letter - Sierra Pines United Methodist Church

Greetings Fellow Parishioners,

In this unprecedented age of massive misinformation, we find ourselves in a global pandemic that in this country has become politicized beyond our wildest dreams. I have been in the trenches caring for patients for 18 months who have contracted Covid and we continue to see rising levels of hospitalizations and deaths among the unvaccinated.

There have been many questions and emails directed to the Pastor about being in a closed space with other people. Is that safe? Will I get covid? Do vaccinated people pass on covid? Should I just stay home and safe? Does it matter if I’m vaccinated because I can still get Covid? Do children pose a great risk of transmission? I’m old or immunocompromised, if I get Covid at church, will I be hospitalized or die?

I am not a virology expert. I am a physician who has been working on the front lines for 18 months. My brain is saturated with Covid information, since that has been our primary focus for a year and a half. Our clinic is overrun right now with exposures and positive testing, mostly in the unvaccinated population.

I will also say that I believe every American has a right to decide for themselves if they want the vaccine or not. I think as Christians, our first duty is to be there for one another, comfort one another and respect one another. I’m not trying to be mean or bullying, but I am fatigued by the politicization of this deadly pandemic. Allow me if you will, to give you some information that is verified by medical journals, the CDC and medical experts. Nothing I post here will be from social blogs, politically driven websites or you tube. I would caution you to stay away from those sites. Valid information is important. We use information everyday to make decisions for our lives. That information needs to be truthful so we can make good decisions for our lives and the lives of our families. This is no different.

Do vaccines work against Covid? They reduce the viral load in your body, and help your immune system develop antibodies to the virus. Since this is a novel virus (the SARS component, not coronavirus in general) we have very little immunity to its effects. The rate of death from Covid in unvaccinated individuals varies from 5%-16% depending on the risk factors of the individual (other health issues, age, immune status, ect). The rate of death in a fully vaccinated individual is less than 1%
Am I at risk of going to church if I’m fully vaccinated? But you’re equally likely to come into contact with a Covid infected individual when you go to Home Depot, Safeway, Holiday, the fair, a concert, a meeting, ect. Covid is out there and it isn’t going away anytime soon. I can almost guarantee you will come into contact with a Covid infected individual at some point. In fact, most of our members are vaccinated, so your risk is actually less than in the general population. The hard truth is that at some point, with the number of unvaccinated individuals in society and the virulent mutant strains, many predict that we will all be exposed to Covid within the next few years. Those who are vaccinated have a 99% chance of surviving that exposure.
Why do we have to wear masks? Wearing a mask protects others from viral particles flying out of your mouth when you speak, sing or breathe. The protection a mask provides (around 30% decreased transmission) is a small price to pay for being in fellowship with others and respecting their health and well being. Wearing a mask protects the mask wearer from viral particles flying out of other peoples mouths.
Do children transmit Covid more than others? No, children infected with Covid have the same transmission rates as adults infected with Covid. Vaccinated children are no more likely to transmit the virus than anyone else who is vaccinated.
Can I get Covid from a fellow parishioner who is vaccinated? Yes, you can, though the rate of transmission is markedly reduced in a fully vaccinated individual. Nonetheless, no vaccine is perfect and certainly breakthrough illness is possible. Typically, it is a much less robust infection than in non-vaccinated people and unvaccinated are likely to transmit the virus for a longer period of time. It is estimated that for every patient who contracts the Delta variant, s/he will infect 3-5 other individuals (unvaccinated).
I’m old and immunocompromised. I’m vaccinated but I’m scared. Should I be in an enclosed space? That is an individual call. We are still determining the rate of vaccine effectiveness in immunocompromised patients. But that data coming in suggests that young and old, sick and not sick are still protected against death and hospitalizations far more than the unvaccinated. The death rate is still below 1% in all vaccinated patient populations across the world. There are also social and psychological consequences associated with continued isolation. We are social beings and meant to be in fellowship with one another. While certainly no one wants to die from attending church, I would submit that you risk dying simply by living in the world.

Conclusion:

No one can make the determination for you whether you will be safe and comfortable in church. I will say that with our largely vaccinated congregation, I would submit your risk is actually less than going into the supermarket or to a movie.

