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Reality Check: The Delta Variant

Reality check time. The Delta variant is now the dominant strain of COVID in Maryland. At the beginning of July, we were averaging close to 50 new cases each day and less than 100 people were hospitalized across the state. Less than 4 weeks later, we are averaging >300 cases per day and 173 people are hospitalized as a result of COVID infections.

The Delta variant spreads much faster than the previous strains of COVID. It multiplies faster and generates higher numbers of viral particles than even the Alpha (UK) variant that caused a wave of hospitalizations and deaths from March through May. The Delta variant spreads about as quickly as chickenpox. For those under 30 years-old, you can ask your parents or older siblings about what happened when one of their classmates got chickenpox. Although chickenpox causes blisters all over the skin, just like with COVID, the main route of spread is through respiratory droplets and aerosol.

I’m not going to belabor the fact that vaccinations are the best way to minimize what is shaping up to be another surge of infections, hospitalizations, and deaths. The remainder of this update is aimed at providing more information about the Delta variant and answering a few questions about the vaccines, including, “Why hasn’t the FDA given full approval yet?”

-What’s different about the Delta variant?

This variant has several mutations (genetic changes compared to previous strains) that allow it to attach to our cells more effectively. These mutations also trigger faster multiplication and higher virus levels in our bodies.

-Speaking of new variants, why do they appear?

Viruses contain genetic material, either RNA or DNA. Like in all biological organisms, these strands of genetic code are necessary for reproduction. Every time an organism reproduces, new copies of genes are made. Random mistakes can occur each time new segments of RNA or DNA are created. For the most part, these genetic errors are minor and do not change the newly formed virus’s ability to cause disease. A small percentage of these genetic errors, called mutations, lead to new virus particles with altered ability to infect people. These changes can lead to viruses that are either less dangerous or substantially more dangerous. Viruses that have significant genetic alterations are called variants.

Viruses can only mutate into new variants after they infect someone. The more people who remain susceptible to COVID infection, the more variants will continue to develop. This is one more reason for younger and healthy people to get vaccinated and not end up as incubators for possible virus variants.

New variants have been first identified in Europe (Alpha), Asia (Delta and Kappa), North America/U.S. (Epsilon and Iota), Africa (Beta and Eta), and South America (Gamma and Lambda). There is no way to predict when or where the next variant will emerge.

-What are the health consequences of these mutations?

It is much easier to transmit Delta from person-to-person. Just as concerning, studies have shown that people are 80% more likely to require hospitalization than was seen with earlier strains of COVID. With the original strain of COVID, the average person was likely to infect 2 others. With Delta, that has increased to one person infecting 6 or 7 others. We were also seeing a lag of 5-6 days between the time a person was exposed to the original strain and when they became infectious to others. That interval is only 3-4 days with Delta. As a result, this variant spreads more quickly and to more people.

-Why is “Delta” capitalized?

I don’t know. It’s all Greek to me.

-I’ve heard that some people are getting infected with the Delta variant despite being fully vaccinated. What gives?

No vaccine is 100% effective, so some breakthrough infections are expected. The Pfizer and Moderna vaccines continue to be very effective, particularly against severe episodes of disease. Studies show 96-97% prevention against hospitalization for those who have completed both doses, and >99% protection against death. However, because this variant attaches more strongly and multiplies in greater numbers there have been more cases of mild illness after vaccination. Studies out of the U.K. show protection against mild illness at 80%. U.S. studies are showing 88% effectiveness. Research on the original strain showed 93-94% protection in adults against even mild infection.

-That’s a lot of numbers. Can you boil it down to better explain what it means for me?

If we take the midpoint of the U.S. and U.K. studies (85% prevention of any infection and 96-97% prevention of hospitalization):

An unvaccinated person is 6-times more likely to get sick and 30-times more likely to end up in the hospital than a vaccinated person of the same age and general health.

9,589 Marylanders have died from COVID, almost every one of those were unvaccinated, including 170 deaths in people under the age of 40. COVID is responsible for the greatest drop in U.S. life expectancy since World War II.

-I’m young and healthy. Aren’t I more at risk from the vaccine than from the virus?

