The Doctor Is On: Fields Tough Questions About COVID-19

“The lockdowns weren’t really necessary.” “The vaccination mandates won’t solve the problem.” “Look at how Sweden’s done, and it didn’t enact major mitigation measures.” “Why do our children need to get a COVID-19 vaccination when there is zero chance of them dying from the disease?” “The delta variant isn’t that serious.” These are questions and statements you can hear at any social event, on the Web, television, or radio. Everybody in health care has probably had to field these and other questions that generally suggest that society’s reaction to COVID-19 was an overreaction. The questions are often posed by brilliant people, like the scientist who spoke to Infection Control Today^® (ICT^®) recently about these and other concerns. (The scientist does not wish to be identified.) We put that scientist’s questions to Kevin Kavanagh, MD, a member of ICT^®’s Editorial Advisory Board and a frequent contributor to both our print and website publications. In other words, we put Kavanagh in the ring by proxy, and Kavanagh came out swinging. Here’s a sample: “I need to ask you this. Do you really want to have our children as the guinea pigs to find out what the delta variant’s going to do? Because let’s face it, we are we are confronted with a more contagious, a more lethal virus that’s more apt to affect the young.” Read on.

Infection Control Today®: How do you explain the United Kingdom’s data on COVID-19, which appears to show that hospitalizations from the delta variant are 60% unvaccinated versus 40% vaccinated. There doesn’t seem to be that much of a difference there.

[1:38] Kevin Kavanagh, MD: Well, the data that I’ve seen is 35% vaccinated. And if you equate that with a full vaccination rate in the UK of approximately 58%, that gives you an overall vaccine efficacy of preventing hospitalizations of 40%. Now that on the surface doesn’t look good. So, you really have to drill down those figures. You have to remember England does not use exclusively mRNA vaccines. They have probably purchased well over 500 million doses, only about 117 million of those are the mRNA vaccines. Another 100 million are the Oxford/AstraZeneca vaccines along with some other vaccine manufacturers. And those vaccines are completely different technology. And to be honest with you, I don’t think the

Kevin Kavanagh, MD

Oxford/AstraZeneca vaccine works very well on the variants. I believe that was the vaccine that South Africa even stopped distributing because it didn’t work well with the South African variant. When you look at that figure, you have to remember that we’re not talking about vaccines having the same effectiveness. If you could get data on just the mRNA vaccines, I believe the efficacy on preventing hospitalizations would be in line with what we’re seeing in the United States and what Israeli data have shown in that it is almost 90% or above. In the United States, over the past several months, the vast majority of hospitalizations—99 plus percent—are in the unvaccinated. At this point, you don’t have to theorize on the efficacy of the vaccines. You can look at what has happened in the United States. Now presently, we are getting confronted with the delta variant. And personally, I think that that efficacy is going to fall a bit, especially if you’ve had your vaccine greater than five months out, and you are over the age of 60. Or if you have an immunocompromising condition. And that’s why there’s some talk of boosters. But right now, go out and get vaccinated. It’s extremely important.

ICT®: Vaccinated people seem to have about the same viral load as unvaccinated people and are just as infectious. True?

[4:16] Kavanagh: Well, that may be true. It is true that studies have shown that they have the same viral load, but we don’t know for how long that viral load lasts in the vaccinated individual. Again, if you look at the experiences from Israel, their head of the Ministry of Health stated that if you’re vaccinated you spread the virus one half as much as unvaccinated individuals. And so that’s going to cut down on the spread and that’s important. Now, six months ago, vaccinated individuals would crush the virus and not spread it. But remember, we’re using last year's vaccine with now a new variant, the delta variant. But even at 50%, if you can slow down the spread by 50%, combine that with other public health strategies, you’ve got a workable plan to get out of the pandemic. In other words, the vaccines from last year went from a panacea to this year where they are an important layer of armor.

ICT®: The UK data for the delta variant is about the same as the flu. What’s your response?

