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Are You Protected Against The Delta Variant?

Welcome, everyone. I'm Dr. John Whyte, the chief medical officer at WebMD, and you're watching Coronavirus in Context. What is happening with the delta variant? Are we all going to need boosters in the fall? Do we have to start wearing masks, whether or not we're vaccinated? So to help give us the answers, I've asked one of the best experts I know. Dr. Eric Topol is the editor-in-chief at Medscape, and is joining us from San Diego, California. Dr. Topol, welcome.

ERIC TOPOL

Great to be with you, John.

JOHN WHYTE

And I've got to start off with the delta variant. You can't turn on the news without hearing about it. You and I have talked about variants before, how do we differentiate 'scariance,' in terms of what we need to worry about. I want to start off, though, by asking about vaccinated people. How concerned for those that are vaccinated be when it comes to the delta variant?

ERIC TOPOL

Well, we'll see a report in the New England Journal today that indicates that vaccinated with the mRNA vaccine is very high protection. This is from Public Health England, a large sample, also comparing with alpha variant. So the suppression or protection from infection is about 80% or better, and from severe illness, hospitalization or death, 95%, 96%. So the protection is excellent.

But because of the fact that we have 160 million Americans who have been fully vaccinated, we've got some people there who are going to get infected. Most of them will have mild illness, or even without symptoms, if they get tested. So this is something that I think, because of the math, in the denominators portion, so people are getting a skewed sample or sense of what's going on here. The vaccines we have are potent against delta. They're not as good as prior versions of the virus for just preventing infections, but they're just as good for preventing severe illness.

JOHN WHYTE

All of them? You had some preliminary information preprint about the JandJ vaccine, a different type of vaccine that we've talked about, not the mRNA, like Pfizer and Moderna. Still--

ERIC TOPOL

Right.

JOHN WHYTE

--very good protection--

ERIC TOPOL

There's two--

JOHN WHYTE

--or not as good?

ERIC TOPOL

Well, there's no-- yeah, John, there's no clinical effectiveness reports for JandJ. There are two lab studies, you know, whereby they take serum and expose it in the lab to the variant from people who've been vaccinated. And in those two studies, both of them show, with the JandJ vaccine, that the level of neutralizing antibodies was lower, but still above the threshold for protection.

And then in a preprint yesterday from NYU, it showed that it was less than the mRNA vaccines, but not contradicting the other one. So there's definitely some protection. The question is, is it good enough? And you know, I think this is something that's uncertain right now. We have a lot of anecdotes of people with JandJ vaccines getting a breakthrough, but we don't have the data to cinch it yet. My suspicion is it's probably an issue, but I don't know for sure.

JOHN WHYTE

But Eric, how do we really know how many breakthrough infections there's been? CDC has stopped counting unless it's hospitalizations or deaths. So how do we make those accurate assessments?

ERIC TOPOL

Yeah, well, we have a real problem with lack of adequate tracking here. And we know that the more you'll test, like is being done at the Olympics right now or by the sports teams in certain places around the world, like the UK is testing fourfold more than us-- our testing has gone down as our outbreak has gone up, which is the wrong move. So there are more breakthroughs that are asymptomatic that are only getting picked up by testing.

But more importantly, there are people who are symptomatic, not getting tested. We want to sequence the virus when there's enough sample because it's not just a matter of defining delta. We also want to stay ahead of this. There could be future variants of concern. So we are not doing this appropriately. And over a billion dollars was allocated to CDC to do this. And that was months ago, and nothing has happened.

JOHN WHYTE

Let's get to what listeners really want to know, Eric. They want to know, if I've been fully vaccinated, do I need to wear a mask, at least indoors? We saw that's happening not far from you in California, in Los Angeles, the recommendation to wear masks, irrespective of vaccination, inside. So it gets confusing. So what should listeners be doing? Let's assume they're fully vaccinated. Do they need to wear a mask at all? Do they need to change their behavior right now?

ERIC TOPOL

Right. Well, I mean, I think this is pretty clear. As you're alluding to the LA County, a very impressive surge of cases. And of course, all this was happening when the masks were abandoned in California. So I think the data is speaking to us that using a mask indoors if you're vaccinated is prudent, and especially if it's more than a very brief encounter. And the more people, the more vital the mask is needed, and the less ventilation. I call it the delta stress test for a vaccine, right? That is, if you are vaccinated, you're in good shape, but this is a very contagious strain.

