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Wednesday, October 27, 2021

Asset Class Valuations and Expected Returns: U.S. Stocks (Oct. 21, 2021)

 


Da Bear’s Perspectives

Vol. 1, No. 4 - October 21, 2021

By Ron A. Rhoades, JD, CFP®

Associate Professor of Finance, Gordon Ford College of Business

Director, Personal Financial Planning Program, Western Kentucky University

Financial Advisor and Content Specialist, ARGI Investment Services, LLC

To contact Ron, please email: bear@argi.net

 

 

October 2021 Update on Asset Class Valuations

In this edition, I focus on questions sometimes raised by investors whom I have met with recently – is the U.S. stock market overvalued? If so, what should I do?

As with most other editions of Da Bear’s Perspectives, this is a longer read, with more detailed discussion of the issues presented. For those who dare to peruse the following, enjoy!

 

Executive Summary

Despite some recent volatility, stock indexes for most of the world remain near their highs.

In particular, U.S. growth stocks are at high valuation levels, relative to their assumed mean level of valuations. U.S. value stocks are more reasonably valued, as are value stocks in Europe, Asia, and emerging markets.

Reversion to the mean of asset class valuations occurs quite often. Yet, absent an economic shock, reversion to the mean can take many, many year – possibly 10, 15, or even more than 20 years.

Due to reversion to the mean (or partial mean reversion), lower expected returns for several asset classes are anticipated over the next 10-15 years.

U.S. equity strategies employing multiple factors, such as the value, size, quality, and/or profitability factors may fare better over the next 10-15 years, compared to a “total stock market” approach.


The U.S. Stock Market (Overall) Is Substantially Overvalued

According to my own analysis of asset class valuations,[1] as of the mid-October 2021, U.S. large cap growth stocks are particularly overvalued.

“Growth stocks” are high-priced stocks, relative to recent or projected earnings, revenues, book value, cash flow (or free cash flow), or dividends. “Value stocks” are “low-priced stocks” relative to the same measures. Different methodologies exist for classifying stocks as either “growth” or “value” (or something in between, often denoted as “core” stocks).

“Large cap stocks” are generally stocks of companies with a total stock market valuation (i.e., total value of all of the company’s outstanding stock) of $10 billion or greater.

The overvaluation of U.S. large cap growth stocks has, in turn, has influenced the entire U.S. large cap stock universe to be overvalued.

The overvaluation of U.S. stocks can be discerned from valuation ratios, of which there are many types.

This chart of the Shiller CAPE10 [also known as the P/E 10 ratio, or as the cyclically adjusted price-to-earnings (CAPE) ratio], is a valuation ratio that averages the past 10 years of earnings of the companies found within any country, or within any equity asset class. It most commonly is referred to as “CAPE10” as it is applied to the Standard & Poors’ 500 Index, which index includes 500 of the largest U.S. companies on a cap-weighted basis. By using an approach that levels earnings over 10 years (with inflation adjustments for prior years’ earnings), the Shiller CAPE10 avoids large swings in valuations that can occur when corporate earnings rapidly rise and fall.

The Shiller CAPE10 illustrates the present over-valuation of U.S. stocks, relative to the mean, with the ratio at 38.63 as of October 21, 2021 (slightly up from the 38.52 ratio seen on July 13, 2021).

 Source: https://www.multpl.com/shiller-pe  Retrieved Oct. 21, 2021

The historic mean of the Shiller CAPE10 valuation ratio (since 1870) is 16.88.[2] However, due to changes in accounting practices and standards that occurred around 2001 (relating to how goodwill is written off), a reduction of dividend payouts, and other factors,[3] some financial academics argue that a more reasonable “mean” might be around 19-26.[4] Reflective of the general long-term trend toward higher equity values (using price relative to earnings), from January 2000 through October 2021, using monthly data, the arithmetic mean of the Shiller CAPE10 was 26.73, while the median was 26.15.[5]

Additionally, many might argue that, given the extremely high monetary and fiscal stimulus seen since the start of the pandemic in early 2020, substantially higher valuations are justified.[6]

The maximum value of the Shiller CAPE 10 valuation ratio was 44.19, which occurred in December 1999 at the height of the dot-com bubble.[7]

The Shiller CAPE ratio is a good indicator for long-term forecasts,[8] and may be one of the most statistically significant predictors of long-term U.S. stock market returns.[9] A chart from Lyn Alden, looking at similar valuation ratios done for both U.S. and foreign markets, shows a strong negative correlation between high valuations of various stock indexes and future returns, when looking at the future returns over a 15-year period:   

https://www.lynalden.com/shiller-pe-cape-ratio/

Past performance is not a guarantee of future results. The data shown in the chart referenced above is derived from multiple sources and is assumed to be accurate. Returns shown are “real returns” (inflation-adjusted), but such returns do not reflect the costs incurred by investing in specific mutual funds or ETFs, or directly into equities. The returns shown do not reflect ARGI’s (or any other investment adviser’s) investment advisory fees. Much of the data above is derived from country indexes; you cannot invest directly in an index.

However, there exists a wide dispersion of possible returns, even after the Shiller CAPE 10 ratio has reached very high heights.

Source: Research Affiliates


Reasons Why U.S. Stock Prices Are High

At times the market can appear “manic-depressive,” with stock market values being depressed relative to their assumed normal levels (“norms”). At other times the stock market can appear to be euphoric, with prices quite high relative to their norms. 

In the present case, it appears that a major reason behind this extraordinary move of U.S. stocks is largely due to irrational exuberance.[10] In this regard, stock valuations (both individually, and as broader asset classes) can be substantially driven by investor psychology. Investors tend to act with herd behavior, and as investors pour into equities other investors often follow them. In addition, other behavioral biases, such as “fear of missing out,” are often involved in changes to investor sentiment. 

Another reason for high stock valuation levels is the potential role of low interest rates. In traditional financial theory, interest rates are a key component of valuation models. When interest rates fall, the discount rate used in these models decreases (assuming all other inputs into discount rates stay the same). This causes the price of the equity asset to appreciate, as future earnings of companies have greater value. This is particularly true with growth stocks, which often have higher earnings projected farther into the future. As the discount rate falls, the price of the equity asset should appreciate, assuming all other model inputs stay constant. So, lower interest rates are often used to justify higher equity prices.

Additionally, low yields on fixed income investors drive some investors to equities. Many investors conclude that there is no alternative to investing in equities if they desire to preserve the real value (i.e., inflation-adjusted value) of their wealth, or to outpace inflation over the long term.

Another argument in support of high prices is that the equity markets are simply pricing in a future economic recovery, as more and more Americans return to work following the recent COVID-19 pandemic. (Unfortunately, due to the Delta variant and other reasons, COVID-19 continues in the U.S. in a more limited way, and COVID-19 is still causing serious economic problems in many countries, especially those in which vaccination rates are low.)

Additionally, the monetary stimulus from the Federal Reserve (via low short-term interest rates, and quantitative easing, primarily) and the likely fiscal stimulus (arising from a multi-trillion spending package likely to be enacted later in 2021 through the reconciliation process, to which the U.S. Senate filibuster does not apply), may spur U.S. economic growth forward. Indeed, in late June 2021 the International Monetary Fund raised its 2021 U.S. growth projection sharply to 7.0%, due to a strong recovery from the COVID-19 pandemic and an assumption that much of President Joe Biden's infrastructure and social spending plans will be enacted.[11]

The International Monetary Fund foresees strongeconomic growth, around the world, through 2022.

Still another reason, related to investor psychology, is the rise of the social media hype of certain “meme” stocks, such as Gamestop, AMC, Blackberry, Bed Bath & Beyond, Clover, SoFi, and others. Individual investors on Reddit and Twitter tout these and other stocks, often resulting in rapid growth of each company’s stock price. A disconnect occurs between the “intrinsic value” of a stock, and its stock price, as speculation is fueled. Panic selling of these stocks can often occur, even at the slightest adverse news or other headwind. 

