Two COVIDS … Two Americas Surviving a Pandemic in a Post-Factual Age This is a column that I’ve wanted to write for at least a year now but it always has seemed to take a backseat to one or more pressing issues any given week. But I was re-emboldened to do so this week when I read an article in the New York Times by David Leonhardt that beautifully captured many of the thoughts I’ve had over the past year since vaccines became our reality and not some far off distant hope.

Before the advent of the mRNA vaccine COVID-19 was actually the LEADING CAUSE OF DEATH in the United States for the first twelve months of the pandemic … from March 2020 through February 2021 exceeding that of heart disease and cancer. I don’t know how many of you are actually aware of this … especially those of you who repeatedly refer to it as a “cold or flu.” It was so much more than that for the first year … and for the unvaccinated it remains to this day the leading cause of death in our country. However, given the prevalence of the vaccines [70% of the country vaccinated including 85-90% of the population at the highest risk] it’s place on the hierarchy of death has dropped to #3 for 2021 as a whole, back behind the usual suspects but still ahead of stroke.

Not surprisingly, COVID’s starkly different impact on the young and old has been one of the virus’ defining characteristics. It tends to be mild for children and younger adults but is often severe and dire for the elderly. More than three-quarters of all the COVID deaths in the U.S. have occurred in patients 65 years old and older. So you would think that older Americans would be more fearful of the virus than younger Americans. Yet they are not! That is one of the most striking misconceptions this virus has produced. In reality old and young people express similar levels of concern about their personal risk from COVID. And by some measures, young people are actually more worried. The most plausible explanation for this perplexing phenomenon is political ideology.

Older Americans, as a group, tend to lean to the right, while younger generations lean to the left. And no other factor influences COVID attitudes as strongly as political ideology as several polls have repeatedly shown. Across broad demographic groups, Americans have broadly similar attitudes toward COVID and this is not just true of the old and the young, but also of men and women, rich, middle class and poor. The partisan gap, however, is huge. Many Democrats say that they feel unsafe in their communities; are worried about getting sick from COVID; and believe the virus poses a significant risk to their children, parents and friends. Republicans are less worried about each of these issues. So who is right? Not surprisingly there is no single answer to that question as I alluded to in detail back in October [Facebook, 10/30/21] when I wrote the lengthy article on COVID becoming endemic. Different people have different attitudes regarding risk. Some find driving in a snowstorm to be an acceptable risk but others do not. Neither is necessarily wrong. But polling does show that many, if not most, Americans have adopted at least some irrational beliefs about COVID.

In our highly politicized country many people seem to be allowing partisanship to influence their beliefs and sometimes to overwhelm scientific evidence. Millions of Republican voters have decided that downplaying COVID is core to their identity as conservatives, even as their skepticism of vaccines means that the virus is killing many more Republicans than Democrats. Where on the other hand, millions of Democrats have decided that organizing their lives around COVID is core to their identity as progressives, even as ongoing or repeated pandemic isolation and disruption are fueling mental health problems, drug overdoses, violent crime, rising blood pressure and growing educational inequality. As one infamous gun-control advocate [David Hogg] tweeted last year, “The inconvenience of having to wear a mask is more than worth it to have people not think I’m a conservative.” No where is this dichotomy more clearly seen than around the vaccine. The COVID vaccines have been and remain remarkably effective at preventing serious illness. If one is vaccinated, one’s chances of getting severely ill are extremely low. Even among people 65 and older, the combination of the vaccines’ efficacy and the Omicron variant’s relative mildness means that COVID now appears to present no more danger than a normal or severe flu to them. For the unvaccinated, however, COVID is worse than ANY common virus. It has already killed 882,000 Americans, the overwhelming majority unvaccinated. But when you consider the level of worry about getting sick that Americans have when viewed by vaccination status you find that among the Unvaccinated only 14% are “very worried,” 25% are “somewhat worried,” 29% are “not too worried,” and a whopping 27% are “not at all worried!” Among the Vaccinated but no Booster 22% were “very worried,” 39% were “somewhat worried,” 26% were “not too worried,” and just 11% were “not at all worried.” Lastly, among the Vaccinated with a Booster: 22% were “very worried,” 46% were “somewhat worried,” 25% were “not too worried,” and 6% were “not at all worried.” This is a remarkable disconnection between perception and reality. While the majority of those vaccinated and boosted say they are worried about getting deathly sick from COVID, the truth is riding in their car presents a greater danger to them. On the other hand, the majority of the unvaccinated say they are not particularly worried. And the starkest, saddest way to understand the irrationality of this view is to actually listen to the regret of the unvaccinated people who are desperately sick from COVID or who have watched loved ones die from it. A California prosecutor famously said last month, “There’s nothing that matters more than our freedoms right now,” at an anti-vaccine rally. She died of COVID earlier this month.

