Imperative: Avoiding Delta Strain COVID Contagion

"[Those infected with the COVID variants were for the most part youngerm less likely to have underlying health problems] but nonetheless had  higher crude risks of hospitalization and ICU admissions."

"It is remarkable that we detected a clear and significant elevated risk of uncommon delayed outcomes, such as death."

Canadian Medical Association Journal-published study authors

"Canada is battling a different pandemic from the one it faced in early 2020."

"The virus has become smarter and more dangerous, which means that we need to be smarter too."

"Perverse pandemic misinformation [has stoked vaccine hesitancy and vaccination refusal, jeopardizing hopes of achieving herd immunity]." 

"[Leaders in Alberta and Saskatchewan with high and rising COVID cases are facing critical care demands where both provinces' leaders] decided to disregard the cautions of scientists who warned of the dangers of VoCs (variants of concern), instead promising] the best summer ever."

Krsten Patrick, (interim) editor-in-chief, CMAJ editorial

"India had really done a great job of controlling COVID, and then all of a sudden they lost control, they had this massive explosion."

"Looking at the chaos that Delta wrought in India, we should probably have known that this is really bad."

"I think the experiece now, over and over in the pandemic, is when something blows up in one country or another, pay attention to what they're telling you."

"On top of that, when they [COVID variants] infect people, they're more likely to make people really sick. We see this across the lifespan. It's not like this is only 70-year-olds. When we see 40-year-olds die of this, 50-year-olds in the ICU in significant numbers, that's probably also a variant thing.":

"I don't think we'll be in this for another year. We are going to see seasonal epidemics of a very nasty coronavirus. But that's very different from a pandemic that takes down society."

Dr. David Fisman, epidemiologist, Dalla Lana School of Public Health, University of Toronto

Security guards and a heath-care worker wait for patients at the Women's College Hospital COVID-19 testing centre in Toronto. (THE CANADIAN PRESS / Frank Gunn)

 

The recently published study that appeared in the Canadian Medical Association Journal was the work of epidemiologists David Fisman and Ashleigh Tuite, both with the Della Lana School of Public Health at the University of Toronto. Their study confirms that COVID-19 variants while more contagious than the original Wuhan strain of the coronavirus are also responsible for making those infected more ill. And of those variants none is more infectious and certain to cause serious illness than the Delta strain.

The two researchers based their study on over 212,000 cases of COVID-19 recognized between February through to June in Ontario, finding higher risks of hospitalization, intensive care admissions and rates of death with 'variants of concern' (VoCs). People infected with the Alpha, Beta or Gamma variants were seen to be about 50 percent likelier to be hospitalized or to die in comparison to those who were infected with the original strain.

The risk of hospitalization with Delta turned out to be 108 percent higher, with intensive care admissions an alarming 235 percent higher, and shockingly, 133 percent higher death rates. Only 2.8 percent of the total cases in the study were attributed to Delta, currently the dominant strain in circulation. What has also been validated is that on average younger, less health-impacted individuals are being infected with the variants. On the other hand, vaccines succeeded in "undoubtedly blunt(ing)" variants' severity with 80 to 90 percent protection of dying from COVID, even if the vaccinated contracted COVID.

And even though vaccine-induced immunity is beginning to wane and their effects may turn out not to be as lasting as hoped for, they don't represent the sole factors "dimming the light at the end of the pandemic tunnel", explained out Kirsten Patrick, pointing to the tsunami of outright false information circulating in the general public on COVID and vaccinations. Most of those who ended up in critical care with COVID-19 are the unvaccinated.

The study by Drs.Fisman and Tuite has conclusions consistent with other studies out of England, Scotland and Singapore whose findings were also of higher risks of poor outcomes with the Delta variant infections. And the conclusions fit right in with India's experience with the coronavirus. As Dr. Fisman pointed out, the variants are more infectious so it becomes more difficult to control outbreaks and harder to control their spread. And with their greater infectiousness the numbers required to reach herd immunity soar.

To the present, an estimated 15 percent of eligible Canadians continue to decline vaccination. The Ontario study encompassed 212,326 people screened for variants who had tested positive for SARS-CoV-2. The mutations that resulted on part of the spike protein, more readily adhered to and entered human cells. On a more optimistic note, Dr.Fisman pointed out the down-trend of the number of people an infected individual infects and that deaths too caused by COVID are diminishing in total numbers.