The Phenomenon of Reversion to the Mean

There is always a tendency to believe “this time is different.” Yet, reversion to the mean of asset class valuations, over the long term (15-20 years), is likely to occur.

The reversion to the mean principle suggests asset prices and historical returns eventually will revert to their long-run mean level. The academic evidence for mean reversion, over long periods of time, is fairly strong. For example, a recent academic paper reviewed a large sample of stock indexes in seventeen countries, covering a time span of more than a century, and analyzed in detail the dynamics of the mean-reversion process for the 1900-2008 period. They found that the speed at which stocks revert to their fundamental value is higher in periods of high economic uncertainty caused by major events such as the Great Depression, World War II and the Cold War. In essence, large price movements in relatively short periods of time - when great economic uncertainty exists - may account for a high mean reversion speed. However, at other times it can take many years, and even decades, for mean reversion to occur.[12]

Similarly, Campbell and Shiller demonstrated that high valuation multiples such as aggregate book-to-market (BtM) or earnings-to-price (E/P) ratios, both of which signal low current prices, have been found to forecast high subsequent stock market returns.[13]

However, mean reversion is not universally accepted in academic circles.[14] Stock price movements occur for a variety of reasons, and it can be difficult to isolate mean reversion as the cause of movements in valuations of asset classes when so many variables exist. Some academics continue to favor the “random walk” theory of asset prices, arguing that mean reversions are not predictable.[15]

Even if mean reversion is accepted (as it is in many financial circles), mean reversion does not always occur to the historical mean, as a new mean may be set by ongoing developments in the equity markets. As a result, predicting the effect on mean reversion of over-valuation or under-valuation might be tempered by assuming that mean reversion occurs only partially. As stated by Robert Arnott of Research Affiliates: “Valuation multiples, yields, and spreads have shown a powerful tendency to eventually mean-revert toward historical norms. However, since mean reversion is somewhat unpredictable, our models only assume partial mean reversion – spread out over the decade to come – in setting our return forecasts.”[16]

Mean reversion – over the very long term – for broad asset classes, is highly likely to occur. However, I do not mean to suggest that high stock values today will cause declines in stocks in the near term (although it is possible). There is very little evidence to suggest that mean reversion for broad asset classes consistently occurs over short time periods, such as over 1 year, 3 years, or even 5 years.

As seen in the next section, high valuation ratio levels imply future long-term (15-20 year) lower return for certain stock asset classes.


Varied Opinions on the Expected Returns of Various Asset Classes.

There are many opinions about the future returns of stock asset classes.

Some estimates of 10-year expected average annualized returns for various asset classes are undertaken by several investment firms. The following summarizes their data, for select asset classes, for a U.S.-based investor. The Research Affiliates estimate also gives an indication of the wide dispersion that exists, as to possible future average annualized returns over the next 10 years.

            U.S. large company stocks:        1.5% (RA) (with 5% probability of returns of 5.6% or greater,

and 5% probability of returns of -2.5% or less)

                                                            2.4% to 4.2% (VG)

                                                            5.6% (SSGA)

                                                            6.4% (BR)

            U.S. small company stocks:        3.0% (RA) ) (with 5% probability of returns of 8.5% or greater,

and 5% probability of returns of -2.5% or less)

                                                            2.1% to 4.1% (VG)

                                                            6.1% (SSGA)

                                                            7.2% (BR)

            Foreign developed markets:     6.4% (RA) (with 5% probability of returns of 11.0% or greater,

and 5% probability of returns of 1.9% or less) (EAFE)

                                                            5.7% (MSCI Europe) (SSGA)

                                                            4.5% (MSCI Pacific) (SSGA)

                                                            8.2% (Europe) (BR)

            Foreign emerging markets:       8.3% (RA) (with 5% probability of returns of 13.9% or greater,

and 5% probability of returns of 2.8% or less)

                                                            5.8% (SSGA)

            Commodities:                          1.4% (RA) (with 5% probability of returns of 5.7% or greater,

and 5% probability of returns of -2.9% or less)

                                                            4.3% (SSGA)

[Projections above include data from Research Affiliates (RA) as of September 30, 2021 as derived from its Asset Allocation Interactive online resources, and from Vanguard (VG) as of June 30, 2021, and from State Street Global Advisors (SSGA) from its Long Term Asset Class forecasts as of September 30, 2021, and from the Blackrock (BR) Capital Market Assumptions - Asset Return Expectations and Uncertainty (as of June 30, 2021).]

[Please be aware that the information presented on the prior page represents local (U.S. dollar) return forecasts for several asset classes and not for any ARGI fund or strategy. These forecasts are forward-looking statements based upon the reasonable beliefs of the sources set forth below and are not a guarantee of future performance. Forward-looking statements speak only as of the date they are made, and neither ARGI nor Ron A. Rhoades nor any of the firms listed below assume any duty to update forward-looking statements. Forward-looking statements are subject to numerous assumptions, risks, and uncertainties, which change over time. Actual results may (and likely will) differ materially from those anticipated in forward-looking statements. Asset return projections gross of fees relating to investments, or which might be charged by ARGI or another investment advisor.]

Note that while the foregoing projections assume reversion to the mean occurs over a 10-year period, I would again caution that mean reversion, in the opinion of some academics, has a greater probability of occurring over a 15-year to 20-year period.

Not all analysts project positive returns for stocks. For example, GMO LLC projects, over the next 7 years, -6.2% annual (nominal) returns for U.S. large company stocks, -8.2% annual returns for U.S. small company stocks, and -0.9% annual for international large company stocks. GMO does project that Emerging Markets Value stocks will possess an inflation-adjusted annual return of +2.4% over the next 7 years.) [Source: GMO 7-year asset class real return forecast, as of August 31, 2021.]

My own analysis (using price-book valuation ratios for the Russell indexes for U.S. stock asset classes over the past 40+ years, and Fama-French research indices for long-term returns), I further break down U.S. asset classes by value and growth stocks. Doing so shows a wider discrepancy in expected average annual returns over the next 15 years, as between growth stocks and value stocks, and illustrates that we are likely in a “growth stock” bubble:

            U.S. large company growth stocks:        -2.9%

            U.S. large company stocks:                    3.6%

            U.S. large company value stocks:           5.6%

            U.S. small company growth stocks:        1.7%

            U.S. small company stocks:                    8.7%

            U.S. small cap value stocks:                   9.5%

[Projections reflect market prices as of the close of trading on October 14, 2021 and utilize historical and current price-book ratio data for indexes and index ETFs from the Frank Russell Corporation, with adjustments to future returns undertaken by Ron A. Rhoades to reflect projected rates of inflation, and projections of U.S. economic growth, over the long term. Ninety percent of the reversion to the mean (as measured over the past 20 years) of asset class valuations is assumed, rather than full mean reversion. These projections are undertaken by Ron A. Rhoades, individually, and are not undertaken by ARGI’s investment department nor its investment committee. Forward-looking projections are subject to numerous assumptions, risks, and uncertainties, which change over time. Actual results may (and likely will) differ materially from those anticipated in forward-looking projections set forth above, as there exists numerous factors at play and the dispersion of actual returns can be quite wide; only the median projection is shown. There exists academic research that reliance on price-book ratios may not be the best valuation metric to use as a forecaster of returns, given the rise of goodwill and other factors affecting book values, and changes in the industry composition of indexes, over time.[17]]

 

Conclusion: Yes, A Growth Stock Bubble Exists

As of the date of this writing, U.S. stocks are likely in a “growth stock bubble,” similar to the prior bubble in growth stocks (i.e., high-priced stocks, relative to book value, or sales, or earnings) seen in 1999-2000. The driving factors behind these high valuation levels include speculation by individual investors and “euphoria” leading to chasing returns (as occurred 22 years ago).

