21st July, 2021 2:59 pm
Alabama currently ranks last the nation in COVID-19 vaccination rate, with only a third of the state population fully vaccinated and the Delta variant running rampant.
Vaccinations in Alabama have slowed to a near standstill. As of late week, Alabama’s positivity rate ranked among the top five in the nation. Hospitalizations have doubled. The Alabama Department of Public Health resumed its daily updates due to the surge, and all the while, the Delta variant is here, accounting for 85 percent of COVID-19 cases at one Alabama lab.
We asked Dr. Michael Saag, director of the Division of Infectious Disease at UAB, several pressing questions about our current COVID situation, which he considers a major emergency in our state and country.
Below, he discusses Alabama’s vaccination rate, why people remain reluctant to get vaccinated, what people should know about the Delta variant, why there’s nothing political about protecting yourself from a deadly virus and how we are making the same mistakes we did when COVID was peaking by rushing back to normal life.
You say the timing in discussing COVID is critical right now, that we are beginning to see yet another surge, almost exclusively among non-vaccinated people. First of all, before we dive a little deeper into some of this, why is the timing so critical, and what is the message you want to get out to people about this potential surge?
Dr. Michael Saag: We’re seeing the consequences of a wide open July 4th holiday weekend. People who are vaccinated appropriately were going around without masks and congregating. But people who are not vaccinated were basically behaving as if this was all over, the COVID experience was done and we can just get on with our life. Meanwhile, the Delta variant had other plans. That’s exactly what happened. We are seeing, as a consequence of the unvaccinated folks congregating without masks and in large groups over that weekend, huge numbers of new cases like we haven’t seen since February and March of last year. And it’s rising exponentially. So now is a time for everyone to hit the pause button and rethink how they individually are responding to this pandemic.
The amount of hospitalizations statewide is up. The number of infections reported is also rising. Alabama hasn’t seen this many COVID-19 hospitalizations reported since March. Why are we trending in this direction?
I think the single cause is that two-thirds of our population are not vaccinated. Full stop. That’s enough to explain everything. And the Delta variant is 10-times more infectious than the original SARS virus. To put that in real terms, back when I got infected in March 2020 with the original virus, you would have to be in a closed space within three or four feet of someone for about 10 minutes to be assured of picking up the infection. With the Delta variant, all you have to be is in contact with them for about one minute, maybe a little less, and you’ll pick up this virus. I don’t think the public has quite understood that yet, but we’re finding out in a real way. Our numbers are up over 330 percent from two weeks ago. So this is just the beginning. It’s not stopping today simply because we’re talking about it. It’s going to get worse. And as it gets worse, what’s different this time around is that this is affecting mostly 20, 30, 40-year-old people. The older folks in the state of Alabama, about 80 percent of them, have been vaccinated, compared to about 20 percent or a little less of the people between the ages of 18 and 35. So the 18-35-year-old folks are saying “Well why should I worry about this? Even if I get it no big deal.” But that’s not true. The hospital is now becoming full with people in their 20s, 30s and 40s, some of whom are on ventilators, some of whom are dying.
In May of 2021, in the united states, 18,000 people died from COVID. 17,850 of those folks were not vaccinated. That 99.2 percent. In June, same story. Ten thousand people died, 99.2 percent were not vaccinated. And among the people who were vaccinated and died, those individuals were mostly immunocompromised, meaning they had solid organ transplants where the immunity from the vaccine wasn’t strong enough to protect them from progressive disease. For those who were unvaccinated, that have no pre-existing immunity, so they’re totally vulnerable. This is a public healthy emergency right now — a true emergency. I know you’re tired of hearing that, but that’s what we’re dealing with. And people with public health expertise would be derelict in our duties if we didn’t sound the alarm. This is an emergency right now.
While the Delta variant doesn’t appear to be more deadly than the initial strain of coronavirus, health experts say it is more contagious. What do people need to know and consider about the Delta variant?
That it’s 10-times more infectious than the other virus, and if you were able to dodge the bullet last winter, you are much less likely to be able to dodge it this time. And here’s the thing. Once you get it, you lose control of how your body responds. I’ve heard over and over again: “Well I’m a healthy person. I’m not worried about getting it.” Some of those healthy people end up in the hospital and some of them on ventilators. This virus doesn’t care what your health status is too much. It’s going to infect you, and once that happens, there’s no do-over button. You can’t hit reset like it’s a video game. It’s going to run its course, and you don’t want to be in its way.