By the same token, I know that some Democrats believe that their approach — with their emphasis on minimizing any COVID risks — comes with little downside. But the polls also call into question much of their argument … especially when it comes to children. One of the few areas that the poll respondents, both Democrats and Republicans, agree on is a widespread concern that pandemic disruptions are harming their children. People are right to be worried, too. Three medical groups — representing pediatricians, child psychiatrists and children’s hospitals — recently declared “a national emergency in child and adolescent mental health.” And beyond that, the worst effects have been on black and Latino children, as well as children in high-poverty schools.

Many Democrats are effectively dismissing these costs and instead focusing on the minuscule risks of COVID hospitalization or long COVID among children. Most Democrats, for example, say they favor moving classes online in response to Omicron, despite widespread evidence that remote schooling has failed and little evidence that shutting down schools leads to fewer COVID cases. Closed schools certainly do more damage to children and vaccinated adults than Omicron does. Democrats like to think they are the party that respects science and evidence, and on several issues such as vaccines and perhaps even climate change they may be right. But just because something is usually true doesn’t mean it always is. On COVID, both political tribes really do seem to be struggling to read the evidence objectively. And as a result, the country is suffering thousands of preventable deaths every single week while also accepting a preventable crisis of isolation that’s falling particularly hard on our country’s children. So I hope this helps … regardless of exactly where you may fall on the political spectrum … at least I hope it makes you think and perhaps reconsider any deeply held beliefs about the virus that may not actually be based in reality. But more than anything else it is both my hope and my prayer that it can perhaps provide a patch of common ground that we all can find a way to move beyond our partisan differences and come together on.

So on to what’s new. Many of you have expressed your care and concern as well as sending your best wishes this past week as I finally have gotten to experience the virus from the patient’s perspective. Today as I write this it has been ten days since my symptoms began. I like so many others was the victim of a false negative rapid antigen test which delayed my diagnosis by a day and strangely by the time I found out I was actually positive I had already turned the corner. For me, Omicron was really not much different than the recent cold I had right after Christmas [I was positive for Rhinovirus by PCR] which actually lasted almost three weeks. Omicron only made me fairly sick for about 12 hours on the Friday afternoon/evening the week before last with fever, myalgia and malaise causing me to basically sleep for the next 14 hours. By Saturday when I went for PCR testing I had already turned the corner. I deferred ordering one of those precious and few boxes of Paxlovid that we have in our community preferring to save it for one more in need and instead quarantined with my wife at our new beach home on Ochlockonee Bay for a week [hey it’s tough but someone has to do it] and plan to re-enter life tomorrow providing I retest negative today [actually my swab was collected yesterday]. I have been blessed by God no question and am grateful for the magic immunity [although not perfect] provided by three doses of the mRNA vaccines and probably some immunity built up from well over one hundred exposures to the virus over the past two years. I guess it was bound to happen eventually and better to have faced the fury of Omicron rather than that of Delta.

So far as Omicron goes … it seems to be in recession over most of the country already [as forecast] as well as in our neck of the woods. Our phone calls started decreasing perhaps 10-14 days ago, though we still have patients testing positive every day [including four yesterday]. That, however, doesn’t mean the horror show has begun to recede yet … on the contrary, deaths have surged this past week reaching 3,895 on Wednesday surpassing the peak level of death that we saw in January 2021 [3,400 deaths/day at peak] as the mass vaccination campaign was beginning to roll out. By comparison, the Delta variant topped out at 2,000 deaths/day … a threshold that Omicron reached last week. So look for Omicron to be the most deadly strain of all as predicted just due to its supreme contagiousness. And now I hear there has been isolated in France a variant of Omicron that is almost twice as contagious [how is that even possible??? … since measles and Omicron share the title of most contagious viruses ever]. This virus is not going to be called Pi however, but Omicron BA.2 … go figure. If you insult it like that, it may just decide to kill us all. BA.2 … really! Maybe they really mean BE A OMICRON TOO!!! But I diverge … hopefully all this herd immunity that Omicron has built up in the population will hold BA.2 in check. It doesn’t seem to end though. And why would it? It has apparently already spread to forty countries [including the U.S. Britain, Denmark where it is now accounting for 40% of the cases, India, Sweden and Norway]. And before you get too comfortable … just know there is a BA.3 as well. Yes, Omicron is a triplet virus … all three are sub-variants of each other … each different in a few loci but all related to each other. BA.3 is seems to be the runt of the litter. I guess he gets what ever is left over. BA.2 apparently spreads faster but it would seem that BA.1 got the first plane out of South Africa and had a head start attacking the world. So while it may help to be uber contagious, sometimes you just need a break in life [even if you’re just a virus]. But don’t worry, the other two are coming!!! Seriously though, so long as vulnerable people remain out there we will be dealing with COVID in one form or another, perhaps for a very long time.

