Wednesday, August 4, 2021  |  Category: Eduvation Insider

Delta Whiplash

Good morning, and welcome to August!

As promised, I spent much of my long weekend working on my weekly “Pandemic Précis” for you, intending to publish it yesterday… but it quickly got out of hand, as did some weekend chores, so instead I will be sharing it with you over the next 3 days.

Today, a look at the resurgence of COVID19 in the southern hemisphere (where it’s cold and flu season), and how the Delta variant is changing the game entirely, whether you’re vaxxed or not…

 

 

Pandemic Précis

Much like I reported last week in “COVID on Steroids,” the Delta variant is driving an upsurge in COVID19 cases worldwide, hitting southeast Asia particularly hard – but the entire global south is suffering a winter surge in the pandemic…

 

Southeast Asia Struggles

Last week, Thailand was setting daily records for new COVID19 case counts, imposing curfews and lockdowns, and suspending most domestic flights. (They even turned 15 disused railway cars in Bangkok into a 240-bed COVID19 isolation ward.) Cambodia imposed new lockdowns in areas bordering Thailand. India has seen the biggest increase in new cases in 3 weeks. Malaysia surpassed 1M cases and almost 8,000 deaths – despite being in lockdown since June. Malaysian doctors staged a walkout as hospitals grappled with shortages of beds, ventilators and oxygen. Indonesian politicians were trying to balance public health and economic ruin, extending some restrictions while permitting outdoor markets and restaurants to reopen, despite logging more than 3.5M cases and 100,000 deaths, with 4 days of record-high fatalities in the past week alone. South Koreahas detected its first cases of the Delta+ variant, connected to a fully-vaxxed traveller returning from the US. There were also new outbreaks in Vietnam, Myanmar and the Philippines.  National Post

 

“Fortress Australia” Crumbles

Sadly, Australia’s COVID-free status has crumbled quickly in the face of the Delta variant too. (Australia remains at 33/15 vaccination, one of the lowest in the OECD.) Queensland had previously been able to contain COVID19 outbreaks through snap 3-day lockdowns, but there’s “no dodging Delta”: the state has seen 13 outbreaks in the past 6 weeks, the latest centred on schoolchildren under age 10 in Brisbane. Hospitals in Queensland are under pressure as 300+ healthcare staff, relatives of the schoolchildren, have been forced into isolation. (Only 80% of healthcare workers are currently vaccinated.) With record-high case counts in New South Wales, Sydney has been locked down until Aug 28, and 300 soldiers will be going door-to-door to help enforce isolation orders. A pilot project to allow international students back into the country has been put back on hold again. (So far, Australia’s economy has lost an estimated $6B due to a year in which international students could only study online from home.) PM Scott Morrison has indicated the borders will not reopen to international students until 80% of adult Australians have been vaccinated, which may take until Dec 31.

 

China Locks Down

On Monday, China imposed more extreme travel restrictions and quarantine orders than it has in the past 18 months, in response to a new outbreak driven by the Delta variant. (It is looking as though China’s COVID vaccines are less effective against Delta than the mRNA shots used elsewhere.) China’s “draconian” approach to containment has been effective until now, but clusters of hundreds of cases have arisen in almost 30 cities, apparently starting with Nanjing. Wuhan is testing all 11M residents after just 7 new cases there. Today, China sealed off residential communities in Zhangjiajie, and announced a list of local officials who would be punished for having a negative impact on pandemic prevention efforts. Some analysts are questioning whether China will be able to loosen border restrictions in time for the 2022 Winter Olympics, planned for Beijing in February.  Washington Post

 

And speaking of Olympics…

 

COVID Hurdles in Tokyo

With just 39/28 vaccination so far, Japan is imposing an expanded state of emergency after days of record COVID19 infections driven by (what else?) the Delta variant. Tokyo is logging 3,000+ new infections per day, some hospitals are already full, and Japanese PM Yoshihide Suga is warning that the country’s medical system could soon collapse if the pandemic spike continues. But so far just 276 cases have been confirmed among people connected to the Olympics, including just 24 athletes – most cases are among third-party contractors, who are subject to less stringent testing (and more likely to leave the Olympic bubble).  National Post

