What’s Going On with Delta?

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For much of August, the U.S. South showed up fire-engine red on our map of COVID-19’s spread in the U.S., meaning case counts were shooting up. But now, Florida, Louisiana, Mississippi, Arkansas and Missouri show up in shades of green, meaning cases—while still high—are trending down.

Does that mean the Delta surge is nearing its end?

If covering the pandemic for 18 months has taught me anything, it’s that confident predictions often come back to bite you. But there is reason for cautious optimism. Past U.S. surges have played out in short, intense bursts, and some experts have predicted, based on Delta’s behavior in other countries, that U.S. infections could peak in late August or early September. Covidestim, a modeling project from researchers at Yale, Harvard and Stanford, points to another promising sign: In more than half of states, a person infected with COVID-19 would currently be expected to transmit the virus to less than one other person, in what is perhaps a sign of waning community transmission and/or better population immunity.

Still, we shouldn’t get ahead of ourselves. The U.S. is recording an average of about 150,000 new diagnoses per day, a number not seen since this past winter’s pre-vaccination spike. And in many states, like South Dakota and West Virginia, the trends are going in the wrong direction—and fast. That suggests Delta may be moving to new states, rather than fading away completely.

The situation may become even messier as the school year gets underway. Far more kids have gotten seriously ill during this wave compared to previous ones, in part because of Delta’s contagiousness and in part because children younger than 12 cannot be vaccinated, whereas older Americans are better protected from infection. In a worst-case scenario, pediatric ICUs nationwide may be heading for a repeat of what the South has seen this summer.

While the virus behaves in mysterious ways, people in the U.S. are not powerless. The Delta variant is indeed extra contagious, but the summer surge also coincided with relaxed mask guidelines and, for many people, a return to indoor activities. In South Dakota, one of the states currently seeing the largest increases in cases, the spike seems to be related to large-scale gatherings at the Sturgis Motorcycle Rally. That suggests our behavior matters just as much as the virus’. Getting vaccinated, wearing masks indoors and avoiding large crowds can all help the Delta surge come to an end.

TODAY’S CORONAVIRUS OUTLOOK

About 445.6 million doses of the COVID-19 vaccine have been shipped to various U.S. states as of this afternoon, of which some 372.1 million doses have been administered thus far, according to TIME’s vaccine tracker. About 52.7% of Americans have been completely vaccinated.

More than 219 million people around the world had been diagnosed with COVID-19 as of this afternoon, and more than 4.5 million people have died. On September 2, there were 631,605 new cases globally.

Here’s how the world as a whole is currently trending:

Here’s where daily cases have risen or fallen over the last 14 days, shown in confirmed cases per 100,000 residents:

And here’s every country that has reported over 4 million cases:

The U.S. had recorded more than 39.5 million coronavirus cases as of this afternoon. More than 643,000 people have died. On September 2, there were 153,143 new cases and 1,588 new deaths confirmed in the U.S.

Here’s how the country as a whole is currently trending:

Here’s where daily cases have risen or fallen over the last 14 days, shown in confirmed cases per 100,000 residents:

All numbers unless otherwise specified are from the Johns Hopkins University Center for Systems Science and Engineering, and are accurate as of Sept. 3 1 a.m. E.T. To see larger, interactive versions of these maps and charts, click here.


WHAT ELSE YOU SHOULD KNOW

The U.S. economy gained only 235,000 jobs in August, according to new data from the U.S. Bureau of Labor Statistics—far below this year’s average of 586,000 per month and economists’ expectations of more than 700,000 in August. The retail and dining sectors lost jobs in August, which suggests the Delta-related surge is again putting the squeeze on customer-facing businesses.

South Africa will no longer export Johnson & Johnson vaccines to Europe, under a deal struck by leaders from South Africa, France and the European Commission. The shots will instead be distributed among people on the African continent, where only about 3% of the population is fully vaccinated against COVID-19, compared to nearly 60% in the European Union. The European Commission will also return shots already shipped to Europe from South Africa to help aid the continent’s vaccination campaign, CNN reports.

The U.S. government will invest $3 billion in the vaccine supply chain, in an effort to help manufacturers churn out more shots and supplies for both the U.S. and the rest of the world. Federal officials have not publicly announced which companies will receive that money, but White House COVID-19 adviser Jeff Zients said yesterday that funding will be channeled toward firms that make materials needed for vaccine production and administration, as well as facilities that fill vaccine vials and those that make personal protective equipment.

Employers and private businesses around the world have begun to mandate COVID-19 vaccination. Now, Italian officials are mulling a population-wide vaccine requirement for anyone old enough to receive a shotaccording to Reuters. Such a policy wouldn’t happen until the European Medicines Agency gives the shots full approval, but it would still likely be unpopular in a country with a significant vaccine-hesitant population. At present, about 70% of Italians 12 and older are fully vaccinated.

