Oh, how the tide has turned. Three months ago, COVID was ravaging my homeland, India. The Delta variant was burning through the country like an uncontrolled wildfire. People carted dying relatives town to town, desperately seeking hospital beds or a whiff of oxygen. A cousin in India said, “COVID is not taking lives, just the beds. Lack of oxygen is taking lives.”
I watched India’s suffering unfold and felt guilty for living in one of the world’s most resourceful and scientifically advanced countries. My homeland was floundering, but at least my other homeland — the U.S. — was finally on track.
104 million Americans had been vaccinated. The Pfizer vaccine alleviated the worst outcomes of the B.1.1.7 and B.1351 variants. Adolescents aged 12-15 were gearing up for vaccine eligibility within days, and the CDC was reporting the U.S. could see a sharp decline in COVID cases by July if nationwide vaccinations continued. Health care workers had proper PPE, millions of people were getting vaccinated each week, and infection rates were declining steadily. We could finally see Spring’s light at the end of the year’s tortuous dark tunnel. Our country was in the home stretch.
Now the Delta variant is here and I have to wonder, Who were we kidding? We don’t live in a world where vertical borders prevent airborne particles from crossing time zones. Planes and boats carry viruses from one country to the next like microscopic stowaways. The virus doesn’t abandon ship. It mutates, and adapts, and colonizes.
We had a real chance to strangle this monster, to show the rest of the world how it was done, to help them all in the process. We let that chance slip away. Not everyone and not everywhere, but enough people got complacent. Some waited for herd immunity to carry the load—a number that crept from 60 to 70 to 85 percent, depending on what you read and when you read it—and others just figured it would pass. Now the Delta variant, the same one that tore through India and Great Britain, has twisted out of our flimsy grip and is roaring with laughter.
How did this happen?
Misinformation. Political discord. Vaccine hesitancy. The bottom line is our vaccination rate faltered. The CDC reported that on August 1, 2021, approximately 400,000 Americans received their first COVID dose. While that seems high, it’s less than a quarter of the peak in mid-April. We haven’t maxed out eligible people (only 58.1 percent of eligible people were fully vaccinated as of a week ago). We’re maxing out the number of people who know COVID’s real repercussions are far worse than the vaccine’s feared ones.
The U.S now has the third-highest rate of vaccine skepticism among 15 of the world’s largest economies. Our vaccine surplus is so large the FDA extended Johnson & Johnson’s vaccine expiration dates to avoid throwing out perfectly good doses. Less than a week ago, President Biden announced the U.S. has donated and shipped more than 110 million doses to 60 countries. While I applaud the humanitarian effort, I question the fate of those doses if the 41.9 percent unvaccinated eligible people in our country had wanted them.
It makes me wonder: Why does science take a backseat to unsubstantiated pseudoscientific claims?
Spreaders of vaccine disinformation fill their social media accounts with statements questioning COVID’s existence and purporting unproven treatments (never mind the fact that we wouldn’t need treatments if COVID didn’t exist) with little to no peer-reviewed scientific research to support their anti-vaccine claims. According to Imran Ahmed, CEO of the Center for Countering Digital Hate, twelve people — the “disinformation dozen” — produce 65 percent of the shares of anti-vaccine misinformation on social media platforms.”
Is it easier for some to believe that a science-backed treatment is inherently more dangerous than an unknown herb plucked from a field? Perhaps. But what do they say to the approximately 216 kids hospitalized daily in the U.S. over the past week, particularly in areas where vaccine coverage is low? Bad luck? You weren’t strong enough? What would have made them stronger?
Yes, there are measures underway to increase vaccinations—full FDA approval, social media crackdowns on misinformation, and government, company, military, and college mandates. But let’s be honest, many Americans are fighting these measures, as they will fight future mandates, and the next vaccine.
