Weekly COVID Update – Dec. 3, 2020

Current Situation: Bad & Getting Worse

The charts below show a leveling off and in some cases a slight drop after Thanksgiving. This is most likely a mirage, caused by reporting delays normal for a weekend and compounded by the Thanksgiving holiday. I have not encountered a single serious epidemiologist who thinks were headed for anything but more increases, or as Anthony Fauci called it, a “surge upon a surge.”

One thing to keep in mind. Health care workers are getting worn out. They were reaching that state in April, but since then, they have had to absorb long hours, grief, fear for themselves and their loved ones, and countless deaths of their comrades – almost 2,000 of them to date.

I made the mistake of calling them “heroes,” and I was rightly called out on that. What does it mean when we call someone a hero? It means we celebrate their lives, we respect their advice, we hold them up as models for our lives. But this is not what’s happening in this pandemic. Instead, we have millions of people who claim it’s too hard to wear a mask. We have a White House that is planning 24, yes 24, indoor Christmas celebrations this month. We have countless numbers of citizens who ignore the risk and throw indoor parties. We even have outraged “citizen investigators” who break into hospitals and try to prove that reports of ICU’s getting overwhelmed are fake news.

No, the 25 million health care workers in the U.S. are doing their jobs. They are trying to keep us healthy. They don’t need us to call them heroes. They need us to follow science based health precautions and keep our bodies out of their hospitals.

Vaccines & Herd Immunity

It’s too bad that “herd immunity” is associated with the crackpot pseudo-epidemiologist Dr. Scott Atlas, who fortunately resigned a couple of days ago. Many months ago, real epidemiologists, using data from China and Italy, were able to establish both the R0 range for COVID, and from this, the percentage of the general population that would need to have immunity for the virus to be defeated. The R0 is somewhere between 2.0 and 3.0, requiring somewhere between 60% to 70% of the population to have antibodies to achieve herd immunity.

There is a direct relation between R0 and herd immunity. If the R0 (pronounced “R-naught”) is very high, as in the case of measles at around 15, herd immunity isn’t reached until 90% of the population has antibodies. That’s why a cluster of anti-vaxxers can turn a neighborhood into a disease cluster or cause an outbreak of disease in a place like Disneyland.

The big question looming before us is this: will enough people take the vaccine to get us to the herd immunity threshold? Let’s see what would be required, using an in-between requirement of 65% and a US population of 330 million.

The US population of 330 million x 65% = 215 million people. From that, we can deduct approximately 20 million people who will probably be infected by early spring of 2021. That leaves 195 million people who will need the vaccine, assuming the people who tested positive actually have enduring antibodies.

The two main vaccines both require a double dose, so that would require distribution of 390 million vaccinations. Until we have at least 355 million doses distributed to 178 million people, we won’t even meet the lower bounds of herd immunity.

To get that many people vaccinated will take a massive coordinated public relations push as well as a highly sophisticated logistical plan. Even if the logistics are 100%, without a successful public buy-in, we’ll all have to continue to wear masks and worse, deal with periodic surges of COVID. In other words, herd immunity = return to normalcy. Anything short of that means some variant of what we’re living with today.

A USA Today Poll in September indicated that 2/3 of all Americans would not take a vaccine when it became available. In September, I had my doubts about vaccine safety, so I think we have to take this number with a grain of salt. Once I was convinced that the Trump administration had not compromised the process of proving safety and efficacy, I no longer had any doubts about getting vaccinated.

The bottom line question, then, is this: how many people will remain steadfastly against taking the vaccine, and will there be enough of them to make herd immunity impossible? Put another way, where will those 178 to 195 million people come from?

The chart above makes a lot of assumptions, and I don’t claim that it’s absolutely valid. It’s main purpose is to get you thinking about what would be required to achieve various levels of herd immunity, given the political realities in our country.

This calculation uses voting as a proxy. For example, you could assume that 80 million people voted for Biden, and that 90% of them would get over their skepticism about Trump and take the vaccine. Along with them, you might assume that of the 80 million eligible people who didn’t vote, half of them were not covid-deniers. If we assume that 90% of those 40 million people would take the vaccine readily, that gives us a total of 108 million people vaccinated.

Eligible voters are also in families and have children. The average family has around 2.2 children, but not all of these 108 million people have families. Let’s assume that half of them do, though, giving us another 54 million children who would likely get vaccinated. Now we’re up to 162 million people, or 16 million people short of our minimum goal, using a herd immunity requirement of 60%.

