They’re called mild cases. But people with breakthrough covid can still feel pretty sick.

Authors: Fenit Nirappil The Washington Post Aug. 31, 2021

Andrew Kinsey knew that even after being vaccinated against the coronavirus, there was a chance he could still fall ill with covid-19.

He just never expected to feel this lousy from a case doctors call mild.

For nearly a week, Kinsey felt like he had been “run over by a truck.” He struggled to walk a few steps and to stay awake through episodes of the TV show “Doomsday Preppers.” He returned to work last Monday as a corporate litigator but needs midday naps.

“The vaccine appears to have worked to protect my lungs, so that kept me from having life-threatening symptoms, but at the same time, a so-called mild course can be . . . sort of the sickest I’ve ever been in my life,” said Kinsey, who is 38 and lives with his wife and three children in Pennsylvania. “It’s important for people to know that what they picture in their head of a bad cold isn’t necessarily what will actually happen even if they get a mild course.”

Kinsey and other vaccinated people who develop breakthrough cases of covid-19, the illness caused by the virus, are learning a mild case may not seem so mild to the person enduring the infection. Those cases can be as modest as a few days of sniffles, but, in other circumstances, can spawn debilitating headaches and fatigue. Symptoms can persist longer than the usual cold.

But public health authorities and scientists stress that research overwhelmingly shows that coronavirus vaccines are keeping people out of the hospital and that most breakthrough cases are mild or moderate.

Seven vaccinated people who ended up sicker than they expected shared their stories and said they did not want to cast doubt on vaccines – because they believe their outcome would have been much worse had they not been inoculated. Instead, they said they want to help fellow vaccinated people weigh their risks as they decide when to wear a mask and whether to attend a wedding or travel for vacation. They also do not want people to assume a mild case is trivial.

Kinsey is re-examining how he weighs risk this upcoming school year after his family’s battle with the virus. He’s not sure how he and his wife, Lisa, who is also vaccinated, were exposed. They are generally cautious and wear masks to protect their daughter Sarah, who is too young for vaccines at age 8 and has significant medical issues.

Sarah also contracted the virus and was hospitalized for nearly two weeks, later mostly recovering while her vaccinated siblings stayed healthy. For at least several months, the family expects to have protection from natural and vaccine-induced antibodies. But Kinsey says his experience was a reminder of the urgency of paying close attention to the changing understanding of the virus.

Matt Longman, who is 41 and lives in Tucson, Ariz., said he had a 103-degree fever, experienced aches in his elbows and toes like he had never encountered before and could not stop shaking even after wrapping himself in three blankets. Longman fears he would have ended up in the hospital had he not been vaccinated, especially because his immune system is weakened from migraine treatments.

Model predicts 100,000 more COVID deaths unless U.S. changes its ways

AUGUST 27, 2021 / 7:50 AM / AP

The U.S. is projected to see nearly 100,000 more COVID-19 deaths between now and December 1, according to the nation’s most closely watched forecasting model. But health experts say that toll could be cut in half if nearly everyone wore a mask in public spaces.

In other words, what the coronavirus has in store this fall depends on human behavior.

“Behavior is really going to determine if, when and how sustainably the current wave subsides,” said Lauren Ancel Meyers, director of the University of Texas COVID-19 Modeling Consortium. “We cannot stop Delta in its tracks, but we can change our behavior overnight.”

That means doubling down again on masks, limiting social gatherings, staying home when sick and getting vaccinated. “Those things are within our control,” Meyers said.

The U.S. is in the grip of a fourth wave of infection this summer, powered by the highly contagious Delta variant, which has sent cases, hospitalizations and deaths soaring again, swamped medical centers, burned-out nurses and erased months of progress against the virus.

Deaths are running at over 1,100 a day on average, turning the clock back to mid-March. One influential model, from the University of Washington, projects an additional 98,000 Americans will die by the start of December, for an overall death toll of nearly 730,000.

The projection says deaths will rise to nearly 1,400 a day by mid-September, then decline slowly.

But the model also says many of those deaths can be averted if Americans change their ways.

“We can save 50,000 lives simply by wearing masks. That’s how important behaviors are,” said Ali Mokdad, a professor of health metrics sciences at the University of Washington in Seattle who is involved in the making of the projections.

Already there are signs that Americans are taking the threat more seriously.

Amid the alarm over the Delta variant in the past several weeks, the slump in demand for COVID-19 shots reversed course. The number of vaccinations dispensed per day has climbed around 80% over the past month to an average of about 900,000.

