From the dangerous front lines of public health

Last Friday, a man shot up the Centers for Disease Control buildings [gift] near Atlanta. The shooter is dead and so is a policeman who apparently got in his way. Investigators have not yet reported what they think went down. According to the shooter's family, he was suicidal and fixated on vaccines. Law enforcement officers found several long guns near his body. 

This violent attack was neither random -- nor, fortunately, effectually targeted. 

The attack also raised understandable questions about Donald Trump's Secretary of Health and Human Services, the COVID vaccine denier Robert F Kennedy Jr. Mr Kennedy said appropriate words about the shooting at one of the institutions he "leads," but who can believe him? 

Dr. Katelyn Jetelina, MPH PhD, writes the substack Your Local Epidemiologist sharing information and reflections on the state of the practice of public health. She explains from the perspective of the workers:

The hardest-hit area was the National Center for Immunization and Respiratory Diseases (NCIRD) and the Immunization Safety Office (ISO). These are people who have carried a lot of the weight of the pandemic, endured relentless hostility, and have faced six months of attacks on vaccine policy. Many have almost no reserves left. And now, on top of everything, they were literally under fire.

Those bullet holes are a haunting, terrible metaphor for what public health has endured over the past six months—and the past six years.

We’ve endured doxxing, hacking, strangers at our homes, death threats in our inboxes, croissants thrown at us in coffee shops. Installing a new security system just because we volunteer for something or show up on TV. Wearing heart monitors because our cortisol levels have started impacting our organs. Deciding not to put our kids in daycare at the CDC campus because it may be targeted. Then firings. Defunding. Politically charged and targeted rhetoric.

And now a shooting happened. It could have been much worse if it weren’t for a police officer—who left behind three kids of his own—making the ultimate sacrifice. This doesn’t make it any less scary.

 Jetelina continues, trying to make sense of the atrocious and inexplicable.

One question keeps coming up from colleagues in my text messages: Why do we keep doing this [keep working in public health]?

I know why. Because people in public health care too much about our country to stop. Because we care about our kids’ futures. Because we believe in a better life. Better community. Better health. We will serve our neighbors even if they don’t understand what we’re doing or why it matters. It’s in the blood of public health workers, woven into every late night, every hard decision, every moment we choose service over family or safety, whether it’s running into an Ebola outbreak or writing a policy brief.

In the next week, the glass will be patched, the windows replaced, the bullets swept from the floor. And this story (which has barely made the news) will vanish. But the trauma, the fear, the exhaustion will remain.

We’ll go back to our desks, our meetings, our spreadsheets. We’ll keep working to stop the spread of disease. We’ll keep working to prevent the next shooting. We’ll keep working for communities that may never know our names.

And we’ll do it knowing we were targeted simply for doing our jobs, jobs that protect even the people who hate us.

But make no mistake: this cannot be the cost of caring. We need more than patched glass. We need a country that values the people who protect it, recognizes the importance of words and their real-world consequences, and values community and neighbors, not just self. Now. Before the next shot is fired. 

• • •

The Atlanta CDC campus appears to be an expanse of fine modern glass and steel buildings, now complete with bullet holes. But somehow this story brought to mind this neighborhood vaccination station set up in the Bayview district of San Francisco in May 2021. A picture of Public Health, indeed!

A righteous rant ...

I reproduce here a righteous rant from Simon Rosenberg. His Hopium Chronicles project may be a little too Democratic Party-oriented for the taste of most of my friends. But you got to love that he activates people, in the style of, and in homage to, FDR and Harry Truman.

I've made this a little easier to read:

In these first six terrible months of Trump they have told us who they are and what they want - they want our country to be poorer, weaker, less safe, less healthy and less free. 

The agenda is clear. There is no American greatness or a better tomorrow. Their way is a diminished country, with fewer opportunities for our people, an end to our democracy, and a nation less able to chart our course in a competitive world. They want for more them and less for all of us. They cannot run away from who they are and what they are doing. There isn’t any way to put lipstick on this Trumpian pig. 

And unlike 2024 we cannot shirk from our responsibility to tell this part of the story. 

For the first step in defeating Trumpism is to make sure every voter available to us understands exactly who they are and what they mean for our nation’s future. 

The passage of the Big Ugly [Budget Bill] gives us an opportunity to go tell this bigger story about this rancid agenda of sabotage, plunder and betrayal. We are no longer limited in our comms and story telling to the elements of the big ugly. We must now in fact integrate the elements of the big ugly into their broader agenda and attack it on all fronts. They have betrayed us and we can and must find a better way, together. 

• The tragedy in Texas has started a national debate about their “more for me, less for all of you” agenda. 

• The return of measles has given us an opportunity to talk about their assault on our health care. 

•Trump’s ongoing tariff fiasco allows us to talk about his core betrayal of working people by raising prices not lowering them. 

• His attempt to create a secret police gives us an opportunity to talk about his authoritarian fantasies and abandonment of the Constitutional order here in American. 

