In quelling pandemic, officials confront perilous chasm with the unvaccinated

adjustedmay21covidcases-300x158Even as millions of us glide into a summer with high hopes of putting the pandemic behind us and returning to greater normality, huge public health challenges persist in quelling coronavirus infections, chief among them being — how the heck do we get the unwilling vaccinated now?

Just before the long Memorial Day holiday weekend launched, the head of the federal Centers for Disease Control warned that the nation has reached the difficult — and promising —  point where experts figuratively can see either a glass half empty or half full.

At least half of the nation’s population now is fully vaccinated, the agency reported, with 61% of adults (those 18+) having received at least one vaccine dose. Millions of parents are hurrying to ensure that those as young as 12 receive their coronavirus shots, as now not one but two vaccine makers have developed data showing products to be safe and effective for younger patients.

But U.S. leaders, from the White House down, find themselves huffing and puffing a lot — and with others they’re pulling out extreme means — to try to get as many people as possible nationwide to stop dragging their feet, wringing their hands, or clutching extreme and unsupported views and to get vaccinated.

Unvaccinated at much heighted health risk

The unvaccinated have put themselves at demonstrable and needless health risk, and consequences could result from persistent vaccine hesitancy and resistance, the Washington Post reported:

“The big question now is whether the virus will be thoroughly squelched through mounting vaccinations — or whether it will smolder in areas with low immunization rates and potentially flare when colder weather returns, said David Rubin, director of PolicyLab at Children’s Hospital of Philadelphia, which has been modeling the outbreak for more than a year.”

Separately, Washington Post staffers examined coronavirus infections, hospitalizations, and deaths — adjusting to see their effects on the unvaccinated (see figure above), reporting:

“The country’s declining Covid-19 case rates present an unrealistically optimistic perspective for half of the nation — the half that is still not vaccinated. As more people receive vaccines, Covid-19 cases are occurring mostly in the increasingly narrow slice of the unprotected population … adjustments for vaccinations show the rate among susceptible, unvaccinated people is 73% higher than the standard figures being publicized. With that adjustment, the national death rate is roughly the same as it was two months ago and is barely inching down. The adjusted hospitalization rate is as high as it was three months ago. The case rate is still declining after the adjustment.”

The information site Vox reported that:

“[E]xperts are increasingly worried that, in the southern half of the country, the return to normalcy could be a mirage and that summer could bring another wave of the virus in parts of the country. ‘I’m definitely worried,’ Saskia Popescu, an epidemiologist at George Mason University, [said]. The concern isn’t about another nationwide surge, but potential state or local spikes.”

Southern states, politically conservative and supportive of the Republicans who have downplayed or dismissed the pandemic from its start, soon will see temperatures spike. This will force more people indoors into air-conditioned spaces and in closer contact with each other in a region that has shown some of the lowest acceptance of public measures like face covering and distancing. Southerners might safeguard themselves with vaccination. But inoculation rates in the region are among the lowest nationwide, with some rural and exurban counties showing paltry uptake of coronavirus vaccines.

Public health experts fear not only coronavirus outbreaks in areas with low vaccination rates but also the rise in these areas of viral variants that are growing in number, infectiousness, and lethality around the globe. The more the virus goes unchecked, the greater the likelihood that it mutates, including in damaging ways to humans. Nations around the globe are clamoring for vaccines that too many in this country are declining to take.

Persuading the hesitant and resistant

Opinion surveys have tracked the cited rationales from the unvaccinated in this country. They say they are waiting still for the vaccines’ safety and effectiveness to be proven — this, despite hundreds of millions of doses administered with rare, serious side-effects and widespread good outcomes, most notably plunging infections, hospitalizations, and deaths.

Some of the resistant say they worry about vaccine reactions that might keep them out of work. So, some employers and organizations are offering workers paid time off — to get vaccinated and if they experience negative side-effects (headaches, muscle pain, tiredness, and other symptoms of vaccines protective responses).

Others say they might be persuaded by other incentives to get vaccinated. This has spawned giveaways of gift cards, tickets to sporting and entertainment events, and even bountiful statewide lotteries from Maryland to California. Celebrities, athletes, and prominent people are participating in public campaigns to persuade people to get vaccinated.