However, in other respects the market environment is somewhat different than that seen in the “dot.com” era. Today’s “growth stocks” don’t just consist of many revenue-less technology stocks, but instead are led by large companies with more diverse revenue streams. Future earnings are of these larger, more established growth stocks are often projected quite high – and such future earnings are discounted less due to the relatively low interest rates existing today.

Please realize that none of these future asset class projections are “certain.” Forecasting investment returns, even over the long term, deals with probabilities, rather than certainty. As I instruct my students, as to the price factor:

“A highly diversified basket of value stocks (i.e., those stocks with low p/e, p/b, p/s, or p/cf ratios, or some combination of the foregoing) possesses an approximately 80% or greater probability of outperforming a diversified basket of growth stocks over any given 20-year period of time.”

I do not mean to imply that, in the event of a shock to either the financial system or to the economy as a whole, value stocks would have positive returns during such a period of time. Indeed, in the most significant market downturns in U.S. history (e.g., the start of the Great Depression, as well as the 2007-9 Great Recession), value stocks fell further than growth stocks. Simply put, some of the characteristics that classify stocks as “growth” also tend to promote the ability of those growth stock companies to better endure substantial economic declines.

Ever since early 2009, global equities have risen fairly steadily, with only moderate declines occurring (and the more substantial, but short, decline seen in Feb/March of 2020). But we must remember that the stock market does not always go up, even over 5-year and 10-year periods of time. In fact, there can exist substantial periods of time when the overall U.S. stock market underperforms the rate of inflation or just barely outperforms inflation.[18]

 

What to do now?

A long-term investor will likely be well-served by substantial tilts away from growth stocks, and toward U.S. mid-cap/small cap value stocks, foreign developed markets mid-cap/small-cap value stocks, and emerging markets value stocks, over the next 10-15 years.

A multi-factor strategy, such as those incorporating factors such as the price (value) factor, size (small cap), quality, and profitability, possesses a high probability of outperformance, relative to U.S. equities overall, over the next 10-15 years.

Nearly three years ago I read where a well-known, large investment firm described the market environment as the most difficult one they had ever seen. Yet, since then, the equity markets – like poor Icarus of Greek mythology – have ventured even closer to the sun.

This does not mean that investing in stocks should be abandoned, especially since no other major asset classes appear to be undervalued at present. However, an advisor’s discussion of long-term changes to a client’s strategic asset allocation, and an advisor’s effort to re-set client expectations of future equity returns, may prove to be worthwhile.

Until the next time …

Very truly yours,

Ron (Da Bear)

Email: bear@argi.net



[1] Using data I have accumulated on price-book ratios, it appears that, relative to mean and median levels, overvaluations exist for U.S. large company growth, balanced, and value strategies, and for U.S. small company growth, using Russell indexes for p/b ratios, and Fama/French data for historic returns. See later discussion in this article, for mean projections of returns.

[2] Per Robert Shiller website, and from https://www.multpl.com/shiller-pe. Data retrieved 10/21/2021.

[3] See, e.g., Rob Arnott, Vitali Kalesnik, and Jim Masturzo, “CAPE Fear: Why CAPE Naysayers Are Wrong,” Research Affliliates, January 2018.

[4] See, e.g., Larry Swedroe, “Swedroe: This Metric in Dire Need of Context,” www.etf.com (July 14, 2017)

[5] Using data from https://www.multpl.com/shiller-pe; data retrieved 10/21/2021.

[6] See, e.g., Lechner, Gerhard and Lechner, Gerhard. Does the Shiller CAPE Predict a Crash of the S&P 500? (March 17, 2021), in which the author concludes: “The forecast of the author is that the overvaluation will accelerate and exceed the previous peak of December 1999, because the monetary expansion will continue in 2021. The author believes it is likely that the new peak will be reached as early as 2022. After that, the risk of a stock crash increases sharply. Maybe, an increase in inflation and rising interest rates will cause a sudden drop.”

[7] Supra n.1.

[8] Keimling, N. (2015). Predicting Stock Market Returns Using the Shiller CAPE — An Improvement Towards Traditional Value Indicators? SSRN Working Paper, 1-39.

[9] Jivraj, Farouk and Shiller, Robert J., The Many Colours of CAPE (October 13, 2017). Yale ICF Working Paper No. 2018-22

[10] Shiller, R. J. (2015). Irrational exuberance. Princeton: University Press

[11] David Lawder, “IMF raises U.S. 2021 growth forecast to 7%, assumes Biden spending plans pass,” Reuters (July 1, 2021).

[12] Spierdijk, Laura and Bikker, Jacob Antoon and van den Hoek, Pieter. Mean Reversion in International Stock Markets: An Empirical Analysis of the 20th Century (April 1, 2010). De Nederlandsche Bank Working Paper No. 247

[13] Campbell, John Y., and Robert J. Shiller. 1988. “Stock Prices, Earnings, and Expected Dividends.” Journal of Finance, vol. 43, no. 3 (July):661–676

[14] See, e.g., Ronald Balvewrs, Yangru Wu, and Erik Gilliland. Mean Reversion across National Stock Markets and Parametric Contrarian Investment Strategies, The Journal of Finance, Vol. LV, No. 2 (April 2000), stating: “For U.S. stock prices, evidence of mean reversion over long horizons is mixed, possibly due to lack of a reliable long time series.”

[15] See, e.g., Yang, Xinye and Yang, Xinye, Economic Theory Foundations for the Long-Term Investment (March 18, 2021), stating: “Applying the Random Walk Theory to finance and stocks suggest that stock prices change normally, making it impossible to predict stock prices. The random walk theory corresponds to the belief that markets are efficient and that it is not possible to beat or predict the market because stock prices reflect all available information and the occurrence of new information is seemingly random, as well, in the short run. However, according to Burton Malkiel, the stock market does not conform perfectly to the mathematician's idea of the complete independence of the stock prices concerning past performances (Malkiel, 2003).”

[16] Rob Arnott, Jim Masturzo, “All Asset All Access: Long-Term Forecasts Help Identify Compelling Investments Today,” PIMCO Insights (Feb. 25, 2021)

[17] See, e.g., Choi, Ki-Soon and So, Eric C. and Wang, Charles C. Y., Going by the Book: Valuation Ratios and Stock Returns (August 26, 2021). 

[18] Comparing an index for the overall U.S. equity markets (as measured by the CRSP 1-10 Index, with data provided by the Center for Research in Security Prices) to an index for consumer inflation (CPI-U, published by U.S. Commerce Department):

·       The average annualized return for the U.S. equity markets was 10.09% for 1926-2000.

·       The average annualized rate of inflation was 2.86% for 1926-2000.

·       The worst nominal performance for the CRSP 1-10 Index was a -0.28% average annualized return over a 15-year period, which commenced in September 1929.

·       The worst nominal performance for CRSP 1-10 Index was a 1.96% average annualized return over a 20-year period, which also commenced in September 1929.

·       However, after adjusting for inflation, the worst real average annualized return for the CRSP 1-10 Index, over a 20-year period, was a cumulative 18% - still positive, but just barely.









Monday, August 23, 2021

Even Vaccinated, I Got COVID. And It Isn't Pretty, Folks.

I have been quite careful about COVID-19. I strictly quarantined for over a year, teaching my college classes from home, via Zoom. I was so pleased to be able to travel and visit my financial planning clients in June, as the number of COVID-19 cases waned. And I was so looking forward to being back in the classroom in late August.

Then the Delta variant happened.

I was not too worried. I had been fully vaccinated back in March. In late July I did an antibody test, which showed I had a level of antibodies that placed me in the top 40% or so of all those who had received vaccinations.

(Day: -4) Tuesday, August 17th, was my first day back on campus. I attended an outdoor student social event (masked only part of the time). And I had lunch with a faculty colleague (masked only while driving to/from the restaurant; not masked when sitting across from each other).

