As the Delta variant gains traction in the United States, Kyle Allred, PA, and Professor Roger Seheult, MD, discuss important questions about COVID-19 and the latest research on this highly transmissible mutation.
Top 10 COVID-19 Delta Variant Questions & How To Prepare
In our latest MedCram update, Kyle and Dr. Seheult cover the most common questions about the Delta variant, ranging from immunity and long-COVID symptoms in vaccinated versus naturally immune populations, to the Delta variant and the challenges it poses to younger patients. They also answer specific questions about vaccines for children, the latest treatment and testing strategies, and how to protect ourselves and our communities from future COVID-19 variants.
Watch the full interview here, listen to it on our podcast, or read the transcript below.
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Kyle: Dr. Seheult, I’ve gathered 10 important questions about the delta variant, starting with: for people who have been fully vaccinated or already had COVID-19, how worried should they be about the delta variant?
Dr. Seheult: Good question, Kyle. So let’s tackle the first part of that question, which is those that have been vaccinated in terms of the delta variant. So in comparison to those who have been vaccinated, people who have not been vaccinated have about an eight-fold increased risk of coming down with SARS-CoV-2 delta variant, and when we talk about hospitalization, which is the big problem of course with the cytokine storm and the pneumonia, the risk drops 25-fold for those that have been vaccinated against those that have been not vaccinated.
So there is quite a bit of a difference now that’s not as big as it used to be before the delta variant, but it still holds that. And so in terms of worrying about it, I would not worry if you’re vaccinated. Now, there has been a little bit of a reduction in the ability of the vaccines to prevent infection and we’re seeing more and more of that, but, again, that is an eightfold improvement over not being vaccinated.
Now let’s get to the second part of your question, and that is related to those that have been infected previously. Now, we did a video on this and we went through the data that was published recently in Nature that showed that people who have had a 12-month history since their first infection with SARS-CoV-2 had reduced effectiveness of their antibodies against the delta variant.
Now, if we were not talking about the delta variant, we would be able to say that based on the data coming out of the Cleveland Clinic that there really is no difference between those that are vaccinated and those that have been previously infected. But the delta variant has actually changed that, we believe, based on at least some of this data that’s coming out on antibodies, albeit that antibodies aren’t the end-all-be-all of immunity. There’s T cells and B cells. We don’t have all the data yet for those that have been infected previously with COVID-19 non-delta variant, but the data seems to indicate that there may be a reduction in the immunity of those that have had SARS-CoV-2 in the past against the delta variant.
Kyle: You mentioned a waning immunity with time for people who have previously had COVID-19, and we know that that is happening as well at least with regards to antibodies for people that have been fully vaccinated. So there’s more and more discussion about getting a booster dose of the currently available vaccines, especially for people that have an underlying medical condition or immunocompromised. What are your thoughts on getting a booster shot at this time?
Dr. Seheult: Good question. So if we look at the mRNA vaccines, right after they got the vaccination, after the second dose, there was a 90-plus percent protection or efficacy against SARS-CoV-2, and that has gone down into the mid-80s based on the most recent study that looked at it six months after vaccination. So, it’s a very modest reduction in terms of just time.
That being said, some things have changed in the last six months. Not only are we not dealing with the same old SARS-CoV-2 virus, in fact, we’re dealing with the delta variant. Two variables that we’re looking at: number one, has there been a reduction in immunity over time, and is the reduction in immunity just because of time, or is it because of the new variant?
And so we’ve looked at that and we’ve done actually a video looking at the delta variant and vaccines. And what we’ve shown is two very different endpoints. Number one, how the vaccines prevent infections, which is important from epidemiological and also from just catching the disease and spreading it to somebody else. And number two is how do the vaccines prevent hospitalizations and death?
So let’s first of all tackle the infection, which is a very high bar. So what we’ve seen against the delta variant is that there’s been a reduction from about 80, 90 percent down to about 70 percent. Now that’s not zero percent, but that is a smallest reduction from ninety percent to seventy percent. As we’ve said before there’s about an eightfold difference in terms of those that have been vaccinated against those that have not been vaccinated.
When we look now at the second endpoint, which is hospitalization, that has maintained a very good efficacy of over 90 percent, at least in the mRNA vaccines at preventing hospitalization and so there’s this question about decline in immunity and whether or not we need a booster at this point. A third shot of the same vaccine is probably just going to give us higher antibody levels against the same type of SARS-CoV-2 wild-type infection that we had months ago.