 

“Hard-won gains are in jeopardy or being lost, and health systems in many countries are being overwhelmed.” – Tedros Adhanom Ghebreyesus, WHO Director General

 

 

South America Hit Hard

With just 17% of Latin America and the Caribbean fully vaxxed, the Pan-American Health Organization warns that COVID19 is “devastating” the Americas. The Delta variant has now been identified in 30 of 35 countries, and Argentina, Colombia, Cuba, Ecuador and Paraguay are among the countries with the world’s highest death rates from the pandemic.  Reuters

 

UK Defies Expectations

When Boris Johnson’s government lifted public health restrictions on Jul 19, projections were that the Delta variant would drive a massive surge in new COVID19 cases – although it was hoped that the health impacts of a Delta-driven wave would be reduced by the UK’s progress in vaccinations (currently 70/57). Surprisingly, though, new daily case counts have dropped in half, while hospitalizations and fatalities have surged to the highest point since March. The decline in transmission might be driven by school closures for summer, a week-long heatwave, or even a surge in self-isolation. (The NHS COVID19 app pinged 620,000 people in a week and instructed them to quarantine.) Perhaps the fear of being quarantined is preventing people from seeking COVID19 tests in less severe cases. Maybe the combination of vaccination and prior exposure has achieved a level of herd immunity. There is some evidence that the end of the Euro 2020 soccer championships has reduced indoor socializing. (Scotland, eliminated earlier from the Euros, saw its case counts start dropping 2 weeks earlier than England.) Noted Imperial College London epidemiologist Neil Ferguson is starting to speculate that perhaps “the pandemic could be in the rearview mirror” soon. But the next few weeks remain unpredictable, as the delayed impact of “Freedom Day” starts to be felt: “the way down is always bumpier than the exponential rise on the way up.”  Washington Post 

 

American Tragedy

The US, on the other hand, has entered a self-imposed fourth wave of the pandemic, driven by Republican vaccine hesitancy and political opposition to common-sense public health precautions. Nationally, daily case counts have risen six-fold over the past month, and now exceed the peaks of the first 2 waves. Daily COVID19 deaths have also climbed 40% in the past 2 weeks, although they remain about one-tenth of the peak back in January. The country has struggled to reach president Biden’s July 4 target for vaccinations, finally reaching it a month late, on Monday – leading him to urge states to offer $100 cash incentives for newly vaccinated Americans.

 

Deplorable States

Florida is the national epicentre of the pandemic now, and has hit record levels of COVID19 infections (21,683 on Saturday alone) and hospitalizations. Hospitals are overwhelmed across Florida, but governor Ron DeSantis continues to oppose mask mandates or vaccine requirements, instead passing an executive order to prevent school mask rules. (Sadly, 19,000+ American children have been hospitalized with COVID19 already, and Florida reported 21,000+ COVID19 infections among children under age 19 last week alone.) Thankfully it appears that the states being hit hardest by the Delta variant (such as LA, MS, OK, TN, and also FL) are now seeing vaccination numbers bounce back strongest. Louisiana and Nevada have even reimposed mask mandates on vaxxed and unvaxxed alike.

 

 

Delta Whiplash

It’s been obvious for months that the Delta variant was going to transform the dynamic of the pandemic. (Back on March 25th I first drew your attention to the so-called “double mutant” strain in India, B.1.617.2.) As Delta spreads worldwide (132 countries to date), data is accumulating to underscore its virulence and resistance to vaccines. As The Atlantic put it, “the Delta whiplash is here” as the new variant “caught the country off guard and forced us to revisit our mitigation strategies.”

