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Daniel R. Howard, MD, PA, Baltimore, MD (2025)

11/29/2021

OMICRON VARIANT OF COVID-19

I am very concerned about the new Variant, called Omicron (also known as B.1.1.52), being reported in the news. Here is some information about Omicron.

Background:

B.1.1.529, now labeled Omicron, was identified in a specimen collected from a patient from South Africa on November 2nd. It was reported to the WHO on November 24th. This variant has over 50 mutations compared to the original Covid-19 viral strain, with 32 of those mutations occurring in the Spike protein, which both binds to human cells, and has antibodies (from prior infections and immunizations) bind to it. Therefore, big changes in this protein are of concern, both for potential for increased spread, and for resistance to immunity from vaccination or prior infection.

Omicron’s mutations look worrisome. The Delta variant had two mutations in the region of the Spike protein called the Receptor Binding Domain (RBD), the portion that binds to human cells, and presumbably this contributed to its higher transmissibility. Omicron has ten.
At about the same time this variant was identified, there was a tremendous increase in the number of cases of Covid-19 in South Africa. The number of cases to begin with in South Africa were relatively low, 200 or 300 new cases a day. This spiked up to 2000 – 3000 over the course of a couple of days. With a fairly low baseline, it’s hard to tell what a spike means, as it could just be some statistical noise, but it certainly is a concern. Now, at this point, it’s not know whether the increased cases are due to Omicron or not, and it will be a few more days before we find this out. We do know that many of the cases in the region surrounding Johannesburg and Pretoria are due to Omicron, which increases the level of worry about this.

How did this variant start?

No-one knows for sure. However, given both the large number of untreated HIV patients in South Africa, and the very large number of mutations, it seems likely that the Covid-19 virus replicated in an uninhibited manor in a highly immunosuppressed AIDS patient, resulted in the accumulation of such number of mutations.

Where is Omicron now?

It seems to be concentrated in South Africa in the Gauteng Province surrounding Pretoria and Johannesburg, although the full extent of the spread is not clear at present. Isolated cases have been identified in several countries now, including Belgium, Australia, Britain, Italy, the Czech Republic, Germany, and Hong Kong. Thirteen proven cases, out of a total of 61 Covid-19 positive cases, were identified on two airplanes from South Africa that arrived in the Netherlands two days ago. I’m not aware if the remaining 48 have been tested for Omicron or not. There are no reported cases in the United States right now, but there will be soon.

Why the Travel Interdictions?
Well, this started in Europe, with Britain being the first nation to halt travel from Southern Africa, followed rapidly by other countries imposing travel bans, quarantines, or both. Europe is already struggling with Covid-19, with hospitals in many nations currently overwhelmed, so the presence of another problematic variant could be catastrophic. Other countries, including the US, followed the European lead.

Basically, the travel interdictions just buy a little time to figure out whether this variant is really as worrisome as it seems, and to plan for other measures that might be needed to slow the spread.

How much do we need to worry?

We don’t know at this point. While the structure and mutations of Omicron are very concerning, and the situation in South Africa are concerning, it’s really too early to know how concerned we need to be. There have been some other variants that initially looked to be worrisome, but never spread enough to be a problem. We’ll likely know within the next two weeks. I do think it is unlikely that Omicron will be completely resistant to vaccine-mediated immunity; Vaccination will probably provide some degree of protection against severe infection and death.

What can I do to protect myself?

Get vaccinated! Even if Omicron is partially vaccine-resistant, vaccines will likely provide some degree of protection. Get the primary vaccines, and get a booster when eligible.
Continue masking in high-risk environments, such as poorly ventilated indoor spaces (and avoid such spaces whenever possible, even if masked, as masking provides inadequate protection against aerosolized transmission). Limit your exposure to unvaccinated individuals. Continue to socially distance when appropriate and feasible.

09/28/2021

We’re offering Pfizer 1st, 2nd, and booster Covid-19 vaccines for those eligible, and 1st and 2nd Moderna. Call Georgia at 443.904.4150 if you need a vaccine!

08/02/2021

The Delta Phase of the Covid-19 Pandemic

It's clear the United States is entering a very dangerous phase of the Pandemic. This will be worse for the unvaccinated, and will be severe in areas with low rates of vaccination. We'll see hospitalizations, intubations, and deaths in the unvaccinated population, likely approaching the levels of some of the earlier peaks.

