against Delta. Data from Israel is mildly discouraging: The Pfizer vaccine Israel used (the same one I got) is effective against Delta, but less so than against earlier strains.

Vaccine effectiveness in preventing both infection and symptomatic disease fell to 64% since June 6, the Health Ministry said. At the same time the vaccine was 93% effective in preventing hospitalizations and serious illness from the coronavirus.

The ministry in its statement did not say what the previous level was or provide any further details. However ministry officials published a report in May that two doses of Pfizer’s vaccine provided more than 95% protection against infection, hospitalization and severe illness.

But other studies report higher numbers:

In Britain, researchers reported in May that two doses of the Pfizer-BioNTech vaccine had an effectiveness of 88 percent protecting against symptomatic disease from Delta. A June study from Scotland concluded that the vaccine was 79 percent effective against the variant. On Saturday, a team of researchers in Canada pegged its effectiveness at 87 percent.

The article goes on to note that assessing effectiveness in the field is harder than in a controlled study. (That’s why medical researchers use two different terms: Controlled trials measure “efficacy”, while field data measures “effectiveness”.) One key difference: In real life, vaccinated people know they are vaccinated, so they may behave differently.

One speculation is that the different results might reflect how long ago someone got vaccinated.

The Israeli data also raise an important question that it may be too early to ask: Does the declining effectiveness rate have to do with waning protection among the vaccinated given how early Israelis began receiving their shots?

Pfizer is now collecting data on booster shots that would be given six months after the initial vaccination. Experts are conflicted over whether to recommend that the single-dose Johnson & Johnson vaccine be followed by a booster. It seems like a good idea, but hasn’t been tested thoroughly yet. Getting a Pfizer or Moderna shot on top of a J&J vaccine is likewise untested.

Not as much data is publicly available about the Moderna vaccine (which my wife got) and Delta. Like the Pfizer, it seems to be effective, but less so.

My conclusion: If you’re vaccinated, don’t fret, but don’t get cocky. You’re like a soldier with a good helmet and armored vest; protected, but not invulnerable.

South Dakota and Vermont. One red state that isn’t seeing an outbreak right now is South Dakota. Ashish Jha, Dean of the Brown University School of Public Health, explains how two states, Vermont and South Dakota, took very different paths to arrive at the same result: the lowest-risk (green) category for Covid infections.

The two states are similar in some demographic ways: small states, mostly rural, older population, similar median incomes. But they achieved high levels of Covid immunity in different ways: Vermont vaccinated three-fourths of its people compared to South Dakota’s half. But South Dakota acquired immunity the old-fashioned way: by getting a large percentage of its people infected. 40 out of every 100,000 Vermonters have died of Covid, compared to 230 out of every 100,000 South Dakotans.

Governor Noem appears to be proud of that record of getting her constituents killed unnecessarily. She bragged about her Covid response at CPAC Sunday, and questioned the “grit” of Republican governors who enacted mask mandates and closed businesses.

Here’s a rule of thumb: Whenever Republicans pat themselves on the back for having the “courage” to “make the tough decisions”, you can be pretty sure that someone is about to die.

Rhode Island and Mississippi. Looking at the long-term state data shows other interesting patterns. Early in the pandemic, before anybody really knew what they were doing, Covid ravaged the Northeast. So if you looked at death totals per capita a year ago, New Jersey, New York, Massachusetts, and Rhode Island were at the top of the list by a wide margin.

They still are, but Mississippi, Arizona, and Alabama are catching up. (They’ve already passed Connecticut.) Mississippi (2500 deaths per million) may soon edge out Rhode Island (2577) for fourth place. Rhode Island still hasn’t reported a death in July, while Mississippi is averaging 3 per day, a number which is likely to increase.

In terms of total cases per million, Rhode Island is the only northeastern state still in the top ten, which otherwise is entirely made up of red and purple states like the Dakotas, Utah, Iowa, and Arizona. New Jersey is down at 13, New York 17, and Massachusetts 31. (The Northeast had its cases early, when treatment was much less advanced. Hence: more deaths per case. Also, Covid tests were hard to get early on, so it’s possible that the number of cases in the Northeast was underestimated.)

My assessment: The Northeast learned from its experience, and has been more rigorous about shutdowns, mask mandates, distancing, etc. Red states in the South and West refused to learn from the example of the Northeast, so they have had to repeat the experience.

Northeasterners died because they were surprised by something new. Red staters are dying of stubbornness.

Kill your audience. One reason red states are slow to learn is that conservative leaders in politics and the media seem to be actively trying to get their followers killed.

Up until now, the primary mode outside the true fever-swamp precincts has been Just Asking Questions—or, in Tucker Carlson’s case, Just Asking Questions about why no one is allowed to ask questions, which in turn leaves the viewer believing there are not just questions to be asked but answers that are bad, even though we’re still actually dealing in questions about questions.

But the rhetoric keeps escalating, as these things tend to do. This week, in a particularly egregious exploitation of his audience’s presumed stupidity, Carlson observed that most people dying of Covid in Ohio had already outlived their life expectancy, so the pandemic itself (which has killed more Americans than combat in World War II) is “overhyped“. I have to wonder how many of Tucker’s viewers looked at the graphic below and concluded that Covid might help them live longer.

“This is the — I think, I honestly think is the greatest scandal of my lifetime by far,” he said with all of the expected breathlessness. “I thought the Iraq War was; this seems much bigger than that.”

The “this” at issue? That the government would “force people to take medicine they don’t want or need” — something that the government is not doing. That President Biden said a few hours earlier that public health professionals might go into communities to offer the coronavirus vaccine to those limited by time or mobility from seeking it out themselves was misinterpreted by commentators like Carlson to suggest that government patrols would soon be seizing people off the streets to inoculate them.

And if “they” can go door-to-door offering vaccines that you can refuse, but which might save your life, why couldn’t they go door-to-door to impose all kinds of tyranny? Here’s Rep. Madison Cawthorn of North Carolina.

Think about the mechanisms they would have to build to be able to actually execute that massive of a thing. And then think about what those mechanisms could be used for. They could then go door to door and take your guns. They could go door to door and take your Bibles.

Of course, the DC mayor’s office is already sending volunteers door-to-door, without any complaints of Bible or gun seizures.

During a CNN interview, Illinois Republican Congressman Adam Kinzinger (who already burned his bridges in January by voting for Trump’s second impeachment) denounced this kind of rhetoric as “insanity”.

What President Biden said is: We’re willing to come to your house to give you the vaccine. At no point was anybody saying they’re going to break down your door and jam a vaccine into your arm despite your protests. This is outrage politics that is being played by my party, and it’s going to get Americans killed.

But outrage politics works in certain circles, which is reason for conservatives to celebrate it. At CPAC this weekend, vaccine refusal was an applause line:

“Clearly, they were hoping — the government was hoping — that they could sort of sucker 90% of the population into getting vaccinated,” Berenson said. “And it isn’t happening,” he said as the crowd applauded people rejecting the safe, effective, and free vaccines.

Nobody is saying this part out loud, but I see a pretty cold calculus at work: If conservatives can get another Covid wave started, not only would that make Biden look bad, but it might spark another round of mask mandates and business closures. Then in 2022 Republican candidates can run against the “tyranny” that they themselves made necessary.

That plan may be evil, but it shows grit, and the courage to make the tough decisions.