Oh heck, why not talk about vaccines, too, while I’m at it?
Ed Yong at The Atlantic has a good interview up this morning on the reality that unvaccinated folk are not a monolith of science-deniers but a complex group of people with serious questions and obstacles to getting vaccinated. (You can get the summary on Twitter at the first link if you can’t get past the paywall at the magazine.)
I can vouch for the barriers-to-access. When I went to get my first shot, what I assumed would be thirty minutes total trip time turned into a 90-minute ordeal, including, after an hour wait at the pharmacy, having to explain to the pharmacist that I came for the brand vaccine advertised as the only one the pharmacy was offering, not the alternative that he was now holding in a syringe in his hand ready to poke.
–> Um, no, really sir, I put a lot of research into which of the three available shots had the safest profile for me given my serious pre-existing condition I wrote down on the intake form, and you telling me “this one is just as good” does not change that fact. He caved and went and got me the brand that was advertised on all the flyers taped up around his pharmacy.
This would have been a nightmare if I’d had to watch little kids while I waited, or had tried to come on my lunch break, or was counting on a ride from someone. In contrast, went to a different venue for the second shot, and sure enough, thirty minutes total (home-shot-home-again), no problems.
So there’s that.
Meanwhile, I want to talk about some distinctions that Ed Yong’s article doesn’t address, and that have come to my attention over the past couple weeks.
Reminder: I am a person who is fully vaccinated. I am very content with that decision, despite the fact that yeah, I was absolutely wiped out by the second dose, lost a week of being able to function (another factor cited in Yong’s interview, and no small potatoes to people who don’t get sick leave and do need to work) and no I won’t say I’m “fully recovered” and back to where I was pre-vaccine, but that’s life with the body I have, and COVID would have been just as bad or worse.
I’m not, at all, anti-vax. At all. Not at all.
So. Complexities.
#1 What portion of the unvaccinated already had COVID?
I’m in conversation with a group of young adults (ages 18-22) who are being threatened by their university with loss of scholarships, etc., if they don’t get vaccinated. Why? Because, in this cohort, one of the young adults was COVID-naive, got vaccinated with the Johnson & Johnson vaccine, and subsequently came down with symptomatic COVID disease. The remaining students in the affected group all are either vaccinated or had confirmed-by-the-university COVID infection last school year, or both.
Their state’s public health administration draws a line in quarantine regulations between vaccinated vs. unvaccinated, but not between previously-infected and never-infected. The university doesn’t want to deal with quarantine mandates, which would negatively impact the students’ ability to carry out some high-profile service work they do for their school (the reason this subgroup is being targeted).
Reality check: I’m told, but haven’t verified and can’t (because no sane administrator would commit such a thing to writing nor acknowledge it publicly), that some other high-presence student groups on campus are quietly being told by their staff supervisors, “Just don’t let anyone know if you get a cold. We can’t afford to shut down.”
So, summary: Administration is feeling the heat to pressure students into vaccinating because the incentives set up by the state health department dramatically affect the school’s ability to operate.
Okay fine, except the students who had confirmed COVID-19 infections last school year are able to use Google. Some studies cited in conversation that show the sources they are finding as they research this topic from quarantine:
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2780557
“The study results suggest that reinfections are rare events and patients who have recovered from COVID-19 have a lower risk of reinfection. Natural immunity to SARS-CoV-2 appears to confer a protective effect for at least a year, which is similar to the protection reported in recent vaccine studies. ““In a commentary in the same journal, Florian Krammer, PhD, of the Icahn School of Medicine at Mount Sinai in New York City, said that although natural infection tends to induce lower and more variable antibody concentrations than COVID-19 vaccines, ‘the findings of the authors suggest that infection and the development of an antibody response provides protection similar to or even better than currently used SARS-CoV-2 vaccines.’
He added, ‘The SIREN study adds to a growing number of studies, which demonstrate that infection does protect against reinfection, and probably in an antibody-dependent manner.'”Florian Krammer is on Twitter. Very reputable source. Calls it like he sees it, not political re:COVID: https://twitter.com/florian_krammerInteresting article by him as something to add to your knowledge on the topic generally: https://www.nature.com/articles/s41591-021-01432-4.epdf And the meme to go with: https://twitter.com/walterswiston/status/1414769649095520259“In a Cox proportional hazards regression model, after adjusting for the phase of the epidemic, vaccination was associated with a significantly lower risk of SARS-CoV-2 infection among those not previously infected (HR 0.031, 95% CI 0.015 to 0.061) but not among those previously infected (HR 0.313, 95% CI 0 to Infinity).
“Conclusions Individuals who have had SARS-CoV-2 infection are unlikely to benefit from COVID-19 vaccination, and vaccines can be safely prioritized to those who have not been infected before.““The relative risk for PCR positivity was 0.22 (95% CI, 0.17-0.28) for vaccinated individuals and 0.26 (95% CI, 0.21-0.34) for individuals with prior infection compared with no record of vaccination or prior infection (Table).”
These studies largely predate the surge in Delta-variant infections sweeping their state, so don’t take them as Gospel. However, it certainly appears to these young health-science majors that there is virtually no difference in the level of immunity conferred by the vaccine vs. conferred by a previous infection. It seems the data is showing that if you’ve previously been tested and found COVID-positive, then your immunity status is equivalent to that of someone who has been fully vaccinated.