On the other end of the spectrum, U.K. regulators reportedly may not recommend vaccines for healthy children ages 12 to 15. While shots are recommended for children with underlying conditions that put them at risk of severe disease, U.K. authorities are still assessing whether immunization is necessary for healthy kids, given their relatively low risk of hospitalization or death. The country’s regulators are, however, analyzing whether universal pediatric vaccination may be necessary to maintain safe schools.

Dr. Anthony Fauci, the top U.S. expert on COVID-19, added to the back-and-forth on booster shots yesterday, noting that a three-shot regimen will probably become standard for COVID-19 vaccines. He said a three-dose system would likely ensure more “durable” protection against the virus than a two-shot schedule, CNN reports. Ultimately, though, that decision isn’t up to Fauci. It will be decided by regulators at the U.S. Food and Drug Administration, who are set to discuss booster shots at a meeting later this month.

Worried About Breakthrough Infections? Here’s How to Navigate This Phase of the Pandemic.

Many people are seeking definitive answers about what they can and can’t do after being vaccinated against Covid-19. Is it OK to travel? Should I go to a big wedding? Does the Delta variant make spending time with my vaccinated grandmother more risky?

But there’s no one-size-fits-all answer to those questions because risk changes from one individual to the next, depending on a person’s overall health, where they live and those they spend time with.

The bottom line is that vaccines are highly protective against serious illness, and, with some precautions, will allow people to return to more normal lives, experts say. A recent study in Los Angeles County showed that while breakthrough infections can happen, the unvaccinated are 29 times as likely to end up hospitalized from Covid-19 as a vaccinated person.

Experts say anxiety about breakthrough infections remains pervasive, fueled in part by frightening headlines and unrealistic expectations about the role of vaccines.

“There’s been a lot of miscommunication about what the risks really are to vaccinated people, and how vaccinated people should be thinking about their lives,” said Dr. Ashish K. Jha, dean of the Brown University School of Public Health. “There are people who think we are back to square one, but we are in a much, much better place.”

While the Delta variant is causing a surge in infections in various hot spots around the country, including Florida and Louisiana, there will eventually be an end to the pandemic. Getting there will require ongoing precautions in the coming months, but vaccinated people will have more freedom to enjoy life than they did during the early lockdowns. Here are answers to some common questions about the road ahead.

To understand why there is no simple answer to this question, think about another common risk: driving in a snowstorm. While we know that tens of thousands of people are injured or killed each year on icy roads, your individual risk depends on local conditions, the speed at which you travel, whether you’re wearing a seatbelt, the safety features on your car and whether you encounter a reckless driver on the road.

Your individual risk for Covid after vaccination also depends on local conditions, your overall health, the precautions you take and how often you are exposed to unvaccinated people who could be infected.

“People want to be told what to do — is it safe if I do this?” said Dr. Sharon Balter, director of the division of communicable disease control and prevention at the Los Angeles County Department of Public Health. “What we can say is, ‘These are the things that are more risky, and these are the things that are less risky.’”

Dr. Balter’s team has recently collected surveillance data that give us a clearer picture of the difference in risk to the vaccinated and unvaccinated as the Delta variant surged from May 1 through July 25. They studied infections in 10,895 fully vaccinated people and 30,801 unvaccinated people. The data showed that:

  • The rate of infection in unvaccinated people is five times the rate of infection in vaccinated people. By the end of the study period, the age-adjusted incidence of Covid-19 among unvaccinated persons was 315.1 per 100,000 people over a seven-day period compared to 63.8 per 100,000 incidence rate among fully vaccinated people. (Age adjustment is a statistical method used so the data are representative of the general population.)
  • The rate of hospitalization among the vaccinated was 1 per 100,000 people. The age-adjusted hospitalization rate in unvaccinated persons was 29.4 per 100,000.
  • Older vaccinated people were most vulnerable to serious illness after a breakthrough infection. The median age of vaccinated people who were hospitalized for Covid was 64 years. Among unvaccinated people who were hospitalized, the median age was 49.
  • The Delta variant appears to have increased the risk of breakthrough infections to vaccinated people. At the start of the study, before Delta was dominant, unvaccinated people became infected 10 times as often as vaccinated people did. By the end of study period, when Delta accounted for almost 90 percent of infections, unvaccinated people were five times as likely to get infected as vaccinated people.

While unvaccinated people are by far at highest risk for catching and spreading Covid-19, it’s also possible for a vaccinated person to become infected and transmit the illness to others. A recent outbreak in Provincetown, Mass., where thousands of people gathered in bars and restaurants, showed that vaccinated people can sometimes spread the virus.