The takeaway from the study of the Delta variant is that vaccinations should not be regarded as simply an altruistic choice that primarily keeps severe disease from spreading to older and more vulnerable populations.  Nathan Denette/The Canadian Press

Delta Scenarios

COVID-19 test    Mario Tama/Getty Images

"Will vaccines end the pandemic? [Yes], because, when I looked at the data the epidemiology in Israel, the U.K., the U.S., I said the countries that have vaccinated the most aggressively have seen the fastest declines in cases per day, and they were staying down."

"But this virus spreads so fast, and is so contagious that, if 20 percent of the population is not vaccinated that will be more than enough to keep this thing going, and give it the opportunity to keep mutating."

"What does it mean, on an individual basis, if  you've been vaccinated and we've got Delta around?"

"You still shouldn't get as sick as if you had no vaccine, so there's no doubt it's better to get vaccinated."

"You might not have a high viral load in your nose, and you might not spread ... but nobody knows their nasal viral load. Which is why I'm telling people,'Wear your mask for another few months, until we see what happens here'."

Rodney Russell, professor of immunology and virology, Memorial University

"In this vaccinated group [contracting COVID], we're seeing much milder disease. And this is going to be very much the norm for the next few months, or possibly years."

Tim Spector, epidemiologist, King's College London

"What is very different about those patients [seriously ill Delta COVID patients] is that, for the most part, they have been young people, and almost all of them, in our experience in Saskatchewan, have been unvaccinated folks."

"We have not seen a single patient land in the ICU who is double-dose vaccinated."

"[A future scenario where an asymptomatic spread continues for four to eight weeks then a not-so-silent spread] and we will have the nucleus of the fourth wave. I think we do need to understand that's going to happen; we need to make sure that we continue to be cautious."

"This fall is not a reason to double down on public health measures -- certainly, I think most relaxations of public health measures are appropriate."

"This is more of a warning to double down on the efforts to vaccinate."

Dr. Hassan Masri, critical care and ICU specialist, Saskatoon

Tourists crowd in to the Midway Geyser Basin on July 14, at Yellowstone National Park in Wyoming. Yellowstone is one of many national parks seeing record numbers of visitors this summer, even as coronavirus cases are rising in many states. Natalie Behring/Getty Images

The hope pinned on vaccines coming to the rescue, that once the majority of a population received their double dose of vaccine, the pandemic would recede and just politely pass into history doesn't appear after all, to be loyal to the premise. What was assumed just over a month ago when medical science proclaimed itself timidly satisfied that the threat volume had passed; saved once again by the ingenuity of medical science, nature intervened to teach humanity yet another lesson: It isn't over until it's over.

The trio named the "Three Big Vaccinators" have gone from resounding success in defeating the SARS-CoV-2 virus to a sad comeuppance. Thinking they'd cleared the deck of further threat, relaxation orders went into effect; the population in the U.K., Israel and U.S. celebrated wildly at the prospect of a return to freedom from care over the predation of a nasty, killing virus. And then, precipitously, everything changed as a resurgence of COVID arrived courtesy of the Delta variant.

The mutation first recognized in India in the fall of last year now represents the most dominant strain on the globe. Its contagion level has hastened infection even as the world has made a strenuous effort to build mass immunity through inoculations. Without "really, really high immunity, there's going to be a tonne of virus in the population", warned Dr. Russell. Cognizant of the percentage of populations remaining vaccine-hesitant and others vaccine-hostile.

Those who have been vaccinated and still contract COVID (breakthrough infections) are not seen to be occurring at breakneck speed; vaccinating deters the virus from taking hold and when the virus does infect, its affect is significantly less impactful. No vaccine offers full protection, the vaccinated infected have a much lower rate of serious disease and much, much lower threat of death from COVID.

Confirmed cases per million in Britain are "pretty high up compared to those around us", said epidemiologist Tim Spector, where two-thirds of adults have been given two doses of an approved vaccine.The rolling seven-day average just before the July 19 "Freedom Day" was over four times higher than a month earlier, with Britain reporting over 48 thousand new cases at week's end with hospitalizations increasing over 42 percent in a single week.

Spain, Portugal, Greece and the Netherlands are seeing rebounds possibly attributable to "the very special properties of the Delta virus" which has the capacity to stick to human cells far more effectively than the original virus. The situation has seen Israel reinstate indoor mask rules, while in the U.S., an increase of 70 percent over the previous weeks has been seen in confirmed COVID cases, with deaths 26 percent higher. Where poor vaccine uptake occurred outbreaks have risen significantly.

