It’s been six weeks since my last post, and enough has happened that I think an update is in order.

This wave has crested for most of the United States. Delta was going to be a problem no matter what, but this wave was made much, much worse by anti-vaxxers and politicians who fought science at every turn.

Idaho, Montana, among others, are the worst they’ve ever been. Some areas are starting to ration care [i.e., let people die because there is no room left]. Florida and Texas had their worst portion of the epidemic in the last six weeks. It’s staggering; we’ve had vaccines available for anyone who wants them for months, and in some states, the vaccination rate is shockingly low. Delta gave you a choice, get vaccinated or get Covid, and millions chose the latter.

Worse still, politicians are fighting for Delta and going as far as to prevent others from taking common-sense precautions like wearing masks indoors and checking vaccination status.

In SF, we’ve been fully open for a bit. With the Delta surge, the city mandated vaccination records check for bars and restaurants and an indoor masking mandate. In my experience, people obey the mask mandates at stores or concerts but not in bars and restaurants. Our own Mayor was caught in a packed jazz club unmasked, and she stated, “at the end of the day, everyone who comes in here has to show proof of vaccination. That gives me a lot of reassurance.”

In SF, teachers must be vaccinated or tested weekly, and there is a mask mandate.  90%(!) of 12-17-year-olds are vaccinated. As a result, several weeks into the school year, there have been zero outbreaks.

So it’s possible to be fully open and not have a surge that wrecks your medical system. These days there are no activities that I’m avoiding.

The FDA fully approved the Pfizer vaccine a few weeks ago, and [fingers crossed] we may get a EUA for kids 5-11 by the end of October / early November. For kids under 5, I would expect it to be a few more months.

The big question has been about boosters. This week the FDA advisory panel chose not to believe the data in front of them and voted to endorse a much more limited booster program than is warranted. They endorsed boosters only for those 65+ and immune-compromised.

I suspect they are making the same mistake they did early in the pandemic. They were worried about the supply of masks for medical professionals instead of just saying that they discouraged anyone from using masks. Now they are worried about the supply and optics of Americans getting a third dose before most people get their first. They were wrong about masks, and they are wrong about this.

Worse still is that the data they are reviewing isn’t even theirs. The FDA has essentially stopped any data collection related to breakthrough cases. This is particularly bad because none of the countries that do good data collection use J&J. As a result, the FDA is flying blind on the dose that 5+% of Americans received. If I had gotten J&J, I would get a booster shot now.

For mRNA vaccines, it looks like Moderna is holding up much better than Pfizer. Both are still highly effective at preventing hospitalization, but Pfizer has more breakthrough cases. There are likely two reasons for the difference. One, the Moderna dose was significantly higher than the Pfizer. Second, the timing was further apart. We have several shots over 6-24 months for most vaccines we take, and the longer intervals can create better immunity.

In Israel, only 61.9% of the population is fully vaccinated, not much better than the 54.5% of Americans that are. They started their vaccination campaign earlier and are seeing a large wave currently. However, their hospitalization rates are still far below us; the vaccines work at their primary goal, preventing severe illness and death.

I don’t know what the fall/winter will be like. It seems likely we’ll have more waning immunity among everyone. Last winter, the surge was terrible, but I suspect we’ll see a much more limited run, probably more similar to a bad flu season. For perspective, over 600,000 people have died of Covid, and in a bad flu season, about 60,000 people die in the US.

I continue to believe and act like that pandemic is essentially over in high vaccination rate places. Now that this wave has ended, it’s likely that there is a high level of acquired immunity even in lower vaccination areas. I expect over the coming 6-8 weeks; Covid levels will continue to drop.

Suppose a new variant becomes a concern or case counts spike for other reasons. In that case, I’ll modify my behavior, but I feel good about being out and about in the world.

As always, reach out if you have any questions.