I also believe that we need one another, and we need to be in fellowship with one another. I have missed greatly the community of faith we have at SPUMC and I know others have as well. I take risks everyday being exposed to covid, and in fact I was one of the unlucky 3% that contracted a nasty case of covid despite being vaccinated. That being said, I was praising God everyday I was sick, knowing I would not be hospitalized, I wouldn’t die and I wouldn’t have long term horrible consequences from Covid-SARS. In a way, I’m glad I got it and got over it. My immune system is stronger now and I have much less fear. My greatest fear was contracting Covid from my patients before the vaccine was available.

I have tried to present information factually and to the best of my ability. The data is constantly changing because that’s what data does. That’s why we continue to collect and analyze data, so our decisions are informed by new incoming information. Has this pandemic and the information been confusing? Yes, there have been changes everyday. In my opinion the bottom line, is vaccinate, and continue to be kind to your fellow human beings by wearing a mask in confined spaces, washing your hands, and avoiding touching your face and mouth. In these troubled times, seek the wisdom of God, and seek the wisdom of those He has given the ability to synthesize complex information, create life-saving vaccines and life-saving medication and the health care providers who are there to take care of you and your family.

May you be safe and well and I hope to see you in church soon. If you have further questions, I am happy to address those individually. References are printed below for your edification.

Love in Christ, Dr Sam Johnson

References:

In late June 2021, our 7-day moving average of reported cases was around 12,000. On July 27, 2021, the 7-day moving average of cases reached over 60,000. This case rate looked more like the rate of cases we had seen before the vaccine was widely available.

https://www.cdc.gov/coronavirus/2019-ncov/variants/delta-variant.html

Available evidence suggests the currently authorized mRNA COVID-19 vaccines (Pfizer-BioNTech and Moderna) are highly effective against hospitalization and death for a variety of strains, including Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), and Delta (B.1.617.2); data suggest lower effectiveness against confirmed infection and symptomatic disease caused by the Beta, Gamma, and Delta variants compared with the ancestral strain and Alpha variant. Ongoing monitoring of vaccine effectiveness against variants is needed.

https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html

A growing body of evidence indicates that people fully vaccinated with an mRNA vaccine (Pfizer-BioNTech or Moderna) are less likely than unvaccinated persons to acquire SARS-CoV-2 or to transmit it to others. However, the risk for SARS-CoV-2 breakthrough infection in fully vaccinated people cannot be completely eliminated as long as there is continued community transmission of the virus.

https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html

At this time, there are limited data on vaccine effectiveness in people who are immunocompromised. People with immunocompromising conditions, including those taking immunosuppressive medications, should discuss the need for personal protective measures after vaccination with their healthcare provider.

https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html

Accumulating evidence indicates that fully vaccinated people without immunocompromising conditions are able to engage in most activities with low risk of acquiring or transmitting SARS-CoV-2. The benefits of avoiding disruptions such as unnecessary quarantine and social isolation might outweigh the low residual risk of becoming ill with COVID-19, generally with mild disease.

https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html

All authorized COVID-19 vaccines demonstrated efficacy (range 65% to 95%) against symptomatic, laboratory-confirmed COVID-19 in adults ≥18 years.

For each authorized COVID-19 vaccine, efficacy was demonstrated across different populations, including elderly and younger adults, in people with and without underlying health conditions, and in people representing different races and ethnicities.
The Pfizer-BioNTech COVID-19 vaccine also demonstrated high efficacy against symptomatic, laboratory-confirmed COVID-19 in adolescents aged 12-17 years.

All authorized COVID-19 vaccines demonstrated high efficacy (≥89%) against COVID-19 severe enough to require hospitalization.

All authorized COVID-19 vaccines demonstrated high efficacy against COVID-19-associated death.

In the clinical trials, no participants who received a COVID-19 vaccine died from COVID-19; the Moderna and Johnson & Johnson/Janssen trials among adults ≥18 years each had COVID-19 deaths in the unvaccinated placebo arm.

https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html

Preliminary data from the clinical trials among adults ≥18 years old suggest COVID-19 vaccination protects against symptomatic infection and may also protect against asymptomatic infection.

