Photo by CDC on Unsplash

Definition of terms in this post:

  • Covid — aka Covid-19, an often serious and occasionally fatal illness caused by the SARS-CoV-2 virus
  • SARS-CoV-2 — the novel coronavirus first identified in Wuhan in late 2019 that can cause Covid
  • asymptomic — being shown to be infected by SARS-CoV-2 but showing no signs of illness, not even mild ones
  • variant — a genetic variant of SARS-CoV-2 virus, which when it replicates creates one or more mutations which can have varying degrees of impact on how the virus impacts people. The CDC currently lists three classes of SARS-CoV-2 variants: those of Interest, Concern, or High Consequence. But as Variants of Interest have no impact on vaccine effectiveness, and, as of writing this, there are no Variants of High Consequence (that we know of), we’re only going to talk here about Variants of Concern (VoC).

If I were predicting the score of the finals in the Covid vaccine vs virus USL Championship 2021, it would be 9-to-1, a decisive win for Team Vaccine. If the rest of the world were vaccinating at the pace of places like Bhutan, the US, UK, Israel, Chile, and Bahrain I’d just go ahead and declare the vaccine the winner of the 2022 World Championship, and I’d doubt there would be much of a championship in 2026, just local tournaments. Team Virus, including the star variants who get substituted in, simply stands no chance against the superior defence and attack of Team Vaccine.Kelley and I are among the approximately 24% of Americans fully vaccinated against Covid.[1] A large and loud voice inside me is clamouring to go to a pub. I long to sit down, take off my mask, and order a pint. I want to sip Guinness, eat something—something I haven’t planned, shopped for, or cooked—and have a lazy conversation about nothing in particular with another human being, live and in person, while around us the hum of strangers’ conversation rises, and outside on the sidewalk a passerby bumps into someone they know, bends down to pat their dog, and stands, unmasked, to chat for a while. I yearn for it.

But I haven’t done it yet. Why?

Let’s begin with why I’m so convinced Team Vaccine is the winner.

While the Moderna and Pfizer mRNA vaccines (Kelley and I got Moderna) have been shown in trials to be 95% effective, several real-world studies (for example, in Israel) show that even in the wild it is an astounding 91% effective against Covid. Further, and excitingly, it’s been shown that the majority of those vaccinated not only don’t get sick with Covid, they don’t get infected with SARS-CoV-2 at all. In other words, they’re not just asymptomatic, they are wholly virus free and therefore cannot pass the virus on to anyone else, vaccinated or unvaccinated. In the majority of cases, vaccination stops transmission dead. Virus replication inside a host is prevented: a chance for the virus to mutate further is thwarted.

For the small minority of vaccinated people who do become ill, the illness is very much reduced: among the vaccinated—particularly those 75 and over—hospitalisations have plummeted.

However, while being fully vaccinated is amazing it does not provide perfect protection. There are occasional breakthrough infections.

Here in Washington State, as of 14 April, 1.7 million people have been fully vaccinated. Of those 1.7 million, 217, or 0.013%, have had breakthrough infections. Many of those 217, if not most—it’s unclear from the press release—had either no symptoms of Covid or mild symptoms. However, 5 of the 217 died. (All were aged 67-94, frail, and dealing with multiple underlying conditions.)

The takeaway: of all those vaccinated in Washington State, only 0.003% actually died of Covid.

It’s Not Done to compare statistical apples and oranges[2] but indulge me for a couple of paragraphs.

In Washington State over the entire course of the pandemic, of the total WA population of about 7,615,000 people, 5,415 total have died of Covid, that is, 5,410 unvaccinated people: 0.071%.

If you compare those two rates of death-by-Covid, the vaccinated dying at a rate of 0.071% and the unvaccinated at 0.003%, then you see that fully-vaccinated people have 0.42% of the chance of death that unvaccinated people do. That is, unvaccinated people are more than 200 times as likely to die of Covid than those who got their shots.

If you run those sets of calculations for the US as a whole, you end up with vaccinated residents having 0.57% the chance of dying as the unvaccinated, a little less than 200 times as likely to die.

If you compound statistical heresies and take the simple mean of unweighted-for-population WA and USA results, you essentially get 0.5%. If you are unvaccinated you are 200 times more likely to die that your fully-vaccinated neighbour.