The biggest difference between last summer and fall and now is that we can do something to prevent this, and that’s get vaccinated. You get vaccinated, not only do you reduce your risk to a very low number. The Delta variant can break through a vaccinated person. About 25 percent of the people who have been vaccinated will get infected with the Delta variant, but the disease is a short duration of mild symptoms, and unless immunocompromised won’t progress to severe disease. But for those people who are unvaccinated, not only are you putting yourself at risk, you’re putting those people who have been vaccinated that are immunocompromised at risk. And that’s, in my view, a tragedy because this is totally preventable. Those deaths in May, the deaths in June and the ones that are happening in July are totally preventable deaths. How can we put up with that when we have readily available vaccine for everyone?
Are children more at risk with the Delta variant? One expert said we don’t have evidence that it infects children to a varying degree than it infects adults. Are you aware of any differences?
Yeah, the Delta variant will infect children much more than the original strain simply because the Delta variant is much more infectious. The question then becomes, “Are they going to get sicker?” The jury is out on that still. There’s a study out of Scotland that suggests they are getting sicker per person infected. We know people under the age of 12 are not eligible for vaccines. They’re the ones who are getting infected in pretty large numbers right now. There are case reports, stories out of Mississippi with 10-12 kids in ICU. We’ve had several cases here at UAB and Children’s Hospital of younger people going into the hospital and ICU. It’s not universal by any stretch, but why take the risk?
Children, if they are not vaccinated and they’re going out into crowds around other unvaccinated children, should be wearing a mask. Period. They should be. I want to see kids go back to school as much as anyone. But I think if I were a parent, even if the schools don’t require it, I would send my child to school with a mask, unless they’re able to get vaccinated. This virus is just revving up right in time for school season. And once this virus gets into a school situation, it’s going to run rampant because that’s what the Delta variant does. Seventy-five to 80 percent of the cases in Alabama right now are Delta variant. It’s here. It’s running rampant.
So you would recommend that all schools require masks, but even if they don’t, you would recommend parents have their kids wear masks to school anyway?
The responsible thing, in my opinion, for school systems to do is to require a mask. And if they won’t step up and do the right thing, then the parents should take care of their own kids by having them wear a mask. I would reiterate, though, that a mask does most of its work covering the mouth and nose of someone who’s infected. So even if your kid goes to school with a mask and they’re not infected, if a child next to them has COVID, the mask on your child will help some, but the best protection for your child is for the child who is infected to be wearing a mask. And the problem is that a lot of times kids are infected for several days before they develop symptoms, spread the virus before they know they’re sick, and so the exposure can happen inadvertently just in the normal activities of what kids do.
What I don’t understand is why there is so much political pushback for mask requirements or for that matter, vaccine mandates. Somehow this has become so political that people are talking about in some states making it illegal to have mask mandates in their state. I don’t understand. I guess they just want to see people die. But it doesn’t make sense to me why they would have prohibition on a mask mandate when you’re dealing with a public emergency. It’s indescribable to me.
The first thing to think about is this is not a question of get the vaccine or don’t get the vaccine. This is a question of the relative risk of a side effect from the vaccine versus a relative risk of getting COVID and getting very sick and dying. That’s what we’re weighing out here. We’ve had well over 400 million doses of these vaccines that have been given, and there’s no surprise. It’s exactly what we thought we would see. Side effect profile is among the best for any vaccine we’ve ever had, and the efficacy (the effectiveness of the vaccine) is about as good as you can ever expect, much better than we ever had for the influenza vaccine. So that’s the risk of the vaccine and the benefit.
Once you get COVID, you just have to experience whatever is going to happen. And it’s a heck of a lot worse than getting a side effect from the vaccine, I can promise you that. There aren’t people coming into the hospital and going on ventilators from a vaccine. And there are plenty of people having that happen when they get COVID. Imagine the world if we did not have a vaccine. What would we be going through right now with Delta variant? At least the older folks are being protected because they were wise enough to get the vaccine. It’s the younger populations and people who have dug their heels and said “I’m not getting the vaccine.” Well, you’re putting your life on the line. You’re putting yourself in harm’s way, in my view, unnecessarily.
There are a lot of people who are hesitant about getting vaccinated, where perception about COVID is in stark contrast to reality. We just published a story that says the overwhelming majority of Americans who said they won’t receive a vaccine fear side effects more than the virus itself. It also says more than 25 percent of fully vaccinated people believe the dangers of COVID-19 were exaggerated for political reasons. In this time you consider so critical for proper messaging and making sure as many people as possible are vaccinated, what is your message to people who remain on the fence about getting the shot?
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