Season’s Greetings to All!

I’d like to offer a Merry Christmas to everyone celebrating today, but also Warm Winter Wishes to the rest.

I believe we all win when we give others the benefit of the doubt: if I tell you Happy Holidays instead of Merry Christmas, I don’t intend to denigrate your savior. Instead, I hope you recognize that my own beliefs differ, but you have my respect for your Joyeux Noël.

My favorite Christmas lyric is “peace to men of goodwill!” May this message find every reader safe, secure, feeling cozy and full of joy.

A December 23rd article in the New York Times informed me that for many—especially women, people aged 18-44, and independents or Republican voters with modest incomes—2021 might be the source of even more stress over the holidays than 2020.

So many are exhausted and demoralized.

I immediately sent a text to my sister-in-law upon reading that story. I thanked her for all that she does, especially when I’m on the other side of the country, and told her how grateful I am that she married into our family. What a delight to enjoy—and like!—one’s relatives.

It’s easy to overlook kindness when life feels hectic. Extending a hand to someone else is a surprisingly effective way to find one’s own balance.

Let someone know they are appreciated today, and perhaps you can ease some of that holiday stress afflicting a loved one or yourself. If your home is beautifully decorated or you’re dining in relative splendor, make sure whoever provided such bounty to you knows it matters.

And offer to do the tidying up if someone else arranges most of your holiday cheer! A shout out to my kids who washed all the dishes after our festive dinner last night.

For all that I am firmly aware of the rising caseload of the Omicrom variant, and the lingering specter of inflation punishing our pocketbooks, December of 2021 offers good news that I feel compelled to acknowledge. Let’s look at those sunny spots on the horizon.

Without being totally divorced from reality, it is definitive that we are seeing some of the highest daily COVID-19 case rates of the entire pandemic. I agree that this sucks! Omicrom is a rip-roarin’ beast of infection; it’s many times more infectious than Delta, which superseded those original strains of SARS-CoV-2 from early 2020.

In spite of that ugly, hospital-cramming fact, the amazing step forward of mRNA vaccinations means that the novel coronavirus is now, finally, actually only approaching the flu in terms of order of magnitude of lethality.

According to David Leonhardt’s Dec. 23rd article in the New York Times, here’s some hard data on the current degree of risk from COVID-19:

The risks here for older people are frightening: A rate of 0.45 percent, for instance, translates into roughly a 1 in 220 chance of death for a vaccinated 75-year-old woman who contracts Covid.

You’ll want to view the article to see its excellent graphs to get the fullest picture.
That is frightening, but what about when we consider other common ailments? From the same article:

One reassuring comparison is to a normal seasonal flu. The average death rate among Americans over age 65 who contract the flu has ranged between 1 in 75 and 1 in 160 in recent years, according to the C.D.C.

Until I read this story, I wasn’t aware that COVID-19 has become, for a vaccinated senior citizen, less deadly than an average flu. What a powerfully reassuring data point! I find this a reason for great hope.

Before I go on, allow me to make obvious this other point: the unvaccinated† are not nearly so safe. COVID-19 is much deadlier for the unvaccinated than flu is.

The last flu outbreak to kill millions, plural, was the “Asian flu” of the mid-1950’s, with a total death count estimated around 2 million souls worldwide.

An otherwise similar unvaccinated elderly woman is 13 times more likely to die of COVID than the vaccinated hypothetical person above. There remains a much, much higher probability of death for that unvaccinated 75 year old woman than she would face in a typical flu season.

COVID-19 leaped onto the charts as the third leading cause of death for Americans in 2020, and the elderly bear the brunt of this burden. We lost 1.8 years of life expectancy last year; that’s the worst decline in over 70 years, since WWII saw so many killed between 1942-43.

It is wonderful that we’re moving toward taming the novel coronavirus from killer of millions to “only” fatal to hundreds of thousands. While not enough, that is good, and it should be appreciated…when it actually happens.

As of November 22, we’d lost more Americans in 2021 than we did in 2020. No one should ever forget that.

