“Mutantism on the March” :Chapter 72 “More Trouble in Quebec”

Spiritaki Jiber and his self exiled group of scallywags were wiping the sweat off their brows after their narrow escape from Zortixia. They had vacated the Zortixian atmosphere at such great velocity it was a wonder the navigator had held the ship together.

Their destination was Earth where they were hoping to join forces with Eno Ergot and launch an epic battle campaign that would result in the subjugation of the entire galaxy. Jiber thought Ergot was an idiot and that he could easily manipulate him and his crew. Jiber had always thought most Zortixians were imbeciles. They had savoured a wholesome and beneficial power rather than riches and luxury. The Jiber would rather horde gold bullion than rule fools because from wealth power was generated. Jiber’s father near the end of his rule was savouring philosophy rather than greed and when you followed that path a population was bound to become rebellious.

Jiber had scant knowledge of Earth. He planned to join forces with Eno Ergot and swindle Earthlings into believing they were embarking in a great Crusade. These Earthlings, primitive and aggressive as he had heard, would make a great conquering army and the first planet to fall under the flag of The Opposite would be Zortixia. All he had to do was promise them something grand and they would come flocking to his cause. Or perhaps he could cause discontent, seize power in some state and enslave enough people to create his army. Lacking soldiers he would be forced to rely on Earthlings.

Few Zortixians had ever visited Earth and no one had been interested until recently after Montenez had returned for a visit. All voyages to Earth were forbidden without the highest approvals. There was fear that Earthlings were so backward that unscrupulous Zortixians were afraid they could be very easily manipulated through superior Zortixian technology and intellect. Earthlings were always on the verge of war and if any side were given the advantage of advanced Zortixian weaponry the consequences would be grave.

They touched own in the black of night in some deserted area full of odd-looking buildings. Many of them sported different flags. A survey party scouted the area finding they were on an island with a vast metropolis across a river. The river that swirled around the island had a foul odour. The survey party reported several signs with a message “WELCOME TO EXPO 67”. The crew bedded down for the night.

RKS Wine: Smoke and Gamble’s Appassimento: My Grandmother Would be Mortified!

My late mother used to sing part of a song of which I do not know the name of but she did say she learnt it from my grandmother. The refrain was “lips that touch liquor will never touch mine”. Yes my grandmother was in the Temperance movement in Ontario. Grandmother would be mortified by not only wine but the other sins of smoking and gambling. The question is what decadence does this wine bring to the glass? Is it sinfully delicious? Nanny R was also a member of the Ontario Censor Board for films. God help a film that dared showed a breast!

It is garnet in colour. On the nose very dense and rich with black cherry, cassis, blackberry and blueberries. A vague resemblance to Late Bottled Vintage Port but this wine is higher toned. On the palate moderate tannins and very a long decadent finish. The fruit seems distant and builds like a tidal wave more than a tsunami. Full of blueberry, cherry pie, marshmallows, vanilla and a hint of milk chocolate. Consider this as a high-quality Cabernet Sauvignon and Cabernet Franc on steroids. Hand me a pack of cards and a pack of smokes but first I should say this wine might be good for sipping for a glass but I think it really deserves the very best cut of beef or ox and you’ll have hit gold at the craps table not at a somewhat second-rate casino in Ontario but more of a Bellagio casino in the sin city of Las Vegas.

A kiln used for drying grapes at Smoke & Gamble

Now the price? A bit high at $49.95? Well, the quality is extremely high so why not splurge. You’d pay the same price for a bottle of entry level Champagne so why not transfer that thought of bubbly luxury to a bottle of this Smoke & Gamble wine?