Mass sites have shuttered slowly, in favor of mobile and pop-up operations, as well as campaigns in public clinics, schools, universities, houses of worship, and mass transit sites. Vaccines and appointments are now widespread and readily available, experts say, in neighborhood and chain pharmacies, as well as in hospitals and doctor offices.

The Biden Administration, to its credit, ramped up efforts to ensure more equitable distribution and administration of vaccines, targeting poor areas and communities of color for intensive public information and inoculation campaigns.

The infection tears through communities of color, still

That said, the nation’s capital has become a glaring, negative example of the pandemic’s sustained damage, as the Washington Post reported:

“Black people make up more than 80% of coronavirus cases reported in the District [of Columbia] in recent days, compared with 46% late last year, a disparity that D.C. Mayor Muriel E. Bowser (D) highlighted in a [May 25] call with Ward 8 community leaders … The share of new infections involving black people spiked sharply in the city starting around mid-April, when the coronavirus vaccine became widely available to D.C. residents. The share of cases involving white people, meanwhile, has fallen below 10%, compared with 33% of cases in December. It is yet another way in which the highly contagious virus — which has disproportionately sickened and killed people of color throughout the pandemic — has exacerbated the nation’s deep racial divides.”

Similar trends have been detected elsewhere, including in Kentucky and Tennessee, the newspaper reported. The Los Angeles Times had this trend report:

“Black residents of Los Angeles County now have the highest risk of coronavirus infection and Covid-19 hospitalizations and death of any racial or ethnic group, new data show. Since the first few months of the pandemic, Latinos in L.A. County have been the hardest hit group; the Covid-19 death rate among Latino residents surpassed that of all other racial and ethnic groups for the first time 11 months ago and remained in the lead for both the second and third waves of the pandemic. But in recent weeks, there’s been an unmistakable shift, and now Black residents are twice as likely as Latinos and three times as likely as white and Asian American residents to die from Covid-19.”

Officials in communities with marked pandemic disparities say they must redouble their efforts to sharply increase vaccinations in hard hit communities, as well as providing hot-spot areas with heightened medical services.

President Biden has set a goal for his administration to see the nation achieve 70% vaccine coverage for adults by July 4 — a target that officials say remains in striking distance.

The push for vaccination has been supported by schools, colleges, and universities, which in growing numbers are telling students they must get coronavirus shots if they 12 and older and their health permits. As employees head back to more normal or even hybrid work in person, employers are, for now, avoiding vaccination mandates and offering sometimes extensive incentives, instead.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damages that can be inflicted on them by an array of awful circumstances and things, including:

In these cases, a crowd of problem people and institutions — these can include doctors, hospitals, insurers, regulators, and politicians — may press victims to move on, settle up, and they fast forget the lonely agony of the suffering. It can, however, take a long time for patients to recover from terrible illness or injury. Harms can last a lifetime. Patients may need medical services, as well as financial and other support for months or years. They also need closure and justice for wrongs done, as well as the sense that they may be able to help others avoid the problems that afflicted them.

Vaccination versus risk — what outcomes show

We are not done with the coronavirus and the huge trauma it has inflicted on us all. Please get vaccinated. All medical interventions carry risk. But vaccines’ benefits long have been shown to far outweigh their harms. The evidence grows by the day about the startlingly powerful outcomes of the coronavirus vaccines. As the New York Times reported:

“Immunity to the coronavirus lasts at least a year, possibly a lifetime, improving over time especially after vaccination, according to two new studies. The findings may help put to rest lingering fears that protection against the virus will be short-lived. Together, the studies suggest that most people who have recovered from Covid-19 and who were later immunized will not need boosters. Vaccinated people who were never infected most likely will need the shots, however, as will a minority who were infected but did not produce a robust immune response.”

Consult your doctor if you have concerns. Don’t hesitate to talk with loved ones and people you respect if you have doubts.

By the way, don’t toss away those face coverings too swiftly. They may be a good thing to wear in closed, crowded, and poorly ventilated spots, especially as there’s no way to know for now who has gotten vaccinated and who has not. Masks may not be needed outdoors, and they’re less important for the vaccinated. Still, experts also say they are seeing surges in common illnesses, specifically colds and the flu, as people race to get out and mingle. Face coverings and distancing have proven effective in tamping down respiratory ailments, and they should not be stigmatized, particularly for people who, say, may be immunocompromised (with chronic conditions like cancer).

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