Author: Scott Childers

My name is Scott Childers; I’m a husband and father of two and an internal medicine physician in the division of Hospital Medicine at the University of Michigan. I also happen to be a lifelong Michigan fan and season ticket holder for both basketball and football. I am writing this letter to urge the University of Michigan and the University of Michigan Athletic Department to move forward with mandating vaccinated status for attendance at all University of Michigan athletic events; including football games at Michigan Stadium this fall. Allow me to also state that I am not an epidemiologist, and most importantly, the opinions expressed here represent mine alone.

I’ve been living the reality of caring for COVID19 patients admitted to the hospital for these past 18 months. Also, like all Michigan fans I watched a broken and disjointed season in 2020 that saw a for all-intents-and-purposes empty Michigan Stadium. I’ve witnessed completely full intensive care units, moderate care units, and general wards lead to wholesale restructuring to try to accommodate the incredible rise in cases. I’ve participated in emergency contingency planning for the use of off-site field hospitals to help with the surge that filled and overwhelmed our hospitals last year. With the advent of highly efficacious and safe vaccines this past winter I have also seen a wholesale shift in the census of COVID19 patients in the inpatient setting, and shared in the hope that the end was nearly on the horizon. Yet,18 months in here we are, now in the middle of our 4th wave of cases. Football season approaches with the promise of in-person attendance returning, and while I cannot wait at the same time I am incredibly concerned. Why is it that the Delta variant is of such concern? Why should the University of Michigan, already mandating vaccines for its Faculty/Staff/Students at all campuses, take the next logical step and mandate proof of vaccinated status for attendance at University of Michigan athletic events?

First, let’s cover what is the “Delta variant” and why is it important? Delta is a variant/mutation of SARS-CoV-2 that has been identified as a “variant of concern” by the SARS-CoV-2 Interagency Group. A variant of concern is “[a] variant for which there is evidence of an increase in transmissibility, more severe disease (e.g., increased hospitalizations or deaths), significant reduction in neutralization by antibodies generated during previous infection or vaccination, reduced effectiveness of treatments or vaccines, or diagnostic detection failures.” Its significance is that in unvaccinated as well as immunosuppressed populations who demonstrated an attenuated response to initial vaccine doses, we are seeing a marked jump in case rate once again. The CDC tracks 7-day moving averages of cases and there has been a 14% increase in the most recent 7-day moving average of daily new cases (133,056) compared to the prior 7-day moving average (116,740). The current case number of 133,056 for this period is 93.9% higher than the peak observed on July 20, 2020 (68,636). “Nationally, the combined proportion of cases attributed to Delta is estimated to increase to 98.8%”. Essentially, the massive influx of new cases at this time are entirely secondary to infections caused by this Delta variant of the virus.

Why are we seeing this significant jump? Hospital admissions for confirmed COVID-19 infections are currently at their highest levels since the start of the pandemic in Alabama, Florida, Louisiana, Mississippi, Oregon, and Washington. Many factors have played a role; from rolling back of mask/social distancing mandates in many communities, to highly variable vaccination rates, as well as the significantly higher transmissibility of the delta variant. In reading about the pandemic you will very likely come across a term “R-naught” that is best thought of as a gauge for how infections or transmissible a virus is. R naught represents on average the total number of people a single infected person can spread the disease to. The higher the R-naught, the more people a single person can pass the infection to. Currently for Delta this reproductive rate sits at approximately 6, meaning that each infected person will spread the infection to six other people on average. This is a dramatic increase compared to an estimated R-naught of 2-3 for Covid-19 prior to the delta variant. An R naught that is anything greater than 1 means that the infection is growing, or worsening, within a population. It is also crucially important to remember that R-naught is not a fixed number, and there are measures that can be taken to help reduce it.

One of my University of Michigan colleagues, Dr. Preeti Malani, recently published an outstanding paper in the Journal of the American Medical Association (JAMA) that provides a thorough and frank summary of where we stand at this point in the pandemic, the role of the Delta variant, and the importance of continued vaccination and vaccine mandates: “With an R0 of 6, it will be extremely difficult to slow the spread of the Delta variant because the herd immunity threshold (ie, the proportion of persons who would need to be fully vaccinated, infected, or both, to interrupt endemic transmission) would need to be greater than 85%.” The authors note that even in countries like Iceland, where more than 90% of people 16 and older are vaccinated, case rates have increased secondary to the Delta variant. However, even more importantly, despite the increase in the number of cases, the number of Covid-19 related deaths and serious illnesses has NOT increased in Iceland. The authors note that “These data suggest that even if herd immunity is not achieved for COVID-19 (given the Delta variant), high levels of vaccination will help prevent hospitalizations and deaths as SARS-CoV-2 moves toward endemicity.”