Appassimento is an old Italian tradition of drying grapes naturally until they are shrivelled leaving a concentrated juice as compared to “regular wine” made with ripe grapes with more liquid juice so you are getting a concentrated and more intense wine with the appassimento method. And it results in a more expensive product as water in the wine is reduced. In this case the grapes are placed on a tray and placed in a kiln. A kiln you say? Well a kiln can be an entire building or a smaller shipping like container like structure. Kilns were used for tobacco drying years ago when Ontario was a big tobacco producer. The idea is that air circulation is constant created by fans that dries the grapes. Might I say you are drinking an Ontario Amarone?

spreading out grapes on tray for insertion into the kiln

By the way my grandmother might have been a stern old bird but she taught me to be a very mean Scrabble player that could rack up over 300 points in every game. And as to the sins of gambling, smoking and alcohol I respect her beliefs and I even agree with her about smoking and gambling but a life without wine is like doing San Quentin time.

A blend of Cabernet Sauvignon and Cabernet Franc with all ageing finished in French and American oak for close to five years.

(Smoke & Gamble 2015 VQA Appassimento, Dover Wines and Spirits, Norfolk, Ontario, $49.95, LCBO # 19933, 16.5%, 750 mL, Robert K. Stephen A Little Birdie Told Me So Rating 94/100).

The Unvaccinated: A new social class of lepers?

Should I Ask My Friends If They Are Vaccinated?

COVID-19 vaccine etiquette and considerations for all the people in your life.

BY KERI ALTHOFF AND ELIZABETH STUART | JUNE 21, 2021

If you’re fully vaccinated, almost all interactions are quite low risk for you. But you might still want to know about others’ vaccination status to help think through how to make activities as low risk as possible for everyone.

This is particularly true if you interact regularly with high-risk individuals or people who haven’t been vaccinated yet, such as children under 12 years old.

You can get practice and gain comfort in asking friends about their vaccination status before interacting closely with them. Below are a few specific examples of navigating some tricky scenarios.

If you learn that someone isn’t vaccinated, when appropriate—with close friends and family, for example—consider asking them why not and see if you can help address their concerns. (See How Can I Talk to My Friends and Family About Vaccines)

Let us know what questions you’re hearing: publichealthquestion@jhu.edu

SCENARIO: I am fully vaccinated. How can I ask my friends if they are also vaccinated before we hang out? Should it change our plans if someone is not?

Absolutely! If you are hanging out with fully vaccinated friends, you can enjoy each other’s company without masks and social distancing.

If there are unvaccinated friends in the mix, you may wish to enjoy your gathering outside or in spaces where masking and social distancing is more comfortable. Asking your friends about their vaccination status is as simple as “I have been vaccinated for COVID-19. Have you?” If they don’t wish to answer, you should engage with the person as if they are unvaccinated.

SCENARIO: My dentist told me that she’s not going to get vaccinated. Should I find another provider?

It is perfectly appropriate to seek out service providers who you know are vaccinated.

SCENARIO: My friend told me that asking someone about their vaccination status is a HIPAA violation. Is that true?

It is not a violation of HIPAA to ask someone about their vaccination status. The Health Insurance Portability and Accountability Act (HIPAA) restricts doctors and insurance companies from disclosing information about their patients.

SCENARIO: My fiance and I are finally rescheduling our postponed wedding for later this summer. Is it ok to ask that guests who plan to attend get vaccinated beforehand so everyone can be safe? Should we require proof of some kind?

Encouraging guests to be vaccinated to attend your wedding is appropriate. You may even wish to gather information on an individual’s vaccination status on the RSVP card.

But people may be dishonest about their vaccination status, proof may be difficult for vaccinated people to provide, and there may be people who are vaccinated but still practice masking and social distancing as extra layers of protection for themselves (particularly if they are immune compromised) or others in their household. You might want to also consider how or whether knowing that information would or would not change your plans.

Unless you have a small gathering and you are confident everyone is vaccinated, remind your guests of the CDC guidance for unvaccinated people and provide masks and space for guests to socially distance themselves.

SCENARIO: I’m newly back into the dating scene and eager to meet people. How can I ask them about their vaccination status before we hang out?

Communication is key to relationships. Asking about vaccination status can help build communication and is important for understanding how to follow CDC guidelines.

