Blow by Blow, a Passing Fancy?

Delta variant, now the Delta plus variant with Lambda and other variants waiting in the wings as other mutations are yet to come. Each more virulent, contagious and vaccine resistant than the previous mutation. The head of the World Health Organization is telling us that there should be a moratorium on booster shots until the rest of the world catches up with at least 10% vaccine penetration to stem the tide of mutation. End of September at least, he says. But there is a catch: the level of outbreaks here in the United States, almost all among unvaccinated individuals, has resulted in explosive infection, hospitalization and even mortality rates in irresponsible, conspiracy theory driven, red states. Florida, Texas, Arkansas, Missouri and Louisiana are “poster states” for vaccine resistance and absurdly escalating infection rates. Almost all preventable.

Not only is this irresponsible American phenomenon of vaccine resistance an amplifier of mutation and infection a threat to the United States, it creates a mutation breeding ground that disproportionately impacts the rest of the world. We are becoming one of the greatest super-spreader nations on earth. Israel has already implemented a policy of booster shots for those over 60 or with other medical vulnerabilities to infection. We must as well. Infectious disease specialists here in the United States are also beginning to watch even those who received vaccine inoculation in January and February (or earlier) face a gradual reduction in the efficacy of those injections. A booster shot seems inevitable, both to restore the COVID resistance in general and perhaps to address the more virulent mutations, present and possible future.

Thus, our addressing the need for more immediate booster shots, notwithstanding the WHO request for a moratorium, just might be more of global interest than might occur at first blush. That does not mean we should stop providing vaccines without strings to countries everywhere, but we do have the capacity to cover our own population, at least the intelligent segment, with boosters while still providing vaccines to nations in need. What is particularly frightening is the refocus of COVID mutations, from the Delta variant (responsible for 93% of all new infections) and beyond, on younger children, some of whom are seriously impacted and many of whom also face a lifetime of long COVID symptoms and risks.

Florida, an extreme example of governmental stubbornness to take the mutating virus seriously, legally banned mask mandates in the state for example (including public schools) and is also a petri dish of examples of childhood infection rates. The new infections impact children everywhere, but: “The rise in pediatric hospitalizations follows a similar spike in new cases among children in Florida. The state health department reported 10,785 new COVID-19 infections among children under 12 for the week ending July 29.” MSN News, August 5th. That under 12 segment, not yet eligible for vaccinations, is beginning to return to school. And unlike prior COVID patterns, children no longer have an automatic physiological advantage in fighting off the disease. The new variants have adjusted to target the young too.

We also know that while hospitalization and death risks are significantly reduced to those with full vaccinations, the Delta and beyond variants can still infect those properly inoculated (often with no or undetectable symptoms), who become inadvertent carriers and spreaders of enhanced COVID. To understand exactly how contagious these variants are, Adele Peters, writing for the August 5th FastCompany.com, tells us: “It lasted only a few seconds: One man walked past another man in a mall in Sydney. When officials later watched CCTV footage of the encounter, they saw that this was the only interaction between the two. But it was enough for one of the men, who didn’t realize that he was infected with the delta variant of the coronavirus, to infect the other.

“As COVID-19 cases from the delta variant continue to swell, it’s clear that some things are fairly risky—it isn’t an ideal time to spend hours sitting unmasked in a crowded bar, especially with unvaccinated people. But how risky is it to quickly pass someone at a grocery store or wait in line at a bank?

“It makes sense that spending more time with someone poses more risk, though worst-case scenarios like the one in Sydney show that it’s technically possible for the virus to be transmitted even during a fleeting encounter. ‘The challenge is that, of course, the amount of an exposure that’s required to cause an infection is always going to vary,’ says David Dowdy, associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health. ‘It’s always going to be possible for a very fleeting exposure to cause an infection. But it’s always going to be much, much more likely for a very intense exposure to cause an infection. It’s the same thing as saying, ‘Can you get the flu from passing someone on the street and they sneeze? Yes, of course you can.’ But how many people do you pass on the street, and how often do you get the flu from them, versus if your child gets the flu [and infects you]?’

“The question is difficult to answer because little data exists. As of a year ago, in the U.S. nearly five of six cases of COVID-19 went undetected, according to a recent study from the National Institutes of Health that looked at blood samples. Even when people get tested and realize they’re infected, contact tracing is sporadic at best. In parts of the country last year, more than half of people with COVID-19 declined to share their contacts. When infections surge, contact tracers also often don’t have enough resources to keep up. And it gets harder to discover which person infected others if a large percentage of people in an area are sick.”

HIV, which began its killing spree in the 1980s, is still with us, although containment treatments (which took decades to develop) have severely curtailed its deadly impact. While there are very expensive nascent treatments (such as monoclonal antibodies) for COVID beginning to be available, our current reality seems to be to learn how to live, survive, where COVID continues to infect. 

Given the mutations and the limited number of global inoculations, the stubborn refusal of many even to consider vaccination, COVID seems likely to stick around for at least the immediate future (a few years or more). But COVID’s dangers are indifferent to political considerations, adherence to conspiracy theories that minimize its impact and simple human stupidity. If the virus could speak, it might simply say, “Hey humanity, bring it on! Keep doing what you are doing!” And while there is case law and constitutional precedent for vaccine mandates here in the United States, the enforcement pragmatics and political risks make that unlikely. Guess we shouldn’t require automobile seatbelts either.

I’m Peter Dekom, and it is exceptionally difficult watching self-righteous individuals insist on what is effectively a right to spread disease to unwilling people with whom they have contact.