This is 1,000-fold more viral load, viral copies are hanging out in our nasal upper airway than in the Wuhan original strain. That's a lot more viral load. So the vaccines are great, but they are not perfect. And if we don't pass the stress test, if we don't wear the mask, that's not a good thing. And a mask is simple, and it helps, as does distancing and ventilation and, when you can, avoid indoors. If you're only with known vaccinated people, the risk is reduced. But it isn't certain because we still know it's possible that a vaccinated person could be in the presymptomatic phase, and still potentially be transmitting. It's very low chance, but it's still possible.

JOHN WHYTE

Because we thought a little while ago that vaccinated persons may not be spreading. We really don't know the answer for sure, do we?

ERIC TOPOL

Well, I think if they're symptomatic, they can.

JOHN WHYTE

Yeah.

ERIC TOPOL

The question is that, even in the couple of days before they develop symptoms, it looks like those who have had a substantial viral load, I don't see any reason why they couldn't transmit. It's just that this is rare, and you just don't know. So I think the smart thing is just, for the moment-- we're going to get through this delta wave, it's a matter of weeks, but for the moment, just assume kind of the worst-case scenario. Wear a mask indoors. You know, you're not going to regret it.

JOHN WHYTE

How concerned are you about what's happening in India? What's the preliminary data from Israel about the potential need for boosters? Again, we have some conflicting information. Pfizer says they're getting boosters ready for the fall. CDC and FDA says, hold on, there's no data that says we're going to need boosters. You and I have talked about it a couple months ago, before we had delta variant. Now, we're going to hear about-- you mentioned on your Twitter handle lambda variant, where we still need to have more data on. And I do recommend to everyone that they follow you on Twitter. How concerned are you about what's happening in other areas of the world that are going to impact what happens here?

ERIC TOPOL

Right. Well, you know, I think delta is expressed in different countries very differently. So if you look at Indonesia and Russia and Bangladesh and South Africa, so many places, it's been ravaging these countries. They have very low vaccination rates, less than 20%, or even less than 15%, and so they're feeling the full brunt. Now, if you look at the UK and Portugal, Israel-- these are high vaccination places-- they have markedly blunted the impact of delta. But as you've alluded to, John, in some elderly people, many months passed when they got initially vaccinated. They have some breakthrough infections.

And it raises the question as to whether people of vulnerable, especially vulnerable people might need a booster as we go forward. It seems likely in the elderly or people who are immunocompromised even now, of course, because they're not getting a third dose, and we know certain people, like organ transplant individuals, will benefit from a third dose. But will we need a booster for all people? That's still very uncertain.

And we haven't any new data, no evidence to make a judgment. I'm sure we will see that in the months ahead. But right now, as you know, John, the White House crew, administration reviewed the data Pfizer had, and said it wasn't compelling. And of course, that data hasn't been shared with us. So we'll see more of it. Eventually, we'll be able to make a call. But I'm thinking it's not an all thing, it's not everyone. But we'll see as evidence accrues whether that is the right sense of where we're headed.

JOHN WHYTE

Is there a danger of too many boosters perhaps selecting out certain variants, and then perhaps exposing yourself to something later on in terms of immune protection?

ERIC TOPOL

Yeah, I mean, I think the problem here with the booster we've just been talking about, it's just the same darn vaccine. And so all it does is just kind of rev up the immune response to the spike protein, but it doesn't have the multivalent vaccine specifically against delta. And moreover, we know we could make vaccines that would knock out the entire SARS-CoV virus family, all the pan-coronavirus, and we're not pushing on that enough, because that could potentially be ready in the months ahead, too, and get us equipped to deal with any variant. So I'm disappointed that we're still going to be reusing the original vaccine, rather than shifting to one that would basically squash delta, would be even more potent. I know that's in the works, and delta is the most challenging version of the virus we've seen for sure, but I think we have to think bigger, and think about, you know, whatever epsilon or omega, we've got to think about--

JOHN WHYTE

Omega.

ERIC TOPOL

--those and just get-- yeah, we've got to get a vaccine ready for all things, all variants. And we can. I know we can do this.

JOHN WHYTE

What does September look like?

ERIC TOPOL

Hm. I'm actually right now thinking September, we'll be over this delta hump.

JOHN WHYTE

OK.

