One last word on efficacy rates and a return to normal

I wrote a lot of words on Thursday about COVID vaccination statistics because I’ve been frustrated that the media – and by extension, the majority of Americans – continue to focus on the potential for more public health and economic distress from the pandemic instead of the positive overall direction we’re headed. It’s understandable, I suppose, since we’ve gone through such a bizarre shared experience and we’re likely always going to be worried that it will happen again.

And it might! I know that the positive impact that the several vaccines are already having doesn’t eliminate the possibility that some variant might still prove resistant to those vaccines, or that something else might happen that takes us back to square one. But what seems likely is a return to normal this summer, provided we understand that eradicating COVID can’t be the requirement for that to happen.

Some media are covering this good news. Vox produced a great seven-minute video that explains what the efficacy rate of the different vaccines really means and why that number isn’t the really important one:

It will be a bit irritating if we reach the so-called “herd immunity” – 70 percent or so of people vaccinated against COVID in the United States – but due to ongoing political and cultural clashes, those of us who’ve been vaccinated will still need to wear masks in public settings to protect those who’ve chosen not to, since it will be possible to be vaccinated but contract the virus, be completely asymptomatic, and spread the virus to those who don’t have protection. That’s why masks and social distancing will probably still be needed this fall, though not at the same level as over the last year.

It is good news, and it’s a credit to rational, science-based thinking, that we’re going to leave the pandemic behind.

A deeper dive into COVID data

I’m taking a deeper dive into some COVID-19 data today. I’m concerned and frustrated that the coverage of the virus has been, and continues to be, too shallow. We’re focusing on things like cumulative numbers of deaths, which has been terrible and significant, certainly. But the real story is much more complex than that, which makes it more difficult to comprehend and results in media stories that focus on things like temporary upticks in positive cases – spring breakers! high school athletes! anti-mask protests! – instead of the generally positive impact that the still-early rollout of vaccines has had already, and what that promises for later this spring and summer.

Overall vaccination numbers are improving

The fact that we have one vaccine for the coronavirus that causes COVID is amazing, though it’s the result of not just months of hard work but years of research into the types of vaccines that are being used, such as the messenger RNA (mRNA) type used in the development of the Moderna and Pfizer/BioNTech vaccines. COVID provided a real-time stress test of the ability to develop such vaccines quickly and safely, and the concept bodes well for future similar viruses in the future.

The COVID-19 pandemic was declared in March 2020, and by the end of the year, we already had vaccines being administered in the U.S. and elsewhere. The pace of vaccinations was painfully slow at first, as supply lines were developed, but has been ramping up significantly over the past several weeks. Specifically, on New Year’s Day 2021, only 22,194 Americans had been fully vaccinated (statistics are all from the Centers for Disease Control and Prevention’s COVID website at covid.cdc.gov unless otherwise noted). As of March 24, 46,365,516 Americans are fully vaccinated, and over 85 million have received at least one dose of the two-dose regimens (myself included). The whole thing is a remarkable achievement and worth feeling very good about.

Hospitalizations have dropped

Around the end of 2020 during the holidays, hospitalization rates rose to a level that hadn’t even been seen during the initial months of the pandemic in March and April. The peak week for COVID-19-related hospitalizations was the week of January 9, 2021. Since then, the number of hospitalizations due to COVID has dropped sharply, as shown in the following chart:

Notice how the numbers haven’t just dropped overall, but the proportions between the different age cohorts have changed as well. Previously, older Americans were being hospitalized at much greater rates than younger people, with about 77% of those in the hospital being 50 or older (and 51% over the age of 65). In the most recent week’s data from March 13, only 69% are 50 or older and only 37% over the age of 65. That’s huge, and likely due to the focus on vaccinating older Americans first after healthcare and other essential workers.

COVID-19 has killed older people almost exclusively

Take a look at these two graphs:

This data includes roughly 408,000 U.S. deaths related to COVID-19, so not everyone who has died so far. But it’s unlikely that the numbers would change much if all of the data were included. Out of over 23 million positive cases of COVID-19 in the CDC’s database, most of them are people between the ages of 18 and 64; in other words, active adults, going to work, maybe not being as careful with social distancing, etc. That’s not surprising, especially when you consider how many K-12 schools went remote during 2020 in response to the pandemic.