However, the vaccinated are not completely safe.

There are a lot of breakthrough infections in the vaccinated--it's not the "rare and unusual" event any more, not with Delta being predominant. There was a local cluster recently fairly similar to the Provincetown outbreak reported by the CDC; I'm seeing them in my practice now; and they've been reported in nursing facilities.

Most of these vaccinated folks will not get severely ill, and deaths will be quite rare. However, as those who received vaccinations (or were infected and not re-vaccinated) over 6 months ago see some waning of immunity, and as our elderly and immunosuppressed populations has more exposure, we'll see more hospitalizations of the vaccinated, with some severe cases.

I think that the Pandemic will spread until we have reached herd immunity, which is probably at around 90 % infected or vaccinated based on information coming out of Britain. At that point, we'll probably see a steep drop in cases, as seen in Britain, and in India and Nepal, which are probably in a similar situation.

Vaccination is the key to limiting serious illness, but it doesn't prevent infection, and almost certainly does prevent spread of infection, in those vaccinated. It does decrease the risk of infection a lot though, and that is clearly a big benefit.

Unfortunately, I also think it is almost inevitable that there will be a variant that escapes immune surveillance from immunity from prior infection or vaccines, and therefore "booster" vaccines, updated for the upcoming variants, will be required at intervals, which are yet to be determined.

Life will continue to be very different for the foreseeable future.

06/16/2021

My Thoughts on Covid-19
World: 177,470,902 cases worldwide, with 3,839,934 deaths . Number of cases world-wide is dropping off sharply now, as are deaths. There continue to be some hotspots, such as India, which is improving significantly at this point, and Nepal, which seems to be about two weeks past its peak. Cases continue to rise very steeply in South Africa and Namibia, which is very concerning. Although most nearby countries aren’t reporting increases in cases, this is probably due to very limited testing in most sub-Saharan African countries. For example, Ghana is reporting very few cases, but hospitalizations for Covid-19 have increased to the rate that there is nearly 100% hospital occupancy, so they probably have a severe unreported outbreak. In addition, Kenya has sharply rising Covid-19 death rates despite only a minimal increase in reported cases. I remain extremely concerned about Africa being the next India.
South America, especially Brazil, but also Argentina, Peru, and Venezuela continues to experience very high levels of infection without either increases or decreases.
US: 34,351,185 cases. 615,717 total deaths Equivalent to losing the entire population of the City of Baltimore in a little over a year
Both cases and deaths continue to drop off very steeply as vaccination rates climb. This is primarily due to vaccination.
US Vaccines: 53.2 % of the entire population has gotten at least one vaccine, and 44.4 % of the population is now fully vaccinated, with a much higher percent of those over the age of 18 vaccinated. There are differences in the reported vaccination rates depending on whether everyone is counted, or only those over age 18. There are major regional disparities, with 12 states having ove 70% of adults vaccinated, but several well under 50% of adults.
MD: 461,392 known total cases since the beginning of the pandemic.
9472 total deaths so far.
We are at 194 Covid-19 patients hospitalized statewide, down about 100 from last week, and the lowest it has been since early March, and the rate is declining quite rapidly.. 54 of those hospitalized are in the ICU’s across the state, the lowest rate since March 26th, and declining as well.
State-wide 7-day positivity rate 0.82%, which is extremely good news.
MD Vaccines: 72.2 % of those over the age of 18 have received at least one vaccine, and 52.6 % of those are fully vaccinated.
GENERAL: Although most news is generally good, there are still some very serious concerns, primarily concerning the variants. The nomenclature has been changed; the Indian variant is now called the Delta virus; it was previously referred to as B.1.617.2. B.117, the UK variant, is now called Alpha.
The Delta virus is predominant in India, and has now become the dominant virus in Great Britain. Great Britain, which has done a great job of vaccinating, has noted more than a doubling of its Covid-19 cases in the past two weeks. The Delta Virus now accounts for almost 10% of all Covid-19 cases in the United States.
It’s not clear if the Delta variant makes people sicker than the standard viruses and other variants, but information from India suggests that this is the case. Data from a study in Scotland also indicated a doubling of the hospitalization rate for the Delta virus compared to the B.117 (now called the Alpha virus)
The Delta variant appears to be at least 40 - 60% more transmissible than the prior Alpha, which was already much more transmissible than prior virus strains, and appears to be less susceptible to vaccination. Resistance to Delta is poor after one Pfizer vaccine, providing only 33% protection, but quite good after a second one, giving around 88% protection, again indicating the importance of getting fully vaccinated. There is no data on the Johnson and Johnson vaccine, but protection with the AstraZenica vaccine against this variant is probably around 72% based on one study, which is concerning because the J&J vaccine is made with a similar technology.
The Reproductive rate in the United States has taken a sharp upward turn in the past week, which really concerns me. It was 0.8 one week ago, now is 0.9. I will be following this number very closely!
To refresh everyone’s memory, the R is the number of people that each infected person is, on the average, likely to infect. If it is greater than 1, the epidemic will grow, and if less than one, it will die out. This change is likely due to both the opening up process, and the spread of variants with a higher reproductive number (B117, now called alpha, and Delta).
The reproductive rate is primarily dependent on three things: inherent characteristics of the virus, number of vaccinated individuals, and human behavior (such as masking and distancing). The R0 (the reproductive number for the virus before vaccinations and masking, etc., was believed to be about 3.5. The R0 for the Delta variant is suspected to be much higher, estimated to be between 5 and 7.
This means it is much more likely to be transmitted, and a much much higher level of vaccination, probably over 90%, is needed to reach herd immunity.
Assuming the Delta variant does take over in the US, which I believe it will, I unfortunately predict we will have another outbreak in the early winter. This outbreak will likely affect primarily unvaccinated people; but I do worry about vaccinated elderly patients and those with immunosuppressive disorders, which may not mount as vigorous of an immune response, as well as those who have received the J&J vaccine, although there isn’t much data on these issues at this point. I hope I am wrong about this, but I don’t think we are over this yet.

