[Act-ma_discuss] A sane and sober assessment: Why you shouldn’t get Covid right now

Thu Jan 13 22:18:42 PST 2022

Thanks to Mary Sabolsi for this splendid and sane essay-- please share!

Why you shouldn't get Covid right now

Hospitals are never entirely safe places. Patients going into hospitals under the best of circumstances are still at risk for a number of misadventures secondary to being hospitalized: hospital acquired infections (lines, catheters, and multi drug resistant bacteria), adverse outcomes from immobilization (blood clots, pulmonary embolism, and muscle wasting), mental status changes, adverse drug effects/interactions, and accidents (falls) are all commonplace “side effects” of being hospitalized.  

Presently, Mass ICUs and hospital beds have been running at 80-90% capacity for at least two weeks. Hospitals are not designed to run at this high capacity for such a long period of time.  Standard ICU care requires one nurse for each patient, but if that staffing is not available, what do you do? Give each nurse two patients and hope for the best. You have no choice, but one nurse taking care of two critically ill patients is not really ICU care, even if the nurse is critical care certified and the care is being delivered in an ICU. The same goes for the other levels of hospital care.  More than anything, the amount and technical skill of nursing staff is what makes an ICU or even a hospital what it is.  If you don’t have the nurses, you can call the care what you like, but quality will suffer, and some patients will die as a result. They will die from Covid, but they will also die from all the other things that will get missed because of the decrease in qualified nursing staff that Covid is causing.

The Town’s vaccine requirements need to be interpreted cautiously in the present setting as well. Many people will read, “You are required to show proof of vaccination to enter a restaurant” and interpret it as “If everyone in the restaurant is vaccinated, it is safe for me to eat there.”  Sadly, with the Omicron variant, this is no longer the case. Vaccinated or not, you are perfectly capable of contracting Omicron.

There is a bit of good news in the vaccine requirements. If you have to show proof of vaccination to eat inside or outside at a restaurant or go to a bar, more people will get vaccinated, which is the only way this ends. Also, if you are vaccinated and boosted, your risk of dying from Omicron is about 10% of the risk of an unvaccinated person of dying. Or for every 10 people who die from Omicron, 9 will be unvaccinated and 1 will be vaccinated.  

However, given that the current US daily case rate is about 850,000 new cases daily, if only 10% of those people are hospitalized, that still amounts to new 8500 hospitalizations DAILY, which is not remotely sustainable. It still remains to be seen what the hospitalization rates will be for Omicron, but things are starting to get dicey. Viral shedding in waste water aside, even if Omicron cases dropped to zero tomorrow, we would still be in for at least another 4-6 weeks of hospitals being strained to the brink. This is not safe for anyone.

I applaud the new vaccine requirements, but I believe the Town will have to go further and require vaccination for children to attend school.  Recently, the SC said Biden could not force private employers to require their employees to be vaccinated or tested. However, the SC did NOT say that private employers cannot require their employees to be vaccinated. They can, if they so choose, and they should.  Also, Biden could just man up and require that all US residents be vaccinated.  He can’t make corporations require vaccination, but he can likely require it himself directly.  There is a lot of law that supports government action in a public health emergency.  

Children can avoid restaurants and bars, but they must go to school. Omicron is likely every bit as infectious as measles. No health department would hesitate to require measles vaccination for school entry, and they should not hesitate to require Covid vaccination either.  They can delay a Covid vaccine requirement, but I doubt they can avoid it if we are ever to have any hope of schools returning to normal.

Just because the federal and state governments have grown weary of lockdowns, does not mean it is safe to conduct business as usual. It just means they are falling down on the job. People have a tendency to think matters are always improving. The vaccines are a vast improvement, but viruses will keep mutating as long as they keep replicating. It will be tough for a mutation to arise that is more infectious than omicron, but if you want to see if it is possible just continue to allow the virus to keep infecting people. Every new infection has the possibility of producing new mutations. We don’t hear about them because they are not clinically significant.  We only hear about the mutations that: (1) result in a variant that is significantly more infectious and/or (2) result in a variant that is undeterred by current vaccines.  So far, we have only seen mutations that have had the first effect. Each new mutational variant that we have heard about has been significantly more infectious than the variant that preceded it. Because it is more efficient, it replaces the prior variant and becomes the dominant strain.  However, there are likely many thousands of other variants that don’t make the grade.  

However, in the setting of many hundreds of thousands of new cases daily, there are literally millions of opportunities for mutations to occur, and they are occurring all the time. Is it possible for a variant to arise that is more infectious than Omicron? Yes. Is it probable? No, but if there was ever a set of circumstances that could result in the production of such a variant, it is our present situation of out of control replication. We are playing Russian roulette.

Vaccine escape and disease severity are variables that are independent of infectivity (efficiency of transmission).  When a new “significant” variant arises, it comes to scientific attention because it has enhanced infectivity compared to the current dominant strain. However, whether the clinical outcome in unvaccinated individuals will be less or more severe than the prior variant is completely unknown, and clinical outcome is in NO way related to the increased infectivity that brought the variant to attention. The same is true with respect to how the new variant will interact with the vaccine compared to the prior variant. Each clinical characteristic of the virus is controlled by a portion of its genetic material (RNA for Covid). RNA is less stable than DNA so it accumulates mutations more rapidly.  The mutations can appear anywhere in the viral RNA, and they occur randomly. Every cell that gets infected eventually bursts spilling out thousands of new viral particles. Each infected person generates many thousands or even millions of viral particles. With every replication, the possibility for one or more mutations exists.

Stay safe and act thoughtfully. Your life and the lives of your families and friends depend on it.

Very best regards,

Mary Sabolsi

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