The upcoming debate over Congress’ Fiscal Year 2026 budget gives us an extended opportunity to explain the harms of their agenda to the American people. 

Democrats in state and localities across the country can start to immediately organize town halls, hearings and other community conversations to talk to their constituents about what the Big Ugly and the broader GOP agenda means for them (and we need to help them do this). 

For it is no longer notional or a promise. It is here. 

And people are dying. The economy is slowing. Prices are rising. Our debt is exploding. 

Masked men are disappearing people into foreign and domestic gulags. Measles has returned. 

The world is laughing at us. 

They’ve given themselves huge tax cuts while levying one of the largest tax increases in history on working people. 

Our leader is a fucking painted clown, a joke, an impulsive and out of control fool, being enabled by unprecedented cowardice in what was once the Party of Lincoln and Reagan. ...

What else, Simon? Unfortunately, there's always more when a conman is dependent on hyping up a base of the vengeful and deluded.

They want to reinvigorate HIV and kill more people

Mostly poor and Black people ...

Amid the general carnage of the Trump coup against American government, it's easy to get lost in a recital of horrors. But here's one that feels awfully familiar. 

Click to enlarge. Marked for death.

The administration has brutally shut down PEPFAR, the global program launched by George W. Bush to limit the further spread of HIV, the virus that causes AIDS. Yesterday recipients around the world were ordered to shut down and not even distribute anti-HIV drugs already in their possession. Here's the NY Times:

The Trump administration has instructed organizations in other countries to stop disbursing H.I.V. medications purchased with U.S. aid, even if the drugs have already been obtained and are sitting in local clinics.

... Appointments are being canceled, and patients are being turned away from clinics, according to people with knowledge of the situation who feared retribution if they spoke publicly. Many people with H.I.V. are facing abrupt interruptions to their treatment.

But most federal officials are also under strict orders not to communicate with external partners, leading to confusion and anxiety, according to several people with knowledge of the situation.

... Without treatment, virus levels in people with H.I.V. will quickly spike, hobbling the immune systems of the infected people and increasing the odds that they will spread the virus to others.

About one in three untreated pregnant women may pass the virus on to their babies.

Interrupted treatment may also lead to the emergence of resistant strains that can spread across the world.

One study estimated that if PEPFAR were to end, as many as 600,000 lives would be lost over the next decade in South Africa alone. And that nation relies on PEPFAR for only 20 percent of its H.I.V. budget. Some poorer countries are almost entirely dependent on the program.

This is premeditated murder.   

UPDATE, January 29: The PEPFAR cancellation has been momentarily rescinded, but the coup by the President and his tech bro handlers continues. The KnowNothings rule.

It's still COVID!

When an election turns on very small margins, everyone who thinks they know why a shift in voter preferences happened can plausibly make a case for their opinion. And Donald Trump's victory over the Harris-Walz ticket was small:

Trump’s margins — both in raw votes and in percentages — were small by historical standards, even for the past quarter century, when close elections have been the rule, including the 2000 Florida recount election and Trump’s previous two races in 2016 and 2020. ... PBS

Sure, there was some movement away from Dems everywhere -- but also Dem candidates, especially for the U.S. Senate, did well in even in battleground states and the lower House of Congress remains almost evenly split.

So observers are still largely in "pick your poison" mode for explanations.

And I'm sticking to mine: the experience of COVID and COVID polarization somehow tossed many Americans off-center and we're still addled by a lingering awareness that our trust in how the world works could be upended by a germ -- or something else unknown and unforeseen.

David Wallace-Wells has chronicled how COVID and COVID politics have shaped our memories of living through the pandemic. His account might surprise you:

The story is this. When Covid arrived on American shores, the United States did not have to collapse into Covid partisanship, with citizen turning against citizen and each party vilifying the other as the source of our national misery. Instead, political leaders could have moved forward more or less in unison, navigating epidemiological uncertainties unencumbered by the weight of the culture war.

You may be laughing, but this is actually a pretty good description of what genuinely happened in the spring and summer of 2020, despite how you may remember those days now. Back then, the president was a lightning rod who seemed to polarize the country’s response all by himself, although he had rhetorical help from podcasters and radio hosts, governors and members of local school boards. But at the state and local levels, for many months, red and blue authorities moved in quite close parallel. For the most part, red and blue people did, too. ...

Present divisions came along later, with the development of vaccines (delivered to arms, though not invented, during the Biden term) and the higher mortality, especially in red states, in the pandemic's second year.

And from there, we got to where we are now, with Donald Trump appointing health authorities whose prominence was raised by distress about COVID. Here's David Wallace-Wells again.

[Robert F. Kennedy Jr.] owes his current selection to pandemic backlash and the intuition, in Trump world, that Covid contrarians should be drafted into a broad insurgency against the institutions of science. ... the others named for top public health posts, though not transparent cranks, are also Covid contrarians whose most important qualification for these positions are their crusades against the public health establishment during the pandemic period: Stanford’s Jay Bhattacharya to lead the National Institutes of Health, and Johns Hopkins’s Marty Makary to run the Food and Drug Administration. Dave Weldon, Trump’s pick to oversee the Centers for Disease Control and Prevention, was a vocal vaccine skeptic long before the pandemic.

