“This will happen because two governors valued commerce over human life.”
By Dr. Michael Fine, MD in UpRiseRI
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He is the chief health strategist for the City of Central Falls, RI, and a former Director of the Rhode Island Department of Health, 2011–2015.
He is currently the Board Vice Chair and Co-Founder of the Scituate Health Alliance.
He is the recipient of the Barbara
Starfield Award, the John Cunningham Award, and the Austin T. Levy Award.
Take-home points
- The Covid-19 vaccine does not protect people from getting or spreading Covid-19.
- We can expect 70 to 100 preventable deaths in December and between 100 and 600 or more deaths in January, mostly among people over 60.
- 18 to 25 of those deaths in December will be among people under 60
- 25 to 150 of those deaths in January will be among people under 60
- About half of those deaths will be in people who were vaccinated.
- Masks help prevent Covid-19 from spreading but they only reduce spread by 53 percent.
- Government has failed to protect Rhode Islanders. We can protect one another by avoiding parties, stores, bars and restaurants. Starting now.
- Omicron is going to upend our lives in January, whether we are tired of all this or not.
I am writing on December 19, 2021, from Scituate, Rhode Island. Scituate is a little place, population 10,000, in a little state, population one million. I work sometimes in Central Falls, Rhode Island, the smallest, poorest and most densely populated city in the smallest state in the union.
Still, I have the sense of being on the front
lines of a war we are losing, at least at the moment, against Covid-19. Rhode
Island is once again the most infected state in the nation. Central Falls had a
similar dubious honor for a time in the spring of 2020. It was briefly the most
infected place in the world, the most infected place in the nation and the most
infected place in Rhode Island.
Central Falls is
struggling with Covid-19 again, but it is pretty well vaccinated because of the
courage and dedication of committed mayors, a city council who went door to
door registering people for vaccination, and because of the incredible heroism
of my friend and colleague Dr. Beata Nelken, who opened a pediatric practice in
January of 2020 and since then has taken it upon herself to stop Covid-19 in
Central Falls. She and her staff test 100-150 people a day themselves and
vaccinate 30-40 people a day of all ages, including many who are undocumented,
people no one else seems to care about.
I am writing to tell you
about a clear and present danger that I and many other public health
professional fear will impact everyone in Rhode Island, everyone in the U.S.
and around the world by the middle of January, and to tell it to you straight.
I’ll discuss Covid-19 and
the vaccines to prevent hospitalization and death and our ineffective, and
perhaps pathetic response first, then the Omicron variant and the unique risks
of social disruption it presents, and then discuss how our political
polarization has both inflamed our risk and incapacitated our response, in
three separate but interconnected essays, which will come out once a day for
the next three days.
Apologies in advance for
writing these just before the holidays. The timing stinks, but the virus isn’t
taking time off for the holidays, unfortunately. Most likely the holidays will
spread the virus faster and farther, as people gather and spend time together.
But first, some good news:
Young people and kids are not at significant risk from Covid-19 or its Omicron
variant; and the damage done by the Omicron variant, which I fear may be
significant, is likely to be done by the middle of February or the beginning of
March. Even though the variant will be gone, the damage to our culture and our
politics will be with us for years to come.
Now some facts, which some
public officials don’t seem to want you to know, but which you need in order to
think clearly about the Delta and Omicron variants of Covid-19 so that you can
protect yourself, your family and your community.
Rhode Island today has the highest rate of Delta variant virus spread in the nation. More than 1100 people are testing positive every day when you adjust for the number of daily tests, which means 11,000 or more people, or one to two percent of the population, have and are spreading the virus every day. That number is doubling every two weeks or so.
Rhode Island hasn’t done anything effective at all to stop the
spread of the virus, so that this number is likely to continue doubling every
two weeks, at least until the Omicron variant arrives in force. The Omicron
variant spreads at least twice and perhaps three or more times as fast as
Delta. We don’t know how Omicron will impact Delta spread or the number of
hospitalizations and deaths or whether both variants can infect the same person
at once or what that might mean.
We are now losing about six to seven people every day, or about half the number we were losing at this time last year, when the then Governor, acting far too late to save lives, mandated masks and restaurants, bar, and school closings.