(Day: -3) Wednesday, August 18th: I found that my colleague had tested positive for COVID. Later I learned that some students at the outdoor social tested positive for COVID.

(Day: -2) Thursday, August 19th: Faculty Department meeting, in which we all wore masks and sat more than 6 feet away from each other. Halfway through the meeting I starting having mild symptoms, and left the meeting. I immediately went to the health clinic and got the quick test. It came back negative!

(Day: -1): Friday, August 20th: I finished my three days of 2-hour-a-day instruction to freshmen students who arrived on campus a week early to acclimate. In these classroom settings I wore my KN95 mask. Students wore masks, but several did not have them over their noses (despite my reminders).

After instruction ended, about noon, I began to have more severe symptoms. Went home, and went to bed.

(Day: 0). Saturday, August 21st I awoke with a vast array of symptoms. Coughing. Sore throat. Terrible headache, as if I had a sinus infection (but I only had a slight nasal congestion). Chills. Shortness of breath. And very weak.

Went to our physician's offices, who also provide a walk-in clinic and testing seven days a week, for a COVID test. No surprise, it came back positive. More bad news - my blood pressure was extremely high. My oxygen level was dangerously low. And the chest X-ray they immediately took indicated shadows in my lungs (I have never smoked or had any lung damage). I had also just started medication for a temporary condition, which medication was suppressive of my immune system. The physician assistant called my personal doctor, who ordered me to the ER to get evaluated for monoclonal antibody therapy.

There are two hospitals in Bowling Green, KY. I chose the one that did not have reports of an overburdened ER over the prior week, due to COVID. My physician's office called the ER in advance, and gave me a copy of the chest X-rays and exam notes. My devoted wife immediately took me to the chosen hospital.

It was busy. I registered in a half-hour. But there was a delay in getting back to the examination areas. I finally was escorted back - past rooms full of COVID-19 patients, some intubated. In one room an entire family was present, and crying - I assumed their loved one had just passed away.

I was led to another waiting area, not an exam room. A physician's assistant (PA) appeared, and took new vitals. Same very high blood pressure, and low oxygen levels. The PA reviewed everything conveyed to her about my medical history, and asked me more questions. She left, then returned 20 minutes later.

Yes, I should have monoclonal antibody infusions, she said. Under normal circumstances, I would even be admitted, given the number of symptoms I possessed. But, the flood of persons in the ER (and in other rooms at the hospital) - due to unvaccinated persons arriving with COVID-19 - was such that there was no open room to provide the injection, nor was there the availability of a nurse for 2 hours to undertake the procedure. While a clinic in town offered the treatment, they were not open on weekends. The PA said she would try to get me treated, as soon as possible, but to return home and quarantine.

My own quarantine would last for 10 days, and this day was pronounced "Day 0."

My wife, Cathy, who had driven me from location to location that day (with the windows down, and both of us wearing our masks), took me home. She moved her gear into the guest room for an extended stay. I am confined to my bedroom, which fortunately has an adjacent work area for my computer work, when able to do same. Pursuant to the PA's instructions, I was to have no contact with others. Food was placed in a tray outside the door, to be quickly retrieved by me.

I took more Tylenol and went to bed.

I was a little disappointed. Although I was glad to be home in my own bed, as a practical matter treatment to me was being rationed, due to resource constraints. All those people who had not been vaccinated were tying up the ER and hospital resources.

At the same time, I was very appreciative of all of the health care providers I saw. Some looked exhausted. Yet all were patient and professional, and were doing their best.

(Day 1 - Sunday, Aug. 22nd). Awoke feeling quite lousy, and very weak. Had gotten up twice in the night, to again take medication to relieve body aches and headaches.

Then, got a call from the PA at the hospital. They could get me in that morning for the monoclonal antibody infusions. Great!

Did the infusions, and went back home. Two unfortunate side effects of the infusion ... slight nausea, and significant diarrhea. As if my life wasn't already fairly miserable.

Severe chills had me shaking for an entire hour that afternoon. No t.v., no reading. Just lying down and sleeping, as much as I can. Had the interesting delusion of talking to my wife and dog, as if they were laying upon the bed next to me, before I realized that they were not there. (Was a good conversation, however!)

No appetite, and no desire to eat dinner. Tried to keep up with fruit juices, in order to stay hydrated. Another long night - mostly sleeping, between fits of coughing and heading to the bathroom.

(Day 2 - Monday, August 23rd.) Awoke very weak. Drank some water. Took a shower. Took Tylenol again.

By mid-morning many of the symptoms were diminishing. Headache was less severe. Chills were gone. The monoclonal antibody treatment, which typically takes 24-48 hours to kick in, seemed to be helping - significantly.

Worrisome, however, was my coughing up of small amounts of blood mixed in with clear mucus. Informed my physician, who told me this condition was common, not to worry, but to monitor it and keep him informed. The sounds (rattling) from my windpipe I could hear, when I laid down quietly, were also common in this circumstance.

Today was to be my first day of classes this Fall semester. Another professor is covering two of my classes. The two more advanced classes were canceled for today, and I hope to do Zoom sessions when the classes next meet on Wednesday.

Just writing this has worn me out. Time for another nap. (As one colleague emailed me today ... hydrate, nap, repeat.)

PLEASE:

If you have not already done so, get vaccinated. Your vaccination is a gift of love to your family, friends, and community.

If you are vaccine hesitant, please read my prior post, from a month ago, exploring the need to engage in critical thinking before making any decisions.

Even if you are vaccinated, wear a mask, without exception, when out and about. I did not, just once or twice, the very first day I was "out and about." I regret my decision to "take the risk" in not wearing a mask at all times.

As I have learned, the Delta variant is not to be taken lightly. Even fully vaccinated, and even with great care from the health care providers I have seen, the last three days of my life have been a blur - with levels of discomfort I've not encountered often in my life.

Yet, I know it could have been much worse. If I had not been vaccinated previously, who knows if I would have even survived. I could have easily been that departed soul whose family members grieved in an ER treatment room.

I have some days ahead for recovery. Still dealing with symptoms. And merely typing this - my first time on a computer in 72 hours - has left me drained.

Take care, everyone. - Da Bear


Monday, July 26, 2021

A Personal Message to University Students Regarding the Delta Variant of COVID-19 and the Decision to Get Vaccinated

 An Open Letter to University Students Regarding Your Choice to Become Vaccinated (and Your Personal Responsibility to Become Well-Informed)


By Ron A. Rhoades, JD, CFP®[i]

July 25, 2021


This communication represents the author’s own views, and are not necessarily the views of any institution, organization, firm, clan, tribe, gang, cult, nor motley group of characters to which the author currently belongs or has ever been kicked out from.


I urge all readers of this article, who remain unvaccinated, to fully explore the evidence (from multiple sources), and to discuss the issue with their family physician.


  

FROM USA TODAY, JULY 21, 2021: “IT’S TOO LATE” – A PHYSICIAN HAS TO TELL PATIENTS.


An Alabama physician glumly says she is making "a lot of progress" in encouraging people to vaccinate – as she struggles to keep them alive.

 

Dr. Brytney Cobia, a hospitalist at Grandview Medical Center in Birmingham, wrote in a recent Facebook post she is treating a lot of young, otherwise healthy people for serious coronavirus infections.

 

“One of the last things they do before they're intubated is beg me for the vaccine," she wrote. "I hold their hand and tell them that I'm sorry, but it's too late."

 

In her post, Cobia wrote that when a patient dies, she hugs their family members and urges them to get vaccinated. She said they cry and tell her they thought the pandemic was a "hoax," or "political," or targeting some other age group or skin color.

 

"They wish they could go back. But they can't," Cobia wrote. "So they thank me and they go get the vaccine. And I go back to my office, write their death note, and say a small prayer that this loss will save more lives."[ii]

 

CONSERVATIVE MEDIA AND POLITICAL LEADERS CHANGING THEIR MESSAGE – “GET VACCINATED.”