... Democrats have grown increasingly invested in, and identified with, the management style and worldview of the credentialed elite — with the Republicans, once the party of the country’s establishment, growing a lot more unruly as a party and a coalition.

But there are a few things that are nevertheless strange about what Benjamin Mazer called “The COVID-Revenge Administration” and the way its are united primarily by a “lasting rage” about the initial handling of the pandemic.

The first is that the federal pandemic response was actually supervised by Trump and many of those whom he appointed, the first time around. Americans often tell the story of Covid now as though our pandemic response was run by safetyist liberals in an unreasonable panic. But while Trump was remarkably indifferent to Covid in 2020, he was also, for the entire period we now remember erroneously as “lockdown,” in charge. (Americans often remember that period as stretching for multiple years; in fact, all but one state withdrew its stay-at-home orders within three months.)

The second is that, nearly five years on from the first reported Covid case, it’s not clear to what extent the public as a whole really did hate the country’s initial response to Covid. America exited the pandemic emergency into a period of post-pandemic exhaustion and frustration, one that undoubtedly contributed to public irritation with those liberals many Americans understood to be in charge....

Click to enlarge.Via Kevin Drum

... And the third is that, early in the pandemic, many of the leading Covid contrarians, including some of those now at the top of Trump’s short list, were among the most inaccurate voices making claims about what were then probably the two simplest and most important questions facing anyone trying to right-size the pandemic response. Namely, how bad things could get and how long it might last.

... at the outset, many of the most outspoken contrarians — today claiming vindication, complaining about censorship even after building huge social-media followings during the pandemic, were telling us that the most important thing to know about the pandemic was that it was simply not a big deal.

Over the course of the pandemic, many continued to argue against restrictions, even as they’d lessened considerably, and even as the disease made a mockery of their predictions about its ultimate toll. In time, the American public has in some ways grown more sympathetic — forgetting the panic of the initial months, taking somewhat for granted that the death toll would land near where it did and assessing the wisdom of those mitigation measures as though they had no effect on mortality at all. (As it happens, some research suggests that those measures could’ve saved hundreds of thousands of American lives.)

But to suggest that mitigation was pointless because the measures were ineffective in preventing mass death is functionally the opposite of arguing that it was pointless because so few lives were at stake. ...

“The problem with pandemics is that people want to forget them,” Michael Lewis wrote last spring in the foreword to “We Want Them Infected.” Of course, many people do want to forget, and understandably. But others want to litigate and relitigate and relitigate, and in some ways the imbalance of motives may be a bigger problem than pandemic amnesia itself, allowing those with the sharper critiques to furnish the frameworks that the otherwise indifferent grasp for when trying to make sense of their own experience. ...

We're all a little nuts when it comes to the pandemic and, for the moment, the anti-expertise side of various arguments is getting a turn in the sun. Let's hope we don't come to grief during their ascendancy.

 Dr. Leana S. Wen responded to the questions raised by seeing RFK implanted on top of U.S. health policy in "Should I get my vaccines while I can? Your questions, answered." (gift article) She's not entirely alarmist, but she suggests you make sure your vaccines are up to date if possible by January 20.

From the pest house ...

First off, I should say that Covid is not being very miserable. Some fevers, a little woozy, but mostly necessary isolation even from the EP who has advanced to a negative test. I yearn to follow.

Click to enlarge.

After some mild bureaucratic obstacle jumping, my Kaiser doctors prescribed paxlovid -- and I just want to share that the drug's packaging is a revelation. Pictured above.

Why don't most drugs come with packaging which embodies the instructions as this does? You just do what it says ... it is even color coded.

I raise that because, right before I caught the Covid, I'd been taking a week long course of an antibiotic as a preventive precaution when having a tooth extracted. You know -- I was prescribed a neat little bottle of 21 pills to be ingested three times a day. And within a couple of days, pre-Covid, I found myself confused: had I really taken the morning dose? Or the midday one? I just did the best I could.

I know that there are specialized pill boxes for this sort of thing. Or I could have created a card to check off the doses as I took them. But wouldn't it be better if the packaging the drug comes in did the trick, easing compliance? 

In particular, Medicare should require drug companies to package all drugs we old timers might take in this instructive way. Just a thought.

Vaccination permutations

This graph from Kevin Drum surprised me.

I figured that one of the consequences of our political polarization over COVID vaccines would be that increasing numbers of parents would start resisting medical and educational insistence on vaccinating children, one of the triumphs of modern public health. Kids mostly don't have to suffer from nasty childhood diseases these days. A very significant fraction of the increase in life expectancy over the last century came from more individuals living to age five because of escaping childhood plagues.

But apparently the COVID wars have, if anything, slightly increased vaccine coverage among very young children. Maybe all the noise has increased parental awareness - and possibly even broadened access?