Only two things can change how non-vaxxers perceive COVID vaccines: education and trust. We need to sincerely hear their reasons, and then gently clarify misinformation—vaccines don’t introduce disease into our bodies. They stimulate our immune systems to obtain immunity without getting the disease. Vaccines don’t alter our DNA. Their safety has been tested. Medicines have potential side effects, but illnesses have definite ones. COVID kills indiscriminately; vaccines don’t.
Trust is harder. How can we help people trust these vaccines? I suppose on a deeper level, it’s more about trusting the people that make the vaccines. Big pharma, for-profit companies—sure, they are the money makers. But behind the scenes, the vaccines are created by men and women who’ve accepted the charge to make this world—not just individuals—safer and healthier. They’ve spent years studying, researching, and testing potential vaccines with dedication and patience, including the mRNA technology in COVID vaccines. Just because the COVID vaccine’s rollout was fast-tracked to combat the pandemic doesn’t mean the scientists cut corners in designing and testing it.
Unfortunately, we don’t have the luxury of slowly educating and gradually building trust. COVID is terrorizing our planet now. The world is shaking its heads at the U.S., wondering what happened. We were supposed to be the leader. This morning, an aunt in a small town in India sent me a WhatsApp message: “I have taken the vaccine … the positivity rate has gone down … I am worried for America … how r u?” I don’t know. America, how are we? It’s not too late to destroy this monster, but if the unvaccinated remain unmoved, it will be soon.
The U.S. may have entered into a new phase of the COVID-19 pandemic, but the public health crisis is far from over. The nation’s hospitals and health systems will likely be dealing with its after effects for decades, according to new findings from Fitch Ratings.
Specifically, health implications related to the coronavirus will drive elevated health system utilization long after the acute phase of the pandemic has ended, likely leading to increasing costs and higher insurance premiums for years to come.
These costs will emerge from the necessary addition to outpatient capacity to deal with the ongoing treatment of chronic conditions related to what may be permanent damage caused by the virus.
WHAT’S THE IMPACT?
It’s nigh impossible to determine the magnitude of these effects, said Fitch. It will be dependent on tangential health issues related to deferred diagnostic testing and treatment during the pandemic. Since related conditions are likely to develop over time, Fitch doesn’t anticipate these issues to directly affect the credit profile of issuers in the U.S. healthcare system.
In the near term, health insurers have been able to incorporate expanding COVID-19 claims data, estimates of infection trends and pent-up demand for previously deferred care into 2021 premium rates, which should benefit cost management and pricing this year and next.
However, for healthcare providers, the expansion of the healthcare system over the long term will likely exacerbate traditional pressures on operating performance, such as tight labor and wage markets for experienced staff, rising pharmaceutical expenses and supply costs in general.
Although the U.S. has glimpsed signs of the pandemic’s potential end over the past couple of months, the ultimate story of the pandemic is still being told.
The infection rate is once again trending up, presumably due to a combination of factors, including a dramatic reduction in demand for new vaccinations, the rapid spread of the more infectious Delta variant and the reduction in mitigation measures.
THE LARGER TREND
The rising numbers of COVID-19 infections in the U.S. are occurring mostly in communities with low rates of vaccinations, with Centers for Disease Control and Prevention Director Dr. Rochelle Walensky saying in July that “This is becoming a pandemic of the unvaccinated.”
Data published by USA Today shows that cases are rising in all 50 states, with some startling increases in certain areas. Rhode Island, for example, saw cases almost triple in a one-week period, with Maine and Vermont following closely behind. Massachusetts, Alaska and Kentucky have seen their cases more than double in that time, followed by Minnesota, Florida and Texas.
Cases are rising fastest in Arkansas, Florida, Missouri and Nevada, all of which have low vaccination rates, according to Market Watch. In all four of those states, less than half of residents are fully vaccinated.
Vaccine hesitancy remains a problem, with many Americans reluctant to get their shots or unwilling to do so. In May, a Sermo poll showed that more than 72% of physicians surveyed said that patients continue to voice concerns over vaccine side effects.