[5:50] Kavanagh: That’s different metrics, different ways of calculating it. When we look at flu data, they’re projecting the epidemiologically of cases that have occurred, but aren’t reported. A lot of different methodology goes into that to come up with a number. When you’re looking at COVID-19 data this is just the number of people that have died. And when you’re looking at the field hospitals, the filled ICUs, they’re already putting up tents again down in Houston. I mean this is not the flu. You see countries that have had mass graves. I mean, how many times have you seen mass graves from the flu? You just don’t see it. That said, I don’t want to mitigate the flu. That is also a very dangerous virus. It’s kind of like saying that speeding at 150 miles an hour is not so bad compared to speeding at 80 miles an hour. No, you shouldn’t be speeding 80 miles an hour, either. Speeding is speeding, it’s got to be dealt with. We do need to pay as much attention to respiratory pathogens as what we have paid to surface pathogens and pathogens in water. So yes, we do need to be more conscientious about the flu. But the delta variant and these other variants are much more lethal than the flu. And I think you can see that United States last year, if you look at excess death data, we have well over 900,000 deaths from COVID-19. And we’re going to get hit again this year. Every variant seems to produce a new wave, and we cannot keep going through variant after variant, wave after wave. We need to start changing our behavior. And changing our behavior is key to getting us through this pandemic.

ICT®: Explain Sweden. Not in terms of Norway, but in terms of New Jersey. About the same population and no mandatory anything. Half the deaths of New Jersey and they have herd immunity.

[8:15] Kavanagh: No, Sweden does not have herd immunity. We’ve heard that before. They continued to get crushed by cases and deaths. No, you can’t develop herd immunity, you just get hit with another variant. If you look at Sweden, compared to any of the Nordic countries—if we don’t want to compare it to Norway, compare it to Finland or Denmark. Sweden has almost an eightfold times higher number of deaths per capita than those three countries. If you want to cherry pick and pick a small area of the United States and say they’ve done better than New Jersey, well, let’s face it, New Jersey, along with New York, was one of the hardest hit states early on with the D614G variant. New York also had its own variant called the New York variant. So, you’re just comparing apples and oranges at that point. And I should add that it is a myth to think that Sweden didn’t take serious steps to stop this pandemic. Again, that is a fallacy that people think that. And the population followed public health strategies. They weren’t as stringent as the other Nordic countries, but Sweden didn’t do as well. For example, in Sweden, people were encouraged to work from home. There was social distancing. This included nightclubs and bars. They even closed down some of the venues if they weren’t following strategies. Over 70: staying at home. Events [with over 50 participants were cancelled]. They closed high schools and colleges and they discouraged travel. And when I say discouraged travel, a 75% drop in the traveling that was occurring around Stockholm. During Easter, which would seem to many to be the time to go travel and visit people, there was a 90% drop. The big difference between Sweden and America is Sweden actually had the public following some strategies. As in America, we had about half the population ignoring them, going out and living however they wanted to and spreading the virus. And unfortunately, we still have that today. So, number one, Sweden has not done well. They have not done as well as the other Nordic countries. And number two, it is a fallacy that they haven’t enacted serious steps.

ICT®: Explain India. Very low vaccination rate and a Third World country. Dramatically lower death rate than United States.

[10:57] Kavanagh: India has extremely poor reporting. It’s been estimated that India’s death rate may be 10 times that. Their health care system collapsed. They had bodies going down the Ganges. They would only accept as a person who would be counted as a COVID death if they had a test when tests weren’t available to people, and they couldn’t even access the health care system. India also was only counting people who did not have any comorbidities, which would lower their rates by another 50% to 80%. Now, India has been crushed by this virus. And, similar to Brazil, similar to New Guinea with the Ebola epidemic, there’s been a lot of political action trying to mitigate the effects of this pandemic. Peru is another example. Where they have the lambda variant which, again, crushed their population. The government was not reporting deaths. And finally, we had some very, I think, courageous physicians and nurses that pushed for accurate reporting and now the official toll is over three times higher, and they have the highest death rate per capita in the world. So no, India is an example. I have friends in India, I have doctors in India that I know, and when I call them, they think the country is about ready to fall apart and the world is coming to an end. I mean, they are that pessimistic. So no, if you think India is great, just look at the pictures that are reported in the [Times of India]. It is it is horrific over there. And unfortunately, if we don’t get our act together, this is what we may be facing with the delta variant in our nation.