ERIC TOPOL

If you watch India, they had almost no vaccines, and in about two months, they went from to a hellish, horrific situation to back to baseline. So basically what happens is it runs through the people it's going to run through, right? And most of them are unvaccinated. Some are vaccinated, but the vast majority unvaccinated. It doesn't, of course, hurt people with prior COVID as much. And I think people tend to forget that. If you've had COVID, you'd be better off to get one-dose vaccine, but at least you have some natural immunity. But it runs its course, it finds as many hosts as it can, and it goes through a population, like it will in the United States, and it's done for that time. I mean, it's still around, but it's not going to be-- yeah.

So then the question is, will another variant or another wave come through? We don't know yet. You know, lambda doesn't look like it's going to be the one. There's nothing out there yet that looks like a delta, you know, plus, a true worse than delta. But the fact that it isn't contained in the world, it could be cultivating that next version. So I'm optimistic about September, but I don't know beyond that what's going to happen.

JOHN WHYTE

Well, I'll check in with you in September, as well, if not sooner. I always appreciate you taking the time. As I said at the beginning, I always turn to you when we have to find out what do we really need to know. So thank you, Dr. Topol.

ERIC TOPOL

Thanks, John. Always great to have a chance to talk with you. ","publisher":"WebMD Video"} ]]>

Hide Video Transcript

[MUSIC PLAYING]

JOHN WHYTE

ERIC TOPOL

Great to be with you, John.

JOHN WHYTE

And I've got to start off with the delta variant. You can't turn on the news without hearing about it. You and I have talked about variants before, how do we differentiate "scariance," in terms of what we need to worry about. I want to start off, though, by asking about vaccinated people. How concerned for those that are vaccinated be when it comes to the delta variant?

ERIC TOPOL

JOHN WHYTE

All of them? You had some preliminary information preprint about the JandJ vaccine, a different type of vaccine that we've talked about, not the mRNA, like Pfizer and Moderna. Still--

ERIC TOPOL

Right.

JOHN WHYTE

--very good protection--

ERIC TOPOL

There's two--

JOHN WHYTE

--or not as good?

ERIC TOPOL

JOHN WHYTE

But Eric, how do we really know how many breakthrough infections there's been? CDC has stopped counting unless it's hospitalizations or deaths. So how do we make those accurate assessments?

ERIC TOPOL

JOHN WHYTE

ERIC TOPOL

JOHN WHYTE

Because we thought a little while ago that vaccinated persons may not be spreading. We really don't know the answer for sure, do we?

ERIC TOPOL

Well, I think if they're symptomatic, they can.

JOHN WHYTE

Yeah.

ERIC TOPOL

JOHN WHYTE

ERIC TOPOL

JOHN WHYTE

Is there a danger of too many boosters perhaps selecting out certain variants, and then perhaps exposing yourself to something later on in terms of immune protection?

ERIC TOPOL

JOHN WHYTE

Omega.

ERIC TOPOL

--those and just get-- yeah, we've got to get a vaccine ready for all things, all variants. And we can. I know we can do this.

JOHN WHYTE

What does September look like?

ERIC TOPOL

Hm. I'm actually right now thinking September, we'll be over this delta hump.

JOHN WHYTE

OK.

ERIC TOPOL

JOHN WHYTE

ERIC TOPOL

Thanks, John. Always great to have a chance to talk with you.

Covid Vaccines 'highly Effective' Against Delta Variant

Covid-19 vaccines are "highly effective" in preventing hospital admission with the Delta variant of coronavirus, according to new data from Public Health England (PHE).

Both the Pfizer/BioNTech and Oxford/AstraZeneca jabs are just as good at coping with the Delta variant first identified in India as the Alpha variant first identified in Kent, the data suggests.

PHE's study of hospital admissions found:

– The Pfizer/BioNTech vaccine is 94% effective against hospital admission after just one dose, rising to 96% after two doses.

– The Oxford/AstraZeneca vaccine is 71% effective against hospital admission after just one dose, rising to 92% after two doses.

– Protection against death is also expected to be high, but further work is under way to confirm this.

– Unvaccinated people have twice the risk of hospital admission with the Delta variant as the Alpha variant.

– Among those who are vaccinated, 12 people in every 100 may end up in hospital with Delta compared with eight for Alpha.

The PHE researchers said: "These findings indicate very high levels of protection against hospitalisation with the Delta variant with one or two doses of either vaccine."