Read more about Dating in the Time of COVID-19

SCENARIO: My 12- and 14-year-old kids are newly fully vaccinated and want to hang out with their friends, but there are some kids under 12 who haven’t been vaccinated and others whose status we don’t know. How can we keep everyone safe?

A general rule is that if you’re going to be gathering with people from multiple households who aren’t vaccinated—or if you don’t know everyone’s vaccination status—look for lower-risk activities:

Stay outdoors
Keep masks on while indoors
Keep the group small

When considering gatherings, keep in mind local COVID-19 spread and protection in your community. The number of cases per 100,000 population and the proportion of people vaccinated can help guide your decision-making. If COVID-19 rates are high and the gathering is large and among people whose vaccination status is largely unknown, or if there are going to be lots of children, consider more safety measures or even postponing the event for a later time.

This guidance could also apply to families who each have children older than 12 and children younger than 12 under the same roof who want to socialize with other families.

Keri Althoff, PhD ’08, MPH ’05, is an associate professor in Epidemiology with a joint appointment at the School of Medicine. She is the Provost’s Fellow for Research Communication at Johns Hopkins.

Elizabeth Stuart, PhD, AM, is the associate dean for Education at the Bloomberg School and a professor in Mental Health, Biostatistics, and Health Policy and Management. She was recently appointed as a Bloomberg Professor of American Health.

Canada announces more sanctions on Belarus

Canada imposes additional sanctions on Belarusian individuals and entities over attacks on human rights and fundamental freedoms

From: Global Affairs Canada

News release

June 21, 2021 – Ottawa, Ontario – Global Affairs Canada

The Honourable Marc Garneau, Minister of Foreign Affairs, today announced new sanctions against 17 individuals and 5 entities under the Special Economic Measures Act (SEMA) in response to gross and systematic violations of human rights occurring in Belarus. These measures are being taken in coordination with the United States, the United Kingdom and the European Union.

On May 23, 2021, the Belarusian regime yet again demonstrated its clear disdain for fundamental human rights—and media freedom in particular. On the pretext of a dubious and still unverified bomb threat, the Belarusian regime diverted Ryanair Flight 4978 from its planned course in order to land in Minsk. Upon landing, Belarusian journalist, Roman Protasevich, and his companion, Sofia Sapega, were detained by Belarusian authorities.

In addition to being a flagrant attack on freedom of expression, this reckless, brazen act by the Belarusian regime jeopardized the safety of the flight’s other passengers and constitutes serious interference in the fundamental principles and international rules that ensure civil aviation safety around the world.

Once again, side by side with the United States, the United Kingdom and the European Union, Canada is maintaining pressure on the Belarusian regime to end its repeated assault on the human rights and dignity of the Belarusian people.

“Tove”: Finnish Entry for Best International Feature Film at the 93rd Academy Awards”

“Tove” is Finnish gem. Impeccable as to acting, writing, cinematography and direction. As a reviewer of films, I have little interest in the big Hollywood “blockbusters” although I will admit “Sound of Metal” which received a few Oscar nominations was a welcome break from the Hollywood blockbusters one sees 70% of Air Canada passengers watching on a flight to and back from Europe. That was years ago when I was last in Europe where just about everyone was watching “Black Panther” while I was listening to Electro Trance. And I had the East Indian special meal while for most it was chicken or pasta and knowing Air Canada they run out of the standard choices so you end up with pasta. So my tastes may differ from the mainstream.

It is during the end of the Second World War in Helsinki that painter Tove Jansson struggles as a painter to make a living. Her art on canvass does not capture the Finnish audience. She is the daughter of a famous Finnish sculptor who urges Tove to continue painting but Tove isn’t selling oil on canvas very well. But as a sideline to keep her relaxed she has created a comic series of drawings-based on creating characters called Moomins that live in a fantasy world. To put her work into context she is ahead of H.R Crumb “Felix the Cat” by decades although her cartoons are much more wholesome. But they are innovative and unique. She is asked by Vivica Bandler, daughter of the mayor of Helsinki and a theatre director, to make invitations for her father’s birthday party. She then is asked to create a mural at City Hall. And her distraction now becomes her career which takes off after she writes a play on the Moomin world, directed by Vivica, which is a smashing success and leads to a daily comic strip in a leading London newspaper.

