Why do vaccinated people need to mask? See Gupta’s answer

By Dr. Sanjay Gupta, CNN Chief Medical Correspondent

I still remember the feeling I had on December 13, 2020 — the date the first vaccines rolled out of the Pfizer facility in Michigan, destined for hospitals and vaccination centers in every state in the country. Typically reserved scientists described it as the “medical moonshot” we had all been waiting for: a powerful tool against the new virus that had paralyzed the world for almost a year. Those first doses shipped out across America were supposed to signal the next phase of this pandemic — and it felt as if the whole country could soon let out a collective sigh of relief.

As I waited to get my first shot, I remember thinking how completely ordinary, and how completely extraordinary, it was all at the same time. Here was a snippet of messenger RNA from the virus, delicately wrapped in a little lipid envelope and delivered to each of our bodies via two shots, spaced a few weeks apart. This mRNA would prompt each of us to manufacture a little piece of the coronavirus (the spike protein) which would in turn prompt our immune system (our body’s defense mechanism) to create antibodies and other immune cells in response.

While the vaccines seemed to be created within months, whereas they normally take years, the technology behind this vaccine was actually the culmination of a couple of decades of work by some of the most brilliant minds in science and medicine. It quickly became clear the vaccines worked extraordinarily well and have the potential to truly revolutionize medicine beyond this pandemic.

I kept reflecting how this moment could be a turning point — the beginning of the end of the pandemic; light at the end of a very long, devastating tunnel.

The more things change, the more they stay the same

Eight months ago, while I was waiting for my turn to get the shot, the headlines were about the surging numbers of cases, hospitals buckling under pressure, dire predictions for more of the same in the months to come, and the politics of mask wearing.

Today, I’m heartbroken to read the same headlines: case numbers climbing, hospitals in some places inundated with patients, predictions of “the worst is yet to come,” and cries against mask mandates. And this time, vaccine mandates, too.

I want to be clear: This was not inevitable. Even without vaccines, the country became far sicker than it should have. The vaccines were supposed to wrap us with near-impenetrable armor and provide longer lasting protection. Of course, armor only works if you wear it, and the same is true of vaccines.

If you look at the map, the five states with the highest percentage of new cases in the US are Florida, Texas, California, Louisiana and Georgia. Almost one in every five new cases of coronavirus — 19.2% — are from Florida alone, yet the state only has 6.5% of the US population. All of those states, except California, have fewer than 50% of their populations fully vaccinated.

Among the states with some of the lowest rates of new cases per 100,000 people, you’ll find many of them have among the highest rates of vaccination in the country, such as Vermont, New Hampshire, Maine and Maryland.

President Joe Biden’s chief medical adviser, Dr. Anthony Fauci, and others warned this great vaccination divide would cleave the country in half, especially when coupled with the very transmissible Delta variant that has been sweeping the country.

“When you have such a low level of vaccination superimposed upon a variant that has a high degree of efficiency of spread, what you are going to see among under-vaccinated regions — be that states, cities or counties — you’re going to see these individual types of blips. It’s almost like it’s going to be two Americas,” Fauci predicted on CNN at the end of June.

“You’re going to have areas where the vaccine rate is high, where more than 70% of the population has received at least one dose. When you compare that with areas where you may have 35% of the people vaccinated, you clearly have a high risk of seeing these spikes in those selected areas,” he said.

Fauci called the situation “entirely avoidable, entirely preventable.”

Vaccines protect us from getting sick

Despite the latest news and research — showing that even among people who are vaccinated, there is some risk of getting infected with the coronavirus — the most recent data from the US Centers for Disease Control and Prevention shows only about 6,600 breakthrough cases were severe out of more than 163 million fully vaccinated people, and more than a quarter of those were classified as “asymptomatic or not related to Covid-19.” Put another way: More than 99.99% of people who are fully vaccinated have not had a breakthrough case resulting in hospitalization or death. And yes, that’s even taking into account the more transmissible Delta variant.

There is some good news. The pace of vaccination is picking up across the country. An average of 681,373 doses are reported administered each day, according to the CDC’s latest data. That includes an average of 446,300 people getting their first shot each day — a 24% increase over last week and the highest it’s been since July 4.

Worst to first

The vaccination rate is picking up even in states where residents have been more reluctant to get vaccinated. For example, Louisiana, where just 37% of the population is fully vaccinated — and which had the most new cases per capita last week — saw daily vaccination rates rise 111% compared to three weeks ago. The state ranks 47th overall for the share of the population with at least one dose of vaccine, but last week ranked first in new vaccinations per 100,000 residents. Alabama, whose average more than doubled from three weeks ago, ranks 46th overall in vaccine coverage but third in last week’s pace; and Mississippi was 50th overall but eighth last week.

“This may be a tipping point for those who have been hesitant to say, ‘Okay, it’s time.’ I hope that’s what’s happening,” National Institutes of Health Director Dr. Francis Collins said Sunday on CNN’s “State of the Union.”

“That’s what desperately needs to happen if we’re going to get this Delta variant put back in its place.”

But we still have to do better if we want to get this pandemic under control. Our average of 446,300 people getting their first shot each day is still well below our peak in mid-April, when an average of nearly 2 million people were doing so. As things stand now, there are about 140 million people in this country who have still not even gotten one shot, and of that, more than 90 million are age 12 and older and thus eligible to be vaccinated.

If we had maintained the vaccination pace of early spring, the entire eligible population would’ve gotten at least one shot by now. It didn’t happen, despite the widespread availability and zero cost. Having just returned from Japan, where only 30% of people are vaccinated, I was reminded just how scarce — therefore valued — these vaccines are around the world. In India, just 7.5% of the population is fully vaccinated. In many African countries that number is less than 5%, and in Haiti, it’s less than 1%.

