COVID cases are trending up across the country by 11% since last week. In total, we’ve had almost 34 million cases and about 606K deaths in the US since COVID arrived. Deaths are still occurring at about 300 people per day. COVID is much worse in regions with lower vaccination rates. I’m seeing colleagues report having 100+ hospitalized COVID patients in their hospital and running out of ventilators. While masks are off and bars and restaurants are full, clearly this is not entirely over yet. It is a race between vaccinations and the natural development of variants that may overcome the vaccine. Mutations and the development of variants is completely expected, yet we can slow the development of variants by reducing transmission. Thus, the vaccine, which protects people from COVID infections and saves lives.
Virginia, and specifically Arlington County, continues to be in reasonably good shape. Within the ER, we had another week where we did not diagnose any cases of COVID out of the almost 400 patients we tested. This represents 0 cases 3 of the last 4 week among our “symptomatic” patient group and 0 cases for 3 weeks in a row among our “asymptomatic/screening” patients. The hospital spent a couple days recently without any patients with active COVID in the hospital but now we do have some hospitalized COVID patients. In a bit of a historic moment, our hospital COVID task force that has been meeting on Friday mornings since March 2020, made the decision to pause/stop meeting at the conclusion of today’s meeting. While COVID rages around the world, and may spike in certain areas of the country, for now, the formality of a multidisciplinary meeting can be put on hold at VHC.
Although our numbers look good, I am concerned about the Delta and Lambda variants. Delta now is the dominant variant, up from less than 10% just a few weeks ago. It’s much more transmissible and may have more severity. Israel released data this week estimating that the Pfizer vaccine is about 64% effective against Delta. Canadian and British studies estimate effectiveness against symptomatic infection to be about 88%. Recall, previously, Pfizer was believed to be 90-94% effective against other variants. Fortunately, the vaccine remains about 93% effective against severe disease versus Delta (compared to 97% for the original and non-Delta variants). In a recent study out of Nature, the Delta variant appears much more infectious in people who have only received the first dose of the 2 dose mRNA vaccines, while fully vaccinated people “retain significant protection” against the Delta variant. The researchers also showed increased antibody potency for patients who previously had COVID and then got one dose of the vaccine compared to natural immunity. Pfizer and Moderna are reporting that a 3rd dose of the vaccine 6 months after the second dose will increase the immune response and both companies are also working on a vaccine directed against the Delta variant, with trials expected to start in August. At this point, the science doesn’t point to needing a booster shot but I’m glad it’s being researched. There is also a new variant that is worth keeping an eye on. A pre-print version of an article that has not been peer reviewed yet was posted about a week ago on Lambda. Lambda was first identified in Peru and has some mutations in the spike protein. Recall, that the vaccines are based on identification of the spike protein so changes in that protein could impact the vaccines effectiveness. Additionally, these mutations in Lambda may make it more transmissible. At this point, it is believed that vaccines and monoclonal antibody therapy will be effective against Lambda.
At the end of the day, the vaccine is really about reducing sickness and death. Yes, I hope it keeps me from getting COVID altogether, but if I do get COVID, I really hope to not get too sick. You only have to look at June data from Maryland to see the benefits of reducing death. Of the 130 people who died of COVID in June in Maryland, none of them were vaccinated. On a broader scale, the CDC is reporting that 99.5% of all COVID deaths among a subgroup of states (they didn’t identify which states) in the last 6 months were among unvaccinated people. The vaccine is doing exactly what it’s supposed to do—it’s keeping people from dying. This is real world data that should be enough to convince even the most vaccine hesitant people to get vaccinated as soon as possible.
Some women who are breastfeeding are hesitant to get the vaccine because of concerns of the vaccine altering their breast milk. Although the Academy of Breastfeeding Medicine states “that there is little plausible risk that vaccine nanoparticles or mRNA would enter the breast tissue or be transferred to milk,” researchers at the U of California, San Francisco, set out to see if breast milk contained mRNA vaccine. Seven volunteers provided multiple samples of their breast milk for analysis. Scientists were not able to detect mRNA vaccine in any of the samples (they did have positive control groups). They believe this is early evidence, albeit in a small study sample, that mRNA vaccine is not transferred to the infant and hypothesize that if any mRNA below the level of detection was transferred to the infant, it would be degraded in the digestive process.
There is one sad case that is worth mentioning. It’s the death of a 13-year-old Michigan boy who died a few days after his second dose of vaccine. His death is being investigated and it may take months to identify a cause. Based on news reports, he did have fevers and muscle aches after the second dose but was not reported as being critically ill. He went to sleep and never woke up. While incredibly sad, one’s risk of dying of COVID is still higher than your risk of dying from the vaccine. As scientists, we make recommendations on large data sets, not on one off cases, no matter how sad the case is.
So getting back to my concern about variants and the possible decrease in effectiveness of the vaccine with the Delta variant….while I’ve enjoyed not wearing masks at the grocery store, I am not taking my masks out of my car yet. I wouldn’t be surprised if there is a push/mandate for masks indoors again this fall, at least in certain regions of the country (particularly where vaccination rates are low) or situations (you have risk factors for a bad outcome and will be in a crowd).
Science matters. Get vaccinated. Wear a mask when you’re supposed to. We’re almost there.