The seven-day moving average for COVID-19 deaths in the United States is around 1,800, the same as in early December 2020, before any vaccines were authorized for emergency use. How is that possible, 10 months after safe and effective vaccines began to be administered?
It's due to a combination of three interrelated factors: the Delta variant's increased transmissibility and virulence; the degree of immunity in the population, which is a function of both the efficacy and durability of the vaccines; and the decisions of individuals and policymakers. Peoples' reluctance to get the COVID-19 vaccine – what's known as "vaccine hesitancy" – has played a large role in the nation's failure to reach herd immunity. As of Oct. 6 the U.S. population is only 56.4% fully vaccinated, which makes us 41st most vaccinated in the world, despite being the headquarters of vaccine development for all three FDA-approved vaccines.
Over the course of the pandemic, the goal of COVID-19 vaccine has evolved; originally it was intended to prevent symptomatic infections (the criterion for efficacy in the clinical trials). With widespread vaccination, we are now seeing so-called "breakthrough" infections (mostly mild) in vaccinees, but the vaccines have been highly effective at preventing hospitalizations and deaths.
Misinformation is rife and has its roots both in domestic political activism and insidious foreign propaganda. Much of the anti-vaccine sentiment is the product of what can only be described as an industry, the principal protagonists of which are an organized group of professional propagandists. As reported in the science journal Nature, they are people "running multi-million-dollar organizations, incorporated mainly in the United States, with as many as 60 staff each." Some of the most prolific were identified by the Center for Countering Digital Hate, which found that a small number of people, the "Disinformation Dozen," produce 65% of the shares of anti-vaccine misinformation on social media platforms.
Some of the misinformation about vaccines comes from an unobvious source: the Russian government's propaganda apparatus, which seeks to promote misinformation in the United States via social media. This preceded the COVID-19 pandemic. A study published by academics in 2018, "Weaponized Health Communication: Twitter Bots and Russian Trolls Amplify the Vaccine Debate," found that thousands of Russian social media accounts were spreading anti-vaccine messaging. From an examination of almost 2 million tweets posted between 2014 and 2017, the researchers found that Russian troll accounts were significantly more likely to tweet about vaccination than were Twitter users generally. They noted that Russian tweets like, "Apparently only the elite get 'clean' #vaccines. And what do we, normal ppl, get?!" seem intended to exacerbate socioeconomic tensions in the United States.
Russia is at it again now, in earnest. Using online publications to raise concerns about the rapidity of the coronavirus vaccines' development and their safety, they have been conducting an aggressive campaign to undermine confidence in the Western coronavirus vaccines. Although it's unclear what percent of online anti-vaccine propaganda and resulting vaccine hesitancy stems from Russian interference, its impact is very real in prolonging the pandemic and causing morbidity and mortality.
A frequent trope of this propaganda is that a pandemic whose infections have a 99.7% survival rate isn't a big deal – but even a small percentage of deaths is significant when the number of cases is huge. The U.S. passed 700,000 deaths a week ago.
Moreover, there is a high incidence of persistent symptoms after the acute COVID-19 infection. A poorly understood and poorly defined syndrome called Long COVID can result even following mild cases of the virus. The costs of preventable COVID hospitalizations are huge, as will be the downstream costs of treating millions of people for persistent post-COVID symptoms and, especially, Long COVID.
Every COVID infection is marked by viral replication and the appearance of new mutants which are then tested for "evolutionary fitness" – that is, higher transmissibility – by Darwinian selection. Therefore, as unpleasant as mask and vaccine mandates and other strictures may be, in order to curb the current pandemic and prevent the emergence of a new, worse variant(s), we need to continue to "flatten the curve" of infections with aggressive vaccination and non-pharmaceutical interventions (NPIs).
The current surge in COVID cases has also strained hospitals, which were already overburdened after a year-and-a-half of an ongoing pandemic. With intensive-care units in COVID-19 hotspots operating at maximum capacity, people who come to emergency rooms for things such as heart attack, stroke, appendicitis, or after trauma, can find themselves without a bed. An Alabama man with heart failure recently died after 43 hospitals turned him away due to lack of ICU bed space. Public health officials in Alaska have activated the state's emergency crisis protocols, allowing 20 medical facilities to ration care if needed.
One unobvious issue that concerns the shortage of ICU beds is that some hospitals are significantly over ICU capacity. How does that happen? They've converted their step-down units, which normally have monitoring, etc., for people such as post-heart attack patients, to makeshift ICUs: putting ventilators, sophisticated monitoring, and other equipment in them, but lacking adequate staff. Thus, with ICUs overloaded, the quality of care overall suffers, with the doctors, nurses, respiratory therapists, EKG techs, and other specialists all spread much thinner than normal.
Beyond the impacts of the COVID-19 Delta surge in our hospitals and social media accounts, there are also longer-lasting effects on the U.S. economy. For example, with globalized supply chains disrupted due to local COVID outbreaks, semiconductor production has slowed, halting car manufacturing at automakers around the world. In other industries, such as durable goods, the replenishment of depleted inventories is slow due to delays at ports. Many Americans are so concerned about the availability of merchandise for Christmas shopping that, according to a survey by CreditCards.com, 27% of holiday shoppers planned to begin buying gifts before the end of September – and that includes 13% who started or planned to start in August!
Early on in the pandemic, Federal Reserve Bank Chairman Jerome Powell predicted that the full recovery of the U.S. economy would hinge on COVID-19 vaccine uptake. In April of this year, he added that global vaccination efforts are "not only the right thing to do" but "also the smart thing to do."
With hospitals and global supply chains strained, and no end of the pandemic in sight, vaccine uptake is a critical part of reaching a post-pandemic world in which the SARS-CoV-2 virus and COVID-19 become endemic – that is, persisting in the population, but at a manageable level. We've previously written about the need for health communications messaging that addresses people's core values and speaks directly to their concerns, but also convinces them to do what's in their – and society's – best interest.
Sheeva Azma, a freelance science writer and editor, digital content strategist, and communications professional, is the founder of science writing company Fancy Comma, LLC. Henry I. Miller, a physician and molecular biologist, was the co-discoverer of a critical enzyme in the influenza virus and the founding director of the FDA's Office of Biotechnology.