·       Fox News launched a public service announcement urging people to get the Covid-19 vaccine this past week.[iii]

·       Sean Hannity, on Monday, told his viewers to “please take Covid seriously – I can’t say it enough.”[iv]

·       “U.S. Senate Minority Leader Mitch McConnell is calling for more Americans to get vaccinated, [stating:]  ‘These shots need to get in everybody’s arms as rapidly as possible or we´re going to be back in a situation in the fall that we don’t yearn for — that we went through last year … This is not complicated.”

·       “Utah’s Republican governor, Spencer Cox, encouraged people in the state to get vaccinated and blamed conservative media for stoking vaccine hesitancy. ‘We have these talking heads who have gotten the vaccine and are telling other people not to get the vaccine,’ Cox said, according to The Hill. ‘It’s dangerous. It’s damaging. And it’s killing people. It’s literally killing their supporters and that makes no sense to me.’  When asked about Cox’s comment, [Senator Mitch] McConnell urged Americans to ‘ignore all of these other voices that are giving demonstrably bad advice.’”[v]

·       Several “Republican governors also redoubled their efforts to get their constituents vaccinated, including Missouri's Mike Parson, West Virginia's Jim Justice and Florida's Ron DeSantis.”[vi]


THE DELTA VARIANT OF COVID-19 “IS A DIFFERENT DISEASE” AND SPREADS FAR MORE EASILY

 

“’This is a different disease. This is much worse,’ Dr. Clay Marsh said during the state [of West Virginia] COVID-19 briefing. “The more I learn about this, the more I’m worried … Marsh said people infected with the delta variant have 1,000-times more virus in their airways, compared to the original COVID-19 virus. That high concentration, he said, allows the variant to easily spread from person to person …..”[vii]

 

YOUNG PEOPLE ARE AT FAR MORE RISK OF INFECTION FROM THE DELTA VARIANT

 

“Mississippi's “recent sequencing data of 231 Delta variant cases show the variant spreading among young Mississippians:

  • Those ages 39 and under make up 65% of Delta variant cases
  • Of that group, those ages 1-17 account for almost 34% of Delta variant cases””[viii]

 

DEATHS AND HOSPITALIZATIONS AMONG THE YOUNG ARE MORE COMMON FROM THE DELTA VARIANT, AS IS THE OFTEN SEVERE LONG-TERM COMPLICATIONS CALLED “LONG COVID”

 

“Just how many deaths will occur as a result of the recent uptick in transmission is still unclear. Even if they die at lower rates than older adults, some of the younger adults hospitalized in recent weeks will still die. But cases only started rising in the past few weeks, and it can take people with Covid-19 that long to die, and another few weeks for their deaths to be recorded.”[ix]

 

“Even though treatments are better than they were originally, a larger share of patients are ending up in intensive care, and the fatality rate for those patients remains high, experts said. ‘That’s just indicative of the more virulent quality of the delta variant … It will make people sick, even people that are young and would not have felt any consequence from the original wild variant.’ Frighteningly, he said, far more children are being hospitalized, which was very rare until recently.”[x]

 

“The UK's top doctor has warned that more young people will get 'long COVID' as the Delta variant, which is now responsible for most of cases in the US, pushes up infection rates … One in three people who get symptomatic COVID-19 develop long COVID, defined as at least one self-reported symptom lasting for more than 12 weeks …”.[xi]

 

WE EACH HAVE PERSONAL CHOICES – AND A RESPONSIBILITY TO MAKE A WISE, INFORMED CHOICE.

 

As of July 21, 2021, new infections of COVID-19 nearly tripled over the past two weeks,[xii] and even higher rates of infection will occur soon. A “fourth wave” of COVID-19 has started. Unlike previous waves, more and more younger people are becoming infected.

 

Unlike the COVID-19 pandemic situation throughout 2020 and early into 2021, each of us individually possesses the freedom to make a choice – whether to get vaccinated or not. Individual decisions should be made using a cost-benefit analysis.

 

With the freedom to make choices also comes responsibility – to make decisions that optimize our own health outcomes. And that personal responsibility also includes to consider the well-being of others around us. A society benefits from prudent decision-making, by individuals, who carefully consider the choices they face to optimize their own outcomes, but also considering the impact of their decisions upon their family members, friends, and the greater community.

 

In this communication, I seek to gather the insights from many different sources, so that you – university students around the United States - may better make an informed decision. I caution that I am not a physician, nor am I trained in public health. Yet, I seek to relay facts and figures gleaned from those who are researching and communicating about COVID-19.

 

It is my sincere hope that you, the reader, will carefully consider these facts, and undertake your own additional investigations in order to make an informed personal decision.

 

Furthermore, I urge you to discuss your investigation, and any tentative conclusions you may reach with your personal physician.

 

EXPLORING VACCINE HESITANCY. We should not dismiss, outright, the hesitancy of those to becoming vaccinated. But those who are hesitant to receive a vaccine against COVID-19 should, in turn, carefully research and explore the facts, and undertake a cost-benefit analysis (which is set forth below).

 

There exists a lot of erroneous facts and opinions about vaccinations for COVID-19. In May 2021, Kaiser-Permanente Health Monitor Survey reported that approximately two-thirds of the unvaccinated believed at least one erroneous fact about the vaccines; many respondents held multiple inaccurate conclusions.[xiii]

 

Please permit me to briefly explore some of the major reasons for vaccine hesitancy:

 ·       A large reason for vaccine hesitancy appears to be distrust of the government, which has increased substantially over the past five decades since Watergate.[xiv] And, for some, a distrust of “science” also exists.

o   Yet, the reality is that “very few Americans actually oppose vaccines. For instance, only a tiny proportion of parents forgo vaccination for their children. Prior to the pandemic, vaccination rates were generally high and stable for very young children and those of school-entry age. For example, 95 percent of children were vaccinated against measles, mumps, and rubella with the MMR vaccine in the 2018–19 school year. Pockets of hesitancy remain and improvement is needed on some vaccines, but we should not confuse the visibility of a small number of anti-vaccine activists with sentiment toward vaccines in the broader population.”[xv]

o   Politico reports: “Many people are turning down Covid vaccines because they are angry that President Donald Trump lost the election and sick of Democrats thinking they know what’s best.”[xvi] Yet, Trump rightfully launched the programs that led to rapid development of the vaccines, and Trump has been vaccinated. Trump has also urged others to become vaccinated. “Sean Hannity and other Fox News reporters earlier this week suddenly changed their tune, as did many Republicans on Capitol Hill, calling on their viewers and constituents to sign up for the vaccine.”[xvii] Emotions in politics run high, but might I suggest – whether you are Republican, Democrat, Green Party, other political party, or independent – that you focus on the cost-benefit analysis for your health and life, personally, as well as upon the effect of COVID-19 upon your community. Are there better ways to make a political statement, that don't endanger yourself or others?

·       There is a belief, especially among those who are ages 18-24, that they are invincible.

o   This belief was similar to that seen in the late 1950’s. “When the Salk vaccine came out, parents were very keen to have their children vaccinated, but young adults were not convinced that they were at risk and did not get vaccinated. Only after additional epidemics showed that that they too could die or be paralyzed by polio did adults turn up to get vaccinated.”[xviii]

o   As discussed below, young people – even very healthy adults – are at some risk of death, and at a great risk of long-term symptoms, from catching the Delta variant of COVID-19.

o   For those attending colleges and universities, if you are not vaccinated and are exposed to a person with COVID-19, you may be forced to quarantine (and miss classes) for ten days, or longer. And if you catch COVID-19, a similar period of quarantine will occur – and you will likely have days (or even weeks) where you are unable to effectively keep up with your course work (due to symptoms from which you are likely to suffer). Of course, there is even the possibility of severe illness, hospitalization, and even death, as explained below.