White House COVID-19 coordinator Jeff Zients said Tuesday that in Alabama, Arkansas, Louisiana and Mississippi, “more people got their first shots in the past month than in the prior two months combined.”

Also, millions of students are being required to wear masks. A growing number of employers are demanding their workers get the vaccine after the federal government gave Pfizer’s shot full approval earlier this week. And cities like New York and New Orleans are insisting people get vaccinated if they want to eat at a restaurant.

Half of American workers are in favor of vaccine requirements at their workplaces, according to a new poll from The Associated Press-NORC Center for Public Affairs Research.

Early signs suggest behavior changes may already be flattening the curve in a few places where the virus raged this summer.

An Associated Press analysis shows the rate of new cases is slowing in Mississippi, Florida, Louisiana and Arkansas, some of the same states where first shots are on the rise. In Florida, pleas from hospitals and a furor over masks in schools may have nudged some to take more precautions.

However, the troubling trends persist in Georgia, Kentucky, South Carolina, Tennessee, West Virginia and Wyoming, where new infections continue to rise steadily.

Mokdad said he is frustrated that Americans “aren’t doing what it takes to control this virus.”

“I don’t get it,” he said. “We have a fire and nobody wants to deploy a firetruck.”

One explanation: The good news in the spring — vaccinations rising, cases declining — gave people a glimpse of the way things used to be, said Elizabeth Stuart of Johns Hopkins Bloomberg School of Public Health, and that made it tough for them to resume the precautions they thought they left behind.

“We don’t need to fully hunker down,” she said, “but we can make some choices that reduce risk.”

Even vaccinated people should stay vigilant, said Doctor Gaby Sauza, 30, of Seattle, who was inoculated over the winter but tested positive for COVID-19 along with other guests days after an Aug. 14 Vermont wedding, even though the festivities were mostly outdoors and those attending had to submit photos of their vaccination cards.

“In retrospect, absolutely, I do wish I had worn a mask,” she said.

Sauza, a resident in pediatrics, will miss two weeks of hospital work and has wrestled with guilt overburdening her colleagues. She credits the vaccine with keeping her infection manageable, though she suffered several days of body aches, fevers, night sweats, fatigue, coughing and chest pain.

“If we behave, we can contain this virus. If we don’t behave, this virus is waiting for us,” Mokdad said. “It’s going to find the weak among us.”

It Finally Peaked: The Delta Of Delta Turns Negative

Authors: BY TYLER DURDENWEDNESDAY, AUG 25, 2021 – 08:26 AM

Ten days ago we said that, according to Morgan Stanley calculations, the Delta wave will peak in 1-2 weeks. Well, golf clap to Morgan Stanley’s Matthew Harrison who, with uncanny precision, was spot on and exactly at the midpoint of “1-2 weeks later” the ascent of Delta variant new cases in the US has now peaked, and it’s all downhill from here. 

According to Bank of America’s Hans Mikkelsen, evidence – such as the University of Washington’s IHME model – suggests “the US is now past the peak level of daily COVID-19 infections caused primarily by the Delta variant.”

To be sure, there are a few caveats here: while daily new cases – a subset of new infections – also showed a small decline yesterday (to 147,294 from 147,550 the prior day on a 7-day average basis), BofA warns that this data is noisier due to varying levels testing activity and potentially Hurricane Henri.

But even the “much cleaner data” for number of people hospitalized with COVID-19 confirms that the peak is now in the rearview mirror: while the number rose “just” 7.8% the past week which, due to its lagged nature and very rapid pace of decline, Mikkelsen notes that this “is consistent with the US being past peak level infections.”

Moreover the recent one-percentage point decline in the COVID-19 test positive rate to 9.32% – another indicator that the US is now past peak level infections – highlights one driver of high daily case counts is merely more testing activity.

What does this mean for markets, if not the economy and political propaganda?

Well, if the US has not already seen peak COVID-19 case numbers, BofA is confident that reaching that milestone is “imminent.” More importantly, with the UK as guide, the decline in case numbers on the other side could be rapid.

The IHME model forecasts a 50% decline from peak level daily infections by October 11th, and by September 22 – the timing of the next FOMC meeting – the predicted decline is nearly 40%. This, according to BofA, bodes well for reopening trades that underperformed so far in 2H21 as the US COVID-19 situation deteriorated; it does not bode well for those who are praying that the delta variant will force the Fed to delay tapering.

