As the CDC Data Tracker shows, the United States continues to suffer from an expanding wave of COVID-19 cases attributed to the delta variant. As has been the cases for several weeks, that outbreak is concentrated in the Southeast. Which, unfortunately, includes the same areas about to be hit with the winds, rain, and storm surge of a major hurricane. 

During Saturday’s morning briefing at the Pentagon, Central Command noted flight wings and troops that were now working with earthquake relief in Haiti, with the evacuation in Afghanistan, and teaming up with FEMA to prepare for the impact of Hurricane Ida. That’s a pretty full slate on anyone’s calendar. But it’s all taking place against the background of a pandemic that makes everything worse, everything more difficult, and everything more challenging. That Joe Biden guy, he picked a helluva time to be president.

Everything would be a little easier if there weren’t a solid contingent of Republicans pulling for Team Virus. Not only are people who claim they won’t take the vaccine because it lacks sufficient testing downing mixtures of horse dewormer and malaria medication on the advice of Facebook groups, there remain a number of GOP governors actively fighting against efforts to protect both children and adults.

And, by a total noncoincidence, on Friday, Florida scored yet another record day for both cases and deaths.

Earlier this week, Helen Branswell at STAT addressed one of the core frustrations of the last few months: vaccines that “flirted with perfection” are now “sinking back to earth.”

It’s hard to remember now that when the initial push was made for vaccines against COVID-19, the target was to exceed just 50% efficacy. That kind of protection, paired with some continued social distancing guidelines, seemed like enough to break the back of a disease whose R0 was then thought to be between 1.5 and 3.2.  That kind of number put COVID-19 closer to the transmission rates of seasonal flu or the common cold than to monsters like measles or polio. How bad can viruses be when it comes to transmissibility? Considerably worse than COVID-19.

Transmissibility of various viral diseases

The point here isn’t that SARS-CoV-2 is a wimp when it comes to transmissibility, or R0—which, as Harvard’s Global Health Institute explains, “represents, on average, the number of people that a single infected person can be expected to transmit that disease to.” An R0 of over six is very high, and some estimates have pegged the delta variant up in chickenpox territory, closer to 10. This also doesn’t represent that there’s endless potential for things to get worse. Yes, the rapid movement from around 2.5 to around 6.7 would seem to indicate that there is still considerable “leg room” when it comes to the evolution of SARS-CoV-2, but that doesn’t mean that some variant further down the list of viral fraternities is going to Rho Tau Omega its way to matching the mumps virus. Every viral structure has its limits. We just don’t know this one yet.

What’s key here is that, even though chickenpox, polio, and mumps are much more contagious than even the delta variant, the United States is not overrun with these diseases. That doesn’t mean they don’t still occur—there are still around 200,000 cases of chickenpox in the United States each year, and around 20,000 cases of mumps. What keeps each of these extremely contagious diseases from running rampant across the country is the same: vaccines.

And if the first thought is, “well, the COVID-19 vaccines aren’t as good as they used to be,” the same thing is true of mumps and chickenpox. Those vaccines have also lost some of their punch over time—and they were never as good at protecting against infection as the COVID-19 vaccines were when they first emerged from the labs.

What keeps these diseases down is vaccination rates. And what keeps the vaccination rate high is mandatory vaccination. 

Over the last 30 years, over 91% of all schoolchildren in the United States have been vaccinated against the mumps and chickenpox. That doesn’t stop outbreaks among the unvaccinated—since 2013, the CDC reports that there have been numerous surges of mumps. The response in treating these outbreaks has often been to give children in the area a booster shot. That booster can temporarily raise effectiveness of the mumps vaccine from 88% to 97%. That booster is generally a third shot, as most children are already vaccinated against mumps twice. But what keeps each of these mumps outbreaks from turning into a mumps epidemic is that 91.5% vaccination rate—a rate that is only achieved because public schools, and most private schools, require vaccination.

Chickenpox and mumps are worse than COVID-19 when it comes to transmissibility, but they don’t become epidemic because of vaccines. Polio was far, far worse than any variant of COVID-19, and in 2019 there were only 175 know cases. Like smallpox before it, polio is that close to being something that exists only in the history books and some carefully controlled cold storage unit.

Vaccines can stop viral epidemics. They’re just about the only thing that can.

On Saturday morning, The Washington Post editorial board addressed the frustrations of the COVID-19 pandemic. Shifting rules, rising cases, and now vaccines that just don’t seem all that effective anymore. Even nations like Israel, where rates of vaccination are much higher than in the United States, are seeing a delta surge that just doesn’t seem to stop. When the delta wave peaked in the U.K. and began to decline, it seemed like a pattern the U.S. might hope to follow in a few weeks. But instead of dropping back to where they were in spring, U.K. cases started moving up again. 

So where is the hope that seemed so tantalizing just weeks ago? Right where it was: with vaccines. The vaccines are still highly effective, much more effective than the average flu vaccine and right up there with the most effective vaccines against respiratory diseases.

The sobering truth is that the way out of this pandemic is immunity. Immunity comes from two sources: being vaccinated, or surviving an infection. Recent studies have shown that both vaccines and previous infection provide protection against serious illness from COVID-19. The difference in that one of these routes poses the risk of death, long-term disability, and bankrupting medical bills. The other is fast, safe, and free.

Eventually, the pandemic will end. However, the second sobering truth is that a solid third of Americans seem dead set on taking the long, dangerous, and senseless route—through overcrowded ICUs and past exhausted, increasingly frustrated healthcare workers—to get there. And nothing seems capable of talking them out of it. With more than 670,000 official deaths on the books, Republicans aren’t just refusing to push vaccines, they’re creating laws against even checking to see if someone if vaccinated. 

They’ve picked a choice of how to get through this thing, not just for themselves, but for their children, their neighbors, and to a large extent, the nation. And if that seems like a death cult, then … well, here’s Mississippi Gov. Tate Reeves, as reported by the Daily Memphian.