So where do we stand in terms of vaccinations in this country, and more locally, in Washtenaw County? “As of August 16, 2021, the US Centers for Disease Control and Prevention (CDC) estimates that 168.7 million people have been fully vaccinated in the US, which represents 50.8% of the population and 59.4% of the vaccine-eligible population.” The Washtenaw County dashboard tracks vaccine rate as well and as of 8/17/21, 57.7% of residents of all ages (who are eligible) are fully vaccinated. The state of Michigan’s tracking site currently reports that 55.1% of eligible individuals are fully vaccinated in the state, and 65% of eligible individuals (16 years of age and older) have received at least 1 dose of the vaccine. Surrounding counties Wayne (61.6% fully vaccinated) and Oakland (65.3%) both have slightly higher portions of their population fully vaccinated at this time. Unfortunately, these numbers are nowhere near where we need to be in order to ultimately slow the rate of spread of the virus, we need to continue to improve these percentages and do so dramatically. How then can we can increase our vaccination rates?

Today, Monday, August 23rd, the FDA granted full approval to Pfizer’s COVID19 vaccine following a clinical trial of over 44,000 patients. “As the first FDA-approved covid-19 vaccine, the public can be very confident that this vaccine meets the high standards for safety, effectiveness and manufacturing quality the FDA requires of an approved product.” The way forward to end the pandemic is abundantly clear: increased vaccinated rates across the board. This approval, in my opinion, represents a significant step for further mandates to be put in place to help increase the number of vaccinated individuals. Dr. Malani et al, note in their paper that “courts have, so far, upheld institutional vaccine mandates and to date more than 700 colleges and universities have adopted COVID-19 vaccine requirements.” Multiple universities including Tulane, Oregon, and Oregon State have adopted vaccine mandates for attendance at football games on their respective campuses this fall, additionally the Las Vegas Raiders have mandated vaccinated status for attendance this season. Vaccine mandates are not new, they have existed for healthcare workers, military, and school-age children in all 50 states prior to this pandemic. With the Pfizer vaccine now fully improved, I anticipate the number of organizations that make vaccines mandatory will dramatically increase.

With case numbers steadily rising (including alarming increases in pediatric cases as schools return), and hospital capacities shrinking at an alarming rate, I implore all of us to take the necessary steps to help reduce the spread of this virus: get vaccinated! Not only are you protecting yourself, but you are simultaneously protecting others in your community as well, many of whom may not yet have the option of a vaccine at this time or are immunocompromised. We should also continue to take appropriate precautions such as masking and social distancing as there are still significant portions of our eligible population who remain unprotected, and of course this does not include children who at this point are still not eligible for the vaccine outside of clinical trials. It is important to remember that a football game does not occur in a vacuum, on 7 or 8 wondrous football Saturdays each fall, 110,000 or more congregate in Michigan Stadium from all over, and after the action on the gridiron is over, they return to families and friends. A vaccine mandate

The University of Michigan has already mandated that all of its faculty, staff, and students show proof of vaccinated status on each of its campuses. I applauded this decision when it was announced and appreciate the direct and indirect impact on public health that policies like this can have in the surrounding community. I now urge U of M to take the next logical step in the face of overwhelming data demonstrating steadily worsening case rates alongside continued proof of efficacy of available vaccines: mandate vaccinated status for attendance at all U of M athletic events. This is an opportunity to have a meaningful impact on our surrounding community while truly embodying a “Leaders and Best” mentality and making the Big House the home of “the largest crowd watching a football game anywhere in America today” safely! The infrastructure for uploading proof of vaccinated status is already in place at U of M with the ResponsiBLUE application that I use on a daily basis to pre-screen before arriving at the hospital. Incorporating a system at the gates of Michigan Stadium where first pass requires proof of vaccinated status and then second pass scans your ticket (physical or digital) should not require wholesale changes to our current entry process. Any of you who have been to a game know that security already pre-screens you before you arrive where your ticket is scanned. We have the ability to do this, both for ourselves and for others who have not yet had the opportunity to be protected by a vaccine to date. I truly believe that U of M can do this safely and set an example for others to follow, and I earnestly hope that U of M seizes the opportunity.

Be safe, and of course: Go Blue!