More Progress! Also something about Kids, QBs, and the Cost of Care

Measurable Progress Continues

19% of Oregon is fully vaccinated, and more than 31% have had at least one dose. I’m predicting that about 60% of Oregonians will want to get vaccinated, so we’re well on our way to getting doses to many of the people who want them.

Looking back to COVID Convos #35, I predicted that the pandemic would be over by Memorial Day. I stand by that prediction but want to clarify that the pandemic will be over for those who choose to be vaccinated.

Some credit goes to President Biden for forcing Kate Brown’s timeline so that all adult Oregonians will be vaccine eligible on April 19th. Vaccine production has really ramped up, shipments are coming through, and deployment into arms is getting much more efficient. Even though you probably won’t get your shot right on 4/19, I’m forecasting that you will have both doses in your arm (or your single dose of J&J) in time for Memorial Day.

As a timely reminder that mRNA vaccines really work, here’s a study just released this month that looked at vaccine efficacy in nearly 4,000 high-risk frontline workers like me: 80% effective after one dose, 90% effective after a second dose. Success. And reassuring!

Who Won’t Get Vaccinated?

The pandemic won’t be over by Memorial Day for people who aren’t vaccinated. Those folks will still risk getting COVID, and some of them will still get sick and end up in the ICU or worse. April data shows that there is a clear “4th wave” of infections in Oregon right now. But while there have been a handful of breakthrough cases of disease in vaccinated people in the PNW, those are occurring in 0.01% of the immunized population. 99.99% COVID-proof is really good, so the 4th wave of cases is almost completely driven by unvaccinated individuals.

If you are not yet eligible, keep safe until you get your doses. Also, if you have decided you don’t want the vaccine you probably have your reasons, and that’s Ok. But…. then there is Josh Allen, star QB of my Buffalo Bills. Allen is a guy with a really strong arm, but he wasn’t drafted for his IQ or his epidemiology chops. He says he’s “a big statistics and logical guy” and he’s not convinced he needs the vaccine.

If I was the team doctor I’d point out some statistics and logic to him: in his age group the vaccine is 95% effective, and has nearly no side effects. But the side effect of not getting vaccinated? Getting exposed, having a positive test, getting benched for the week, and watching your team miss the playoffs because the Bills don’t have a decent backup quarterback. Getting immunized is statistical and logical, Josh!

But What About the Children?

Pfizer will soon release a new data set showing that their mRNA vaccine is 100% effective in kids aged 12–15. This data is being presented to the FDA and will be used to justify expansion of vaccine eligibility down to age 12, and my sources say that Moderna has a similar data set that can be expected in the next 2–3 weeks.

Time for another COVID Convos prediction: Middle School-aged kids will be able to get dose #1 in June. Summer sleepovers will be back by the 4th of July! I’m optimistic about this prediction because we are rapidly reaching the point where vaccine supply exceeds demand. If my prediction that adults will be immunized by Memorial Day holds, then kids will be lining up for their turn in June.

Is the shot really 100% effective in teens? No, but it’s pretty close. Notably, Pfizer only looked at symptomatic cases so it likely missed some asymptomatic positives. Consider also that this disease disproportionately afflicts the elderly, and spares the young. Because kids have such a low rate of infection in the first place, it’s much easier to move the needle towards 100% disease avoidance.

Time For a Little Rant

A recent NYT story sits at the crossroads of two of my interests, COVID and ER billing. According to the story, Lenox Hill Hospital “billed $3,358 for a [COVID] test” which the patient felt was very unfair. Yes, that would be unfair if it was true, but this is not correct: her $3,358 bill is actually for the entire ER visit. The ER is always a horribly expensive place to go for care, as I’ve previously written about. (←that links to a good essay, you should read it. I even linked you behind the paywall so it’s free!)

Advice: You should not go to the Emergency Room unless you’re having an Emergency. Is a UTI an emergency? No. When your daughter breaks both her arms, is that an emergency? Depends, but unless things are horrifically deformed or there is a bone sticking out through the skin, no. Having a heart attack? Yes, yes that’s an emergency! Want to get a COVID test? NO, definitely not an emergency!

The ER is obligated by EMTALA to thoroughly examine, test, and treat everyone who walks through their doors. This gets expensive! If you just simply want a test, whether it’s COVID or an X-ray or whatever, don’t go to the ER. That’s why I tell my friends, my neighbors, and you, my dear readers of CC, that if you have a medical question, don’t feel bad asking me. I’m not your doctor, but I can answer questions for free, and that might save you hundreds or thousands of dollars.

Quick update to the NYT story, the director of the hospital in question has responded and said nearly the same thing as me, specifically: “When patients arrive in an emergency department, federal law requires that they be evaluated and treated, regardless of their ability to pay. Patients requesting a Covid-19 test are advised when they walk in — orally, in a written consent form and with signage at the registration desk — that their test is considered an emergency visit”

Exactly. It is not the test that costs so much, it’s the ER visit.

COVID Convos is available here, but is also free to share on Substack.

Doctor, Reader, Thinker

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