July 20, 2021

"it ain't over til it's over" *

As much as we want to celebrate and return to normal after our pandemic period, we are now facing a “reality check”. SARS-CoV-2, the virus, and COVID-19, the disease are here to stay. Not just in countries with limited access to vaccines, but here in countries that have easy access. Mostly because our rate of vaccinations has dropped way off, we are seeing increasing rates of COVID-19 across the US. Now Canada has surpassed the US in percent of citizens vaccinated, after having a much slower roll out. Good for them!

As the Delta variant spreads readily in the US, infections and hospitalizations are increasing, more so in areas with low uptake of vaccines. For many, life is not returning to normal. Instead families are facing grief and loss. Most of the infections are in the unvaccinated, but breakthrough infections are occurring in the vaccinated. With the new Delta variant, effectiveness of the vaccines drops from the mid-90’s to 88% by some estimates. The State of Virginia has some good data showing how effective the vaccines are in preventing serious illness and death, but they are not 100%. The Massachusetts’ Department of Public Health has recent data that shows only 4,450 “breakthrough” cases of COVID among 4,195,844 vaccinated people with only 303 people hospitalized and 79 who died.

Why breakthrough cases? The vaccines were designed to help prevent serious illness and death, which they do. Some people have no symptoms and a positive test because their immune system prevents the virus from spreading beyond the nose. However, for some, underlying medical conditions may cause immunosuppression. Data shows that people who are immunocompromised due to cancers and HIV may not get a strong response to the vaccine and are at risk. The older we are, the less immune response we may have to the vaccine. Exposure to a higher viral load at inoculation can possibly overwhelm the immune system. Further, despite J&J’s reassuring data about their vaccine’s performance against the Delta variant, some other concerning data shows the J&J vaccine has decreased effectiveness against the delta, perhaps as low as 33%..

The Delta variant is surging in areas with low vaccinations rates, which increases more breakthrough infections, simply due to numbers of exposures. We are all starting to hear of people we know with infections: a dental hygienist, friends hoping to visit from another state, a family trip to Disneyland, state senators from Texas. These reports remind us to keep ourselves safe. Beware the indoor birthday party.

Wash your hands, cover your nose indoors, and be sensible.

And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading.

*Yogi Berra said this.

https://www.washingtonpost.com/health/in-this-summer-of-covid-freedom-disease-experts-warn-the-world-needs-a-reality-check/2021/07/17/895be6e8-e58c-11eb-b722-89ea0dde7771_story.html

https://www.bbc.com/news/world-us-canada-57869947

https://www.nytimes.com/live/2021/07/18/world/covid-variant-vaccine-updates/canada-surpasses-us-vaccination-rate-after-lagging-for-months

https://www.seattletimes.com/seattle-news/health/this-isnt-over-even-as-life-gets-back-to-normal-for-many-covid-19-continues-to-kill/

https://www.vdh.virginia.gov/coronavirus/covid-19-data-insights/covid-19-cases-by-vaccination-status/

https://yourlocalepidemiologist.substack.com/p/how-many-breakthrough-cases-are-there

https://www.bostonglobe.com/2021/07/13/nation/state-says-number-covid-cases-vaccinated-people-is-incredibly-low/

https://yourlocalepidemiologist.substack.com/p/vaccines-among-immunocompromised

https://www.nytimes.com/live/2021/07/20/world/covid-variant-vaccine-updates/the-johnson-johnson-one-dose-vaccine-is-less-effective-against-the-delta-variant-a-study-suggests

https://www.theatlantic.com/science/archive/2021/07/coronavirus-breakthrough-infections/619416/

https://www.mercurynews.com/2021/07/19/californias-delta-covid-surge-would-vault-a-dozen-or-more-counties-to-widespread-purple-tier/

https://www.washingtonpost.com/health/2021/07/17/delta-cases-rising/

https://www.nytimes.com/2021/07/05/upshot/covid-birthday-parties.html