·       Some members of minority groups have particular aversion to medical treatments.

o   “Dark and tragic episodes from the past, such as the Tuskegee syphilis study, remain deeply rooted in the consciousness of minority communities. In the 40-year experiment, Black men were misled about the research and forced to suffer from untreated syphilis, despite the availability of penicillin. Present-day problems, such as the lack of access to adequate health care and insurance, persist in minority communities.”[xix]

o   Lacking a personal perspective on these issues, I can only urge members of minority groups to discuss the issue of reluctance to take a COVID-19 vaccination with their family physician, members of the clergy, or others that they may trust for guidance.

·       There exist concerns among some that the vaccines may have long-term adverse effects.

o   Having seen advertisements from personal injury attorneys pursuing cases against pharmaceutical companies for medications that turned out to have greater adverse effects than advertised, the concern about long-term effects from any medication should not be surprising.

o   Yet, vaccines are highly, highly unlikely to possess long-term adverse effects.

§  “It’s true that reports of new side effects can sometimes take months to emerge as a vaccine goes from populations of thousands in clinical trials to millions in the real world, encountering natural variations in human responses along the way. But more than a hundred million Americans have already passed that point in their vaccinations and the first participants in the clinical trials are now beyond a year.”[xx]

§  “Side-effects nearly always occur within a couple of weeks of a person being vaccinated,” says John Grabenstein, director of scientific communication for the Immunization Action Coalition. He adds that the longest time before a side effect appeared for any type of shot has been six weeks. “The concerns that something will spring up later with the COVID-19 vaccines are not impossible, but based on what we know, they aren’t likely,” adds Miles Braun, adjunct professor of medicine at the Georgetown University School of Medicine and the former director of the division of epidemiology at the U.S. Food and Drug Administration.[xxi] 

§  “A key reason for this limited window of side effects is the short time all vaccines stay in the body, says Onyema Ogbuagu, an infectious diseases specialist at Yale Medicine … Unlike medicines that people take every day or week, vaccines are generally administered once or a handful of times over a lifetime.”[xxii]

§  “The mRNA never enters the nucleus of the cell, which is where DNA lives, so it does not affect a person’s DNA.”[xxiii]

·       The fact that the vaccines are “provisionally approved” has increased hesitancy among a small percentage of adults.

o   However, the U.S. Food and Drug Administration is widely expected to grant full approval this fall, faster than the time line for full approval for other medications.

·       It is about personal choice and freedom.

o   Yes, it is, in most instances.

  •       Our society must, necessarily, balance personal freedom with protection; we elect representatives to legislate the rules by which personal choice and freedoms might be curtailed, subject to Constitutional protections. For example, the right to drive a car is not absolute - there are many regulations that require we drive in a manner that makes it safer for ourselves and for others.

  •       It is also about a responsibility to take charge of one’s own health future, as well as a responsibility to the communities in which we work and live.

o   There is no federal law that mandates vaccines for all citizens. However, states and employers[xxiv] generally have the right to require vaccination.

§  The courts have upheld vaccination requirements in the past (such as the many K-12 school districts that require vaccinations, or even vaccinations required of all citizens in a municipality[xxv]), and most recently have also upheld Indiana University’s requirement for its students to be vaccinated.

o   Hopefully we will not see massive shutdowns of businesses. Yet, some businesses will suffer, particularly in areas with low vaccination rates (where the Delta variant is likely to cause higher rates of transmission). While not as severe as 2020, we will likely see reduced economic activity, and the loss of some jobs, due to the Delta variant’s impact. We can lessen this impact by each of us carefully considering the issue of vaccination.

o   Any society, to thrive, also requires individuals to think about people other than themselves. The problem with the “personal choice” argument – taken to an extreme – is that “this is an infection where it’s not only about you. If you don’t get vaccinated, it’s not only you who takes the risk. You risk a lot of people around you, including people you like and love.

 

THE DELTA VARIANT IS CAUSING A FOURTH WAVE OF INFECTIONS. We are all more than tired of COVID-19 and the restrictions our society has endured over the past year-and-a-half. Yet, the troubling “fourth wave” has arrived in the form of the Delta variant. The daily count of new cases of infection, here in the United States, has risen from an estimated 80,000 cases per day (the “confirmed number” was only 11,000 or so) in mid-June, to about 235,000 (reported number is, again, lower) on June 23, 2021.[xxvi] Projections from the IMHE indicate that the number of daily new infections will likely rise to 300,000 by mid-August, and that such number will likely continue through the fall of 2021.[xxvii]

 

DAILY DEATH TOLLS ARE INCREASING. The IMHE estimates that the daily death toll in the United States will return to over 700 a day by the beginning of September.[xxviii]

 

STRATEGIES TO MITIGATE THIS FOURTH WAVE. The IMHE states: “We believe there are two main strategies to respondto the Delta surge that each state should consider.

 

[REDUCE VACCINE HESITANCY.] First, every effort should be taken toM reduce vaccine hesitancy and increase the coverage of mRNA vaccination. This likely should include targeting communities where vaccine hesitancy is high for messaging, outreach, and enhanced access.

 

[WEAR MASKS – EVEN IF VACCINATED.] Second, based on the evidence from around the world, we estimate that mRNA vaccines are 81%–83% effective in preventing Delta variant infection. Johnson & Johnson may prevent only 64% of Delta variant infections. Vaccinated individuals may be playing an important role in transmission. Mask mandates for the unvaccinated and vaccinated should be considered in communities with rapid increases in transmission.”[xxix]

 

THE COST-BENEFIT ANALYSIS. In this chart I present a discussion of the issues – with answers discerned from sources judged to be reliable – that I hope will inform your decision.

 

ISSUE

IF YOU ARE UNVACCINATED

IF YOU ARE FULLY VACCINATED

The likelihood of catching COVID-19

Says Carlos del Rio, an infectious-diseases doctor and executive associate dean of Emory University School of Medicine in Atlanta: “If you’re not vaccinated, you are really in trouble because it’s likely you will get infected.”[xxx]

 

Some unvaccinated people have caught COVID-19 for a second and third time. “[P]eople who go unvaccinated after catching COVID-19 are more at risk of catching it again. The reasons are the length of natural immunity from the infection is believed to only last a short time, and different variants circulating increase the risk.”[xxxi]

 

Some media have reported statements by political leaders and even physicians that everyone who is not vaccinated will eventually catch COVID-19, at least once. While the risk of catching COVID-19 for the unvaccinated is always extremely high (and ongoing), I could not find any medical evidence that suggests that catching COVID-19 is an absolute certainty for the unvaccinated.

As “of July 12, out of 159 million fully vaccinated people, the CDC documented 5,492 cases of fully vaccinated people who were hospitalized or died from COVID-19, and 75% of them were over age 65.”[xxxii]

 

For the Delta variant, the “[d]ata so far suggests efficacy rates of more than 67 percent for the J&J vaccine, 72 to 95 percent for the Moderna vaccine, and 64 to 96 percent for the Pfizer-BioNTech vaccine.”[xxxiii]

 

“Even in those with good immunity, vaccine protection is likely to wane over time, though researchers aren’t sure yet of the speed at which that occurs.”[xxxiv]

 

“On Thursday, the CDC presented data to its panel of vaccine advisers indicating that immunocompromised people comprise about 2.7% of adults in the US.

When immunocompromised people are infected with coronavirus, the data showed they are more likely to get severely ill. If they are vaccinated, the data showed they are more likely to have breakthrough infections. A study in the US found 44% of hospitalized breakthrough cases were immunocompromised people, while a study in Israel found a rate of 40%.

’Emerging data show there is an enhanced antibody response after an additional dose of mRNA COVID-19 vaccine in some immunocompromised people … While early data show some potential benefit to administering an additional dose, more evidence is needed to determine safety and effectiveness in immunocompromised people.’ ‘[xxxv]

The likelihood of death from COVID-19, in the United States

While the official number of confirmed deaths in the United States due to COVID-19 has risen to 610,000, evidence exists that the actual number could be 1,000,000 or more. Out of an estimated 330,000,000 Americans, that means that the risk of death, overall, is likely at least 1 in 300.

