Covid-19 diary: Part 38

By Matthew E. Milliken
MEMwrites.wordpress.com
May 17, 2021

On Sunday, I took a long walk without wearing a mask for the first time in a number of months. It felt odd.

The Centers for Disease Control and Prevention abruptly changed its guidance on Thursday, May 13, announcing that fully vaccinated individuals need not wear masks or social distance in most circumstances. Masks are still mandated for public transportation, including airplanes, and transportation hubs, such as airports and train and bus stations, and should be worn when required by state or local rules or by business or workplace guidance. Masking is also still required for workers and visitors in health-care facilities, although an exception has been carved out when one or more visitors and a patient are alone in a room where everyone present has been vaccinated.

The mask recommendations were lifted because vaccines have proven to be so effective against the novel coronavirus that causes Covid-19. Vaccinated individuals can still get sick and even die from Covid, but such breakthrough infections are rare and tend to be mild. What’s more, vaccinated people don’t seem to pass the disease on to others with any frequency. Further, coronavirus variants by and large appear to be susceptible to the vaccines, despite previous concerns.

The CDC’s loosened guidelines may have been inspired by the experience in Israel, which has had one of the world’s most successful vaccination campaigns. In a recent Science paper, Ran D. Balicer and Reut Ohana, top officials at the Clalit Research Institute, an affiliate of the largest insurer and health services provider in Israel’s universal health-care system, observed:

By early February, 38% of the population had received at least one vaccine dose (80% of those over age 50), and an additional 7.5% had documented past infection (thought to confer some protection). In view of high vaccine uptake rates, and because interim analyses of a large local cohort showed high (>90%) vaccine effectiveness, the risk of resurgence and its expected burden was deemed sufficiently hedged. The lockdown was therefore lifted, despite a stagnated high incidence (over 8000 daily infections).

Exceeding predictions, a sharp 90-day continuous decline in new infections followed — a >100-fold decrease in documented infections and a >50-fold decrease in severe cases — despite gradual removal of most restrictions. Several indications suggest that this was driven mainly by the vaccination campaign rather than seasonality or residual lockdown effects. The decline in severe cases was first evident among the elderly (earliest-vaccinated group) and only weeks later among younger, mostly unvaccinated age groups. By late March, over 55% of daily COVID-19 mortality occurred among a small (<1.6%) subgroup — unvaccinated adults over 60 years old.

Indeed, the American pandemic continues to recede, albeit slowly. The seven-day trend for daily new deaths has fallen to 603.6, the lowest mark since early July, and the rolling-week trend for daily new cases has dropped below 33,900, the lowest level since late June. The trend for daily new cases stood at 71,503 on April 14 but by Sunday had fallen for 30 of the past 31 days. (All recent data in this and the following two paragraphs are for Sunday, May 16.)

The seven-day average of hospitalizations, remarkably, is at 35,440. Not only is this below the autumnal low point on Sept. 27, 2020 (36,412), it’s lower than at any point since April 6, 2020 (33,871). That was right as the U.S. coronavirus crisis was first exploding under President Donald Trump, who on April 3 had said of the pandemic, “I said it was going away — and it is going away.” 

Nearly 2 million vaccination doses are being administered each day, down from a peak of nearly 3.4 million daily doses in mid-April. More than 157.5 million Americans had received at least one inoculation as of Sunday, representing 59 percent of U.S. adults. At the current pace, it will take until Aug. 22 for 70 percent of the total population to get vaccinated.

There have been objections to the new CDC recommendations for a variety of reasons. The recommendations seem to overlook the danger to children younger than 12 years of age and people with compromised immune systems. No vaccine has yet been approved for youngsters in the former group, and those in the latter group either may not be able to be vaccinated or may not develop the same protections as those with typical immune systems.

The CDC also seems to believe that unvaccinated Americans will observe federal health guidelines and wear masks, an assumption that rests on very shaky ground. Since unvaccinated individuals are able to infect vaccinated ones, federal health officials may be underestimating the risk of so-called breakthrough infections.

However, the government can point to Israel, where new daily Covid-19 diagnoses have dropped below 50 and less than one Covid-19 death is being recorded on a daily basis. These are absolute numbers, by the way, and not on a per capita basis. (This Our World in Data page has a variety of charts, some of which display current data and some of which have updates going only until mid-February or mid-March. Be sure to examine the graphs with the most recent information.)

This is all well and good, but if you consider yourself or your loved ones to be at higher risk, you might well continue masking in public situations, even if you yourself have been fully immunized.

I personally wonder how much the CDC guidance was crafted with the goal of providing a major incentive for unvaccinated Americans to get their shots. Unfortunately, this would work better if there were any reliable way for people to determine who had been vaccinated and who had not. As it is, there’s a thriving black market for blank vaccination cards, and a number of people have resisted establishing “vaccine passports” that would more definitively show who was and was not immune to Covid.

(To be fair, there are valid civil-liberties reasons to be skeptical of limiting public access. On the other hand, Covid-19 is, you know, a deadly pandemic and public-health emergency, and both travel and education enrollment are routinely limited to those with proof of vaccination against a battery of diseases.)

I’ll confess that I am not yet ready to unmask in a public indoor setting. But as mentioned at the top, I am ready to do so outdoors.

That’s not just because I have confidence in my newfound vaccine protection. It’s also because new reporting shows that the risk of outdoor infections appears to be much lower than previously thought. As David Leonhardt reported in The New York Times on May 11, counts of outdoor transmission seem to have been exaggerated due to poorly understood reports of Covid-19 spread at construction sites in Singapore.

“I’m sure it’s possible for transmission to occur outdoors in the right circumstances,” Dr. Aaron Richterman of the University of Pennsylvania told Leonhardt, “but if we had to put a number on it, I would say much less than 1 percent.”

So when I went out on Sunday, I had a pair of masks in my back pocket and nothing on my face but sunscreen, fresh air and sunlight.

I’m not going to lie; it felt weird. When I encountered a few people on my walk, I did what I’ve often done outdoors for the past 14 months or so, especially when not masked: I turned my head away and held my breath.

But I didn’t worry about holding my breath until I was all the way past those people. I feel sure that medical science is protecting me from the scourge of Covid-19, and I think that as time goes by, I’ll be more and more confident that I can go unmasked both indoors and out and still remain safe.