California has decided not to fight the fight over the COVID vaccine in the public schools. The Los Angeles Times explains there are good reasons for educational institutions to opt out of this culture war:

Unlike the other vaccines required for school enrollment in California, the COVID vaccines are unreliable at preventing infection or transmission, providing at best modest protection against infection for only a couple of months. 

In contrast, the vaccines already required for school attendance, such as those for measles, mumps, rubella and polio, reliably prevent outbreaks when local vaccination rates reach a certain threshold. The hepatitis B and varicella (chickenpox) vaccines afford protection against infection for years, diminishing long-term transmission risks. The tetanus vaccine provides only individual protection, but it is administered in combination with vaccines for diphtheria and pertussis, which protect against outbreaks over the long term. 

We never had any evidence that the COVID vaccines would work like vaccines that provide a high degree of lasting protection against infection and transmission, conferring so-called herd immunity.

So I guess this polarizing cartoon was not as clever as it seemed in 2021. We live; we learn.

The GOP is killing its own base among old people

This isn't about vaccine-rejection and anti-masking hysteria. This was pre-COVID:

In this national analysis [from the BMJ - a peer reviewed publication from the trade union of the British Medical Association], we found that Americans living in counties that voted Democratic during presidential elections from 2000 to 2016 experienced lower age adjusted mortality rates (AAMRs) than residents of counties that voted for a Republican candidate, and these patterns were consistent across subgroups (sex, race and ethnicity, urban-rural location). The gap in overall AAMR between Democratic and Republican counties increased more than sixfold from 2001 to 2019, driven primarily by changes in deaths due to heart disease, cancer, lower respiratory tract diseases, unintentional injuries, and suicide.

Click to enlarge

 "Unintentional injuries" is a euphemism for opioid deaths.

It's not so much that old Republicans were dying of different causes than old Democrats -- both were mostly afflicted by heart disease, cancer, and cardio-vascular ailments. But Democratic counties did a better job of reducing mortality among their old people, based on such factors as Medicaid expansion (access to health insurance coverage), stronger tobacco and gun control, and more generous social welfare systems in general.

It does seem counter-productive -- no, ghoulish -- for a political party to cooperate in killing off its supporters.

H/t commenters at Emptywheel.

COVID is becoming a killer of the young

I didn't know this. Apparently over the last year, COVID has been the leading medical cause of death in the United States among people under 55. Not chronic diseases, not suicide, or other gun episodes -- but COVID.

Click to enlarge

According to Inside Medicine:

Many believe that Covid-19 is merely a cold for all young people and a death sentence for a handful of older folks who probably would have died around the same time anyway. 

That is wrong. 

We know there has been extraordinary “excess mortality”—that is more deaths than usual during the pandemic. It’s not just that people dying of cancer happened to have caught Covid in the last weeks of their lives. Rather, people are dying way early—sometimes months, but more often years and decades earlier than they otherwise would have. 

... What surprises many is just how many young and middle-aged adults have died. Nearly 250,000 people under the age of 65 have died of Covid-19 in the United States so far. Around 61,000 of these deaths were in people under the age of 50. 

Those of us 65 and older are 90% fully vaccinated in the United States. Covid can kill vaccinated people, but in the most part, serious outcomes -- deaths -- happen to unvaccinated people, who are largely younger.

• • •

We're very COVID conscious around here at the moment as a household member has tested positive. So far, so good here.

Killing off the base

The indefatigable Charles Gaba is at it again, presenting visually the statistical evidence that Republicans have chosen to kill off their own supporters rather than to try to preserve their tribe's health.

The Former Guy didn't want there to be a deadly pandemic. Mass illness and deaths would upset the stock market and derail his glide toward re-election. Besides, most of the early 2020 deaths from COVID in the United States were on the blue Democratic coasts, no concern of his. He made the choice to throw the job of fighting the novel virus to state governors -- then failed to provide resources and back up from the federal government. He poo-pooed public health precautions. He egged on anti-mask protesters.

Even when scientists invented a vaccine (during his term of office!,) he encouraged resistance to the life-preserving injections.

And the inevitable consequences followed: coronavirus cases in areas that listened to Democrats and, eventually to President Biden, saw lower cumulative death rates. Red areas that voted for GOPers overtook and then surpassed the pandemic death rates in Blue counties and states.

Click to enlarge.

"The cumulative death rate in the reddest tenth is now over 48% higher than the bluest tenth."

Killing off your own base seems an unsustainable strategy for a political party, but traumatized people may yet give it a further run ...

Gaba has created an animation from these figures which is worth clicking through to absorb.

Playing politics with the plague

David Leonhardt reports:

... the per capita death toll in blue America and red America was similar by the final weeks of 2020.

And then came the vaccines. And the death toll from the virus diverged in line with political leanings.
 

Click to enlarge.

In order to undermine a Democratic administration whose standing depends on ending the pandemic, Republican politicians are encouraging and endorsing vaccine resistance. And that is killing off a disproportionate number of their own supporters.