04/28/2021

Covid-19 Here and in the World

World: 149,461,088 cases worldwide. 3,152,089 deaths. Cases continue to rise worldwide, and we are now at a worldwide point worse with both cases and deaths than we were at the peak of the Winter surge.
Everyone has probably heard about India, where the healthcare system has collapsed at this point. Patients are dying in line at doctor’s offices and ERs. India is reporting 201,000 deaths, but it is believed they may have 10X as many deaths as reported, as even in normal times only 24% of deaths result in a death certificate. Some regions are running out of wood to perform cremation fires, and air pollution is up, despite reduced auto transport, due to wood-burning fires from funeral pyres. The situation is catastrophically bad, worse than any of us can even imagine, and likely to get worse before it gets better.
Brazil is in a similar situation. Both situations are due to the presence of Variant strains of Covid-19.
Many European countries continue to do poorly, despite overall declines in cases in Europe. France, Russia, and Turkey continue to have increased cases.
US: 32,927,352 cases. By reported statistics, the US has the largest number of cases, but we are probably really at this point well behind India, Brazil, and Russia. Cases are now declining nationwise.
587,385 total deaths. Deaths have plateaued for now, but will probably drop as deaths lag cases by at least a couple of weeks.

US Vaccines: 42.5 % of the population has gotten at least one vaccine (which is very highly protective), and 29 % of the population is now fully vaccinated. Israel saw dramatic declines in number of cases, in hospitalizations, and deaths, when they hit 45% of the population fully vaccinated; hopefully that will happen here as well, even though that number is far below what is needed for herd immunity. As I mentioned last week, it may be very difficult now to actually reach herd immunity despite availability of vaccines, due to fairly wide-spread vaccine resistance.

MD: 444,491 known total cases since the beginning of the pandemic. 677 overnight, which is a decline.
8501 total deaths so far. These numbers, as much of the US, are at a plateau, and I think we’re about halfway through Phase 4 of the pandemic here in Maryland.

We are at 1130 Covid-19 patients hospitalized statewide, down about 150 from last week. 269 in the ICU’s across the state, also down significantly.
State-wide 7-day positivity rate 4.04%, down almost a percent since last week, which is a very good indicator.

MD Vaccines: 31% are fully vaccinated. Vaccines are readily available now. I’m vaccinating patients in my office after receiving our long-awaited delivery this week.

CDC New Guidance

Fully vaccinated people no longer need to wear masks outdoors, except in crowds. They released a useful infographic showing relative risks for vaccinated and unvaccinated individuals, which I believe is data-driven and relatively accurate.

Guidance regarding outdoor masking reflects the limited risk of outdoor activities.

