Condensed and paraphrased from The Atlantic (published Sept. 20, 2021; read article here):
What we know about the virus
We know it better than we once did. We know that it can set off both acute and chronic illness, that it spreads best indoors, that masks help block it, that our vaccines work. We know that we can live with it—that we’re going to have to live with it—and it can exact a heavy toll.
Still, this virus can surprise us if we’re not paying attention. It is changing all the time; and that sometimes creates new risks. In a matter of weeks, the Delta variant upended the relative peace of America’s early summer and shifted the pandemic’s endgame.
The role of vaccines has changed
From the very beginning, vaccine experts warned that respiratory diseases are tricky to immunize against. The coronavirus first takes hold in the nose (which is why tests involve nose swabs), and injections into the arm are just not very good at stimulating immunity in the nose. Flu shots, for example, tend to be only 10% to 60% effective at preventing flu. Covid-19 vaccines are good at boosting immunity deep in the lungs to protect against severe disease, and if similar would prevent hospitalizations and death, but the coronavirus would still circulate. So vaccinating as many people as possible, as quickly as possible, is still the most effective way to control the virus.
With the Delta variant, which now accounts for nearly all U.S. cases, breakthrough infections are possible, but tend to be mild or asymptomatic. With case numbers getting very high in parts of the U.S., additional layers of protection, including improved ventilation and masks, are necessary to protect people, especially those who are still unvaccinated including children.
The percentage of vaccinated people is important
The Delta wave hit America harder than the U.K., not only because fewer Americans are vaccinated, but also because the most vulnerable Americans aren’t as vaccinated. Risk rises sharply with age. In the U.K., nearly everyone over 65 is vaccinated; in very few places are more than 2% of people over 65 not fully vaccinated. But that’s above 10% in many counties of the American South and Mountain West. A community where 10% of residents are unvaccinated seniors has five times as many people who might need an ICU bed than one where that number is only 2%. Also, vaccine coverage in the U.S. varies dramatically from county to county, and the virus spreads more easily among concentrations of unvaccinated people.
Who’s most at risk keeps changing
Vaccines have shifted the risk on the community level. Older people and health-care workers were among the first to get vaccinated. Younger people had to wait longer, and children under 12 still are unvaccinated while vaccine makers figure out dosages. This has shifted the virus’s burden to children.
At the same time, the virus has been evolving into speedier forms. Kids still seem relatively resilient compared with adults, but Delta is a faster spreader, making it a greater threat to everyone who is unvaccinated, putting children at higher risk than previously.
Relative risk also will keep shifting. Our immunity could wane. People who are currently fully vaccinated may eventually need boosters. Infants who have never encountered the coronavirus will enter the population, while people with immunity will die, and vaccinated people won’t all have the same immunity. Some, including the immunocompromised, might not respond as well to the shots. Our assumptions about who the virus might hit hardest will keep changing, and so will who is falling ill.
As vaccination rates increase, more cases will occur in vaccinated people
This summer stories appeared in the media about vaccinated people getting infected. If the vaccines work, how could that happen? The answer is simple: Even though vaccinated people have much lower odds of getting sick, they’ll make up a larger share of infections, hospitalizations, and deaths if there are more of them. Vaccinated people are less likely to get infected, but as their proportion of the community rises, so does their percentage of infections. But as more people are vaccinated, there will be fewer infections overall. So if you’re still trying to decide whether to get vaccinated, don’t look at the percentage of sick people who were vaccinated, but at the percentage of vaccinated people who got sick, which will be much lower than the percentage of unvaccinated people who got sick.
Rare events are common on a large scale
Some commenters downplayed specific risks because they were “rare”: Deaths, long COVID (which isn’t actually rare), infections and multisystem inflammatory syndrome among children, and more. But when infectious diseases spread widely enough, relatively rare events can rack up large numbers. A one-in-a-thousand event will occur 40,000 times when 40 million people are infected. These events can’t be written off, especially when they involve loss of health or life.
As outbreaks spread, more types of rare events become noticeable. So a wider pandemic is also a weirder pandemic. Many aspects of Covid-19’s mystique—the range of symptoms and affected organs, the possibility of persistent illness, and reinfections—are common to other viral illnesses, but aren’t noticed because those illnesses don’t sweep the world in a short period of time. Similarly, as this current post-vaccine surge continues, breakthrough infections will seem more common, newspapers will report more stories about them, and more people will know someone who had one.
There is no single “worst” version of the coronavirus
Right now Delta, a super-transmissible variant that hops into human airways, copies itself, and blazes back out into the community, is especially well poised to rip through the world’s mostly unvaccinated, mostly immune-naive population, which is what it’s doing. Laxness about masking, distancing, and other infection-prevention measures in the U.S. has given Delta plenty of opportunities to hop from human to human, fueling its rise here. The Delta variant has about as good a home-field advantage as it can get.
But things might look drastically different for a population with a lot more immunity. Strong, speedy immune responses will keep the virus from thriving on its swiftness alone. In such an environment a stealthy variant that can slip past antibodies might be the one that dominates. The virus could still spread, but would have to spread by different means. Mutations that make it less visible enable it to stick around in airways longer, and transmit to more people in the process. As the world gradually acquires immunity, variants like Delta might be superseded by such mutations. These transitions will happen at different rates in different countries with different access to vaccines and immunity profiles. Then, which variant is more threatening will change at the border.
All the variants share some common weakness. They can be stopped by combining vaccines, masks, distancing, and other measures to cut the conduits they need to travel and spread. When viruses spread faster, they can be tougher to control. But they can’t persist without us, and our behavior matters too.
[Now for my thoughts. I have mainly two to share. First, wearing masks and getting vaccinated are the best defenses we have, and whether people use them isn’t just an individual choice; refusing to participate affects others in a multiplicity of ways. We all have a community responsibility here. Second, when I see people arguing the overall death rate is low — I’ll give you figures in a moment — I think of the Vietnam War.
According to the CDC (here), of 330 million Americans, about 120 million (36% of total population) have been infected, 102 million (31% of total population, 85% of those infected) have experienced symptoms, 6.2 million (1.9% of total population, 5.2% of those infected) have been hospitalized, and 767,000 (0.2% of total population, 0.6% of those infected) have died. So some people argue the odds of dying are too low to worry about.
Roughly 2.7 million Americans served in Vietnam, and about 58,000 of them were killed. Thus the death rate was about 2.1%, or 1 chance in 50 of being killed. Would you feel comfortable with that? But wait. The deaths were concentrated in front-line combat units, which comprised about 10% of total personnel, so the odds of death for infantrymen, forward observers, medics, and others in the front lines were magnitudes higher, maybe 15% or so. Even if you weren’t uncomfortable with the general odds, would you be comfortable with those odds?
The point is, Covid-19 deaths aren’t evenly distributed among the vaccinated and unvaccinated populations. Currently, virtually all Covid-19 deaths are among the unvaccinated, and as they’re about 30% of the population, and with more than 1,400 people dying from Covid-19 every day, their odds of being killed by the virus are comparable to the death rate before vaccines, which was something like 2% of those infected. Still comfortable with that? It’s easy to think of this as something that happens to other people until it happens to you, and then it’s your funeral. This is preventable, so why take the risk? What do you get out of that?]