Update on Corona Virus Pandemic with Dr Peter
7/12/21

The news around Covid 19 is sobering.
Tale of Two Cities – “It was the best of times and the worst of times.”

There are two situations and responses going on right now.

One story in the developed countries and populations, and another story in the underdeveloped world.
There is a much more difficult situation in underdeveloped areas.
Even in those countries, like the US, there are two populations – those who are vaccinated and those who are not and still at risk.

Marin County – 75% vaccinated. Some areas in the US there is only 20% vaccination rate.

There have been great strides. We have discovered we can develop vaccines quickly and many delays in that process were bureaucratic. We have a greater understanding of viruses and pandemics.

The various waves of Influenza virus in the 1918 pandemic were most likely due to different variants with different transmissability and death rates. There was very little understanding and ability to determine how to prevent and deal with the virus.

The US has had only a handful of serious overflow situations and has been able to deal with the needs pretty well. But in India and other places there has been a lack of supplies, oxygen, beds and essential equipment.

Clearly, international travel has made things worse and we may need to deal with international travel differently in future situations.

How well we are doing with mutations

Vaccines are holding up extremely well against the variants, including the Delta variant and Delta Plus.
Prevention of symptomatic cases about 70% – 80%. Some a little bit lower. Prevention of serious symptoms and hospitalizations is about 90%. So with very few exceptions, all the vaccines are very effective against hospitalization and death. They decrease symptomatic disease and substantial decrease in transmission.

The Delta variant R0 (R naught) is about 6. This is highly transmissable. The original strain had an R0 was about 3. We can reduce the R0 with prevention measures.

U.K. vaccination rate about 60% and with prevention measures has reduced the R0 to about 1.1.

Lambda variant: Different variant than the Delta. Don’t know which is more transmissable. The impact of Lambda may just be regional.

Delta Variant

We know India went through a phase where it seemed they had herd immunity and lifted restrictions, then the Alpha variant came in and then the Delta variant took over.

The Alpha variant was only slightly more transmissable than the original strain. It did not cause a big wave in the US that was anticipated. The Delta variant will cause a new wave, especially in areas with low vaccination rate and lack of safety measures.

July 4th weekend was first big event and increased exposure since restrictions loosened. Look for increase case counts 2 weeks following that date. Most cases will be with in unvaccinated people and hospitalizations will be mostly in that population. Hospitalizations will follow 10- 14 days after the rise in cases. Hospitalizations will be blunted in the vaccinated population. We will have to see how it plays out.

Delta variant is becoming the dominant strain now. Over 50% of new cases in the US are the Delta variant. This varies regionally. In Missouri it is well over 70%. In CA it is 30-40%. In a month or two it will most likely be the dominant variant everywhere.

Delta Plus – the Delta variant with one additional mutation added in. That mutation does make it a bit more resistant to the vaccines.

Delta variant is more transmissable.
For example – outdoor transmission with the other variants has been quite limited, especially with distance and masking. Sporting events transmission in the stands outside – very limited transmission. However, we have seen transmission of the Delta variant in outdoor settings in recent weeks. We may have to take additional precautions, especially those who are not vaccinated.

Another example – if someone in a family contracted Covid, usually the entire family was not affected. Perhaps one or two others. With the Delta variant, it is not uncommon to see entire families that catch it from one person who got it first. This can be a problem with getting caregivers for entire families.

Also – those people who contracted Covid from a different variant can still get sick with the Delta variant if they are not vaccinated.

Delta variant and sub types will be running rampant across the world. Indonesia is getting hit hard with the Delta variant wave, although it wasn’t as bad with the original strain of the virus. Africa is also getting hit hard and the vaccination rate is only 1% and the virus will be unimpeded.

In the UK there are over 30,000 cases per day and 90% are Delta variant. It’s an explosion of Delta variant. Expecting over 100,000 cases per day in the coming weeks.
“Freedom Day” on July 19 – releasing all restrictions. A lot of concern this is a bad time to do this.
One argument is that now is better than doing it in the fall when there are other respiratory illnesses that will require hospital beds.

Symptoms with Delta variant:
Different presentation than the Alpha variant. Alpha: cough, sore throat, headache, fever, loss of sense of smell, loss of sense of taste.

Delta is presenting more like a cold. (headache, sore throat, runny nose, no fever, loss of smell is not as common) Can easily believe it is just a summer cold. Definitely test people who have mild symptoms.
One case at the Nevada City clinic of a vaccinated person testing positive with symptoms.

Break through infections: More likely over age 65 or have other health issues.

Differences between vaccinated and unvaccinated people:
Case positivity rate is about 5X higher in unvaccinated people. Population of 100,000 people, for every symptomatic case in vaccinated group, there will be 5 cases in the unvaccinated group.

Hospitalization in vaccinated people are rare. Nevada County has over 50% vaccinated. Only 2-3 cases hospitalized briefly overnight.

Long Haul: Not sure how different the rate of long haul symptoms in people who were vaccinated when the contracted Covid. It seems like it will be a big difference, but not clear yet.

Increasing pressure on people to get vaccinated, especially in education and work settings. This will probably escalate, especially with FDA approval of vaccines.

Nevada County Public Health Department states: If you are unvaccinated, you are 79x more likely to die from Covid, and about 8X more likely to get infected and get symptomatic Covid.

Still seeing no boosters on the horizon as an expectation. Pfizer company recommending, but CDC is not seeing it as a necessity. This is a positive sign and tells us the vaccines are doing well.

How will different locations respond if case counts really jump and this is a major wave that comes?
Too bad we don’t have a crystal ball to see what will happen. Not clear if we would have more lockdown or change in behaviors. Watch how the hospitals do. If the hospitals just have modest admissions there may not be many restrictions. If hospitals are overwhelmed there may be more restrictions imposed. Medical staff are exhausted. We have plenty of supplies on hand in the US but staff is exhausted. Public health departments are worn out.

Mainland Europe – case counts going up.
In places where the vaccination rate is good, many cases will be mild and not lead to hospitalization.

Holland has increased > 500%
Greece 140%
Malta 800%
Switzerland 95%
Belgium 80%
France 65%
Denmark 65%
Italy 50%
Israel 50%

Asia is also seeing increases.
Vietnam 130%
S. Korea 60%
Indonesia 40%
Bangledesh 35%

Americas
USA up 14%
Mexico up 45%
Canada – best vaccination rate and cases are continuing to fall.
Brazil – still very bad conditions
Peru – new variant “Lambda”

Nevada County
Case counts also going up. Over 40 cases in a few days. Testing going down as well.
UC Davis is helping with genotyping now. Getting faster results on genotyping so we can know about variants.

Case Positivity Rate in NC has gone up a bit from 2.9% to 3.9%.
Probably underreported deaths – families are insisting that Covid 19 is NOT listed on death certificate.
NC local hospital – surge in hospitalizations related to drugs and alcohol use. This is part of the fallout of the pandemic.

Vaccination rate at Ananda Village is over 80% which is hopefully approaching herd immunity.

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