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Sunday, May 23, 2021

A Second Wave?

Can we (should we) strive to learn from what is going on a world away in India? The British Broadcasting Corporation (BBC) reported recently that India is being devastated by a "second coronavirus wave." Incredibly, other countries have somehow avoided devastation. The volume of SARS-CoV-2 infections has been devastating worldwide. But, note India with 19 million diagnoses and over 200,000 killed; yet, next door in China less than 100,000 total infections and less than 5,000 deaths according to Worldometer.

The focus of the BBC story, however, is not a comparison of a regional curiosity. It is a critical expose of the challenges faced there in obtaining medical care. The BBC says that "heartbreaking stories . . . are coming in from across India," which is in the midst of what they describe as a "wave (that) is proving to be more infectious and deadlier in some states."

The story notes that the volume of diagnoses is increasing. The increased infection rate is blamed on India "let(ting) its guard down" when infection rates began to fall in January. The public apparently returned to a sense of normalcy then, which included "big religious gatherings, the reopening of most public places and crowded election rallies." This is characterized as "a false sense of normalcy (that) crept in."

Some lament the current wave and prognosticate that the country should have seen it coming in January, but failed to act. The result, they allege, is a current "tsunami" of diagnoses. This tsunami includes reports of daily infection over 250,000. Hospital beds are in short supply, as is oxygen and other necessities. the BBC reports that cities are "frantically trying to build extra capacity in hotels and stadiums." That is reminiscent of our experiences last year in Los Angeles and New York. Huge sums were expended to convert facilities, but they were not widely used. The physicians in India also lament the shortage of trained professionals.

Despite the efforts of medical professionals, the rate of reported death is notable. Some assert "that the actual number of deaths could be much higher" than even reported. The BBC notes that "crematoriums have been running day and night in several cities." Some claim that the government death data is simply not compatible with their observations. It is fair to say the situation is dire. There are fears that a mutation in the virus may even impact the effectiveness of vaccines.

However, things in America seem to be improving. In Florida, there are many open restaurants, the beaches are streaming with tourists, and there is a sense of normalcy. I have traveled extensively in the last 16 months (throughout the so-called lockdowns) and my recent perceptions are of a return to normalcy. See We're Really Back (April 2021) and a Great Hamburger with a Smile (April 2021). On a recent trip to Tennessee, the masks were off and the crowds were rocking. Reports I get from around the country recount similar easing of the great tension. Months after many had eschewed the face mask, the CDC even joined the club. 

And yet, there are still those masked up persistently. I have heard them criticized. But that is a personal choice. We should all remember that some part of our population faces medical challenges that we cannot know of and perhaps cannot even comprehend. It seems inappropriate for me to judge someone for choosing to wear a mask any more than for wearing a hat in the Florida sun.  Likewise, as a colleague recently noted, it seems as inappropriate for anyone to question vaccination status or vaccine perspectives. 

So, do we have anything to fear at this point, "but fear itself?" (Franklin Roosevelt 1933). One main point of the BBC story is complacency. Officials there believe the second wave results, in part, from "let(ting) its guard down" when infection rates began to fall in January. That might be a lesson for us all. I predicted in February 2021 that our pace of 1.3 million vaccinations a day would have the whole population vaccinated here by October 11, 2021, see The Future's so Bright (February 2021).

But, I was wrong. In that post, I expressed some criticism of the "experts" or "science" that predicted on April Fools Day 2020 that a vaccine was not probable for 18 months (they were wrong). I noted that I might be wrong about October 11, 2021, and encouraged the reader to look back and correct me. I was wrong. Since then, our vaccination rates have far exceeded that 1.3 million daily. Americans have largely embraced the vaccine. 

According to CNBC, the rate peaked at 3.4 million daily vaccinations on April 13, 2021. The rate was reported towards the end of April at about 2.7 million per day. But, at that time 30% of the U.S. population, 98 million, was "fully vaccinated" (that is two shots for those that need two and one shot for others). At least one dose had been administered to 43% of the U.S. population, 143 million. According to OurWorldinData, as we near the end of May, 128 million are now fully vaccinated, about 40%. There are encouraging pockets noted in which the rate is even higher. 

Why the decrease in daily doses? That is a fair question. But, by what measure are we disappointed in 2.7 million per day? There are 328 million people in this country, and 128 million are fully vaccinated. In the month of May, that has increased by about 30 million. That is palpable progress. 200 million still need attention; dividing that by 2.7 million per day (assuming each of the 230 million needs two shots, which is an overestimate) yields 148 days. That is October 18, 2021 (my prior prediction was October 11). That is IF everyone gets vaccinated. That is IF all 230 million still need two shots. The fact is that not everyone will be vaccinated and not everyone needs to be. 

And, it is imperative to remember that not everyone wants the vaccine. I respect that. But, CNN reports that "herd immunity" will "likely hinge on continued vaccinations." Their experts doubt COVID can be eradicated (as we did with Smallpox), but might be eliminated (as we did with "measles, rubella, and diphtheria,"); each was "largely stamped out by vaccination." But, remember, every day people are contracting COVID-19. What of that number? Statista reports that about 33 million Americans have been infected. Notably, some of them have also been inoculated, but the point remains there are more than the reported 128 million who have antibodies, not to mention the many who are "partially vaccinated" (one shot of the two). 

Notably, CNN explains that some believed "80% of a population needed to be inoculated" with smallpox. Johns Hopkins says "Usually 50% to 90% of a population needs immunity before infection rates start to decline." It warns, however, that these are not "magic threshold" numbers. Science promises no guarantees. But if 80% holds, that is 262 million of us in this country. There are those who have suffered from this disease and thus have some immunity, but even without that, we are 134 million from that 80%, or (134 x two shots = 268, 328/2.7 = 99 days), August 30, 2021.

What can we learn from India's current challenges? We might rationally continue to socially distance, wash our hands, utilize antiseptics, and remain vigilant. There is merit in getting inoculated against COVID-19, though I will not ask you your opinion nor bully you for whatever decision you have made. Let us not be complacent. We need not look toward a full return to normalcy in the months to come, normalcy is thankfully here. But, let us guard against a second wave as India and others are experiencing. We do not need or want a second wave.