The analysis included 14,019 cases of the Delta variant, of which 166 people ended up in hospital.

The data covered the dates of April 12 to June 4 for emergency hospital admissions in England.

Health and Social Care Secretary Matt Hancock said: "Our UK vaccination programme continues at pace and has already saved thousands of lives. It is our way out of this pandemic.

"This evidence of the effectiveness of two doses against variants shows just how crucial it is to get your second jab.

"If you have had your first dose but haven't booked your second yet – please do so. It will help save lives and boost us on the road to recovery."

Dr Mary Ramsay, head of immunisation at PHE, said: "These hugely important findings confirm that the vaccines offer significant protection against hospitalisation from the Delta variant.

"The vaccines are the most important tool we have against Covid-19 and thousands of lives have already been saved because of them.

"It is absolutely vital to get both doses as soon as they are offered to you, to gain maximum protection against all existing and emerging variants."

Vaccines minister Nadhim Zahawi said: "It is extremely encouraging to see today's research showing that vaccines are continuing to help break the link between hospitalisation and the Delta variant after one dose, and particularly the high effectiveness of two doses.

"If you're getting the call to bring forward your second dose appointment – do not delay – get the second jab so you can benefit from the fullest possible protection."

It comes as other research in Scotland also suggests the Delta variant is associated with about double the risk of hospital admission compared with the Kent variant.

Nevertheless, two doses of either Pfizer or AstraZeneca were found to be protective, experts said.

Two doses of the Pfizer/BioNTech jab was found to provide 79% protection against infection from the Delta variant, compared with 92% against the Alpha variant.

The Oxford/AstraZeneca vaccine offered 60% protection against infection with the Delta variant compared with 73% for the Alpha variant.

Experts said this lower vaccine effect may reflect that it takes longer to develop immunity with the Oxford jab.

Professor Aziz Sheikh, director of the University of Edinburgh's Usher Institute and EAVE II study lead, said it was important that "when offered second doses, people take these up, both to protect themselves, and to reduce household and community transmission".

The data was based on 7,723 cases and 134 hospital admissions that were found to have the Delta variant.

How Coronavirus Vaccines Still Help People Who Already Had COVID-19

Some people who have been infected with coronavirus have questioned whether they really need vaccines.

The U.S. Centers for Disease Control and Prevention recommends people get vaccinated regardless of whether they've already had COVID-19. That's in part because it's still unclear how long immunity lasts after an infection. Studies have shown that antibodies hang around in the blood for at least eight months after getting sick, but some recovered patients have gotten reinfected (SN: 6/11/21; SN: 8/24/20).

COVID-19 jabs give the immune systems of people who were previously infected an extra leg up to fight the coronavirus, including against new, more transmissible variants, other research shows. And because the delta variant, first identified in India, can spread among vaccinated people, that extra layer of protection for recovered patients is probably helpful (SN: 7/30/21).

"If you've had exposure to COVID before, don't think you're immune to variants," says Benjamin Ollivere, a trauma surgeon who studies COVID-19 at the University of Nottingham in England. "Have your vaccines."

Now, the evidence that even recovered people benefit from the shots is mounting. Based on the latest studies, here's what experts know about past infections and getting vaccinated.

One dose may work, but two could be better

One vaccine dose might be sufficient to protect people who have already had COVID-19, lab-based studies suggest (SN: 3/3/21). One shot for those who recovered from a prior infection boosts virus-attacking antibodies to levels similar to those of vaccinated people who got two doses of an mRNA vaccine, researchers reported August 6 in JAMA. A second dose, however, didn't further increase antibody levels for previously infected people.

Antibodies aren't the only part of the immune response that benefit from the vaccine, although the immune proteins are crucial to prevent infection. A single shot was enough for recovered patients to reach high levels of a subset of immune cells called T cells, researchers reported August 3 in Cell Reports. T cells help coordinate and ramp up the immune response when a person is exposed to the virus again.

That suggests that people who had COVID-19 and then were vaccinated with a single dose could be as protected as fully vaccinated people who were never sick. But whether that plays out in the real world, outside the lab, is unclear.

A CDC-led study of previously infected people offers a hint. Kentucky residents who had recovered from a coronavirus infection but weren't vaccinated were around twice as likely to get infected again as their vaccinated counterparts, researchers report August 6 in Morbidity and Mortality Weekly Report.

