COVID ROARS BACK!

COVID ROARS BACK!

Personal Journal of a Health Reporter

The CDC has changed its tune: MASK UP!  Coronavirus SARS-CoV-2 is back as the dreaded Delta Variant.  As for the CDC, what took you so long?

On July 7 the World Health Organization posted an urgent message, shared on YouTube, that SARS-CoV-2 infections were again on the rise.  On July 9, the Parkchester Times posted that warning to our "Videos" section.

As my family sat down to dinner Thursday, July 15 my eldest daughter Kathryn, visiting from LA, became distracted by messages on her phone.  When she looked up, she informed us, "Five of my VACCINATED friends in LA just tested positive for COVID; four of them in the last 48 hours."  Here are the facts in Kathryn's words:

Two weeks ago, 6 different people I know personally in the LA area tested positive for COVID and were all very sick with symptoms (not in need of hospitalization, thank goodness). 2 of them were COVID long-haulers who were still suffering from long term symptoms a year after their first round of COVID in May 2020, and all 6 were fully vaccinated with 2 dose vaccines (not J&J). They all had the Delta Variant.

Of those 6, 1/2 of them (3 ppl) got it the same night at the same event and I've heard at least 4 other people I don't know personally (friends of friends) also got it that night.

This is all anecdotal.  At the time the CDC was still saying how rare breakthrough cases were amongst the fully vaccinated even for the delta variant, and that breakthrough cases are typically mild.  That may be true statistically, but it certainly feels different emotionally when you know 6 people in your friend group alone and 4+ friends of friends all sick despite being vaccinated.

That same day, July 15, Los Angeles County announced it was re-imposing indoor mask mandates for everyone, vaccinated or not, beginning Sunday, July 18.  Said the Los Angeles Times:

The latest order not only puts the county further at odds with both the California Department of Public Health and the U.S. Centers for Disease Control and Prevention — both of which continue to maintain that vaccinated people need not cover their faces indoors — but puts officials in the precarious position of asking the inoculated to forfeit one of the benefits recently enjoyed.

That night I emailed Dr. Marc Rendell of Los Angeles, to see what he could tell me.  He responded the next day (July 16):

The British situation is showing that vaccinated people do catch SARS-CoV-2.   As far as the protection from severe disease, that remains to be seen in the large population studies now proceeding in the UK and Israel.  Most people with Covid-2 manifest nothing more than common cold symptoms, with or without vaccination.   It is the older patients who tend to have the bad breakthrough results.

In the week that followed, information continued to come from Israel suggesting vaccinated people were being infected with the Delta Variant, and that some were getting sick.  Meanwhile, infections continued to rise, across the United States and around the world.  On July 19, the American Academy of Pediatrics recommended universal masking in schools.  Dr. Daniel Griffin discussed that recommendation on This Week in Virology July, 23, which we posted to our Videos section July 24.  Yet the CDC continued to recommend a double-standard with respect to indoor mask wearing: that it apply to unvaccinated persons only, and continued to refer to the increased infection rate as a "pandemic of the unvaccinated."  It wasn't until the Washington Post obtained and published an internal CDC slide presentation on Thursday, July 29, that the CDC published a Massachusetts study in the its Mortality and Morbidity Weekly Report of Friday, July 30, and along with it updated its recommendation.  In an abrupt turnabout, the CDC now recommends that indoor mask wearing apply to vaccinated as well as unvaccinated Americans.

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In the United States as a whole, from June 21, 2021 to July 30, 2021, daily COVID cases jumped from 8433 to 101,171, an increase of 1200%.

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The trend in California data is similar for the same time period, with quirks in recent data.

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Here in New York City, we're up 1000% - a tenfold increase.

A little nomenclature: there's a distinction to be made between SARS-CoV-2 infection and COVID-19 disease.  There are also various measures of how much virus is in a person's system - Ct value if it's from a nasal swab, viremia if it's measuring virus in a person's blood.  Doctors may quibble about the meaning of terms like "transmissible."  The bottom line concerning the Delta Variant is likely NOT that it moves through the air any differently than "wild type" SARS-CoV-2 or other variants, but that it replicates faster inside the human body.  Most people's immune systems are ultimately able to put an end to virus replication, but there are differences in the speed with which people's immune systems are able to mobilize and get the job done.  Older people's immune response tends to be slower.  Vaccinated people's immune systems will be faster, in general, than persons whose immune systems have not been trained to target the SARS-CoV-2 virus by a vaccine.  This is the case even if their antibody level has waned; an ability referred to as "immunological memory" and generally associated with white blood cells, especially T and B cells.  By being FAST TO REPLICATE (because it is fast to gain entry to our cells), the Delta Variant can reach higher populations (viral loads) BEFORE a person feels any symptoms.  This is especially true in one's nose and sinuses (and connected organs such as eyes and inner ears) even in vaccinated people, making them contagious pre-symptoms.

So the Delta Variant is FAST, and, like previous SARS-CoV-2 variants, has ways of tripping up signaling among the cells that initiate the immune response.  As SARS-CoV-2 gains entry to cells and utilizes their systems to replicate, it's also disrupting, sending ripples that become a tsunami of effects across the sea of chemical reactions and transformations that signal other cells, so that even when the virus is gone, those waves of dysregulation continue to propagate, leading to severe COVID-19 disease.

The bottom line is: we need to be fast, too.  Fast to adjust to this new reality.  Fast to approve at least one of the vaccines that currently have only emergency use authorization so our leaders can stop the two-faced doubletalk and make a clear recommendation concerning vaccination requirements.  Fast to grant an EUA to the NovaVax vaccine and address that company's supply chain issues, fast to implement fast-track testing of that vaccine in children and teens in case it proves safer than the mRNA type, and fast to identify and supply people with treatment taken at home, before a choice must be made to hospitalize them.

There's more to be said.  We will do our best in the coming days to bring you real information and insights.