No. Although some teens and young adults who have been very sick or died from COVID infections had known, pre-existing medical conditions, others seemed perfectly healthy. To date, 10 Marylanders under the age of 18 have died from COVID and hundreds have been hospitalized. 45 deaths have occurred in people in their 20’s along with >1,000 hospitalizations. Although exact numbers aren’t available at this time, an increasing number of young people are dealing with long-term symptoms from COVID infections. Many of those infections were mild, but led to fatigue, breathing problems, joint pain, and other problems lasting for months. No deaths in Maryland have resulted from vaccination and only a few hospitalizations have occurred out of the more than 3 million people who have been vaccinated.

COVID infections can trigger all sorts of inflammatory reactions and blood clots in seemingly healthy people whose bodies had never been stressed before by an aggressive virus. Although rare incidents of myocarditis (heart inflammation) have occurred in young men after vaccination, a study by the NCAA of college athletes showed myocarditis rates >100 times higher after COVID infections than as a result of vaccination.

-Microchips, Magnetism, DNA alterations, and Infertility from vaccines?

No, No, No, and No. All of those rumors are completely false. Whether it’s COVID vaccines or any other health-related topic, please don’t rely on social media or cable tv for advice. Your health is at stake and that’s too important to trust to unsubstantiated posts or television personalities who profit off of sensationalism and fear. Keep in mind that people make money from every click on their website or keeping you tuned in through the next commercial break, not the accuracy of the content they post or report. If you have questions or concerns about something you see on the web or television, please ask your doctor or nurse practitioner. Quality research has been done and respected national health experts have been able to prove that none of the above “risks” actually occur. The National Association of Reproductive Medicine, which is the organization of U.S. fertility specialists, strongly recommends vaccination for their patients, as does the American College of Obstetrics and Gynecology.

-If the vaccines are so much safer than the risks of infection, why hasn’t the FDA given full approval already? Why do they still have Emergency Use Authorizations (EUA)?

The FDA has a very strict protocol for full authorization of vaccines. That protocol was put into place decades before COVID appeared. For less life-threatening infections, like chickenpox or shingles, there is not the same urgency to make the vaccine available to the general public. It is rare for EUAs to be issued. The last time the U.S. faced health threats comparable to COVID was in the era of polio (paralysis and death) and rubella (severe birth defects when pregnant women were infected).

Evidence of effectiveness and safety have been collected more quickly for COVID vaccines than any other vaccine in history. This is a result of massive amounts of federal funding starting during the Trump Administration that enabled an extraordinarily rapid ramp up of vaccine production accompanied by large scale studies to monitor vaccine effectiveness and detect potential side effects. Never before have so many people spanning such a broad range of ages, races, and underlying health conditions been enrolled in vaccine trials.

Simultaneous outbreaks of widespread infection across the U.S. and across the globe, along with over 340 million vaccine doses administered in the U.S. and almost 4 billion worldwide, have led to the collection of quality data at an unprecedented speed.

It is a certainty that the FDA will issue full authorization for the Pfizer and Moderna vaccines. The Johnson & Johnson will likely receive full authorization as well. The J&J vaccine is somewhat less effective than the other vaccines, but it does provide meaningful protection and only requires one dose. The exact timing of full authorization is dependent on meeting the strict protocols that were enacted decades ago.

-I’m at the point where I’m ready to get vaccinated. Which vaccine is best for me?

The best answer to that question will come from your personal healthcare provider. In general, the vaccines from Pfizer and Moderna have consistently been more effective regardless of the strain of COVID that has circulated. Although 2 doses are required for these vaccines to be fully effective, the protection is substantially better than the J&J vaccine, especially against the Delta variant.

The only significant side effect seen with the Pfizer and Moderna vaccines is a relatively rare incidence of myocarditis in younger men. As noted earlier, even for young men, the risk of serious health risks from being infected by the COVID virus is much greater than from vaccination. The American Academy of Pediatrics, the American Heart Association, the American Academy of Family Physicians, the CDC, and many other expert medical organizations urge everyone eligible for vaccination to move forward and protect themselves and those around them.

-How long will protection last once I’m vaccinated?

The exact answer is not known, however, the first vaccine recipients were inoculated 1 year ago and they continue to have good protection. There is emerging evidence that people with severely compromised immune systems (organ transplant recipients, those receiving certain types of chemotherapy or immunosuppressing medications for certain autoimmune diseases, etc.) may benefit from an additional dose. The experts at the CDC are evaluating current studies for these subgroups of people.

If additional variants arise, this may impact the need for supplemental vaccination.

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