In the Moderna trial, among people who had received a first dose, the number of asymptomatic people who tested positive for SARS-CoV-2 at their second-dose appointment was approximately 67% lower among vaccinees than among placebo recipients (0.1% and 0.3%, respectively)
Efficacy of Johnson & Johnson/Janssen COVID-19 vaccine against asymptomatic infection was 74% in a subset of trial participants.

Real-world vaccine effectiveness

Multiple studies from the United States and other countries have demonstrated that a two-dose COVID-19 mRNA vaccination series is highly effective against SARS-CoV-2 infection (including both symptomatic and asymptomatic infections) caused by ancestral and variant strains and sequelae including severe disease, hospitalization, and death. Early evidence for the Johnson & Johnson/Janssen vaccine also demonstrates effectiveness against COVID-19 in real-world conditions.

Table 1a. Effectiveness of COVID-19 Vaccination Against SARS-CoV-2 Infection and Symptomatic Disease

Country	Population	Vaccine	Outcome	Vaccine Effectiveness*
United States13	General adult population	Pfizer-BioNTech or Moderna	SARS-CoV-2 infection	89%*1
United States14	General adult population	Pfizer-BioNTech or Moderna	SARS-CoV-2 infection	86%*2
United States15	General adult population	Pfizer-BioNTech or Moderna	Hospitalization	96%*1
United States16	Healthcare workers	Pfizer-BioNTech	SARS-CoV-2 infection	97%*2
		Moderna	SARS-CoV-2 infection	99%*2
United States17	Healthcare workers, first responders, and other essential and frontline workers	Pfizer-BioNTech or Moderna	SARS-CoV-2 infection	90%*2
United States18	Healthcare workers	Pfizer-BioNTech	SARS-CoV-2 infection	96%*1
United States19	Healthcare workers	Pfizer-BioNTech or Moderna	Symptomatic disease	94%*1
United States20	Healthcare workers and residents in a skilled nursing facility	Pfizer-BioNTech	Residents: symptomatic disease	87%*2
			Residents: hospitalization	94%*2
			Healthcare workers: symptomatic disease	87%*2
United States21	Hospitalized adults ≥65 years old	Pfizer-BioNTech or Moderna	Hospitalization	94%*2
United States22	Health system members ≥18 years old	Johnson & Johnson/Janssen	SARS-CoV-2 infection	77%*2
United Kingdom23	Healthcare workers	Pfizer-BioNTech or AstraZeneca	SARS-CoV-2 infection	90%*2
United Kingdom24	Healthcare workers	Pfizer-BioNTech	SARS-CoV-2 infection	86%*1
United Kingdom (Scotland)25	Healthcare workers	Pfizer-BioNTech or AstraZeneca	SARS-CoV-2 infection	92%*2
United Kingdom26	Adults aged ≥ 80 years, including those with multiple underlying conditions	Pfizer-BioNTech	Symptomatic disease	85%*2
Israel27	HMO members >16 years old	Pfizer-BioNTech	SARS-CoV-2 infection	89%*1
Israel28	Health system members	Pfizer-BioNTech	<60 years old: SARS-CoV-2 infection	93%*2
			≥60 years old: SARS-CoV-2 infection	92%*2
Israel29	General adult population	Pfizer-BioNTech	SARS-CoV-2 infection	92%*1
			Symptomatic disease	94%*1
			Hospitalization	87%*1
			Severe disease	92%*1
Israel30	General population ≥16 years	Pfizer-BioNTech	SARS-CoV-2 infection	93%*1
			Hospitalization	94%*1
			Severe disease	94%*1
Israel31	General population ≥16 years	Pfizer-BioNTech	Symptomatic disease	97%*1
			Severe/critical disease	98%
			Hospitalization	97%
			Death	97%
Israel32	Healthcare workers	Pfizer-BioNTech	Symptomatic disease	97%*1
Israel33	Healthcare workers	Pfizer-BioNTech	Symptomatic disease	90%*3
Italy34	Healthcare workers	Pfizer-BioNTech	Symptomatic disease	95%*1
Denmark35	Long term care facility residents	Pfizer-BioNTech	SARS-CoV-2 infection	64%*1
	Long term care facility staff	Pfizer-BioNTech	SARS-CoV-2 infection	90%*1
Sweden36	General adult population	Pfizer-BioNTech	SARS-CoV-2 infection	86%*1	×

https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html

In addition to the studies listed in Table 1a, further evidence of the impact of vaccination with Pfizer-BioNTech and Moderna COVID-19 vaccine has been demonstrated among healthcare workers, with major reductions in SARS-CoV-2 infections among those receiving two doses of COVID-19 vaccine even when community transmission was increasing. (37-39)

