It’s been a lugubrious couple of days, at least as far as the weather is concerned. Dreary, gray, with intermittent rain showers. Very Seattle. Such weather used to make me homesick but as I haven’t lived in Seattle for nearly thirty-five years, that phase has passed. Now it merely makes me sleepy. I came home from work yesterday, sat down on the bed with every intention of doing some writing and woke up four hours later. Of course this meant that when it was actually time to go to bed, I was bouncing off the walls and ended up staying awake most of the night binge watching old episodes of Supernatural. I’ll get myself back on track through the weekend. I don’t have much scheduled other than a Halloween party tonight. I have a feeling I will make an appearance but not stay too late.
We haven’t run the numbers for a bit. We’re at just over 745,000 deaths in the US and just about to hit five million deaths worldwide (the world figure is a major undercount as there are significant parts of the globe without access to appropriate testing to know whether deaths are related to coronavirus or not). The Delta Wave is pretty much on the downslide both locally and nationally, but we’re not out of the woods. Nationally we’re still losing somewhere between 1000 and 1500 people a day which is a good deal higher than the numbers late this past spring when the roll out of vaccine and better social behavior were driving spread way down. And then Delta… I’m waiting for another strain to start spreading as we still have a large unvaccinated reservoir in the US population. In Alabama, we’re up to about 2/3 of adults having at least once vaccine and 55% being fully vaccinated. It’s better than it was but there’s still a long way to go. The senior population is doing much better. In Alabama, nearly 90% of those over 65 have had at least one shot and more than three quarters are fully vaccinated. I can breathe a little easier about my patient population.
The senior generation has gotten themselves vaccinated. Nationwide, 97% of those over 65 have had at least one shot and nearly 90% are fully vaccinated. Despite being heavy consumers of Fox News and other propaganda outlets, they understood the very real risks to them and their health. The prevalence of vaccination in the age group means that the Delta wave did not really do much damage to older Americans. The death rate over the last six months for them is comparable to other respiratory viral illnesses such as influenza or respiratory synicitial virus. Delta killed and is still killing the middle aged who decided to put politics and tribal identity ahead of their own health concerns. Older adults have memories of prior pandemic disease such as polio and the miracle wrought by the public health vaccination campaigns of the 40s through the 70s. Those under sixty may recall getting their shots but would have no real adult memory of the rise and fall of epidemic disease. Never having experienced it, to them it’s not quite real – it’s a relic of a bygone time like the grainy black and white photographs of the two World Wars. So when pandemic disease showed its ugly head in the modern era, younger generations were not prepared to process what was happening to them and their society. In that liminal space between events and reactions, various forces took root, urged on by a political system that thrives on controversy, one up manship, and a sort of high stakes football game with each side trying to move the ball to their own end of the field and tackling the opposing side as they do so. And here we are.
I still haven’t figured out if these musings are going to become another volume of The Accidental Plague Diaries (relatively easy) or if they are going to transform themselves into something quite different with time. I don’t foresee us really being out of the pandemic until next spring (although many of my living patterns, as they happen in a segment of society with very high levels of vaccination, are returning to what they were pre Covid). Viruses are sneaky and, as they are such simple organisms, they are constantly mutating and sometimes those mutations are fortuitous for the virus to begin spreading anew or to create more serious illness in the host. I have a feeling we’ve got another wave or two to come. As the vaccination levels are going up, albeit slowly, with luck they will not be as serious as the Delta wave of this summer.
As I presumed, the government has not mandated vaccines on the population. They have, however, mandated them on federal employees and contractors as a condition of employment. The government doesn’t want sick employees and quarantines to interrupt its business any more than it has to. It doesn’t want sick or quarantined military troops. The troops that are fussing about the vaccine are being a little silly. They had to have all sorts of vaccines as part of their induction into service including things like anthrax to protect against biological warfare agents. Now they’re complaining? State and local governments in blue areas are also mandating public employees, especially first responders, health workers, and school employees., be vaccinated. In most areas, there is grumbling but when people realize their job is on the line, they get vaccinated and they are fine. The hospitals of Los Angeles are not overrun with school district employees suffering serious vaccine complications. In red states, they are busy passing laws preventing local governments from mandating vaccines for public employees and are searching for ways to nullify the federal mandates. They won’t have much luck. There is well over a century of precedent allowing such actions in public health emergencies and the few Covid related questions that have reached our conservative supreme court have been turned away in favor of vaccination.
The private world, with our ridiculous employment based health insurance system, has realized that they will be on the hook for many many expensive hospitalizations if vaccination is not widespread and is coming down firmly on the side of vaccination as a condition of employment. No, it’s not a violation of your rights for them to do this. They can mandate all sort of things regarding your job such as uniforms, dress code, safety policies etc. This is just one more thing in that long list. If you cannot abide by the employer’s rules, you are free to seek employment elsewhere or to become self employed and set your own rules. Some large companies are not allowing sick leave to be used for Covid quarantine if you are unvaccinated making it time off without pay. I suspect that the insurance plans offered in 2022 when people go through their annual open enrollment a year from now, will have a new rider denying coverage for Covid claims in the unvaccinated who cannot prove medical contraindication or long standing religious belief regrading vaccine use.
Where will all this leave us? I think it means that the next inevitable wave of Covid will be confined to rural and suburban areas in states which have not taken vaccination seriously for political reasons. Most city dwellers, whether in red or blue states are vaccinated and so even though the population density is higher in cities, the virus will have less purchase, especially if we keep up the new patterns we have developed of moving dining and other social activities outside as much as the weather permits. As more and more data becomes available, it’s becoming increasingly clear that the virus is not easily transmitted in outdoor environments (or indoor environments with high airflow). It’s also not particularly transmitted on surfaces. So you can let the kids trick or treat outside and you don’t have to Clorox the candy. The new normal should be for the adults to sit on the porch with the candy bowl to hand it out rather than inside the house.
The weather is changing (that’s where we came in on this essay). And with that, social behavior is going to start changing and we’re going to move more indoors. Then we have the holidays with the usual gatherings and travel patterns. Will this lead to a fresh wave this winter? I’m hoping that there’s enough vaccine out there that we’ll see a little blip up but not a steep curve as we had in July and August with Delta. Time will tell. If Halloween parties make an impact, we’ll be seeing rates of hospitalization increase again in mid November. Thanksgiving will become apparent in mid December, and Christmas/New Years in mid to late January. Assuming I haven’t gone completely barmy, I’ll report back on all that when the time comes.