As for what it means for US society that the media and politicians will no longer be able to scaremonger with the Delta variant, that’s beyond the scope of this post, suffice to say that we fully expect the “independent media” to quickly shift their focus to the “unexpected” emergence of the lambda or some other, even “deadlier” variant, which politicians will immediately weaponize in their neverending quest to convert the US into one giant authoritarian nanny-state.

Delta cases show 300 times higher viral load – S.Korea study

by ReutersTuesday, 24 August 2021 09:11 GMT

Authors: By Sangmi Cha

SEOUL, Aug 24 (Reuters) – People infected with the more transmissible Delta variant have a viral load 300 times higher than those with the original version of the COVID-19 virus, when symptoms are first observed, a South Korea study found.

But the amount gradually decreased over time – to 30 times in four days and over 10 times in nine days – and it matched levels seen in other variants after 10 days, the Korea Disease Control and Prevention Agency (KDCA) said on Tuesday.

The higher load https://www.reuters.com/business/healthcare-pharmaceuticals/people-with-allergic-reaction-mrna-vaccines-can-get-2nd-dose-delta-viral-load-2021-07-26 means the virus spreads far more easily from person to person, increasing infections and hospitalizations, a health ministry official Lee Sang-won told a news conference.

“But it doesn’t mean Delta is 300 times more infectious…we think its transmission rate is 1.6 times the Alpha variant, and about two times the original version of the virus,” Lee said.

The Delta variant of the novel coronavirus was first identified in India and the Alpha variant in the UK.

To avoid the spread of the Delta variant, now the dominant strain https://www.reuters.com/business/healthcare-pharmaceuticals/delta-covid-variant-now-dominant-worldwide-drives-surge-us-deaths-officials-2021-07-16worldwide, the KDCA urged people to immediately get tested when developing COVID-19 symptoms and avoid in-person meetings.

The rapid spread of the Delta variant and low vaccination rates have caught much of Asia off-guard, especially in emerging markets, even as economies in Europe and North America reopen.

The study compared the viral load of 1,848 patients infected with the Delta variant with 22,106 people who had other strains.

South Korea reported 1,509 new coronavirus cases for Monday, raising the total to 239,287 infections, with 2,228 deaths.

It has vaccinated 51.2% of its 52 million population with at least one dose of a vaccine, while 23.9% have been fully vaccinated. (Editing by Jacqueline Wong)

Our Standards: The Thomson Reuters Trust Principles.

Delta variant: What is happening with transmission, hospital admissions, and restrictions?

Authors: Elisabeth Mahase BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1513 (Published 15 June 2021)Cite this as: BMJ 2021;373:n1513

Are covid-19 hospital admissions increasing?

Yes. The number of new cases of covid-19 has been rising in the UK for the past few weeks, and admissions of patients to hospital are following suit. As of 9 June the number of people in hospital each day with covid-19 exceeded 1000, after having fallen to the hundreds in the middle of May after the previous wave.1

Is this because of the delta variant?

Cases were expected to rise at least a little as restrictions eased, but the new delta variant seems to have complicated matters.2 Public Health England figures show that the variant now accounts for 90% of UK cases, with the total number exceeding 42 000. Research indicates that delta is associated with an estimated 60% higher risk of household transmission than the alpha variant, which was already much more transmissible than the original version of the virus. There are also suggestions that delta could carry a much higher risk of hospital admission.

Speaking to the BBC on 13 June, Andrew Hayward, an adviser to the government’s Scientific Advisory Group for Emergencies (SAGE) and professor of infectious disease epidemiology at University College London, said, “I think it’s now very clear that we will have a substantial third wave of covid infections. The really big question is how much that wave of infections is going to translate into hospitalisations. The fact that we’ve got 55% of the adult population double vaccinated means that this will be substantially less bad than it could have been, but we still don’t know exactly how bad it could be.

“Sixty per cent more infectious is extremely worrying—that’s the main thing that will drive the speed with which the next wave comes along. And the fact that the level of hospitalisations from this infection appear to be maybe up to double those of the previous infection is of course also extremely concerning.”

Another concern is that the covid vaccines seem to be less effective against the delta variant, especially after one dose. A PHE preprint found that the Pfizer-BioNTech vaccine was 88% effective and the Oxford-AstraZeneca 60% effective against the delta variant two weeks after the second dose, but both vaccines were only 33% effective against symptomatic disease from delta three weeks after the first dose.3 However, the most recent PHE analysis of 14 019 delta cases (14 June) indicates that two doses of either vaccine are still highly effective against hospital admission: 96% for Pfizer-BioNTech and 92% for Oxford-AstraZeneca.4

Speaking at a Science Media Centre briefing on 9 June, Neil Ferguson, director of the Medical Research Council’s Centre for Global Infectious at Imperial College London, said, “There’s still quite a lot of uncertainty about what the vaccine efficacy against the delta will be for those more severe forms of disease. It’s well within the possibility that we could see another third wave, at least comparable in terms of hospitalisations, maybe not as severe as the second wave.

