COVID-19 and the Delta variant: what you need to know in August 2021

Like many of you, we’ve been enjoying a summer with small slices of normality. But, as we predicted, things are quickly getting worse again — some areas are already at the worst levels they’ve been in the entire pandemic — as the Delta variant and bad actors within our society continue to do damage.

This post brings you up to speed on what’s changed and what you need to know.

Summary:

• The vaccines work and all available data says they are safe. Anyone who tells you otherwise is lying or ignorant.
• The populations and geographical areas seeing huge spikes in hospitalizations and deaths are the heavy anti-vax / anti-mask areas.
• If you’re vaccinated, it’s extremely unlikely you’ll get sick enough to require a hospital. But you can still pick up and retransmit the virus.
• Expect to get a booster shot this winter (or at least eight months after your first round). The existing shots still work months after the poke, but the data shows a booster is worth it.
• Ivermectin is rumored to work, but it does not.
• Masks and social distancing while indoors continue to be the best ways to protect each other besides vaccines. N95 masks are worth it compared to other masks.
• You don’t need to worry about surface transmission, ordering food delivery, etc. The only real risk is sharing air with infected people, who may or may not have symptoms.
• Besides actually getting a serious case of Covid, one of the biggest personal threats you face is needing the hospital for some non-Covid reason while the system is overwhelmed. Do what you can to minimize the need for hospitals.
• You should plan for continued supply chain and broad economic weirdness through at least the end of 2022.
• Broad lockdowns are unlikely — but regional lockdowns in areas with low vaccination / masking rates are.
• COVID-19 is still a new disease, and learning how to protect people from it is an ongoing process. Science works!

You are not a horse. You are not a cow. Seriously, y’all. Stop it. https://t.co/TWb75xYEY4

— U.S. FDA (@US_FDA) August 21, 2021

Do I need to wear masks again? What kind?

All of the data continues to show that outdoor transmission is rare. The natural air movement disperses any virus particles.

If you are not vaccinated, you absolutely should wear a face covering when spending time indoors with people not in your household. It’s such an easy way to do your part and be a good person — consider it the very cheap price you pay for choosing not to get the shot.

If you are vaccinated:

• It’s still helpful to wear a simple mask when going to public places like the supermarket. You could be transmitting the virus, so do your part and block your mouth.
• But we’re now recommending wearing a proper N95 (or better) respirator when going inside public places so that you protect yourself from the people in society who don’t do their part.
• If you have a friend come inside of your house for a visit, for example, and you trust they’ve been vaccinated and safe, then it’s reasonable to be maskless.
• But with the recent surge, many people are now wearing simple masks in that “friend over for dinner” situation.

Thankfully, N95s are becoming more available. We just bought a 50-pack of these comfortable and foldable Kimberly-Clark N95s for $50 off Amazon, for example.

Reminder: Simple cloth masks (and bandanas, neck gaiters, etc) protect other people from the wearer. To protect yourself, you need to wear a proper respirator that filters all of the air coming into your mouth and nose.

More: What to look for in N95 masks

Is hand sanitizer worth it?

It helps, but it’s not high on the priority list because the data continues to show that hands are not a major transmission route. The highest impact times to wash your hands or use sanitizer is before eating or touching your face, and after touching people or things outside of your household, such as a public store door.

Are the vaccines working? Which vaccine is best?

Yes, they’re absolutely working. Over 98% of COVID-19 dead in July 2021 were unvaccinated. You can see the relationship when comparing maps of vaccine rates and hospitalization rates:

 

Current data shows that every vaccine available in the US is safe and effective. But the mRNA vaccines — Pfizer and Moderna — seem to have an efficacy edge over the Johnson and Johnson vaccine.

It’s not clear if any of this is due to an inherent efficacy edge, or just the fact that mRNA vaccines are being given in two and three doses while Johnson and Johnson is still single dose.

Vaccines from other parts of the world are not as effective.

Do the vaccines wear off over time? Do I need a booster shot?

Yes, the vaccines do wear off over time. There isn’t enough data on the Johnson and Johnson shot yet, but the mRNA vaccines appear to slowly wear off. Yale Medicine is optimistic that those shots will remain effective for at least a year.

Israel, which vaccinated over 90% of its elderly people with the Pfizer vaccine early this year, recently approved a third shot for the elderly population after data showed cases rising in this group. The vaccine was still working, and nearly completely abolished deaths and hospitalizations, but efficacy against milder infections had dropped measurably.

