Thread by @thrasherxy

1. So today I want to write a thread I've been nervous to write.

In January and February, according to CDC data, 42% of ppl who died of Covid were vaccinated.

It's possible that in the near future, a MAJORITY of people dying of Covid may be vaccinated.

2. How can this be? What does his mean?

Well, it does NOT mean that vaccines don't work (though seeing many Covid deaths among the vaccinated will make ongoing vax efforts harder). The vaccines work, but they're being asked to do too much & their effects are not equally felt.

3. Different populations are more or less at risk for Covid death. Elderly ppl are, by age, VERY at risk. They are also highly vaccinated. According to the NYT, about 91% of ppl over 65 are vaccinated, compared to just 73% of 18-64 yr olds. nytimes.com/interactive/20…

4. A vaccinated 65 year old, while better protected, is NOT free of Covid risk, especially since the US is asking vaccines to do WAY too much work.

Vaccines are a tool. They lower levels of sickness and death, but they do not stop them, nor do they stop transmission entirely.

5. We are doing WAY too much to hamper vaccine efficacy. They work work best when they encounter viruses as infrequently as possible.

But the lifting of non-pharmaceutical interventions (NPIs) like crowd size, mask, and vaccine requirements is overwhelming vaccines efficacy.

6. And in the absence of NPIs, people who are elderly, disabled, immunocompromised (or some combination) are NOT going to be as protected by a vaccine as people who are younger, able-bodied, and with robust immune systems.

(See @edyong209's piece) theatlantic.com/health/archive…

7. The virus is getting more transmissible. As @EricTopol showed in the below sketch, Omicron (BA.1) was more transmissible than Delta, and BA.2.12.1 (the current dominant version of SARS-CoV-2 circulating) is more transmissible than the 1st Omicron. Now, some scary state data...

8. Here's data from the two states I live in most, Illinois and New York. The data shows rising hospitalizations, NY on the left, IL on the right.

Both show that RIGHT NOW, hospitalizations are at the same level now as they were with Delta—and rising.

But—
(h/t @Infoseepage )

9. Remember that, unlike last fall, there are few or no:

—mask rules

—crowd rules

—vax requirements for stores, movies, sports events

—there's NO MORE FREE TESTING OR TREATMENT for the uninsured

And—scary as it is—remember that BA.2.12.1 moves more & faster than Delta

10. The good news is that vaccines are responding well at preventing death (tho not necessarily at preventing long Covid), tho not equally for everyone.

The bad news is that the vaccines aren't working as well as they did during the Delta—and not just bc of fewer NPIs.

11. Vaccine efficacy is waning over time. And when it does, the effects of that lessening protecting will harm the elderly more than younger ppl, the disabled more than abled ppl.

The answer to waning efficacy are NPIs (almost all gone) and boosters.

And, hoo boy...

12. According to the CDC, we are woefully under-boosted.

About half (49.4%) of all eligible have gotten boosters, but only a third (32.3%) of those over 65 have!

Those vaccinated but un-boosted seniors (w waning immunity & less protection from NPIs) = vaccinated deaths.

13. Now, why have half the eligible general population not gotten boosted?

Why have 2/3 of SENIORS not gotten boosted?

It's NOT bc they are suddenly vax hesitant! They got vaccines!

It's bc, largely, the vast public health apparatus that vaccinated America has disappeared.

14. Money for Covid?

Gone.

The ability for the uninsured to get tested or treated for free?

Gone.

Mass vax centers?

Gone.

National advertising campaigns?

Gone.

What survived?

—Spending on war

—Middle/upper class ppl WFH

—Ppl who see Drs. anyway getting boosters.

15. What is emerging is what I have feared all along—what I have studied for a decade with HIV/AIDS, and what I see happening with SARS-CoV-2.

This is virus is not becoming "endemic" at this point necessarily; it is settling into what I call a "viral underclass."

16. The term viral underclass was coined by @SeanStrub in 2011, which I wrote about in @Slate in 2020: slate.com/news-and-polit…

17. The viral underclass is where viruses are most likely to transmit, reproduce and hospitalize or even kill humans.

So, where is SARS-CoV-2 thriving RN?

Well, it is transmitting EVERYWHERE in the US—tho the harms will be unevenly felt.

18. But where it transmits and who it will hospitalize or kill will create two difrent groups.

For instance, only 8% of office workers are FT in Manhattan. They’re less likely to be exposed & more likely to be boosted, rest if infected, get Paxlovid nytimes.com/2022/05/10/bus…

19. At the same time, ppl who are undocumented line cooks might be vaxxed. But they don’t WFH but 100% in poorly ventilated kitchens. They are seeing unmasked ppl all day. They’re unlikely to be boosted & can’t afford testing or treatment.

They, too, may die while vaccinated.

20. In terms of boosting, the same dynamic is emerging w SARS-CoV-2 as I see w HIV/AIDS.

HIV is a slow acting virus. It can take yrs to make you sick, 10-15 yrs to kill you. Yet ppl (usually Black & homeless) will show up on death’s door in ERs & die of AIDS days later.

Why?

21. Because they’ve not seen a doctor in 10-15 years and never knew they had HIV let alone AIDS.

The uninsured can’t get Covid tests—even tho we KNOW not having access to healthcare means you’re more at risk for severe Covid sickness and death.

familiesusa.org/resources/the-…

22. So what will happen now?

Ppl w insurance—already less at risk for Covid death—will get boosters at their annual checkups & enjoy protection. (Good.)

But ppl w/o insurance—already at MORE risk for Covid death—won’t get boosted & their vax efficacy will decrease . (Bad.)