The gap in Covid’s death toll between red and blue America has grown faster over the past month than at any previous point. 

In October, 25 out of every 100,000 residents of heavily Trump counties died from Covid, more than three times higher than the rate in heavily Biden counties (7.8 per 100,000). October was the fifth consecutive month that the percentage gap between the death rates in Trump counties and Biden counties widened.

Leonhardt extrapolates from present data that some combination of natural immunity from past infections, additional vaccinations, and better treatments, will reduce future death rates. This trend line won't go on forever. But as long as the virus is rampant, unvaccinated people in red areas will become the preponderance of the casualties.

A lot of people have died to serve the interests of Republican politicians. It's not extremist to conclude this a criminal atrocity.

Clashes of values

A few weeks ago, I posted about struggles within organized labor about whether unions could support vaccine mandates by employers aiming to compel members to get their shots. 

Now that the Federal Drug Administration has fully approved the Pfizer shot, we're seeing headlines like this: 

 

Kind of puts the party of unrestricted business liberty for the rich in a bind, if big companies start demanding proof of inoculation from their workers, while the FoxNews-base howls about tyranny.

 

Today the national leader of the American Federation of Teachers explained to the Times' Kara Swisher how her union came around to working with school authorities toward universal vaccination. 

Randi Weingarten
... we operate as a democracy. If you believe that our job is to help make sure that schools are safe, which I believe it is, for our kids and for teachers and the rest of the education community, and you know that vaccines are the single most important way to do it, we got to a resolution, passed unanimously by our leadership, that said that we’ll work with employers, not oppose employers, on their vaccine requirements, including mandates. And what’s happened thus far is that that’s what everybody has done. You see California did it on a statewide basis. New Jersey is doing it on a statewide basis. New York City, Washington, D.C., Chicago are doing it on local bases. Some of the vaccine policies have become vaccinate or test. Some of the vaccine policies are full vaccination with the exemptions of medical or religious, but at the same time, I get emails frequently from people who have told me that they will drop the membership if we endorse vaccine mandates. ...

Kara Swisher
Should teachers be required to approve [accept?] a vaccination if required? 

Randi Weingarten
There’s always this issue about privacy. Yes, I think that we should. I think that this is a community responsibility. And I think that the issue about distrust of the government authorities runs so deeply that there’s always this pushback. If I could do anything, if I had a magic wand, and I could do anything in life, it would be to try to recreate the trust in public schooling, the trust in government doing the right thing. I think the level of distrust and a sense of — this libertarian sense of freedom as opposed to the community social contract — the first class I ever taught when I taught as a school teacher at Clara Barton High School in New York City was about the Lockean social contract and that in a democracy, you give up some rights in order to make sure that you create community and the right to life, liberty, and the pursuit of happiness.

My emphasis added.

Unions aren't perfect. Far from it. But they are a kind of democracy, far more so than most workplaces. And their survival and the well-being of their membership depends on collective solidarity -- a healthy value in a pandemic and a democracy.

From the 'hood: saving lives

I have no idea whether this is a functioning service, but it seems like a good idea. These posters have turned up on local walls.

Narcan, the commonly recognized brand name for the drug Naloxone, is a drug that rapidly reverses an opioid reaction. 

Thanks to a state law, Californians can purchase naloxone directly from a participating local pharmacist. A statewide standing order permits community organizations to dispense naloxone to a person at risk or in a position to assist a person at risk without a prescription.

Drug users survive thanks to rapidly administered Narcan shots.

Oblivious or sociopathic? Or something else?

It's getting angry out here. Those of us who are vaccinated are losing patience with folks who could get their coronavirus shots -- and don't. We've had a couple rounds in our extended family; stubborn vaccine refusals almost derailed a family gathering planned for a year in one case -- and in another instance interfered with end-of-life care arrangements for a friend.

This is not hypothetical -- I vacillate between being rendered speechless that people I know should be so unconscious of any obligation to the communities in which they live -- and convinced I'm encountering individual sociopathy.

Paul Krugman, the caustic economist, lays out my feelings exactly.

To say what should be obvious, getting vaccinated and wearing a mask in public spaces aren’t “personal choices.” When you reject your shots or refuse to mask up, you’re increasing my risk of catching a potentially deadly or disabling disease, and also helping to perpetuate the social and economic costs of the pandemic. In a very real sense, the irresponsible minority is depriving the rest of us of life, liberty and the pursuit of happiness. 

Furthermore, to say something that should also be obvious, those claiming that their opposition to public health measures is about protecting “freedom” aren’t being honest.

Andy Slavitt is an experienced fixer. In 2013, when the Obamacare website rolled out and crashed, he came along and knocked things into shape. He ended up head of Medicare/Medicaid in the federal health bureaucracy and then served as an advisor to the Biden White House on COVID response.  Now he's trying to help all of us cool down. What follows is a lightly edited Twitter thread.

