Professional perspective and corrections: vaccine, hospitalizations, role of government, Bay Area comparisons

Email, by Richard Fleming, M.D., November 17, 2021, with permission

Hi Benicia City Council members,

Thank you for taking the time to discuss and consider the safest way forward for our city during the pandemic. I hope you can take a few minutes to consider the following points:

1. Vaccination rate.  According to publicly available data from the California Department of Public Health, the fully-vaccinated rate for the city of Benicia is 67.7%.  We have never been above 70% and certainly never been above 80%, numbers which have been mentioned in past city council meetings. (If we include those who got only one shot, the percentage is 76.7%, but the more important number is those who are fully vaccinated.) I strongly urge you to use the CDPH-reported fully-vaccinated rate for Benicia in future city council meetings. Also keep in mind that many fully-vaccinated people have not yet gotten boosters, and are beginning to lose some degree of immunity. Thus, the proportion of our city which has good immunity against covid-19 is actually less that 67.7%.
   You can see the state-provided numbers here:
   https://dig.abclocal.go.com/kabc/ca-vaccine-tracker/CA_vax_zip_map.html
2. Vaccine availability is not a good measure of our city’s immunity to covid-19.  It is not a good metric to use in making public health safety decisions. Vaccines are equally available throughout the Bay Area, yet our city’s vaccination rate is below the average vaccination rate for the other 8 Bay Area counties. It is clear that availability of the vaccine does not equate to uptake of the vaccine. It is better to make public health decisions based on the actual level of immunity, rather than the potential level of immunity.
3. Are cases or hospitalizations a better metric to follow? As Councilmember Largaespada noted at last night’s meeting, covid cases can vary depending on how much testing is being done. He correctly pointed out that the hospitalization rate is a better gauge of the virus’ impact on our city. I am unaware of Benicia-specific hospitalization data, so Solano County’s data is a fair proxy. The August City Council decision used cases as the metric to follow. I strongly urge you to change this metric to hospitalizations, since this measure more accurately captures how the pandemic is affecting our residents. Also, it is important to not view ICU capacity as equivalent to hospitalization rates. Councilmember Largaespada interchangeably referred to ICU capacity and hospitalization rates, but those are two very distinct and different measures. Since treatment options for covid-19 have improved dramatically, many covid-19 patients who are quite sick are now being safely managed on standard medical units or step-down units. The only ones needing ICU beds these days are the sickest of the sick. If ICU capacity in our county is going to be used as a metric, we could have stopped all public health precautions several months ago.
4. Should covid public health policies let those who choose not to be vaccinated live with the consequences of their decision? At your meeting last night, it was said we at some point need to just move on, and accept the fact the virus will be with us for a long time. Since vaccines are now widely available, it is up to individuals to decide whether to get them or not. I have two responses:
   (a) Yes, covid-19 will likely become endemic at some point, like influenza. But we are not there yet. In fact, we are far from that point. In very bad influenza years, the country loses an average of 142 people per day. Covid-19 is still killing over 1,000 people per day. Covid-19 is surging in many areas of the country and the world, and the coming winter months, along with holiday parties, will very likely increase the risk of viral spread. Most public health experts do anticipate covid-19 will become endemic and something we need to manage in our lives. But we are not there yet.
   (b) Government has always had a role and responsibility to help protect people from themselves. That is why, for example, we have seat belt laws. The availability of seat belts does not necessarily mean they will be used, so we have laws which force people to use them. Even more importantly, government has a role to insure people not make individual decision which harm others. That is why why have drunk driving laws. A person may feel they can hold their liquor and drive safely, but the government has decided to not leave that judgment up to each individual. With covid, those who opt to not be vaccinated are both putting themselves at risk and putting others at risk. It is fully appropriate for government to adopt policies to protect both the individual and the community from those who are putting themselves and others at risk.
5. What other Bay Area counties are doing. At last night’s meeting, I said that the other eight Bay Area counties are all retaining mask mandates. As was correctly pointed out, Marin has lifted their mask mandate, but it is only lifted for fully-vaccinated people. Partially vaccinated and unvaccinated people are still under a mask mandate. Marin has the highest vaccination rate, the lowest hospitalization rate, and the lowest death rate in the Bay Area. Contra Costa has not yet made a decision to lift their mask mandate. They along with several other counties are lifting mask mandates for selected businesses, but only when 100% of employees and customers are fully vaccinated. The other Bay Area counties have fared better during the pandemic than Solano County, and are approaching easing up on precautions very cautiously. I strongly encourage you to follow a similar approach.

Thank you for your work helping safeguard our community.

Richard Fleming, MD

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For details on Council’s discussion and outcome, see: “Benicia City Council debates changing mask mandate, decides to keep in place, will review again on Dec. 7“