Editors’ Picks

Even so, many experts believe the risk of getting infected from a vaccinated person is still relatively low. Dr. Jha noted that after an outbreak among vaccinated and unvaccinated workers at the Singapore airport, tracking studies suggested that most of the spread by vaccinated people happened when they had symptoms.

“When we’ve seen outbreaks, like those among the Yankees earlier in the year and other cases, almost always people are symptomatic when they’re spreading,” Dr. Jha said. “The asymptomatic, pre-symptomatic spread could happen, but we haven’t seen it among vaccinated people with any frequency.”

Another study from Singapore looked at vaccinated and unvaccinated people infected with the Delta variant. The researchers found that while viral loads in vaccinated and unvaccinated workers are similar at the onset of illness, the amount of virus declines more rapidly in the vaccinated after the first week, suggesting vaccinated people are infectious for a shorter period of time.

In many cases it will be safe, but the answer depends on a number of variables. The risk is lower with a few close family members and friends than a large group of people you don’t know. Outdoor gatherings are safer than indoor gatherings. What’s the community transmission rate? What’s the ventilation in the room? Do you have underlying health issues that would make you vulnerable to complications from Covid-19? Do any of the vaccinated people have a fever, sniffles or a cough?

“The big question is can five people sit around a table unmasked if we know they’re all vaccinated,” Dr. Jha said. “I think the answer is yes. The chances of anybody spreading the virus in that context is exceedingly low. And if someone does spread the virus, the other people are not going to get super sick from it. I certainly think most of us should not fear breakthrough infections to the point where we won’t tolerate doing things we really value in life.”

For larger gatherings or even small gatherings with a highly vulnerable person, rapid antigen testing using home testing kits can lower risk. Asking people to use a test a few days before the event, and then the day of the event, adds another layer of protection. Opening windows and doors or adding a HEPA air cleaner can also help.

Children under 12 probably will not be eligible for vaccination until the end of the year. As a result, the best way to protect them is to make sure all the adults and older kids around them are vaccinated. A recent report from the C.D.C. found that an unvaccinated elementary schoolteacher who didn’t wear a mask spread the virus to half of the students in a classroom.

Studies show that schools have not been a major cause of Covid-spreading events, particularly when a number of prevention measures are in place. A combination of precautions — masking indoors, keeping students at least three feet apart in classrooms, keeping students in separate cohorts or “pods,” encouraging hand washing and regular testing, and quarantining — have been effective. While many of those studies occurred before the Delta variant became dominant, they also happened when most teachers, staff and parents were unvaccinated, so public health experts are hopeful that the same precautions will work well this fall.

Dr. Balter noted that masking in schools, regular testing and improving ventilation will keep children safer, and that parents should be reassured by the data.

“The level of illness in children is much less than adults,” she said. “You do weigh all these things, but there are also a lot of consequences to not sending children to school.”

In many cases it will be relatively safe for vaccinated people to spend time, unmasked, with an older relative. But the risk depends on local conditions and the precautions the visitor has taken in the days leading up to the visit. In areas where community vaccination rates are low and overall infection rates are high, meeting outdoors or wearing a mask may be advised.

If you’re vaccinated but have been going to restaurants, large gatherings or spending time with unvaccinated people, it’s a good idea to practice more social distancing in the days leading up to your visit with an older or vulnerable person. Home testing a few days before the visit and the day of the visit will add another layer of protection.

Gregg Gonsalves, an assistant professor of epidemiology at the Yale School of Public Health, said he recently visited his 87-year-old mother and did not wear a mask. But that is because both of them are vaccinated and he still works mostly from home, lives in a highly vaccinated area and has low risk for exposure. He is also investing in home testing kits for reassurance that he is not infectious.

“If I just came back from a big crowded gathering, and I had to go see my mom, I would put on a mask,” he said.

The answer depends on the precautions your workplace has taken. Does the company require proof of vaccination to come into the office? Are unvaccinated people tested regularly? What percentage of people in the office are unvaccinated? What steps did your company take to improve indoor air quality? (Upgrading the filters in ventilation systems and adding stand-alone HEPA air cleaners are two simple steps that can reduce viral particles in the air.)

Offices that mandate vaccination will be safer, but vaccination rates need to exceed 90 percent. Even an 85-percent vaccination rate is not enough, Dr. Jha said. “It’s not going to work because one of those 15-percent unvaccinated is going to cause an outbreak for every single person in that room,” he said. “You do not want a bunch of unvaccinated people running around your offices.”

The people who have the most to gain from booster shots are older people, transplant patients, people with compromised immune systems or those with underlying conditions that put them at high risk for complications from Covid. People who received the single-dose Johnson & Johnson vaccine may also be good candidates for a second dose.