Table 1b. Effectiveness of COVID-19 Vaccination Against Asymptomatic SARS-CoV-2 Infection

Country	Population	Vaccine	Outcome	Vaccine effectiveness
United States40	General adult population	Pfizer-BioNTech or Moderna	Asymptomatic infection	80%*1
United States18	Healthcare workers	Pfizer-BioNTech	Asymptomatic infection	90%*2
Israel31	General adult population	Pfizer-BioNTech	Asymptomatic infection	92%*2
Israel32	Healthcare workers	Pfizer-BioNTech or AstraZeneca	Asymptomatic infection	86%*2
Israel33	Healthcare workers	Pfizer-BioNTech	Asymptomatic infection	65%*3

https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html

Data from multiple studies in different countries suggest that people vaccinated with Pfizer-BioNTech COVID-19 vaccine who develop COVID-19 have a lower viral load than unvaccinated people.(41-44) This observation may indicate reduced transmissibility, as viral load has been identified as a key driver of transmission.(45) Two studies from the United Kingdom found significantly reduced likelihood of transmission to household contacts from people infected with SARS-CoV-2 who were previously vaccinated for COVID-19.(25, 46)

https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html

Vaccine effectiveness in immunosuppressed people

Evidence of reduced antibody response to or reduced immunogenicity of COVID-19 mRNA vaccination has been observed in the following groups: people taking certain immunosuppressive medications like rituximab (47-50) or mycophenolate (50-53), people with hematologic cancers (54, 55), and hemodialysis patients (56). At this time, data on vaccine protection in people who are immunocompromised are limited; in addition, the impact of immune suppression on COVID-19 vaccine effectiveness may vary by condition.(55, 57) Complete data on which immunocompromising conditions might affect response to COVID-19 vaccination are not available

https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html

Efficacy and effectiveness

A growing number of studies in Israel, Europe, and the United Kingdom have demonstrated high real-world effectiveness (>85%) of two doses of Pfizer-BioNTech COVID-19 vaccine while Alpha was prevalent.(24, 29-31, 33, 36, 146-148) Studies from Qatar have demonstrated high effectiveness against documented infection with Alpha and Beta ≥14 days after receiving the Pfizer-BioNTech vaccine (90% and 75%, respectively) and the Moderna vaccine (100% and 96%, respectively); importantly, both vaccines were 96%–100% effective against severe, critical, or fatal disease, regardless of strain.(149, 150)

https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html

Notably, in the United Kingdom, Canada, and Israel, vaccine effectiveness against hospitalization related to Delta was 93%–100% and comparable to that observed with Alpha.(148, 153) Data from the United Kingdom observed that the recent resurgence in COVID-19 cases is being driven by replacement of Alpha with the Delta variant and infections occurring in unvaccinated children and young adults.(155)

Breakthrough infections

Despite high efficacy, vaccine breakthrough cases are rare but inevitable, including infections caused by circulating variants. From January through May 2021, COVID-NET data from laboratory-confirmed COVID-19-associated hospitalizations in adults ≥18 years of age, for whom vaccination status is known, showed <3% of hospitalizations occurred in fully vaccinated persons. CDC conducts nationwide monitoring of vaccine breakthrough cases resulting in hospitalization or death.

https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html

Among hospitalized or fatal breakthrough cases reported to CDC as of July 19, 2021, 74% were aged 65 years or older. One U.S. study observed that 44% of breakthrough infections were among people who were immunocompromised, similar to results reported from Israel.(157, 158)

(NOTE, 5,800 WORLDWIDE HAVE DIED AFTER BEING FULLY VACCINATED. MILLIONS OF VACCINES HAVE BEEN GIVEN. 5,800 AMONG THE HUNDREDS OF THOUSANDS OF INFECTED FULLY VACCINATED INDIVIDUALS EQUALS A DEATH RATE OF FULLY VACCINATED INDIVIDUALS OF 0.019%. FATALITY FROM UNVACCINATED COVID VARIES FROM 5-16% DEPENDING ON CO-MORBID FACTORS.