“Almost certainly I think that deaths probably will be lower. The vaccines are having a highly protective effect, and cases in hospital are milder, but still it could be quite worrying. There is a lot of uncertainty.”

What is different about the delta variant?

In some ways the delta variant is an “improved” version of the alpha variant, making it more easily transmissible and more of a concern.

Speaking at the Science Media Centre briefing, Wendy Barclay, professor of virology and head of infectious disease at Imperial College London, explained, “The delta variant has got two important mutations in its spike protein, or sets of mutations. One is at the furin cleavage site, which we think is quite important for the fitness of the virus in the airway. The virus that emerged in Wuhan was suboptimal in that respect, so it transmitted, but perhaps not as well as it might. The alpha variant took one step towards improving that with a certain mutation, and the delta variant has built on that and taken a second step now, a bigger step, towards improving that feature.”

Why is delta able to transmit more easily?

Barclay said that the current data indicated that the virus was “fitter in human airway cells,” meaning an increased amount of the virus in the infected person, and so they may expel more virus out into the air to pass on to the next person. This is supported by the testing data, which show that the CT value (cycle threshold)—the number of amplification cycles needed for the virus to be detected—seems to be lower in samples from delta infected people, meaning they contain more virus.

Another suggestion is that if this variant is better at infecting human airway cells, people may become infected after a lower exposure.

Does delaying the easing of covid-19 restrictions make a difference?

Yes, because it allows more people to receive two doses of the vaccine. Barclay said, “Any delays, just from a purely scientific basis, will help, because they will allow more time for people to get the second dose. And also just having the second dose is not quite enough. You need to get around seven days after the second dose for the vaccine to really boost the immune response up to the levels that you’d like it to be.”

The final stage of lockdown easing in England, which had been expected to be on 21 June, has now been delayed to 19 July.

Even if the death rate with delta is lower, could the healthcare system still be overwhelmed?

Absolutely. Rising hospital admission rates would increase pressure on the already exhausted health system and could overwhelm it. Writing in BMJ Opinion, the chief executive of NHS Providers, Chris Hopson, said, “Given current NHS pressures, any increase in covid-19 admissions will set back progress on tackling the care backlog. Are we ready to accept this trade off?”5

This message has been echoed by other health leaders, including NHS Confederation deputy chief executive Danny Mortimer, who told the media the current situation was “extremely precarious.”

He said, “Health leaders are all too aware that rising infections, and especially at such a rapid rate, can easily lead to major rises in hospital admissions. Even a slight increase in admissions will affect capacity and could put recovery efforts at risk. Covid-19 hospital admissions are already going up, and that will put capacity under strain, especially as the latest performance figures showed 5.1 million people are waiting to start treatment.”

Are more children becoming ill?

There are no official figures on this, although leaders in the area of child health have refuted suggestions made by members of the Scottish government that children were now more at risk from covid-19 and that many had been admitted to hospital.

Steve Turner, Royal College of Paediatrics and Child Health registrar and consultant paediatrician at Royal Aberdeen Children’s hospital, said, “As it stands there are very few children in hospital in Scotland and across the whole of the UK due to covid. We’re not seeing any evidence of an increase in paediatric admissions with covid. A very small number of admissions who test positive for covid is what we’d expect.

“Our experience over the last 15 months is that many children who test positive have come into hospital for something else, like broken bones. At the moment the situation in the UK is stable. The number of children in hospital with covid remains very low.”6

The Vaccinated Are Worried and Scientists Don’t Have Answers

Authors: Kristen V. Brown and Rebecca Torrence  14 hrs ago

Anecdotes tell us what the data can’t: Vaccinated people appear to be getting the coronavirus at a surprisingly high rate. But exactly how often isn’t clear, nor is it certain how likely they are to spread the virus to others. And now, there’s growing concern that vaccinated people may be more vulnerable to serious illness than previously thought.

There’s a dearth of scientific studies with concrete answers, leaving public policy makers and corporate executives to formulate plans based on fragmented information. While some are renewing mask mandates or delaying office reopenings, others cite the lack of clarity to justify staying the course. It can all feel like a mess.