What I think we actually need and what a lot of experts are requesting and looking for and what the vaccine companies are working on is getting a third dose that is actually targeted against the variants of concern, like the delta variant. In fact, the WHO has come out and said, you know, instead of using these vaccines to give a third dose to people who already have fairly good immunity, let’s give it to those countries that have not been able to get their population’s vaccination rate up, and so that can prevent further infections and of course further infections will prevent the generation of further variants of concern.
Kyle: Will there continue to be more and more variants, potentially even variants more challenging than the delta variant?
Dr. Seheult: Yes, I think there will be and there may be already, and so we can look at the lambda variant which is down in South America. And anywhere there are raging infections going on, you’re going to increase the risk of a variant being produced in a population that is a variant of concern. Let’s remember that when an individual is infected with the virus, that individual can make up to a billion, even a trillion copies of the virus, and in some of these outbreaks like we had in India, there was 400,000 people a day becoming infected. So you put those together, and you can see very easily that when the virus is not very good at replicating itself perfectly, you’re going to get variants.
Now most of those variants are not going to be variants of concern; they’re going to be mutations that render it ineffective and so forth. But every once in a while, you’re going to get a variant that hits it on the nail, that becomes more infectious, more contagious, more able to put people into the hospital, like we’re seeing here with the delta variant, and perhaps even so with the lambda variant, which is in South America. And so yeah, this is going to happen. In fact, it’s possible, let’s just say that with the delta variant waning — that’s right, the delta variant going down in places like the like India and also in the UK — that the delta variant, depending on what we do here in this country, and we’ll talk more about that, we might be able to see the delta variants starting to come down again even before we head into winter of this year. Some experts are saying that that is certainly within the realm of potential. Who knows what type of variant we’re going to have this winter, so stay tuned.
Kyle: You mentioned that these so-called breakthrough infections for people that are fully vaccinated are relatively rare, but if someone is fully vaccinated and they get COVID, presumably with a delta variant, if you’re in the United States, is long COVID, these long-term COVID symptoms, still occurring in people with these breakthrough infections after they’re fully vaccinated?
Dr. Seheult: Yeah, they can, and actually there was a study that was published in Israel back when the alpha variant was the the main predominant variant, and in there, these healthcare workers who are exposed on a daily basis to COVID-19, SARS-CoV-2 virus, three percent of them, despite being vaccinated, three percent contracted COVID-19. And about one in five of those three percent develop symptoms that lasted beyond six weeks. Now the definition of long-COVID is actually 12 weeks, but the six-week period of time was enough for them to be concerned about long-COVID.
Kyle: When do you think this delta wave or surge is going to peak, and what can we learn from other countries that have already reached their peak with delta variant cases and are now coming back down?
Dr. Seheult: Well, a lot of scientists have put forth their propositions, in terms of when this delta peak or this delta wave peak is going to happen. And it’s going to start to come down but nobody really knows for sure. I mean, they’ve had some models and none of the models really have pinpointed the previous peaks that we’ve had, so nobody really knows. There’s a lot of variables that go into it and this is basically how it goes.
The first thing, though, I would say is to really understand this, you really have to understand exponential mathematics. And to sort of give you an idea about how our brains are not really tied in to think exponentially, let me give you this example. Suppose, I gave you an option of a million dollars today or I give you a penny today, and every day, the next day I gave you twice as much as I gave you the day before for 30 days. Which one would you choose?
So a million dollars, or a penny tomorrow, two pennies the next day, four pennies the next day, eight pennies, and the guy who gets a million dollars goes and buys a house and that seems perfectly legitimate, but the guy who gets a penny and knows that for the next 30 days he’s going to get double that, goes out and buys a house, a boat, a car, and you’re like “what?” You’re crazy right? Because at the end of that first week he’s only going to have, what, 64 cents? And then after that maybe a few hundred dollars, and then maybe after that third week only maybe ten thousand dollars. But the law of doubling tells you that by the end of 30 days, just on that 30th day alone, we’ll be paying him over 5 million dollars.
And the key here is that the numbers get big late, and that’s the key point when you have to understand how the virus replicates and how you have exponential growth is that we don’t want to get to that point, because once we get to that point, we only have 900 and some thousand acute care beds here in the United States and if we were to get to that point we would completely saturate our healthcare system. We wouldn’t be able to take care of anything else, let alone all of the COVID-19 cases, so we don’t want to get there and that’s why we have to institute things before we get there.
