COVID-19: Silver Lining?

There may be a Silver Lining to the past month, where it appears our Coronavirus has gained new superpowers.  In fact, the Delta variant is now as contagious as chickenpox, more adaptable than a Republican Congressman, and evolving faster than a speeding conspiracy theory. There is much news to cover – in the last week several viral hypotheses have been resolved with new evidence, and we might have just found the Achilles Heel of the virus.

This Pandemic is proving worthy of the term “going viral”.   About a month ago, we wrote about “COVID-3799“, but today we’re at 3,997 detected strains.  Yes, Karen, we’re watching Evolution in Real Time.  And here’s what we recently learned while catching, err… watching…

Key Points:

1. Vaccines work, BUT cases are rising because of the Delta variant.  For a while, we overwhelmed the Virus with our vaccines, and cases were falling throughout the country… until the Delta variant latched onto the UNvaccinated and ramped cases back up to levels not seen since February.  This  resurgence has occurred everywhere, even in areas with high vaccination rates like Massachusetts and Santa Clara County, CA.

   

   It is clear from data in counties which track the details, that the rate of cases in UNvaccinated people is far higher than among those vaccinated. See for example the increase in cases in Marin County, CA, (at left) where the UNvaccinated case rate is triple that of the vaccinated. [Charts and Details on Delta]

2. Vaccines were never supposed to be perfect, for example, the 95% confidence interval for Moderna was at 88 to 98% effectiveness back in January. With Delta as transmissible as chicken pox, we now have a larger number of opportunities to find the 5 to 10% of cases where the virus beats the vaccine.  In addition, we now know more about how our vaccines fade in effectiveness… So, it’s now Vaccinated people who are catching Delta (called BreakThrough Cases [BT]).    [Details on fading vaccine efficacy].
3. Vaccinated people can pass on COVID to others, including the vaccinated. This was an open question until recently, but with the viral load of Delta at 1,269 times more than the Wuhan strain, it’s easy to understand this occurring. Detailed studies from Singapore and Provincetown, MA recently made this exceedingly clear.  The Good News is threefold: a) You are Less Likely to catch Delta, if vaccinated, and b) IF you catch the Delta Variant, your outcomes are much better vaccinated, and c) IF you catch Delta, the virus is less likely to create harmful new variants in your body. The Bad News follows… [Details on Vaccinated COVID-19 Transmission]
4. Vaccinated BT cases can result in Long COVID. Long COVID is the long term organ damage and symptoms resulting from the virus: heart damage, lung damage, brain fog (which a UK study showed included loss of brain tissue).  Because COVID-19 is a vascular disease, it can affect a wide range of your body parts. Long COVID could turn out to be the real legacy of this Pandemic, leaving a generation of health problems and care costs. Now, an informal study shows that 20% of BreakThrough cases ALSO get Long COVID. [Details on Long COVID Breakthrough Cases]

5. 

   Finally, we’re only in this mess because people haven’t been diligent about their public health behaviors. They didn’t take the virus seriously last year – starting with our then-President. Many people failed to get vaccinated as soon as they could, leaving the doors and windows open for the vaccine to enter and continue its evolution, and it has succeeded. People also failed to wear masks in many areas of the country for most of last year, and now people – including those vaccinated – are treating this Virus as Old News, when it is very much alive and well. So what might motivate the vaccine hesitant? First, the news that the UNvaccinated are no longer safe around vaccinated people. And secondly, a new small study showing that COVID-19 harms human sexuality.  Will that get people’s attention? Read on for… [COVID-19 Impact on Human Sexuality]

DETAILED DISCUSSIONS:

Impact of Vaccination on Cases

Here are some updated graphs for five US states: California, Massachusetts, Michigan, Missouri, and Texas, plus Santa Clara County in the NorCal Bay Area. The plot shows daily new cases per million residents (DNCs/M) vs. percent of total population with one or more doses for the time period from 1 Jan through 20 Jul 2021. Data is from ourworldindata.org and scc.gov. There is no time axis: January points are nearest the left edge; July points are the rightmost for each curve, as the % vaccinated increases.

The three US states currently experiencing the worst Delta outbreaks are Missouri, Florida, and Texas. All three are lagging well behind the US average for percent of residents vaccinated (FL not shown on chart). The very rapid rise in DNCs/M in Missouri exceeds even the scary rise in new cases seen in the spring in Michigan due to the statewide outbreak of the Alpha variant. In spite of the MI state legislature passing a law forbidding state and PH authorities from imposing any sort of mask mandate, and of MI being behind the US average on vaccinations, the state has not seen the same acceleration in cases of Delta that are happening in FL, TX, and CA, at least so far.

At right is a time series comparison of the DNCs/M and vaccinations for Massachusetts and Missouri. You can see that the Delta outbreak started about a month earlier in MO. Even though DNCs have not reached Jan’21 levels yet, their acceleration is more rapid than during the worst Dec/Jan surge, which has experts like Prof. Michael Osterholm worried that Delta cases will eventually peak at an even higher level; and this is the just the summer season.

