July 24, 2021
Since my last letter on July 21, the case counts for 3 days have been reported (ADPH has resumed its daily reports). Brace yourself. On Thursday, there were 1,567 new cases; on Friday, daily cases rose to 1,733; and today, there were 1,888 more cases. As a result, the 7-day moving average is now 1,379 cases per day. And the weekly positivity rate is at least 15.5%. As of Friday, there were 727 patients in 105 reporting hospitals (6.92 patients per hospital) and an average 5.7 deaths per day for the last week.
Considering only 34% of Alabamians have been vaccinated and over 80% of new cases are caused by the Delta variant, our current surge is hardly surprising. In fact, it was inevitable.There are some who held out hope that Alabama’s high rate of natural infection in December and January would compensate for its low vaccination rate today, but that hope is unfounded. One study comparing the level of immunizing antibodies in vaccinated vs naturally infected individuals found that antibody levels in naturally infected individuals varied widely depending on the severity of the disease, but they ranged from offering the same protection as vaccination to just 1/20th of the protection gained from vaccination. https://www.news-medical.net/news/20210623/Higher-levels-of-antibodies-from-COVID-19-mRNA-vaccine-compared-to-natural-SARS-CoV-2-infection.aspx.
The study cited above was conducted before Delta arose as the dominant strain. According to UAB’s Dr. Nathan Erdmann, an infectious disease expert, “Now with Delta, prior infection is unlikely to offer much protection at all. The quality of the immune response with a vaccine is much better....I don’t really count natural infection as relevant to herd immunity. They are nowhere near equivalent... Herd immunity based on prior infection is a fundamentally flawed interpretation.”
So, the heart of the problem we face is clear. The longer it takes to achieve herd immunity through vaccination, the more likely it is that a coronavirus strain will emerge that is resistant to vaccines. After months of downplaying the urgency of the situation, Gov. Ivey finally put it where the goats can get it: “It’s time to start blaming the unvaccinated folks, not the regular folks,” she told reporters. “[T]he unvaccinated folks that are letting us down. These folks are choosing a horrible lifestyle of self-inflicted pain.” Although the Governor accurately identified the culprits, she ignored the fact that children under 12, who cannot get vaccinated, have been rendered defenseless in the process.
A recent study out of Israel suggests we may already have reached the turning point. According to the study, the Pfizer shot was just 39% effective in preventing infection in the country in late June and early July, compared with 95% effective from January to early April. In both time periods, however, the shot was more than 90% effective in preventing severe disease. Nevertheless, news that the Delta variant may have mutated its way around the Pfizer/Moderna vaccines has sent shock waves around the world.
Data from this Israeli study clearly caught the attention of the Biden Administration, indicating a need to speed up authorization of booster shots for vaccinated individuals. The Administration announced it is purchasing an additional 200 million doses, potentially for that purpose. The calculus is complicated, however, because the need for a booster shot could be a further deterrent for the unvaccinated and would at least provide more ammunition to the anti-vaxxers.
Although it seems inevitable that a booster shot is forthcoming, if not imminent, it presents a paradox wrapped in a dilemma down here in Alabama. It’s certainly fabulous news for people who are already vaccinated. But in states like ours, where barely half the adults have received one dose and only 42% of adults are fully vaccinated, the celebration will be muted. To induce enough citizens of Alabama and other Southern states to get even one shot, much less three, will take more education - perhaps re-education is the better word. Just yesterday, CMS (Medicare) reported that fewer than 50% of people who work in nursing homes in Alabama are vaccinated. If that doesn’t leave you gobsmacked, nothing will. The totals:
7/10 - 534
7/12 - 610
7/14 -1,398
7/15 - 965
7/16 - 999
7/19 - 2,343
7/20 - 1,391
7/21 - 1,632
7/22 - 1,567
7/23 - 1,733
7/24 - 1,888