The third shot was given to most of the elderly cohort about five months after the second one, and within weeks, Israeli health authorities observed a steep drop in the percentage of cases seen among the elderly. Accordingly, they have begun administering third doses to the general population in phases.

The US will do the same beginning in late September, and you should get one as soon as you are eligible.

A booster shot specifically tailored for the Delta variant is likely to be approved in the US around the end of 2021, and it will probably be a good idea to get that as well.

How effective are the vaccines against Delta? Lambda?

Very effective (> 95%) at preventing serious illness and hospitalization. In terms of preventing infection itself, one study says the Pfizer vaccine is only 42% effective at blocking transmission while the CDC and other studies say it’s closer to 75%.

At this moment, despite over 97% of US cases now being Delta, the evidence continues to show that the top vaccines do their job.

The Lambda variant has been burning in South America for a while, and there is evidence that it evades immunity from the less-effective attenuated virus vaccines like Bharat, Sinopharm, and Sinovac, and probably natural immunity obtained by infection with the wild type. However, in vitro evidence shows that mRNA vaccines and the Regeneron antibody cocktail still work well against Lambda. In addition, there are hardly any cases of Lambda in the USA, which means we would receive a significant warning from the CDC’s variant monitoring system before it became common here, if it ever does.

When can my kids get vaccinated?

Probably pretty soon. Pfizer just presented early trial data on its vaccine for younger children to the FDA, and a later phase trial is ongoing. The FDA and health officials have been saying different things at different times about the likely timing of approvals, but the most likely outcome seems to be that pivotal trial data will be submitted in September, leading to an approval in October.

Does Ivermectin work to prevent or treat COVID-19?

No. Not even a little bit. There was only one high-quality clinical study suggesting that Ivermectin worked for treating COVID-19. Or at least, we thought it was high quality until it turned out the authors had fabricated the data from whole cloth. That study was retracted, and there’s no good evidence showing that Ivermectin works. People who get COVID-19 should be cared for by infectious disease doctors, who will use proven tools like antibody therapies, remdesivir, dexamethasone, and other therapies which may be proven out in the future.

This is an important issue because a lot of people are trying to use Ivermectin to treat or prevent COVID-19. The Mississippi State Department of Health has said that about 70% of poison control calls in the state now relate to Ivermectin poisoning.

How dangerous is Delta for children?

A little bit dangerous. Delta is more serious for children than prior strains of SARS-CoV-2, causing a much larger percentage of cases to result in death and hospitalization. However, this percentage is still small overall, ranging from fractional percentages to just under 2% depending which state you’re looking at.

Children can contract and transmit Delta just as easily as adults.

Children can also get PASC, known as “Long COVID,” but probably at a lower rate than adults. Not much is known about how long cases of Long COVID will last — time will tell.

This produces a paradoxical situation where pediatric hospitals are overflowing, and hundreds of children are dying, and thousands are getting serious side effects like MIS-C, and hundreds of thousands, perhaps millions, are getting Long COVID, and children are contributing significantly to the overall spread of the disease to adults, while any individual child is in only a modest degree of danger unless they happen to get unlucky.

The way to handle this, from the individual perspective, is pretty simple:

• Until they get the poke, treat your kids like you would any other unvaccinated person. They can get it, spread it, and possibly get sick.
• If your unvaccinated child is sent to full-time in-person school, especially in areas with lots of cultural pushback about masks and so on, you should assume your kid will get the virus at some point.
• If they do get sick, the chances of serious illness or death is low. But it does exist, and it seems to be growing.
• You can prepare for this by working with them on personal hygiene, noticing if their friends are sick and not sharing juice boxes with them, and so on.
• The vast majority of teachers report that kids seem to be fine with wearing masks. It’s the loud parents causing the problems.

Is COVID ever going away?

Yes, the pandemic will end at some point. But the SARS-CoV-2 virus is so dispersed, and has so many reservoirs in isolated human and animal populations, that most experts think we’re unlikely to ever eradicate it.

The way things “get back to normal” is by reaching herd immunity, which gives the virus much less room to mutate into something even worse than Delta while “keeping the curve flat” so that systems like healthcare aren’t overwhelmed.

The longer a big chunk of society (over 20-30%) stays vulnerable to the virus, the longer this will drag out with more potential for mutations that reset the clock.

A useful threshold for the substantive end of the pandemic in the USA is the attainment of under 100 COVID-19 deaths per day, along with a justified confidence that this number will not be exceeded again, absent a major new and unexpected development. 100 deaths a day is approximately the number of deaths we see from the flu, car crashes, and so on — ie. it’s a number society is willing to deal with indefinitely.