We are doing nothing to prevent the spread of the virus this year besides vaccination, so it is likely the virus will spread. Last week the new Governor announced very weak measures to reduce viral spread – masking at large events, and masking or vaccination for smaller venues.
These measures cannot do more than reduce the
speed at which the spread doubles by a few percentage points. Key health
professionals endorsed the Governor’s weak measures as the best outcome they
could hope for politically. Their inability to speak clearly about what we must
do failed Rhode Island.
Our hospitals are nearing capacity; health care workers, already exhausted, are burning out; many health care jobs are unfilled. It is likely that hospitals will overflow in the next week and/or need to move to crisis standards of care, because of which some people will die unnecessarily because we will lack the capacity to care for them.
We will start losing ten to fifteen or more people a day because so many people are infected, and the impact of being one of the most vaccinated states in the union will disappear, lost in our mismanagement of community spread.
And that’s all before
Omicron arrives in force. Most of the people who are hospitalized and die will
be over sixty, and at least half of those will be vaccinated, with many being
vaccinated and boosted.
This won’t happen because
there is anything at all wrong with the vaccine. This will happen because two
governors valued commerce over human life and because two governors tried to
practice public health, a discipline in which they weren’t trained and didn’t
know, and failed at it – and because our legislature sat back and watched them
proceed with reckless indifference to the value of human life.
The very excellent Covid-19 vaccine protects most people younger than 80 and those without significant chronic disease against hospitalization and death. BUT THE VACCINE DOES NOT PROTECT PEOPLE WELL AT ALL FROM GETTING OR SPREADING COVID-19.
The vaccines do not offer perfect protection against hospitalization and death for people up to eighty. They fail to protect at least five percent, and likely as many as 15 percent, of younger people from hospitalization and death. Our vaccines offer very weak protection, if any, for people over eighty, and people with significant chronic disease.
Five to ten percent of people over eighty who
contract Covid-19 will be hospitalized or die. One person in one hundred over
sixty years old in the United States has already died of Covid-19, and an even
higher proportion of people over sixty died in Rhode Island. That number is
likely to grow and grow fast.
Public officials, including the otherwise very good people at CDC and others in government, don’t want me to say vaccination doesn’t stop the spread of the virus and that it doesn’t work very well if at all for people over eighty and those with serious chronic disease because they are afraid these facts will discourage people from getting vaccinated and vaccinating their kids.
They believe, incorrectly, that
vaccination alone can stop the spread of the disease, because they are ignoring
what is happening right in front of their eyes and refuse to believe the very
able public health professionals who work for them.
All this means that we should be doubling and tripling our efforts to protect people over 80 and those with significant chronic disease from getting Covid-19, because infection carries a high risk of hospitalization and death in that group, vaccinated or not vaccinated.
Those people should be staying home, having food and supplies
brought to them, making sure everyone who comes near them is tested before any
contact, masked during contact and those contacts should be brief, at least
until community transmission drops to below 100 new cases/100,000/week. We need
to focus on the elderly and those with chronic disease with all our resources,
on their mental health as well as their protection. That’s the only way to
reduce hospitalizations and deaths right now.
Unfortunately, it is
simply too late to stop the spread of infection now. Covid-19 is like a cancer
that has metastasized.
All this also means that
CDC and HHS are wrong on three key recommendations:
First, vaccinated adults should need to mask when they get
together, which is different from CDC guidelines. Vaccinated adults from
different households should rapid-test before they are together, and they
should mask whenever community transmission is high. (That means when community
transmission is high, we also need to limit indoor dining and drinking, and
rapid test everyone on entry if we must allow indoor dining and drinking at
all.)
Second, anyone who is vaccinated and is a close contact to
someone who is Covid-19 positive needs to quarantine for at least seven, or
better, for fourteen days, and not leave quarantine until they have a negative
PCR test on the seventh and tenth days. That’s because vaccination doesn’t
prevent the vaccinated person from getting and spreading the disease, and
because the incubation period is between three and fourteen days.