A study from Houston, Texas observed that Delta caused a significantly higher rate of breakthrough infections in fully vaccinated people compared with infections from other variants, but noted that only 6.5% of all COVID-19 cases occurred in fully vaccinated individuals.(162)

^{WHY DO WE HAVE TO STILL WEAR MASKS?}

Individual and community-level prevention measures in addition to vaccination have been shown to help reduce the spread of SARS-CoV-2.(163-167) However, there can be individual and societal costs related to physical distancing, quarantine, school and business closures, and other prevention measures.(168-175)

Modeling studies suggest that adherence to other prevention measures, such as wearing masks and physical distancing, continues to be important in the context of vaccine implementation.(176-184) In one study, complete relaxation of prevention measures for the entire population prior to adequate vaccination coverage (60-80% depending on the population considered) resulted in essentially no reductions in SARS-CoV-2 infections.(178) However, in the context of rapid vaccine implementation, the benefit of non-pharmaceutical interventions decreases: preliminary data from one study found prevention measures in the United States could begin to be relaxed 2-3 months after vaccination began if a rate of 3 million doses administered daily were attained(185). Correspondingly, preliminary data suggest that increasing vaccination rates may allow for the phasing out of some prevention measures as coverage increases.(184) With high vaccine effectiveness and increasing vaccination coverage, preliminary modeling studies conducted prior to emergence of the Delta variant predicted that vaccinated people returning to normal activities will have minimal impact on the course of the pandemic.(185, 186)

COVID-19 vaccines currently authorized in the United States have been shown to be effective against SARS-CoV-2 infections, including asymptomatic and symptomatic infection, severe disease, and death. These findings, along with the early evidence for reduced viral load in vaccinated people who develop COVID-19, suggest that any associated transmission risk is likely to be substantially reduced in vaccinated people. While vaccine effectiveness against emerging SARS-CoV-2 variants remains under investigation, available evidence suggests that the COVID-19 vaccines presently authorized in the United States offer protection against known emerging variants, including the Delta variant, particularly against hospitalization and death. Data suggest lower vaccine effectiveness against confirmed illness and symptomatic disease caused by the Beta, Gamma, and Delta variants compared with the ancestral strain and Alpha variant.

Evidence suggests the U.S. COVID-19 vaccination program has the potential to substantially reduce the burden of disease in the United States by preventing serious illness in fully vaccinated people and interrupting chains of transmission. The risks of SARS-CoV-2 infection in fully vaccinated people cannot be completely eliminated where community transmission of the virus is widespread. Vaccinated people can still become infected and spread the virus to others. Current efforts to maximize the proportion of the U.S. population that is fully vaccinated against COVID-19 remain critical to ending the COVID-19 pandemic.

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“All of the available vaccines have been proven effective at preventing severe illness, hospitalizations, and deaths,” the CDC’s statement said.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in a statement on the new figures, “You will see breakthrough infections in any vaccination, when you’re vaccinating literally tens and tens and tens of millions of people. One of the important things that will be done and must be done is to sequence the genome of the virus that is the breakthrough virus.”

https://www.bmj.com/content/373/bmj.n1000

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Covid-19: Fully vaccinated people can carry as much delta virus as unvaccinated people, data indicate

BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n2074 (Published 19 August 2021) Cite this as: BMJ 2021;374:n2074

Commenting on the findings, the University of East Anglia’s Paul Hunter noted, “There is now quite a lot of evidence that all vaccines are much better at reducing the risk of severe disease than they are at reducing the risk from infection. We now know that vaccination will not stop infection and transmission, [but it does] reduce the risk. The main value of immunisation is in reducing the risk of severe disease and death.”