THE DELTA VARIANT AND BEYOND--EXPERT COVID-19 UPDATE

I just sat in on a Covid-19 update presented by the Newswise science news service featuring three experts:

Perry Halkitis, a public health psychologist and applied statistician at New Jersey's Rutgers University,

Eleanor Wilson, a medical doctor and infections disease specialist at the University of Maryland, and

David Souleles, Director of UC Irvine's Covid-19 response team, recently retired .Orange County Public Health Director

Delta is for Dangerous . . .

Credit: The Spinoff/ISO FORM LLC

The focus of the update was the emergence and trajectory of the delta variant and what that implies for the US.

Here are some of the key points the three experts made:

--The delta variant is a serious threat in the US and worldwide.

--As recently reported, the level of viremia--the viral load in the bloodstream--from a delta-covid infection is 1,000 times higher than from previous versions of the virus. That's probably what is making it so infectious.

--According to Dr. Wilson, the infectiousness, or "R-nought" value, of the original version of Covid-19 was estimated to be between 1 and 3. Statistically that means that one infected person would pass the virus to one to three others. The beta version's R value was between 4 and 6. The delta variant is 8 or 9. The only virus known to be more easily transmitted is measles, with an R value of 13.

--Unfortunately, the current vaccines appear to offer less protection against delta than against earlier versions of the virus. However, even though they may not completely protect against catching the virus, they are still highly effective at preventing serious illness, hospitalization and death. As such, vaccines remain our most important and urgent line of defense. "If we want to get back to normal life, we need our vaccination rates to be much higher," Souleles says. "That's priority number one to get our lives closer to what they were in January of 2020."

--That doesn't just include the US. The billions of people worldwide who are still not vaccinated are not just at risk personally, but represent a huge reservoir of current and future Covid-19 cases and so a huge opportunity for the virus to continue to mutate and spin off even more dangerous variants. "It's a global problem," says Wilson. "We have to vaccinate everyone. If we give the virus fewer opportunities to replicate, we win."

--All three of the experts were very concerned about the portion of the US population that are not yet vaccinated. They emphasize the importance of recognizing that this is not a monolithic group of dedicated vaccine refusers. Instead, these are individuals with many different issues, including very real medical, scheduling or other practical issues, normal anxieties and fears, such as a fear of needles, along with exposure to partial or incorrect information, and, unfortunately, a substantial number of people with politicized resistance to the vaccine and other protective measures. 

--They advocate both continued public education and persistent one-on-one outreach, aimed at recognizing and addressing each person's specific issues. "The media need to help people figure out what's real and what's not real, people who are being bombarded by misinformation," says Halkitis.  

"It takes a lot of conversation, but you have to keep doing it," says Wilson. To which Souleles adds, "Not just one conversation, maybe three, four or five."

--However, when education and patient one-to-one persuasion don't work, stronger steps may need to be taken. "I'd take a "tough-guy-from-New-York" approach," says Halkitis. "If you live in a civil society and you want to navigate spaces like concerts, restaurants, jobs and schools, you need to be vaccinated. Macron did it in France. If you want your children to go to school, they have to be vaccinated."

--All three agree that we need to track the course of the delta variant and any new variants that emerge with great attention, and that they could easily force a re-instatement of controls that have only recently been lifted. "Where we were six weeks ago is not where we are today," says Halkitis. "The next week will be very significant."

To summarize, the delta variant is highly contagious, surging rapidly, and is a potential game-changer. Everyone is eager to get back to something like the old normal, or on to a less restrictive new normal, but ultimately, it's the trajectory of the virus that will determine that. That trajectory is at least partly under our control through vaccination and other public health measures that we're all too familiar with. 

"We've got the tools," Souleles says. "We've just got to apply them on a broad scale."

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REA 7/23/21

NOW WE KNOW WHY DELTA IS SO DEVASTATING

The delta variant of the covid-19 virus is now the dominant strain in the U.S. and worldwide, accounting for more than half of new infections and driving up hospitalization rates and deaths in many U.S. states and multiple countries. 

We now have the first clues as to why the delta variant spreads so easily--at least twice as fast as the original virus. Just-released research from China reveals that the variant was detected in infected people two days earlier than was typical of the original virus--in 4 vs. 6 days--and, strikingly, the number of virus particles produced and potentially spread by sufferers was up to 1260 times higher.

Credit: Fortune.com

"This virus has surprised us," says  Emma Hodcroft, a molecular epidemiologist at the University of Bern, Switzerland, after reviewing the new study. 

The one-two punch of faster development after infection and vastly higher viral load combine to make the virus more quickly and easily transmitted, and make testing-contact tracing and quarantine-one of the main weapons in the battle against the pandemic--less effective.

"Putting it all together, Delta's really difficult to stop," says Benjamin Cowling, an epidemiologist at the the University of Hong Kong.

Unfortunately, with low vaccination rates in many states, along with the relaxation of most covid-related restrictions, we're going to hear a lot more about this virulent covid variant.

