“Control your destiny or someone else will.” - Jack Welch
“You are master of your own destiny. You can influence, direct and control your environment. You can make your life what you want it to be.” - Napoleon Hill
The numbers are going up and we have no one to blame but ourselves. Every day the numbers of COVID positive cases go up as well as the number of deaths. Unlike last summer where the numbers went down, we are seeing quite the opposite this summer. There has been a 43.3 percent increase of cases over two months ago
A 41.1 percent increase in the seven-day average of new hospitalizations last week, and a 39.3 percent rise in deaths, as compared to the week ending on June 26. Surprisingly there are increases in positive cases in children 12 and under. Almost 72,000 positive cases in children 12 and under were added the past week, a substantial increase from the prior week, when about 39,000 cases were reported. After declining in early summer, child cases have steadily increased in July.
Two things will bring the numbers down. Vaccinations and Masks. This virus is unpredictable and the coronavirus has shown a frustrating resilience. New variants of the pathogen could extend the pandemic into 2022.
Overall, only 49.9 percent of all Americans are fully vaccinated, according to the CDC. That figure doesn’t account for those who have natural immunity from having fought off COVID-19, developing antibodies in the process. Earlier this year the immunization goal was 70 percent of American adults. Now the experts believe that about 80 percent of the population has to be vaccinated (or retain natural immunity from a previous COVID-19 illness) to achieve herd immunity.
We need to realize we are not dealing with the original COVID -19 virus of a year ago. We are now dealing with its variants which we do not know as well because of the speed of mutations that are occurring and why the “RULES” keep changing because we all must realize this pandemic is a very fluid situation and the rules of last week may differ from the rules of this week.
Alpha, Beta, Gamma, Delta — there have been four Covid-19 variants of concern that have altered the course of the pandemic at different points in the past year and a half. The Delta variant came to the US in March and now makes up 93% of all the new COVID-19 cases. Data suggests that the Delta variant is possibly twice as transmissible as the original strain, and there’s some early evidence that it might lead to more severe cases. The current mRNA vaccines still appear highly effective against serious illness from the Delta variant, but because they were designed to target the original strain, the shots may not be as effective as against Delta, which has a number of mutations on the virus’s spike protein.
A study in the New England Journal of Medicine found the two-dose Pfizer-BioNTech vaccine reduced the risk of a symptomatic Delta infection by 88%. Another study that hasn't been peer reviewed found the Pfizer-BioNTech and Moderna mRNA vaccines reduced the risk of hospitalization by 91% for people who weren't immunocompromised. Unvaccinated adults who were previously infected with COVID-19 were twice as likely to be reinfected as those previously infected but also fully vaccinated, researchers found.
A case-control study in Kentucky found a more than two times higher risk of COVID-19 cases among unvaccinated adults with prior infection compared with their fully vaccinated counterparts (OR 2.34, 95% CI 1.58-3.47), reported Alyson Cavanaugh, PhD, of the CDC, and colleagues, writing in an early edition of the Morbidity and Mortality Weekly Report.
Why we are seeing mutations: In the unvaccinated, each time the virus infects a new cell, it starts to makes copies of itself and as it copies, it makes random changes known as mutations. Most mutations aren’t useful and die out, but some can be tolerated and passed on, said Ben Neuman, chief virologist at Texas A&M University’s Global Health Research Complex. Coronaviruses are typically slow changers. They will mutate, as any virus does, but they don’t evolve at an alarming rate. But what has shocked scientists is the rate of evolution, or how quickly these variants of concern acquired new mutations, according to Nathan Grubaugh, an evolutionary virologist and associate professor of epidemiology at the Yale School of Public Health. In general, the coronavirus goes through about one to two transmission cycles a month. But the variants of concern have acquired many more mutations much more quickly. Alpha, for example, didn’t just acquire one or two mutations, it picked up 17.
The leading hypothesis is that it took a prolonged infection probably in an immunocompromised person whose body had a tough time clearing out the virus to collect this many mutations so rapidly. From there, the virus spread to somebody else before taking off and shooting through entire communities.
