Biden: We shouldn't see much of a surge in hospitalizations and deaths -- but wear that mask anyway


Yeah, I don’t know. I grasp the point: The fact that so many people are vaccinated means we’re destined to see fewer severe cases in a new wave, but we might see even fewer if we mask up and reduce transmission further. Every little bit of precaution helps when you’re facing the most contagious variant yet. Masking the vaccinated is about slowing the spread, according to Ron Klain.

Anyone who starts vaccination today isn't fully protected from the virus for six weeks. Also, CDC is concerned that even vaccinated people MIGHT transmit Delta: you are masking to slow the spread.

— Ronald Klain (@WHCOS) July 29, 2021

But to someone who follows COVID news casually, telling them that the next wave won’t be so bad but that the vaccinated should mask up anyway is hard to grok. If the vaccinated are safe and the new wave won’t be dire, why not keep on rocking maskless?

Good luck with this message, Joe:

Pres. Biden on delta variant: "Cases will go up further before they start to come back down."

"But while cases are on the rise, we're not likely to see, according to experts, a comparable rise in hospitalizations or deaths in most areas of the country." https://t.co/59tsvc7M0Y pic.twitter.com/ROYIqtVWyD

— ABC News (@ABC) July 29, 2021

Two and a half months ago, before Delta, he put out this video. Hoo boy:

Folks, if you’re fully vaccinated — you no longer need to wear a mask.

If you’re not vaccinated yet — go to https://t.co/4MYpWqXVVo to find a shot, and mask up until you’re fully vaccinated. pic.twitter.com/qcyG2WyCG2

— President Biden (@POTUS) May 13, 2021

If you think Biden and the CDC are being overcautious in asking the vaccinated to mask indoors, be advised that Surgeon General Vivek Murthy suggested today that they might want to mask outdoors too.

Didn’t scientists already all basically agree that the virus isn’t spreading outdoors? Did I hallucinate that? Or is this another post-Delta change to the science?

“So the people that we’re most concerned about are the unvaccinated,” Murthy said when Mitchell asked him about potential spread of the virus between vaccinated people. “For example, if you happen to have a lot of interaction with folks who are unvaccinated, let’s say you’re a parent like me who has young children at home who are not vaccinated, that’s a circumstance where we’re being extra cautious and wearing that mask even if you’re fully vaccinated, wearing it outside, when you’re in indoor public locations, is an extra step to protecting those at home.”

Why the hell are the surgeon general and the CDC on different pages when it comes to outdoor masking?

We won’t see the mystery data on which the CDC based its new mask guidance until tomorrow but ABC think it has to do with a nasty and unusual outbreak in Provincetown, Massachusetts.

[W]ithin weeks, health officials seemed to be on to something much bigger. The outbreak quickly grew to the hundreds and most of them appeared to be vaccinated.

As of Thursday, 882 people were tied to the Provincetown outbreak. Among those living in Massachusetts, 74% of them were fully immunized, yet officials said the vast majority were also reporting symptoms. Seven people were reported hospitalized

Before Provincetown, health officials had been operating under the assumption that it was extraordinarily rare for a vaccinated person to become infected with the virus. And if they did, they probably wouldn’t end up passing it on to others, such as children too young to qualify for the vaccine or people who were medically vulnerable.

There’s nothing in ABC’s story about the viral load in the Provincetown patients or evidence of a vaccinated person infecting others, but it’s surprising to hear that so many vaxxed people got sick enough to experience symptoms. One would assume that if you have enough virus active in your body to cause you fever or chills or whatever, you also have enough n your nose and throat to infect someone else. We’ll see what the data says tomorrow, but the CDC is concerned enough about the vaccinated becoming vectors for Delta that they’re now asking them to get tested if they know they’ve been exposed to someone who’s infected, even if they’re asymptomatic. The guidance before Delta was that the vaccinated didn’t need to worry about that anymore.