 

1,000x More Virulent

We’ve seen plenty of evidence already that the Delta variant spreads substantially faster than other strains of COVID19, including the Alpha (UK) variant. (It is already responsible for 80% of COVID19 cases in the US, and 70% of sequenced variant cases in Canada.) It has a shorter incubation period, and its R0 value could be as high as 8.0. The CDC warns that the Delta variant is as contagious as chicken pox and “likely more severe” than any previous COVID19 strain, generating 1,000x more virus in the body, and driving more severe disease more quickly. A study in Scotland found that Delta doubled the risk of hospitalization compared to the Alpha (UK) variant. “The Delta variant is the fastest, fittest and most formidable version of the coronavirus that causes COVID19 the world has encountered.”

 

“This is like a wildfire, this is not a smoldering campfire. It is full-on flames right now.” – Michelle Barron, uColorado Health

 

 

Breakthrough Infections

Even worse, there is growing evidence that the Delta variant has achieved a measure of immune escape, bypassing immunity from previous infection or, in some cases, from full COVID19 vaccination as well. The CDC reports that 6,587 fully-vaccinated Americans nonetheless have been hospitalized due to Delta, and estimates ~35,000 symptomatic breakthrough infections are occurring each week. Stanford U reported 7 confirmed cases of symptomatic COVID19 among fully-vaxxed students last week. The CDC reports that 74% of 430 people infected in a Massachusetts outbreak had already been fully vaccinated. “We are fighting the same virus, but a virus that has become fitter.” (South Carolina senator Lindsey Graham is the latest fully-vaxxed politician to nonetheless catch COVID19, and experience flu-like symptoms.) Public Health England reports that 23% of those hospitalized with Delta in Britain were in fact fully vaccinated. In Singapore, 44% of Delta cases were in fully-vaxxed people (with Pfizer or Moderna), although they were not falling seriously ill. In Israel, the Pfizer vaccine appears to be only 41% effective at preventing symptomatic infection. A new study from Imperial College London concludes that fully-vaccinated people have a 50% reduced risk of infectionfrom Delta infection of any kind, and 59% protection from symptomatic infection. It also found that young people were driving transmission, up to the mid-July peak. Another study in the New England Journal of Medicine found that Pfizer was 88% effective against Delta, while AstraZeneca was 67% effective.

 

“The last thing you want is to loosen restrictions when you’re confronting the most formidable version of the virus yet.” – Eric Topol, Scripps Research Translational Institute

 

 

The Risk to Others

Now granted, if you are fully vaccinated the Delta variant is unlikely to put you in hospital, but because it generates so much virus, studies suggest that you will nonetheless be contagious to others – perhaps even if you are asymptomatic. Studies in Wisconsin and Singapore have found similar “viral loads” in nose and throat swabs from vaccinated and unvaccinated patients. That means you could pose a serious risk to others who are either unvaxxed (including children under 12) or whose immune response to the vaccine was insufficient.

 

“The War has Changed”

These emerging facts about the Delta variant led the CDC last week to reverse its previous guidance on masks for the fully vaccinated. Two months ago, the prospect of ditching the face mask requirement was considered a great motivator to encourage vaccination. Now, the CDC wants all Americans – fully vaxxed or not – to wear facemasks in indoor public places, in regions where COVID19 is spreading rapidly. (And 63% of counties in the US currently qualify.) The CDC also recommends all K-12 students, teachers and staff wear masks, regardless of their vaccination status. The shifting guidance based on emerging scientific evidence will naturally be construed as “backtracking” by some, and will lead to even more skepticism by the vaccine hesitant. A leaked internal CDC slide deck warns that “the war has changed.” Yale U has already reinstated its mask mandate for indoor spaces (as have many others).