Still others have reported ongoing misinformation discouraging people from getting vaccines. And close to 30% of physicians reported encountering patients who have skipped their second dose due to unpleasant side effects from the first dose, or concerns over side effects.
The Biden administration is working to stamp out misinformation that might dissuade people from getting coronavirus shots, a crucial task as the nation shifts into the next, more difficult phase of its vaccination campaign.
The White House announced Friday that 100 million Americans are now fully vaccinated against COVID-19, but the nationwide rollout is plateauing as fewer people sign up for shots.
Administration officials and health experts know the difficulty ahead in getting vaccines into as many people as possible, and are trying to eliminate the barriers to doing so.
Authorities need to dispel the legitimate concerns that make people hesitant, while also stopping waves of misinformation.
This past week, top infectious diseases expert Anthony Fauci corrected Joe Rogan, a popular podcast host who himself later acknowledged his lack of medical knowledge, after Rogan said young healthy people don’t need to be vaccinated.
“You’re talking about yourself in a vacuum,” Fauci said of the podcast host. “You’re worried about yourself getting infected and the likelihood that you’re not going to get any symptoms. But you can get infected, and will get infected, if you put yourself at risk.”
White House communications director Kate Bedingfield also joined in the criticism.
“Did Joe Rogan become a medical doctor while we weren’t looking? I’m not sure that taking scientific and medical advice from Joe Rogan is perhaps the most productive way for people to get their information,” she told CNN.
Rogan’s comments were trending on Twitter for two days before he attempted to walk them back.
“I’m not a doctor, I’m a f—ing moron, and I’m a cage fighting commentator … I’m not a respected source of information, even for me,” he said.
Public health experts said Rogan’s comments were irresponsible, and potentially dangerous because they could perpetuate hesitancy.
“You have a responsibility as an adult, you have a responsibility as a community leader, your responsibility as a communicator to get it right,” said Georges Benjamin, executive director of the American Public Health Association.
While Rogan is not a political figure, he has one of the most popular podcasts in the world, and an enormous platform.
Rogan hosts the most popular podcast on Spotify. Rogan said in 2019 that his podcast was being downloaded 190 million times per month.
People are not getting all their information from Rogan, but when his comments clash with what public health experts say, that is problematic.
“It’s not so much that Joe Rogan’s a comedian, he’s very popular with people sort of leaning on the conservative side, especially young people. And that’s the group that we have to reach, especially young men,” said Peter Hotez, a leading coronavirus vaccinologist and dean of Baylor University’s National School of Tropical Medicine.
Hotez, who has appeared on Rogan’s show in the past, said he thinks the host was just misinformed. Hotez said he has reached out, and wants to help Rogan have a more productive discussion about why it’s so important for everyone to be vaccinated against the coronavirus.
Polls show vaccine hesitancy is declining, but the holdouts are not monolithic, and experts believe trusted messengers will be needed.
“I just think they have to speak the facts. You speak the facts, and anytime you discover the facts that are incorrect, you try to correct them,” said Benjamin. “And … I don’t think you demonize the individual, nor do I think you try to pin motive to it, because you don’t know what the motive is.”
Some people are most worried about side effects, some are concerned about the safety of the vaccines and some people don’t think COVID-19 is a problem at all. There are also likely some people who will never be convinced, and try to sow confusion and distrust.
Biden administration officials are aware of the harmful impact of misinformation, but know they are walking a fine line between people who legitimately want more information and those who just want chaos.
“We know that people have questions for multiple reasons. Sometimes because there’s misinformation that they’ve encountered, sometimes because they’ve had a bad experience with the healthcare system and they’re wondering who to trust, and some people have just heard lots of different news as we continue to get updates on the vaccine, and they want to hear from someone they trust,” Surgeon General Vivek Murthy said during a White House briefing.
For the White House, using medical experts like Fauci to correct obvious misinformation is part of the strategy to boost vaccine confidence.
