I haven't posted about COVID for awhile, partly because everyone is sick of the topic but mostly because it seemed pretty clear how the game was going to play out. But just as we were rounding third base and heading for home plate, the delta variant arrived. There were concerning mutations before, but this one is a game-changer. In fact, it has me wondering exactly how much a virus has to mutate before we stop calling it a "variant" and give it a new major release number.

This isn't just a little more drift towards increased virulence - the symptoms are different and everything we've learned so far about how to protect ourselves from infection is called into question. People are catching it outdoors now, something that was actually pretty rare with the OG virus. There are now documented cases of people being infected by passing an infected person in the mall. The chances of household spread have jumped from a surprisingly anemic 25% to 90%. A crew of airplane cleaners was reportedly infected - is it actually spreading through surface contact now? Do masks even work any more? 

I've been trying to process the new information and figure out what it actually means. How should I change my behavior? Does it make a difference if I make that evaluation based on my own personal welfare or the general welfare of society? And is this the worst twist that COVID could have taken, or is it not as bad as it sounds?

THE BAD NEWS 

• In Provincetown, MA (one of the most vaccinated states in the country) almost 900 people got infected over Fourth of July. 75% of them were fully vaccinated. Remember when we thought 50 people was a big infection cluster? 
• Anecdotal reports from hospitals around the country strongly suggest that the delta variant makes people sicker. Younger people (including an increasing number of children) are ending up in intensive care. And they get sicker faster - average time from onset to hospitalization is shorter, and from initial hospitalization to ICU. 
• The R0 of this variant is tentatively estimated at 5-9, which is approaching the virulence of chicken pox. Chicken pox virus wafts on the wind. Do you know what percentage of adults in the US have had chicken pox?  95%. Think about that. Pretty much every unvaccinated person is going to get this. Sources who are still describing the delta variant as "twice as contagious" need to get with the program. More like 3 or 4 times. 
• There are clearly way more breakthrough infections with Delta than the government wants to admit. Data from Israel, where they seem to be more committed to distributing actual facts than the US health care establishment, has found that the Pfizer vaccine is just 39% effective at preventing infection now that delta is the dominant variant there. This compares to about 90% effective with the original virus. That is a stunning decline. 
• And vaccinated people who get infected can spread the virus, which rarely happened with the earlier variants. That's what really changes the whole social calculus. Now vaccinated people can infect other vaccinated people. 

THE GOOD NEWS

• The vaccines really are effective at preventing serious illness and deaths, even the J&J vaccine. Only 3% of people coming into hospitals with COVID now have been fully vaccinated. And I think that includes the population that was hospitalized for reasons unrelated to COVID and just turned out to have it when they were routinely tested. 
• Vaccination rates are finally going up in states like Missouri, Alabama, and Arkansas. A lot. Nationwide, it's up 26% from 3 weeks ago. In Alabama and Arkansas the vaccination rate has doubled. I suppose it's only a matter of time before even Florida Man takes notice of what is going on and rethinks things. 
• It looks like India and the UK have peaked out and are headed back down again. I've analyzed these graphs before and noted that the time from the top of a steep peak back down to baseline is usually 6-8 weeks, pretty much independent of mitigation steps. It's usually pretty symmetrical - 6 weeks up and 6 weeks back down. It will be interesting to see if the pattern holds, especially with 2 countries in such different situations vaccination-wise. 
• It's not really as communicable as chicken pox. There's an overlap between the highest R0 estimates for COVID (5-9.5) and the lowest estimates for chickenpox (8.5-12). It's moving up into the hideously contagious category, but probably not quite that contagious. Yet.

SO WHAT SHOULD I DO?
My first reaction was to start masking up and avoiding crowds again, hoping that this spike will peak and crash within a couple of months. That's a revision of my initial strategy of just trying to ride out the pandemic without getting infected.  

But maybe that's not the right strategy anymore. If everybody is going to catch it, maybe now is as good a time as any. I'm relatively freshly vaccinated and in good health. A mild case of delta variant on top of a recent mRNA vaccination might just put the cherry on the top of lifetime immunity to this virus. 

It's highly unlikely that the SARS-2 virus is going to kill me now, or even make me very sick. But there's still Long COVID to worry about. There's not enough known about that, but it doesn't sound like having a mild case makes you any less likely to have lingering symptoms. So maybe the best approach is to hunker down and wait it out until there's a booster shot available, especially one tailored to the variants. 

And why exactly is the government urging people to mask up and take precautions rather than just get vaccinated and let it play out from there? What do they think the end game is? Are they counting on the whole thing burning itself out in another 6 months? Another year? Or are they assuming that there will eventually be a booster that could protect the entire population? 

Remember way back on April 7 when Wisconsin insisted on holding in-person elections and everybody expected a big spike in COVID infections a few weeks later? Well, it didn't happen. There were a handful of (possible) infections reported among poll workers and voters, but nothing that could remotely be called a spike in the overall numbers. If anything, I think the rate of confirmed infections in Wisconsin declined slightly during that period.