Tove’s Moomin sidelines her desire to be a painter and the fantasy world she has created strikes a chord with the world so a painter is converted into a comic strip artist. She is exposed to the comic strip world by her lover a married Parliamentarian Socialist and newspaper owner Wirtanen. And her cartoon fantasy world takes Finland and Europe by storm. This includes a passionate lesbian relationship with Vivica Bandler.

Vivica is a bit of a promiscuous lesbian with a long string of lovers. There is no permanent connection with her and Tove eventually settles down with a Finnish lesbian until her death in 2001.

A story of an artist with a love of painting overshadowed by her comic strip, plays and novels based on the Moomin world. One is not certain if Tove has accepted her fame without reservation.

Tove settled into a lesbian relationship until her death in 2001. I see her as a combination of H&R Crumb “Felix the Cat” and J.K. Rowling “Harry Potter”.

Was there some horrific struggle consuming Tove as a painter vs. a cartoonist? I do not think that is the case but there is her strong desire to be recognized as a painter which is not accepted by her sculptor father nor the authorities awarding grants to artists. She is hurt by the lack of recognition as a painter but well rewarded as a cartoonist.

The film starts either virtually or in theatre July 2 in the Inside Out Festival (Toronto)/Cinema du Musée (Montreal)/ViIFF Connect (Vancouver)/Carbon Arc (Halifax). As of August 10^th it can be rented on Vimeo.

Note the title of the picture she is painting at the end of the film!

The film is based on Tove Jansson’s life. With English subtitles.

You can catch the trailer here. https://vimeo.com/ondemand/tove2/518184800

The film seems promoted subtlety as an LGBTQ film. I can agree with that but the life of Tove is so fascinating the LGBTQ angle is subsumed.

The film is directed by Zaida Bergoth. Alma Pöysti as Tove deserves an Academy Award for her riveting performance. Krista Kosonen as Vivica also deserves an Academy Award for best supporting actress.

“Mutantism on the March” :Chapter 71 “Is Eno Ergot a Mutant?”

At Le Havre the SS Zorollia was granted with the same curiosity and fanfare that it had received in New York City. To the relief of Ergot and his crew the French customs authorities did nothing but stamp the crew’s passports and did not bother to search the ship. After the first day of the “museum exhibits” Eno wandered into town looking for some inspiration. He stepped into a co-operative café operated by a group called L’Ordre des Mutantes Francais”. He found a deserted booth and ordered a Pernod from a midget waiter. He noticed the clientele to be a different lot with many of them walking on crutches missing limbs or rocking back and forth uttering strange phrases. The last time he had observed so many strange looking people was the night he and his crew had organized a charity ball of the United Mutations in New York. Now they were staring at him, the only “normal looking” person in the establishment. Probably he thought as he was wearing a garish pirate outfit he was simply another mutant. But there was one fellow who continued his staring at Eno and he introduced himself as Jean-Paul Tarty an eminent French philosopher. Tarty bowed and introduced himself to Eno. Eno sensed this was an intelligent man who might be able to tell him where he could find Bluebeard. After Tarty and Eno finished their small talk about their favourite French wines Eno popped the question if Tarty knew the whereabouts of Bluebeard. The reply from Tarty was, “Monsieur Ergot you must be aware this pirate Bluebeard is but a myth or if he did exist he has been dead for many years. But then again you look like a mutant to me. He may exist for you so please excuse my forthrightness with you.”

