Week 42 coronavirus update – vaccines, new strain, herd immunity, vaccine hesitancy, politics vs reality (an op-ed)

Vaccine availability

We have still heard nothing about getting vaccines at the office for distribution directly for our patients.

However, I and my staff will be vaccinated at one of the Centura Hospitals within the coming week.

Despite a large amount of vaccine hesitancy in the population, I am now convinced that there is enough safety and effectiveness data to be willing to receive the vaccine. I did not expect to be a candidate for the vaccine until next month, but am grateful for the opportunity.

More vaccine trials are getting underway, but the Astra-Zenica/Oxford and Johnson & Johnson vaccine trials have released no more information since some preliminary information several weeks ago. Ongoing release of information from the Pfizer and Moderna vaccine trials continue to confirm their on-going effectiveness and safety.

New mutation in the UK

A new mutation in the SARS-CoV2 virus has occurred in the UK with inconclusive evidence that it is more dangerous than the current mutation #2, which happened in January of this year.

There is some evidence of spread to Germany and even perhaps to the US, but confirmation is still pending.

Active study is ongoing with all available vaccines to see if this mutation will be covered under the immunity induced by each vaccine.

It is too early to know the significance of this mutation. To have a third mutation in a year is not unusual for viruses and so far the mutations have not been worse than the original virus that hit China last December.

Herd immunity

This concept is one that states that when enough of a population becomes immune to a certain infectious organism, illness from that organism falls from an epidemic level to a background level. Background level means infrequent and sporadic infections.

Herd immunity is a statistical model and not a hard and fast biological experience. That mathematical model was originally created in the 1930’s to try and figure out how many people had to be immune to influenza before we quit having massive outbreaks.

After lots of number crunching, the number settled out that roughly 70% of the population had to be immune to influenza before we would quit having outbreaks.

The head immunity model has persisted with modifications over the years. In most recent history it came back to public awareness during the H1N1 influenza epidemic of 2008. That outbreak began to subside after about 2 years AND that was even with its inclusion in the yearly influenza vaccine.

Two years after that outbreak of the H1N1 flu the CDC found that 60+% of individuals tested had antibodies against H1N1. That roughly supported the herd immunity number of 70%.

According to the most recent iterations of that model, regions with lower international travel and lower population densities (rural Alaska) need a lower number of immune individuals, perhaps as low as 50-60%. Areas of high population density and exposure to more international travelers (major metropolitan areas) appear to need as much as 85% immune individuals to prevent spread of “that” illness.

In the end this is all a bunch of statisticians crunching numbers. I suspect the results have some rough reflection of reality, however these determinations are most useful for public health professionals and politicians in making decisions.

I bring this issue up, because we have seen Dr. Fauci from the CDC recently increase his prediction of the head immunity level from 70% to 85% regarding COVID-19, citing undisclosed “recent research”.

I have found Dr. Fauci’s public presence to be one of remarkable integrity while dealing with substantially profound political pressures. However recent other comments he has made suggest that the increase in the herd immunity number may be statements trying to convince those who are vaccine hesitant to get the vaccines when they are available.

Regardless the ideas and statistics of the herd immunity model appear to convey useful information. For each of us though, it comes down to how we contribute to the “herd immunity”. Either we get sick from COVID-19 and recover or we get vaccinated.

At the present time, the likelihood of surviving COVID-19 appears to be much greater with vaccination than from getting the illness, at least for those of us over age 50.

Vaccine hesitancy

Recent studies have shown that somewhere between 30-60% of us are hesitant to receive the COVID-19 vaccines that are available.

I am greatly sympathetic with this stance. I have considered myself to be one who was neither the first nor last to prescribe a new therapeutic agent when it came out. That approach has been applied to my analysis of the development of the currently available COVID-19 vaccines.

The most recent information available is for over 60,000+ vaccinated individuals. Follow-up of all vaccinated individuals is ongoing.

I have been diligent about monitoring for signs of toxicity or complications from these vaccines as well as all other therapies available for COVID-19.

As of this time I would strongly encourage all that have the opportunity to receive the available vaccines to accept that opportunity. Their effectiveness and safety justify their use. Admittedly we will not know for some time how long the immunity lasts or if there are any long term complications. But that is a risk we have to accept when there appears to be any new treatment available.

I am personally willing to accept all risks associated with the currently available vaccines in order to minimize the likelihood of contracting and spreading COVID-19 to my patients, friends, acquaintances, and family.

Politics vs. Reality (a bit of an opinion opportunity)

I like to stay out of politics as it appears to be yet another contentious ideology. I do not mind political ideas until someone mistakes them for reality. Politics is an ideology that governs behavior and can even represent a way of interpreting one’s experience. But it is not an accurate representation of reality. Perhaps as we get older, these ideas are easier to grasp than reality.

Politics and medicine are entirely different.

Political ideas are based on ideas, which are quite mutable, deeply personal, and easily influenced.

Medicine strives to be based on a scientific understanding that is not changed by personal opinion or experience.

Recently I came across a patient who was concerned that I might be a Democrat, because I was advocating the wearing of masks and social distancing. I did not really care about that person’s or his friends’ thoughts about my political, religious, ethnic, or sports team preferences, but labelling me as a Democrat clearly raised a question of the credibility of my opinion in his eyes. I had to leave it to his decision whether I was a “Democrat” or a physician.

In medicine we always confront other peoples ideas as a doorway to benefit or a hinderance.

I recently read an article that described a substantial number of Kansas doctors leaving their practices because of the backlash to their practicing the medical standard of face mask use and social distancing. Most disturbing was that the exodus was from more rural areas, leaving those areas absent a significant degree of medical care.

I certainly get it. We aIl make decisions based on personal experience. I see a number of people from out-lying counties from the Denver metro area who know of no one who has gotten COVID-19 and related that only a few in the county have gotten it and none have died.

All of us have to make our own decisions.

Regardless of what one thinks, my practice is based on an ideology that is not altered by personal opinion. I am a biological medical practitioner. I care about applying the scientific knowledge and experience I have to keep people alive as long as possible, regardless of race, religion, skin color, sexual orientation, politics, sports team preference, hobby preference, or any other orientation to life.

So stay well and stay safe!