Summer optimism wilts as contagious Delta variant rages in unvaccinated

cdcjanjuly21covidcases-300x180The sunny optimism that the coronavirus pandemic might finally be quelled is fading as fast as a two-scoop ice cream cone in the summer swelter.

The stark rise of the Delta variant, with its fast-surging infections, hospitalizations, and deaths, has reminded experts and the public of the pandemic’s gravity, as well as its ability to not just sustain but to mutate rapidly and require quick-changing responses.

Officials across the county are urging people anew to cover their faces indoors, distance, and, for heaven’s sake, to get vaccinated if they have not done so already. Maybe the unvaccinated could be paid $100 by states from coronavirus relief funds to get the shots, President Biden has suggested.

The federal government, as decided by Biden, will take a lead in shoving the reluctant or resistant to get shots, pronto, requiring millions of U.S. workers to undergo regular and extensive virus testing, face covering, and distancing if they will not.

Biden initially deferred to the Pentagon on vaccination and other public health measures for its forces. The top brass has said it, too, largely will follow requirements for other U.S. workers, requiring military and civilian personnel to “attest to their vaccination status,” reported the Washington Post, which announced a vaccine mandate for its staff. “Those unable or unwilling to take that step will have to wear masks, socially distance and undergo regular coronavirus testing …Their travel will also be restricted.”

That’s the tougher tactic adopted in similar ways, too, by governments in California, New York, and the city of Los Angeles, as well as tech giants like Google, Facebook, and Netflix.

Consensus builds for vaccination mandate in health care

More than 60 of the nation’s largest, best-known, and influential health care professional societies and organizations signed on to a joint call for “all health care employers to require their employees to be vaccinated.”

The organizations endorsing a vaccine mandate for health workers included the American Medical Association, American Nurses Association, American Academy of Pediatrics, Association of American Medical Colleges, and National Association for Home Care and Hospice.

“Do no harm is a core ethic for all those who care for the sick and injured. I think that physicians and, frankly, all those working in the health care system, have a fundamental obligation to patients by getting vaccinated for preventable diseases such as Covid-19,” said Audiey Kao, MD, PhD, the AMA’s vice president of ethics.

Despite the outcries the moves provoked — yet again — officials across the country are reinstituting public health measures calling for people to cover their faces indoors and distance, especially in the growing areas, including the District of Columbia, where the Delta variant is causing high community spread. The CDC has shifted on face coverings for kids returning to schools, now urging educators to require them for youngsters returning to in person classes in just a few weeks.

The mask rules, including in the Disney theme parks, set off a protesting vocal minority once more, and initially provoked consternation and confusion. The Centers for Disease Control and Prevention, which hasn’t won notice for its clear communication, eventually retook the conversation about the seriousness with which the public should regard the latest pandemic surge.

The agency did so, by explaining the virulence of the Delta variant and the growing peril of the coronavirus’ startling, speedy mutation.

Vaccines, for now, offer high protection against Delta and other variants. But the world also may be a mutation or two away from a coronavirus strain against which the novel, existing immunizations cannot protect, the CDC warned. It is dangerous for so many people to be unvaccinated and for the Delta variant to rip through this large and unprotected population, which also is serving as a mutant breeding ground.

Doubters about renewed face covering rules, while noisy at first, also may be seeing facts quiet their evidence-free whining. The CDC is seeking to rebut the anti-science crowd by underscoring the increasing information about the Delta variant’s perils to public health.

Causes for rising official concern

The strain, experts say, appears to be more transmissible than other strains. It appears to carry with it high viral loads, which make it both more infectious and to cause more severe illness in the infected.

While “breakthrough” cases remain rare and the vaccine offers high protection, Delta infections are occurring among the vaccinated. The CDC has estimated that 35,000 vaccinated people a week in the United States are having symptomatic breakthrough infections out of a vaccinated population of more than 162 million.  Delta appears to be as contagious as chicken pox, and, in the few instances where the vaccinated contract it, they carry sizable loads of the virus and can spread it far too readily.

