A Tale of Two COVIDs

Image of a headline from SFGate from January 11, 2022: “Head of COVID response for UCSF’s ER dept.: ‘I have not intubated a single COVID patient during this Omicron surge’”

“‘The crisis from the Omicron peak is not generated by serious COVID illness in regions with highly vaxxed populations,’ Noble wrote in an email to SFGATE. ‘The crisis we are suffering in the Bay Area is largely driven by disruptive COVID policies that encourage asymptomatic testing and subsequent quarantines. … The vast majority of COVID-plus patients I take care of need no medical care and are quickly discharged home with reassurance.’”

I read this story last night (linked below), and while it helped put some puzzle pieces together for me — for example, how does San Francisco’s ICU bed availability look so good and yet hospitals are overwhelmed? — it also helped me understand the particulars of why I’m finding this wave of COVID freshly exhausting and confusing.

Omicron is a turning point in the USA’s experience of the pandemic because the gulf has widened between how communities are hit. In very vaccinated areas like San Francisco, our problem is not currently that vast numbers of people are very sick, it’s that lots of people are testing positive and isolating, and that’s grinding the gears of everything from hospitals to schools, public transit to food delivery.

This is not the case in parts of the country with low vaccination rates, where hospitals are overwhelmed because lots of very ill COVID patients are once again in need of intensive care *as well as* medical staff shortages because of isolation protocols. Those areas are still facing 2020-style pandemic crisis, while high-vaccination communities are entering a new phase of negotiation with this coronavirus.

Basically, right now, it sounds a lot like San Francisco and other areas that have vaccination rates roughly in the herd immunity range (70–90%) are starting to grapple with whether the policy prescriptions for this pandemic are causing more chaos than the virus itself. And that is basically a complete inversion from the public safety stance we’ve taken for the last two years to get us to this point. There’s a huge amount of cognitive dissonance in that.

And, yet, the practical approach in this very moment remains much the same: Stay out of hospital right now, because the system is under pressure. Try not to catch COVID, because the knock-on effects are still knocking on.

There’s a nationwide COVID spike happening, but the stories coming out of it vary widely. What’s going on in San Francisco is not what’s happening in rural Michigan. It’s hard to take in how much is going on across the country, how it differs from place to place, how the national news relates to your county, and what that means about what you should do today.

Risk assessment through COVID has always been exhausting — everyone has different personal health to consider, unequal socioeconomic starting points, wildly variable obligations in terms of caring versus ability to isolate…

And, two years on, partisanship is a bigger predictor than other demographic data of vaccination status, with unvaccinated adults now more than three times as likely to lean Republican than Democratic, and likelihood of death from COVID far more likely in red counties due to the plague of rampant misinformation.

For blue urban areas, we may spend the next few months fumbling through how the future looks with COVID largely minimized through vaccination and willingness to use appropriate PPE when called for. Another phase of adjusting our behavior is coming, and it’s going to feel weird compared to the dystopian new normal we’ve practiced thus far.

Please, get vaccinated, get your boosters, and be excellent to one another. There are signs of hope, though so much uncertainty still. We get through this by taking sensible precautions to protect each other.

For reference:

The story quoted and pictured here

San Francsico vaccination data

A rural Michigan doctor’s perspective on this surge

Partisanship as predictive of COVID vaccination status

COVID deaths in red and blue counties

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