As always, it’s the questions you don’t pose that always get the best answers. Wrapping up a Zoom conversation with Sansum CEO Kurt Ransohoff and Medical Director Marjorie Newman, I asked the obligatory last question — whether there was anything we hadn’t touched upon that I should know.
Ransohoff, a man whose grin and grimace have become increasingly interchangeable over the past 18 months of COVID hell, broached an issue that in less ominous times might seem like a highly arcane medical metric — the R-naught factor. It’s a measurement used to track how infectiously fast one disease moves compared to another. Or, in the case of COVID, how much faster the Delta variant moves compared to what Ransohoff referred to as “the ancestral strain,” meaning the one that was kicking our ass until the past two months.
Speed, in this case, really means bodies. Live ones at first, and dead ones eventually.
Ransohoff, it turns out, had just issued a public missive on the state of the state of COVID in which he highlighted that the Delta variant had an R-naught factor of 5 compared to an R-naught factor of 2 for the ancestral strain.
“I don’t think that people really get how big a difference that is,” Ransohoff said. “It’s so much bigger than the difference between 5 and 2 suggests.”
With that, Ransohoff started playing out the math. Imagine you’re on a populated desert island with no infection, he said, and then someone shows up carrying the virus. Under the R-naught 2 scenario, Patient X would infect two others; they in turn would infect two others, and they in turn would do the same. After three links in this daisy chain, 15 people would find themselves infected.
Now, if you substitute an R-naught factor of five, Patient X would infect five people, each of whom would then infect five others, and when they were through infecting another five each, that would bring the total to 156.
After three cycles.
That’s 156 infected people versus 15.
And that’s why the Delta variant has health professionals like Ransohoff and Newman spooked.
The big news is that the Food and Drug Administration (FDA) has just finalized approval for the Pfizer vaccine, meaning that employers can now legally require their employees to be vaccinated. For medical professionals, the state has taken any choice out of the administrators’ hands; those not vaccinated by September 30 will no longer be on the job. Whether that means they won’t have jobs anymore is an HR detail, Ransohoff said, that has yet to be worked out.
Nationwide, 30 million-40 million vaccine stragglers have reportedly been waiting for FDA finalization to get a quick jab in the arm. In Santa Barbara County, that number is in the ballpark of 40,000. According to Ransohoff, 99 percent of Sansum’s 200-plus doctors, nurse practitioners, and physician assistants have been vaccinated. (One high-profile medical specialist, however, has reportedly been refusing the vaccine, but Ransohoff declined to discuss specific cases. Anyone who has not been vaccinated, Ransohoff said, has been getting tested at least once a week.) Of the clinics’ 1,300 support workers, he said, all but 130 have been vaccinated. And 10 percent of them, he said, got vaccinated this Friday, suggesting that perhaps the hoped-for FDA effect is working.
Sansum, like medical facilities throughout the country, has experienced a wave of turnovers the likes of which it has never seen before. Workers get burned out, decide life is too short, can’t find child care, or all of the above. All this places serious stresses and strains on any system. All employers are affected. Ransohoff said he stopped off at a 7-Eleven in Goleta only to find the front door chained shut with a sign saying it was closed because of no staff. “We have had more turnover of staff than we’ve ever had before,” he said.
In the meantime, Ransohoff finds himself bewildered by the growing vehemence of vaccination opponents. “We regularly check people for tuberculosis,” he said. “We check every year. Nobody that I can recall ever said, ‘I am entitled for you to not know whether I have TB.’ I have never seen anything like this.”
This Tuesday, the county supervisors heard a loud and vehement earful from COVID vaccine resisters, some of whom likened the new mandates — be vaccinated or be tested — to the Third Reich and Nazi Germany. From the beginning, Ransohoff and Newman have been loading Sansum primary care doctors with data about the disease and its treatment so that they in turn can provide their patients with information. Along the way, they have found themselves fighting a constant rear guard action against arguments raised by the doubters and skeptics. What works? “Everybody’s different,” Ransohoff said. “Some people, all they need to hear is that you and your wife and daughters have all been vaccinated and they’re good,” he said. “Others, it doesn’t matter what you say.”
Have he or Newman ever heard any arguments from the skeptics that gave them pause?
Their answer was as emphatic as it was instantaneous.
According to statistics provided by Ransohoff, unvaccinated people in California are 68 times more likely to be hospitalized than vaccinated people and 58 times more likely to die. Breakthrough cases are happening with increasing frequency. The county supervisors heard this Tuesday that the number of vaccinated people hospitalized throughout Santa Barbara County was 12 percent. That was as of the end of July. This coming Tuesday, the supervisors will hear the number is significantly higher than that. The number 30 percent has been whispered but has not been confirmed. Whatever the actual number is, it remains unknown for the time being how many of these people suffered from comorbidities that made them especially susceptible. Ransohoff is acutely aware that skeptics have seized upon breakthrough cases to argue the vaccine doesn’t work. He cited an 80-year-old vaccinated patient who got infected but weathered the storm at home. “This was not a failure of the vaccine,” he said. “It was a success. It showed the vaccine worked. If he hadn’t been vaccinated, the chances of him winding up in serious trouble were infinitely greater.”
With the September 30 deadline fast approaching, Sansum is trying to figure out how to handle exemption applications — allowed by law — for medical or religious reasons. “Where do you draw the line between religion and ideology?” he wondered. “How are we supposed to determine this? All this is very nebulous in the law. And we still don’t know. I can tell, though, our intention is not to engage in any inquisition of our employees.”
Next Tuesday, the Board of Supervisors will be addressing the issue for the third week in a row. On the table is a proposed policy that will require all 4,300 county employees to be vaccinated or tested. Board chair, Supervisor Bob Nelson, announced this item would be the last matter the board would hear. Two hours have been scheduled. Based on the previous two hearings, that might be enough only for the opponents.
On a side note — perhaps a futile grasp for some sense of balance and perspective — it’s worth remembering how for the four years Donald Trump occupied the White House, 90 percent of all left-of-center diatribes against his regime included some angry allusion to Nazi Germany. My only point is that it always sounds unhinged and off-kilter, no matter who says it.
In the meantime, just remember Kurt Ransohoff’s warning about the R-naught factor — 5 is immeasurably bigger than 2. After three rolls of the dice, that’s 156 people as opposed to just 15.
Do the math yourself.
And see you Tuesday. Bring a spare catheter; it could take a while.