While it might have been morally and politically satisfying to see such a spike (since predictably the whole thing turned into a completely partisan political battle) the outcome is very good news. And not just because we all hate to see an increase in human suffering (although of course we do, right?). The thing is, voting is a lot like grocery shopping these days. You stand in lines outside the store for an extended period of time, then wander around a fairly large enclosed space for several minutes having passing encounters and short interactions with other random patrons and workers. It has been my considered opinion that this sort of activity creates non-zero but extremely minimal risk of infection. If a ton of people had gotten sick from voting, I would have had to rethink that and start worrying more about my infrequent forays to the store. Now I don't have to. Yay.

 Oh, DavE, how I miss you. You would have gotten the title reference. To the rest of you, it's just another way of saying I'm still posting about the coronavirus. As things evolve and more facts are available, I'm starting to see public advice that is more helpful than "The best way to protect yourself is to wash your hands," as well as a more nuanced approach to hand-washing. I've been putting together a health protocol for myself in the time of plague and trying to get in the habit of following it.

BEST and EASIEST ADVICE. Don't shake hands! This virus doesn't live very long on surfaces, but anybody who is sick is going to have it on their hands. Because the 2nd best advice is also practically speaking impossible.

2nd BEST and HARDEST ADVICE. Don't touch your face. This is usually followed by a long article citing studies about how often people unconsciously touch their faces, rub their eyes or noses, touch their mouths, etc (about 20 times/minute I think). Sure, people, don't touch your face. Good luck with that. But assume that anybody you might be shaking hands with probably has touched their face 20 times in the last minute and proceed accordingly.

COUGH INTO YOUR ELBOW 
This one is hard for me because I learned to cover my mouth with my hand as a child when I coughed or sneezed and am having a really hard time unlearning it. It's complicated by the fact that after my first fall/winter cold I end up with a dry cough and slightly drippy nose that lasts all winter and usually well into the early spring pollen season. This alone is going to make me into a pariah in the Time of  Rinderpest, I'm afraid. But at the very least, I am trying to remember to cough into my elbow. 

WASH YOUR HANDS
Washing your hands is good basic hygiene, and certainly the best way to avoid SPREADING germs (especially food-borne microbes and things like norovirus that thrive on surfaces). Under most circumstances, I don't see it doing much to protect the hand washer from infection, although I suppose it can't hurt. Washing your hands in a public bathroom probably does more harm than good in that regard, although if you're in there already for *ahem* other reasons you might as well go through the whole "lather up for 20 seconds" routine. But if you don't want to just infect your hands again the second you touch the door handle on the way out you need to take additional precautions (use a paper towel or your elbow or something). 

One idea that I picked up from a couple of people right here in this forum (but have not actually seen anywhere in the Public Health Advice) is to wash your hands thoroughly when you come home (from work, shopping, whatever). I haven't ever done that unless I'd been doing something unusually grimy, but I'm starting to do it now. That might actually help protect you, the hand washer.

USE SANITIZING WIPES
In public spaces hand washing is rarely practical, and it irritates the heck out of me to see all the official advice that ends with "use hand sanitizer if you must, but washing your hands is SO MUCH MORE effective."  Sure, if you're at home! If I had any sanitizing wipes I would use them primarily to wipe down objects in public spaces: airline tray tables, bathroom door handles, shopping cart handles, etc.  Maybe my credit card after someone else had handled it. And a few things at home, like the bathroom sink when there are people visiting or sick people in the house. 

Since I'm clearly not the first person to think of this, you can't buy alcohol wipes right now, so I made my own. I'd rather have some actual travel wipes to take with me to the airport, but in the absence of such I have soaked some cotton cosmetic pads in a mixture of isopropyl alcohol and aloe vera gel and will carry them in a ziplock bag. I think I can get through TSA with that. 

ACTUALLY BEST AND ABSOLUTELY HARDEST ADVICE
Don't go out. Don't travel, don't go to parties or conventions, don't take public transportation. It sounds like a little light shopping at non-busy times is probably not a great infection risk (assuming you wipe down the shopping cart handles with alcohol). But anything social? Right out. The greatest danger is being in closed spaces with other people for an extended period of  time. Outdoors exposures are less dangerous unless it is really crowded. The official definition of "close contact" seems to be "within a 6 foot proximity of an infected person for more than 10 minutes."

I am not following this last advice (yet). I am in fact, getting on an airplane tomorrow and flying to Oregon, which is an emerging nexus of infection. It's not that bad yet, there or here, and I think we'll be okay. But I suspect we'll be cancelling our May trip. And I am increasingly concerned about attending Minicon. I think about a 50/50 chance at this point, depending on how community spread evolves in the next few weeks.