The development of new variants that rise to the level of concern is actually extremely rare. There have probably been hundreds of thousands of events where a host of new mutations have occurred, but those versions of the virus weren’t very fit so they died out before becoming a variant of concern. Just because the virus evolves, doesn’t mean it’s going to become a variant of concern.
But, when you give the virus so many different opportunities to infect new people, it will inevitably test out new variations. As long as there are people for SARS-CoV-2 to infect, the coronavirus will continue to evolve. We’ve never seen anything like SARS-CoV-2 before. We’ve never had a pandemic of this scale with so much global mixing. A variant that pops up in Brazil can be in Japan or the United States in a moment’s notice, Grubaugh said. What happens around the globe is going to impact the rest of the world — we aren’t living in a vacuum. This makes it a lot harder to predict what’s going to emerge and where.
“We know that most of the variants we see emerge from people who are not vaccinated,” said Dirk Dittmer, a virologist at the University of North Carolina’s School of Medicine who is currently working on a variant tracking project in North Carolina. According to Grubaugh, one of the most important things to understand is that things change and we have to be ready for those changes. It’s not that the science or our understanding of Covid-19 has changed — the virus has changed.
“The key to stopping new variants is to vaccinate so thoroughly that SARS-CoV-2 is not able to find enough new hosts to sustain itself,” Neuman said.
As the super-transmissible Delta variant marches across the US, mutant versions are developing. Among the latest iterations giving the world's public health officials pause is AY.1, also known as "Delta-Plus."
The two variants are genetically similar, which is why they share the same Greek letter. But Delta Plus (also known as AY.1) has an extra mutation in the code for its spike protein, which helps the coronavirus access our cells. Delta Plus has made its way to at least 29 countries and 17 US states. According to the Washington Post, that same mutation has been found in some substrains of Alpha, which had been the dominant strain in the US this spring until Delta took hold.
"Interestingly enough, this exact same mutation appeared in the Beta variant, and the Beta variant has been out-competed by the Delta variant," Kenneth Stedman, PhD, professor of biology at Portland State University in Oregon, tells Health. "So, it may turn out that Delta-Plus is actually worse than Delta. We don't know."
At present, Delta-Plus accounts for a tiny fraction of COVID cases in the US: Just 0.1%, per data released Wednesday by the US Centers for Disease Control and Prevention (CDC). Delta is responsible for an estimated 93% of COVID cases in the US, according to CDC data.
Booster Shots: There are in our future due to the new variants like the Delta Plus, the Lambda variant from Peru which is starting to make its way across the US as well as a yet unnamed variant that is appearing in Florida which is coming from Columbia. These are variants of interest. Not variants of concern. Bear in mind the Delta variant started off as a variant of interest back in March and now is a variant of concern in July.
Pfizer has announced that it has already developed a COVID-19 vaccine targeting the Delta variant and also said that it had manufactured the first batch of mRNA for a clinical trial, which it expects to begin in August (if granted regulatory approval).
Moderna on Thursday said it expected that a third dose of its COVID-19 vaccine would be necessary before the winter, saying protection from the shot could fade over time. While Moderna is developing vaccine candidates tailored to fight variants including Delta, Stephen Hoge, Moderna's president said. The initial booster would likely be the original formulation of Moderna's vaccine given at half the strength of the first two shots.
We have two key weapons in fighting this virus: one is masks, the other is vaccines. We all must realize that the battle is not over. The variants are real and are changing. Only 49.9% of the US is fully vaccinated. This is the reason why we are seeing the recent increase of COVID cases going from 11.000 cases per day in June to over 100,000 cases in July. This is why we are seeing new variants. If you do not believe this is a real crisis visit your local hospital or speak with a hospital worker. The science and the math do not lie.
Let’s all smarten up. Let’s follow the science and the numbers. Not the politics. This virus and its mutations are proving to be a formidable foe. Because of COVID’s ability to mutate quickly we need to achieve herd immunity and quickly or we may experience a situation where the vaccine does not work. If this happens it will take time to develop a new one. If that is the case, we will see shut downs again.
Until next time: Be safe, Be well, Be Smart, Get Vaccinated and Wear your Mask.
James A. Vito, D.M.D.