Experts increasing knowledge about the Delta variant, its transmission, and harms has pushed officials quickly to increase precautions significantly, including with face covering rules. They appear to have been startled in part by an outbreak that started around Independence Day among party-hearty denizens of Providence, Mass. More than 900 cases have been linked to individuals engaging in extensive indoor and outdoor contacts, with researchers scrutinizing just under half the affected and gathering detailed information from them.

The big takeaway: The Delta strain tore through the vaccinated, as well as the unvaccinated, as the newspaper reported of a previously undisclosed internal CDC report:

“About three-quarters of infections occurred in people who were fully vaccinated, and that group had received vaccines from Pfizer-BioNTech, Moderna and Johnson & Johnson. Scientists at the Broad Institute of MIT and Harvard, a research institute in Cambridge, Mass., involved in the genetic analysis of the outbreak highlighted that this was not a single event. At least five events sparked the outbreak, so it is not possible to blame it on one party or one bar. ‘There’s no one person or spot to blame here,’ said Daniel Park, group leader for viral computational genomics at the Broad Institute. ‘The thing that’s catching the attention in national public health is that you can have these types of events; there’s no one particular bar that did any worse than another. Simply mixing that many people in one place with delta going around, with a decently high vaccination rate isn’t quite enough.

“The scientists, along with officials at the Massachusetts Department of Public Health, reported that 79% percent of vaccinated breakthrough infections were symptomatic. Four of five people who were hospitalized were fully vaccinated. They are analyzing the genetic fingerprints of the virus samples taken now to trace chains of transmission and determine how commonly fully vaccinated people were infecting one another. The presence of similar amounts of virus in the noses of vaccinated and unvaccinated people raises the possibility they are both contributing to spread, but many scientists think that vaccinated people should be less likely to spread the virus. Similar findings may be emerging from other locations.”

Not good. Especially considering the much-watched pandemic metrics: The nation is averaging ~70,00 diagnosed coronavirus cases daily, the New York Times reported, noting:

“The national outlook is worsening quickly, with a fourfold increase in new cases per day over the last month. Hospitalizations and deaths are also growing, but at far lower rates than cases. Cases, hospitalizations, and deaths remain well below peak levels, and the three approved vaccines remain effective against the virus. About 97% of hospitalized coronavirus patients have not been vaccinated. Every state is reporting significant case growth, but the latest surge has been driven largely by severe outbreaks in a handful of states … The highly infectious Delta variant has caused huge spikes in cases in MissouriArkansasLouisiana, and Florida. Louisiana, which was averaging fewer than 400 cases a day at the start of July, is now reporting more than 2,400 cases a day, the most since January. The county that includes Jacksonville, Fla., is averaging more than 900 cases a day.”

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damages that can be inflicted on them by an array of awful circumstances and things, including:

In these cases, a crowd of problem people and institutions — these can include doctors, hospitals, insurers, regulators, and politicians — may press victims to move on, settle up, and they fast forget the lonely agony of the suffering. It can, however, take a long time for patients to recover from terrible illness or injury. Harms can last a lifetime. Patients may need medical services, as well as financial and other support for months or years. They also need closure and justice for wrongs done, as well as the sense that they may be able to help others avoid the problems that afflicted them.

We are not done with the coronavirus and the huge trauma it has inflicted on us all. Please get vaccinated. All medical interventions carry risk. But vaccines’ benefits long have been shown to far outweigh their harms.

It also is becoming harder and harder to fathom why anyone would want to put themselves, their loved ones, colleagues, and communities at such high peril by not getting vaccinated now.

Unconvinced? Read yet more about researchers worry that all too common “long” covid cases may heighten these patients’ risk for the debilitating and scary cognitive decline of dementia and its most common form of Alzheimer’s disease. Or how the virus may damage male potency. Ugh.

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