Thu 2021-Jul-29

# Anger Among the Vaccinated

Somebody asked me why vaccinated people in the US seemed to be always so angry at the unvaccinated. Hmpf.

## So… are the vaccinated angry?

Damn right, we are!

Here we’ve been doing the right things: masking, social distancing, getting vaccinated, remote work when possible, and so on. It’s been hard, but it’s doable for the most part. (Special sympathy for essential workers, or those in miserable jobs where they can’t avoid contact, and so on.)

But the knuckleheads who think COVID is a hoax, or that it’s caused by 5G networks, or that the vaccine will sterilize you or microchip you or magnetize you or give you the Mark of the Beast or… it just makes me feel ill to go on. They’re the ones holding back the economy; they’re the ones on the side of the virus helping it breed new variants; they’re the ones poisoning each other’s minds with nonsense.

A recent NYT article [1] sums it up (before diving into endless anecdotes, as is the wont of most reporters):

As coronavirus cases resurge across the country, many inoculated Americans are losing patience with vaccine holdouts who, they say, are neglecting a civic duty or clinging to conspiracy theories and misinformation even as new patients arrive in emergency rooms and the nation renews mask advisories.

The country seemed to be exiting the pandemic; barely a month ago, a sense of celebration was palpable. Now many of the vaccinated fear for their unvaccinated children and worry that they are at risk themselves for breakthrough infections. Rising case rates are upending plans for school and workplace reopenings, and threatening another wave of infections that may overwhelm hospitals in many communities.

And if that’s not enough for you, consider the thoughts of Thanh Neville, an ICU physician at UCLA, writing in HuffPo [2]:

My experiences in the ICU these past weeks have left me surprised, disheartened, but most of all, angry.

I am angry that the tragic scenes of prior surges are being played out yet again, but now with ICUs primarily filled with patients who have chosen not to be vaccinated. I am angry that it takes me over an hour to explain to an anti-vaxxer full of misinformation that intubation isn’t what “kills patients” and that their wish for chest compressions without intubation in the event of a respiratory arrest makes no sense. I am angry at those who refuse to wear “muzzles” when grocery shopping for half an hour a week, as I have been so-called “muzzled” for much of the past 18 months.

I cannot understand the simultaneous decision to not get vaccinated and the demand to end the restrictions imposed by a pandemic. I cannot help but recoil as if I’ve been slapped in the face when my ICU patient tells me they didn’t get vaccinated because they “just didn’t get around to it.” Although such individuals do not consider themselves anti-vaxxers, their inaction itself is a decision – a decision to not protect themselves or their families, to fill a precious ICU bed, to let new variants flourish, and to endanger the health care workers and immunosuppressed people around them. Their inaction is a decision to let this pandemic continue to rage.

And it’s not just a few people here, a few people there. It’s very specifically the American South and the Mountain West. Take a look at the map on the right from the CDC COVID tracker project [3], showing degree of community spread at the county level in the US. Remember where the Confederacy was in the US Civil War? They never really went away, you know. They’re just the Repubican base now. Very Republican, and very base.

Paul Krugman, the 2008 Nobelist in economics with a part-time columnist gig at the New York Times, put it succinctly [4]: COVID has become a red-state crisis, and they’re trying to drag down the rest of us with them:

• 47% of Republicans say they’ll refuse vaccination, versus 6% of Democrats
• As we’ve shown here before (a couple of times), Krugman confirms the strong negative correlation between Trump voting and vaccination.
• There is strong geographic concentration, as the map shows. Krugman points out that New York City has 5 COVID patients hospitalized per 100,000 people; Florida has 34. That’s almost 7x greater! Florida governor DeSantis has barred businesses from requiring proof of vaccination, which is just feeding people into the red-hot jaws of Moloch.

The places needing NPI (Non-Pharmaceutical Interventions, like masking) on top of vaccination are almost surely the ones that will shout “Freedumb!” and refuse.

## Variants

In the meantime, the virus is honing its skills at infecting people. Because of course it is. The Delta variant is extremely contagious, to the point where once it gets a foothold, it outcompetes all the other strains and becomes virtually the only strain infecting a population.

Consider this graph at right, from CoVariants.org. [5] It shows the prevalence of the different variants as a function of time, in the US. The Delta variant is in green. Note that, since its introduction in April 2021, it has driven out all other COVID variants.

