How much of a COVID risk was Obama's birthday bash?

(AP Photo/Morry Gash)

I agree with Peter Spiliakos that the party should have gone on. Precautions were taken. If a group of immunized and recently tested adults can’t get together outdoors because of Delta then we might as well lock down forever.

We want elite influencers incentivizing vaccination, don’t we? Well, the creme de la creme of the liberal political and cultural establishments got together in Martha’s Vineyard last night to drink, dance, and revel, all because they’re confident that the vaccines will protect them from any serious complications. They put their own asses on the line to test that proposition. If it works out okay, with few infections and no one ending up seriously ill, it’ll be a marquee example that vaccine proponents can point to as further proof that the shots pay real health dividends.

On the other hand, if it ends up being a superspreader event with scores of guests infected, the high likelihood that none will end up in the ER will be given short shrift in the ensuing media frenzy over the fact that even a mass gathering of vaccinated people with extra precautions in place wasn’t safe with Delta on the loose. That could discourage holdouts from getting their shots. And if the outbreak ends up spreading across Martha’s Vineyard, potentially endangering older people, Obama will have to explain why he declined to settle for a more modest celebration.

“Democrats supportive of the former president privately expressed surprise at the casual disregard for optics and wondered why it took until just days before the party for Mr. Obama to change course,” the Times reported a few days ago about his decision to “scale back” his original guest list. Doesn’t look like he scaled it back much:

They’re “outdoors” in the sense that they’re in a tent, which is open on the sides, but a covered partial enclosure will provide less ventilation than if guests were in the open air. And I’ll bet most were indoors for at least a few minutes at some point in the evening, if only to use the bathroom. One guest posted photos and then deleted them “due to the rules,” which I assume was Obama’s concession to members of his party worried about “optics.” At a moment when the Democratic establishment is urging Americans to take COVID seriously again, having the public watch 44 cut loose maskless with the likes of Steven Spielberg and George Clooney will … complicate that message.

Especially since the details that they were all vaxxed, tested, and (mostly) outdoors will slip through the cracks as the footage circulates.

Two months ago, having a blowout bash with all of your immunized friends wouldn’t have been a problem. The hot vax summer was upon us courtesy of Pfizer, Moderna, and Johnson & Johnson. Two months later, with hospitals in Delta hot spots filling up, we’re back in a nightmare of rampant transmission and rising death. Former Trump advisor Tom Bossert has been studying the numbers and spotted an alarming divergence between our Delta wave and the one in the UK. That country has a larger share of its population vaccinated than we do, but not wildly higher. And it’s possible that we have a similar degree of overall population immunity due to the number of people here who’ve had COVID and recovered. And yet, for reasons that are unclear, a much higher share of Americans are getting seriously ill from Delta than Brits are:

The grimmest piece on the pandemic that I’ve read this summer is this new interview with scientist Eric Topol titled “Too Many People Are Dying Right Now.” As Delta began to spread in the U.S., experts like Topol expected a surge in cases but a much gentler rise in hospitalizations and an even milder rise in deaths, all thanks to vaccination. Instead we’re seeing about the same ratio of cases to hospitalizations now as we saw during our pre-vaccination winter wave. How can that be when we know that the vaccines substantially reduce one’s risk of hospitalization? Topol isn’t sure but he’s worried:

I mean, one of the worst signals that I’ve seen is San Francisco. San Francisco is like Vermont, they’re even a little higher than Vermont for fully vaccinated — it’s 70 percent of the population of San Francisco county and it’s going through a very substantial hospitalization spike, unlike Vermont.

So I look at San Francisco as a bad bellwether for what might be coming. Why are they doing so poorly right now for hospitalization? Why is it so different than Vermont? If there’s that many people getting so sick, something’s just not right…

In San Diego, too, we’re having hospitalization increases, too — not as bad as San Francisco, but our vaccination rates are quite good for California. But they’re not preventing a surge of new patients in the hospital.

And the rate of rise — it’s scary. We’ve never had a rise like this for the country. And, okay, a lot of it is from Florida and Louisiana. But the rate of rise is just… scary. The fact that this ratio is being maintained, compared to a monster-wave, pre-dating vaccination…

What’s going on?

We can spitball various explanations, none of which are mutually exclusive. The most obvious is that, even in countries like the U.S. and UK where a high-ish percentage are vaccinated, there are still millions of unvaccinated adults who haven’t had COVID and are vulnerable. Hospital physicians across the country have spent the past few weeks attesting that nearly every person landing in their ERs for COVID hasn’t had their shots. Even if Delta never infected another vaccinated person, it could fill up U.S. hospitals simply by preying on the remaining non-immune population.

Another possibility is waning immunity. Topol says he recently treated an otherwise healthy 70-year-old woman who was vaccinated back in January and ended up with a breakthrough case that left her near death. Israel has already recommended third doses for people 60 and over due to studies showing their immunity waning over time, at the very moment Delta is rocketing around the country. The data showing that you’re unlikely to land in the hospital if you’ve had your shots is overwhelming, but the more time passes after vaccination, the less robust your immunity will be. And if you’re a senior citizen, you’re starting from a low-ish baseline of immunity to begin with.

A third possibility is that the ratio of cases to hospitalizations isn’t what it appears to be. Topol hinted at that in a tweet today:

Officially, the U.S. is averaging around 110,000 cases and 55,000 hospitalizations at the moment, a two-to-one ratio similar to what we saw this past winter. But if we’re not testing nearly as much as other countries, it stands to reason that our data is missing a ton of infections. Scott Gottlieb has been speculating about that for weeks, arguing that the true number of daily cases in the U.S. might be upwards of a million per day. Many of those “missing” cases are likely to be young adults who overcome their infection without much difficulty and so never bother getting tested. Many others are probably breakthrough infections in vaccinated people who also get through their illness quickly and therefore don’t take the time to get tested.

If the true case/hospitalization ratio is 1,000,000 to 55,000, say, that’s much more in line with we’d expect from a COVID wave where half the population has been vaccinated. If Gottlieb is right and the number of “hidden” cases is wildly greater than we realize, it’s a testament to how insanely contagious Delta is — but also a testament to how well the vaccines are performing. Remember what happened to India, a country with little population immunity at the time, when the new variant showed up.

Finally, it could be that the U.S. population is less healthy than the UK’s on average, landing more people infected by Delta in the hospital here than there. Just last week a new study found that obesity was “strongly associated with hospitalization, need for oxygen therapy, higher viral load, and an altered immune response” to COVID. In the UK, an estimated 28 percent are obese. In the U.S., 42.4 percent are. We simply have a larger share of vulnerable people than Britain does.

Anyway, good luck to everyone who was at Obama’s party. They should all be fine, but some may have a hard few days ahead of them.