Yet savor the positive news as much as you dwell on the negative and your life will be better. If you are fortunate enough to have been vaccinated, your personal risk now pales compared to those who’ve mostly been tricked out of taking a life-saving inoculation

.

In addition to the lifesaving wonder of vaccines that measurably reduce deaths amongst our most vulnerable population, we’ve also seen two new drugs approved as treatment options for COVID-19 in the USA this week. Where the latest variant has rendered ineffective some‡ of our most effective earlier therapies, these new treatments arrive just in time.

They could also save us a lot of money.

To have new treatments people can self-administer at home—thus sparing exhausted, overburdened hospital staff while our total case numbers reach record heights—is another blessing. It’s hard for me to quantify how much I would prefer to pick up a prescription from my local pharmacy for a few days’ worth of pills if I had COVID over making repeated visits to a hospital or clinic.

The antiviral COVID pills from Pfizer and Merck will initially cost the federal government around $700 per dose. This represents an enormous savings spread over millions of doses vs. pricier monoclonal antibody treatments all of which cost $1200 or more at the heavily discounted government bulk purchase rate.
Patients will also be spared unpredictable fees for visiting those staffed locations necessary to administer IV therapies. In an era of high inflation—and personally facing a mandatory switch to a new health insurance plan from a different provider starting January 1st—I find this a great relief.

I’ve never had a confusing or even shocking bill after visiting a pharmacy, unlike every time I’ve been a patient at a hospital. Reflecting on the fact that I’m so incredibly privileged that I’ve never had a gap* in my insurance coverage, it seems likely that others fear surprise bills far more than I do.

The pandemic isn’t over. Thoughtful individuals should still be wearing masks and making efforts to improve ventilation while meeting with those outside their households. That said, we understand more than ever about how COVID-19 spreads. Many of us are vaccinated, thus protected against the worst outcomes of the disease. Available treatments have expanded from desperate guesses to multiple effective therapeutics.

This ugly, lonely, uncomfortable period in history will end, though those of us who’ve lived through it may well spend the rest of our lives processing the experience. For example, many of us grew up with grandparents whose behavior was permanently affected by surviving the Great Depression.

Right now, on Christmas Day, 2021, I encourage you to look for the positive anywhere you can. Experiencing terrible events isn’t the only predictor of future suffering; so is how one responds to those challenges, and what one makes with the memories.

Things could be better, but, of course, they could also be worse. Having made it to my father’s house and remained in good health in spite of the journey, I find so much to celebrate this year.

May all these little celebrations be less fraught in 2022.

Wishing every reader good health, good cheer, and a large measure of optimism for the year ahead!

♦

†It was a painfully frustrating message replete with disinformation from an old friend the other day that prompted me to research and think about these comparisons. For the vaccinated, COVID may now be similar to a “mere” flu; for the unvaccinated elderly, endemic COVID-19 is still a virulent threat to be taken seriously.

Publicly available data makes all of this very clear. In 2020, 3 million people died from COVID-19. In a usual year, flu kills between 290,000 and 650,000 around the world. No math degree is required to calculate that somewhere in the ballpark of four to 10 times as many deaths occurred in 2020 than we would have expected from “mere” influenza.

‡The two most commonly prescribed antibody treatments, those made by Eli Lilly and Regeneron, don’t work against the Omicrom variant. Only GlaxoSmithKline’s sotrovimab—the most recently approved monoclonal antibody therapy—offers protection from Omicrom. These therapies cost thousands of dollars per dose (retail of ~$3000-5000 according to this news story, though other sources state that the federal government bought in bulk for $2100 per Regeneron dose and $1250 each for Eli Lily’s) and are administered intravenously, requiring a trained health care professional’s presence for every dose.

*Though the Affordable Care Act has led to a major increase in how many Americans have health insurance at any given time, in 2020, 9.5% had some coverage but also experienced a “gap” in continuous care, whereas another 12.5% remained completely uninsured.