“We have to be humble about what we do know and what we don’t know,” said Tom Frieden, a former director of the Centers for Disease Control and Prevention and the head of the nonprofit Resolve to Save Lives. “There are a few things we can say definitively. One is that this is a hard question to address.”

Read more: Booster Review Delayed by CDC as Debate Swirls Over 3rd Shot

Absent clear public health messaging, vaccinated people are left confused about how to protect themselves. Just how vulnerable they are is a key variable not just for public health officials trying to figure out, say, when booster shots might be needed, but also to inform decisions about whether to roll back reopenings amid a new wave of the virus. On a smaller scale, the unknowns have left music lovers unsure if it’s OK to see a concert and prompted a fresh round of hang-wringing among parents pondering what school is going to look like. 

In lieu of answers, what has emerged is a host of case studies providing somewhat different pictures of breakthrough infections. Variables including when the surveys were conducted, whether the delta variant was present, how much of the population was vaccinated and even what the weather was like at the time make it hard to compare results and suss out patterns. It’s difficult to know which data might ultimately carry more heft.

“It’s quite clear that we have more breakthroughs now,” said Monica Gandhi, an infectious disease expert at the University of California, San Francisco. “We all know someone who has had one. But we don’t have great clinical data.”

One of the best known outbreaks among vaccinated people occurred in the small beach town of Provincetown, Massachusetts, as thousands of vaccinated and unvaccinated alike gathered on dance floors and at house parties over the Fourth of July weekend to celebrate the holiday — and what seemed like a turning point in the pandemic. About three-fourths of the 469 infections were among vaccinated people. 

Read more: Are Covid Shots Working? What the Real World Tells Us

Authors of a CDC case study said this might mean that they were just as likely to transmit Covid-19 as the unvaccinated. Even so, they cautioned, as more people are vaccinated, it’s natural that they would also account for a larger share of Covid-19 infections and this one study was not sufficient to draw any conclusions. The incident prompted the CDC to reverse a recommendation it had issued just a few weeks earlier and once again urge the vaccinated to mask up in certain settings.

Still, the particular details of that cluster of cases may have made that outbreak especially bad, according to Gandhi.

“The rate of mild symptomatic outbreaks in this population was higher because of a lot of indoor activity (including intimacy), rain that weekend, not much outside time and mixture of people with different vaccination status,” she said in an email.

A newly released, far larger CDC case study of infections in New York state, meanwhile, found that the number of breakthrough infections has steadily ticked up since May, accounting for almost 4% of cases by mid-July. Those researchers cautioned that factors such as easing public health restrictions and the rise of the highly contagious delta variant might impact the results. 

Yet another CDC case study, in Colorado, found that the breakthrough infection rate in one county, Mesa, was significantly higher than the rest of the state, at 7% versus about 5%. The report suggested it was perhaps because the delta variant was circulating more widely there, but also noted the ages of patients in Mesa and the lower vaccination rate may have played a role.

Research out of Israel seems to back the idea that protection from severe disease wanes in the months after inoculation, and more recently, that breakthrough cases may eventually lead to an uptick in hospitalizations. The information is preliminary and severe breakthrough cases are still rare, but it bolsters the case that some people will need booster shots in coming months.

Case studies and data from some states in the U.S. have similarly shown an increase in breakthrough cases over time. But with the delta variant also on the rise, it’s difficult to tell whether waning immunity to any type of coronavirus infection is to blame, or if the vaccinations are particularly ineffective against the delta variant. It could be both, of course. Changing behavior among vaccinated people could be a factor, too, as they return to social gatherings and travel and dining indoors.

All that said, some facts are well established at this point. Vaccinated people infected with the virus are much less likely to need to go to the hospital, much less likely to need intubation and much less likely to die from the illness. There’s no doubt that vaccines provide significant protection. But a large proportion of the nation — almost 30% of U.S. adults — have not been vaccinated, a fact that has conspired with the highly contagious delta variant to push the country into a new wave of outbreaks. 

“The big picture here is that the vaccines are working and the reason for the spike in the U.S. is we have too little vaccine uptake,” Frieden said. 