Many activities continue to be very risky for unvaccinated individuals. I believe one reason the CDC released these guidelines at this time was to encourage vaccination at a time when vaccine administration is slowing down, probably mostly due to vaccine resistance.

MIT study showed that for indoor spaces, little difference between 6 feet of distancing and 60 feet of distancing. This is almost certainly correct, and is due to aerosolized spread of Covid-19 in interior spaces.

Vaccines and Exercise
There is now good data showing a 50% increase in antibody titers, as well as decreased infection rates, in those undergoing 30 minutes of aerobic exercise 5 times a week. This is one more reason to continue, or to start, a regular aerobic exercise regimen.

Variant Viruses

The situation in India is almost certainly due to the wide-spread distribution of a Variant virus containing double mutations. The variant is B.1.617, and it appears to be both more lethal, and to spread much more rapidly, than other variants noted elsewhere. The two mutations are the E484Q, which is very similar to the E484K (EEEK) mutation, found in the British, Soouth African, and Brazilian variant, and is likely responsible for the poor Covid Outcomes in those countries.

The other mutation is the L452R mutation, found in the California Variant, which almost certainly contributed to the severity of the recent outbreaks there.

This is, however, the first time those two mutations have been found in a single virus variant. Clearly, re-infection occurs with the B.1.617 variant, and studies are ongoingd to determine how much resistance to vaccines occurs with this variant.

This certainly raises the possibility of these types of variants being transported and taking hold in places, such as the US, which are now doing fairly well with the Pandemic. As long as there are areas where viral replication is out of control, various mutations will continue to arise, with some resulting in more lethal or more transmissible viral variants.

01/25/2021

COVID-19: 1.25.2021

What’s happening in the World, the US, and Maryland:

World: 99,846,375 cases worldwide. 2,140,550 deaths.

US: 25,702,125 cases. 429,490 deaths. 3416 deaths reported overnight. Rt data shows only 8 states with Rt over 1 now, which is good news, as it indicates the infection is likely to be dying out, at present, in the United States.

MD: 341,452 known total cases since the beginning of the pandemic. 2145 overnight.
6690 total deaths, 28 overnight. This number continues to decline. 1668 currently hospitalized, which has now dropped by 200 since last week. The hospitalization peak was 1952, around 2 weeks ago. There are currently 392 patients in with Covid-19 in the ICU’s across the state, and this continues to inch down as well.
State-wide 7-day positivity rate 7.21%, which continues to trend downwards.
Rt in Maryland 0.94, which continues to slowly decrease.

All of the critical indicators in Maryland, and, indeed, in most of the nation, continue to trend the right direction.

However, we are far from out of the danger zone with Covid-19. There was a lot of news over the weekend about Variant B117 (the British variant). Boris Johnson, British Prime Minister, announced it may be 30% more lethal than standard virus. However, this is based only on very preliminary population based data, and no definite evidence that this is true. Data showed that those infected with B117 were 30% more likely to die after hospitalization. While this is concerning, there is no information about comparative age or comorbidity information, which we know has a dramatic impact on mortality. For example, if the virus disproportionality infected elderly, we would expect higher death rates. There is some speculation that the 10X higher spike protein density with B117 (which almost certainly is responsible for the higher rate of spread) could cause more severe infections, but this remains speculation at this point.

What we do know about B117 is that it appears to be 50-70% more infectious, which may mean many more deaths, especially if it spreads before vaccinations are fully in place. It is now in 34 states, and is reported to be spreading rapidly in at least some of those states. It is likely responsible for an recent outbreak in an Ontario Nursing home of 130 residents, where 124 of them and most staff were rapidly infected with Covid-19, with 25 resident deaths.

I continue to be even more concerned about some of the other variants. The South African variant named 501Y.v2, is one of the most worrisome to me at the moment. There is a lot of bad news out of South Africa right now. The Eastern Cape of South Africa which was hit fairly hard in the first waves, is experiencing another terrible surge in cases. Even more concerning are the numerous anecdotal reports of repeat infections; there have been some isolated reports of this everywhere, but it seems much more common in South Africa. This is very, very worrisome to me, as it may indicate that immunity against one strain does not mean immunity to other strains. There are some in vitro (lab only) tests that this may be true, as “neutralizing antibodies” don’t seem to necessarily block the ability of the new variant to attach to human cells, although more research is needed regarding this. This variant has not yet been found in the US, but it is likely only a matter of time.