COVID post-vaccination resembles the symptoms of a bad cold, with runny nose, headaches, sneezing and sore throat. When loss of smell is involved it is more of a recognized symptom linked to COVID. The unvaccinated are clearly at risk of becoming infected and becoming ill. "This is becoming a pandemic of the unvaccinated", stated U.S. Centers for Disease Control and Prevention Director Dr. Rochelle Walensky.

French research supports the case for a second dose. Samples of blood taken from individuals given one dose of Pfizer or AstraZeneca "barely inhibited" Delta. Two doses, on the other hand, generated a neutralizing response for 95 percent of test subjects. 

Experts believe that the Delta variant, which was first detected in India, is far more contagious than the virus that tore through the world in 2020.   Photograph by Raj K Raj / Hindustan Times / Getty

Locating the Next COVID Variant Outbreak

"[Delta is] the next scariest variant that is worrying people [all the more so that most people in Ontario received only a single dose of inoculation against the SARS-CoV-2 virus]."

"There is a lot of pressure [to complete the test], but, at the end of the day, we want to make sure it works. We have to balance the time pressure with the quality and reliability of the test."

"Scientists, we have very few eureka moments and I guess that's one of them [testing community wastewater for the presence of COVID]."

"A million-dollar question right now in the field is trying to correlate the case numbers in the city or any surveyed area with the wastewater signal, and we still don't really have a good idea of how to do that."

"I think at this point in time, [it] is not a question of if it's going to happen. It's a question of when and so the earlier we can get this information into the hands of public health officials, the better."  

Tyson Graber, research cell biologist, Children's Hospital of Eastern Ontario

Scientists at the CHEO Research Institute in Ottawa say this is the first test in Canada that can detect the variant first reported in the U.K., using wastewater. (Francis Ferland/CBC)

The World Health Organization, in a bid to move identification of viruses away from the geographic location in which they originally surfaced has now resorted to renaming the U.K., India, Brazil, South Africa variants with the letters of the Greek alphabet to make them neutral in character. Dr.Graber and other researchers are working frantically in the creation of tests to track the latest variants of concern, to be found in municipal wastewater in an expanding move to more fully understand how the viruses causing COVID-19 mutates.

Funding has just been made available to the project out of CHEO and the University of Guelph, to financially support the research on testing potentials. The funding has come out of Genome Canada, Ontario Genomics and Illumina for researchers working out of the University of Ottawa, Children's Hospital of Eastern Ontario, and the University of Guelph, collaborating on the project. It is vital to develop new and expanded testing for the purpose of measuring variants, and all the more critical that it be done as expeditiously as possible at a time when the variant that surfaced first in India, now known as Delta spreads in Ontario and elsewhere in the world.

It has proven to be more contagious than the U.K. variant (now identified as Alpha) which was responsible for the virulence of the third wave that pushed through Ontario, taking hospitals to the brink of operational collapse. The urgency to identify the presence of these viruses in wastewater increases in the face of the reality that the Delta variant is known to be more resistant to vaccines. One dose of vaccine offers merely 33 percent protection against this version of COVID-19 in comparison to the 50 percent protection against the Alpha variant.

 

Scientists are still working to develop a test that will detect variants first found in Brazil and South Africa using wastewater. (Francis Ferland/CBC)

 

An incomplete schematic of rates of variants is currently the reality reflecting the fact that only a small percentage of clinical samples in Ontario are sequenced in the bid to identify variants of concern. Wastewater surveillance increases knowledge of which variants are circulating and spreading. Delta has been found to be the dominant strain in the United Kingdom, at the present time. While in Ontario a small number of cases have surfaced.

 

Peel, the hardest hit region in southern Ontario, can expect the Delta variant to dominate within a month, according to its chief medical officer, Dr.Lawrence Loh. Who made his projection reliant on wastewater data leading him to the conclusion that in his region variant spread is a looming threat. Labs in Ontario will now be processing metagenetic wastewater testing, long done at the National Microbiology Lab in Winnipeg. 

 

The end function of wastewater monitoring is to identify potential outbreaks before they are diagnosed in people through clinical testing. This is the kind of testing that can give medical authorities a heads-up a week in advance of clinical tests verifying the presence of the COVID-19 virus or its variants. That heads-up can prepare the medical community to react before people develop symptoms, measuring as well infections in people without symptoms.

The additional research funding is meant to expand metagenetic testing to research centres across the province from the genetic sequencing currently done that can produce a picture of what to expect in regions of the province. Dr.Graber, who had previously developed a test to identify wastewater Alpha variant, is now focusing his team on like tests for Delta and the Brazil-surfaced variant now identified as Gamma.