Third, no one should be asked to test weekly if they are not
vaccinated: the mandate to get vaccinated or test weekly makes no public health
sense. Everyone, vaccinated and unvaccinated, can get and transmit infection,
which means everyone who works in a congregate setting (with people from
different households) or circulates or shops regularly, should be PCR tested
twice a week as long as the level of community transmission is greater than 35
new cases per 100,000 per week and until we have gone at least three months
without a Covid hospitalization or a Covid death.
That also means that there is no public health justification to require vaccination (from the perspective of disease transmission) – and that vaccine passports are useless.
There is
public health justification to require vaccination and masking, particularly of
health care workers, from the perspective of continuity of operations:
hospitals, practices, EMS, police, fire and businesses can’t operate without
staff, and unvaccinated unmasked people are many times more likely to contract
and transmit Covid-19, and miss work in large numbers, which will make these
organizations very difficult to operate, a situation that I expect to occur
again the U.S. by mid-January because of the Omicron variant – but more on
Omicron later.
All the vaccination
shaming can and should now stop. At one level, I don’t care if you get
vaccinated or not: The life you risk is only your own. I do care if you mask,
test, isolate if infected, and quarantine after a contact. Masking, testing,
isolation and quarantine matters helps us control community transmission, which
is much more important than the vaccination rate in preventing hospitalizations
and deaths.
Finally, CDC has also
missed the boat on recommendations for large group events , dining, and bars.
CDC failed to define large group events, likely, to avoid alienating the
religious community. Many people in that community became infected,
hospitalized or died as a result. CDC needs to define large group events as
anything over fifty people and recommend that all of them go virtual as long as
the community transmission rate is over 100 new cases/100,000/week.
A word on masking. Masking
is 53 percent effective at preventing the spread of virus from people who are
infected. We actually don’t know how effective masking is at preventing a
person who is masked from becoming infected. But even 53 percent effective
means 47 percent ineffective: masks reduce the dissemination of virus but won’t
stop that dissemination. Better to be masked than unmasked while community
spread is high.
But like vaccines, masks
alone don’t stop the spread of Covid-19. Testing alone doesn’t stop the spread
of Covid-19 at all. Contact tracing, isolation and quarantine alone don’t stop
the spread of Covid-19, particularly when community transmission is greater
than 35 new cases/100,000/week, because no department of health in the universe
has the resources to reach all infected people and their contacts when there
are so many people infected.
As many better organized, better disciplined, and more unified nations around the world have shown, good public policy, intelligent social caution when disease is spreading, vaccination, testing, contact tracing, isolation and quarantine can reduce hospitalizations and death significantly.
Toronto, just over the border, has
five percent of our infection rate, very few hospitalizations and a fraction of
our deaths: 3721 deaths in a very diverse city of four million. Rhode Island,
one million people, has had 3000 deaths so far, or almost four times as many
per capita. Other cities and nations have done far better yet.
We can also do better, but
we must want to save lives more than we want to party, shop, and eat out. At
least in the short term.
The way to do better is to focus on reducing community transmission to under 35 new cases/100,000 people per week, or no more than 50 new people testing positive with Covid-19 in Rhode Island each day. (Right now we have about 1100 people testing positive in Rhode Island each day.)
Community transmission measures how many people have and are transmitting Covid-19 presently. It is not a pure measure – the number of people tested and who are getting tested regularly impacts the number of people who test positive, but it’s the best measure we have of disease activity.
Most
experts think that at least two and as many as ten times the number of people
testing positive is the real number of people who get Covid-19 each day,
because many cases have no symptoms so people with them don’t get tested, and
many people with symptoms don’t get tested anyway.
On a day when a thousand people test positive, likely two to ten thousand got Covid-19. And while Covid-19 is most infectious the day before a person gets symptoms and for a day or two after, people with Covid-19 can stay infectious for up to ten days.
On a
day when a thousand people test positive and two to ten thousand people
actually got Covid-19, there are likely ten times that number who have and can
transmit Covid-19 (all the people who got Covid-19 in the ten days before) so
twenty to a hundred thousand people are actually walking around Rhode Island
with and able to transmit the disease.
Yikes.
