Pandemic numbers do add up — to a complex and persistent health menace

faucijim-300x216An Ohio congressman got testy with one of the nation’s leading infectious disease experts, insisting that Dr. Anthony Fauci instantly cough up a metric to tell politicians and the public exactly when the coronavirus pandemic will end. Fauci declined to offer a simple 1-2-3 answer, trying to supply a nuanced and thoughtful response, instead.

The further anger his comments provoked may suggest it’s time to look yet again at the pandemic by the numbers. They do, indeed, tell a story but read it and them with care.

A tragic toll equivalent to noted U.S. metropolises

The infection — which has claimed 3 million lives globallyhas killed at least 565,000 Americans as of April 16 and infected not quite 32 million in this country.

The disease’s deaths are likely underestimated and now exceed the 2000 U.S. Census populations of cities like Denver, Seattle, Nashville, and Charlotte. The toll is climbing toward the equivalent of the 2020 estimated population of the District of Columbia.

To get a sense of the scale of the reported virus infections, it exceeds the 2020 estimated populations of the country’s 10 largest metropolises and is roughly equivalent to the number of Americans who would benefit if Congress would increase the federal minimum wage to $15 an hour.

Despite huge gains in coast-to-coast vaccination campaigns, the nation has not gotten close, experts say, to achieving the safeguards of “herd immunity.”

Federal officials reported, as of April 16, that ~128 million Americans or 38.5% of the adults in the country, have received at least one dose of coronavirus vaccine. Almost 44 million older adults (65+), or 80.4% of that group, has gotten at least one dose of vaccine.

Still, the nation is recording 71,000 cases daily — 16,000 more than a month ago. Thirty-eight states are reporting increased infections, with Michigan alone accounting for 10% of the daily cases. Hospitals across the country report they are treating 47,000 infections, the highest number of cases severe enough to require that care since March 4. At the same time, California is reporting the nation’s lowest positivity rate, a 1.5% figure that has not been seen since the pandemic began. The state also says just under 40% of Californians have received at least one dose of vaccine.

A vaccine paused in U.S. over blood clotting concerns

Concerns about rare blood clotting incidents have caused federal regulators to pause the use of the Johnson and Johnson vaccine. Experts had high hopes for it because it does not require the cold or super cold handling of other vaccines and it requires only one dose — a big favorable for it with reluctant patients and those who struggle to get to vaccination sites, notably those in poor, hard-working, and under-served communities of color.

The J&J vaccine received emergency-use authorization from U.S. officials later than two other vaccines (from Moderna and Pfizer) and J&J has suffered through manufacturing problems that kept the company from fulfilling its federal supply targets.

That also has meant that J&J vaccines amount to 4% of the doses given in the country, and experts, while scrambling to deal with the product pause, have said they think it will not have major effects of the nation vaccination campaign.

The adverse J&J cases, akin to those affecting the AstraZeneca vaccine, affected relatively small numbers of patients — 222 with AstraZeneca (used overseas and not in the U.S.) and six with J&J. The half dozen in the U.S. “were women between the ages of 18 and 48, and all developed the illness within one to three weeks of vaccination,” the New York Times reported. “One woman in Virginia died, and a second woman in Nebraska has been hospitalized in critical condition.”

Some other numbers may provide needed perspective on the abundance of caution shown by federal officials, the newspaper reported:

“More than seven million people in the United States have received Johnson & Johnson shots so far, and another 10 million doses have been shipped out to the states, according to data from the Centers for Disease Control and Prevention.” (For perspective, 34 million people have received the AstraZeneca vaccine).

The newspaper also noted this:

“In the United States alone, 300,000 to 600,000 people a year develop blood clots, according to CDC data. But the six cases that led to the pause involved a rare combination of symptoms. The clots occurred in the brain, in a condition called known as cerebral venous sinus thrombosis. The clots were accompanied by low levels of platelets, a component of blood that helps form clots that normally help heal wounds.”

Measuring health interventions’ risk

The fury over the J&J pause — which critics say is an overreaction, given the persistent severity of the pandemic — has angered some women. They say drug regulators have accepted far worse results for oral contraceptives than what the public has experienced with coronavirus vaccines.

Angela Rasmussen, a microbiology Ph.D. and virus expert at Georgetown’s Center for Global Health Science and Security, wrote a thoughtful New York Times Op-Ed and posted her views succinctly on Twitter, reporting of blood clotting issues:

“For perspective, here are some numbers:

  • 1 in 1,000,000: J&J vaccine
  • 1 in 3,000: oral contraceptives
  • 1 in 5: hospitalized Covid-19 patients

“As someone who got the J&J vaccine 8 days ago, and who took oral contraceptives for 20 years, I’ll take these odds.”

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.

We are not done with the coronavirus and the huge trauma it has inflicted on us all. Please get vaccinated when it’s appropriate for you to do so. All medical interventions carry with them risk. But vaccines’ benefits long have shown to outweigh their harms. Consult your doctor if you have concerns. Don’t hesitate to talk with loved ones and people you respect if you have doubts about vaccines.

Vaccines carry risks but consider the metrics with care

But there’s another number that patients should consider with the pandemic still raging:

The CDC, as part of its studies, found that (at the time) 66 million people in this country had gotten their full two doses of a coronavirus vaccine and waited at least two weeks for maximum immunity to develop after their second dose. In that sizable group, officials have identified 5,800 “breakthrough” cases in which patients then developed coronavirus infections.

These instances — and others that researchers can find — will be studied thoroughly.

But let that sink in: the vaccine protection extended to all but 0.008% of the fully vaccinated population.

Here is what the New York Times reported about precautions for recent recipients of the now-paused vaccine:

The CDC and the [Food and Drug Administration] recommended that people who have received the Johnson & Johnson vaccine within the past month contact their doctors if they experience severe headaches, abdominal pain, leg pain or shortness of breath. Officials said the most common symptom of the disorder was a persistent, moderate to severe headache that begins six days or later after the shot.”

For all the rest of us, well, we all can, for a little while longer, keep up public health recommendations. Get tested if you think you have been exposed to the disease. We can practice great hygiene (especially with hand washing), keep our faces covered, maintain distance, and avoid closed and confined spaces with poor ventilation. Depending on the disease’s spread in our communities, we may be able, with safeguards, to move about more easily and enjoy a greater return to normality. But it makes no sense to be reckless, to gather in large numbers and without face coverings and distances, or in packed and badly ventilated indoor spots.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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