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Aaron E. Carroll: COVID is now a crisis for the unvaccinated

If you and most of the people in your area are vaccinated, things are substantially better than they used to be.

(Francisco Kjolseth | The Salt Lake Tribune) Registered nurse Yazmin Tovar gives Taylor Hilmo, 16, her first dose shot of the Pfizer vaccine as people are vaccinated against COVID-19 at the former Provo High School at 1125 N. University Ave. on Wednesday, July 28, 2021.

Case counts are rising, some hospitals are filling up, and the Centers for Disease Control and Prevention is again recommending universal masking in areas where cases are surging. But to suggest that COVID-19 is an escalating emergency in the United States is not quite right. The truth is that the vaccinated and the unvaccinated are experiencing two very different pandemics right now. If we don’t confront that, the nation can’t address either appropriately.

The CDC’s announcement will lead many to believe that the pandemic is getting worse. But if you and most of the people in your area are vaccinated, things are substantially better than they used to be. Hospitals are relatively clear of COVID-19. Few deaths are occurring. People may still be worried, and some may be masking, but much of their panic is that the stuffy nose they woke up with may be COVID-19.

Sometimes it is. As has always been the case, breakthrough infections of COVID-19 remain possible. Such reports have become more frequent. Because the vaccines are not 100 percent effective, some vaccinated people will get infected, some will get sick, and in rare cases, some may even be hospitalized. The success of the vaccines has long been predicated on preventing severe illness, which they do, rather than on preventing any infection.

If the vast majority of vaccinated people who get COVID-19 recover with no real issues, how much should we worry?

There are four other endemic coronaviruses in circulation. They all cause colds. It would be a major victory if we could relegate SARS-CoV-2, the virus that causes COVID-19, to this group. For the vaccinated, right now, that victory has largely been achieved.

One of the reasons we can’t celebrate yet is that none of this is true for the unvaccinated. For them, the pandemic has not changed much. Hospitals are filling up again in states where rates of vaccination are low. In those places, more people are on ventilators, and many are still dying.

Even in places with high rates of vaccination, some people can’t be vaccinated. Others do not respond as well to the vaccines because they are immunocompromised. The very elderly are still at higher risk because a breakthrough infection is more dangerous for them. Children aren’t eligible to be vaccinated yet, and while they’re at relatively low risk for severe illness, they may need some extra protection.

It’s critical to act at a local level to protect all such people in our communities. Others should mask up around them, try to limit indoor contact with them and sit a little farther away. That’s what we did before the vaccines, and it’s still good practice. Specific masking recommendations for those at highest risk make sense.

The single best thing we can do for such people, though, is to get everyone around them immunized.

Across the country, the vast majority of severe illness and deaths are among the unvaccinated. Fewer than 1,200 vaccinated people have died of COVID-19 as of July 19. Over 97 percent of people who are hospitalized for COVID-19 are unvaccinated, according to the CDC

Breakthrough cases should be addressed to avoid possible transmission (it remains unclear how much vaccinated people who get infected contribute to spread), but they are not the most important metric for measuring the end of the pandemic. If most breakthrough infections cause colds or limited illness, they really aren’t the main concern, unless they start resulting in serious illness and deaths. For the most part, they’re not right now.

Even the Delta variant is not a major threat to everyone in the United States. It is largely a threat to the unvaccinated. It’s more infectious, it’s spreading more quickly, and most people aren’t being as careful as they were months ago. Delta is therefore causing the unvaccinated to get sick, and they’re still going to the hospital, and they’re still dying.

Despite this difference, reporting on the relative percentage of Delta cases every day is causing vaccinated people to panic and sowing some doubt about the effectiveness of vaccinations. But it’s clear from the data on hospitalizations and deaths today compared to when the Alpha variant was on the rise at the beginning of the year that the United States is in a much better situation now.

That’s because more people are vaccinated, including most Americans over 65.

Many may read the CDC’s continued focus on masking and distancing as an acknowledgment that the vaccines don’t work well enough. Leaning heavily on masking and distancing is what we did when we didn’t have vaccinations. Today, such recommendations are less likely to succeed because they are more likely to be followed by those already primed to listen — the vaccinated — and to be fought and ignored by those who aren’t.

Hospitalizations and deaths are rising in some areas not because someone didn’t wear a mask at the ballgame. They’re occurring because too many people are not immunized.

This is why I’ve advocated vaccine mandates. I don’t understand how we can mandate wearing masks but not getting vaccinations.

It may take enormous political capital to enforce mandates or huge incentives, but it will be worth it. COVID-19 is not even close to a crisis for those who are vaccinated, but it is a true danger to those who are unvaccinated. Our policies and actions should continue to reinforce that message while helping the latter join the former.

(Photo by Marina Waters) Aaron E. Carroll is a contributing opinion writer for The New York Times. He is a professor of pediatrics at Indiana University School of Medicine and the Regenstrief Institute who blogs on health research and policy at The Incidental Economist and makes videos at Healthcare Triage. He is the author of “The Bad Food Bible: How and Why to Eat Sinfully.”

Aaron E. Carroll is the chief health officer for Indiana University and the vice president for faculty development at the Regenstrief Institute. He blogs on health research and policy at The Incidental Economist.

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