So there’s your evidence that the Delta variant is way worse than the others in terms of infection rate: it’s driven the others to near-extinction.

You don’t want to mess with it. If you’re unvaccinated and haven’t already had COVID-19, then you will get the Delta variant of COVID-19. You don’t want that; there’s evidence that mortality is also worse with Delta.

Your best alternative is to get vaccinated.

## Beginnings of Breakthrough Infections

From the New England Journal of Medicine comes yet another Israeli study of breakthrough COVID-19 infections in healtcare workers. [6] They began receiving vaccinations in late 2020, so this is basically looking back at a 6 month period.

• Now, healthcare workers are not typical COVID risk compared to the rest of us civilians: they are exposed, over and over, every day, to patients with severe COVID. So any risk we see here will be higher than you or I might experience.
• On the other hand, over the period of the study, the Alpha variant (B.1.1.7) was dominant (about 85% of the samples). So that’s less risk than you or I might experience.

The first result: out of $N = 1497$ fully vaccinated healthcare workers, they observed 39 SARS-CoV2 breakthrough infections. Crudely, that’s a rate (or probability/unit time) of:

$\frac{dp_{\mathrm{COVID}}}{dt} = \frac{39}{1497} = 2.6\% / 6\mathrm{ months}$

Using our usual method of posterior Beta distributions to estimate a 95% confidence interval on this, we get:

> qbeta(p = c(0.025, 0.975), shape1 = 39 + 1, shape2 = 1497 - 39 + 1)
[1] 0.01914348 0.03541974


That’s pretty good, really: 2.6%/6 months (95% CL: 1.9% – 3.5%).

What’s got people squirming somewhat uncomfortably, though, is the rate of “long COVID”. They defined this as > 6 weeks of symptoms. Here they lost 3 patients to follow-up, known in the biz as “censoring”. (Though they don’t make this obvious: you have to dig into the supplementary material, page 5, to find this out!) So their rate of long COVID is an eye-popping:

$\frac{dp_{\mathrm{longCOVID}}}{dt} = \frac{7}{36} = 19.4\% / 6\mathrm{ months}$

That’s a scary large number! But it’s only 36 patients, so we really should estimate the 95% confidence interval to see how seriously to take it:

> qbeta(p = c(0.025, 0.975), shape1 = 7 + 1, shape2 = 36 - 7 + 1)
[1] 0.09826564 0.35155238


So that’s a nice wide 95% confidence interval, from 9.8% – 35.1% over 6 months of observations. In fact, it’s wide enough to make this not terribly meaningful: they’ve shown long COVID in breakthrough cases can happen, but we don’t have much information on how often beyond a vague sense that it might be more than we’d like.

That’s what exploratory studies are like, with very small samples. But now somebody else can use this to design an adequately powered study of long COVID breakthrough infections, and this can guide them about the number of patients to follow.

## The Weekend Conclusion

Yeah, we vaccinated folk are mad at the willfully unvaccinated folk. (Those who are unvaccinated for valid medical reasons like immunosuppression or cancer treatment of course get a pass, and our sympathy.) The unvaccinated are prolonging the pandemic, breeding variants, and just generally damaging the lives of everybody else… for no good reason.

## Notes & References

1: RC Rabin, “As Virus Cases Rise, Another Contagion Spreads Among the Vaccinated: Anger”, New York Times, 2021-Jul-27.

2: T Neville, “I’m An ICU Doctor And I Cannot Believe The Things Unvaccinated Patients Are Telling Me”, Huffington Post, retrieved 2021-Aug-01.

3: Centers for Disease Control, “COVID-19 Integrated County View”, CDC COVID-19 Data Tracker, retrieved 2021-Jul-29.

4: P Krugman, “How Covid Became a Red-State Crisis”, New York Times, 2021-Jul-29.

5: EB Hodcroft, “CoVariants: SARS-CoV-2 Mutations and Variants of Interest”, CoVariants.org, retrieved 2021-Jul-29.

6: M Bergwerk, et al., “Covid-19 Breakthrough Infections in Vaccinated Health Care Workers”, New England Journal of Medicine, 2021-Jul-28.

Published Thu 2021-Jul-29

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