ICT®: Since it will be impossible to vaccinate the 8 billion people in the world so as to reduce potential mutations, what benefit is there for vaccine mandates for the 150 million Americans who are not vaccinated? Remember, the alpha came from China, and delta came from India.

[13:03] Kavanagh: Well, you can control travel, you can control entrance into the country, and you can vaccinate everybody in the world. We did it with smallpox. We can do it with this virus. It just needs to get done. But it’s hard to do it when we’re actually making our own variants over here. I mean, we’ve had the California variant, we’ve had the New York variant. And if people keep spreading it, this is what’s going to happen. I can tell you that over the course of humanity, civilizations have fallen because of infections. There is no doubt about that we have had massive deaths in populations due to infectious disease. And what separates us now is our scientific knowledge. But if we’re not going to leverage that, we’re in no better position than a tadpole. And to think that we’re not going to have the same fate as they did back in the dawn of time or in the Middle Ages is ridiculous. If we’re not leveraging our science and know-how that’s the fate we may well have, because this delta variant, it’s not done with this yet. We will see a huge surge. It may go away quite quickly. And then waiting in the wings is another variant that will come, and reinfections will occur. You cannot achieve herd immunity with a highly mutating virus. In fact, very few infectious diseases have ever gone away due to just herd immunity. And certainly with this variant and with [SARS-CoV-2], we are in trouble especially if it is found in animal hosts. And it looks like that may have happened with the whitetail deer. We’ll just have to wait and see. We know it can get into zoo animals. We know it can get into cattle. There was a report that [Tennessee Gov. Bill Lee is approving funds] to get the cattle vaccinated, but not so much for people. So, it’s absolutely ridiculous at this point.

ICT®: I know this touches close to home because you have grandchildren. And you’ve just gotten an article published in the Louisville Courier Journal arguing that schools should not reopen now. Why should children be vaccinated even though they have zero chance of dying from the disease?

[15:39] Kavanagh: Well, first of all, that is old variant data, and you’re trying to apply that to the delta variant. The delta variant is tending to focus on children more than the other variants. If you look at the pediatric hospitals in the states that are surging, they are full. For example, in Louisiana the pediatric hospital there had during the last surge seven of its ICU beds filled with pediatric patients. Now they have 20. And they’re pretty much at the same level and, of course, now getting a little bit above, the surge that we previously had. This is affecting kids and kids can be affected long term. The idea of focusing on deaths is absolutely ludicrous. I know patient after patient and my friends also have been affected. They are developing long COVID. And I’m talking about arrhythmias, chronic coughs. One has her hair falling out two to three months after the infection. It is not good. This is causing heart disease, myocarditis, vasculitis in a number of patients. No, not everybody, but in a number of people. And as I think you’ve seen there, there was a little scare regarding some of the mild carditis in the young individuals who are getting the vaccine. That rarely occurred, was relatively mild, and it resolved. But we are seeing a much higher rate of heart disease in people that are getting infected. And this is including young children. We had reports last year of football teams in the Big 10 closing down football practice, etc. because of heart disease. And this is the reason. COVID-19 is not just respiratory, it affects every organ of the body. This is a serious type of infection. And we need to be focusing on trying to keep this virus from spreading, plus protecting our young. Now I know some people will say, “Well, that’s just a theory” and go on and on. “We don’t know exactly what the delta variant’s going to do.” Well, that’s correct. But we know pretty much what it’s going to do from other countries. I need to ask you this. Do you really want to have our children as the guinea pigs to find out what the delta variants going to do? Because let’s face it, we are confronted with a more contagious, a more lethal virus that’s more apt to affect the young. And we are doing less this year than what we did last year to protect them. It makes no sense.

