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

Confronting Delta in New Zealand

"At the moment, it's not totally beyond hope that New Zealand could control its new cluster, but the odds are against it"

"In a very short space of time, they could be trying to slow the spread and flatten the curve just as Britain was more than a year ago."

"All power to New Zealand for keeping deaths so low, but the issue is that if your policy fails and you haven't got anything else in place, it will be as bad as if you had let it rip right from the start. New Zealand could find all the sacrifices of the past year wasted if they do not get their population immunized quickly enough."

Paul Hunter, professor of health protection, University of East Anglia

"The government is realizing it can't go another year without opening up, but it can't do that without a high level of vaccination and societal license."

"It's a lot easier to lock down than to open up."

"Meanwhile, the tech sector is crying out for high quality labour that can't get into the country, and the hospitality sector is crying out for imported labour. These sectors are hurting and they can't take advantage of New Zealand's position."

Sir Peter Gluckman, former chief scientific adviser, director of the Koi tu Centre for Informed Studies, New Zealand

"Early on in the outbreak, New Zealand was a great example of how you could deal with the virus through lockdowns and social distancing."

"We have to accept that now we've moved on from that. It's incredibly difficult to secure your borders forever, and the only thing New Zealand is left with is vaccination, otherwise they are pretty much fighting a losing battle because you are always going to have the virus knocking on your door."

Professor Jonathan Ball, expert on emerging viruses, University of Nottingham

Wellington, New Zealand, during lockdown last week. Credit...Hagen Hopkins/Getty Images

New Zealand, as of a number of countries able to defend themselves from the onslaught of the SARS-CoV-2 virus that causes COVID-19, because like them, it represented a castle with a watery moat surrounding it for defence purposes, cloistered itself from the potential of infection from outsiders, with closed borders. There was no emphasis on inoculating its population against the infectious virus, only keeping it at bay, until presumably, it would 'give up' and 'go away'. But it never did, and was highly unlikely to do so, in its ongoing revisiting of previously successful countries suddenly assailed by a more virulent strain of what they had previously evaded.

So few New Zealanders have been vaccinated against COVID, an estimated 80 percent, not inoculated, are now vulnerable to the hugely infectious Delta strain doing its geographic rounds and successfully leaving an island nation suddenly finding itself confronting the variant. There is no demographic which had been naturally exposed to COVID with useful antibodies against re-infection, much less the greater numbers susceptible to infection, never vaccinated. The island has become a proverbial sitting duck.

Scientific circles now look in on the dilemma facing the country with the plunging popularity of its Prime Minister, Jacinda Ardern, now on the horns of a predictable dilemma. So confident in locking away the island from outside infection it was thought by the country's medical authorities that there would be no need to inoculate the public against a virus whose presence would be receding. Only, of course, that's not what happened; the virus has come roaring back in a more infectious variant.

Ardern saw no help for it but to once again re-impose another lockdown; no longer is New Zealand     COVID-free. Not that it has yet been completely overrun with cases, they're still in low numbers albeit rapidly advancing. Yet on the other hand, to remain in isolation is to ensure that its declining economy has nowhere else to go but down, and yet further down, its surpluses enjoyed in the years before COVID now a dim memory.

In its favour still, is that it is an island with natural protection afforded by surrounding seas, that it is  relatively sparsely populated, that a start has been made on inoculation, with confidence that by the end of December the majority of New Zealanders will have been vaccinated. The concern remains, however, that despite its tiny death toll resulting from the past year-and-a-half's protective measures the future may reveal some unexpected turns with deaths in the thousands reflecting its over-reliance on isolation and lack of focus on vaccination.

New Zealand is grappling with increasing COVID infections   Getty Images

A Tale of Two Outbreaks

 

"First there was one asymptomatic infection at the airport in Nanjing. The next day, there were more than a dozen. By the end of that week in July, daily infections had climbed to nearly 50, suggesting exponential spread across more than 1,000 kilometers. In less than three weeks, daily cases ballooned to more than 100, scattered across half of the nation. Then it ended, almost as quickly as it began. The number of infections dropped to single digits the next week amid tightening curbs, then zero. More testing will show if it has been vanquished."

"The blazing spread of the delta variant across the country became the biggest test of China’s COVID control model. Ultimately it penetrated nearly 50 cities across 17 provinces and reintroduced the virus to "Wuhan, which had been COVID-free for over a year."

