I believe that medicine’s potential is much more than the version we see in the world today. A doctor should be an educator with the goal of bringing patients to a place of deeper understanding of who they are in the world. To me, medicine is ultimately about self-empowerment through self-knowledge and growth.
There’s a lot going on! We have a long friday bulletin for you where we talk about:
Delta and Lambda variants
Testing for immunity
We can start with the Delta Blues.
No, I’m not talking about the Mississippi Delta Blues,
although a little background music would be welcome.
Covid-19 and the Delta variant has brought a spike to the Berkshires. 2 weeks ago we had 20 cases; 1 week ago 44 cases. This week we have 124 cases. Cases at our local hospital are starting to rise again, mildly at this point. There have been 2 recent deaths, both in vaccinated individuals. Today I will make the case that taking extra precautions is warranted due to evidence of 1) waning vaccine efficacy and 2) increased variant contagiousness.
National 7 day averages are up to nearly 100k new cases per day.
Three states account for roughly 40% of the infections in the country, with Florida alone seeing 20% of new COVID cases nationwide.
Notable International news
Much of the world is confronting the Delta wave in some form or another. The head of Japan’s medical association called for a national state of emergencyand its Prime Minister said only seriously ill COVID patents and those on the verge of becoming so would be hospitalized. It’s not a great scenario for the Olympic Games.
The vaccine works against Delta, right?
Short answer: Yes (there is evidence of protection from severe cases but not without limits). Breakthrough cases are rising because the vaccine is showing us that its protection wanes.
Israel’s Health Ministry last week released data suggesting that people vaccinated (Pfizer) in January had just 16 percent protection against infection now, while in those vaccinated in Aprilthe effectiveness was at 75 percent.
Breakthrough infections were responsible for three-quarters of COVID-19 cases in an outbreak during large public gatherings on Cape Cod, and nearly all sequenced cases were the Delta variant, researchers found.
Of 469 cases linked to multiple summer events and large summer gatherings in Provincetown, 346 (74%) occurred in fully vaccinated people, and almost 80% of those cases were symptomatic, reported the Massachusetts Department of Public Health.
Locally in the Berkshires, 47 residents and 10 staff members were positive for COVID-19 at the North Adams Commons Nursing Home. The majority of the cases are among vaccinated people. Four have been hospitalized so far.
Data on breakthrough cases in the US might not be as strong as studies coming out of Israel and elsewhere because the CDC stopped tracking breakthrough infections starting May 1, 2021, unless such cases result in hospitalization or death, because the breakthrough infections had typically been so mild. For CDC tracking purposes, a mild case of COVID-19 after vaccination is not considered a “breakthrough infection.” In any case, evidence is mounting that adjustments are needed.
What about checking a lab test?
Can Antibody testing help?
The CDC warns against checking for immunity with the lab tests because existing testing is neither sensitive nor specific to prove immunity.
So what are the Symptoms now?
Research from Britain on symptom tracking released on June 23, by which point the Delta variant had become dominant in the U.K., showed slight differences in symptoms between unvaccinated and vaccinated patients — and in some cases, even between those with one shot versus two.
There were three symptoms all patients commonly reported, no matter their vaccination status: headache, runny nose, and a sore throat were the top symptoms among vaccinated people, partially vaccinated people, and unvaccinated people. But beyond that, things diverged. For example, unvaccinated patients were more likely to report a fever, while patients who’d been vaccinated, whether partially or fully, were more likely to report sneezing. Additionally, patients who hadn’t gotten vaccinated and those with only one shot reported a persistent cough more often than fully vaccinated people. Interestingly, fully vaccinated patients were the only group who regularly experienced a loss of smell in their top five symptoms.
In any case, adjustments should be made. One idea is to lay low if you can while the wave passes. And people expect the wave to pass.Remember the Rule of three’s. Use two out of three interventions to ensure low exposure:
well ventilated environment,
wearing a mask.
Workplace adjustments are likely warranted depending on your situation.
Dr Fauci has joined the ranks of experts anticipating a fast peak from this surge of cases. Laying low is best for the short run, especially if this is going to be fast and furious. Nobody sprints a marathon. Sprinters empty their reserve and flame out in short order. That’s how I see the Delta variant (a nice Olympics metaphor for you).
If India and the UK provide the expected precedent we should do the same. Massachusetts climbed up to 1000 cases per day and now is under 700. Have we peaked already?
I thinks it’s rather remarkable that these experts are being vocal about expecting a drop soon. I don’t see any clear sign that we are peaking nationally. These guys don’t say things like that unless there is some certainty about it. There are also not in the business of reassurance. Their main approach to ensure the population is vaccinated is to emphasize the data that we are at risk. So this discussion of an expected drop is notable.
And now on to the big question: Roosters
Sorry for the typo. I meant Boosters.
There are lots of questions circulating about vaccine boosters.
Laboratory data shared by Pfizer suggest a third “booster” dose of vaccine could offer more protection against the Delta variant.
Israel approved a third shot of Pfizer’s COVID-19 vaccine for citizens over 60 years of age.
Germany, France, and the U.K. — have pulled the trigger on booster doses, especially for more vulnerable populations.
WHO says no to boosters because of disparity globally. Why pack on a third with unclear benefit when many haven’t received one?
Right now the emphasis domestically is still on the people who haven’t been vaccinated to get fully vaccinated.
Regardless, I predict boosters are coming.
There are very small studies but it does appear that the boosters increase the antibodies and protection.
Most experts are recommending to wait for now although I’m hearing that there are at least a small number of people who have sought them out and received a booster in advance of official policy.
Many experts are pointing to safety concerns over the booster. We have to be mindful there are side effects to the vaccines and we don’t have information yet on what risks might come with the boosters.
My advice is to use the rule of three’s and wait for official guidelines.
What about Lambda?
In June, the World Health Organization declared the Lambda variant, which emerged in Peru in August 2020 and has been recorded in cases in Texas and South Carolina, as a “variant of interest.”
There is no consensus yet on what it might bring, but a Japanese preprint study suggesting the vaccines don’t protect against Lambda has raised eyebrows. Other scientists are seeing it as being similar to alpha, which was not a doomsday scenario.
Give me something so I can sleep at night.
For one thing, there are no signs that natural immunity is waning. In fact, data from the 2004 SARS outbreak has shown that evidence of natural immunity spans to the present day.
Furthermore, there have been a lot more cases in the States and the world than the official tally. A lot more. An ex FDA Commissioner estimates that now there are likely a million cases per day or more even though there are 50,000 -100,000 being captured. This has been the situation all along. How many million case days does it take for the virus to burn out its reservoir?
Plus we are always working on things. A company in Sweden is working to develop an inhaled version of the COVID vaccine, which may be able to circumvent the “cold chain” needed by injectable versions. We are going to get there. I promise. And actually in the big scheme of things we have already arrived. We have all we need to make today a really good day.