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COVID-19 Monthly Update: August 2021

By Eileen West, MD

Delta Variant

There are a number of updates on the coronavirus front, as you all are no doubt noticing. The Delta variant, which was first identified in India in December, is now the predominant strain the U.S. It is more than twice as infectious as the initial COVID strains seen in early 2020. The Centers for Disease Control and Prevention (CDC) described Delta as more transmissible than the common cold, influenza, and the viruses that cause MERS, SARS, smallpox and Ebola—and called it as contagious as chickenpox. This means it is easier to catch and easier to spread through respiratory exchange than initial COVID strains.

Symptoms with the Delta variant may be different. There seems to be less cough and loss of smell, but more headache, fever, runny nose and sore throat in areas where >90% of cases are of the Delta variant. The average incubation period (referring to the time from exposure to symptoms), is four days instead of six days with the initial strain. The Delta variant also appears to be capable of making unvaccinated individuals sicker than previous strains.

And there’s the worry on many people’s minds—the Delta variant is more capable of giving vaccinated individuals “breakthrough” infection. We are seeing infection once again in vaccinated individuals, but it is important to remember that the majority of these cases are asymptomatic or quite mild, and still are no more likely to cause serious illness or death in those who have been vaccinated.  Those with “breakthrough” infections can carry very high viral loads and are capable of spreading the virus to others. However, the transmission period appears to be shorter, and the amount of transmission actually taking place seems to be lower than expected. It is still very rare for a vaccinated person to give another vaccinated person COVID-19. A vaccinated person is still much less likely to catch COVID than an unvaccinated one. For those who are not yet vaccinated, the situation in our country continues to get worse and worse. Virtually all of the ICU admissions and deaths in this country in the past several months have involved unvaccinated people.

What about the next variant? As the virus spreads among unvaccinated individuals, it has the opportunity to multiply rapidly and to mutate into more worrisome strains. Variants are divided into three categories: Variants of Interest, Variants of Concern, and Variants of High Consequence. Currently, there are four Variants of Concern circulating in the United States: Alpha (B.1.1.7), Beta (B.1.351, B.1.351.2, B.1.351.3), Delta (B.1.617.2, AY.1, AY.2, AY.3), and Gamma (P.1, P.1.1, P.1.2). You can learn more about them HERE https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-info.html#Concern. There are no Variants of High Consequence circulating in the United States at this time. Variants of High Consequence show “clear evidence that prevention measures or medical countermeasures (MCMs) have significantly reduced effectiveness relative to previously circulating variants.” There will inevitably be other variants which arise, such as a Lambda variant and Delta Plus variant which are Variants of Interest at this time. For now, the Delta variant is predominant.

Vaccination

Since we are seeing more infections in vaccinated individuals, does this mean that the vaccine doesn’t work anymore? No

Is it possible the new variants have changed enough that the vaccines just don’t work anymore? See the discussion about variants of High Consequence.

Does this mean that immunity from the vaccine can wear off, and a booster is needed? We do not have extensive data on this, although we expect to have a great deal more in the weeks ahead.

The CDC has just made recommendations that a booster vaccine be given to people 8 months after initially being protected with one of the two mRNA vaccines (that is, 2 weeks after the second dose of the Pfizer or Moderna vaccines). If you are seriously immunocompromised then a booster is recommended now. Beginning September 20th, the rest of the vaccinated population will be eligible for a booster shot in roughly the same order as we saw for the first vaccines. We are working with the Health Department to obtain booster vaccines for the clinic and will keep you informed.

Identification

Testing is one of the keys to stopping transmission. We offer a variety of testing options which you can view HERE.

Treatment

The mainstay of treatment remains supportive care, with monitoring of oxygen levels at home to make sure they remain above 92%. Shortness of breath is still the most urgent symptom to send patients to the hospital for further evaluation. If you are aged 65 or older, or have a BMI over 25 and you contract COVID, you may be eligible for an outpatient monoclonal antibody infusion. A doctor’s order is required to receive monoclonal antibodies at several infusion centers nearby, including Inova. Please note that the available data does NOT support the use of steroids, ivermectin, hydroxychloroquine, high dose Vitamin C infusions, or other drugs in the outpatient setting. Antibiotics can help a secondary bacterial infection if one develops.

Summary

In summary, The Delta variant SARS-CoV-2 virus has taken COVID-19 to a different level. It is spreading fast and can be life-threatening, particularly to those who aren’t vaccinated. It’s important to note that the vaccines continue to be effective against serious illness and death. Perhaps the biggest lesson we have learned in the past few months is that vaccines WORK. They keep people safe from severe illness. If you have not yet been vaccinated, I strongly urge you to get your “Fauci Ouchies.”

Boosters are now recommended starting immediately for those with serious autoimmune issues, and after September 20th for other vaccinated individuals.

Please continue to wear a mask, avoid indoor crowds, and stay current on vaccines!
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