People who were only partially vaccinated — meaning they had received only one of two mRNA vaccine doses or had finished a vaccine regimen less than two weeks prior to being infected — were about 1.5 times as likely to be reinfected as fully vaccinated people. So, even one shot offers protection, but two doses could be slightly better. (One caveat is that few people in the study were partially vaccinated, making it harder to estimate the risk of infection.)

Larger studies will help pinpoint whether previously infected people need more than one dose for protection, the researchers say.

Shots are the best defense against variants

Using a single shot to protect previously infected people is promising, but the spread of delta and other variants has called into question whether that single shot is enough.

Lab-based studies suggest that even a single COVID-19 shot makes antibodies from previously infected people better at recognizing other versions of the coronavirus. One mRNA vaccine dose was enough to increase infection-halting antibodies to levels up to 1,000 times higher than before vaccination, researchers reported in the June 25 Science. That was true not only for an early version of the virus from China, but also the beta variant, which first emerged in South Africa, and the closely related virus that caused the 2003–2004 SARS outbreak.

Survivors of that 2003–2004 outbreak also benefit from COVID-19 vaccines. Antibodies from vaccinated SARS survivors could stop not only the coronaviruses behind SARS and COVID-19 from infecting cells, but also animal coronaviruses from bats and pangolins, researchers reported August 18 in the New England Journal of Medicine.

Increasing the amount of time between two vaccine doses can also help antibodies learn to recognize different coronavirus variants, Ollivere and colleagues report August 10 in Science Translational Medicine. Previously infected, fully vaccinated heath care workers in the United Kingdom — where officials allow shots to be given up to 12 weeks apart rather than the standard three or four — had antibodies that could attack variants including beta.

See all our coverage of the coronavirus pandemic

It's unclear whether the findings would be the same for the delta variant, but Ollivere expects that antibodies from previously infected, vaccinated people should fight that variant off too. That should hold true as long as there are no major structural changes in the spike protein, which would help the virus better hide from antibodies, he notes. "And we know delta doesn't have structural changes."

A separate study supports that hypothesis. Previously infected and vaccinated health care workers in France had antibodies that recognized delta better than antibodies from workers who were infected only, researchers reported in the Aug. 12 Nature.

There's hope that vaccines can tackle yet-to-be-seen variants, too

The more people the coronavirus infects, the more mutations it will pick up, making some experts concerned that more worrisome variants than delta may be on the horizon (SN: 7/2/21). But the immune system is apt at rolling with the punches, continually refining its antibody arsenal to better recognize even mutated forms of the virus (SN: 11/24/20).

One recent experiment offers even more evidence of vaccine-induced antibodies' ability to recognize emerging variants. Antibodies from recovered COVID-19 patients who had been vaccinated stopped a version of coronavirus with 20 changes in it spike protein. The spike protein acts as a key to unlock and infect cells, but even with all the changes, antibodies still prevented the virus from infecting cells, researchers reported August 8 at bioRxiv.Org.

In the study, which has not yet been reviewed by other scientists, virologists Fabian Schmidt, Yiska Weisblum and colleagues engineered a harmless animal virus that doesn't make people sick to sport mutated coronavirus spikes. The virus with 20 changes could replicate in lab-grown cells, but it didn't fare as well as a version of the virus without those mutations — which suggests that the combination of mutations had negative consequences for the virus.

The team then tested how well antibodies from vaccinated or recovered people attacked the mutated virus. "The main question was, 'What will it take for this virus to evade immunity?'" says Weisblum, of Rockefeller University in New York City.

Those 20 changes to the spike protein were enough to make the virus resistant to antibodies from vaccinated people who were never exposed to the virus, as well as antibodies from previously infected people who never got their shots. But people who were previously infected and vaccinated still had other antibodies that recognized the virus and stopped it from infecting cells — a sign that their immune system had adapted to better recognize its target.

It's not impossible that a virus with that many mutations in the spike protein will pop up somewhere around the world and cause problems even among vaccinated people, though that remains to be seen, says Schmidt, also of Rockefeller University. Current variants of concern like beta and delta have around 10 spike mutations. If the virus did accumulate more mutations, booster shots should protect people, the finding suggests.

As antibodies evolve over time, they "know what to do," Weisblum says. Future vaccines might include slightly varied versions of the virus, to help the body craft a strong immune response. But even if researchers can't predict how the virus might change in the future, she says, "the immune system will take care of the rest."

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