As I’ve said, you really, seriously would not want to take those numbers to the bank. But even if we imagine they’re off by a factor of ten, by my back-of-the-envelope math unvaccinated folk are twenty times more likely to die of Covid than vaccinated folk.

Those are pretty persuasive odds. So if you’re dithering, go make an appointment right now to get your shot. I’ll wait.

Ah, you say, but how effective are the vaccines against those flashy superstar variant players? To answer that, let’s first take a quick detour into how vaccines work. And along the way I’ll swap metaphors.

I’ve seen several people on social media asking why a 90 lb woman gets exactly the same dose of, say, Moderna vaccine as a 250 lb man. The answer is that vaccines aren’t drugs or toxins (like opiates, or alcohol) that act directly on the body; their action is not weight dependant. Moderna’s mRNA vaccine is a blueprint of instructions for our bodies to read and follow in order to make something the immune system can be trained to recognise as an enemy and so defend against if we encounter it in the wild. In the case of Moderna, the instructions are for making a particular piece of the protein found in the part of the SARS-CoV-2 virus called spike. The spike is what helps makes SARS-CoV-2 so transmisslble: it’s what latches onto specific parts of a cell’s membrane, the ACE2 receptor, and allows the virus to invade individual cells where it then coopts the cell machinery and replicates.

Think of the vaccine as an instruction sheet that shows your body how to put together a bunch of giant cardboard cutouts of a recognisable bad guy, let’s say Thanos—slide tab A into slot B, fold along dotted line C—which, when you’ve put it together, become silhouette targets to train apprentice superheroes on a gun range. In itself the cardboard cutout isn’t dangerous; all it does is sit there and be recognisable as a target, to say, in effect, This is what the enemy looks like! If you ever see anything remotely resembling me in the future, swarm, attack, kill!

After two doses/training sessions, two different squads of your immune system, B lymphocytes and T lymphocytes, will recognise that Thanos/SARS-CoV-2 spike protein on sight; they are now alert, on patrol, and loaded for bear (while the original Thanos cardboard targets just dissolve and get flushed away). If the body encounters Thanos/spike in the wild, the B lymphocytes’ job is to latch onto the spike and prevent the virus from attaching to and infiltrating any of your individual cells, and T lymphocytes’ job is to annihilate via suicide attack any individual cell that does get invaded.

It’s a very clever and efficient system—unless for some reason the immune system doesn’t recognise Thanos/SARS-CoV-2 spike and so doesn’t spring into action against it.

Which brings us back to variants.

We are now closing in on 600,000 deaths in the US, and 3m worldwide. Globally, the pandemic is accelerating and vaccines have not yet reached, never mind been administered in, a huge proportion of countries. As a result, the virus is replicating madly and variants—strains of virus whose genetic code has mutated—are springing up faster than we can keep track of them. (The more virus there is out there, and the more often it replicates, the more often it will mutate.) The greater the variance of a virus—the less it looks like the original Thanos target—the more likely it is to be able to escape recognition.

There are many variants—with more appearing everyday. What matters here, though, are Variants of Concern (VoC).[3] According to the CDC these are variants that demonstrate:

  • Evidence of impact on diagnostics, treatments, and vaccines
  • Evidence of increased transmissibility
  • Evidence of increased disease severity

The first VoC I was aware of was B.1.1.7. First identified in the UK, it is by some estimates 50-70% more transmissible than the original strain of SARS-CoV-2 (it’s spike is more efficient at grabbing ACE2—it still looks like Thanos but just has stronger hands). It’s now the most widely found strain in the US and many other countries. There is some disagreement about whether B.1.1.7 is also more deadly—those infected tend to carry higher viral loads—though the most recent study suggests that it is not. Whether that convinces you or not (and my jury is out), what does seem to be clear is that this super successful variant is not vaccine resistant in the real world.

Then there are the so-called South African (B.1.351) and Brazilian (B.1.1.28) variants. These, like B.1.1.7 are more efficient at grabbing ACE2 but they also have a mutation, E484K (often called Eek), also in the spike protein—that acts as a partial disguise. So now Thanos not only has stronger hands, he’s also wearing a funny red hat that from some angles changes his silhouette. This means a certain number of defending lymphocytes might not recognise this variant as an enemy. But only a certain number. In vaccinated people there are still way more—way, way more, many multiples more—defenders than attackers. So even if some of them don’t recognise the enemy, the enemy is still easily overwhelmed.