Where’s the rub?

So, now that a remarkable feat of science has been created, we have to address the obstacles that prevent it from having its maximal benefit. In many other countries, it is access, but in the United States, it is hesitancy, which comes in all sorts of different forms. We have to combat vaccine hesitancy — an issue as old as vaccines themselves, the first instances appearing soon after the first vaccines were popularized in the 1800s.

According to a Kaiser Family Foundation poll released in mid-July, concerns about side effects, the newness of the vaccine, and perceptions about not needing to get vaccinated were among the top reasons people gave for not getting their shot.

So, let me try and address these one by one. These are the same conversations I have been having with my own neighbors and friends.

As far as safety goes, more than 4 billion doses of coronavirus vaccines have been administered worldwide. In the United States alone, more than 347 million doses have been administered.

These are some of the widely used medical products on the planet, and as a result there is a remarkable amount of real world data.

Throughout the vaccination campaigns, the number of side effects have been and remain consistently and extraordinarily low. The CDC is constantly searching for side effects. That is how the agency was able to confirm 28 cases of rare blood clots among the 8.7 million doses of the Johnson & Johnson vaccine administered in the US. The side effect monitoring system is very sensitive and the news has been good. Overall, side effects have been minuscule.

What is not minuscule is the number of deaths caused by Covid-19: more than 4.2 million deaths worldwide, including more than 610,000 here in the United States.

As for the newness of the vaccine, and the fact that the ones here in this country are not fully approved — simply “authorized” — by the US Food and Drug Administration, the agency has said it is working as fast as possible to get that done. But it is a complicated and time-dependent process that, until recently, used to take more than a decade to complete.

To give an emergency use authorization, the FDA had asked for two months of data, whereas for full approval the agency requires six months’ worth. There is also a review of manufacturing facilities and even discussion about how it will be marketed in the future. It adds layers of complexity that can be agonizingly slow, but may also provide a layer of confidence in the process.

“I can’t speak to a date when we intend to have this done. But what I can say is we are going to move with all due diligence to get the review done with our usual high quality, as rapidly as we can,” Dr. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, told The Washington Post on Friday.

“We know how important it is for people to be able to get vaccinated. We know that there are students going back to college who would like to see a licensed vaccine before they get vaccinated. And we understand that, and we will work toward getting this across the finish line as rapidly as possible,” he said.

The last of the top three reasons for not getting vaccinated — perceptions about not needing the vaccine — might be the trickiest to tackle, although it shouldn’t be because the statistics are stark.

Covid-19 is a disease that wasn’t known to us 20 months ago, but still became a leading cause of death in the US last year. Its closest competitor, heart disease, doesn’t have a vaccine to prevent it, but Covid-19 does.

And even though millions of people in the US have become infected with the coronavirus, and hundreds of thousands have died of Covid-19, there are still many pockets of the country where people feel they escaped the worst of the pandemic and no longer need to worry, or that they never had to worry in the first place.

But the Delta variant has changed that calculation. Delta is unforgiving and will take advantage of even a quick chance encounter to infect.

If you look at the data, the death rates and hospitalizations have plummeted over this spring and summer, but that is only part of the story. If you dig a bit deeper, there are alarming trends. According to an analysis by the Kaiser Family Foundation, of about half the states (those that provided data), more than 95% of hospitalizations and deaths have been among unvaccinated people. That number now includes young and formerly healthy people, not just older Americans and those with underlying health conditions.

The country is no longer being split into vaccinated and unvaccinated. It will quite simply be divided between vaccinated and infected. It is also why masks will once again be commonplace for a time. As we hopefully continue to increase vaccination rates, we want to simultaneously hit the brakes on viral transmission, and masks in high-risk areas are the most effective way to accomplish that; masks, to help us bring viral transmission to low levels around the country, and high levels of vaccination to keep us there.

One of the most common questions about the vaccine: What if I previously had Covid-19? It is a very fair question, and there is plenty of evidence showing that natural infection can provide good immunity. I want to be clear before I continue: By now you must realize that achieving immunity by naturally getting infected is a terrible idea and could land you in the hospital or worse. Vaccination is an exponentially safer way to achieve immunity. But, the question you are likely asking is more nuanced: Do you still need a vaccine if you already had Covid-19?

The official guidance from the CDC is yes. And, here is why. Existing data provides evidence that the vaccine will provide more durable immunity, and may also be protective against future variants.

These are always critically important metrics, and even more so now, as we deal with the Delta variant. Again, this isn’t dismissing the immunity from a previous Covid-19 infection, but making the case that adding a vaccine will provide better protection going forward. While the United States recommends a full two-dose course of the Pfizer/BioNTech or Moderna vaccines, some countries have recommended getting at least one shot in those with previously known Covid infections. The rationale is the original infection provided the same initial immunity as the first shot of a vaccine, and then a second shot would act as a powerful booster.

These are the real discussions I have been having with friends and colleagues and I know winning over people in this last camp may be the most difficult of all, because it does involve conversation — possibly a series of ongoing conversations — with loved ones, friends and perhaps a personal physician or trusted pastor, who can talk to the hesitant or reluctant person in a way that resonates with them personally. And victory will be hard won, measured one person at a time.

I try to do it all the time. For example, as I walk through my daily life, as an on-air correspondent, as a doctor, and in this space. I do it not only because I love my family, but because I love yours, as well.

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CNN’s Andrea Kane and Nadia Kounang contributed to this report.