“Our approach is to provide, and flood the zone with accurate information,” White House press secretary Jen Psaki said Friday. “Obviously that includes combating misinformation when it comes across.”
The administration has also invested $3 billion to support local health department programs and community-based organizations intended to increase vaccine access, acceptance and uptake.
Still, experts said different messengers are needed, especially when trying to reach conservatives who may now view Fauci as a polarizing political figure.
“There needs to be a better organized effort by the administration to really understand how to reach groups that are identified in polls as saying they won’t get vaccinated,” Hotez said. “We need to figure out how to do the right kind of outreach with the conservative groups, and we’ve got to do something about” the damage caused by members of the conservative media.
In a recent CBS-YouGov poll, 30 percent of Republicans said they would not get the vaccine and another 19 percent said they only “maybe” would do so.
The underlying mistrust comes after a year in which Trump and his allies played down the severity of a virus that has killed more than half a million Americans already.
A national poll and focus group conducted by GOP pollster Frank Luntz showed Republicans who voted for President Trump will be far more influenced by their doctors and family members than any politician.
To that end, a group of Republican lawmakers who are also physicians released a video urging people to get the COVID-19 vaccine.
The video, led by Sen. Roger Marshall (R-Kan.), features some of the lawmakers wearing white coats with stethoscopes around their necks speaking into the camera.
When a Miami school said earlier this week that it wouldn’t allow vaccinated teachers in its classrooms, its founder cited “vaccine shedding” as her main concern.
The trope is currently abuzz in anti-vaccine circles, said Nicole Baldwin, MD, a pediatrician who has been a target of attacks by the anti-vaxxer community.
“It’s amazing, and sad, what people will believe,” Baldwin told MedPage Today.
Essentially, they believe that people who’ve had the vaccine can somehow shed the spike protein, which in turn can cause menstrual cycle irregularities, miscarriages, and sterility in other women just by being in close proximity.
“This is a new low, from the delusional wing of the anti-vaxx cult,” said Zubin Damania, MD, a.k.a. ZDoggMD, in a video he recently posted to bust vaccine shedding myths.
Damania said the misinformation originates from an earlier claim that syncytin, a protein involved in placental formation, bears some structural similarities to the spike protein, and therefore vaccination would interfere with women’s reproductive systems. Many a fact check has shown that vaccines don’t target the protein.
Once injected, the vaccines prompt cells to make the spike protein, but it’s usually cleared in 24 to 48 hours, leaving little opportunity for “shedding,” even if it could occur — which it can’t, Damania emphasized.
Another logical fallacy he pointed out: “Why, then, wouldn’t natural spike protein do the same thing? Wouldn’t you be more scared of natural coronavirus infection? Oh, but it’s ‘natural.'”
Damania noted that there are legitimate questions and research about whether the coronavirus itself and vaccines have an impact on women’s menstrual cycles. Since the beginning of the pandemic, women who’ve had COVID-19 reported changes to their menstrual cycle, and Damania said that researchers are assessing reports of changes to the menstrual cycle following vaccination.
Regarding the potential relationship to vaccination, “we don’t understand, first, if it’s true, and if it were true, what is the mechanism?” he said. “Anything that causes stress, inflammation, and an immune response may have an effect on the menstrual cycle. … Could it be that the vaccine causes a temporary change in menses? Sure, it’s possible, and it’s being looked at.”
Leila Centner, co-founder and CEO of Centner Academy, the Miami school that has banned vaccinated employees, told NBC News in a statement that “tens of thousands of women all over the world” have reported reproductive issues from being around someone who has been vaccinated.
Baldwin pointed out an Instagram video, now marked as misinformation, in which a nurse, Maureen McDonnell, RN, and a physician, Lawrence Palevsky, MD, discuss the effect of vaccines on women’s menstrual cycles.
“This isn’t just a trivial thing,” Damania said. “It’s quite harmful.”