ICT®: Senator Lindsey Graham recently suffered from a breakthrough infection. He had some flu symptoms but seems to have recovered. Is that really what we have to fear now? Is that worth all the lockdowns and the mandates? The masking mandates? The vaccination mandates?

[19:16] Kavanagh: Well, yes. This can be a deadly virus. And of course, I’m not sure he recovered. I haven’t heard anything about Lindsey Graham in the past several days. He got flu like symptoms, which I consider fairly severe symptoms in the beginning of the illness, and I haven't seen reports since that time. I hope that he will have a full recovery. These can be quite problematic, these breakthrough infections. One of our board members from Health Watch USA last week, fully vaccinated in February, developed COVID. She was in the ER on Sunday. I tried calling her today and she didn’t answer so I’m a little bit worried. She didn’t appear to be doing the greatest. Didn’t get admitted. But to be honest with you, to get admitted now with COVID, you’ve got to be needing some sort of respiratory support at this point. It’s pretty scary. We have another past [Kentucky] state representative, which, according to one of the news reporters, is also hospitalized. He was fully vaccinated back in February. And they were at that time thinking of placing him on the vent. I checked his Facebook page, and there’s just prayers for that individual. When I went down to see my primary care doctor, I asked her about COVID-19 and what she was seeing. And she told me that the day before she took care of 18 possible COVID patients, six of which were positive, five were vaccinated. Treated them on an outpatient basis. But the day that I was seeing her she said she had to admit somebody that again was elderly and had to go to the hospital. Fully vaccinated individual. This is the reason why Israel is giving boosters to those that are over 60 that had been vaccinated with mRNA vaccines greater than five months previously, because this is the age group that appears to be most affected by this. And as you know, the United States was vaccinating elderly and high-risk individuals very early on. We were one of the first in the world. And so now with this delta variant, we’re seeing some immunity wane and some of these people getting reinfected. The United Kingdom is planning on instituting boosters sometime in September. But you need to remember that England had a three-month lag period between the first and second shot. And because of that, people are not so long out from that second shot. They’ve got a little bit more time. The data that we started out with is quite disturbing: That 35% of the hospitalizations are in those that were vaccinated. But again, they use a whole bag of different types of vaccines. And the AstraZeneca vaccine doesn’t seem in my opinion to be as efficacious with some of these immune escape variants. We saw that with the South African variant. And that is a whole virus; attenuated viral vaccine. It’s not an mRNA vaccine. Completely different technology. I would still strongly recommend that people get vaccinated, even if you’ve had a previous infection. As you know, in a recent article that we’ve published, if you have a previous infection, and you get vaccinated, your chances of getting a reinfection or a breakthrough infection with the delta variant is lessened. It will still boost your immunity. You want your immunity as high as you can during this period of time that we’re at risk for contracting delta.

ICT®: At what point does the cure become worse than the disease? At what point do we have to take into consideration the surgical procedures that had to be put on hold? The mental health problems? Deaths of despair? Children not being able to socialize properly because they can’t go to school in person? Is it worth closing schools for children? They don’t seem to be as prone to getting COVID-19. I know what you answered before is that we haven’t delt with the delta variant before.

