Usually, we celebrate a "breakthrough." Science experiments, tests, progresses, and periodically someone proclaims a "breakthrough." But sometimes a breakthrough is not good news. The recent focus of our overdriven news processes has been "breakthrough" infections and the "Delta" variant. It is not surprising, but fascinating that medical science seems to be learning new things about SARS-CoV-2 daily. As a result, their advice for us Epsilons seems to constantly shift. Their consensus is our reality, and their science is as yet not conclusory.
What is happening is not a positive use of the term "breakthrough," but the occurrence of cases that "breakthrough" the protection of the vaccine. The AP describes this as "dispiriting" for the entire nation. Studying those who tested positive, despite being vaccinated, the scientists in one study now conclude that we are all capable of carrying and thus spreading SARS-CoV-2. We have to keep in mind that this is based upon one small recent study. And, if we have learned nothing else from COVID, we must remember that conclusions and recommendations (consensus) remain subject to change.
To the variants first, "Delta" is the big concern as August marks 17 months since Florida's first infection in March 2020. There was great consternation when SARS-CoV-2 was geographically described. That was denigrated as inappropriate and worse. Then, our national press proceeded to label the early variants with geographic references. The same national press that derided any inclination to name this SARS similarly to the infamous "Spanish Flu," blithely spread geographic references. For more, see Vaccinations Implications (February 2021). So, kudos for moving away from geography and using the Greek alphabet to label variants (although at least one business out there might appreciate some other method).
So, what is happening in SARS-CoV-2? The Associated Press (AP) reports that those who are vaccinated can carry as much viral load as those who have thus far avoided the vaccine. That seems to suggest that whether they become ill or not, vaccinated or not, all people can carry and therefore potentially spread the SARS-CoV-2 virus that causes COVID-19.
The Associated Press article is focused on the recent study that led the Center for Disease Control to reverse its masking recommendation. There has been much vacillation on masks throughout this pandemic. See Anger and Acting Out (June 2020) and The Science of Consensus and Masks Again (June 2021). We have simply been all over the map on masks, various types, various locations, mandates, recommendations, and more.
On July 27, 2021, the CDC changed its recommendation - now all (vaccinated or not) are advised to wear masks "indoor and in places with high virus transmission," NPR reported.
On May 13, 2021, the CDC said vaccinated people did not "need to wear face masks indoors or outdoors," CNBC reported.
On March 2, 2020, the U.S. Surgeon General asked us to stop buying masks and assured us "“They are NOT effective in preventing the general public from catching #Coronavirus," according to CNN.
In July 2020, that same Surgeon General recommended wearing masks, according to USA Today.
It is a challenge to keep up with the recommendations. The rules seem in persistent flux. The same Surgeon General noted last year that "we follow the science and when we learn more, our recommendations change," according to USA Today. In that vein, the recent (July 27, 2021) change in mask recommendation is said by the CDC to be driven by science. The recent study described in the AP story is said to be the foundation for this latest reversal. The theme, however, seems to be less about vaccinated people getting COVID-19, though the focus on "breakthrough" cases might make one struggle with that.
The recent study focuses on 470 people following an outbreak in Provincetown, Massachusetts. As an aside, this is an idyllic little town that is worthy of a summer visit should you ever get the chance. There, people apparently returned to regular activities in May 2021, which included "densely packed indoor and outdoor holiday events at bars, restaurants, guest houses and rental home(s)." When the "seaside town" came alive this summer season, it apparently came alive at full steam. No one in the press is focusing us on avoiding high-risk social settings, distancing, or other precautions.
One of those infected in Provincetown noted “The dominant public messaging has been that the vaccine means a return to normal." He strove to correct this, concluding instead that the vaccine is "a few steps toward normal, not the zero-to-sixty that we seem to have undertaken.” In other words, at least some conclude that the vaccine is not a license to throw caution to the wind.
Health officials on Friday released details of that research, which was key in this week’s decision by the Centers for Disease Control and Prevention to recommend that vaccinated people return to wearing masks indoors in parts of the U.S. where the delta variant is fueling infection surges. The authors said the findings suggest that the CDC’s mask guidance should be expanded to include the entire country, even outside of hot spots. In other words, those scientists are very worried about Delta and faithful to their consensus mask solution.
Despite the recent change, we are not back to the CDC recommending that we each wear two masks, as it was in February 2021, according to CNET. In Vaccination Implications (February 2021), I questioned when the scientists might recommend three instead of two, or four instead of three. If one is good, can it ever be true that more is not better? I actually had a friend who began wearing two at a time last winter. They were perched atop a massive beard (The CDC actually has guidance for beards, and OSHA has regulations for respirators and beards that the CDC has referenced). I wondered at that seeming contradiction. Another example of the simple inquiry - "are we each protecting ourselves?"