So on to where exactly we stand as of today. The rapid spread of Omicron BA.1 has clearly peaked in the United States and did so on January 18 with a startling 1,178,403 new cases in a single day [and please recall as I’ve stated weekly now for over a month that these numbers above and to follow are serious undercounts as they do not include people testing at home and the high false negative rate for rapid antigen tests vs. this variant]. We are now seeing nationally on average 484,497 new cases per day … so well below 50% of just where we were 10 days ago. The case positivity rate nationally is down to 25.0%. In Florida the numbers look similar where we are now down to 30,606 new cases yesterday from a peak of 66,669 nineteen days ago. That, too, is less than half of where we just were just 2.5 weeks ago. The statewide positivity rate also fell [for the first time since Omicron arrived] last week to 29.3%. Locally in Leon County we are down to an average of 600 new cases per day over the past week from a peak of 889 new cases per day last week … a 32% drop. However, our case positivity rate remains very high at 28%. For my recently adopted other home county of Wakulla, they averaged 73 new cases per day over the past week, down from 94 last week, a 22% decrease. And finally, the case positivity rate in Wakulla County also remains very high at 32% and still climbing. We have lagged behind the rest of the state by about 7-10 days throughout, since Omicron started in South Florida when it arrived in the state.

It is when we get to discussing the “lagging” indicators that the story starts to get especially grim. The hospitalization rate in the US seems to have just crested at 146,069 patients with 25,624 in the ICU [on January 22, there were 151,070 inpatients nationally with 26,110 in the ICU]. Locally we are running a hospital census of roughly 200 inpatients over the past week with some daily fluctuations. This amounts to a 33% increase from last week and a 144% increase over the past two weeks. It is the burgeoning death totals that are most staggering for Omicron as feared … and this is not primarily because it is so virulent [it is not … perhaps 30% less so that Delta] but because it is so very contagious. You can just tell by the raw numbers of people infected by this strain that this was bound to happen even if it was thankfully less virulent than its predecessors. This past Wednesday we recorded 3,895 deaths in a single day. This breaks the record we set this time last year by almost 800 patients. In fact, we have just about averaged the peak daily death total for the original coronavirus when it was at it’s absolute worst for this entire week. Those numbers are still climbing so it is quite sobering. And again, the vast majority of these patients are unvaccinated. So far as the state of Florida goes we are losing on average now 320 patients per day and our cumulative death toll stands at 64,955 as of today. Locally in Leon County, we have lost at least 10 patients [including one of my most favorite patients] to Omicron [cumulative death count is 540] and Wakulla County has lost 3 [cumulative total is 109 patients]. I do expect these numbers to continue to rise for the next 3-4 weeks or so.

On the brighter side, I do think Omicron provides those of us “fortunate” enough to be afflicted with an excellent form of “natural immunity.” I think coupled with the mRNA vaccination immunity for the original coronavirus it only pads our defenses against what is still to come. You may have heard that Moderna began testing a booster vaccine against specifically the Omicron variant this past week and Pfizer has a similar vaccine in development. So for those of you who are able to dodge Omicron [and my hat is off to you if you can] it won’t be too much longer before you can join us with this new form of “hybrid” immunity. That is it for this week. I do hope you will carefully consider what I discussed in the first portion of this update and reconsider some convictions that you may have regarding COVID that are just factually incorrect and let’s all see if we can find a meeting place in the middle that will better help us to get through all of this together rather than on opposite sides screaming at each other.