23. THIS is how the viral underclass wil comprise a majority of Covid deaths. Despite getting jabbed in the largest mass vaccination campaign in US history, they’re largely denied boosters, NPIs, good ventilation, etc (and plagued by pre-existing social determinants of health).

24. It didn’t have to be this way!!

The US could have admitted we COULD vaccinate 4 million ppl a day (!) and pay for the healthcare ppl need & kept that infrastructure to deliver boosters & treat cancer and MS and HIV & anything else.

We could have learned, adapted & grew.

25. Instead, the infrastructure was dismantled and we got war, increased economic inequality, more oligarchy and a return to normal.

But normal produced a million deaths! The ruling class wanted to trick us into accepting ONE MILLION DEATHS as “normal.” scientificamerican.com/article/there-…

26. If you’d like to know more about the history of the viral underclass, and would like to learn from people I’ve learned from, reported on and loved who live in it, please check out my book 🙏🏾 bit.ly/viralunderclass and be in conversation w me this summer & fall about it

27. Some other reading and action resources:

Union your workplace. As workers, use your collective power to make your communities safer.

Organize with a group like @MarkedByCovid. @kdurquiza and that whole community are doing such important work markedbycovid.com

28. Learn about and support disability-centered activism, like the Disability Visbility project, who are doing such important work to create a world where pandemics are less likely to happen and less severe on humans when they do disabilityvisibilityproject.com

29. Read @DisVisibility @SFdirewolf’s new book penguinrandomhouse.com/books/688504/y…

30. Read @wsbgnl, whose tweet showing nearly half (47.7) percent of Arizona’s Covid deaths inspired this thread. @wsbgnl is the clearest, sharpest, most precise and most ethical interpreter of data I’ve read on this site

31. Follow the health equity work of @uche_blackstock and @oni_blackstock pbs.org/newshour/amp/s…

32. Read @realLandsEnd and @avierkant’s new book and follow their podcast @DeathPanel_ bookshop.org/books/health-c…

33. Always read @gregggonsalves thenation.com/article/societ…

34. Always read @KatherineJWu theatlantic.com/health/archive…

35. Always read @edyong209 theatlantic.com/health/archive…

36. Learn about abolition, and how it can create a world without policing, racism, ableism and violence—and which can allow wellness to flourish—by reading books like @dereckapurnel’s penguinrandomhouse.com/books/675803/b…

37. Always read @lindavillarosa, especially her new book penguinrandomhouse.com/books/604283/u…

38. Always read @brian_goldstone and get involved with housing justice. Being without a home is a MAJOR driver in getting sick or dying from Covid or AIDS newrepublic.com/article/154618…

39. And for the snarky ppl saying “If everyone were vaxxed then 100% of deaths would be among the vaccinated,” well

A) The US getting to 100% would mean we were a very different

B) Cuba’s at 94%, averages 0 deaths a day; the US is averaging about 2,800 deaths (a 9/11) a week

40. I think that’s all (for now)

41. Also read @JoshuaPotash, who always weaves together our various crises and shows how they’re connected.

42. Those of us who are vaccinated got them a year or two into the pandemic and not a decade later because of ACT UP. Read actuporalhistory.org

and read @sarahschulman3’s LET THE RECORD SHOW bookshop.org/books/let-the-…

43. Librarians to the rescue. We are going to need more of this, please -- tho at the end of the day, we will need the state to step in and capitalists to step aside

44. Always read @tomscocca indignity.substack.com/p/indignity-vo…

45. For those carping abt probabilities, I do understand them & that we could think abt risk of death per 100K of ppl who are vaccinated vs 100K who are not vaccinated.

But that’s not what I’m interested in, nor does it answer the questions I think are most important right now.

46. Last September, President Biden called this a “pandemic of the unvaccinated.” This was wrong for many epidemiological (and ethical abs public health related) reasons. It gave ppl who were vaccinated the impression what they had to do was done; NPIs weren’t needed and

47. that the only reason the pandemic was lingering on was due to ppl who were unvaccinated. This was not true! Some very vulnerable ppl were unaware of their risks and made lethal decisions. Society largely failed to upgrade ventilation. Scapegoats were named & blamed.

48. But how can you call it a “pandemic of the vaccinated” (which is unfair to ppl who are unvaccinated for a variety of reasons, including infants) when 1/3, or even near 1/2 are vaccinated?

And to circle back to math: this can NOT be explained just by probability.

49. The share of vaccinated ppl *dying* has seemed to grow over time. It does not correspond with an increase in the percentage of ppl who are vaccinated (that’s been flat for a long time) against a decrease in a percentage of ppl who are unvaccinated (also flat).

50. What has changed;

— Who is vaccinated and BOOSTED and who is vaxxed and NOT boosted

—Whose vax have CONTINUED protection versus whose vax offer DECLINING protection

—The conditions of being in (or out) of the viral underclass have created more or less risk

51. Vax is but one tool (and the US has largely given up on increasing its use). There is SO MUCH MORE we can do— like NPIs, better ventilation, and addressing the root causes of what makes a viral underclass in the 1st place that would benefit EVERYONE bit.ly/viralunderclass

52. But we cannot do it by thinking of this as a “pandemic of the unvaccinated.” Not when so many for who are also vaccinated. Not when we need ALL the tools. Not when pandemics, by definition, are global and affect all 7 billion human animals (& often nonhuman animals, too!)

53. The “but statistical probability!!!” crowd really isn’t ready to deal w this. They see every person as a numerical widget & don’t account for waning vax protecting it impacts of class, race etc. Nor for inability to individually calculate risk. Universal precautions, plz!!!

54. Probability people: This is the goal. Cuba is pretty near full vaccination, they have universal healthcare and they STILL use NPIs. And look! 0 percent of their deaths are of vaccinated people, because…