The CAL.20c variant, identified in Southern California, appears to have some of the same characteristics as the South African variant. There is less data regarding this so far, although it is now apparently widespread in Southern California.

A Brazilian variant, called P1, has infected currently 42% of patients in the city of Manaus, which is experiencing a terrible surge of infections, with hospitals totally overwhelmed and patients dying at home because there is no-one available to take them to a hospital. There was no P1 detected in November 2020 viral samples from that city. P1 carries mutations similar to both the UK and South African variants. As is the case in South Africa’s Eastern Cape, Manaus was hit devastatingly hard during the first wave in March. An article published in the journal “Science” projected that 76% of the 2.2 million residents of Manaus were infected in March. If that is accurate, it is seems likely that re-infections may be occurring, as this wave is worse than the first one. Also, with that large of a percent were really infected in the first wave, Manaus would have been well above the numbers expected for herd immunity, although that number too is increased with a more infectious version of the virus).

The Federal Government is obviously very concerned about the new variants, as the CDC abruptly restricted travel from South Africa on Saturday. In addition, President Biden has reimposed an entry ban on travelers from Brazil, the UK, Ireland, and the 26 European countries that allow relatively unrestricted travel across borders, with some tightening of the waivers available to bypass such restrictions, although that was likely planned prior to current information about the new variants.

If indeed one or more of the new variant viruses is less susceptible to protection by the vaccine, we may well be in for a real tsunami of new infection, as Manaus, Brazil, has just experienced. If you’ve ever seen a video of a tsunami, initially the sea slowly ebbs out (as we seem to be seeing with Covid in the United States right now), only to then follow with a wall of water of devastating proportions.

I truly hope this doesn’t occur. But we need to be prepared for it, for our own safety, and that of our families and friends. Getting vaccinated now (which may provide partial, if not full, protection against the new variants), practicing social distancing, masking, hand hygiene, and avoiding enclosed and poorly-ventilated interior spaces, is perhaps even more important now than at any other time in the pandemic.

01/02/2021

COVID-19

What is going on in the world?

World: 84,472,867 cases worldwide 1,837,442 deaths so far. These numbers are likely to double before the Pandemic is brought to some degree of control.

US: 20,619,032 cases. That means 6% of the population are known to have Covid-19 at some point. The real number of infections is certainly much higher than that, as many cases are not picked up.
356,450 deaths. That means that 0.1%, or one in 1000 Americans have already died from Covid-19, with many more deaths to come.
There were 2476 Covid-19 deaths in our nation yesterday.

Covid-19 Vaccines

About 2.5 million doses were administered by January 1st. This is well below the anticipated 20 million by that date. In contrast, Israel has already immunized 10% of it’s population. The vaccine rollout has been a disaster in my opinion, with the Federal government dumping the vaccine distribution on under-funded, unprepared Health Department that have not performed this function in the past. It is really critical to get as many people immunized as quickly as possible to minimize hospital overload and deaths.
The good news, and it is really very good news, is that there have been few serious reactions to the vaccine.

The New Variant Virus

The new virus variant, B117, which spreads about twice as fast as the usual Covid-19 virus, is very widespread in Britain, and some countries in Europe. It probably accounts for the two-fold increase in spread of infection noted in Switzerland.

This variant has now been found in Switzerland, Australia, Belgium, The Netherlands, Brazil, Denmark, Italy, France, Spain, Sweden, Japan, Singapore, Canada, Northern Ireland, Israel, Germany, and now the United States.
B117 has been identified in in the United States in California, Colorado, and Florida. There are likely many others, but the United States is doing very little genomic testing to identify the variant compared to other countries. In other words, I believe this variant is likely widespread in the US, but we don’t have verification of this yet.

None of these patients had travelled, nor had known contact with international travellers, indicating this variant is out in the general population, called “Community Spread”.

This variant Covid-19 virus appears to spread about twice as fast as the usual virus, although no more deadly. However, in the short run, faster spread is much worse than being more deadly, as many, many more people will be infected, resulting in many more deaths than a deadlier virus.

This all the more reason to wear your mask, wash or sanitize your hands frequently, socially distanc, and, most importantly, avoid poorly ventilated interior spaces, especially bars, inside restaurants, churches, gyms, etc., and including your home if you have visitors

12/30/2020

COVID-19

What is going on in the world:

World: 82,519,946 cases worldwide. 1,800,813 deaths
US: 19,982,610 cases. 346,654 deaths.