Eno was a bit surprised about being called a mutant and although he did not understand what it meant he did not like the sound of it. Tarty had vast experience with French mutants and was accustomed with self-denial when it was first suggested to one such a person could be a mutant. There was no need to pressure Eno as one day he would realize the truth. He said to Eno, “My my. You should consider joining the mutant ranks. They will help you find Bluebeard even if he will exist only in your mind. You will find mutants to be a helpful and soulful group of people. They are only too willing to help those mutants who initially fail to recognize they are mutants. Mutants defy existence. They are the sole group in the human species that are responsible for their actions. They negate the established and entrenched way of existence. Therefore they are compelled to reflect upon their own existence. It is only mutants who view life as sacred and that is precisely why they are fighting for their rights. Others who have had these rights ignore them or take them for granted blind to the historical struggle that was waged to obtain these rights, no matter how limited they are. Mutants are fighting for those dreary middle carnivorous man eat man rights they say but that is a lie. They fight for the right to exist, the most basic and unadulterated right. This is the essence of their pureness. They are downtrodden and innocent and the basis for a new civilization. Through the international struggle of the mutants the decadent proletariat, long ago corrupted by their masters, can visualize this corruption and fight for the erection of a just and egalitarian society. In short the mutants are the best societal reflectors around. It’s like being able to see England from Calais on a clear day. If England did not exist then no one could see France just as England could not see France if there was no England. These mutants are pure and simple people yet exceedingly complex. I am sure that they can help you find your Bluebeard.”

Eno considered Tarty a spewer of ridiculous gibberish. Whomever these mutants were they sounded like a ridiculous conglomeration of idiots. Eno responded to Tarty,” listen here Tarty. I came here for a Pernod. Whomever these mutants are I really don’t give a flying fuck about them . I am on earth for adventure. We set sail for Montreal tomorrow and my ship has been converted to a floating restaurant and we are going to make a bundle in Montreal for their world fair called Expo 67. We pirates have never required any organization. We are the only free people and to hell with these sad sack mutants.” With these words Eno left the bar as Tarty mumbled about Kierkegaard and the foundations of Nordic arrogance.

“Mutantism on the March” :Chapter 70 “Boredom Sets In”

The crew was enjoying the racy and fast paced lifestyle but a few of them had succumbed to a strange disease called AIDS. Kind of like scurvy endured by Jacques Cartaway when he had landed in Montreal 400 years ago but boiling birch bark was not the cure? The crew were inter-stellar vagabonds and while the landlubber’s life had its attractions the open seas and adventure were compelling forces they had to reckon with. And besides Rauncho had been sending an endless stream of telegrams pleading with Ergot to return to Columbia. The good life had to end so a farewell banquet was held at the Grump Hotel just off of Columbus Circle where Eno announced it was time to lift anchor and head off. Two New York senators, the mayor of New York and assorted hangers on gathered to pay homage to the goal of international exchange. The puffed-up senator Snurder summarized the ambiance of the evening when he rose to make a toast, “Dear guests New York City is the finest in the world. It has been people like Eno Ergot and his crew that have helped to make it so, Ever since the SS Zorollia has docked he has done much to brighten up and enrich this great town. With the flame of international friendship, he has lit up the face of many a citizen with his warm hospitality and generous manner. We wish Eno the best of luck and fortune in the future and he will be always welcome back in our city with open arms. Our Mayor has informed me as a token of our gratitude all docking charges will be waived. Thank you Eno Ergot and your crew!”

These kind words brought cheers and restrained society ladies banged their shoes on their tables like Nikita Khrushchev yelling, “Bravo”. More toasts were proposed and the festivities lasted until dawn. At this point the totally inebriated crew glided out of the harbour accompanied by fireworks and hoopla that had not been seen since the last visit of the Queen Senilizabeth to the harbour. It was a smooth sail back to Columbia with the crew sucking back a few hundred pounds of Paraguay weed they had skimmed from the cargo and spent time happily fishing for tuna and swordfish.

Rauncho, somewhat distraught as he was behind his delivery schedule, sped up his delivery schedule of the Paraguayan weed to at least 12 more American ports where the SS Zorollia and its “museum” were lauded by politicians and the local populace.