 

 

Pandemic Prognosis

For months now, it has been challenging to predict the state of the pandemic this Fall. The rise of the Delta variant, plateauing vaccination rates, and easing health restrictions leave us with plenty of uncertainty. Here are some thoughts…

 

The Fourth Wave

New national modelling released Friday says Canada is headed towards a 4th wave of the pandemic, thanks to the Delta variant, but its impact will depend upon vaccination rates, and the pace and extent of reopening plans. PHAC warns that we could see a stronger resurgence over the next month, potentially a larger wave than the last, although hospitalizations and deaths may not rise as much. The key to avoiding overwhelming hospital capacity this Fall will be to ensure that 80% or more of eligible Canadians are fully vaccinated by Labour Day – although 90% would be even better.  CTV  |  Globe & Mail

 

A Half-Vaccinated Country

Ashish Jha, dean of Brown U’s School of Public Health, assures Americans “we’re certainly over the worst of the pandemic” and won’t ever return to “the level of suffering and death we saw at the end of last year.” But the Delta variant will challenge the country over the next few months, particularly in less-vaccinated communities, where hospitals may be overwhelmed. Jha anticipates mask mandates will have to continue for years if vaccination doesn’t exceed 75% of the population.  The New Yorker

 

More Pain to Come

Anthony Fauci warned on Sunday that the US is in for more “pain and suffering” as COVID19 cases climb and vaccinations stall. He does not anticipate more lockdowns, but worries that current levels of vaccination are insufficient to “crush the outbreak.” uWashington epidemiologists predict the Delta variant could doublecurrent levels of COVID19 infection, reaching 140,000-300,000 daily cases later this month – although the caseload could be 10x lower if everyone were to wear a mask. (Not likely.) The real issue is the easing of restrictions: “the effect of changes in behavior over the past three to four months has been much greater than the effect of the Delta variant.”

 

6 Key Factors

Six factors will shape how the pandemic plays out this fall and winter. 1) First and foremost, local vaccination rates – including young people and children. 2) Public health measures (masks, distancing, ventilation, testing and tracing) will determine how long any resurgences last. 3) How much protection is provided by past infection among the unvaxxed (which remains unclear). 4) Whether booster shots are required for the vulnerable, or we see seasonal increases in cases. 5) The rate of breakthrough infections and transmission by vaccinated people. 6) The possibility of more variant strains of COVID19 arising, and the speed with which vaccines can be modified.  Time

 

Another Year of Waves

An NYU epidemiologist who served on the Biden-Harris pandemic transition team believes the US is in for “at least another year… of waves and surges of COVID.” Celine Gounder adds that the vaccination threshold to bring the pandemic under control keeps rising as new variants emerge. Ashish Jha, dean of Brown U’s School of Public Health, believes the world will return to a new normal for 2023.  Newsweek

 

Next Up: Lambda

The Lambda variant (C.37), first detected in Peru last August (and first mentioned in the Insider on Jul 6) is being studied carefully to assess its transmissibility and potential for immune escape too. Lambda has already been detected in 1,037 US cases, and in 28 other countries worldwide. In laboratory experiments, Japanese researchers have found that 2 mutations help make it more infectious than the original COVID19, while 3 others help it resist neutralization by vaccine-induced antibodies. The researchers conclude that these properties have helped Lambda drive massive infections in South America, and make it “a potential threat to the human society.”

 

 

Across Canada, provinces are lifting pandemic restrictions and reopening – in some cases, WIDE open. More on that tomorrow! (No, really, tomorrow!)

 

 

#ICYMI

After 18 months of relentless pandemic, many people are saying…

 

Let’s Look Forward

Nottingham Trent U (UK) released a dynamic 1:15min spot in mid-May that invites students to “look forward, think differently and ask the big questions.” NTU promises to encourage students to find what they truly love, and pursue it into a great future. Through a series of rapid cuts, NTU showcases classrooms, labs, social activities, performing arts, athletics, careers, and the city of Nottingham. (Watch it 5 times and you’ll see something new each time.) “This is your future, and we’ll help you write it!”  YouTube

 

 

As always, thanks for reading!

Stay safe and be well,