[23:43] Kavanagh: The pediatric hospitals are filling. But you also need to remember that approximately 120,000 or more children have lost a caregiver to COVID-19. I mean, they can spread the disease. And it’s having a profound impact on them. And people who are not getting elective surgery, they’re not getting it because the hospitals are filling with [patients who have COVID-19]. And even people that have had to have cancer surgery canceled or postponed, it’s not because, “Oh, we’re doing this because of COVID to try to decrease the rate of spread.” No, surgery is being postponed because hospitals are filling. They’re not being postponed to decrease COVID-19 spread. If you don’t have an ICU, you can’t have a major procedure. People are now waiting in ERs in many, many states trying to get a hospital bed or even an ICU bed. It is not a good situation. The choice that we have is to vaccinate, abide by social distancing and social strategy so that we can decrease rate of transmission. Israel, when the infectivity or when the test positivity rate went above 1.5%, they started to talk about expanding testing, greater access to testing, vaccine passports, etc. It’s a whole different attitude in other parts of the world. Australia, New Zealand: They’ll close down a city for just a few cases, like three or four. In here, we’ve decided to live with the virus. And the problem is you can't because it keeps bringing its relatives in with different variants. So, you get immune to one, you’ll get hit by the other. It’s not a workable strategy.

ICT®: I know that you’ve closely watched the debates between Senator Rand Paul—who’s an MD—and Doctor Anthony Fauci of the Centers for Disease Control and Prevention. If you had the power to step in and mediate and tell each man to stay on message in this debate—not to say, “Well, you’re right. I quit,” but to just stay on message, how would you go about doing that?

[26:17] Kavanagh: It’s going be tough, because there’s really not political sides. There’s only the side of what’s going to stop the virus. And this debate that’s going on in this country is going on in very, very few other countries. To say that this is a political solution is crazy when you look at all the different countries that are trying to adopt the strategies that we’re able to enact but won’t. We have countries begging for vaccines but yet we’re throwing them away in our country. And we have people saying you shouldn’t get a vaccine, or it’s up to you to get a vaccine. Well, if you don’t stop the spread of the virus, and slow down the community spread, we’re in trouble. The primary goal of a vaccine, in my opinion, is to stop community spread so we can protect other people. It’s very difficult for that vaccine to protect the individual. Let’s say the vaccine’s 90% effective. Well, if you’ve got very high spread, you’re going to get exposed to the virus 10 times and get it. On the other hand, if you have that spread down very low, where maybe you have 1 chance in 100, or 1 chance in 1000 of being exposed to the virus, then that 90% is pretty good. Because if by chance you were exposed to that virus, you now have a good shield of armor to prevent you from getting infected. Without stopping community spread, without the public embracing vaccines, this just won’t work. I mean, goodness, polio, measles, chickenpox: There is a tremendous vaccination rate for polio and measles. It’s 90% of the children are vaccinated. That’s what stopped the spread of the virus. And unless we do that with delta, which is a much more dangerous virus than polio, we’re going to be in trouble. And that’s the problem. If you look up the stats on polio, delta is much more dangerous. I can just tell you that this country, unless the United States starts doing some drastic changes, as we get iteration after iteration of this virus, we will be in trouble not just from deaths, but from chronic disability that will come through and affect our population.

ICT®: Would you like to end on a more positive note? What do you see that’s giving you some hope?

[28:59] Kavanagh: Well positive is that I think that we’re starting to pick up our vaccination rates. People are starting to become more serious about social distancing and masking on their own. Mandates at this point, unless you have over half the population in a community buying in—or well over half—they’re hard to enforce and hard for them to be effective. But at some point, I think we’re going to need to see those. And we’re also seeing businesses stepping up. Starting to mandate that people who work in their businesses become vaccinated. And I believe that we’re going to see more and more businesses requiring the wearing of masks. Again, masks aren’t 100% [effective] but they cut down on the spread of the virus. It’s a numbers game. Vaccination is a shield, cuts it down a bit. Masks are a shield, cuts it down a bit. Put those two together, and you’re now starting to get some significant protection. You fix indoor building ventilation, you do social distancing, and now you start to formulate a workable plan of getting out of this pandemic. But until we do that, it’s going to be tough. We’ll have a tough time ahead. We have the knowledge, we have the vaccines. It’s just whether or not we want to use them. It’s all within our control.

This interview has been edited for clarity and length.