But the death rates don’t parallel those case numbers at all. In fact, they’re completely skewed toward older Americans. While those 85 years and older make up only 2.4 percent of the total cases, they resulted in 31.9% of the deaths (and, assuming the case and death numbers come from the same dataset), 23.7 percent of people 85 and older who contracted COVID-19 died.

The same pattern happens all the way down the age cohorts: those aged 75 to 84 made up 4.1% of positive cases, but 27.7% of deaths, and had a death rate of 12.1%; 65-74 were 7.8% of cases but 21.3% of deaths (and a death rate of 4.9%). Compare that to children from infancy to 17 years old: 11.7% of all positive cases, but only around 0.1% of all deaths (and a death rate of 0.01%!).

You can do the rest of the math if you like, but in short, with very few exceptions, the risk of dying from COVID-19 belongs almost completely to those 50 and older, and in particular, those 65 and older. Nearly 81 percent of all deaths have been in that 65+ cohort. Children have almost no chance of dying from COVID-19.

Now, before I get accused of the same kind of insensitivity Texas Lt. Gov. Dan Patrick showed a year ago when he suggested that grandparents were willing to die to save the economy (despite being 69 years old himself), let me point out that I’m in the 50+ cohort and would be more susceptible to a serious case of COVID-19, and so I’ve largely stayed home for much of the last twelve months. COVID-19 is serious… but not to everyone, and treating it as a universal health concern when setting public policy is misinformed at best and pandering to peoples’ fears at worst.

COVID shortened the lifespan of older Americans

This is one of the most contentious claims on social media: Many older Americans have one or more pre-existing conditions that may have contributed to their dying from COVID-19. In other words, it’s difficult to tell whether an elderly person, already suffering from medical issues, actually died from COVID.

While it’s true that many of those who died from COVID-19 in the past year had underlying medical concerns, including previous heart failure (12.5%), chronic kidney disease (16.8%), diabetes (35.7%), obesity (48.5%), hypertension (58.4%), asthma (11.9%), and COPD/emphysema (10.2%), most of those diseases – unless very far long in their progression or when combined with a weakened immune system typical of the elderly – were unlikely to kill someone immediately by themselves. COVID-19 has many far-reaching effects on the human body, but its initial focus is on the cardiopulmonary system, making pre-existing conditions in those parts of the body particularly risky. However, it can’t be assumed that someone with one or more of those conditions (I have three of them myself) was going to die in 2020. I have mild hypertension and had a minor heart attack several years ago and have been overweight for decades (all of which have been significantly alleviated over this pandemic year by losing about 60 pounds), so all in all, I was as likely to die by getting hit by a car while riding my bike as any of my pre-existing conditions.

However, I’m pretty sure that my mother, who died in April 2019 at the age of 79, would not have survived COVID if she’d contracted it last year. She was already very ill from several medical conditions, most significantly renal failure. If she’d somehow held on into 2020 and got COVID, it certainly would have been the last straw. But it would have been difficult to say that’s what she died from, since she was already very ill. It’s like watching someone racing toward a cliff in a car who suddenly floors the accelerator at the last second. You could say “If they just hadn’t sped up at the end…” but believe me, they were going over the edge no matter what at that point. While I’m still sad that Mom died, I’m relieved that my family didn’t have to go through the pain of not being able to visit her or be present when she was in their final days, which we were able to do a year earlier.

An elderly person, with or without one or more medical concerns, is at significant risk of dying if they contract COVID. The statistics bear this out. That’s why it’s been so baffling why so many older Americans continued to support the lack of effort by the previous president and his administration to enforce simple protective measures like masks, social distancing, and temporary restrictions on businesses to keep people – especially themselves! – safer.

Vaccines also reduce the severity of illness from COVID

While it’s not time to go back to normal completely, there are really good reasons to believe that we can do so sooner rather than later. If we continue to vaccinate against COVID-19 at the current rate – or even speed that up – we should reach a point of “herd immunity” sometime this summer. We’ll still need to be cautious at times, especially if you’re in the older age groups that will still be more susceptible to serious illness or death, but the vaccines also appear to significantly reduce the severity of the illness.

Recent reports of “breakthrough” infections from COVID in those who have had vaccines show that the efficacy rate of the various vaccines isn’t perfect. But we knew that from the trial results. A 90 percent efficacy rate means that 10 percent of those in the trial who received the vaccine still contracted COVID. However, the severity of symptoms is reduced, in many cases to the point where those who get COVID after being vaccinated can be described as asymptomatic. If COVID-19 can be reduced to just another mild virus, and one that we can continue to vaccinate against in the future, it no longer will be a major concern in the United States.

