Exiting Covid-19: Personal + Public Health

Just as Covid-19’s rapid arrival produced confusion, its rapid exit (at least in certain geographies) is producing similar confusion. To reduce this confusion, we should learn how to make decisions based on two different lenses: personal health, and public health. Since I’m most familiar with my own situation, I’ll explain how I’m thinking about these issues, and perhaps that will help refine your own decision-making process.

Personal Health:

This week marked a sudden and dramatic positive shift in my personal health situation. I (and the other members of my immediate family) received our first dose of the Pfizer-BioNTech vaccine on April 15 and our second dose on May 6. Thus May 20 marked the +14 days mark at which we are officially fully vaccinated.

This shift is not binary; there is strong evidence that mRNA vaccines like Pfizer and Moderna confer strong (80% effectiveness) starting 10 days after the first dose. But there is a big difference between 80%, and maxing out protection at the 95% effectiveness found in clinical trials, and the 90% effectiveness found in the wild. Let’s not forget what effectiveness measures–it indicates that the chances of exhibiting symptomatic Covid-19 infection are reduced by 95%; the reduction in serious outcomes (e.g. hospitalization or death) is even greater.

It is no coincidence that on May 20, I visited my gym for the first time since March 12, 2020, or that today I ate at a restaurant (outside, with a friend who is also vaccinated) for only the second time since March 10, 2020 (I had one outdoor lunch during the summer of 2020, but decided afterwards that while the risk of infection was very small, the added risk prevented me from enjoying the lunch, making it not worth it).

From a personal health perspective, my family are protected, which means that I am no longer worried about our catching Covid-19. We have already booked a trip to Florida for the kids to see their grandparents (who are fully vaccinated of course) and to visit Disneyworld and The Wizarding World of Harry Potter (we had promised the trip as a high school graduation present to Jason, and obviously we had to defer it).

The personal health lens basically says that once you are fully vaccinated with an mRNA vaccine, which is available to nearly every American (note that there are exceptions–the vaccines do not work as well for the immunocompromised, and there are some people who are allergic as well), you can more or less return to your pre-pandemic life with virtually zero risk to your personal health. In fact, if you have been fully vaccinated with an mRNA vaccine, the vaccine-provided immunity likely reduces the risk from Covid-19 to less than what you face from the seasonal flu.

Public Health:

However, despite my personal health situation, I also view things through a public health lens. That’s because the public health situation impacts me personally, as it does all of us.

Covid-19 still represents a small risk, even to the fully vaccinated, because the longer it continues to infect people, the more opportunities there are for the virus to mutate into a form that can evade the current vaccines, and because 95% protection is not 100% protection.

Each of us is a statistic of one; one woman I know was one of the very unlucky few who suffered from blood clots after receiving the Johnson & Johnson vaccine, was hospitalized, and even now is not well enough to return to work. This doesn’t mean that the vaccine is unsafe, but it does mean that “very low risk” is not the same as “no risk”.

It is in all of our interests to see Covid-19 eradicated from our country. Consider the situation in Israel, which has been extremely aggressive with its vaccination program. Over 5.1 million Israelis have been fully vaccinated. Israel only has 5.9 million adults, so this implies that over 85% of their adult population has been vaccinated, which should be sufficient for herd immunity (a state in which outbreaks cannot spread, simply because there are not enough vulnerable bodies to serve as hosts for the virus). And indeed, the Covid-19 situation in Israel is now very good. There are a total of 560 currently infected patients in the entire country (6 out of every 100,000 people). In the United States, the equivalent numbers are 5.8 million (1,770 out of every 100,000 people). This is not actually discouraging; in February, Israel was in pretty much the same place as the United States today. Its active infections have declined 99.3% in the past three months. Were the United States to follow the same trajectory, the country would only have 38,000 infected patients (11 out of every 100,000 people) at the end of August.

Reaching such low levels of circulating virus has numerous positive effects. Besides the reduction in human suffering, stopping the spread will give all of us back our freedom. Not everyone can take advantage of these amazing vaccines.

The vaccines are great, but most children still aren’t vaccinated. There are people who are allergic to the vaccines. And of course, there are the roughly 3% of American adults who are immunocompromised. For example, a recent study showed that nearly half of transplant patients who received two full doses of Covid-19 vaccine showed no antibody response. And of course, every year, nearly 2 million Americans are diagnosed with cancer, and will undergo treatments like chemotherapy and radiation therapy that will suppress their immune systems.

Maybe you’re very lucky, and you and your loved ones don’t fit into any of these categories. But I would hope you would A) feel compassion for those who aren’t so fortunate and B) realize that you might find yourself in one of those categories at any time.

That’s why all of us should participate in easy, low-cost public health measures to accelerate our progress towards a Covid-free environment. When I go into a grocery store, I wear a mask. I probably don’t need to any more, but the miniscule cost and inconvenience of doing so seems like a small price to pay for reducing my personal health risk, but more importantly supporting public health goals. Imagine working in a grocery store; you would have no idea which customers were vaccinated (and thus safe) and which might still be potentially infectious. Customers who wear masks make the workers lives better by reducing risk and worry.

And even if you don’t care about the health of others, do it for the sake of getting back to normal more quickly. The sooner we make Covid-19 exceedingly rare, the sooner we can all lift all mask mandates and other restrictions.

UPDATE: Just to reinforce the effectiveness of mRNA vaccines, Public Health England found that the Pfizer vaccine was 88% effective against the new variant that is ravaging India (down slightly from 93% effectiveness against the older variant that was first detected in England, and is now the dominant strain in the UK and US).

Also, something that I intended to write, but forgot to include before publishing this essay is to remind folks to look at the local Covid-19 conditions, not just national ones, when using the public health lens. For example, the United States just dropped below 20,000 new Covid-19 cases being diagnosed per day, or about 6 per 100,000 per day. In Santa Clara County, where I live, the average number of cases being diagnosed per day about 45, in a county with a population of 2 million, for just over 2 per 100,000 per day, and almost zero deaths. Not coincidentally, 74% of residents who are 12 or older have received at least one vaccine dose. In contrast, Maricopa County in Arizona is seeing an average of 378 new cases diagnosed per day, or about 8 per 100,000 per day. That’s why local conditions are so important; on the one hand, they are much more directly relevant to your personal health situation than nationwide states, and on the other, they show that we can get this entire country to the point where Covid-19 is no longer a significant threat with just a few simple changes.

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