Community transmission is
important because the elderly and those with serious chronic disease aren’t
well protected from hospitalization and death by the vaccine. When community
transmission is high, there’s lots of virus swirling around in the air and many
people infected with it walking around, so the virus will get to and infect the
elderly and those with serious chronic disease. Those people will need
hospitalization, and many will die.
When community
transmission is high, many young people will also get sick. Even though
hospitalization and death are rare in the young, there are many more young
people than old people, and when lots of young people get infected, some of
them will get hospitalized and die: a rare event, multiplied by a zillion people,
produces a significant number of hospitalizations and deaths, even though the
percentage of risk stays small.
Imagine putting a tiny drop of red dye into a bottle of water. If you get some of that water on you, no one will notice the dye because it was so diluted by the water. Now imagine putting seven hundred or a thousand drops of dye into the water. That’s enough to turn the water red, and that red water will stain anything it touches.
And that’s the difference between low transmission and high transmission. When transmission is low, almost no one gets infected, and we have the resources we need to track down each case and its contacts, isolate the case and quarantine that person’s contacts and community transmission stops. When community transmission is high, many people are infected.
They spread the disease to many
others who spread the disease to others still, including the elderly and those
with severe chronic disease, so many people need hospitalization and will die
(about three to four weeks after they get infected) – and the cycle continues
until every susceptible person who is not protected from exposure gets infected
and either recovers or dies.
What’s worse is that people who allow community transmission to occur by not masking and not staying away from big events, bars, restaurants and stores usually never see the consequences of their choices. If I’m young and healthy and have the virus and don’t know it, I’m likely to transmit the virus to three other people (if I have Delta) or eight others (if I have Omicron) who each transmit to between three and eight people, likely young and healthy, who each transmit it to between three and eight others yet and so forth.
With each round of transmission, the virus moves farther and farther from my social circle, and closer and closer to susceptible people. And because the incubation period is between three and five days, it takes nine to fifteen days for there to be three generations of spread. The virus I transmit today ends up in twelve to one hundred and twenty-eight people in between nine and fifteen days.
Then it
takes three to four more weeks before the person I inadvertently and indirectly
infected gets hospitalized and dies. It’s like hitting a pedestrian on a dark
country road at night, only you never ever hear a bump as you run into them and
think you’ve run over a branch in the road.
It is now possible that we
will lose 70 to 100 more Rhode Islanders before the end of the year, and at
least 100 and perhaps as many 600 during January alone, and perhaps more, if
Omicron turns out to be as dangerous as Delta. But 18 to 25 of those deaths in
December and 25 to 150 of those deaths in January will be among people under
60. Covid hasn’t changed. That’s just how the numbers work when many people are
infected and when you understand the known limitations of the vaccine.
About half of those deaths
will be in people who were vaccinated.
We can’t change about 100
to 250 or those deaths. They will come from virus already contracted by
susceptible people. The die is cast for them. Their deaths were preventable.
But we all chose not to prevent them. We decided that pizza parlors, bars and
partying were more important than those hundred or two hundred and fifty odd
lives. Shame on us.
But we can still prevent
another 100 to 350 deaths.
To save between 100 and
350 lives, we have to act together, starting today. We have to do what the
Governor and the legislature has failed to do, which is reduce the rate of
community transmission. We have to vote with our feet, with the choices we make
today and each and every day of the next few weeks.
If everyone stops going to
bars and restaurants TODAY, and stops shopping TODAY, we’ll see a drop in
community transmission in about ten days, or two to three generations of
spread. The load on hospitals and other health care folks will start to drop in
about two weeks.
But not everyone is going
to do that, you might be saying. Almost no one is going to do that. We’ve all
had it with Covid. We’re tired.
And you are probably
right.
But understand our choices
have consequences. We are digging graves for between one hundred three hundred
and fifty people. And nobody knows who among us will get to lie in them.
Or, we can just stay home
for a bit, take the responsibility for public health back from a government
that puts business and commerce before human lives, and, in doing so, rebuild
our democracy just a little, doing for others what we would want others do for
us.
Not a bad choice at this
time of year, when all of us, regardless of race, creed, religion, gender,
language or community, think about and yearn for rebirth.