Dr. Bow Tie
COVID-19: Catching Up As We Fall Behind (Delta Variant, Potential Boosters)
It's been a minute since I wrote one of these. Work has been pretty crazy lately, as I took on more (voluntary) shifts that left me less time to process/research. I also needed a bit of time to reset. It's been a long and frustrating one-and-a-half years, and it was starting to show on me and my thinning patience. But I'm back! A lot has happened.
We recently missed the goal date for 70% of Americans getting at least one dose of COVID-19 vaccination. It was supposed to happen by July 4th. We barely scraped by with a 67%. That's for ONE dose, meaning (for anyone that got the mRNA vaccines) not fully vaccinated/immunized. COVID-19 had temporarily slowed for a while and our efforts became complacent.
COVID-19 is still very present in the United States. Where I live, in Western New York, numbers are thankfully down, but in many communities throughout the country (and the world), cases have surged. Why is this happening?
The Delta Variant (B.1.617.2, originally noted in India), is surging everywhere. I mean, everywhere. As of June 29, it has been found in my county. The Delta variant is up to twice as transmissible as the wild type (original SARS-CoV-2). My parents were planning to go to India earlier this year and had to cancel their trip because the Delta Variant was wreaking havoc through most of India, spreading like…well, spreading like a twice-as-transmissible SARS-CoV-2. Much of India's healthcare system is in shambles, having just gone through a period where hospitals were so full of patients (yet understaffed) that family members had to run to claim oxygen tanks, or get them shipped in from elsewhere. People died in huge numbers.
Now that variant is here, and we’re seeing ICUs fill up again in areas of low vaccination. The most recent area I saw was parts of Arizona, but the highest rates are areas of low vaccination in Arkansas and Missouri (h/t Dr. Eric Topol).
The question arose, of course, “Well, if the vaccines work, why is Delta surging?” The answer is that not enough people are vaccinated. Close to 99% of cases (by some estimates) in the past month in the US were in people not yet fully vaccinated. They had received one shot (some protection but not enough), none at all, or, most frustrating, were exposed in the two weeks before their 2nd vaccine dose could take full effect. I myself have reviewed several cases of people admitted with COVID-19 who were not fully vaccinated and then died.
Dr. Jen Gunter put it best in a Tweet: “Every person who remains unvaccinated is a potential reservoir for a COVID variant that is more vaccine resistant.”
The only protection we have against Delta variant is the vaccine. All of the major vaccines out right now ARE shown to be protective against it, but only after the final dose (meaning two weeks after the dose itself, since it takes that time to take full effect). The non-mRNA vaccines do seem to be showing less efficacy, especially in single dose, and that's why there is talk of a potential second dose or separate mRNA dose to follow those up (more info on that as it gets further research).
As I have repeatedly stated, it is not an individual choice. Vaccination not only protects you, but protects those around you. You do not know who may not be able to create a full immune response due to being immunocompromised. In addition, children under 12 are going to summer camp, summer school, and other in-person programs and they cannot yet be vaccinated. All the adults around them need to protect themselves, and that protection will extend to the children as much as possible until the vaccine trials for kids hopefully prove that they are just as safe and effective for our youngest loved ones.
Since restrictions have lifted, I have gone back to eating in restaurants, and I have gone to see (and play in) bands at bars. It felt normal. I loved it. I don't want to have to go back to stricter mitigation measures and wider lockdowns again. The longer we go without full vaccination at higher rates, the more likely we are to yield a variant that actually might escape the vaccine, which will mean going back to mandated universal masking, distancing, or even lockdowns. Do not let us get there. Please.
That said, the WHO has recommended masking even for the vaccinated folks in light of the Delta variant - this is a global recommendation, so it is not necessarily applicable to all areas, but if your area is seeing a surge in cases, then mask up. Just like you obey traffic laws and wear your seatbelt and respect intersections/traffic lights, you can be vaccinated and still have additional protection from a mask, distancing, and hand-washing.
A quick note: there is talk that Israel's vaccine efficacy fell to 64% with the new Delta variant. I look at this with a healthy dose of skepticism because it has not matched the data from multiple other countries. The study's analysis was a bit unusual, and there were some confounding factors that were not taken into account. In other countries and studies, there is a SMALL drop in vaccine efficacy in from wild type to Delta, but not enough that it escapes our vaccines, thankfully. And most importantly, there has not been a rise in hospital admissions among fully vaccinated people (even in Israel), which is one of the most important things the vaccines can do.
Our enemy has become stronger and smarter. Remember what I said a couple of posts ago about going up against an MMA fighter without training? Of course you don't, because that was over a month ago and there is too much going on. But here's the metaphor: "It's like if you had minimal fight training but got roped against your will into an MMA match against a particularly tough fighter. You might get lucky and survive, and you'd probably learn as you went through the match and pick up some technique. But with no further training, if you go up against that fighter after THEY HAVE learned new techniques and styles, you may not do so well the next time, or at the very least you might take a much worse beating.
But imagine if you trained with an expert, who showed you techniques and tactics that could be used against you, and how you might defend against them, even newer techniques that weren't around when you first heard about the other MMA fighter. You could go into that fight much more confidently, and you would be much better prepared to take on the enemy fighter. THAT'S the difference between surviving a COVID-19 infection and hoping for the best vs. getting a vaccine."
That's how Delta is working right now. Do you want to avoid going back to early pandemic-style life? Get yourself and as many folks as possible vaccinated (fully, meaning two doses).
A note: This applies to people who have already had COVID-19, too, since natural immunity has not been shown to protect against (or prevent spread of) the variants, especially Delta. Even one dose may act like a second dose for those who have had COVID-19 before if they are within a certain window, strengthening our immune memory and response.
DO I NEED A BOOSTER?
The news was abuzz this week with Pfizer's announcement that it was seeking Emergency Use Authorization for a booster vaccine. Let me clear the chatter:
As I have discussed before, Emergency Use Authorization does not mean skipping steps. You still have to go through Phases I-III of a trial, which Pfizer is doing with a booster dose. The only difference between EUA and full FDA approval is the length of time after Phase III - EUA requires only two months of follow-up, while FDA approval requires 6 months (h/t Unbiased Science Podcast).
As of now, most people do not need a booster, according to our data. There was a recent paper in Nature that showed how effective our immune system is when helped by the vaccines, in this case not only the T-cell immune response but creating a memory B cell immune response. Measured levels of long-lasting plasma cells (which store memory of SARS-CoV-2 to remind the immune system to kick it out) were significantly higher in those vaccinated than those not (higher even than those who had previous COVID-19 infection!!). It is literal proof that vaccines work and will work for a long time, and are better than "natural immunity." However, those who cannot form a significant immune response (due to immunocompromise or other factors) or those who received the non-mRNA vaccines (real world data still coming) may need a booster. Emphasis on MAY. The data is still being studied, of course, but as of now, things still look good.
This is preemptive. We have been behind the virus this whole pandemic. It is a wise idea to have an EUA in place for a booster and to not need it, than to need it and scramble to get a booster in place. As scientist Laurel Bristow and others have said, it is better to have a plunger before you need a plunger.
As always, wear a mask (especially if not vaccinated), wash your hands frequently, maintain distance when needed, and get vaccinated! I welcome your questions.