Still, China eliminated the virus in about a month, roughly the same time it took to quell previous outbreaks including one at the start of 2021 that totalled some 2,000 cases. In comparison, cities in Australia have undergone repeated lockdowns, keeping more than half of the country’s 26 million people confined to their homes, without gaining control of the virus. In the U.S., which has never succeeded in containment, relying instead of vaccination, booster shots are slated to roll out next month to shore up protection against its delta resurgence."

Fortune magazine 

Waiting for Covid-19 testing in Nanjing. About 200 cases were reported in an outbreak centered on the city.   Credit...Agence France-Presse — Getty Images

"The vaccines that are currently approved by the WHO all provide significant protection against severe disease and hospitalization from all the variants, including the Delta variant."

"We are fighting the same virus but a virus that has become faster and better adapted to transmitting amongst us humans -- that's the change."

Mike Ryan, top emergency expert World Health Organization

At the end of July China suddenly found itself trying to control the most threatening COVID-19 outbreak it had been forced to confront in months in a return of COVID infections, thanks to the Delta variant. At the same time the United States plans to intensify its efforts to control the Delta strain believed on ample evidence to be more contagious than the original coronavirus.

 

An official lockdown was mandated for hundreds of thousands of people living in Jiangsu province when a cluster of infections was identified in its provincial capital of Nanjing. The infections were tracked to airport workers who had cleaned a plane arriving from Russia in late July. It took little time before infections were detected in Beijing and five provinces. By standards other than China's the number of infections were modest. But the speed of the spread was not.

Across China a total of 206 infections were linked to the original cluster which became the largest in the country geographically in several months. Two locally transmitted cases were found in Beijing's Changping district which spurred lockdown in nine housing communities with a total population of 41,000 people. At the same time a document from the U.S.Centers for Disease Control spoke of the Delta variant causing more severe illness than earlier variants, spreading as readily as chickenpox.

U.S. health officials, points out the document, must "acknowledge the war has changed", and be prepared to intensify efforts to halt the spread. The U.S. struggles to persuade Americans to become vaccinated and adapt to prevention measures like wearing face masks amidst surging cases -- and new research which suggests that those who are vaccinated can also spread the virus.

Three quarters of those who were infected with COVID-19 at public events in a town in Massachusetts had been fully inoculated against COVID. According to the study, vaccinated individuals reflected similar virus loads as those who were unvaccinated; unlike other variants, vaccinated people infected with the Delta variant are able to transmit the virus, the CDC revealed.

 

Authorities in China tested millions of people after an outbreak spread to 15 provinces   Getty Images

 

This realization caused the health agency to change its guidelines recommending that vaccinated Americans once again wear face masks where transmission levels are high. "Given higher transmissibility and current vaccine coverage, universal masking is essential", the document added. Local media reported most of those infected in Nanjing were vaccinated, a situation that led to questions of the Sinovac vaccine efficacy.

"If the goal is to slow down the spread and reduce the fatality rate, [Chinese vaccines] can afford a certain degree of protection", assured the leading Shanghai infectious diseases expert, Zhang Wenhong. The country's top disciplinary watchdog pointed a finger at the airport officials in Nanjing for "poor supervision and unprofessional management", in failing to separate cleaning staff working on international flights from those on domestic flights.

No fewer than 132 countries globally have detected the presence of the Delta variant, making it the dominant global strain, according to the World Health Organization. Over the past few months COVID-19 infections increased by 80 percent in most regions of the world, stressed WHO director-general Tedros Adhanom Ghebreyesus. In Africa, where only 1.5 percent of the population has been vaccinated, infections rose by 80 percent in a few weeks.

"Hard-won gains are in jeopardy of being lost and health systems in many countries are being overwhelmed", he noted. WHO technical lead on COVID-19, Maria van Kerkhove, affirmed the Delta variant to be about 50 percent more contagious than the ancestral strains of SARS-CoV-2 that emerged first in late 2019, in Wuhan, China. The good news is that though hospitalization rates have increased, not so higher rates of mortality from the Delta variant.

If there is any irony here, it is that the country where the coronavirus first emerged and managed to bring it under control -- while it went on to infect the rest of the world -- had  to battle a more virulent strain brought in from abroad. And that same country's vaccines have proven to be less effective than vaccines produced elsewhere in the world scientific-medical community. Yet by strict lockdowns and allied measures, China has time and again brought COVID under control, while throughout the world the virus rages and measures of control lack efficacy.

