A few thoughts and recommendations regarding the COVID Delta Variant
The COVID Delta variant is now the dominant strain in the United States, and COVID cases have increased dramatically since dropping off this past Spring.
So what should you do to protect yourself? First some bad news.
1. The new Delta variant is more severe than the previous COVID variants. Hospital specialists are telling me that the Delta patients are sicker than the patients infected in January and February. More are requiring oxygen and intubation.
2. Delta is more contagious. One infected person will infect 9 other people. That puts its contagiousness on par with chicken pox which is considered very contagious.
3. People who are COVID vaccinated are getting sick from it. These cases are typically mild, and it is rare for someone who has been vaccinated to get Delta and require hospitalization.
4. COVID cases now constitute 16% of all Tarrant County hospitalizations and 13% of all beds. That is up from 2% in June of this year, and the trend is still upward. The pandemic high was 37% in January. Deaths are also up.
There is some good news, though.
1. The vaccines do a remarkable job of protecting us from severe disease. The hospital specialists are telling me they have seen only one vaccinated patient recently and that person went home after a short hospital stay. Data shows that less than 0.004% of vaccinated patients require hospitalization and less than 0.001% die.
2. Half of all folks in Tarrant County and close to 75% of people over age 65 have been fully vaccinated.
3. There are multiple monoclonal antibody treatment regimens for folks with underlying conditions such as diabetes. These treatments have proven efficacy and there should be enough doses in Tarrant County to handle most of these cases.
4. Though we’ve seen antibody levels decrease over a number of months in vaccinated people, memory B-cells that produce the antibodies remain at high levels.
CDC
Last week the CDC recommended that even vaccinated people should wear masks in public. In a somewhat mishandled and staccato series of information releases, the CDC let us know that in their opinion vaccinated people can spread the disease, and that conclusion prompted their new advice. Although there hasn’t been a documented case of that happening, vaccinated people who get COVID have high-enough viral load in their nasal passageways to assume this could be true.
My advice is that if you have not been vaccinated and have not ever had COVID, but you do have an underlying condition (age >65, diabetes, renal disease, lupus, etc.), you should be cautious. Consider wearing a mask in public, wash your hands frequently, and notify your physician the moment you have any symptoms. It will be important to start treatment early if you were to get sick so stay in touch with your doctor.
If you are vaccinated but you have an underlying condition, you can carry on with a fair amount of confidence that if you do get sick your chances of hospitalization and/or death are quite low.
Nevertheless, if you were infected you could suffer from some of the long-term effects of COVID such as neurologic problems. A patient of mine is dealing with short-term memory loss and loss of sense and smell which has been ongoing for over a month. Not fun at all.
If you have been vaccinated and don’t have an underlying condition you should be in good shape. Still wash your hands frequently. Know that it is possible but not proven that you could give Delta to someone else who has not been vaccinated.
I will be watching our Tarrant County hospitalization rates and capacity. We don’t want to over-run our ability to treat COVID patients or anyone who needs hospitalization for any reason.
Governor Abbott has issued a recent statement indicating that he will not allow any local governments to require movement restrictions or mask mandates. Any such requirements will come from him, and that is not likely given the current political climate. The political pressure dynamics could change, though, if our hospitals were to become unable to take care of us.
Side note: A number of folks have asked me about other COVID treatments. After reviewing multiple studies on treatment with Ivermectin I cannot say with any confidence that ivermectin reduces death, hospitalization or symptoms. None of the studies are great and most indicate no benefit. I will say that the data we have on vaccine efficacy and safety, and for monoclonal antibody treatment is much better than anything we have for ivermectin, azithromycin or hydroxychloroquine.
Lastly, the U.K. Delta wave which started a couple months or so before ours seems to be settling out. Their vaccination rates are somewhat higher than ours (72% versus 50%) so we will likely follow a timeline that is longer.
Brian Byrd, MD