Coronavirus Update: August 19, 2021

For this COVID update, let’s start with a few assumptions:

  • You have a few minutes to spare: this is long.

  • You are disgusted with our current CoVID situation.

  • You are discouraged by the seemingly constant changing of information.

It took me several hours of reading, research, writing, and editing to develop what is to follow. Please feel free to question or disagree, but if you're going to email me or comment, please stay civil. If you are moved to irrepressible vitriol by my statements, this is not the blog for you to read. My goal is to simply provide factual medical and scientific information. No, I do not get kickbacks from Pfizer for administering their vaccine (shame on those who have asked me that). No, I am not “getting rich” coding CoVID diagnoses that don’t exist. Lastly, I have three kids who have ALL, without exception, had their mental health negatively impacted by this pandemic over the last 18 months. Now, let's get into it. There are several major issues at play now that I'd like to address: breakthrough infections, boosters, kids and Delta, and masks. BREAKTHROUGH INFECTIONS The CDC stopped tracking breakthrough infections in May. I don’t know why and I wish they hadn’t. Earlier this week, the NYT reported that in seven states still tracking breakthrough data, it appears that breakthrough infections account for 18-28% of cases and 12-24% of hospitalizations. There are a few problems with this information. First, it may not be accurate to extrapolate data from 7 states across the country. Second, many immunized people who get mildly sick are not likely to seek out testing, which means that while breakthrough cases could be underreported, percentages of hospitalizations and deaths may be over-reported. So, how did we get here? It is easy to blame “the southern states” with their low vaccination rates and unabashed “anti-science living.” But that is NOT fair. Yes, some states have lower vaccination rates and these states ARE driving case counts and hospitalizations up. BUT, what really happened? DELTA. I have said before and will say again: this is a nasty variant. It exists because of our inability to vaccinate enough people fast enough. That is not a “south” problem or a “Republican” problem or even an “anti-vaxxer” problem. It. Is. A. Global. Problem. Even if we turn the tide here in the states, variants will crop up until we get vaccines to more people worldwide. The good news is that while Delta is more contagious, it is monopolizing the variant landscape-suppressing other, potentially more dangerous ones. BOOSTERS I think everyone will ultimately need a booster vaccine based on how effectively they worked early on, how slippery Delta is, and the number of breakthrough infections. I will get a booster vaccine when offered without hesitation. For now, those with immunosuppression who received mRNA vaccines should be seeking out booster shots. J and J recipients, sit tight. I think we will soon see recommendations for you. I am sorry. I know this is so frustrating. Don’t get too discouraged by this booster news. We give boosters all the time for preventable diseases (the flu, tetanus, pneumonia, etc.) That does not mean the vaccines don’t work. It means their efficacy can peter out over time. The hard part is not the booster. It was figuring the vaccines out in the first place. That part: DONEZO. KIDS AND DELTA There is little doubt now that kids are getting sick with Delta. Some are getting sicker than with the original strains of CoVID. While one child dying from a preventable disease is too many, the death rates in kids remain low. Because there are so many questions about how this virus behaves in kids and because no child under 12 can be immunized currently, all we can do is engage in the public health measures we know work: distancing, masking, hand-washing, and staying home when ill. MASKS I think everyone, vaccinated or not, should wear a mask in certain situations (indoors/crowds/ in areas of high community transmission.) I sometimes find myself three people deep at the deli counter in Wawa without a mask on and have to rummage around for it in my purse. It is not easy to go back. Just remember, before we had vaccines, we had masks. And the masks were good. Between high flu vaccination rates and public health measures like masking, we had a virtually non-existent flu season last year. Please note that I am not arguing for or against MANDATES. Instead, I am advocating for a public health measure that has been proven to work. By the way, for those that fear that “inhaling all those mask fibers” is dangerous, I would just point to our millions of health care workers in surgical and trauma specialties who have spent decades in masks from sunup to sundown. We do not have an “epidemic” of lung fibrosis in that population. Masks do not cause disease. They prevent it. MASKS AND MENTAL HEALTH Regarding the mental health implications of mask-wearing: I honestly struggle with the answer here. There really isn't a great one. However, after polling my three kids (21, 19, 14) and their friends, many of our patients, and the 12 or so college and high schoolers who interned in my practice this summer, here is what I do know: ALL the kids I spoke to felt that the ISOLATION harmed their mental outlook in dramatic ways — not the masks. Further, given a choice, they all, unanimously, chose to go back to campus, schools, classrooms, and lecture halls in masks, instead of staying home or in their dorms learning virtually. Please know that I am not suggesting that masks are entirely harmless — I acknowledge that kids dependent on lip-reading and those needing facial cues will struggle. I am also not suggesting that my 20-some-odd data points are worthy of scientific publication. I am just sharing what I have observed. NO answer is perfect. But it has to be about the greater good – that is the definition of public health. Seatbelts are mandated in 49 out of 50 states. Yet, there are fatalities every year because a seatbelt traps someone in a car, leading to their death. Still, the burden of the evidence shows that seatbelts save the lives of the wearer. In the case of masks, mask wearers not only protect themselves but also protect those around them. Therefore, I believe people should simply wear a mask — not because of a mandate, but because it is right. This is not where we wanted to be now, but things were a LOT worse last year at this time. All we could do then was hold our breaths for vaccines. Now we have them. They are not perfect, but they are so good. WHOSE FAULT IS IT? It is not the president’s fault, the school administrator’s fault, or the unvaccinated person’s fault. We aren’t here because our experts are indecisive or because there are billions of dollars to be made in some nefarious way. Give the vaccine reluctant a minute. Let the mask-wearers wear their masks in peace. Recognize the absolutely impossible position ANY community leader, business owner, or policy-maker is in right now. We are here because we are living through a once-in-a-lifetime global health crisis. The key is that we get to LIVE. Don't we owe it to those whose lives have been lost to do so with a bit more compassion and grace? I really miss that.


Please note that this information is constantly changing. Numbers and shared articles are current as of August 19, 2021. You can trust that we will continually keep you updated as we learn more; please see our newsletter, Facebook page, or more recent posts to this news blog for updates. Thank you.

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