But many experts say healthy people with normal immune systems who received a two-dose mRNA vaccine from Pfizer or Moderna won’t get much benefit right now from a third shot because their vaccine antibodies still offer strong protection against severe illness. That said, the Biden administration appears to be moving ahead with offering booster shots to the general public starting as soon as the week of Sept. 20.

The largest risk-group we must reach to reduce COVID vaccination disparities

Last night I downloaded the latest Census Bureau July-August week 34 PULSE data. Over two cups of coffee, I ran the obvious multivariable logistic regressions to examine who is now fully vaccinated against COVID.  See the above of this post for the full set of resulting Logit coefficients.

I’m sure Reviewer 2 would order due refinements to my quick analysis, were it immediately submitted for peer-review publication. My capacious study limitations section would note the inherent challenges of population surveys to gauge contentious questions like this. These data surely include response biases and likely overstate the true prevalence of COVID vaccination.

The overall patterns and disparities remain clear enough. Of course, we see huge disparities across regions, by education and by income. A bit more surprising: One group appears especially vulnerable and requires specific outreach…Yup. We must formulate culturally competent public health messaging for heterosexual non-Hispanic white Americans. This group conspicuously lags in vaccination status.

Among self-identified male respondents, heterosexual men were almost four times as likely to report not to be fully vaccinated (19%) as were gay men (5%)–an absolute different quite similar to the gradient observed between men with incomes less than $25,000 and those with incomes between $75,000 and $100,000.

I know that there daunting obstacles to reaching this disparity-population of heterosexual American men. We can’t let these barriers deter us. I’m joking–sort of. OK not really.

Political and social polarization are serious obstacles to our COVID efforts. Tribalization of public health may ironically increase vaccination rates among sexual and gender minorities, the educated, residents of blue states, and the socially liberal. We must find ways to push past these divides.

5 Reasons Why

Cartoon- Bearing the Burden of Anti Mask/Vax Freedom

Explained: The 3 Major COVID-19 Variants

Explained: The 3 Major COVID-19 Variants

As billions of people gear up for widespread vaccination against COVID-19, another issue has reared its head. Three major COVID-19 variants have emerged across the globe—and preliminary research suggests these variants may be cause for concern.

But what makes them different from the original strain?

The following visualizations answer some key questions, including when these variants were first discovered, how far they’ve spread worldwide, and most importantly, their potential impact on the population.

Some Context: What is a Variant?

Before diving in, it’s important to understand why viruses mutate in the first place.

To infect someone, a virus takes over a host cell and uses it to replicate itself. But nature isn’t perfect, and sometimes, mistakes are made during the replication process—those mistakes are called mutations.

A virus with one or more mutations is referred to as a variant. Most of the time, variants do not affect a virus’s physical structure, and in those instances, they eventually disappear. However, there are certain cases when a mutation impacts part of a virus’s genetic makeup that does change its behavior.

According to the U.S. Centers for Disease Control (CDC) a change in behavior can alter:

  • Rate of transmission
  • Deadliness
  • Ability to potentially infect someone with natural or vaccine-induced immunity

Preliminary research has detected some of these changes in the three major COVID-19 variants—B.1.1.7B.1.351, and P.1.

The 3 Major COVID-19 Variants

The three major variants emerged at different times, and in different parts of the world. Here’s an overview of each variant, when they were discovered, and how far they’ve spread so far.

B.1.1.7

The B.1.1.7 variant was detected in the UK in the fall of 2020. By December 2020, it had spread across the globe, with cases emerging across Europe, North America, and Asia.

Currently, the variant has been reported in roughly 94 countries.

Early research suggests it’s 50% more transmissible than other variants, and potentially 35% more deadly than the standard virus. Luckily, studies suggest that some of the existing vaccines work well against it.

B.1.351

In October 2020, the second major variant was discovered—B.1.351. It was first identified in South Africa, but by end of the year, it had spread to the UK, Switzerland, Australia, and Japan.

There are approximately 48 countries with reported cases, and research suggests several of the existing COVID-19 vaccines may not be as effective against this variant.

P.1

The P.1 variant was the last to arrive on the scene.

It was first discovered in January 2021, when Japan reported four cases of the variant, which was found in travelers who had arrived from Brazil.

Approximately 25 countries have reported cases of the P.1 variant, and early research suggests this variant is not only more contagious, but could also have the ability to infect people with natural immunity who had already recovered from the original strain.

Still Early Days

While there have been preliminary studies showing a dip in vaccine effectiveness, some experts emphasize that it’s too early to tell for certain. More data is needed to gain a deeper and more accurate understanding.

In the meantime, experts are emphasizing the importance of following our current public health strategies, which include physical distancing, vaccination, washing your hands, and using masks.

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Covid Delta