Stress and Strain in the U.S. Medical System With the Delta Variant of COVID-19

The Delta variant causes more infections and spreads faster than early forms of SARS-CoV-2

• The Delta variant is more contagious: The Delta variant is highly contagious, nearly twice as contagious as previous variants.
• Some data suggest the Delta variant might cause more severe illness than previous strains in unvaccinated persons. In two different studies from Canada and Scotland, patients infected with the Delta variant were more likely to be hospitalized than patients infected with Alpha or the original virus strains.
• Unvaccinated people remain the greatest concern: Although breakthrough infections happen much less often than infections in unvaccinated people, individuals infected with the Delta variant, including fully vaccinated people with symptomatic breakthrough infections, can transmit it to others. CDC is continuing to assess data on whether fully vaccinated people with asymptomatic breakthrough infections can transmit. However, the greatest risk of transmission is among unvaccinated people who are much more likely to contract, and therefore transmit the virus.
• Fully vaccinated people with Delta variant breakthrough infections can spread the virus to others. However, vaccinated people appear to be infectious for a shorter period: Previous variants typically produced less virus in the body of infected fully vaccinated people (breakthrough infections) than in unvaccinated people. In contrast, the Delta variant seems to produce the same high amount of virus in both unvaccinated and fully vaccinated people. However, like other variants, the amount of virus produced by Delta breakthrough infections in fully vaccinated people also goes down faster than infections in unvaccinated people. This means fully vaccinated people are likely infectious for less time than unvaccinated people.          Centers for Disease Control and Prevention
  

"We saw the largest single-day increase in hospitalizations and have eclipsed our previous high of COVID hospitalizations,"

"There are currently only eight ICU beds available in the state."

Arkansas Governor Asa Hutchinson

An intubated patient inside a negative pressure room in the Covid-19 ICU at a hospital in Joplin, Missouri, on Aug. 3. Photographer: Angus Mordant/Bloomberg

The United States, which suffered the worst case load, hospitalization and death rates of any country, undertook a massive vaccination campaign to reduce the malignity of the SARS-CoV-2 virus and the first wave abated to the point where a sigh of collective relief relaxed the overall vigilance against the infectious and sometimes-deadly virus causing COVID-19. The horizon looked brighter everywhere until the virus began producing variants of the original strain that promised to be more infectious, slightly resistant to vaccines and producing more serious outcomes. 

One of those variants is the Delta strain which certainly turned out to be more communicable in a population and this is the strain that has been wreaking havoc in a return wave of COVID all over the world. In the U.S., a six-month high of new cases is being realized, thanks to the rapid spread of the variant, all the more in those areas of the country where low vaccination uptake has taken place. COVID cases now average 100,000 nationwide three days following each other, an increase of 35 percent over the week before. 

A nurse prepares to enter a room to treat a patient in the Covid-19 ICU ward at a hospital in Jonesboro, Arkansas, on Aug. 4.    Photographer: Houston Cofield/Bloomberg

The state of Arkansas has the misfortune of representing the greatest number of fatalities by population in a nation where a rise of 40 percent has been seen in hospitalizations -- and deaths registering an increase of 18 percent. Records for hospitalization were set in Florida over an eight-day period. The second-largest teaching union in the country announced it is backing mandated vaccinations for American teachers with a view to protecting students too young for inoculation.

The reason for that precaution is obvious enough, seeing that the number of children with COVID-19 being hospitalized is rising country-wide, representing a trend which, according to health experts recognizes the Delta variant as more likely to infect children, as opposed to the original Alpha strain of the virus. The reduction in cases overall in the country in late spring into summer led to pressure to ensure that parts of the population remaining uncertain or uneasy or reluctant to be vaccinated, is gaining momentum.

California, New York and Virginia have mandated vaccinations for their populations; failing that, that weekly testing be undertaken for state employees. Several cities have stood out for their firm position requiring municipal employees to be vaccinated for the public good. New rules were set out last month by the Biden administration that federal workers must provide proof of having been vaccinated, or alternately undertake regular testing, while a mask mandate has been reimposed, along with travel restrictions.

A critical care respiratory therapist works with a coronavirus disease (COVID-19) positive patient in the intensive care unit   Reuters

Private enterprise is also choosing to become involved, mandating COVID-19 vaccinations for their employees. Large national employers like United Airlines, Tyson Foods Inc. and Microsoft are among those corporations mandating vaccination for their employees. Large-scale events have been cancelled, although some events plan to carry on -- like the small town in South Dakota, where the annual Sturgis Motorcycle Rally is set to carry on as usual, preparing to welcome hundreds of thousands of motorcycle enthusiasts. 

Certain to become a super-spreader event.

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