Eno and his crew were becoming somewhat bored with their celebrity status whereas weren’t they to be seen as terrors of the sea and not darlings of haut society? Notoriety seemed to be overcome by respect. Would Bluebeard agree to the taming of the shrew? Eno and his crew were wealthy beyond belief. Eno was willing to make one last trip to France with a huge stash off Paraguayan hashish. This delivery would make all the crew multi-millionaires.

RKS Wine: Mastroberardino’s Irpina Aglianico 2018

Perhaps one of Campania’s best-known wineries what think I of their 2018 Aglianico?

On the nose I am transported to the Greater Naples area of Italy with black cherry, cherry liqueur, blackberry and smells from the Bay of Naples. The aromas are high toned as if they are floating about in a rocket beam to the nose. There is a bit of tar as well which is a characteristic of red wines grown in the volcanic soils of Mount Vesuvius. On the palate sweet red cherry, smoke all in an elegant and understated frame. May I dare to say somewhat of a dainty and aristocratic wine and where or where is a piping hot Neapolitan pizza to serve with this wine?

Vesuvius archeological site; Photo Robert K. Stephen

One of Mastroberardino’s Vesuvius Vineyards: Photo Robert K. Stephen

The best Campanian wines like Aglianico, Piedirosso and Lacrima di Christi have an ability to sucker punch you being so understated and smooth you can go through several glasses and the bottle is gone. Light and spacy and eminently drinkable suitable for so many dishes of Campania.

Aglianico arrived from Greece brought by the Phoenicians. Aglianico is a corruption of the Italian word for Hellenic “Ellinico”. The Greek influence in southern Italy is enormous. You’ll see “Greco” throughout Sicily and Campania. There are even remote villages in Sicily that speak an ancient Greek dialect!

The municipal train from Naples to Vesuvius: Full of hustlers and pickpockets: Photo Robert K. Stephen

Mastroberardino has several small vineyards in the Vesuvius archeological site.

(Mastroberardino Irpina Aglianico DOC 2018, Mastroberardino, Artipalda, Italy, $23.95, LCBO # 93112, 750 mL, 13%, Robert K. Stephen A Little Birdie Told Me So Rating 91/100).

“Socks on Fire”: A Poetic and Lyrical Journey into the Past

“Socks on Fire” is a very highly pedigreed documentary winning the Tribeca 2020 Grand Jury Winner Award for Best Documentary. It played again at Tribeca 2021. It will be showing at select locations in the United States now but I await word how you can see it throughout the world. A wider distribution deal is being worked out. Once widely available I will update this posting with details

It showcases how imaginative and creative documentaries can be.

Bo McGuire is a gay man living in New York City who returns to his hometown Hokes Bluff in Alabama where domineering Aunt Sharon as executrix of his Nanny’s estate has turned into a ruthless and bitter woman intent on locking out her drag queen brother, Uncle John, from Nanny’s house where he had been living. Aunt Sharon even tries to lock him out of the house by changing the locks and is instrumental in having him arrested.

Although the stated goal of Bo McGuire is to document this bitter struggle his underlying intent is to discover his extended family and he does so through creative enactments, old VHS tapes and discussions with those who have influenced his life almost all who are women.

As Bo says at the beginning of the documentary as he burns socks on a clothesline, “What do you do with what the dead left behind? Do you leave with it or set it on fire?”. As far as I can see Aunt Sharon is burning many in her extended family with her greed and hatred of her brother John and as amongst family she has lost all credibility. I have some experience with a death of a family member where property seemed to walk out of the deceased’s house!

For Bo if there is anything he has set fire to is a voyage of self discovery. His narration is melodic if not poetical at times. If anything he has a sense of unflappable calm. His journey takes us down the path of self discovery, death, the importance of family, love, pride, sacrifice, greed, queerness and childhood trauma.

What turned Aunt Sharon into such a cold-hearted monster may be found in her strong affiliation with the church and the manipulation of her husband.

