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The Delta variant of the coronavirus is driving a new surge in Covid-19 cases across the country — and a much smaller increase in cases throughout Vermont.
Health authorities say the Delta variant is far more contagious than previous strains of the virus, but vaccines are still effective at preventing severe illness and death. But with case numbers rising both nationally and locally, how concerned should Vermonters be?
Case numbers have been on the rise for nearly a month, and two Vermont counties — Chittenden and Essex — now show “substantial” Covid spread, according to the Centers for Disease Control and Prevention. The federal health agency has recommended that both vaccinated and unvaccinated people wear masks in indoor public settings in those counties.
On this week’s podcast, VTDigger health care reporter Liora Engel-Smith discusses what we know and what we don’t know about the Delta variant, with help from infectious disease experts Tim Lahey (University of Vermont Medical Center) and Gabriela Andujar Vazquez (Tufts Medical Center). Below is a partial transcript, edited for length and clarity.
I feel like we've been getting news pretty much every day this week about the Delta variant, whether it's coming from the CDC or from other studies. And the picture seems to be that, nationally, this is driving a whole new surge in Covid cases. What I want to pin down today is, how different is that picture in Vermont? We have the highest vaccination rate in the country, and some of the lowest infection rates. How protected are we? How worried should we be?
Liora Engel-Smith: We’ve seen a small, just a very modest increase in infections in Vermont, also because of Delta.
Mark Levine: We continue to see slightly higher numbers of cases. But importantly, our hospitalization and deaths remain very low. A sign that our high levels of vaccination are keeping Vermonters safe.
Liora Engel-Smith: But of course, because we have such a high vaccination rate, we don’t see like these huge jumps that other states are seeing, like in the South and everywhere else in the country.
Dr. Mark Levine this week said in a conference that we have some Delta variant in the state. But the folks who are in hospital right now, they’re all unvaccinated. And so he mentioned that there was very little breakthrough infection. And compared with the folks who are unvaccinated, they make basically the bulk of the new infections.
Mark Levine: The main reason why we still struggle with the virus, even here in Vermont, is the cycle of increased transmission of virus among the unvaccinated population, which continues to lead to more opportunities for mutations, and the production of more variant strains. That's evolution, in real time, occurring right before our eyes.
So the evidence so far, the data that we have so far, shows that the vaccines really are working. And given that Vermont has such a high vaccination rate — I think we’re kind of around 84% right now — that we are fairly well protected. Is that kind of the assumption that we’re making here?
Liora Engel-Smith: Yes and no, right? It depends on you. If you are healthy and you are vaccinated, and you waited your two weeks and you got your two shots or the one shot for Johnson and Johnson, then yes, you’re protected, or maybe a little bit more protected. But you can still get coronavirus if you come in contact with folks who are infected. Say you were traveling outside of the state — you’re still at risk there. And then if you’re immunocompromised or somehow medically fragile, that could cause issues too, because your immune system is not mounting as much protection as you would expect. And so you could get the infection way, way more easily.
It does seem like this week, we’ve learned a lot more about what you referred to as breakthrough cases — these cases where you still get an infection even though you're fully vaccinated. What did we learn from state officials this week about what they've seen in terms of breakthrough cases in Vermont?
Liora Engel-Smith: We’ve seen very few breakthrough cases. We are seeing a slight uptick, because Delta is just a little bit better at spreading. And that's because Delta is more contagious, way more contagious than any of the other variants that we know of right now. The CDC just said this week that it’s even more contagious than Ebola and the flu and the common cold. But the vaccines are still working. They’re just not working as well as they did when we had the other variants circulating.
Last Tuesday, the CDC announced new guidance that even vaccinated people should go back to wearing masks in indoor public settings in parts of the country with substantial or high Covid transmission. At the time of that announcement, no Vermont counties had a high enough case rate to fall into that category. But on Monday, CDC data showed that universal indoor masking was recommended for both Chittenden and Essex counties.
State officials said in response that no new mandates or restrictions were planned.
Liora Engel-Smith: The biggest thing that state health officials said this week was if you’re not vaccinated, now is the time to get vaccinated. Because you still get protection — you're going to be less likely to get hospitalized and have complications if you are vaccinated.
