April 21, 2021
To Members of the Baylor College of Medicine Community:
When I was a child, it was a relatively common practice to have "chicken pox parties." Once one child in the neighborhood contracted chicken pox, parents would bring all the other kids around to visit, hoping they would catch the disease.
Given there was no vaccine at the time (there is today), the thinking was that since the disease was usually milder as a child, you were better off trying to get it, rather than risk contracting it as an adult. I will come back to chicken pox parties in a few moments.
There is some cause for celebration this week. In spite of the J&J vaccine safety concerns that arose last week, our national vaccination effort continues at an impressive pace – 214 million doses administered, 40% of people have received at least one dose, and 26% of the population are fully vaccinated. Vaccination efforts have been particularly effective in older and at-risk people.
Overall, we seem to have reached a steady viral equilibrium. The situation Houston is good, but not great. Our daily rate of new cases is increasing, but almost imperceptibly so. Likewise, the daily growth rate of new hospitalizations and ICU census is increasing very slightly (0.2% and 0.7% respectively). As older people have been vaccinated, hospitals have seen admissions shift to younger populations.
Today, I want to focus on people in their 20s and 30s. We are not in a bad place if you believe the current narrative – which I do. If we remain cautious and continue our vaccination efforts, we will reach herd immunity in the next several weeks, see our numbers improve to the point that most restrictions can be lifted, and we can begin to return to normal.
However, there is another alternative narrative I would like to debunk. It goes like this: Since we have vaccinated most of the elderly, and they are at the highest risk, let the young people – those in their 20s and 30s – take off their masks, forego any restrictions on behaviors and ignore the potential risk of infection. Let them get infected and speed our journey to herd immunity through infection, rather than vaccination. This is the COVID-19 equivalent of a chicken pox party.
The underlying belief that fuels this thinking is that COVID-19 is a benign disease in the young, which is a dangerous and inaccurate belief. True, the disease tends to be less severe in young adults, but it is still a disease with significant consequences. For today, let's concentrate on a single outcome measure – death. I will have more to say about longer-term symptoms and functional impact of the disease in future weeks, which are also consequential, but for now let us focus on the risk of death.
It is true the mortality rate in younger people is sharply lower than in those who are older. During the peak of our January wave the chances of someone between the ages of 55 and 64 dying from COVID-19 was 5.3 per 100,000 population per week.
By comparison, the death rate in younger people is much lower. Those 18 to 24 years old, 0.12; ages 25 to 34, 0.31; ages 35 to 54, 1.37. The death rate in younger people is sharply lower, but I would argue that it is still very significant. I think it is useful to put this in terms of risk relative to another cause of death.
Let us look for a moment at motor vehicle crashes in the US. The overall risk of dying in a car crash is 11.5 per 100,000 population per year. If we normalize this to a per week rate (divide by 52), that comes out to 0.22 deaths per 100,000 population per week.
When you compare this to the chance of death from COVID-19, someone in their 20s is half as likely to die of the virus than in a crash. In your late 20s and early 30s, the chance of dying catches up and is about equal to your risk in a car. Beyond age 35, your viral death risk climbs to six times your risk of a traffic death and accelerates from there.
Let that sink in. You are 30 years old and healthy. As you walk out the door today, your risk of dying from COVID-19 is about the same as your risk of dying in a car crash. Granted, that risk is thankfully low, but it is easily and almost completely preventable.
Here is my message to those in their 20s and 30s.
Get vaccinated. Use common sense when you are out in public. I am in no way suggesting we should be on any sort of lockdown. We need to work, attend school and carry on with our lives as best we can. We should be venturing out, we should be starting to resume activities, particularly once vaccinated.
However, until we reach herd immunity and see our numbers drop dramatically, be cautious. Wear a mask in public places. Get out in public but recognize now is not the time to crowd into any sort of indoor venue. Maintain your distance.
When we truly put this threat behind us, I will be the first one at the party.
James T McDeavitt, M.D.
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