COVID Update: Anti-vaxxers on Twitter/Facebook are a whole different breed from people who haven’t been vaccinated in real life. ...

As with many things, people on these platforms who spew garbage are worth ignoring.

People who have concerns about being vaccinated are well worth listening to.

People with anti-vax messages on social media have more in common with people who spread political misinformation than they do with people who have real concerns about vaccines. ...

-They use “it makes you think” type logic. (“Nine people in the hospital with tremors. Makes you think”)

-Because the mission is only to plant doubt among people already unsure or who have questions, they aim to “just clear the bar” so they avoid radical sounding claims

-They tap into pre-existing beliefs about government tyranny & pharma profits to suggest motives

... These are the exact same techniques used pre- and post-election. It’s a playbook of manipulation, not people who have serious doubts.

If you told me 90% of the major anti-vax messengers had all gotten safely vaccinated themselves, I wouldn’t be the least bit surprised.

... Fortunately that behavior doesn’t represent the people who aren’t vaccinated. ...

People who aren’t vaccinated largely speaking fall into 2 categories:

-One, they have questions or concerns about the vaccine
-Two, they aren’t paying much attention or aren’t motivated one way or another

In category 1, many of these people are routinely vaccinated & vaccinate their kids. Their questions are about the COVID vaccine.

Commonly— Long term side effects? Impact on fertility? Rushed process? Change your DNA? Cause COVID?

People who are vaccinated or unvaccinated cluster in communities. So they know people with the same questions. Many don’t have a regular doctor to ask questions to. Rumors spread easily.

Sometimes these are just low level concerns. They are in the “I’d rather not” category & when cases dropped this spring, any of these concerns exceeded the risk they felt from COVID.

With Delta, a number of them are rethinking. FDA approval next week will move even more.

It’s safe to say at a minimum this group— who skew non-college educated, skew white (& yes Republican)— doesn’t trust messages from the government. 

Local voices matter more— employers, doctors, clergy, small business. Many don’t trust the health care system, including many people of color & even nurses!

The other group generally speaking doesn’t see COVID as much of a threat.

Only 40% of those 18-25 have been vaccinated. Above 25, close to 3 in 4 have.  Much of this group say they would get vaccinated if required by school or jobs. Some who work hourly jobs don’t have easy enough access.

We should have all kinds of time to understand these groups & help them get their questions answered. Antagonizing or shaming people isn’t a great way to treat people & it doesn’t abate the propaganda, it actually aids it.

It’s also important that while they’ve chosen to remain unvaccinated, we protect people who can’t be inoculated.

I’ve had to show my vax card or a negative test 3 times this week (in California) & if unvaxxed people aren’t thrilled, that’s OK.

About 25 million people say they would get vaxxed if work, school or venues required it. They are looking for the nudge to settle their uncertainty.

Others of course will strenuously object. A reasonable discourse on this question would be better than more social media fights.People are getting increasingly pushed into camps. Pro or anti— but that’s not how most people approach a complex question like this.

... But those who want to reduce the toll of the pandemic should ignore, not enable these trolls & try to get back to the things we do in real life like listening & talking to each other. /end

I'm still mad -- but Slavitt is right.

Leaders gotta lead on vaccines

Yet another reason to mourn the late AFL-CIO president Richard Trumka: he was a union leader who did not hesitate to encourage working people to get vaccinated.

Trumka was forthright to the end. On July 27, he was asked whether he supported a vaccine mandate. Many union leaders (including, surprisingly, the usually tough-minded Randi Weingarten of the American Federation of Teachers) have been hesitant to endorse such mandates, neglecting their responsibility to protect members’ health in deference to a few crank anti-vaxxers among the rank and file. Not Trumka. “Yes we do,” Trumka told C-SPAN. “If you come back in, and you’re not vaccinated, everybody in that workplace is jeopardized.”

Trumka managed be a voice for workers and to cooperate well with the broad Democratic Party coalition that elected Joe Biden, no easy task in an anti-labor environment. A part of Trumka's legacy is higher public enthusiasm for labor unions than we've seen in many years.

According to a Gallup poll, nearly 50 percent of nonunion workers told M.I.T. researchers that they would join a union if given the opportunity.

That's not going to hold up if union leaders decide their job is to stick up for the fraction of their members who are hesitant or refuseniks about COVID vaccination. I understand that labor leaders win their jobs via internal union elections and have to represent all their members -- but coddling vaccine holdouts forfeits respect from a public whose majority wants the people they interact with to join them in tamping down the coronavirus.

I'm not surprised that the unions which represent cops and jailers are some of the most resistant. San Francisco plans a vaccine requirement for city employees. According to the Chronicle: 

The San Francisco Sheriff’s Department will see a wave of resignations if the city enforces its policy requiring vaccinations for its employees, according to the Deputy Sheriff’s Association, the union representing sheriff’s deputies.

Mandated vaccines, “will result in law enforcement officers and fire fighters retiring early and seeking employment elsewhere,” the union wrote on its Facebook page Thursday. “Public safety of San Francisco has turned into the Wild West and will get worse when officers quit due to the vaccine mandate.”