To a certain extent, breakthrough cases of any virus are expected. In clinical trials, no Covid vaccine was 100% effective — even the best vaccines never are. The more the virus is in circulation, the greater the risk of breakthrough cases. It’s also common for some aspects of viral immunity to naturally wane over time.map: covid-vaccine-tracker-global-distribution-inline.png© Bloomberg covid-vaccine-tracker-global-distribution-inline.png

For the time being, there are simply more questions than answers. Are breakthrough infections ticking up because of the delta variant, waning immunity or a return to normal life? Are vaccinated people more vulnerable to severe illness than previously thought? Just how common are breakthrough infections? It’s anyone’s guess.

“It is generally the case that we have to make public health decisions based on imperfect data,” Frieden said. “But there is just a lot we don’t know.”

(Adds more on Israeli study in 13th paragraph.)

More stories like this are available on bloomberg.com

©2021 Bloomberg L.P.

Delta variant likely to bring a fall and winter of masks, vaccine mandates, anxiety

Authors: Rong-Gong Lin II, Luke Money Fri, August 20, 2021, 8:00 AM

The rise of the Delta variant has upended previous optimistic projections of herd immunity and a return to normal life, with many health experts believing mask mandates and tougher vaccine requirements will be needed in the coming months to avoid more serious coronavirus surges.

While there are promising signs that California’s fourth COVID-19 surge may be starting to flatten, the fall and winter will bring new challenges as people stay indoors more often and vaccine immunity begins to wane.

The rapid spread of Delta among the unvaccinated — and the still relatively small number of “breakthrough” cases among the vaccinated — shows that significant increases in inoculations will help stop the spread. In fact, officials are now preparing to provide booster shots to those who already got their first series of vaccinations, saying the extra dose is needed to keep people protected.

Still, “the vaccines themselves are not going to likely be sufficient. And during times of increased transmission, we’ll need other tools available to protect all of us — and particularly those who, at this time, can’t be vaccinated, like our children,” said UC San Francisco epidemiologist Dr. Kirsten Bibbins-Domingo.

California is in a better position than other states because of relatively higher vaccination rates, and there is little appetite for a return to stay-at-home orders. But in settings where more people gather, strategies that can be used to keep COVID-19 controlled include ensuring people are either vaccinated, have a recent negative coronavirus test or both, Bibbins-Domingo said.

“There will be a time when we have our masks off again as transmission goes back down. But I think we’re going to have to be prepared that if we’re in an environment when there’s more virus around, that it is sensible that we have another layer of protection — and that will be masks,” Bibbins-Domingo said. “And I don’t think we’re going to be totally throwing our masks away anytime soon, frankly.”

Policies like mandatory masking and requiring vaccines or regular testing in workplaces “are going to be very important if we are ever going to get over this pandemic,” said Dr. Robert Kim-Farley, a medical epidemiologist and infectious-diseases expert at the UCLA Fielding School of Public Health.

It was once thought that as soon as 70% to 85% of a population was vaccinated, communities would reach a high enough level of herd immunity that the threat of COVID-19 would be mostly behind us. Now, “that’s out the window,” Bibbins-Domingo said, and computer models suggest the coronavirus will be with us for the foreseeable future. “Almost certainly, we’ll be dealing with it this winter.”

How long the pandemic will last depends on any new variants that emerge, the ability to adapt the vaccines to them and temporary measures that may be needed to tamp down surges, Bibbins-Domingo said.

There are several key factors that have altered what we previously understood about COVID-19 and underscore just how far off the end of the pandemic still is.

The first is the emergence of the Delta variant — at least twice as transmissible as the previous dominant variant, Alpha, and capable of producing a viral load up to 1,000 times greater in the upper throat.

“The big challenge with Delta is that it’s so much more transmissible than the original strain. … And really, this is possibly an unprecedented change in terms of the amount of the” shift in the so-called R-naught, or the basic reproductive rate of the coronavirus, Shane Crotty, a vaccine researcher at the La Jolla Institute for Immunology, recently told a forum at UC San Francisco.

Originally, a person infected with the ancestral strain of the coronavirus spread it to 2.5 other people on average. But the Delta variant is estimated to spread to five to eight other people. That means that within 10 cycles of transmission of the virus, in a population with no immunity to the virus, instead of fewer than 10,000 people being infected, more than 60 million will be infected, Dr. Carlos del Rio, an Emory University epidemiologist and infectious-diseases expert, said at the same UC San Francisco forum.

This is why vaccine mandates will become more important, especially at places of employment, del Rio said. “I think the going phrase that we’re hearing over and over is: ‘No jab, no job.’ And I think mandates are going to make a big difference,” he said.