Beyond that, if you’re traveling elsewhere, and you’re going to a place where you may have been exposed to coronavirus — maybe you traveled to see family in the South — we got some recommendations to get tested when you come back, to make sure that you're not transmitting the virus or have the virus in your system. If you’re vaccinated, you could be asymptomatic and still transmit the virus the same way as a person who is unvaccinated. That’s really, really important.
And then, all the other things that we sort of expect — like if you have children who are not vaccinated, you definitely want to continue the precautions that you've used all along. Which means stay outdoors, have them wear a mask, wash your hands. And just kind of stay abreast.
Vermonters need to pay attention to what’s happening right now. It’s not time to panic, but it is definitely time to pay attention, and just to kind of watch. Because things are changing very quickly. And what we’re seeing today might not might not be up to date tomorrow.
This seems to be changing so quickly that all of these things that we talked about might evolve in the coming weeks and months.
Liora Engel-Smith: Right. And that’s how it’s been this entire pandemic. Now, it’s even a little bit different. Because before, there were guidelines for everyone, because all of us were not vaccinated. And though some of us were at higher risk, because we’re older or have conditions that make us more vulnerable, we all needed the masks to protect us. And now, some people are vaccinated, and some people aren’t vaccinated. So that creates this differential, almost two worlds. With these two worlds, there are different rules.
With all of that, Vermont has such a low case rate that it seems that state officials are really OK with the “wait and see” approach. That means that we’re not going to get a ton of guidance right now. We're just kind of keeping the status quo until officials sort of figure out what else we need to do, or if we need to do anything else.
Throughout this week, you’ve been talking to experts about how they think Vermonters should be interpreting all this new information that we've been getting about the variant. What have they been saying?
Liora Engel-Smith: I spoke to Tim Lahey — he's an infectious disease expert at University of Vermont Medical Center. And he said, if you don’t want to look at the graphs and try to make decisions — you know, maybe it’s too complicated — the biggest thing is to think about your threshold of risk. How risk-averse are you? Are you really afraid of getting infected? If so, you should wear a mask. It's not going to hurt anyone if you wear a mask in a place where your risk is really low.
Tim Lahey: I think if someone is medically otherwise pretty healthy, and they’re fully vaccinated and not massively risk-averse, I think that it makes sense not to wear a mask in all but the rarest of circumstances.
Liora Engel-Smith: So what’s the rarest of circumstances?
Tim Lahey: Well, personally, I do not wear a mask in the grocery store. And I do go out to eat. But I have to wear a mask at work, where I’m surrounded by vulnerable people in the hospital.
Liora Engel-Smith: And again, it depends on who you are. So if you’re a person who got the vaccine, but you’re immunocompromised, or have a transplant or something like that, then again, you need to take more precautions.
Tim Lahey: The way I would put it is, I think there’s no way to avoid that our behavior has to be shaped by local epidemiology. Numbers have to shape us, but fortunately, it looks spectacular in Vermont, so we don’t have to have lots of restrictions. And who you are — if I had a bone marrow transplant, even in Vermont, I probably would not go out to eat.
Gabriela Andujar Vazquez: At this point, you want to continue — we have a very good, safe and effective vaccine. But we also want to make sure that we take that risk of getting Covid as low as we can, and that we take those decisions in our daily lives.
Liora Engel-Smith: I talked to a Tufts infectious disease specialist as well, Gabriela Andujar Vazquez. She spoke a lot about the fact that folks are confused about the naming of the different variants, and that it's really important that people understand that these are just different versions of the same virus, but Delta is just the most powerful version. That requires us to take more precautions and to sort of reevaluate where we're where we are with the pandemic.
Gabriela Andujar Vazquez: I think that where people are confused is: mandatory, not mandatory — should it be, should it not be? I think that at this point, in terms of masking, it should be advised in the population that are more at risk of getting infections, even though they're fully vaccinated — definitely unvaccinated, but even though they're fully vaccinated — and then give the person the tools to make that decision for themselves.
She's basically saying, it's important for us to at least stay aware and have knowledge of what this is and why it's out there — just to kind of watch our backs, essentially.