Now, what usually happens is people start to see problems. They start to see issues in the hospital and they change their behaviors, so they don’t go to the parties, they don’t have– they don’t go to the concert, they don’t meet with people, they have zoom meetings again, or they wear masks more effectively or more often. When you separate people from each other, the virus doesn’t replicate as well, and that’s really one of the keys in terms of when this peak will come and go. Ventilation as we talked about is also a key player at preventing the spread of the virus, but the third component is vaccination.
Now if you look at what happened in India, yes, there was a big delta wave. It went up and it came down. They didn’t have a lot of vaccinations in the country at the time, but that peak was pretty high. Look at the UK, they are now actually coming down from their delta variant peak, and in their country, they actually have a higher rate of vaccination than we do here in the United States. That plays into the calculations about when these peaks and troughs come. So it’s a complicated question. There’s no really good answer, Kyle.
The other thing I wanted to mention, as well, you know, we talk about vaccination. That’s really at this point for only people who are over the age of 12. What do we do for small children and school-age children, you know, if they come down with symptoms? One of the things that I think would be very beneficial, we have the technology now, is rapid testing, frequent testing, because we want them to go to school. We want them to get an education, and so if we’re able to simply isolate them when they are infected by the use of rapid testing, that could be very beneficial and use it as a focused way of preventing infections in school.
And Dr. Michael Minna, from the Harvard School of Public Health has talked about this as a potential way of keeping our schools open and letting our kids get to school and get the education that they so richly deserve.
Kyle: Are more children getting hospitalized with COVID-19 now that the delta variant is so prevalent in the United States?
Dr. Seheult: Yeah, and in this population of children, those are the ones that are least likely to need to be hospitalized or even die from the virus. But, yes, in the last week and we’re talking here at the beginning of August, in the last week, there’s been an 84 percent increase in the number of hospitalizations in children, that according to the American Academy of Pediatrics. Now coupled in with that, we’re also dealing with a spike on top of a delta spike, called Respiratory Syncytial Virus, or RSV, and we’re seeing that together with a lot of these patients as well. so that is part of the equation. Realize that anybody that’s under the age of 12 in the United States can’t currently get a vaccine. There’s no vaccine that’s been given emergency-use authorization for those children, so I guess if you wanted to see a clear picture of what would be happening right now if we didn’t have vaccines, you can look at that population, which is arguably the best protected population against the virus.
Kyle: And speaking of children, what do you think will happen this fall when kids go back to school and college campuses reopen?
Dr. Seheult: Yeah, so this ties into the previous question about what do we do with the peak? So it really depends on when the peak starts to come down, coupled with when children go back to school. I know that, for instance, in Canada, kids go back to school right after Labor Day, so that starts fairly early. There’s other college campuses that typically start later in September. There’s other private schools that start in August, so it’s sort of going to be a slow build up in the months of August and September. And if they go back to school and they’re not wearing masks, well that’s gonna indelibly allow for some transmission of the virus. But again, this is in a population of kids that are not typically the ones that end up hospitalized.
Now, if you look at that area there of school-aged children, going from college age, at the age of, let’s say, 20, going all the way down to school-aged kids in kindergarten or pre-kindergarten, down to the age of five, now vaccines are going to help the upper portion of that age group, but not the lower portion. So it’s going to be a mixed picture to see what happens. That mixed into it, there’s a lot of college campuses that are mandating or requiring college students that come on campus have to be vaccinated so that’s going to be an interesting variable in the equation. A lot of this stuff is going to be a wait and see, and there’s going to be a lot of debates about whether or not kids can go back to school and whether or not they should be wearing masks, and it’s a political question.
All of that is going to weigh in, and may either speed up or delay the delta variant peak. The attributes of a scientist is someone who looks at the data and makes a decision, and when the data changes, that decision changes as well. So we always have to be looking at the data, looking at the current situation, and then making policy that agrees with that. But, again, the people who make the policy are people who are elected.
Kyle: Dr. Seheult, you work in the ICU as a critical care physician, and you also see patients in your pulmonology clinic that have had COVID-19 and maybe dealing with long-term symptoms. Have treatment strategies, and testing strategies for that matter, changed at all in light of the delta variant?