Second, breakthrough infections — in which fully vaccinated people become infected with COVID-19 — are still uncommon but no longer rare. “I think vaccinated persons are much safer than unvaccinated persons, but they’re not completely safe. Breakthrough infections occur often enough with Delta that you will see them,” del Rio said.

While a vaccinated person with a breakthrough infection can transmit the virus to others, he or she is likely to be infectious for a significantly fewer number of days, del Rio said. “And therefore your contribution to transmission is much lower if you’re vaccinated than if you’re not.”

And that’s why wearing masks indoors remains important. Del Rio said many infectious-diseases doctors never stopped masking indoors, even after the U.S. Centers for Disease Control and Prevention said it wasn’t necessary for fully vaccinated people.

Vaccinated people with breakthrough infections have much more mild illnesses because the body is already equipped to defend itself against the virus and likely can avoid lung illnesses or hospitalization, said Dr. Regina Chinsio-Kwong, a deputy health officer for Orange County. But without prior immunity, the virus can lodge deeper into the body and cause more severe illness, eventually making it very difficult to breathe.

In Los Angeles County in April, fully vaccinated people accounted for 5% of all coronavirus cases; by July, they accounted for 30%. But fully vaccinated people, who now account for 55% of L.A. County residents of all ages, continue to be well-protected against hospitalization.

Unvaccinated older adults — age 50 and above — are 12 times more likely to be hospitalized than their vaccinated counterparts, and unvaccinated younger adults are 25 times more likely to be hospitalized than those who are fully vaccinated in that age group.

For More Information: https://news.yahoo.com/delta-variant-likely-bring-fall-120056591.html

Coronavirus (Covid-19)

A collection of articles and other resources on the Coronavirus (Covid-19) outbreak, including clinical reports, management guidelines, and commentary.

CORONAVIRUS (COVID-19)     VACCINE RESOURCES     VACCINE FAQ https://www.nejm.org/coronavirus

All Journal content related to the Covid-19 pandemic is freely available.

For More Information: https://www.nejm.org/coronavirus

Delta is surging, but is another variant on the way? Here’s what to know about lambda

Ben Sessoms, The Charlotte Observer  


The delta variant is by far the dominant strain of the coronavirus in North Carolina and the rest of the country, but experts say there are also other variants to watch.

Before delta, there was alpha, beta and gamma.

Now there is another, lambda, which is primarily spreading in South America.

Some cases of lambda were found at a Houston hospital last month, according to KHOU11.

Other cases were found in Dallas earlier this week, according to The Dallas Morning News.

But is it spreading in North Carolina? And does the vaccine protect against it?

Here is what you need to know about the lambda variant.

What is lambda?

The lambda variant, or C.37, is a mutation of the original strain of SARS-CoV-2, the virus that causes COVID-19.

It first emerged in Peru back in December. Since then, over 1,200 cases of it have been found there. In Chile, over 1,400 have been reported.

The World Health Organization recognizes it as a variant of interest, meaning that it’s capable of causing significant community transmission.

It’s a step below a variant of concern which includes alpha, beta, gamma and delta, which have been shown to increase transmissibility and have had a significant effect on public health, according to WHO.

Is it spreading in NC?

Among all the sequenced coronavirus samples nationwide, only 810 have been found to be lambda.

By comparison, over 86,000 have been found to be delta.

Due to testing limitations, only a fraction of viruses are sequenced, but officials are still confident they’re an accurate overall representation of variants among infections, The News & Observer previously reported.

The latest data from the Centers for Disease Control and Prevention doesn’t list lambda as a variant of concern in North Carolina.

Is it vaccine resistant?

Dr. David Wohl, infectious disease specialist at the UNC-Chapel Hill, said the lambda variant is potentially concerning because in theory, the COVID-19 vaccines are not as effective against it.

“There’s indications that the antibodies from people who’ve been vaccinated do not neutralize lambda as well as they neutralize other variants,” Wohl said. “That’s the concern with lambda is that in laboratory tests, there may be diminished activity. It still works but not as avidly.”

But some lab tests also show diminished vaccine effectiveness with delta, he said, yet in people, where delta is spreading much more rapidly than lambda, it’s a different story.

“If [the vaccine] didn’t work against delta, we would have our hospital and ICU filled with people who got Moderna, Pfizer and J&J,” Wohl said. “And we’re not seeing that.”

According to state officials, over 90% of people hospitalized with COVID-19, and almost all ICU patients, are unvaccinated.

Dr. Mandy Cohen, secretary of the N.C. Department of Health and Human Services, said at a press conference Wednesday that those who are unvaccinated are four times more likely to get COVID.