The CDC and White House aren’t talking much about the threat Delta might pose to the vaccinated, focusing instead on the risk that an infected vaccinated person might present to someone who’s unvaccinated. If they tell the country that you can still have a difficult course of illness even after you’ve gotten your shots, that might discourage holdouts from getting immunized. But there’s some evidence from Israel that a minority of the vaccinated can have lingering symptoms:

Of the 39 cases of [breakthrough] infection, 27 occurred in workers who were tested solely because of exposure to a person with known SARS-CoV-2 infection. Of all the workers with breakthrough infection, 26 (67%) had mild symptoms at some stage, and none required hospitalization. The remaining 13 workers (33% of all cases) were asymptomatic during the duration of infection; of these workers, 6 were defined as borderline cases, since they had an N gene Ct value of more than 35 on repeat testing.

The most common symptom that was reported was upper respiratory congestion (36% of all cases), followed by myalgia (28%) and loss of smell or taste (28%); fever or rigors were reported in 21% (Table S1). On follow-up questioning, 31% of all infected workers reported having residual symptoms 14 days after their diagnosis. At 6 weeks after their diagnosis, 19% reported having “long Covid-19” symptoms, which included a prolonged loss of smell, persistent cough, fatigue, weakness, dyspnea, or myalgia. Nine workers (23%) took a leave of absence from work beyond the 10 days of required quarantine; of these workers, 4 returned to work within 2 weeks. One worker had not yet returned after 6 weeks.

The sample here is small, just 39 vaccinated people who had breakthrough infections out of a group of 1,497, a rate of 2.6 percent. And among those 39, only a fifth had lingering symptoms. But if it’s true that one in five breakthrough infections produces “long COVID,” that’s potentially hundreds of thousands of vaccinated people across the U.S. population even though any random vaccinated person’s individual odds of having it happen to them is very low.

At least there was some good news from today’s presser:

"We can and we must open schools this fall," Pres. Biden says, "we can't afford another year out of the classroom. Every school should be open." pic.twitter.com/UV77sru7nR

— CBS Evening News (@CBSEveningNews) July 29, 2021

I sympathize with the point Noam Blum made about masking earlier this afternoon: “Mask mandates for the vaccinated make it safer for the unvaccinated to remain unvaccinated. It punishes those who got the vaccine and rewards those who didn’t. You’re just making it easier for them to not get covid without getting vaccinated. A stick for us and a carrot for them.” That’s true, and I continue to think that there shouldn’t be any mandatory masking. Make it clear to the vaccinated that they’re at risk of infecting others and let them choose their own course. But: (1) There are still 20 percent of senior citizens who are unvaccinated due to their own foolishness and (2) most of those senior citizens are family, not strangers, to someone who’s been immunized. I have two relatives myself who are over 70 and have been pigheaded in refusing to get their shots. As much as that annoys me, I appreciate knowing that I might pose a risk to them if I get infected even though I’ve been vaccinated. I don’t care particularly about what happens to strangers who’ve assumed the risk of a fatal infection by not getting immunized but I do care about family. I’ll take precautions to protect relatives from their own poor choices.

And let’s face it, it’s family whom senior citizens spend most of their time around. If the CDC is worried about unvaxxed grandmas and grandpas being infected by their own vaxxed children then it was right to sound the alarm about risk. Whether it was also right to nudge states towards issuing new mask mandates is another matter.

Speaking of sticks and carrots, I’ll leave you with the heart of Biden’s remarks today, in which he announced a mandate for federal workers and contractors to either get vaccinated or tested regularly. There are some good ideas here, from encouraging states to pay vaccine holdouts (which I resent but will grudgingly tolerate if it works) to encouraging employers to give workers time off to get their shots. That’s important, and has been overlooked as a major barrier to vaccination. Many people just don’t think they can afford to lose a day off from work if they end up being laid up by side effects. Tell them that they can get paid anyway and they might flip.

President Biden: "Today, I'm calling on all states and local governments to use funding they have received, including from the American Rescue Plan, to give $100 to anyone who gets fully vaccinated…If incentives help us beat this virus I believe we should use them." pic.twitter.com/ulQW08tPmX

— CSPAN (@cspan) July 29, 2021