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REA 7/22/21

A SIP OF GOOD NEWS, AT LEAST FOR COFFEE LOVERS

It's rare to find out that something you like is actually good for you. But today we can report that coffee really is. Here's the good news, freshly poured:

As part of a large multi-year study, researchers were able to compare coffee consumption and a variety of health outcomes for more than 185,000 people in California and Hawaii. As reported in the July 11, 2021 issue of the prestigious Annals of Internal Medicine, over the course of the study coffee drinkers lived longer and suffered fewer cases of heart disease, cancer, stroke, diabetes, respiratory illness and kidney disease. 

Credit: stokpik/Pixabay

How large were these benefits? On the average people were followed for 16 years, starting at ages from 45 to 75. Over the course of the study 31 percent of the participants died, with cardiovascular disease and cancer being the biggest risks. People who drank one cup of coffee a day were 12 percent less likely to die during the study period than non-coffee-drinkers, and people who drank two or three cups per day were 18 percent less likely to die. 

So not only did coffee add years to people's lives, it also added years of good health.

Veronica Setiawan, an associate professor of preventative medicine at USC's Keck School of Medicine, and the study's lead author, is impressed enough with these findings that she's suggesting that non-coffee-drinkers reconsider. "We cannot say drinking coffee will prolong your life, but we see an association," she says. "If you like to drink coffee, drink up! If you're not a coffee drinker, then you need to consider if you should start."

One of this study's strongest points is the rich ethnic mix of its participants. It enrolled large cohorts of African-Americans, Native Hawaiians, Japanese-Americans, Latinos and whites. It turned out that all of these groups showed comparable benefits from coffee consumption. "This study is the largest of its kind and includes minorities who have very different lifestyles," Setiawan says. "Seeing a similar pattern across different populations gives stronger biological backing to the argument that coffee is good for you whether you are white, African-American, Lationo or Asian."

An interesting wrinkle was the finding that it made no difference whether participants drank caffeinated or decaffeinated coffee. Instead, Setiawan suspects antioxidants and other chemicals in coffee provide the health benefits she found. "Coffee contains a lot of antioxidants and phenolic compounds that play an important role in cancer prevention," she says.  "Although this study does not show causation or point to what chemicals in coffee may have this 'elixir effect,' it is clear that coffee can be incorporated into a healthy diet and lifestyle."

As I finish off my third cup of Joe for the day, it's great to be able to report some news that put a smile on my face, and I suspect will do the same for many others as well.

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REA 7/20/21

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And, as a bonus, another large long-term study finds that, contrary to its reputation, coffee doesn't add to the risk of developing cardiac arrhythmias. In fact, each additional daily cup of coffee was associated with a 3 percent reduction in the incidence of arrhythmia.

However, there really can be too much of a good thing. Just-published research from Australia indicates that people who drink more than six cups of coffee a day are putting themselves at significantly higher risk of stroke and dementia. The devil, it seems, is in the dose.

HOSPITALIZED PATIENTS MORE LIKELY TO SURVIVE IF THEIR PRIMARY PHYSICIAN IS A WOMAN

 A study involving more than 170,000 patients hospitalized in 7 different facilities in Toronto, Canada found that patients whose lead physician was female had a significantly higher survival rate than patients attended by male physicians. Overall 48 out of every 1000 of patients attended by female physicians died in hospital within 30 days compared to 52 out of every 1000 treated by male physicians--almost 8 percent fewer deaths. 

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The results of this large Canadian study are very similar to those of an earlier study of hospitalized Medicare patients in the US, which also found a comparable and significant difference in survival rates between patients treated by female compared to male doctors. You can read my earlier post about this here.

In the Canadian study, the difference in outcomes between inpatients of male and female physicians did not depend on the sex, age, severity of illness, or other characteristics of the patients.

There were several differences that may have contributed to female physicians' better patient outcomes. In particular, they ordered more studies, including CT scans, MRIs and ultrasounds. Previous research has shown that female physicians are more likely to review patient records, consult with colleagues and make referrals, spend more time listening to and talking with patients, show more empathic concern and take complaints and symptoms more seriously, all of which may contribute to better patient outcomes.

Still, before concluding that women are simply better doctors than men, another variable turned out to be equally significant in the Canadian study--the number of years of experience doctors had. Contrary to what one might think, this and other studies have shown that physician years of experience and patient outcome are negatively correlated, that is more years of experience correlates with more rather than fewer patient deaths. 

"Some [studies] suggest that physicians closer to their residency training are more up to date on clinical guidelines and are more likely to follow evidence-based practice, which may improve patient outcomes," the authors explain.

In the Canadian cohort of physicians, the female clinicians had on average 4.3 years of experience vs. 7.4 years for their male colleagues. This age difference proved to be as predictive of patient outcomes as physician gender.

So what's the bottom line? The authors of the Canadian study point out that they do not want to ". . . perpetuate gender stereotypes." So instead of looking for doctors who are female, perhaps we should instead look for doctors who are young, up-to-date in their clinical knowledge, empathic, good listeners and communicators, who take our issues seriously, and are willing to order appropriate tests, consult other doctors and refer when needed. 