This chart shows that the midpoint estimate of 65% would require persuading around 16 million people to take the vaccine who are now reluctant. The lower range estimate of 60% wouldn’t require persuading anyone, but few epidemiologists are using that number.

Also, keep in mind that this model doesn’t take into account the millions of people who will get the first shot but not the second. In other words, I think it’s just as likely that we’ll have to persuade 32 million people to get vaccinated.

Also, this model doesn’t take into account that the vaccines are at best 95% effective. That would mean that if 200 million people took the vaccine, it wouldn’t work for 10 million of them.

Finally, it’s far from a certainty that people who have recovered from COVID don’t need the vaccine. It’s very likely that they will need it, so that may add another 20 million people to the requirements.

These 16 to 32 million people have to come mainly from the 72 million people who voted for Trump and the 40 million apathetic people who didn’t vote at all but who lean toward Trump. If we use the same ratios (65% voter participation), we would need 10 to 20 million Trump voters, along with 6 to 12 million Trump leaning non-voters to take the vaccine.

I believe it is a fundamental error to think that all Trump supporters, whether they voted or not, are anti-vaxxers. Typically, the term “anti-vaxxer” applies to a person who zealously rejects all vaccines, such as Robert Kennedy Jr. These people use pseudo science and cherry-picked data to support their dangerous positions. Most estimates I’ve seen indicate that between 10% and 20% of people are true anti-vaxxers. Mixed in with those people are partial anti-vaxxers, i.e., people who accept their pediatricians’ advice to take the MMR vaccine, but who hold completely unscientific and wrong ideas about the seasonal flu vaccine. The most common idea with these anti-vaxxer-lite people is that the flu vaccine causes the flu, a scientifically preposterous idea.

It would also be a mistake to believe that all anti-vaxxers are Republicans. That’s why I used an estimate of 90% of Democratic voters and non-voters. In that other 10% are millions of people who are anti-vaxxers and anti-vaxxer-lites.

Bottom line: if we assume that we won’t have any success converting the anti-vaxxers, we still have a very good opportunity to convince at least 16 million people who today say they won’t take the COVID vaccine, but who can probably be convinced to take it. It will be much harder to convince 32 million people to do it, but it’s possible. Here is my personal list of strategic points to accomplish that:

  • Don’t lump together people who are skeptical about COVID vaccines with hard-core anti-vaxxers. The latter are people who tend to make motivated reasoning and confirmation bias part of their identity. The former are people whose motivation may come from a misguided social media post or anecdotes from a friend. Consider these people persuadable.
  • Support and defend an energetic public relations campaign for the vaccines. It’s not just the job of government; citizens have to get involved as well. That’s how we beat polio.
  • Of course, take the vaccine yourself. Make sure your family takes it. Tell your friends to take it.
  • Don’t blow side effects out of proportion. Yes, up to 15% of people may experience some side effects – irritation around the injection site, low grade fever, muscle aches, etc. But this is NOT COVID! Don’t exaggerate the side effects, and counter comments from family and friends who are doing that.
  • Acquaint yourself with the facts about the vaccines and the methods used to verify them. You’ll need this so you can persuade people who will listen to facts, but who have seen a lot of misstatements or lies on social media and from ignorant media commentators. At the end of this post, I have a list of sources.
  • I know I’ll get some push-back on this. I support legislation, on a local and national level, to make vaccination mandatory. No shots = no school, just like it is for the MMR vaccine. I can already hear the cries for “liberty” from the same people who won’t wear a mask. Frankly, I’m sick of their one-sided and selfish view of liberty and freedom What about our freedom, our desire to have economic and personal health? What about our freedom to hug our grandkids again and be with our extended family and friend networks? That’s freedom too, and if you ask me, it’s a much more important freedom than your right not to wear a mask or get a vaccine that will allow us to get to herd immunity.
  • Don’t politicize your persuasion to family members and friends. I know, I know — some of you are shaking your heads. Zorgi telling people not to make it political?! Are you kidding?! I used a political model in this post, but that doesn’t mean that I would even mention Trump and/or Republicans if I were trying to persuade a family member of friend. Instead, I would try to find the “facts” that make them skeptical. Then, using the reading list below, I would try to get them to see that their fears were unfounded in this case. I wouldn’t waste my time with hard core anti-vaxxers. We need to win over the “persuadables” first.

More Reading

I’m optimistic about 2021. It won’t be perfect, but it will be infinitely better than the chaos, incompetence, and indifference that were the hallmarks of the federal government’s response to COVID. To use that old trite cliché from the Vietnam War years — there’s light at the end of the tunnel.

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