I wondered at the two-mask people, though there were not many I ran into. I have, however, run into a multitude of people who think that their mask protects them despite being worn below their nose. I have struggled to comprehend how a mask can provide any efficacy if it covers only the mouth. I have found no research to support that the "free nostril" method is effective. In fact, some suggest that the nose is even "better at spreading COVID-19," according to an NBC affiliate. So, back to the breakthrough, perhaps the CDC mantra should reinforce the proper wearing by those who need it, rather than widespread and ineffective wearing by all?
The findings described by the AP have the potential to upend past thinking about how the disease is spread. Previously, vaccinated people who got infected were thought to have low levels of the virus and to be unlikely to pass it to others. But the new data suggests that is not the case with the Delta variant. There were 900 cases studied in Provincetown, and "about three-quarters of them were people who were fully vaccinated." This suggests that infection in the vaccinated is significant. The AP does a poor job describing how it was a 900 case study and yet focused on 470 people cited above.
There are critics. The AP quotes one researcher who questions the results of the Provincetown study. She says the study "does not prove that vaccinated people are a significant source of new infections." She concedes that “there’s scientific plausibility for the (CDC) recommendation. But it’s not derived from this study.” This merely reinforces that there is room for discussion and debate despite the recurrent chorus of "follow the science" that permeates our modern existence. Science is sometimes merely consensus and we have seen consensus change throughout this pandemic. Furthermore, "plausibility" is hardly a sound foundation for systemic changes.
Despite the conclusions cited by the AP, Kaiser reports that such "breakthrough" infections are "rare occurrences." It suggests that no vaccination is 100% effective and these "breakthroughs" are to be expected. Some of them will even be serious, including hospitalization and even death. Kaiser questions why the CDC "currently monitors hospitalizations and deaths, from any cause, among fully vaccinated individuals with COVID-19, but not breakthrough infections, which it stopped monitoring as of May 1." It therefore did its own data analysis and concluded "the rate of breakthrough cases reported among those fully vaccinated is well below 1% in all reporting states, ranging from 0.01% in Connecticut to 0.90% in Oklahoma." The "breakthrough" does not appear to be a major threat, though it is a serious one for a small group that actually contracts the disease.
From these two, the AP and Kaiser, we are presented with two important conclusions: (1) the risks for those who are vaccinated are very small ("below 1%"), but they are real. There is some risk that remains for those who are vaccinated. (2) Despite being vaccinated, we can both carry the SARS-CoV-2 and therefore may spread it. Thus, the CDC's recent mask recommendation seems to perhaps be potentially helpful to many, but largely for the protection of the unvaccinated.
There may be some very valid reasons not to get the vaccination. I have heard anecdotal descriptions of allergy issues. Some have related anecdotal medical contraindications. But, the vast majority seem capable and eligible for the vaccines. Some simply chose to decline the protection. Thus, we are beginning to see vaccination requirement discussions. Will people be forced to protect themselves?
Some employers are already making that demand and people have lost jobs for refusal. Some major employers in Florida are mandating inoculation, as are some local governments. There is the probability that such mandates will lead inexorably to expensive litigation. As yet, the news on such lawsuits has supported mandates imposed by employers.
The President has voiced plans for both incentives and requirements. We see the potential for the federal government to force inoculation (which my military friends assure me is not a recent idea). The CDC is said to be considering nationwide requirements for "vaccines for doctors and other health workers," according to the AP. A White House spokesperson said “The most important takeaway is actually pretty simple. We need more people to get vaccinated.” And, thus, the question may simply be how.
The vaccination, whether through encouragement or requirement, would have people protect themselves. The masks, on the other hand, seem to be recommendations or requirements that those who are vaccinated should protect those who have not taken advantage of that opportunity. I think a great deal of humanity. I believe strongly that people are, at their core, good, caring, and charitable. But, will the vaccinated wear (or effectively wear over their nostrils) masks simply for the protection of others? As scientists study much larger populations than Provincetown, will their consensus change?
As we enter our 17th month of pandemic, we are confronted again with change. We witness science at its best with the delivery of vaccines in record time, and the challenges of shifting consensus marketed as science. We witness doubt, frustration, and ongoing challenges. Time will bring more knowledge. Recommendations will continue to shift. People will continue at risk. But, if you avoid the high-risk environments, practice some reasonable distancing, and get vaccinated, your odds are simply better. Not perfect, but certainly better. Why not improve your odds?