You can be your own judge of whether you're more likely to find these qualities in a male or a female physician. 

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REA 7/17/21

MUST-READ ESSAY BY TIMOTHY SNYDER ON AMERICA'S NEW "MEMORY LAWS"

 Six US states have recently passed laws or guidelines limiting what can be taught about race and racism in US history and in the US today. Twelve more states are considering similar legislation.

                                                 Credit: Patrick Hoesley/Creative Commons

This isn't just a slippery slope; it's a slime-coated declivity that tramples vital facts underfoot and elevates an official narrative and the feelings of discomfort that facts may cause into the arbiters of what can and cannot be taught.

In the June 29th edition of the New York Times Magazine, Yale professor and author Timothy Snyder has gifted us a compelling essay about this dangerous movement, entitled The War on History is a War on Democracy.

I'd add that this isn't just a war on democracy, it's a war on reason and reality. 

If you haven't done so already, please take the time to read it.

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REA 7/13/21

EVEN THE VACCINATED NEED TO GUARD AGAINST VARIANT DELTA

Many of us who have been vaccinated against Covid-19 have at least started to lead more normal lives. Since getting my Pfizer shots, I've traveled by plane, stayed at a B&B and in friends' homes, eaten inside restaurants, and hugged (vaccinated) friends. It's felt great.

But from what I'm now reading, even if we're fully vaccinated, we may not be fully protected against the highly contagious Delta variant.

Credit: ISO-FORM LLC

From the laboratory, as reported in the prestigious journal Nature, we learn that one dose of either the Pfizer or the AstraZenaca vaccines "was poorly or not at all efficient against the Beta and Delta variants." Serum from just one person in 10 partially vaccinated people was able to neutralize the Delta variant. 

A bit more encouragingly, blood serum from 95 percent of people who'd gotten both shots of either vaccine did generate a neutralizing response. However, that response was just one-third to one-fifth as potent against Delta compared to Alpha.

And, in the outside world comes a report from Israel indicating that the Pfizer jab is just 64 percent effective in keeping vaccinated people from catching the Delta variant. The good news is that it appears to be 94 percent effective in preventing severe illness. Still, the actual numbers are not encouraging. In the recent two-week period surveyed, Israel recorded 1,528 new Covid cases. Of those, 1,271 were in fully vaccinated people. Thirty-seven people had to be hospitalized, of which 23 were fully vaccinated. Seventeen patients fell seriously ill, or which 11 had gotten both Pfizer shots.

More recent data from Israel, covering the week of June 27 through July 3 showed that a shockingly high percentage of new Covid cases--85 percent--hit fully vaccinated people. That's essentially the same percentage who are vaccinated in the whole Israeli population. At first glance this could indicate that the mRNA vaccines provide no protection against the delta variant. It's also possible that the 15 percent of the Israeli population who are nor vaccinated have already had Covid or are otherwise immune. In that case these data could indicate that vaccination provides no more protection than a prior bout with Covid. But in either case they clearly show that "breakthrough" infections from the delta variant are far from rare.

And an even more recent report from Israel finds that even two Pfizer jabs are just 39 percent effective in protecting people against the delta variant. The same report is quick to point out that the shots are 88 percent effective in preventing hospitalization and 91 percent effective against severe illness.

The Israeli numbers are described as preliminary and definitely are outliers compared to what some other countries are reporting. However, they clearly show that the Delta variant can sneak past the antibody defenses of a significant number of vaccinated individuals, corroborating what was seen in the lab.

If more proof were needed, an outbreak of the delta variant among staff and patients at a hospital in Calgary, Alberta, Canada provides it. Ten medical professionals who were fully vaccinated nonetheless came down with Covid-delta after attending a party. "It's quite a red flag, honestly," one Canadian health expert said.

It's reassuring that the vaccines still appear to be highly effective in preventing serious illness. Still, I don't want to risk even a mild case of Covid. So, until the Delta variant becomes much less prevalent, or until further data is significantly more reassuring, I'm dialing back from my more freewheeling behavior of the last few months.

"Normal" may be in sight, but, due to the highly contagious delta variant, it's not here yet.

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GET VACCINATED OR NOT? HERE ARE SOME ACTUAL STATISTICS.

 Just a quick note to any vaccine doubters who might still be amenable to facts:

Contra Costa County, in northern California, has begun publishing separate covid case statistics for vaccinated and un-vaccinated people.

The most recent 7-day average shows that among the 72 percent of adults who are vaccinated, the rate of new covid cases was 0.4 per 100,000--i.e. just one vaccinated person out of 250,000 got covid.

Credit: Manit Chaidee

In contrast, among the 28 percent of the county's population who are not vaccinated, the rate was 7.0 per 100,000. That's 17.5 times higher.

I don't know about you, but any time I can cut my risk of getting a potentially life-threatening disease by a factor of 17, I'm going for it.

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