The Fourth Wave
I just reread my last two coronavirus updates, from mid-June and mid-July. Both were a bit Doomsday, I must say. Unfortunately, they were not Doomsday enough. On Friday, a report circulating around the Center for Disease Control over the last week, became public. Recent research from Provincetown, Massachusetts, conducted over the July 4th weekend, shows, through careful contact tracing from attendees of a Holiday gathering, that the Delta virus variant spreads from vaccinated individuals to the unvaccinated population about as efficiently as if both parties were unvaccinated. The virus is capable, even in vaccinated individuals, of setting up shop in the nasal passages and upper airways and making itself at home like your kid in the basement, who just returned from college. In vaccinated individuals, it has a hard time getting deeper into the respiratory system, which is a good thing. But the load of virus in the upper airways is such that it easily spreads to others. The duration of infectivity may be reduced in vaccinated vs unvaccinated people, this is still being sorted out.
The implications of this are not good news for our unvaccinated friends. Right now, most of us are walking around in the Giant, smelling the cantaloupes, and tasting the grapes like the pandemic never happened. After all, we are vaccinated. Unfortunately, we are likely spreading the virus too, infecting the old lady on the scooter down the aisle contemplating her purchase of Little Debbie’s cinnamon swirls. The CDC says that the Delta variant is as infectious as Chickenpox, which is more infectious than Smallpox, or Ebola.
Though I am as guilty as anyone of living the fantasy that this is all over, it’s not. We are living in the mixed analogy of a cesspool and a time bomb all in one. Unless you become a hermit and never leave your house and never let anyone in, you will likely transmit the virus, even if you are vaccinated. A serious mask like an KN95 or N95 may help decrease transmission, but that mask you were wearing earlier on with the big, simulated lips, likely won’t help much. If you are vaccinated, you are not likely to get sick and even less likely to die. But you are likely to spread the virus once you have come in contact with it.
This situation is reminiscent of the first day of Microbiology class in my second year of medical school. The professor, Dr. Eyler, began his lecture with these words: “Folks, we live in a film of feces, and that’s what this class is about.” Except now, and for the next several weeks, we will be living in a film of coronavirus, Delta variant.
The good news is that this may be over sooner than you think. In the next few weeks you will be able to wear one of three tee-shirts. 1)I’m vaccinated, 2) I survived Delta or 3) I’m dead. (You can wear the last one under your suit or dress at the funeral home) It is likely that by the Harvest Moon at the end of September, you will fit into one of the above categories. Herd immunity will be achieved. And this fourth wave will be over. Unless there is another variant on the horizon, resistant to the current vaccines, there will not likely be a winter resurgence, because we will all be immune from being vaccinated or infected, or we will be dead.
Now that’s Doomsday.
So should you change your daily routines because of the spreading of the Delta variant? This is a complex question, because there is tremendous regional variation in viral prevalence in different parts of the country. Maryland currently has a low but rising level of virus. The rate of change of viral prevalence in Florida seems to be doubling every day. Nationwide, cases have shot up from about 11,000 new cases per day in early July, to almost 80,000 now. The cases are likely grossly under reported because many vaccinated people carrying the virus are asymptomatic and are not getting tested.
In our office we are changing the recommendation on using masks, in response to the data that indicates vaccinated individuals can still transmit virus. Because some of the patients in our office are immunocompromised from receiving chemotherapy or other medications, it would be wise for everyone to wear a mask in the common areas of the waiting room and lab to avoid exposing them to virus. Once in the exam rooms, when you are with one of the staff or providers, if you are vaccinated and are comfortable removing your mask, that is ok. Consider purchasing a KN95 mask, which likely reduces transmission of the Delta variant more effectively than the decorative mask you were about to throw away.
As far as visits to the grocery store, etc., again current levels of virus are low in Maryland. All indications are this will change over the next few weeks. As the viral load increases, it would be a good idea to wear a mask in indoor public settings. I expect that we will see the other side of this infection curve in September, so the mask wearing this time should be short lived, as the population rapidly becomes immune. The appearance of a new, nastier variant could change all of this, but let’s hope that doesn’t happen.
As far as booster shots go, information emerging from Israel this week suggests that individuals over 60 who got vaccinated early on in January 2021, have less immunity than those that got vaccinated in March 2021 or later, due to the waning strength of the antibody response. Israel has started to administer booster shots to those over 60. The U.S. is likely to follow suit. Please do not try to get a booster shot yet. You will likely be turned down. Information about when you got the vaccine is in a database and is available to all the centers where they are administered. It is more important for the unvaccinated to get their first shot, than for you to get your third. We are living in interesting times, and things are likely to get more interesting over the next few weeks. Stay informed and follow local guidance that will emerge from the Maryland Department of Public Health. If you are not vaccinated at this point, attend your favorite religious service, virtually, and pray. If friends and family are not yet vaccinated, pray for them too.
Photo credit: Anu jain Rohatgi, The New Indian Express