Seriously Ill COVID Variant Pregnant Women

"There have never been this many pregnant women in ICU in the history of our country or our province. This is unprecedented."

"It is heartbreaking and terrifying. These are young, otherwise healthy women."

"[COVID-19 critical illness is] a new disease for us. It  hit us like a bullet train."

Dr.Mark Walker, professor of obstetrics, University of Ottawa

"Pregnant women who have COVID-19 appear more likely to develop respiratory complications requiring intensive care than women who aren't pregnant."

"Providing ventilator support in pregnancy is more challenging and the risks are greater to both mother and child."

"[SOGC members are reporting] a wave of daily pregnant women coming into Ontario ICUs, many requiring ventilators. These women are getting extremely sick, very quickly."

Society of Obstetricians and Gynecologists of Canada

 

Dr.Walker is scientific director of BORN (Better Outcomes Registry and Network), based in Ottawa, whose purpose is to improve care for mothers and children through the collection, interpretation and sharing of data relating to maternal and newborn health. Currently the group is involved in gathering information about the COVID-19 situation as it relates to pregnant women, in an effort to better understand it and to be in a position to render aid with their care.

As a high-risk obstetrician and researcher, Dr.Walker speaks of feeling utterly terrified in the face of growing numbers of pregnant women being admitted to intensive-care units across Ontario, as a result of seriously troubling cases of COVID-19. In Toronto, some intensive care units see women representing half, even more, of critically ill COVID-19 patients. And of their numbers, a large percentage have been placed on ventilators, a situation that has become critical in recent weeks.

These are the sickest pregnant women that Dr.Walker -- throughout the course of his career of several decades as an obstetrician -- has ever treated. There is now an urgent call by physicians and national and provincial organizations of obstetricians and gynecologists for pregnant women to be prioritized for vaccines. The situation currently is that unless pregnant women are in other priority groups, there is no move as yet to inoculate them as a demographic in need, against COVID-19.

Pregnancy is listed among at-risk health conditions in Ontario and in that category people are scheduled to receive vaccinations beginning mid-to-late May. While AstraZeneca is available now to people over age 40, that excludes many younger, pregnant women. Women who are pregnant must have a prescription from their physician, under guidance from the National Advisory Committee on Immunization when they do qualify for vaccination.

Unvaccinated, pregnant women with COVID-caused respiratory illness become three times likelier to end up in intensive care, and two times more likely to die, than those women who happen not to be pregnant. Variants, now dominating in Ontario, appear to be associated with greater levels of risk and sickness for women who are pregnant than had occurred with the original variants, points out Dr.Walker.

Growing numbers of women in pregnancy, have become critically ill in the past two weeks, at levels far surpassing the beginning of the pandemic. Rumours of a similar phenomenon had reached the ears of obstetricians and researchers, occurring in the United Kingdom, where the B.1.1.7 variant became the dominant strain. Published data had been unavailable until recently. The medical community in Ontario was taken by surprise at the degree to which the U.K. variant is affecting pregnant women.

"It is not often we run into a situation where we are not sure how to manage", stated Dr.Walker of a situation where experienced specialists are trying -- on the basis of their new and growing familiarity with the situation -- to understand its implications. Women's oxygen-saturation levels are being closely watched because of its impact on the health of both mother and baby. In treatment, some women are being subjected to the technique of proning, widely used during the pandemic where severely ill patients are turned on their stomachs to improve oxygen absorption.

For obvious reasons, the prone position becomes extremely difficult in pregnancy. There are also higher rates of pre-eclampsia in pregnant women infected with COVID-19, a pregnancy complication characterized by high blood pressure and symptoms damaging to organs, most frequently the liver and kidneys. Emergency C-sections are performed in some cases, in an effort to save the baby. Preterm labour is also associated with severe COVID-19-related illness in pregnant women.

These women, in their pregnancy make every effort to avoid close contact with others. Many of the women who are pregnant, however, already have children who have been attending school or daycare, and thus contact at some level is unavoidable. 

 

COVID Receding ... COVID advancing

"There are many countries thankfully where that [downward trajectory] is happening. And there are many countries in which that downward trend is not being achieved."

"What we do know in countries that are applying persistent and consistent measures in terms of public health and social measures and individual behaviour that that is affecting the trajectory of all variants."

"[While they -- variants -- have a propensity for higher levels of transmission], what is clear is that the control measures ... are effective in driving that down."

"It's a lesson for all of us [in view of infections rising in some countries] that this is not over. It's not over for anybody. And any relaxation of our resolve is dangerous."

