June 2, 2021
Dear Members of the Baylor College of Medicine Community,
I hope most of you had an opportunity to enjoy family and friends over the Memorial Day holiday weekend, as we paused to reflect on those who gave their lives in service to our country. As I was thinking about the holiday, I also started to consider how different things are today compared with last Labor Day. Memorial Day and Labor Day are the unofficial bookends of summer. It is remarkable how things have changed since the end of summer 2020. I want to spend today contrasting where we were then and now. There are similarities, but also key differences. I will end with a trick question: Are you safer from COVID-19 now than you were last September?
This Memorial Day and last Labor Day were both relatively "good" times, from a COVID-19 perspective. Recall in early September, we were in the valley between the July surge and the yet-to-come winter recurrence. Viral numbers had improved. We were starting to feel more confident. In the Greater Houston Metropolitan Area, new confirmed COVID-19 cases were just over 1,000 and falling. Today, we are averaging less than 400. Then, we were admitting 105 COVID-19 patients daily to area hospitals. Today, that number is down to 76. In early September, the effective Houston R-value was 1.15 indicating viral spread. Today, it is 0.92, consistent with a receding viral burden. In our Labor Day versus Memorial Day comparison, based on viral dynamics, Memorial Day wins.
Last Labor Day not a single person was vaccinated (unless through a clinical trial). Today over 40% of the total U.S. population is fully vaccinated, and 75% of those are 65 years of age and above. Eighty-six percent of seniors have received at least one dose with at least partial immunity. Score another win for Memorial Day.
Last Labor Day, I wrote about the mixed signals in the viral numbers. In my weekly message, I cautioned "given our lack of clarity – and events on the horizon that may promote resurgence – it is precisely the wrong time to relax our vigilance around virus control in our community." Two weeks ago, my tone was much more optimistic: "If vaccinated ... you are relatively safe to remove your mask and eliminate distancing – even indoors." This week, Baylor eliminated masking and distancing requirements in non-clinical settings for everyone who is vaccinated. It is precisely the right time to relax our vigilance, albeit carefully and thoughtfully.
Driving around Houston this weekend, it certainly appears we are more confident. Businesses and houses of worship have started returning to full occupancy, generally with masking recommended for the unvaccinated. The on-line restaurant service Open Table tracks numbers of seated diners. In early September, when compared to the prior year, Houston dining was off about 13%. Current numbers show in-restaurant dining is up about 25%. TSA tracks numbers of air passengers. Last September nationally we saw about 600,000 daily travelers. Today, we are close to 2 million (depending on the day of the year, "normal" is approximately 2.0-2.5 million). Based on public confidence, Memorial Day edges out Labor Day again.
In summary, the viral dynamics have improved, large numbers of people are vaccinated, people are more confident, and things are opening up. Game, set, match goes to Memorial Day 2021.
Back to my trick question. The overall situation is better today than Labor Day 2020. Do you feel safer today compared to last September? Are you less likely to become ill and require hospitalization from COVID-19?
The answer is: It depends.
According to the CDC, our overall national daily admission rate has dropped modestly compared to early September (1.22 admissions per 100,000 population then versus 1.10 on May 16). Keep in mind, this is an admission rate compared to another "good" time when viral prevalence was relatively low.
It is interesting to focus on the age make up of those sick enough to warrant hospitalization. On Sept. 1, people 70 years old and older were responsible for 2.86 admissions per 100,000 total population. By May 16, that number dropped about 15% to 2.42 – very good news, likely driven by the very high vaccination rates in the elderly. There is good news on the other end of the age spectrum as well. For ages 0 through 17, the admission rate remains very low and stable (between 0.12 and 0.14).
Between ages 18 and 59, the story is very different with significant increases in hospitalization rates. The effect is most striking for those in their 30s. On Sept. 1, those aged 30-39 produced 0.48 COVID hospitalizations per 100,000 total population. By May 16, this number climbed to 0.85, a 77% increase. This almost certainly understates the effect as the admissions from this group were not derived from the entire population– the people who became ill were primarily drawn from the smaller unvaccinated subpopulation of thirtysomethings.
Are you safer today than you were last September? If vaccinated, the answer is clearly "yes." In most circumstances, you can take off your mask. You are unlikely to become seriously ill, and you are unlikely to spread SARS-COV-2 to others. However, if you remain unvaccinated your risk of becoming seriously ill is actually greater than it was last September.
If you are unvaccinated, and interpreting all the positive news out there as signs you are safe, your optimism is unwarranted. You are still at significant risk of infection with a pathogen that usually produces mild disease in young adults, but can – and does – result in severe illness. Granted, a daily risk of 0.85 per 100,000 population is low, but not inconsequential. Notably, it is a risk that is almost entirely preventable with a vaccine that is free, safe, effective, and readily available. We have now administered more than 366 million vaccine doses in the United States, and the available vaccines all have remarkably good safety profile.
The risk-benefit analysis here is easy. Plenty of benefit, very small risk.
James T McDeavitt, M.D.
Executive Vice President & Dean of Clinical Affairs
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