Am I guaranteed to get COVID?

It’s not inevitable, but certainly a struggle to avoid. The evidence continues to indicate that a household of vaccinated people who avoid crowds and wear N95 masks when they are indoors around unvaccinated people will likely avoid getting COVID-19. If they keep doing this until the substantive end of the pandemic, they will probably never get COVID-19.

However, it is undeniable that a large percentage of the global population has had COVID-19, and that percentage is growing. High-end estimates suggest that over 40% of the US population has had COVID-19 already, and we are adding millions of new cases every week.

Foreign countries like India and Brazil have higher numbers; serostudies suggest the vast majority of people in both countries have had COVID-19 already. And there are individual neighborhoods and cities with numbers as high as 90%.

Are things going to lock down again? Shelter at home?

It’s possible, but our current belief is that it’s unlikely there will be major country-wide lockdowns again. It was absolutely the right move to take in February – March 2020, when scientists didn’t know much about the new virus, masks and other PPE were widely unavailable, and so on.

Now that those conditions are different, we’re less likely to need the “nuclear option” of shutting everything down to prevent catastrophe. What would change that from unlikely to likely is if there’s an outbreak of a deadly and contagious new variant.

It’s more likely that there will be regional lockdowns — eg. in anti-science areas like the US South, where things are getting pretty bad and local officials will need to flatten their local curve.

What should I do to prepare for another COVID wave?

Prevention:

• Mental health is important. Take advantage of the windows we have now — such as a walk in the park on a nice day — before the weather turns and things potentially get bad again.
• Don’t waste your sanity on things that don’t matter, such as wiping down packages. Do focus on the few core things: vaccines, masks, social distancing.
• Get booster shots when they’re available.
• Get your kids vaccinated when available.
• If you are high-risk and can’t get vaccinated, or a titer test shows you have poor response to the vaccine, consider preventative infusions of the Regeneron antibody cocktail, which just received an emergency use authorization for this purpose.
• Hospitals are filling up — over 20% of US ICUs report being full. You can look up local hospital occupancy here.
• Some people are choosing not to do risky activities such as extreme sports, for example, to lower the chance of needing a hospital but not being able to get in. As another example, nasty car accidents are unusually high at the moment, so drive carefully.
• If you live in a shared building and don’t trust the property managers to already be on top of this, ask them if they’ve upgraded to hospital-grade air filters (like MERV 13 filters).
• If you control your HVAC, replace and possibly upgrade the filters. That, plus opening windows etc when people are over, is the best way to handle ventilation inside your home.

Tip: A great way to reduce the need for hospitals is with a great first aid kit combined with the skills to handle minor medical problems on your own.

In case you or a family member gets sick:

• Keep an ear to the ground for COVID-19 diagnoses in people around you, so you can know to be on heightened alert if you may have been exposed.
• Be on the lookout for Covid symptoms. The current biggest warning flags are still headaches, runny noses, coughs, and fever.
• Test early, test often. PCR tests are easily available now, and covered by most insurance, while at-home rapid tests like the Abbott BinaxNow are fast, private, and cheap, and can be purchased in advance.
• Think about what you would do to isolate yourself or a family member. Can you get the guest bedroom ready so that someone can quickly go in and not need to come out for a while?
• If someone is sick, keep them isolated until they feel recovered and test negative.
• Immediately contact your doctor or a COVID-19 clinic to find out if you should take treatment.  Medicines like antibody cocktails, remdesivir, and others work better if they are given early in the disease course (remdesivir works, but it’s not super effective). And they are much more available now: Regeneron recently announced it is producing half a million doses of its antibody cocktail for use in the USA every month. And antibody clinics in many areas are now set up to administer antibody therapy to newly diagnosed COVID-19 patients in an outpatient setting.
• Notify people they’ve been in contact with — we know that’s a crappy phone call to make, but it’s the right thing to do.

Will we have more economic disruptions?

Yes.

Our twice-weekly news roundups (here’s the latest example) have been dominated for over a year by headlines of shortages in almost every facet of life. Toyota recently announced a 40% cut in production volume due to a lack of computer chips, for example, and toilet paper is once again in short supply in some areas.

If there is anything you need, and you have the funds to buy it, you should probably buy it while you can.

Don’t hoard or make purchases you don’t need. The point is that you can’t assume anything you want to buy will be instantly available. And we do mean anything — these supply chain problems can occur in literally any product or part imaginable.