Baylor College of Medicine

Retirement Was Overrated


July 20, 2021


It was just over a month ago I “retired” from my regular COVID-19 updates. Unfortunately, a lot has changed in that month. I am going to jump back into the punditry pool – hopefully briefly – to help put the Delta-driven changes in our situation into perspective, and in particular to re-emphasize the importance of broader uptake of vaccinations.

Baylor College of Medicine will make vaccination against COVID-19 mandatory soon, after giving everyone adequate time to get the injection(s), and with appropriate medical and religious exemptions. Look for more details to follow very shortly. (Note: Texas state regulations prohibit BCM from requiring vaccination of tuition-paying students. Our students are strongly encouraged to receive the vaccine).

Why now?

We are now in our fourth wave of viral spread. The local and national numbers, which had been dramatically improving, are now trending in the wrong direction. On a seven-day rolling average basis the U.S. is experiencing almost 40,000 new cases per day (likely significantly underestimated, because testing rates are down). This is far worse than our situation a month ago, when we were seeing just over 11,500 cases. However, it is much better than the height of the winter surge when we experienced close to 120,000 cases per day. COVID-19 related admissions are also on the rise. The now-famous Delta variant went from being almost undetectable in mid-April, to holding the top-spot as the dominant variant in the United States today. If you know someone recently infected with the virus, more likely than not it is with the Delta variant. For a succinct summary of the current Delta variant dynamics around the world, I refer you to Dr. Klotman’s excellent summary video from last week.

The local numbers from our TMC institutions have taken a nasty turn. Two weeks ago, we were experiencing an average of 133 new cases in the region per day. Today, 507. Two weeks ago, we were admitting about 50 patients per day with COVID-19. Today that number has doubled, and hospitals are contemplating reopening COVID-19 units. Although we are still well off our January peak, the trajectory is concerning.

This week the Association of American Medical Colleges (AAMC) released a very strong statement “urging [our] member institutions to require vaccination for their employees… for the safety of our patients, communities, health care personnel, faculty and students.” The AAMC is the main representative organization of medical schools and teaching hospitals. It is worth reading the brief announcement in its entirety.

Broader adoption of vaccination is clearly the most important collective action we can take to control the spread of the virus, fully resume normal activities and protect the most vulnerable among us. I harbor no illusions that anything I can write at this point will convince the unvaccinated to take the (safe, easy, effective and free) injection. However, if you are reading this I hope you can still make a difference. If you are close to someone who remains hesitant, they are unlikely to take the plunge based on TV talking heads or social media postings. Many can and will come around based on thoughtful and respectful dialogue with people they know and trust: their physician, their family, their friends. To that end I would like to finish by providing you with a few simple talking points to include in your dialogue with others.

Vaccines are highly effective (Part I). Nationally, the rise in hospitalizations has been driven largely by patients who have not been vaccinated. The fact remains: if you are vaccinated, you are relatively safe; if you are unvaccinated you remain at risk. We are seeing “breakthrough” Delta-driven infections in the vaccinated, but these almost always cause mild disease – cold-like symptoms. Vaccinated, your likelihood of winding up in a hospital is very low.

Vaccines are highly effective (Part II). I spent much of my Saturday trolling through the CDC website looking at viral dynamics around the country. Here is an illustrative example of the current outbreak dynamics. Currently, Vermont has the highest concentration of vaccinated people (67% fully vaccinated), and Alabama the lowest (34%). Does this make a difference? Clearly. Over the past seven days, Alabama has experienced 901 new COVID-19 cases. Vermont? Eight. How about hospital admissions? Alabama: 65 admissions per day. Vermont? Zero. Finally, deaths over the past seven days due to COVID-19? Alabama: 41. Vermont: zero. You could rightly point out that Alabama has a much higher population than Vermont, but even when corrected for population, the rate of new viral cases is more than ten-fold greater in the lightly-vaccinated Yellowhammer State, compared to the well vaccinated Green Mountain State.

Vaccines are extremely safe (your personal thought experiment). The U.S. has currently administered 338 million vaccine doses. Serious side effects have been extraordinarily rare. Rather than review the statistics again to support your personal risk-benefit analysis, do the following thought experiment. Get some paper and a pencil. Reflect for a moment on all the people you know – direct contacts, or friends of friends – who received the vaccine. Write down the names of everyone who had a severe reaction. By “severe reaction” I mean a reaction that resulted in hospitalization or major negative health impact. People with the common and transient body aches, low grade temperature and fatigue should not be on your list. By “people you know” I mean those you actually know. Real acquaintances with names, not someone you read about on Twitter or heard about from the infotainment media.

The people on my list: zero. If you performed the exercise as described above, the overwhelming majority of people reading these words will produce the same result. Zero. Significant vaccine complications from our 338 million injections are extraordinarily rare.

Now repeat the exercise but write down the names of people you know – really know – who had a serious bout of COVID-19 and died, required hospitalization or experienced weeks or months of disability. Virtually everyone will have a least one name on your list. I have five, including one member of our extended family in his early thirties.

Your personal experience reflects the underlying data: unvaccinated, your risk of a bad outcome from COVID-19 far eclipses your risk from the injection. In your risk-benefit analysis, the protective benefit of the vaccine far outweighs the risk of vaccination. It is not even close.

Please continue to discuss vaccination with people in your circle of influence. In the meantime, Baylor will move towards mandatory vaccination, and I hope others will follow. Our organizational decision is evidence-based, and a step we take (echoing the AAMC) for the safety of our patients, communities, health care personnel, faculty and students.

Stay well.

James T McDeavitt, M.D.

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