“I want you to take three messages away from this outbreak,” said Dr. Monica Gandhi, Professor of Medicine at UCSF at a July 30 EMS panel discussion on the contagious Delta variant, currently the predominant strain of the virus in the United States.
In July the CDC released a report on a breakthrough Delta variant infection that surged among fully vaccinated people following a public gathering in July at Provincetown (MA).
According to the study, 346 (74%) out of 469 people who reported COVID-19 symptoms, were fully vaccinated. Testing identified the B.1.617.2 (Delta) variant of SARS-CoV-2 in 119 people (89 % of cases) who had received complete doses of the Pfizer, Moderna or J&J vaccines. Four out of the five patients hospitalized had been fully vaccinated
But symptoms in most cases were mild; as of July 27, no deaths had been reported.
The lesson from this breakthrough said Dr. Gandhi, is that the vaccines work, even though the Delta variant is very transmissible and carries high viral loads. However one cannot conclude from the report that vaccinated people are equally likely be contagious as unvaccinated people. Though breakthrough infections appear to produce similar viral loads in both the unvaccinated and fully vaccinated, vaccinated people appear to be infectious for less time. It’s “more likely that vaccinated people are going to fight the virus,” she said.
The Provincetown study demonstrates that vaccines are living up to their promise, added Dr. Gandhi. The vaccines were designed to and are “amazingly effective in preventing severe disease, hospitalization and deaths.”
But as the Delta variant sweeps through unvaccinated communities, the CDC is reporting a rapid spread of COVID cases and rise in hospitalization rates and deaths. COVID cases reached over 60,000 on July 27. Over 4 million children have tested positive for Covid according to NIH Director Dr. Collins, and at least 1450 children have been hospitalized in the recent Covid variant surge.
In India, where the Delta variant took root before its wildfire spread across the globe, low vaccination rates meant there was little chance of the population withstanding the impact of the infectious Delta variant. When it hit in early March, low rates of immunity combined with high transmissibility lead to a terrible wave of deaths and severe disease.
In the US a large swathe of the population remains unvaccinated. As of August 10th only 49.89% of the population has been fully vaccinated, while only 8.7% are partially vaccinated. Almost 90 million American adults who haven’t had their shot are at risk of infection from the Delta variant which is more contagious compared to other variants.
Data shows that the viral load of people infected with the Delta variant is about 1,000 times higher than those infected by the original SARS COVI-2 virus and replicates much faster. It could be twice as transmissible than the original strain, leading to increased transmissibility even in vaccinated individuals.
The CDC recently recommended masking while indoors in areas of high virus circulation even for vaccinated people, while some state and federal agencies are implementing vaccine mandates for their employees.
Experts at the briefing offered insights on whether masking, vaccine mandates and vaccine passports could contain the unfettered spread of the Delta variant.
In the face of global vaccine inequities where people are desperate for vaccines, “we are leaving vaccines unused” sitting on shelves, remarked Dr.Gandhi. “The dialog will shift toward vaccine mandates.”
Mandates are happening in cities and healthcare settings even without federal approval of the vaccine because of the delay in the approval process..
The San Francisco Dept of Public Health has issued a vaccine mandate for city workers in high risk settings, while New York Mayor Bill de Blasio announced the Key to New York Pass –which will require vaccination proof for indoor dining, gyms and corporate offices, once its launched on August 16. Big tech companies like Google and Facebook now require all on campus employees to be vaccinated or have multiple testings.
Historically, Americans have opposed vaccine mandates as a violation of their constitutional rights to liberty and personal freedom. But do vaccine resisters have the right to control their personal healthcare while putting the safety of the entire population at risk?
They may not have a choice. There is precedent for vaccine mandates following a smallpox epidemic in 1905, when the Supreme Court ruled that vaccines can be compulsory in a public health crisis.
The court rejected a claim from a plaintiff that a vaccine order from the Cambridge (MA) board of health violated his constitutional rights, stating that “There are manifold restraints to which every person is necessarily subject for the common good.”
But it may take more than mandates to convince the populace to wear masks and get a shot for the common good say experts, because of several deterrents.
Currently the FDA has authorized vaccines only for emergency use which makes it difficult to persuade participants to get vaccinated – signing a form to get the vaccine can be a deterrent. A KFF survey of unvaccinated adults reports that “12% fall into a wait and see group while about 13% say they will “definitely not” get a COVID-19 vaccine.
On July 8, Pfizer sought FDA approval for a third booster dose 6 to 12 months after full vaccination, while Moderna in trials has shown that their 3rd booster re-elevates antibody titers.
Approval would help more settings to mandate vaccines, said Dr.Gandhi, but any mandate will come with three exceptions – evidence of natural immunity, religious and medical reasons. “There are always exceptions to be made” for people worried about side effects.
However, not having vaccinations is prolonging the pandemic, she added.
Vaccines are our best chance of stopping the devastating impact of this disease, especially on disenfranchised minorities and communities of color, said Dr. Tiffani Johnson, Assistant Professor of Pediatrics Children’s, Hospital of Philadelphia.
But the unvaccinated are not a monolith. Children under 12 are still not eligible for the vaccine, and even though vaccines are free, the same barriers that exist for accessing healthcare also exist for accessing the vaccine, for people in underserved communities.
Without Internet access to reliable credible information, the ability to schedule appointments, or find transportation, combined with concerns about taking time off work and fear of side effects, makes it difficult to get a shot. Vaccine hesitancy also occurs also from mistrust of the healthcare system from historically disenfranchised communities, said Dr. Johnson.
People are mistrustful or confused when guidelines and recommendations constantly change as new evidence comes out, she cautioned. They have ‘unanswered questions and want to make informed decisions’ about their health and wellbeing.
“So the shame and the blame needs to stop,” said Dr. Johnson. She urged community leaders to create opportunities for “dialog based in empathy and trusted messaging,” and address barriers to getting vaccinated.
Dr. Gandhi shared strategies to incentivize unvaccinated people to get their shot, such as community-based messaging, taking vaccines to the people – into pharmacies, at workplaces, or doctor’s office, offering free transportation and childcare, and giving people paid time off to get the vaccine and to recover.
“The fundamental problem is that vaccines are given on an individual level and individuals tend to see an individual benefit as the main driver,” said Dr. Ben Neuman, an immunologist at Texas A&M. Vaccines do work on immunity through the individual level “but in the big picture, vaccines essentially work through mathematics at the population level.” While studies show that vaccines help at the individual level, the bigger prize, said Dr. Neuman, is to end the covid 19 pandemic.
Higher vaccination rates in the UK, with 88 percent of adults receiving one dose, and 70 percent fully vaccinated, has kept hospitalizations relatively low; after the Delta variant surge, the wave is now receding. An Indian (Hyderabad) study that looked at hospitalizations, found that those who had been vaccinated had 50% less likelihood of bad outcomes like severe disease, ventilator use and death.
“The way to get through the Delta variant is vaccination,” emphasized Dr. Neuman.
An “80 – 90 % effective vaccine is an absolute godsend!”
Meera Kymal is the Contributing Editor at India Currents.