“We know that the vaccine works against all these variants. It does. It’s all relative, though,” Wohl said. “Compared to other variants we’re seeing in some of these lab tests, there are some concerns that maybe the antibodies produced by the vaccine aren’t as good against some of these newer variants.”

How does lambda compare to delta?

Cohen said at a press conference late last month that delta is three times as contagious as the original strain.

Wohl said data is limited

but given how much delta has spread in the past month, he’s not sure if lambda is as transmissible right now.

“In order for lambda to become the predominant virus, it has to outpace delta. It has to have some advantage over delta,” he explained. “Otherwise, you won’t be able to continue to spread because there’s no niche for it.”

“I think we would have seen lambda spread already, if it really was able to be fitter than delta,” he said.

Is a vaccine resistant variant coming?

Given that so many remain unvaccinated, there hasn’t been an evolutionary need for a variant to evolve that’s able to cause severe illness in those vaccinated, Wohl said.

“You really need a pressure to be applied to a virus in order to see it mutate,” he said.

The delta variant is spreading because of low vaccination rates and because it can infect vaccinated people, though a vast majority of cases are mild.

“Right now in our country, given how many people are unvaccinated, there’s a little bit less pressure actually on the virus to become resistant to the vaccines because there’s plenty of easy pickings of people who are not vaccinated,” Wohl explained.

“Maybe that’s kind of a silver lining. That it prevents us from getting infected — and this is all theoretical — with a variant that could be worse,” he said.

Still, Wohl urged the unvaccinated to get their shots because the vaccine protects against severe disease and death.

And even in countries with higher vaccination rates, vaccinations are still working and vaccine-resistant variants are not emerging, he said.

If a vaccine-resistant variant does emerge, Wohl said the mRNA technology in the Pfizer and Moderna vaccines can be adjusted quickly to compensate for such a mutation in the virus.

“I don’t think we’re going to see a truly vaccine-resistant variant for a long time, and by that time, I think we’re going to be better prepared,” Wohl said.

US Covid-19 Breakthrough Infections-are-Uncommon Rising Considerably and D-19 Breakthrough Infections are Uncommon, Rising Considerably, and Sort of Okay

Authors: PETER WEBER 5:20 AM

The Biden administration is advising eight-month booster shots for Americans vaccinated with the Pfizer and Moderna COVID-19 vaccines because the Delta variant, which now accounts for about 98.8 percent of new U.S. infections, is a lot more contagious and the effectiveness of the vaccines appears to wane with time. 

“Fortunately,” the COVID-19 vaccines are “still holding at a high level” of protection from hospitalization and death, Surgeon General Vivek Murthy said Wednesday. “But our anticipation is that if the trajectory that we are seeing continues … we will likely see in the future an increase in breakthrough hospitalizations and breakthrough deaths” without boosters.

Even as the Delta variant surges, “COVID-19 breakthrough cases remain uncommon,” The Wall Street Journal reports, citing its own analysis of data from health departments in 44 states and Washington, D.C. In those states, about 0.1 percent of vaccinated residents got COVID between Jan. 1 and early August, the Journal found.

“This continues to be ‘a pandemic of the unvaccinated,'” but “breakthrough infections accounted for 12 percent to 24 percent of COVID-related hospitalizations” in seven states keeping detailed records, The New York Times reports, citing its analysis. Those breakthrough cases are mostly among older or immunocompromised adults — in Oregon, for example, the median age for a breakthrough-associated death is 83, and 74 percent of breakthrough cases nationwide are among people 65 and older, federal data show. 

The overall numbers remain small, but it’s pretty clear “the chances of a breakthrough infection have gone up considerably,” U.C. San Francisco’s Dr. Robert Wachter tells the Times. “Remember when the early vaccine studies came out, it was like nobody gets hospitalized, nobody dies,” he added. “That clearly is not true.”

“Let’s be real, here: Breakthrough infections are sort of okay,” Larry Corey, a virologist at Seattle’s Fred Hutchinson Cancer Research Center, tells the Journal. “You get infected and you have a cold, maybe an achy fever for 24 hours. But you don’t end up in the hospital, and you don’t end up with that 2.5 percent chance of dying once you are hospitalized.”

“All we’re really seeing, with vaccine breakthrough cases that come into the hospital, are people who are over 80 or have a compromised immune system,” adds Jorge Bernett, an infectious disease specialist with John Muir Health in Walnut Creek, California. “Basically everyone who is on a ventilator is unvaccinated.”