... Union leaders with the city’s fire and police departments did not confirm whether their members were also considering resigning in light of the order, but both said they wished the city had engaged labor leaders at the front end of the process. About 17% of police and 9.5% of fire department employees were not vaccinated as of [August 6] 

It's hard not to feel that these militarized city employees too often act like entitled thugs instead of public servants. 

But it's not just the local cop unions. It's also far too many ordinary public employee and teacher unions.

... In Hawaii, where new daily reported cases rose 103 percent in the past week according to a Washington Post tracker, Gov. David Ige (D) on Thursday announced requirements for all state and county employees to disclose their vaccination status or take weekly tests. Employees who don’t comply could be fired.

As Hawaii reported 655 new coronavirus cases on Thursday — its highest daily total of the pandemic — a joint statement from six Hawaii public unions including firefighters, police and teachers said that although they strongly encourage vaccinations, the governor’s emergency proclamation would impact members’ working conditions.

Unions fight hard to win tolerable working conditions from a system in which too much human labor is valued only as profit for managers and bosses. And at this moment, they are a vital component of a fractious public trying to move beyond a deadly pandemic. Instead of standing up for their hold-outs, labor should be loudly proclaiming broad solidarity and promoting vaccination for all.

GREAT NEWS: on Sunday teacher's union leader Randi Weingarten came out for vaccine mandates in view of arrival of the Delta variant, That's solidarity.

Coronavirus tidbits

The line is back at 24th St. and Capp in the Mission. "Get tested here. Get your vaccine here." It looks as if the Delta virus surge and the return of indoor masks have captured a lot of people's attention.

Unidos en Salud is on the job -- and taking advantage of the chance to offer more of the sort of health care that's inaccessible to so many in the Mission. There's testing here for diabetes and HIV as well as COVID.

• • •

People in San Francisco seem to be taking the renewed indoor mask mandate pretty well. The Chron's headline on its human interest story reads 'How hard is it to get a shot?' For weary San Franciscans, the masks are back.

At the Academy of Sciences, visitors were a mix of resigned and resentful of the unvaccinated.

“It’s ironic you have to wear one in a scientific building,” said Melissa Olcomendy, a preschool teacher, adding that it was discouraging that so many of her fellow homo sapiens had rejected the science and failed to roll up their sleeves for a shot.

“It’s insane,” she said. “But if we have to wear masks again to keep everyone safe, that’s what we have to do.”

“It does feel like we're being re-traumatized,” said Jessica Whitelock of San Francisco, who was taking in the giant tropical fish tank with her son, Caleb, 10. “Masks are the new normal.”

• • •

Meanwhile at the Bulwark, Charlie Sykes highlights a poll that asked who people in this country blame for the Delta COVID-19 surge, divided by vaccination status.

Click to enlarge.

Vaccinated respondents blame the unvaccinated. The unvaccinated are sure the culprits are foreigners -- and the mainstream media! Yikes!

He points out that Florida Republican Governor Ron DeSantis -- who has demeaned vaccination and forbidden cities to enact mask mandates -- is trying to build a presidential campaign on COVID denial. Says Sikes:

Anyone who thinks that failure to manage COVID could hurt a Republican with political aspirations hasn’t been paying attention. If anything, the opposite is true. 

That's a terrifying reality.

COVID-19 doesn't do borders. We must vaccinate the world.

Over the weekend, I was talking with a friend in Nicaragua. Several of us on the call reported that we had received our vaccinations. We asked, "how's it going there?"

He replied that there didn't seem to be any organized effort from the state to get people shots -- maybe the country of 6 million had inoculated 3000 people. He didn't know where they'd been getting the vaccine -- it was a discussion that was so remote from his reality that he seemed not to have much thought about it.

What came to my mind immediately was that, if Nicaragua and other poor Latin American countries were ever going to get vaccines, they would probably be looking to Cuba. Cuba has historically shared medical resources with Nicaragua. The Caribbean island has a developed biotech industry and a history of assisting other impoverished nations.

And so I wasn't surprised to run across this from the Washington Post:

Cuban leader Fidel Castro vowed to build a biotech juggernaut in the Caribbean, advancing the idea in the early 1980s with six researchers in a tiny Havana lab. Forty years later, the communist island nation could be on the cusp of a singular breakthrough: Becoming the world’s smallest country to develop not just one, but multiple coronavirus vaccines. 

... Cuban officials say they’re developing cheap and easy-to-store serums. They are able to last at room temperature for weeks, and in long-term storage as high as 46.4 degrees, potentially making them a viable option for low-income, tropical countries that have been pushed aside by bigger, wealthier nations in the international scrum for coronavirus vaccines. 

They could also make Cuba the pharmacist for nations lumped by Washington into the “Axis of Evil” and “Troika of Tyranny.” Iran and Venezuela have inked vaccine deals with Havana. Iran has agreed to host a Phase 3 trial of one of Cuba’s most promising candidates — Soberana 2 — as part of a technology transfer agreement that could see millions of doses manufactured in Iran. ...