We know this because in the lab—where they pit antibodies and virus variants in test tubes and petri dishes, in vitro—you can see clearly that you need more antibodies to neutralise the virus. But as far as I’m aware there is no real-world evidence that, in the wild, that is, in vivo—in real living bodies—any variant shows the ability to evade the Moderna or Pzfizer vaccine.

Variants continue to spring up spontaneously. Just last month Oregon produced its own homegrown Eek mutation from the B.1.1.7 variant. However, given the pace of vaccination in this country it’s pretty unlikely there’ll be enough virus replication to produce enough wildly different mutations for one to emerge that might fool Team Vaccine’s recognition systems; it’s just gong to be variations on the funny hat and false moustache playbook. One caveat: most of the population needs to be immunised. Right now only 70% of American plan to get vaccinated. I have hope for one group: those those who for various good reasons–a history of their commuity being lied to and abused by government and medical professionals–are showing willingness to listen to their own community leaders who are generally doing a good job of persuading people that, this time, in this one way, they can trust. The other group, though, the so-called vaccine resisters–obstinate right-wing conspiracy theorists, mostly straight white Republican men–are not going to get over themselves until the mRNA vaccines are fully approved by the FDA (as opposed to their current emergency-use status). Once that happens, legally more entities (whether government, business, education, community) can start requring vaccination as a condition of entry and/or participation. And that, I hope, will be more persuasive than appealing to the greater good (which the white right-wing men already, demonstrably, don’t give a shit about).

If we could get the vaccination rate up to 90% I doubt residents in this country would need booster vaccinations tweaked to combat variants.

The rest of the world, well, if we want Team Vaccine to be victorious in 2022 and again in 2026 we need to get the vaccine in billions of arms globally and reduce the mutation feedstock. If we don’t get more people vaccinated, we not only will need those annual or semi-annual booster shots talked up by the Pfizer CEO, we might have to build a whole new vaccine desiged to recognise some other part of SARS-CoV-2.

I can’t imagine anyone—not even Big Pharma—wants that. (The former scenario, the booster shots? Oh yep; they want to make money. The latter? No. You can’t make money if all your customers are dead.)

So, vaccines are awesome, Team Vaccine are the champs. So why am I not going to go to the pub right now, this afternoon? After all, if I’m right—and I think I am—my odds of dying of Covid are vanishingly small, less than my odds of being struck by lightning.

Well, because. For one thing, I don’t want to sit in a pub with a mask on, pulling it to the side only to take a drink then putting it back on—it sort of spoils the point. And right now I’d feel obliged to do that because I’m guessing most of the servers haven’t had their jabs and frankly it would feel Ugly American of me to assume that kind of risk privilege. Then there are the other customers who might glare if I don’t wear a mask because they have to. And then there’s the fact that I haven’t been unmasked in public for 14 months; I haven’t been in a crowded room for 14 months; I haven’t been among strangers for 14 months. It will take some getting used to.

So, to begin with, I might sit outside in a beer garden unmasked. And I most likely will invite other fully-vaccinated folk, two by two, to the house for dinner. And by the time I’ve done that a few times, and then invited six people at once, I’ll be desensitised to crowds, the odds of the servers having been vaccinated will be pretty good, and perhaps as much of 65% of those customers in the pub will also be vaccinated. At that point, I’ll venture out.

And, oh, I’m looking forward to that day!

[1] The numbers are constantly changing. See the CDC’s data tracker for the most recent data.

[2] In the early days of the pandemic medical professionals had no experience of dealing with acute cases; there was no standard of care; the most effective therapies had not yet been determined. best therapies had not been determined. Add to that the fact that the most vulnerable—those 75 and older—the ones most likely to die, were vaccinated first. Add to that the unseparated vaccinated and unvaccinated totals. And that’s just for starters. But we have to start somewhere, so I choose here.

[3] The CDC has a good explanation of various variant classifications along with tables of which variants have mutated how