Conclusion

The events of the past year are always going to affect those who lived through them, though, much like the generation that lived through World War I and the “Spanish” flu immediately afterwards; the Great Depression; World War II; and other major upheavals in society. We’ll always be looking over our shoulders, waiting for the “next virus” to appear, even if it’s another century before a pandemic of this scale happens again.

Lies, damn lies, and statistics

I confess that my headline is intended to grab a few additional readers, because the topic of today’s post – data – isn’t very sexy. In our alternative facts world, having a bit more respect for actual data would be helpful. But the other end of the spectrum, where “data-driven” becomes an obsession or worse, a shield for making difficult decisions without any accountability (“we just followed the data”), is just as bad. And not understanding what the data actually means is worst of all.

All of these problems existed, and continue to exist, when it comes to the COVID-19 pandemic. A year ago, the federal government basically gave up on trying to compile data on COVID testing, infection rates, and deaths. It was left to a handful of reporters and editors at The Atlantic magazine – all working remotely – to come up with what they called the “COVID Tracking Project.” It became the de facto standard for reporting on the pandemic, so much so that the federal government started using their charts in presentations because they had no similar sources themselves, and it spawned hundreds of imitators at the state and local level. Launched by reporters Robinson Meyer and Alexis C. Madrigal along with editor Erin Kissane and data scientist Jeff Hammerbacher, the COVID Tracking Project eventually added several other Atlantic staff members and others to help compile the massive amount of raw data, make sense of and standardize the different measurements, and figure out how to most clearly and effectively communicate the results graphically. It was an immense undertaking and was also very successful, and frankly we owe these folks a huge thank you for their journalism, which filled a critical need while our national leaders were playing politics with the pandemic response.

The COVID Tracking Project has stopped compiling data and will be shutting down for good later this spring, and Meyer and Madrigal have written a look back at its origins as well as providing a warning that we’re still not getting the pandemic data right even today. It’s worth a read.

Significantly, they point out that the speed of data coming in varies greatly and can be affected by many factors, which need to be considered when making assumptions and reacting to changes in the data. We’re making important decisions about when to reopen (or re-close) schools, retail stores, restaurants and bars, and other public health issues using the data, but those decisions are still reacting to data that isn’t fully understood:

Additionally, as I’ve written about before, there continues to be those who argue that the pandemic won’t be “over” and we can’t go back to “normal” until the COVID-19 virus is completely eradicated. That might happen eventually, though it seems unlikely. What is more likely is that the protection provided by the vaccine will reduce the severity of illness from COVID-19 to not much more than a case of the flu or the “common cold” (some variants of which, interestingly, are also caused by coronaviruses, which leads to some optimism that the mRNA method of developing vaccines might eventually “cure the common cold”). While people do die from the flu, especially in years when the influenza strain is particularly virulent, we don’t shut down society when that happens. Instead, we formulate a new flu shot and hope that most people will bother to get it, which in the past hasn’t been the case. Perhaps moving forward we’ll be more diligent about those other available vaccines as well. Perhaps.

Accurate data is useful. Inaccurate data, data whose origins aren’t understood, or just plain made-up numbers masquerading as data, are useless – yet they’re sometimes used as justifications for questionable decisions. The pandemic has shown us that; it would be nice to think we could learn from our mistakes this time.

Mask up, then mask up again

Robin and Batman wear masks, but they won’t help against COVID-19. (Image: istolethetv)

The Centers for Disease Control and Prevention (CDC) announced today the results of a study that shows that wearing tightly-fitted masks, or laying a cloth mask on top of a surgical mask, reduces the chance of contracting COVID-19 by up to 96.5%.

In other news, water is wet. (Then again, is it really?)

I mean, it’s nice to have a scientific study that proves this, but it’s pretty Captain Obvious level, isn’t it? Back in the old days (March 2020), we were told that wearing a mask was mostly to keep us from spreading the virus if we already had it. Later in the year it was pointed out that it might also protect you. Again, pretty obvious.

Health care professionals wear masks, not just to avoid infecting patients, but also to avoid contracting diseases from people who are, most of the time, kind of sick. Masks work.

