That's partly because of the people who've written and shared their thoughtful, complex questions about masks and boosters and schools and travel. For all the stories of ignorant, malicious people undermining public health, there are far more people who are extremely conscientious.
Many questions about delta I still can't answer well, because the situation is actively unfolding, and the permutations of variables are endless ...
What if I'm at an outdoor dinner with 6 other vaccinated people, and one person arrives who isn't vaccinated, and he's speaking very loudly? And then he invites another person who no one knows, and this person says that he had the Russian vaccine, but not in a way that inspires confidence? And he and two other people go indoors briefly without masks, but the windows are open, and I don't have a mask with me, so I put a lampshade over my head, as tactfully as possible, explaining that it's because I have severe lupus (I actually have pretty mild lupus), and we do karaoke, but quietly, how worried should I be?
I joke despite/because I know the concerns are real and valid, and it's nearly impossible to put a numeric risk on any given circumstance. Nor am I at all qualified to dictate anyone's level of worry (which, for most of us, is different from level of risk).
What I can try to do is offer some general perspective. If you're vaccinated and feeling anxious or panicky—you're not alone. I know it's a confusing moment. But I think it's more straightforward than it may seem. At least in terms of what needs to be done.
It has helped me to keep this chart in mind, which compares the COVID deaths among vaccinated people (left) to those among unvaccinated people (right):
That's where we are, as of last week. (These metrics do lag, and I'm keeping a close eye on them. But, for now, that's the pandemic in one chart.)
Despite so much worthwhile, interesting talk of breakthrough infections and the possibility of transmitting the virus despite being vaccinated, the vaccines are working phenomenally well.
The risk among vaccinated people should be closer to 0.0 percent everywhere, but the fact that they are not is less a matter of some failure of the vaccines themselves than the fact that the virus is spreading so widely. If someone unleashed measles all over the country, we'd see breakthrough deaths among vaccinated people, too.
This means we can push closer to 0.0, and we know exactly how to do it: by getting people vaccinated. Vaccines are sort of like life jackets, in that if you drop enough people into a lake, some will drown despite wearing one. But as we drain the water out of the lake, that starts to become impossible. (Not a perfect metaphor? I know, it's been a long week. Why drain a lake? And how?Tell me a better metaphor.)
Also, also reassuring: The pace of vaccination is picking back up. People are realizing that there is no opting out. There is only choosing one column or the other.
Check this out, too:
That chart comes from the Kaiser Family Foundation, as does the one before it. (I swear I'm not being paid by Kaiser Family Foundation. (I'd be open to it!) They just do great work, and I'm a lifelong fan of Julie Rovner.)
What's important about that graph is that it shows the way forward. People who were waiting-and-seeing have had a long time to do that, and they are witnessing the most widely and closely scrutinized rollout of any drug in history. The results are clear and convincing.
This also reminds me that we're not in some hopeless partisan gridlock. It can feel like there's a dividing line between two groups: the vaccinated versus the anti-vaxxers. In reality, the portion of the population who fall in that latter category is nowhere near half, but a steady 14 percent. It's not growing, and it's a relatively small faction.
Even if we never managed to get that number down, vaccinating the other 86 percent of people in coming months could still create a "herd immunity" effect, where nothing like the current surge can happen again. (This wouldn't mean that no one would ever get sick—trying to define a threshold for herd immunity is kind of like trying to define a threshold for "old age" or "love." But that level of vaccination should be enough to extinguish most concerns among the vaccinated, as we'd drive the virus to near obsolescence. There would be localized outbreaks, but nothing sweeping the country.)
I don't relegate people to the "anti-vaxxer" category often or lightly. Here it may be a worthwhile distinction. If a portion of the population has said all along that they would definitely never get vaccinated, no matter what, and they continue to say that despite the current delta surge, I think it's useful to distinguish between that mode of thinking and others that might be deemed simple hesitancy. The "definitely not" perspective reflects certainty that draws on something deeper than facts.
This is true whenever someone says, essentially, that no amount of evidence could convince them of something. At that point, you're in the realm of a deeply held belief. That's importantly different from a simple opinion, or a conclusion drawn from weighing pros and cons, which should change as the pros and cons change. A deeply held belief does not. It is, by definition, removed from external circumstances.
Deeply held beliefs become so intwined with our sense of self that to challenge them is to challenge a person's identity. This tends not to go over well.
The distinction is relevant because it means that most messaging and outreach should be directed toward people who are willing to engage. Berating people who aren't, or barraging them with statistics—however kindly—is most likely to cause them to dig in further (and hate you). It's sort of like approaching a Biblical literalist to rant about how reproductive physiology makes Immaculate Conception impossible. You're just not talking about the same thing.
I'm not suggesting giving up on anyone. But until people are willing to earnestly consider the possibility of getting vaccinated, trying to change their mind is like (another very imperfect metaphor) trying to convince an addict to quit when they haven't yet accepted that they have a problem. It's not going to happen until they're ready to engage. They may even cut you off and become more isolated. A discussion with that person should be very different from a discussion with a person who realizes the issue is serious, and is considering quitting, but isn't sure how, and wants to talk it out.
I also wanted to address the mystery of whether people are indeed spreading the virus after being vaccinated, since we've learned more this week. The fact that this is possible came from a study on an outbreak in Provincetown, Massachusetts, among vaccinated people. Concerning as it was, it was also a more unique scenario than I think was initially made clear. This was bear week in Provincetown. And not just any bear week, but a hot-vax bear week after more than a year of hibernation due to COVID restrictions. That means thousands of people eagerly converging at the tip of Cape Cod (the town bulged from 3,000 to 60,000) with the express purpose of partying in overflowing bars and clubs and pools. Some went out despite feeling symptomatic, but under the belief that it was fine, because they were vaccinated. AsNPR's Selena Simmons-Duffin reported on the scene this week:
So this cluster of cases isn't necessarily indicative of what would happen in the average office or grocery store.
And despite the almost textbook circumstances for super-spreading, it seems that fewer than 2 percent of people on hand got infected, and almost no one got seriously ill, and zero died. To me this reads, ultimately, as something closer to a success story than a cautionary tale.
It's good that the CDC erred on the side of calling this incident to national attention quickly, and amended recommendations to be on the safe side. But this is also not exactly a research scenario that extrapolates easily to many other scenarios. So it's hard to know just what it means. My guess (and hope) is that this outbreak had more to do with the unique circumstances of the time and place, and is not indicative of the likelihood that any given person will get infected after vaccination to the degree that they could be spreading the virus.
Until we know more, I still believe it's worth being extra cautious during this surge. But my hope for vaccinated people is that we will be able to have clearer guidelines before too long, and that they may be something like "definitely don't go out if you have cold-like symptoms, and get tested if you've had a known contact, and wear a mask in XYZ specific, high-risk scenarios." (Don't quote me on that.)
The point is, guidance will become more deliberate and sophisticated than simply telling everyone to wear masks indoors. We're not being ceaselessly borne back into the past; we're just in a storm. And lots of people don't have their life jackets.
What lies ahead—the risk of breakthroughs, the need for masks, the urgency of boosters—depends entirely on how many people get vaccinated right now.
Great piece! If you're vaccinated and test positive because of the delta variant, does this mean you are now immune to the delta variant? Or could you get reinfected? I know this is something that's too early to know