 

However, as noted below, the risk of death from COVID-19 does vary by age and underlying medical conditions.

 

After the receipt of a vaccination against COVID-19, the risk of death among those vaccinated is extremely low.

 

While vaccinations are highly effective at preventing death and serious illness, even for the Delta variant, the protection is not 100% absolute.

 

Moreover, the effectiveness of a vaccination may wane over time. By Fall 2021 it is expected that those at greater risk (over age 65, or with underlying health conditions) may be recommended to receive booster shots.

The likelihood of “severe illness” from the Delta variant of COVID-19, generally

“[U]nvaccinated people account for virtually all recent COVID-19 hospitalizations and deaths in the U.S.”[xxxvi]

 

“Unvaccinated individuals account for virtually all — 97 percent — of the COVID hospitalizations and deaths in the U.S., health officials said in a July 22 news briefing.”[xxxvii]

 

Other variants have triggered more traditional COVID-19 symptoms that resemble the flu, such as the loss of smell, fever, shortness of breath, or persistent cough. However, the Delta variant appears to present more like the common cold, causing upper respiratory symptoms such as a sore throat or runny nose.[xxxviii]

 

“Serious illness” is typically defined to be when hospitalization occurs. And for many this means confinement to the Intensive Care Units, a horrible array of symptoms, and at times intubation (which is very, very uncomfortable, and not something you ever want to endure).

“Real-world studies in Israel, the U.K., and the U.S. showed that mRNA COVID-19 vaccines are over 96% effective in preventing hospitalization and death, and about 90% effective against infection in real-life conditions.”[xxxix]

 

“Current data indicate most COVID vaccines authorized for use offer protection against severe illness caused by the most common variants, with some inoculations—in particular the so-called mRNA vaccines made by Moderna Inc., and Pfizer Inc. and its partner BioNTech SE—providing a stronger defense than others. Research suggests that achieving maximum immune protection requires receiving a full course of vaccine—usually two shots spread across intervals that vary from 2 to 12 weeks apart, depending on the product. And it takes time for the vaccine to take its full intended effect—about two weeks from the last dose, though the protection from some vaccines may build steadily over some months.”[xl]

The greater risks posed to those who are older or possess health conditions

“[T]he likelihood of dying of COVID-19 varies greatly between individuals, depending on factors such as age or underlying health conditions … death increases with age. Adults aged between 30 and 39 years old are already four times more likely to die than people aged 18 to 29 years old. The likelihood of dying increases up to 600 times for those aged 85 and older.”[xli]

 

“Certain medical conditions, such as heart and respiratory conditions, weakened immune system, cancer, diabetes, or obesity can increase a person’s likelihood of dying from COVID-19, regardless of their age. Pregnant people are also more likely to get severely ill ….”[xlii]

“Some individuals may not mount a robust response to the vaccine, meaning they fail to generate sufficient levels of virus-blocking antibodies and the T cells that hunt down and kill virus-infected cells. Of special concern are older people and those who are immunocompromised, meaning they have a weakened immune system because, for example, they have a disease that affects it such as AIDS or are taking immunosuppressive drugs after a transplant or to treat cancer.”[xliii]

 

NOTE: Booster shots may become available in the fall of 2021.

The likelihood of death from COVID-19, in the United States, for younger persons

“ ’We do know that in our ICUs, we are seeing younger people intubated who are very sick or who are on the floors and are very sick,’ said Jeanne Marrazzo, professor of infectious diseases at the University of Alabama at Birmingham. ‘That should be a gigantic wake-up call.’ ”[xliv]

 

“Although children and young adults are less likely to die of COVID-19 compared to older age groups, there is no group that experiences the absence of risk.”[xlv]

 

“Children with COVID-19 can develop a condition called multisystem inflammatory syndrome (MIS-C). In MIS-C, inflammation can develop in any of several body parts, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs.”[xlvi]

It is extremely rare for younger persons (absent significant preexisting health conditions) to have received the vaccine and then catch COVID-19 and become so severely ill that they die.

 

“Israel, which by early 2021 had given more COVID vaccines per capita than anywhere else in the world, recorded almost 400 hospitalizations among fully vaccinated patients by late April. Of those, 234 suffered severe COVID and 90 cases were fatal. A careful review of almost half the hospitalized vaccinated people found their risk of developing a severe illness was magnified by pre-existing ailments, such as high blood pressure, diabetes, and heart failure, as well as medical conditions that weakened their immune systems.”[xlvii]

Risks of side effects from vaccination versus the risks of “long-term COVID”

While death and serious illness (including hospitalization) are risks of COVID-19, another risk is long-term adverse health consequences from those who catch COVID-19.

 

“It’s young adults who are seeing a little more of the long-haul COVID, which can interfere with your quality of life massively.”[xlviii]

 

“Growing evidence indicates that long COVID causes considerable loss in quality of life and is a serious health concern. An international survey published in July 2021 in the scientific journal The Lancet found that 22% of the 3,762 recovered COVID-19 patients involved in the study reported to be unable to work seven months later, and 45% of them required a reduced work schedule.”[xlix]

 

“Among the most common were complications affecting the kidneys and respiratory system; neurological and cardiovascular problems were also reported.  These complications occurred across age groups, including in young and previously healthy individuals.”[l]

An increasing number of studies find that greater than one fourth of patients have developed some form of long COVID. (In one study from China, three quarters of patients had at least one ongoing symptom six months after hospital discharge, and in another report more than half of infected health care workers had symptoms seven to eight months later.) Initial indications suggest that the likelihood of developing persistent symptoms may not be related to the severity of the initial illness; it is even conceivable that infections that were initially asymptomatic could later cause persistent problems. For some, symptoms have now continued for many months with no apparent end in sight, with many survivors fearing that they will simply have to adjust to a “new normal.” More and more sufferers have not been able to return to work, even months after their initial illness. While the number of patients with persistent illness remains undetermined this early in the pandemic, estimates suggest that millions of Americans may enter the ranks of the permanently disabled.

A recent analysis published in JAMA Network Open highlights just how common new or persisting symptoms are in people recovering from COVID-19.  Across 45 studies, more than 70 percent of COVID-19 patients, most of whom were hospitalized for the illness, reported a range of symptoms — 84 in total — months after their initial diagnosis. Shortness of breath, fatigue and sleep disorders were among the most commonly reported symptoms. Anxiety and depression were also up there. What’s more, previous research has found that long-haul symptom are common in people who had mild or asymptomatic cases of COVID-19.

A recent analysis published in JAMA Network Open highlights just how common new or persisting symptoms are in people recovering from COVID-19.  Across 45 studies, more than 70 percent of COVID-19 patients, most of whom were hospitalized for the illness, reported a range of symptoms — 84 in total — months after their initial diagnosis. Shortness of breath, fatigue and sleep disorders were among the most commonly reported symptoms. Anxiety and depression were also up there. What’s more, previous research has found that long-haul symptoms are common in people who had mild or asymptomatic cases of COVID-19.”

As noted previously, vaccinations are not 100% effective against catching COVID-19, but they remain highly effective, even against the Delta variant.

 

While vaccinations are highly effective in preventing serious illness and death from COVID-19, there are side effects. Younger persons, in particular, can suffer from flu-like symptoms for a day or two, especially after receiving the second dose. However, the risks of long-term COVID (discussed at left) far outweigh the risks of temporary symptoms from the vaccine.