General
Vaccinations Well over 2 million vaccines administered with few bad reactions As noted in clinical trials, there seems to be more side effects in those under age 55, less over 55.

Variant Covid-19.
Officially called the 2020 Kent variant, or B.1.1.7. This has noW been detected in the Colorado in a 20 year old man with no travel history, amd with no known travel contacts This means that he contracted it via community spread, so it is highly likely to be spreading throughout the US, and that is bad news.

A lookback at genomic sequences reveals that the B.1.1.7 variant was present in Brazil in April, so it is probably really not a United Kingdom source variant, as was previously suspected.

There is also now information that the South Africa variant has different set of mutations that result in the same amino acid substitution on the spike protein, so this is not due to spread from England, but an independent mutation resulting in the same spike protein change.

This is a selection advantage for this type of variant, in other words, we are seeing Darwinian natural selection in action. This is occurring due to high amount of viral replication in the world, with more opportunities for “mistakes” in the virus, some of which result in changes in the virus, some of which a beneficial for the virus (but not for its victims).

There is no indication that this variant is more deadly, but it certainly does spread more quickly. There is no reason to think that the vaccine will not work for this variant of the virus.

Data from Switzerland and the Czech republic reveal a two-fold faster spread of Covid-19 in recent weeks in those countries, believed to be due to the prevalence of the B.1.1.7 variant in those countries. That makes it even more critical to rapidly get as many people vaccinated as soon as possible!

12/28/2020

Covid-19

What’s going on in the World:

World: 81,126,416 cases worldwide since the start of the epidemic, with 1,771,407 deaths. It is likely we will, despite starting vaccinations, see another increase after Christmas get-togethers, and likely a spike after New Years as well.

US: 19,126,416 cases. 341,138 deaths.

The Variant Covid-19. Initially identified in England, and now called the 2020 Kent variant. Now detected in Canada, Belgium, Netherlands, South Africa, Sweden, Germany, Lebanon, Australia, and Singapore. The United States is not doing sufficient genomic testing to determine whether it is here or not; I suspect it already is.

This variant of the virus is believed to be 53% more infective than the prior virus mutations.

There are 23 mRNA sequence mutations compared to the original Wuhan version. The mutations allow for substitution of an an amino acid on the spike protein, replacing a tyrosine with an arginine. Why this causes it to be more contagious isn’t completely clear at this point.

Genomic sequencing has now identified other mutations that have been clinically significant. The 2020 Lombardy variant allowed approximately 10X as much spike protein on the cell surface compared to the original Wuhan variant; this probably accounts for the more rapid spread in both Italy and New York in the spring. California was primarily infected with the original Wuhan virus, which is probably one of the reasons California fared better in the spring.
The 2020 Kent variant doesn’t make patients sicker, but it is approximately 54% more infective. We don’t know whether this will affect the effectiveness of the vaccine, but computer modeling of the protein suggests it probably will not.

What the increased infectiveness DOES affect is the number of people that need to be vaccinated to reach herd immunity.

Herd immunity is the percent of the population that needs to be immune to stop viral spread. Herd immunity is highly dependent on both viral and host factors. A more contagious virus results in a higher Rt at the same level of human behavior.

We’ve all heard that the population immunity needs to be at approximately 60 - 70% to reach herd immunity; with the higher Rt, that number may well be over 80%.

A simplified calculation of the number needed to reach herd immunity is 1-1/R0 (R0 is the reproductive number calculated at the beginning of a pandemic). Estimates for Wuhan R0 are around 3. (1-1/3 = 67% of the population immune in order to reach herd immunity). If the variant R0 is increased to 4.59 (53% more infective), the number to reach herd immunity is much higher. (1/1 – 1/4.59 = 78% of the population immune in order to reach herd immunity).
Herd immunity is the sum of acquired immunity (infected) and vaccinated immunity. As about 12% of the US population is estimated to have been infected with Covid-19 by CDC modeling (studies indicate about one in 8 cases of Covid-19 have been identified)., we have a 12 % natural immunity., and therefore will need around 70% uptake of the vaccine to reach herd immunity. That may be a difficult goal to attain.

About 0.1% of the population, one in 1000, have died from Covid in 2020, and that number is likely to be close to 2 in 1000 (0.2%) by March of this year, so attaining herd immunity is really critically important to minimize more suffering and death.

Daniel R. Howard, MD, PA

11/29/2021

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