Has the COVID-19 “war” changed with the Delta variant, as the CDC’s leaked documents declared? Not really, former FDA commissioner Scott Gottlieb told CNBC’s Squawk Box this morning. Parsing out the data from the clickbait, Gottlieb points out that the vaccines make the kind of breakthrough transmission cited by this study relatively rare, although perhaps more asymptomatically prevalent than the CDC acknowledged before now.
Therefore, the fully vaccinated are not a big vector for transmission. Nor did people think that the unvaccinated could never transmit the virus in the first place. The big issue is the unvaccinated, who keep choosing to pose a risk to themselves and others, and masking the vaccinated won’t mitigate that risk:
While infections (and transmission) can still occur, the vaccines work very well. In CDC's data they showed vaccinated people had a 25-fold reduction in risk of death, a 25-fold reduction in risk of hospitalization, and 8-fold reduction in risk of disease (Disclosure: Pfizer BoD) https://t.co/oCYjjObm5O
— Scott Gottlieb, MD (@ScottGottliebMD) July 30, 2021
Gottlieb offers common-sense guidance for the vaccinated. If you are in close contact with uniquely vulnerable individuals, including the unvaccinated by restriction (such as small children), take precautions to protect them. Mandating masks for everyone makes no sense at all, in large part because it’s not protecting those who can’t protect themselves. The mandates are clearly intended to protect those who won’t protect themselves, and that’s a recipe for perpetual masking — which people aren’t going to tolerate anyway.
And in fact, as Axios reports, it’s guidance that people are already largely ignoring:
In grocery stores and pizza joints, main streets and downtowns across the country, pandemic precautions range wildly — from nonexistent to 2020 deja vu.
The big picture: As COVID-19 cases surge, especially in states with low vaccination rates, the country is once again in the throes of a fraught cultural and political debate over face masks.
The CDC’s updated guidance this week that even vaccinated people should wear masks indoors in areas with substantial or high transmission was met with a mix of acceptance, frustration and indignation.
Dr. Leana Wen also took a look at the data and reaches the same conclusion as Gottlieb. Wen has a different public-policy agenda for dealing with the implications, but the data makes it clear that the CDC is focusing on the wrong population:
My takeaways from the leaked CDC docs:
1) Vaccinated people can transmit Delta if infected.
2) However, the majority of transmission is still by UNVACCINATED–that's where the focus should be.
3) CDC should have released these data earlier. We can't wait for peer review.
— Leana Wen, M.D. (@DrLeanaWen) July 30, 2021
Let’s point out that the CDC still hasn’t released this data. Someone leaked the data, and it’s still not clear why. As I wrote earlier, this smells of manipulation, either to attempt to quiet critics of its guidance or to do an end run around CDC leadership.
Wen makes this point in service to her preferred policy, a national vaccine passport for access to public venues. That also will never fly and would likely cause the hesitant to turn militantly opposed to vaccination. It would also likely fail in court, as the US does not do internal passporting. But that’s where Wen is going with this argument, even while being correct about the core issue:
“The Biden administration was really uneasy and squeamish all along about this idea of vaccine verification,” Wen said, adding that since there is no universal verification system, “the concern is that the unvaccinated are masquerading as the vaccinated.” …
“There is this idea by the Biden administration that they have to blindly follow the CDC,” Wen said. “Following the science does not mean that you listen to only one scientific institution.”
Wen also likened getting the COVID-19 vaccine to drunk-driving laws, saying that all American adults have the right to drink at home and in private settings, but “don’t have the choice to get behind a wheel of a car intoxicated in a way that you could harm other people.”
Vaccine passports are a seriously misguided response to a personal-risk issue. We don’t require such passporting for, say, MMR or polio vaccines, which prevent deadly transmissible diseases. If we can agree that the unvaccinated are choosing to assume risk despite having an abundance of vaccines available that would eliminate 99-plus-percent of risk of serious illness and death, we can also let them bear the burden of that choice without transferring it to those who act responsibly.
Jonah Goldberg makes this same point at The Dispatch:
Let’s assume the CDC actually has the data to support its policy. There are three primary arguments to require the vaccinated to mask up.
First, we need to protect unvaccinated adults, who account for nearly all COVID-19 deaths and hospitalizations. There would be a good case for this if vaccines weren’t readily available. But they are. At this point, if you choose not to get vaccinated (without a medical excuse), I think that’s profoundly foolish, but that’s your choice.
Second, there’s the matter of children under 12 who still can’t get the vaccine. My heart aches for any child who dies from COVID-19—or anything else. Fortunately, the death rate for children is statistically miniscule. According to the CDC, of the more than 600,000 deaths from COVID-19, only 335 have been kids under 18 (and it’s unclear how many of them had significant additional health issues). According to the CDC, roughly twice as many kids die in car accidents every year. We don’t ban kids from cars.
The third argument, usually only hinted at, is that we need to keep COVID-19 from mutating into an even more dangerous variant that can defeat vaccines. This is a real concern. But masking and even lockdowns won’t prevent that. As best we can tell, the delta variant came from India. We could require Americans to wear masks and even get vaccinated, but that wouldn’t stop the virus from mutating somewhere else. And unless we want to ban global travel indefinitely, or until we vaccinate much of the planet (which we should do), we have to live with that possibility.
It’s even more basic than that. The COVID-19 genie is out of the bottle, and there’s simply no stuffing it back in. We have to learn to live with this virus, and that can’t mean shutting down commerce and forcing people to wear masks for years on end when we have vaccines that render this even less risky than a seasonal flu for the immune. The proper focus should fall on getting the unvaccinated to get their inoculations, and then vaccinate the world to transform COVID-19 into a routine and manageable health-care issue. Masking the vaccinated doesn’t advance those goals at all — and to the extent that it indemnifies the risk-takers, it seriously impedes progress toward that goal.
Update: Jeff Dunetz follows up on the same point:
But along with the health reasons, the vaccine is worth it because, after a year of national quarantine, the shots will allow us to return to a more normal life.
This new CDC mask guidance takes that benefit away from the vaccinated to protect the non-vaccinated. What is beyond comprehension is why are the vaccinated people being punished for the actions of the non-vaccinated? This may sound callous, but the people who decided against getting the vaccine made their own decision—and if they catch COVID, that too is their decision. The CDC and governments who want to mandate compliance with the CDC’s new guidance should keep my family and me out of it.