I haven’t been ill since I started mostly working from home nearly a year ago. I go to the grocery store once a week and occasionally have to go in to my office for something that can only be done there. I started wearing a mask as soon as I could get some (they weren’t easy to find last spring and I bought my first ones on Etsy, of all places). Around October, I started doubling them up. This probably means I hate freedom twice as much as people who only wear one mask.

I’ve enjoyed not having the flu or a cold – or COVID – so much that I may keep wearing them even after I get my vaccination and we’re reached herd immunity. I finally understand why it was so common, even before the pandemic, to see people in Asian countries wearing face masks in public.

Medical-grade masks, like the N95 variety and the related KN95 masks (which aren’t regulated as strictly as the N95 ones) provide excellent protection, but wearing any mask properly can reduce the chance of getting COVID. “Properly” is over both mouth and nose, with no gaps on the sides, top, or bottom. Wearing a second mask over that one reduces the chance even more.

I can’t believe we even are still having this conversation.

Wear a damn mask. In fact, wear two.

The surprisingly good news about vaccines

What will the rest of 2021 look like? Will we ever be able to go to a crowded restaurant or bar this year? How long will we have to keep wearing masks? Will I be able to go back to work in March? In May? By Christmas?

Obviously, lots of people are already working in public-facing jobs and have been all along. But for those who were sent home and have been working remotely, these questions keep coming up. There’s no definitive answer yet, but the news about the several COVID vaccines is better than you might have been led to believe.

News coverage of the vaccines has largely focused on their effectiveness against COVID, with “effectiveness” being defined rather strictly as preventing any infection, regardless of its severity. So the Pfizer/BioNTech vaccine was shown to be 95 percent effective, the Moderna vaccine is 94.5% effective, Novavax is 89% effective, and the Johnson & Johnson vaccine is 66 percent effective. Looking at those numbers, you’d probably want one of them with efficacy percentages in the ninety-percent-plus range, right? But those vaccines are harder to store and administer and require two shots instead of one, so maybe the J&J vaccine is better?

Fortunately, it doesn’t look like you need to choose. It turns out that all of the available vaccines, while having different levels of efficacy against contracting COVID, have virtually eliminated the chance of dying from COVID. David Leonhardt wrote about this on Monday in the New York Times.

[A]ll five of the vaccines — from Pfizer, Moderna, AstraZeneca, Novavax and Johnson & Johnson — look extremely good. Of the roughly 75,000 people who have received one of the five in a research trial, not a single person has died from Covid, and only a few people appear to have been hospitalized. None have remained hospitalized 28 days after receiving a shot.

To put that in perspective, it helps to think about what Covid has done so far to a representative group of 75,000 American adults: It has killed roughly 150 of them and sent several hundred more to the hospital. The vaccines reduce those numbers to zero and nearly zero, based on the research trials.

Zero isn’t even the most relevant benchmark. A typical U.S. flu season kills between five and 15 out of every 75,000 adults and hospitalizes more than 100 of them.

I assume you would agree that any vaccine that transforms Covid into something much milder than a typical flu deserves to be called effective. But that is not the scientific definition. When you read that the Johnson & Johnson vaccine was 66 percent effective or that the Novavax vaccine was 89 percent effective, those numbers are referring to the prevention of all illness. They count mild symptoms as a failure.

The goal was never to eradicate COVID, but to bring it down to a manageable level where it becomes no more than a seasonal irritant similar to influenza. COVID – and other coronavirus-related illnesses – will continue to be with us, and it seems likely that we will need to get an annual “COVID shot” along with, or perhaps as part of, our flu shot. Perhaps COVID will help to improve the percentage of Americans who actually bother to get such a shot; historically, only about half of us get one each year.

If the vaccines are virtually eliminating the chance of dying from COVID (I keep saying “virtually” because, despite these statistics, there are always exceptions), we can potentially return to what was normal before last winter. In many ways, we’ll never return completely to that normal, however. Some of us may continue to work from home, because our employers have discovered that we’re as efficient (if not more so) working from home. Other people have lost their jobs, in many cases because the business they used to work for is no more, and will have to find new employment or even consider retraining for a different career. And there’s the lasting political division we’re experiencing, which was made more acute by the parallel division over lockdowns, social distancing, and masks.

COVID will leave a lasting stamp on the world. But at least there’s a legitimate reason to have some optimism about the rest of 2021 and beyond.