December 28, 2021 - Choices Have Consequences

Choices Have Consequences

December 28, 2021

After landing in Alabama last week, the Omicron variant certainly is making up for lost time. ADPH reported 3,705 cases this morning, a number last seen at the height of the Delta surge in mid-September. The reported positivity rate has gone from 5.5% one week ago to 22.1% today. Not surprisingly, Alabama’s percentage weekly rise (171%) trails only neighboring Georgia (213%) and Louisiana (182%). Florida is not far behind (164%).

Hospitalizations in Alabama are also rising fast. There are now 612 confirmed patients in 103 reporting hospitals (5.94 per hospital), a 48.5% rise in hospitalizations in the last 9 days. Alabama confirmed its first Omicron case only 12 days ago, and hospitalizations normally lag infections by a week or two.

A growing body of scientific evidence suggests that Omicron is less severe than Delta but it all depends on what shots you've had. According to Dr. Craig Spencer, a prominent New York City ER doctor, "Every patient I’ve seen that had a ‘booster’ has had mild symptoms. By mild I mean mostly sore throat, some fatigue, maybe some muscle pain. No difficulty breathing. No shortness of breath. Most patients that had 2 doses of Pfizer/Moderna, but no booster, still had ‘mild’ symptoms. But more fatigue. More fever. More coughing. A little more miserable overall. But no shortness of breath. And almost every single patient I’ve seen that needed to be admitted for Covid has been unvaccinated. Every one with profound shortness of breath. Every one’s oxygen dropped when they walked. Every one needed oxygen to breathe regularly.”

Dr. Spencer’s emergency room observations are consistent with the findings in studies from South Africa to Europe to NYC, that healthy individuals who are vaccinated, and especially those who are boosted, are highly unlikely to develop severe symptoms that will land them in the hospital. Yet, unvaccinated individuals remain vulnerable to severe disease, potentially as vulnerable as if they contracted the deadly Delta variant.

If, as expected, there proves to be a bright line between the outcomes of vaccinated and unvaccinated individuals who fall prey to the highly contagious Omicron variant, then Alabama must confront a grim reality. Less than half our people have received even two shots and barely one-quarter of those are boosted. When you do the math, that means only 1 of 8 Alabamians may reasonably expect no more than a sore throat and fatigue if they get infected. Everybody else is at risk of a more severe outcome. Unvaccinated Alabamians, who total 2.5 million people, could put our hospitals in crisis if they are exposed to Omicron.

It has been 12 months since vaccines became available to adults in the United States, and two full months for children as young as 5 years old. A recent analysis of U.S. Covid-related deaths during 2021 found that states with the lowest vaccination rates - Oklahoma, Alabama, West Virginia, Arizona and Kentucky - suffered deaths at rates 2 to 5 times higher than states with high vaccination rates. Yet, five states - including Arkansas, Florida, Iowa, Kansas and Tennessee - have made the decision to pay people not to get vaccinated. They actually pay unemployment benefits to those who quit their jobs rather than comply with their employers’ vaccination policies.

Have we reached the point where only the willfully defiant unvaccinated Americans remain at risk of severe illness? If so, what are the implications for public policy? For example, is it fair for a school to suspend in-person learning for students who are vaccinated and boosted, just to mitigate the risk for students who refuse to get a single shot? If a hospital has limited ICU beds, should vaccination status be considered when allocating them? Should responsibility for the worst outcomes be shifted to those with the power to control their own outcome by getting vaccinated?

This question goes to the heart of a new CDC recommendation that Americans who are boosted do not need to be isolated after exposure to the virus unless they later test positive. Not surprisingly, this CDC recommendation, which will be followed by most employers, does not extend to unvaccinated individuals. As Omicron gathers steam, there will be more winners and losers based on vaccination status. Of course, most Alabamians who still remain unvaccinated insist that they must have a choice. With Covid-19 - as in life - choices have consequences. The totals:

12/14 - 814 (excluding 841 older cases)

12/15 - 647

12/16 - 816

12/17 - 908

12/18 - 692

12/19 - 552

12/20 - 552

12/21 - 1,254

12/22 - 1,460

12/23 - 2,060

12/24 - 2,466

12/25 - 2,449

12/26 - 863

12/27 - 1,679

12/28 - 3,705