That doesn’t mean you’re guaranteed to be immune. (The vaccines don’t guarantee it either.) Therefore, there are good reasons for someone who was previously infected to seriously consider getting the vaccine. However, the lack of acknowledgement in public health policies of what the published data so far indicate creates a dramatic loss of credibility.
Again. Remember mask-reversal? (Yeah, that was me saying wear a dang face covering back when the CDC and WHO were insisting that masks were wasteful, dangerous, and unpatriotic.) Remember “It’s not from China until we say it’s from China?” There was already no credibility. This discrepancy between public health policy and published information drives the wedge further.
I can’t, for example, find a breakdown of what portions of the unvaccinated population in my state are previously-infected vs. never-infected. From a public health perspective, those are two radically different risk levels, both for personal wellness and for the public at large.
#2 Vaccine risk-benefit profiles vary by the individual.
The group of students I’m in conversation with are all in an age group at extremely low risk, personally, of complications from COVID-19, and all have either been previously-infected or vaccinated, further lowering their risk. Those who are unvaccinated are all individuals whose personal health history puts them at extremely low risk of complications from the infection itself.
That’s not to say it can’t happen. It’s to say that their risk-benefit analysis for their personal healthcare decisions is different from individuals who are older or who have pre-existing conditions that increase the likelihood of serious disease.
In contrast, they have anecdotal information of peers who have had severe reactions to the vaccine, and scientific reports of rare but extremely serious side-effects of the vaccine.
It is not unreasonable for someone who has already survived COVID infection with no lasting harm, and who is otherwise extremely low-risk regardless, to ask: Why should I expose myself to potentially serious vaccine side effects, in a vaccine that has been around less than a year, when the vaccine offers me so little additional protection?
Again, reminder: I’m fully vaccinated. Further, in such a judgement call, I see nothing wrong, whatsoever, in a young, healthy, previously-infected person weighing all the information and determining that yes, getting vaccinated is the best route.
But public health messaging and clear threats from university staff are in no way acknowledging this reality, let alone leaving room for individuals to make a sober and serious weighing of personal risks.
There are of course public health risks and benefits as well, which are different. It’s better for me if these students do everything they can to reduce the chances they become contagious with re-infection. But for the university and state and federal public health officials to entirely disregard and dismiss the serious concerns that these students have about their own safety?
One begins understand the old slogan “Don’t trust anyone over 30.”
(See how high-risk I am? I remember that adage.)
#3 Vaccinated persons are getting symptomatic infection.
On my way to the grocery store yesterday, I was stopped at a traffic light with an electronic billboard. A public health vaccine-promotion campaign flashed onto the screen: Picture of happy middle-aged persons, no mask, faces close together, doing something fun like eating at a restaurant together. The accompanying text was a few short words saying that if you’ll just get your shots, you can go back to normal life worry-free.
I wish I could remember the text exactly, but the message was absolutely unequivocal: Vaccination = no more public health hazard, no more personal risk.
Now to be clear, the data from my state is showing that current COVID-19 hospitalizations are overwhelmingly among the unvaccinated, with a small portion being persons who are vaccinated but have pre-existing conditions that increase their risk of serious disease. At last press release on the topic, new deaths were entirely among unvaccinated persons. Reduction in severity of the disease is an enormous benefit!
[UPDATE: I want to link to an article out of NJ that came across my desk this afternoon, reporting 49 COVID deaths in fully-vaccinated individuals in that state. Seriously: If you have underlying risk factors, your vaccine does not make you bullet proof. Consider continuing to practice, or resuming, additional risk-reduction measures.]
Like I said, I’m very happy with my decision to get my shots. (Also learned in this year of being glued to every press release from the state health department: Rabies is rampant. Get your pets their shots, too.)
But here’s what that group of young adults have observed: The only person in their cohort to get infected this summer was the one who was vaccinated. It was a confirmed COVID-19 infection in a vaccinated person that triggered their state’s quarantine regulations.
Specifically, for anecdotal purposes (obviously one case study is not the science you want to live and die on), the infected student was COVID-naive and vaccinated with the Johnson & Johnson vaccine.
And thus these unvaccinated but previously-infected persons have to wonder: Why are we being treated as the walking public health disaster, and anyone who’s had the shot is allowed to circulate freely with no restrictions, regardless of exposure to someone with symptomatic infection, when it was a vaccinated person who had the infection?
It was a vaccinated person who was the source of the need for the university to implement quarantine. The unvaccinated but previously-infected students who were in the same peer group, and exposed to the same or similar community spread, have had no symptoms and have since tested negative for re-infection. These students can see that their state’s public health policies are divorced from the reality on the ground.
They can see that one category of persons in their peer group who posed no threat of infection or contagion is subject to draconian restrictions and threats, while another category that was the cause of the infection and potential contagion gets to walk free.
And so they do not trust.
Don’t read stuff into this story.
I’m not saying don’t get vaccinated. I’m very, very happy, despite the glitches I encountered, with my state’s mass-vaccination efforts. I’m appalled that other industrialized nations are so very far behind, and so very limited, in their vaccination efforts. I’m thrilled that someone is creating a vaccine that can be deployed in countries with significant infrastructure limits.
What I’m saying is that Ed Yong’s interview with Dr. Rhea Boyd, and my different encounter with a group of vaccine-hesitant persons, are both about real, serious, valid concerns.
If you want cooperation from the general public, honesty matters.
Photo: “Keep your distance” logo, courtesy of Wikimedia, CC 4.0.
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