 

“Over 339 million vaccine doses were given to 187 million people in the US as of July 19, 2021 … There are three deaths that appear to be linked to blood clots that occurred after people got the J&J vaccine. Since we now know how to correctly treat people who develop these blood clots, future deaths related to this very rare side effect can be prevented.”[li]

 

“Since April 2021, there have been more than a thousand reports of cases of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the lining outside the heart) happening after receiving the Pfizer-BioNTech or Moderna coronavirus vaccines in the United States, according to the U.S. Centers for Disease Control and Prevention (CDC). Considering the hundreds of millions of COVID-19 vaccine doses that have been administered, these reports are very rare. The problem occurs more often in adolescents (teens) and young adults, and in males. The myocarditis or pericarditis in most cases is mild and resolves quickly.”[lii]

 

“There have been 100 reports of Guillain-Barré syndrome out of the 12.8 million people who have been vaccinated with the one-dose Johnson & Johnson vaccine. Most of the cases occurred in men over the age of 50 around 2 weeks after being vaccinated. Most people who develop Guillain-Barré syndrome recover successfully after being treated in the hospital … People who have a history of Guillain-Barré syndrome and want to receive a COVID-19 vaccine should talk with their doctor, as there are two other vaccines — Pfizer and Moderna — to choose from.”[liii]

 

 (Risk of catching COVID-19 a second time

“’We know that the level of antibodies one gets from natural infection varies depending on the severity of their infection,’ said Mercedes Carnethon, an epidemiologist at Northwestern University Feinberg School of Medicine. On the other hand, ‘we get a more robust and consistent response from the vaccine.” That makes it a better bet “for immunity over a long period of time,’ she said.”[liv]

 

“It’s also unclear whether the antibodies you developed in response to a coronavirus infection will be able to recognize other variants of the virus.”[lv]

 

“Even if you’ve had COVID-19, getting those shots is well worth it. Scientists have found that even a single dose of vaccine gives the immune system of a COVID-19 survivor a big boost.”[lvi]

 

If you are immunocompromised, see discussion above.

Should the lack of 100% effectiveness of the vaccine deter you from becoming  vaccinated?

No.

 

“No vaccine is 100% effective, and COVID-19 vaccines aren’t an exception. However, this doesn’t mean we should reject them, just as we wouldn’t reject a parachute before jumping from an airplane just because they don’t open in 100% of the cases.”[lvii]

On the necessity to wear masks

While vaccination is the best and far most effective way to guard against COVID-19, masks (especially N-95 masks, properly worn) are the next best means to reduce the risk of transmission.

 

In recent days, the advice to wear masks has returned. From an article from UC Davis Health: “My advice is to continue masking. Even if you’re vaccinated, definitely avoid large indoor gatherings – begrudgingly, again – and mask in grocery stores, drug stores and other locations that don’t verify vaccination status,” said Tuznik. “Socially distanced outdoor activities should be fine, but if you might come into close contact, even briefly, with a stranger, then mask up just in case.”[lviii]

 

From the same article: “I’m fully vaccinated and I still wear a mask at the grocery store or even outdoors in a crowded situation like at the farmer’s market, because many unvaccinated people are choosing to go unmasked and I’m not comfortable with that,” Blumberg explained.[lix]

 

SOME PERSONAL OBSERVATIONS

 

The 2020-21 academic year was tough. Being older and at more risk of serious illness from COVID-19, I chose to teach exclusively online. While I undertook a great deal of preparation to better prepare my instructional techniques (having never taught online before), I was not entirely pleased with the results. Many students, especially freshmen, benefit greatly from the exchanges with professors and their peers that occur in the classroom.

 

Being fully vaccinated, myself, I look forward to returning to the classroom in August 2021. Yet, as the Delta variant continues to surge cases, I will take precautions. Wearing a mask. Washing my hands frequently. Trying to engage in social distancing (although such will be difficult in a classroom with 30-40 students).

 

It is my hope that, after viewing this article, any students who have not yet received vaccination will consult with their family physician, stop by a vaccination site and confer with a health care provider, or just go ahead and get either the Moderna or the Pfizer 2-dose vaccination shots.

 

It is further my hope that very, very few college students will have their studies interrupted from COVID-19, or even worse suffer from severe and/or long-term health effects from COVID-19 (or even die from same).

 

The college experience can be wonderful. It is a time of increased personal freedom. But with that freedom also comes many responsibilities – to one’s self, and to others.

 

The response to the pandemic requires each and every one of us to think critically, to examine all of the credible evidence, then make an informed and rational decision, and then act on that decision.

 



[i] Associate Professor of Finance, Western Kentucky University. Again, this article represents the personal views of the author, and are not necessarily those of WKU nor any other organization or firm with whom the author is associated.

[iv] Id.

[xi] Business Insider, https://www.businessinsider.com/delta-variant-long-covid-young-people-chris-whitty-2021-7

[xiv] David Brooks, appearing on PBS Newshour, July 23, 2021.

[xx] Meryl Davids Landau, “Vaccines are highly unlikely to cause side effects long after getting the shot,” National Geographic (July 22, 2021). https://www.nationalgeographic.com/science/article/vaccines-are-highly-unlikely-to-cause-side-effects-long-after-getting-the-shot-

[xxi] Id.

[xxii] Id.

[xxiv] “On June 12, 2021, a federal District Court in Texas in Bridges, et al v. Houston Methodist Hospital et al, Docket No. 4:21-cv-01774 (S.D. Tex. Jun 01, 2021) dismissed a case challenging a hospital’s mandatory COVID-19 vaccination policy for employees. This is the first court opinion addressing the ability of employers to require employees to be vaccinated against COVID-19 … The Order concludes with a strong endorsement of mandatory vaccine policies in employment, stating that Plaintiffs “can freely choose to accept or refuse a COVID-19 vaccine; however, if [they] refuse, [they] will simply need to work somewhere else…Every employment includes limits on the worker’s behavior in exchange for his remuneration. This is all part of the bargain.” https://www.natlawreview.com/article/federal-court-upholds-employer-s-covid-19-vaccine-mandate

[xxv] On February 20, 1905, the Supreme Court, by a 7-2 majority, said in Jacobson v. Massachusetts that the city of Cambridge, Massachusetts could fine residents who refused to receive smallpox injections. In 1901, a smallpox epidemic swept through the Northeast and Cambridge, and Massachusetts reacted by requiring all adults receive smallpox inoculations subject to a $5 fine. In 1902, Pastor Henning Jacobson, suggesting that he and his son both were injured by previous vaccines, refused to be vaccinated and to pay the fine. In state court, Jacobson argued the vaccine law violated the Massachusetts and federal constitutions. The state courts, including the Massachusetts Supreme Judicial Court, rejected his claims. Before the Supreme Court, Jacobson argued that, “compulsion to introduce disease into a healthy system is a violation of liberty.” On February 20, 1905, the Supreme Court rejected Jacobson’s arguments. Justice John Marshall Harlan wrote about the police power of states to regulate for the protection of public health: “The good and welfare of the Commonwealth, of which the legislature is primarily the judge, is the basis on which the police power rests in Massachusetts,” Harlan said  “upon the principle of self-defense, of paramount necessity, a community has the right to protect itself against an epidemic of disease which threatens the safety of its members.” https://constitutioncenter.org/blog/on-this-day-the-supreme-court-rules-on-vaccines-and-public-health

[xxvi] The Institute for Health Metrics and Evaluation (IHME) is an independent global health research center at the University of Washington, estimates as of July 22, 2021. For updated projections, please visit https://covid19.healthdata.org/united-states-of-america?view=cumulative-deaths&tab=trend.

[xxvii] Id.

[xxviii] Id.

[xxxiv] Jason Gale and Bloomberg, “This is why vaccinated people are still testing positive for COVID-19,” Fortune (July 22, 2021).

[xl] Jason Gale and Bloomberg, “This is why vaccinated people are still testing positive for COVID-19,” Fortune (July 22, 2021).

[xliii] Jason Gale and Bloomberg, “This is why vaccinated people are still testing positive for COVID-19,” Fortune (July 22, 2021).

[lix] Id.