I do not know what documentaries “Socks on Fire” was competing with but this documentary is certainly a good one and winning the Tribeca award is remarkable for Bo McGuire who was the director of the film, his first feature film.

Possible Fall New Wave of COVID?

Will There Be a Fall 2021 Resurgence of COVID-19 in the U.S.?

Infectious disease modelers explore how COVID-19 could play out in the next six months.

INTERVIEW BY JOSH SHARFSTEIN | JUNE 17, 2021

https://html5-player.libsyn.com/embed/episode/id/19348439/height/90/theme/custom/thumbnail/yes/direction/forward/render-playlist/no/custom-color/fb5600/

Public Health On Call

This conversation is excerpted from the June 4 episode of Public Health On Call.Subscribe to Podcast

Last fall and winter saw a surge in COVID-19 cases in the U.S. after numbers dropped in the summer. Will that happen again this year?

Justin Lessler, an infectious disease epidemiologist at the Johns Hopkins Bloomberg School of Public Health, worked with several teams of modelers to explore possibilities based on different vaccination rates and levels of other controls, such as mask wearing and distancing. In this Q&A, adapted from the June 4 episode of Public Health On Call, Lessler discusses several different scenarios—and the troubling element that the models didn’t consider.

You’ve spent a lot of your time in the last year working on models to understand the spread of the virus, and you have recently worked with a group of modelers to look to the future from where we are today. Can you tell us about this work?

This is a multi-modeling effort we call the COVID-19 Scenario Modeling Hub. We wanted to bring in teams with different perspectives and different assumptions to try to get the best sense across the scientific community of how things might proceed in different conditions. This is how we do weather forecasting, and we think it’s the right way to do infectious diseases as well.

What is the difference between scenario modeling and forecasting, and how that is applicable to this model that you build for the future?

In forecasting, we’re really trying to say what will happen. For a lot of reasons, we can only do that for a little bit into the future, kind of like in weather forecasting, where you can have a decent 10-day or maybe 14-day forecast, but you really can’t go much further than that. The COVID-19 Forecast Hub, another multi-modeling effort, realizes that and limits their forecasts to four weeks into the future.

But people who are planning for, say, how long we will need to support people who are put out of work by the pandemic, or what the impacts might be of lots of vaccination hesitancy—they need to know how things might unfold in longer timeframes of three months, six months, or maybe even longer. And then we get into the realm of what I call planning scenarios. We specify some conditions about how things might unfold based on our best understanding of the world now, and then, under multiple scenarios where things unfold in slightly different ways, project how the epidemic might unfold. But we’re perfectly upfront and clear that changes in policy, changes in how people react, or unexpected new variants of the disease could completely change these, so we don’t claim them to be forecasts.

What scenarios were you looking at?

We looked at a 2-by-2 table of scenarios where one dimension was all about vaccination. While in previous rounds the questions around vaccination were often about supply, now they’re about hesitancy and demand. So one scenario [assumes that] demand is going to be high—most people who say they might get the vaccine eventually get it, and we get up to around 83% of the eligible population being vaccinated at a national level. In the low-vaccination or high-hesitancy scenario, we assume that just under 70% of the eligible population actually gets vaccinated.

The other dimension was control measures other than vaccination. We call them nonpharmaceutical interventions, or NPIs. This is the suite of basically everything else: mask wearing, both mandated and by individual choice; restaurant capacity rules; and even personal decisions about whether to go out and do activities as before the pandemic occurred.

So these teams looked at four different scenarios: high vaccination plus a reasonable amount of NPIs, all the way down to low vaccination and not a lot of mask wearing or other types of restrictions.

Yes, exactly.

In three of the four scenarios, we see cases going down and staying low, deaths going down and staying low, and hospitalizations going down and staying low. If we have low vaccine hesitancy, or we’re very slow and cautious in how we ease back NPIs, that’s where the models send us. We level off at lower numbers [of cases], and they get lower a lot faster, if you both keep some control in place and have high vaccination. If we’re high on either dimension [NPIs or vaccination], numbers go down.