Liora Engel-Smith: Yeah. We may have had a period where we thought we were going to be past the pandemic, and where we thought this summer was going to be different. It is different, but it’s different than what we thought. We are now dealing with a new stage of the pandemic. And so we have to, sadly, adapt with it.
What do we know right now about this fall, when students are going to return to K-12 schools, knowing that all kids under 12 are unvaccinated? Taking in this new information about the contagiousness of the Delta variant, how does that change things?
Liora Engel-Smith: We don’t know quite yet. The state is still working through its guidelines. Before we learned about how contagious Delta is, we heard from state officials that we're planning to return to in-school instruction. Gov. Phil Scott seemed to signal that he will issue guidelines, but sort of let districts decide on their own what to do with the guidelines on a case-by-case basis. We’re expecting there’s going to be new guidelines, hopefully coming out either next week or the week after. That’s what we were told at the press conference this (last) week.
But I think that with Delta being as contagious as it is, there might be a chance that the governor and administration are going to reevaluate. A lot of folks are calling for perhaps doing universal masking in schools, even though we have really high vaccination rates. But it’s kind of unclear what’s going to happen at this point.
There's been some talk about whether or not booster shots might be on the table down the line. What do we know about that so far?
Liora Engel-Smith: The FDA does not yet say that we need to get a third shot. It might be something that we'll end up getting very soon, but not yet. Studies are underway right now — I know Israel has a study, and there are a couple of studies in the United States. Some studies are thinking about a universal booster. Some studies are more about thinking about just giving boosters to folks who are maybe immunocompromised or otherwise somehow at risk. Everything changes day to day, so it’s kind of hard to know what’s going to happen next week.
I want to circle back to what you were saying before about how these more recent developments are giving this summer a different vibe from what we expected — that we had gone in anticipating being at a certain place in the pandemic, and it turns out we're actually a little bit further back than we were expecting. It seems like that is really frustrating for people and really confusing for people. Do we have a sense of when we might return to the place where we thought we were? Might we be looking to kind of turn the curve at some point soon?
Liora Engel-Smith: It’s really hard to know. I’ve heard in other states that the rise of Delta, and maybe a little bit the fear of Delta, is driving folks to get vaccinated. That’s a really fantastic sort of outcome. The more vaccinated folks we have, the faster it is that we can stamp out, or at the very least curtail, deaths and cases from coronavirus. But it really depends on what percentage of vaccinations we're going to get to. And then if folks are going to decide, in some of these very high transmission areas, to wear masks, and to do the things that the CDC is saying, or if they're going to say, “Man, I'm so tired of it, I'm vaccinated, why should I wear a mask?” Those are two things that really, really matter here.
The other thing to think about is that scientists kind of expected this. Unlike us normal, mere mortals. We didn’t really think about the pandemic beyond, like, “Hey, this summer is here.” I know I didn't — I thought to myself, “Summer is here, and life is back to normal. Welcome to 2021.”
Right, “I got the shot and that's all the protection I need.”
Liora Engel-Smith: Right, right. But then, we know that the virus mutates. We know this because we know it from the flu virus and from other viruses that are similar to coronavirus. And so there was discussion already that the vaccine might end up being slightly less effective as the virus changes. Delta is sort of the latest one, and is the most contagious of the bunch that we know of right now. And it’s doing exactly what we expected. The virus is trying to evade the vaccine.
There’s a chance that there will be another variant down the line that will be even more strong than Delta, that would be even worse. The immunity that we get from the vaccine would be even a little less. But this is where scientists have said, with the technology that we have, we can adapt the vaccine really quickly and release booster shots, just like we do with the flu shot once a year. Scientists look and see what mutations are out there for the flu, and they formulate the vaccine, and you go ahead and get it and then you're protected until next year. And so it’s possible that coronavirus is going to sort of end up being one of these vaccines that we get just booster shots whenever we find that vaccines lose their efficacy.
But in the meantime, it’s just all the more reason for people to stay aware of what’s happening around them.
Liora Engel-Smith: Yeah. I know it's really easy to say, “Hey, we have the highest vaccination rate in the country.” That's fantastic. But Delta doesn't really care. If somebody comes to your community and they have coronavirus, there could still be substantial trouble for us.
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