As an update to the UK statistics on Delta in our last article, the table below continues to show persons over 50 with a high rate of death, and UNvaccinated people with 3.5 to 4 times more chance of an unfavorable outcome.

Vaccines Fade In Effectiveness

Two factors have caused the vaccines to become less effective than touted when the initial ‘95% protective’ estimates came out. First, vaccines fade in effectiveness over time. As the slide at right from a recent CDC presentation shows, effectiveness after 250 days declines from 95% to 77% with the best vaccines and from 70% to 33% and lower among the others, like J&J, the Chinese and Russian vaccines. The second factor is that the Delta variant is easier to catch (like Chickenpox) and more harmful.

The boxes on the lower slide at <<LEFT represent the range of results for infection and death among several infectious diseases. Note that the vertical axis is a Log Scale, meaning each equal higher vertical segment is 10 times more fatal.  Combined, a stronger virus with a weaker vaccine means more “Breakthrough” (BT) infections among those who are vaccinated.

Vaccinated People Spreading COVID-19

Per CDC Director Dr. Rochelle Walensky: “[when] we examine the rarer BT infections, and we look at the amount of virus in those people, it’s pretty similar to the amount of virus in UNvaccinated people.” Note that studies measured the viral load of Delta at 1,269 times greater than the earlier Wuhan strain of COVID.

In light of data from Singapore and Provincetown, Dr. Walensky gave an update on Covid-19. The full 28-minute audio playback is here: “CDC MEDIA TELEBRIEFING: Update on COVID-19.” Tuesday 26 Jul 2021.

Dr. Walensky stated that the CDC has been following 20+ cohorts of people nationwide, numbering in the tens of thousands of people. These cohorts are comprised of healthcare workers, frontline workers and staff at long term care facilities, many of whom have volunteered to get weekly PCR tests.

A key takeaway is that the CDC now has evidence from testing of Delta cases in the US, that suggests fully vaccinated people who get a breakthrough (BT) case of COVID can be just as contagious as UNvaccinated people who get infected. Specifically, their viral loads, as measured by their Ct values from PCR testing are “quite similar.”  There are other data from the UK, Israel, and Singapore that pretty clearly demonstrate that BT cases of Delta do lead to onward transmission.

The good news is that vaccinated people are having much less severe outcomes from a COVID infection, if one is even detected.  Also, vaccinated people are 8 times less likely to catch COVID and 25 times less likely to suffer hospitalization and death [Bar chart at right].

As shown in the lower slide at right, while protection from mild infection fades, depending upon the vaccine, down to 40% over 1,000 days (~ 3 years) – even with an excellent vaccine, protection against Severe Infection remains over 80%. (Note that these numbers are early results, and we’ll know much more in another 1,000 days.) For those with lesser quality vaccines, the 1,000 day protection can fall to only 10%, but protection against Severe cases remains at 40%. The implication of these charts is that booster shots will make a lot of sense. However, the CDC is still studying who should get those shots, when, and with what vaccines – so stay tuned for another article on that topic.

Breakthrough Cases Resulting In Long COVID

While vaccinated people (and COVID survivors) are much safer from new infections than the UNvaccinated, there is still a serious concern that Breakthrough Infections can cause long term health damage (Long COVID). As a frame of reference, some large clinical observational studies have shown the rate of Long Covid among UNvaccinated people, even those who had mild cases not requiring hospitalization, is likely between 14% and 30%. There is now an INFORMAL study, based on a Facebook group called ‘Survivors’ Corps’, which self-reports 55% of long COVID from vaccinated persons with Breakthrough Infections. As the lead author, Yale Professor Harlan Krumholz, MD, states: “robust data are needed in a larger, unbiased sample to extrapolate rates to the population [at large].”  Final note: Most (but not all) breakthrough infections among vaxed people are widely reported to be mild, but even mild cases are no fun. As Ashish Jha of Brown University says, they can be as painful as getting a broken arm, and rarely, much worse.

Daisy Massey, Diana Berrent, Harlan Krumholz, “Breakthrough Symptomatic COVID-19 Infections Leading to Long Covid: Report from Long Covid Facebook Group Poll.” medRxiv, 25 Jul 2021.

Extra Motivation to Get Vaccinated

According to a recent publication with a small sample size, COVID-19 poses a risk for both erectile dysfunction and male infertility. Given that COVID has shown vascular damage in a number of other organs, this would be logical.  The presence of COVID in male testes is also unsurprising, given that other viruses have been shown to invade the testicles and affect sperm production and fertility.   On the Good News front,  another article shows that COVID vaccination appears safe for the male reproductive system.  Given the outsized role of sex in our society, one would hope that the combination of potential harms from COVID combined with the safety of the vaccine would arouse people’s interest in getting vaccinated.  And, if this issue doesn’t motivate people, then we have a very Darwinian long term solution to this virus….

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