But if we have low vaccination and quickly roll back the NPIs, then we start seeing resurgences in the fall. That’s one of the places the models start having the most variation between them, with some thinking things could get really bad quite quickly, and others thinking things will be relatively good but still seeing moderate increases in cases.

In scenarios where there aren’t as many people as we’d like to see vaccinated, and people give up their mask and other things, what are we looking at for the fall in terms of deaths?

Just to give you a sense of where we are now, we’re seeing around 4,000 incident deaths per week. In the most optimistic scenario, by the end of October that gets down to under 70.

70 deaths for the whole country, per week?

Per week—if we have high vaccination and we keep control measures in place. In contrast, if we have lower levels of vaccination and roll back our control measures a lot, then after having a lull in the summer, we’ll be coming back up and seeing something like 2,500 deaths a week again. That’s a little bit better than where we are now, but trending the wrong way.

Even in the scenarios with low vaccination and moderate amounts of NPIs, or low NPIs and high vaccination, you see less than 300 deaths—but that’s still two or three times more than you see in the most optimistic scenario. Basically, if you succeed on any one of the axes, things like start looking a lot better than they do now. But if you fail on both, or don’t get where you want to in both, the pandemic continues.

How possible is it that we see more than one of these scenarios in different parts of the country?

It’s completely possible. The teams were free to take this national average of 70% overall vaccination rate and apportion that between states based on what we’ve seen so far in terms of vaccination. When you look at that, plus the number of cases the states have seen already, numbers stay low in some states—like New Jersey, which had a lot of cases and has a pretty good vaccination rate also—even in the worst-case scenario. But then if you look at places like Maine, which hasn’t had a lot of cases in the past, you see some pretty significant resurgences in the most pessimistic scenario. But it is certainly the case that the whole country isn’t necessarily going to follow any one of these.

In pretty much all of these different scenarios we see a big decline over the summer. But in some of the scenarios, it really goes up quite a bit in the fall.

So, I see the summer as a critical time for the vaccination campaign. We may be lulled into a sense of security by having so few cases, but if we’re not doing everything possible to get people vaccinated in that period, we could be paying for it in the fall. Do you think that’s a fair conclusion?

I think that’s completely fair. Even though we had last year some localized surges, for the most part nationally we were in pretty good shape over the summer. And then as soon as fall and winter hit, numbers started really going up again. We need to keep that in mind as we think about this year and keep those vaccinations coming.

Also, all these scenarios are a little bit optimistic in one way: They don’t account for a more-transmissible variant or a variant with partial immune escape coming along, which could put us in an even worse position. I think the best way to insure against that is to keep the vaccination rates high over the summer—and as new populations become approved to get the vaccine, make sure we get it out into those groups—so that we have the immunity to protect us from the unexpected in the future.

Update: On June 15, the COVID-19 Scenario Modeling Hub released its sixth round of projections. Key takeaways include:

In scenarios with a 60% more transmissible variant, the Hub expects a national surge of cases to grow over the summer, peaking around mid-September to early October—which is also when schools open and seasonal effects might kick in.
Increasing vaccination coverage from 75% to 86% nationally will help curb the wave and cause it to decrease quicker, but it will not prevent this surge.
Surges will be strongest in states with lower rates of vaccination.
The transmissibility of new variants has a greater impact on future cases than raising vaccination levels from 75% to 86%: A 60% more transmissible variant will result in a surge regardless of vaccination rates, while variants that are only 20% more transmissible may not.
There is still a lot of uncertainty about highly transmissible variants in terms of magnitude and timing, but the main point is—
Higher levels of vaccination coverage will prevent cases and save lives, regardless of how transmissible new variants may be.

See the data here.

Joshua Sharfstein, MD, is the vice dean for Public Health Practice and Community Engagement and a professor in Health Policy and Management. He is also the director of the Bloomberg American Health Initiative and a host of the Public Health On Call podcast.