Dr. Seheult: No, they haven’t. We are still using the same tests that we have been using for months. Now, those tests are just as good at detecting the delta variant as they are the non-delta variant, SARS-CoV-2 that we had at the beginning of the pandemic. What we are doing is we’re having the county health departments and other departments and other agencies testing through and, at random, looking at samples to see what the proportion in that population is of the delta variant and reporting it to us, so that we know how much of a chance that we are dealing with a delta variant in a given population.
Now, that being said, when you’re positive, it’s positive. We treat it exactly the same, and I might want to add here at this point that we at MedCram have been making videos that aid those physicians that maybe are not used to dealing with the intensive care unit who may be needed in a surge to brush up on how to use a ventilator in patients with COVID-19, how to use point of care ultrasound to be able to detect. Ultrasound is a great tool to have because when patients go into the CT scan you’ve got to do a deep clean on that CT scan before the next patient can come in, so you don’t transmit the virus that way. Ultrasound is very easy to clean, you can use it at point of care, right at the bedside, to see whether or not the patient has lung ailments that would require different types of treatment.
So there are a lot of different modalities and a lot of different things that we use in treatment of the patients on the floor and in the intensive care unit in the hospital. And those are still being looked at, still being studied, and I’m not aware of anything that would change in terms of the delta variant.
I will say this, however, is what we are seeing, because now we are having patients that are coming in that are typically not vaccinated and that’s been the majority of the patients that I’ve seen here currently and I am seeing patients coming into the intensive care unit. They are younger, they’re not vaccinated, you know, whereas before in January and February we saw the nursing home units clearing out and being admitted to the hospital. I have not seen any nursing home care units patients residents coming into the hospital. There’s a high vaccination rate in those facilities, so they’re younger, they’re not vaccinated. We’re seeing more patients without comorbidities and unfortunately what we’re also seeing is that these patients are declining in status more rapidly and dying more quickly on the ventilator or what not than patients that we saw back in January and February.
Kyle: And you think they’re declining more rapidly because the delta variant is just more virulent?
Dr. Seheult: Yeah, there’s some data that’s come out of the UK that seems to indicate that there’s a 1.85 times the risk of hospitalization just with the delta variant. Remember that the delta variant can multiply very abundantly in the mucosal tissue, and there seems to be higher viral load counts in these patients, and so you can imagine if there’s higher viral loads, they seem to have in more infected cells before they come in and therefore theoretically a higher cytokine storm. That hasn’t been proven yet with studies but it certainly follows the conclusions.
Kyle: Okay, last question for you. What can we do to protect ourselves to protect our communities from this delta variant moving forward?
Dr. Seheult: Well, we have to have a honest conversation with ourselves and put away all of the politics and all of the other things that come into this question and really see for ourselves, what is it that we can do to make sure that we’re protected and that our family members are protected as well? And as we said, because this is a virus, because it grows exponentially, we’re starting to see it in the community already. We start to look at, what are the things that make sense? So the people that really understand this are physicians, healthcare providers, because we see this on a first-hand basis in the hospital.
It’s interesting to note that the American medical association survey of physicians showed that 96 percent of physicians currently are vaccinated with an additional two percent of them considering to get it in the near future. That’s an extraordinary amount of vaccination in a population and it goes to speak to the efficacy. Now, it’s not denying that there are some people that just can’t get the vaccine, because of reactions that they have in the past, but what it is saying is let’s have a rational discussion about the risks and the benefits and make a decision based on that.
The other thing that we can do is where we can’t get vaccinations done, make sure that we have strategies in place, so that if the time comes and you are sick that you understand what it is that you need to do. So making sure you’re educated on this, and we have a video on MedCram called the “10 Tips If You Are COVID-19 Positive.” I’d encourage you to look at that, because it tells you what to do next.
Also, mask-wearing, things of this nature, distancing, making sure that we’re not spreading the disease unnecessarily, and doing things that are very simple, like opening up your window and allowing ventilation to occur to reduce the incidence of spreading the virus. These are all very inexpensive practical things that we can do, steps that we can take so that we all can have a hand in reducing the incidence of SARS-CoV-2 in our community.
Kyle: Well, Dr. Seheult, thank you as always for sharing your knowledge and your first-hand experience in the hospital with us, and look forward to talking with you again soon.
Dr. Seheult: Thanks, Kyle.