This article treats Cuba as an unreconstructed authoritarian hell-hole. Now there's certainly plenty wrong with Cuba for Cubans. But let's credit the Cuban project with understanding that health care is a right, not a commodity. We in the United States have nothing to brag about while we defend the patents held by rich world pharmaceutical companies against the international effort to make life-saving shots cheap and accessible around the world. 

Meanwhile scientists with a big picture view warn that rich world indifference and corporate greed might mean that mutations render the first wave of coronavirus vaccines obsolete within a year if we're too cheap to make sure protection reaches everyone, everywhere.

The grim forecast of a year or less comes from two-thirds of respondents, according to the People’s Vaccine Alliance, a coalition of organisations including Amnesty International, Oxfam, and UNAIDS, who carried out the survey of 77 scientists from 28 countries. Nearly one-third of the respondents indicated that the time-frame was likely nine months or less. 

Persistent low vaccine coverage in many countries would make it more likely for vaccine-resistant mutations to appear, said 88% of the respondents, who work across illustrious institutions such as Johns Hopkins, Yale, Imperial College, London School of Hygiene & Tropical Medicine and the University of Edinburgh. 

“New mutations arise every day. Sometimes they find a niche that makes them more fit than their predecessors. These lucky variants could transmit more efficiently and potentially evade immune responses to previous strains,” said Gregg Gonsalves, associate professor of epidemiology at Yale University, in a statement. 

“Unless we vaccinate the world, we leave the playing field open to more and more mutations, which could churn out variants that could evade our current vaccines and require booster shots to deal with them.”

QAnon in the 'hood?

It's easy to think this craziness is somewhere else -- until it isn't.

The Mission Mental Health facility down the block from us runs a walk-in COVID test site. People line up there all week; it's free and no appointment required. Friends who've used it appreciate the ease and respect the workers offer. 

Apparently someone doesn't like it.

Some graffiti protester apparently equates coronavirus testing with human trafficking. That's QAnon talk.

Imagine what they think of the Unidos en Salud Vaccination site around the block.

Getting jabbed

Got my first vaccine shot today; no pain and little hassle.

What did I learn?

If you are in California, try MyTurn/CA to schedule an appointment. YMMV, but it was quick and easy for me.

Friendly "Team" members led thousands of us through Moscone Center in downtown San Francisco. All the directions were clear and correct; the team had obviously thought through the logistics thoroughly, while keeping us 6 feet apart and making provision for seating during the required 15 minutes post shot, awaiting any bad reactions. (Didn't have any reaction myself nor did anyone in the cavernous hall while we were there.)

It all made me think of the many jurisdictions which can't seem to run their elections without confusion and hours-long lines outside the polling places. This even happens in Las Vegas where the state government is committed to running accessible elections. There's a lot to be learned from this vaccination process. Most likely elections departments need more funding for more "Team" workers.

Oh yes, also, this site was run by Kaiser Permanente, although open to anyone, regardless of Kaiser membership or lack thereof. Kaiser gives all of us flu shots every fall. They know how to do mass inoculations. Glad the state has given the system this responsibility.

If the ship goes down, they may very well drown too

The Centers for Disease Control decided today that, when a coronavirus vaccine becomes available, at-risk healthcare workers will get some of the first shots. As well these exhausted heroes should.

Here's Kari Jerge, MD (@kari_jerge) reporting what recent weeks have been like for her in the COVID ICU.

For months, healthcare professionals have been hanging on to the guardrails of the top deck of the Titanic.

We have been screaming at the top of our lungs that there is an iceberg dead ahead and begging the captain to turn the wheel.

We have had other passengers who are in the food hall and can’t see the iceberg from where they are standing mocking us accusing us of lying about the iceberg.

“There is no iceberg. You’re seeing things”

“Even if there is an iceberg it is smaller than predicted based on available models”

“You’re getting paid to claim there is an iceberg.”

We are on the ship too. So we are watching the ship approach an iceberg knowing full well that we are going down with the ship.

Do we keep screaming? Even though nobody is listening? Do we jump ship and save ourselves? The water is freezing and we don’t want to desert our fellow passengers.

Do we gather up the other passengers who can see the iceberg and form a human shield to take the impact on ourselves? Do we bum rush the captain and demand he turn?

Or do we stand still, silent, frozen in a state of fight or flight? Paralyzed with sheer terror.

Never in a 14 year career would I have imagined I would see this day....

She has plenty more to say, both about COVID denial and about surpassing grace in moments of horror.

Round 2

MJ.Hiblen: Illustrator - click to enlage

My friend Dr. Jane Jenab called this "Round 2" on Facebook. The medical people taking care of us are close to the breaking point.

In the comments on her post, someone suggested: "I wish that there was also a frontline team of masked community members standing in front of the Medical team .... we need them."

What can we be doing -- besides distancing, masking, hand washing? We are in this together.