It Takes a Village
I’ve never believed this statement more than I do today!
I do have other favorite mantras (like “Heath is More than the Absence of Disease,” “Mental Health Matters,” and “Don’t Be A Jerk”), but today I’m focused on the village vibe.
Why?
I needed my village more than ever when CNN published my newest opinion piece about doctors modeling vaccine confidence.
I’d be thrilled if you read the whole article (linked above). But the gist is this: I take my mask off with my willing, immune-competent vaccinated patients. If doctors don’t trust the vaccines, why should anyone else?
...the biggest hurdle to achieving herd immunity — and to resuming normal life — is the ground game of encouraging vaccine uptake among unvaccinated people.
Primary care physicians — along with other trusted messengers like pastors, clergy and local leaders — are the secret weapon for ending the pandemic. We need to model vaccine confidence and advertise the clear benefits of vaccination. When making medical decisions, people are more likely to trust their health care provider (or other trusted leaders) more than raw data, public health messages or doctors on TV. Trust is the currency in medicine. It is hard-won and precious. Doctors need to leverage that trust to empower patients with evidence-based guidance and optimism. When hope is rooted in science, it's our duty to dispense it.
This issue of masking in the U.S. has been so highly controversial and politically charged that my article invited intense public criticism and overt hostility toward me on Twitter (and elsewhere). But my village of medical/public health experts and data-devoted followers saved the day. I felt loved and supported. (Check out the hubbub if you’re interested and have a whole lotta time on your hands.)
The short story? People are reading my piece. I feel like it’s making a difference. I have zero regrets. And your support means everything.
Thanks, village!!
Sometimes you feel like the village idiot.
In my newsletter last week about kids I made the point that kids are at low risk for COVID-19 and that we should always put the risk of COVID-19 into context when making hard decisions for our unvaccinated kiddos. We should realize, for example, that the risk of COVID-19 is less than the risk of flu in kids. It turns out there have been even fewer deaths from COVID-19 in kids than I knew: according to the CDC, COVID has killed 277 kids under the age of 18 which is about 0.46 per 100,000, far fewer deaths in that age group than in a typical flu season. (I mistakenly said that it was somewhere between two and five in 100,000 kids ages 0-17 that have died from COVID-19). For comparison, in 2017-2018 the flu virus took the lives of approximately 643 kids under age 18.
Thanks to my pals Emily Oster, PhD, and Kelly Fradin, MD, for closely reading my newsletter and noting that I actually overestimated the risk of COVID-19 in kids. Once again, it takes a village! (I don’t actually feel like an idiot in this instance; it was just a handy way to title this section.)
Be a village voice!
To remind: the vaccines (including the J&J) take death and severe disease off the table, they dramatically reduce your risk for getting COVID-19 and significantly drop your risk for transmitting the virus to others.
The vaccines are so effective it can be hard to believe. Back in summer 2020, I recall thinking that we may never get a vaccine. Yet here we are, 14 months later, with a near-perfect vaccine — and perfect was never on the menu.
We won’t get through the worst of the pandemic without vaccinating most of the village. Do we need to vaccinate every single villager to get back to “normal”? Absolutely not. A zero-COVID strategy isn’t realistic or necessary to resume regular life. But when the village is only partially immune as it is right now, we’re all at increased risk. In other words, unvaccinated people are still vulnerable to COVID-19 and can transmit the virus to other unvaccinated people. Vaccinated people are indeed significantly less likely to get COVID-19, but if a vaccinated person does get infected with COVID-19, it would most likely come from an unvaccinated person.
Conversely, each of us — vaccinated or not — is incrementally safer as we vaccinate millions of people every day and edge closer to herd immunity.
So if you know anyone who is hesitant about getting vaccinated, please consider sending them my CNN article or a) ask them why they’re hesitant, b) listen without judgment, and c) gently direct them to the facts. Shame doesn’t motivate people; HOPE does.
Let’s recognize the vaccines’ power and encourage our friends, family, and community-members to get the shot. Tell them about the latest real-world data from the CDC on 92 million Americans: we’ve seen only 9245 breakthrough infections, 27% of which were asymptomatic. When you do the math, the risk of COVID-19 after vaccination is 0.009%.
Many people are worried about the variants. So I’ll remind you that the vaccines continue to be powerful weapons against all of the circulating variants. Other people are worried about the possibility of needing booster shots. To which I say this: the only reason we’d need booster shots is if the coronavirus mutates in such a way that the vaccines are not as effective. So far that hasn’t happened. Moreover, vaccination is going so well in the U.S. that with each passing day we’re choking off coronavirus’ ability to mutate. Worst case scenario? We do need boosters — and we’d get them like we do the flu shot. I wouldn’t spend any time worrying about booster shots. The future of the pandemic in the U.S. is luxuriously bright. (I’d worry instead about India — see below.)
Breaking news: the FDA is set to approve the Pfizer vaccine for 12-15 year olds early next week. Getting them vaccinated will most definitely help the herd.
The upshot? Advertise the vaccine to everyone you see. Tell your grocery store clerk, lawyer, and hairdresser how great it feels to have been vaccinated. Don’t be shy! People need to be reminded that vaccination is our ticket to normalcy. Be a village role model!!
We’re all part of a global village, too.
The situation in India is horrifying and tragic. People are dying, hospitals are overwhelmed, and supplies are running out. These are our problems, too. The virus knows no boundaries or borders. Helping our friends overseas is not only the right thing to do; it’s in our best interest. The virus is spreading like wildfire, and, when unchecked, can mutate and do even more harm.
Perhaps like you, I feel helpless when I read about India. I also sometimes feel strange celebrating the good news at home when our allies around the world are struggling. Here’s what I remind myself: we can simultaneously feel joyful about our own successes and sad about other people’s hardships. We can enjoy the benefits of vaccination — seeing loved ones, socializing with friends, and reclaiming essential parts of our lives — while mourning the losses for others. Joy and sadness, hope and caution, self-care and empathy for others are NOT mutually exclusive.
If you’re looking to help, here are two organizations (among many) that are doing outstanding work in India:
The American India Foundation, dedicated to improving the lives of India's underprivileged women, children, and youth. Donate at www.aif.org.
CMC Vellore, a 3000-bed multi-speciality medical institution of international repute; one of the top-ranked educational, healthcare and research institutes in India. Donate at www.vellorecmc.org.
And last, I got to join a cool new village today.
I was honored to be invited on the podcast In the Bubble hosted by Bob Wachter, MD, chairman of the Department of Medicine at UCSF alongside Craig Spencer, MD, ER physician at Columbia University hospital. We talked about navigating the new "normal" with hope and caution, kindness and empathy, and with data put into context (aka nuanced guidance). I’ll send it out next week once it drops on iTunes.
One last thing: it really does take a village. To work, parent, manage uncertainty, cope with stress, handle adversity — hell, just getting through the day — takes support. I rely on mine. I hope you lean on yours, too. Thanks for being part of my village!
I will see you later this week. Until then, be well.