"We need to be very aware. This virus still has a lot of energy and if the measures we apply are not persistent, comprehensive and aimed at continuing to suppress transmission while introducing vaccines, we will pay a price."

Dr.Mike Ryan, director general, emergency program, World Health Organization

Some countries, such as the UK and Israel, have begun mass COVID vaccination programs. But it’s probably too early to see widespread impact. Joe Giddens/POOL/EPA/AAP

Globally there is good news about COVID-19; the number of confirmed infections with the SARS-CoV-2 virus is dropping. Case numbers have been reduced from over five million a week in January to the current 2.5 million in mid-February. Unfortunately this is neither universal nor uniform in countries all over the world. Some have had better 'luck' in their efforts to control the omnivorous virus than have others. Brazil, for one example of a country hit hard in the first wave of infections, and continuing to see runaway numbers, surpassed a quarter-million COVID-related deaths this week, ranking as the second-highest death toll in the world, behind that of the United States.

Five states in India with its vast population centres, see surging cases of the novel coronavirus. Mosques and schools in Iraq are closed and nighttime and weekend curfews have been imposed. In Mexico, hospitals are desperate for oxygen supplies, and it isn't the only low- and middle-income country to find itself in that position of desperation. In the country with, to date the worst record of deaths resulting from the virus, a steep fall in cases has occurred in the United States, where 73,400 new cases have been diagnosed in comparison to early January when 250,000 cases per day were registered, leading to suggestions the epidemic may be levelling off.

 

Village and community health volunteers are the eyes and ears of Thailand's disease control system, contributing greatly to the country's effective COVID-19 response.  WHO

The new concerns in health circles around the world rest with "variants of concern", highly contagious viruses (VOCs) taking root everywhere. The number of global cases fell for the sixth consecutive week last week, representing an 11 percent decline, in comparison to the previous week, according to a World Health Organization situation update released on February 23. New deaths reported at 66,000 also fell, by 20 percent week-over-week. 

Globally, Friday's figures read 111 million confirmed cases with 2.5 million deaths around the world. The United States, Brazil, France, Russia and India are the countries reporting the highest number of new cases yet some of the steepest declines puzzlingly have been in some of those countries the hardest  hit last year; among them the United States, United Kingdom, South Africa, Israel and Portugal. COVID alert level in Britain declined a notch, reflecting that hospitals no longer see themselves at risk of being overwhelmed.

A three-week lockdown beginning March 8 to stem a surge in cases has been ordered in Finland, which boasts the third-lowest infection rate in Europe, after Iceland and Norway, with 590 reported this week, representing the highest number since the pandemic's start. According to experts, "patience, prudence" and vaccines are beaming a ray of hope for a reprieve from COVID. 

According to Harvard University epidemiologist Michael Mina, vaccines are playing a part in raising hopes as confirmed case numbers are slowly dropping, along with deaths from t he virus, butit is tighter restrictions that can for the most part be attributed to the hopeful signs that COVID may yet be beaten  in shorter order than prophesied by a worn medical community. Across England, as an example, infections have dropped by two-thirds since the lockdown that was initiated in January.

“No one likes lockdowns, they’re terrible and devastating, but they work. If you have a lot of cases in an area with a lot of people and you lock it down you are going to see cases go down and we see this time and time again.”

"[Other measures, such as people wearing masks indoors, are] extremely helpful [in bringing new cases down but we] can’t discount the seasonality [of COVID-19 being a factor in fewer virus transmissions].

We still don’t know enough about it, but that may be a factor."

"We don’t have a cure. We have treatments which are fine but no cure. We know that younger people who are included in clinical trials are unlikely to die because they’re young, but people are still getting pretty sick – and in addition we know there are long-term symptoms from this virus.”

“We have to respect the variants of concern, we don’t know enough about them, we know that some are more transmissible – we saw one COVID-19 mutation get married to another COVID-19 mutation – we still don’t know how that will work, that’s the recombinant virus."

"While we have to be open-minded to new data, as things are reopening we need to approach with caution so we don’t get a third wave."

Toronto infectious disease specialist Dr. Isaac Bogoch  

EPA/Mauricio Duenas Castaneda

"One, we came off of really high numbers from the holidays."

"Second, there is pretty good evidence that people are doing a better job of social distancing and mask wearing."

"Third, I think in a lot of communities, we've had so much infection that you have some level of population immunity. Not herd immunity, but enough population immunity that it is causing the virus to slow down."

Dr. Ashish Jha, dean, Brown University School of Public Health.