Delta variant: we should probably be re-masking

Link post

Like you, I thought I saw the light at the end of the tunnel. It first appeared when vaccines started rolling out a few months back, and got brighter when my family got their vaccine cards signed. It got still brighter as I signed up for my first dose (#ModernaManiacs), got the first shot, waited four weeks, and got my second.

After about a week, a few days after the side effects faded, I stopped holding my breath—literally and figuratively—as people walked past. At two weeks post-second dose, I was “officially” “fully vaccinated.” The light had been reached.

My gym had just started allowing those vaccinated to unmask, and I took them up on the offer. It was science to the rescue, human ingenuity encapsulated in some messenger ribonucleic acid in half a milliliter of lipid suspension in the tip of a single-use syringe. Perhaps for the first time in my life, I was viscerally—if mildly—proud to be an American. We are the world’s biotech capital, after all.

I didn’t pay too much attention at first when the Delta variant hit. The narrative in my Twitter-centered media milieux was pretty simple: “Delta’s gonna kill a lot of unvaccinated people, which sucks, but if you’re vaccinated then you’re safe.”

And then my sister, who like me had gotten the Moderna vaccine, lost her sense of smell.

When her COVID test came back positive, she was only the ~700th confirmed COVID case in New York. Given everything we know about the Delta variant, that was almost certainly the culprit.

On Delta

If you haven’t already, please read Tomas Pueyo’s Delta Variant: Everything You Need to Know. There are a lot of articles out there competing for your attention, but this one is worth your time.

First, the bad news

In short, Delta is probably about 2.5 times more infectious than the OG COVID-19. Here’s what that looks like in the context of exponential growth:


2. Young people like my sister and me are getting infected the most.

3. Preliminary evidence suggests that vaccines aren’t nearly as effective against Delta, reducing infection rates by 64%. By comparison, they seem to reduce OG infections by around 93%.

Some good news

Vaccines are still really effective against serious illness, reducing hospitalization by 96% best we can tell at the moment.

Pueyo thinks that vaccines will be comparably effective against long COVID, bringing the percent of infected people who experience ongoing symptoms down from 15% to ~3%

On long COVID

In my opinion, anyone younger than ~70 and in good respiratory and immune health should be much more worried about long COVID than about death or infection per se. Getting COVID might suck, but a week at home in bed isn’t the end of the world. And the chance of dying, if you’re young and vaccinated, is a rounding error away from zero.

But debilitating, long-term symptoms aren’t out of the picture. Chronic Fatigue Syndrome (CFS) is one of the most serious and mysterious issues in medicine. Although institutional medicine brushed it aside as psychosomatic nonsense for quite a while, it has more recently been taken seriously as a “real” physiological phenomenon—and one often caused by viruses like COVID.

I’m not prepared to explore whether so-called “long COVID” is basically CFS, but they seem quite similar. And, as far as I can tell, death is a lot closer to long COVID in terms of “badness” than is “having a cough for a week.”

Some quick calculations

It seems conservative to estimate that 50% of unvaccinated people will get infected. Let’s take that 64% figure at face value to get of 18% those vaccinated becoming infected. If 3% of these infected cases lead to long COVID or death, we’re looking at 0.54% of vaccinated people suffering a really serious outcome. Maybe it’s lower for the young, but if we take out the 1% fatality rate and leave a 2% long COVID rate, we’re still left with .36%—more than 1 in 300—people like me—young, healthy, and vaccinated—having their lives made considerably worse, possibly for decades.

That means 23 of my fellow 6,300 Georgetown undergrads (we have a vaccine requirement)—people I see in class and in the library—left with debilitating brain fog, fatigue, and exertion intolerance. If we assume that a week with long COVID is as bad as two weeks with acute COVID and these 24 people live an additional 50 years, this is consequentially equivalent to all 6,300 undergrads suffering acute COVID for over a month. Check my math!

I don’t know about you, but this seems pretty bad to me.

And, let me remind you, all this is only for the vaccinated and only for the U.S. Not getting vaccinated may be stupid, but it shouldn’t be a capital crime. 43% of American adults are unvaccinated, and many of them are going to get long COVID or die.

Another light and another tunnel.

Pfizer is already developing a vaccine booster targeted at Delta, and I expect the other pharma companies to as well. More money for them, after all.

I have no idea how long this will take to develop and roll out, but the point is that there’s another light at the end of another tunnel. 23 of my fellow Hoyas don’t have to get long COVID, and thousands of families don’t have to attend yet another premature funeral (although some will, sadly).

Wear a mask.

COVID doesn’t spread by magic; it spreads via respiratory droplets. And you know what prevents respiratory droplets from spreading? You guessed it: masks. Now is not the time or place to relitigate the Great Mask Debacle of early 2020, but lest you forget, public health officials and media outlets regularly spouted bullshit like this:

I don’t have vendetta against Vox—I like Vox! But they screwed this one up.

I fear that the same thing is happening again, to a degree. In the course of trying to make vaccines seem attractive to the unvaccinated, public health and other elite institutions are continuing to insist that vaccinated people don’t need to wear masks. According to the CDC, for better or worse the world’s predominant authority on pandemic dos and don’ts,

If you are fully vaccinated, you can resume activities that you did before the pandemic without wearing a mask or physically distancing…

And people are obliging. At my climbing gym, stocked with health-conscious, affluent, suburbanite Biden voters, virtually no one is wearing one, and climbing inside is anything but a socially-distanced activity.

Of course nobody needs to do anything. But I don’t think the current bare-faced zeitgeist among the vaccinated reflects a dispassionate calculation that the masking up isn’t worth the effort. It reflects the dual influences of top-down guidance and social conformity.

The latter of these influences I can personally vouch for. I started masking up recently, and it feels weird to be virtually the only one. No one brings it up or, probably, even cares, and yet there is a little homunculus in my head that keeps whispering “be self-conscious! You’re not conforming to social norms!”

I bring this up not to signal my independence, but to emphasize how one person’s mask wearing can have social contagion-mediated ripple effects.

I might be wrong, but you should still wear a mask

I might be wrong about something. Maybe Delta won’t be as bad as I think or fear. Maybe vaccines will prove super effective. Maybe boosters will come out faster than expected. Hey, maybe masks don’t work after all!

Even if you suspect I’m wrong, though, how sure are you? 50%? 80%? And, really, what is the cost of wearing a mask? A few bucks and the equivalent in discomfort to wearing your belt half a notch too tight? Forgive my french, but who fucking cares? My sister is OK, thank God, but she could have been one of the unlucky ones left with ongoing symptoms. I could be one of them, and so could you.

Like it or not, we are all social creatures deeply influenced by the norms and customs of our communities. Like you, I thought we had reached a post-COVID-for-the-vaccinated world. Maybe we did, and I hope we will, but now isn’t the time to test our luck.