Tuesday, August 3, 2021
Monday, August 2, 2021
What you should know about the Delta variant of the coronavirus
By Becky Dutch, Vince Venditto, Ashley Montgomery-Yates and Aaron Grubbs
University of Kentucky
As the SARS-CoV-2 Delta variant continues to spread across the United States and hospitals’ Covid-positive intake numbers climb again, many questions remain around both vaccine effectiveness and vaccination rates, and what these numbers could mean moving into the fall.
When viruses replicate, they make billions and billions of copies of themselves. Every time they make a copy, they can make mistakes. Over time, you will expect that normal viral evolution means you are going to start picking up variants. The Delta variant is the first notable variant we’ve seen from Covid-19. It is beginning to spread rapidly in the U.S. because of the large population of unvaccinated people here.
While this is a scary notion, there is good news that comes from this information. We now have on good authority that the Covid-19 vaccine is doing what it was made to do. Most people who have been hospitalized recently for Covid-19 are not vaccinated. This is evidence that the vaccines are working. They are inducing the appropriate immune response to keep us protected, keep us out of the hospital and prevent death.
Some are expecting to see a surge in hospitalization rates coming in the fall. The issue is not that the Delta variant is a more aggressive virus, it is just more transmissible, which makes it easier to catch. Last year, even the people who were not necessarily full believers in what the Centers for Disease Control and Prevention was saying had things in place that kept them safe in ways they did not even realize. Without the mandates we were previously under — masking, no mass gatherings and businesses shut down — health-care workers fear that the variant will cause surges.
The discussion is once again going back to precautions we can take to keep each other safe. Vaccinated people have had a taste of no mask life, but is that really what we should be doing?
There is evidence that suggests a vaccinated person can get the Delta variant. However, those who have gotten it have had a mild infection. Even if you are vaccinated, if you are attending mass gatherings, or have someone in your immediate circle who is immunocompromised, the best solution is to wear a mask. If we’ve learned anything from Covid-19, it is much better to air on the side of precaution when dealing with your health. And if you haven’t yet, get your Covid-19 vaccine!
Becky Dutch, Ph.D., is a virologist and the vice dean for research with the UK College of Medicine; Vince Venditto, Ph.D., is an assistant professor of pharmaceutical sciences in the UK College of Pharmacy; Dr. Ashley Montgomery-Yates is UK HealthCare chief medical officer for inpatient and emergency services; and Dr. Aaron Grubbs is an infectious-disease physician and UK HealthCare assistant medical director of infection prevention and control.
University of Kentucky
As the SARS-CoV-2 Delta variant continues to spread across the United States and hospitals’ Covid-positive intake numbers climb again, many questions remain around both vaccine effectiveness and vaccination rates, and what these numbers could mean moving into the fall.
When viruses replicate, they make billions and billions of copies of themselves. Every time they make a copy, they can make mistakes. Over time, you will expect that normal viral evolution means you are going to start picking up variants. The Delta variant is the first notable variant we’ve seen from Covid-19. It is beginning to spread rapidly in the U.S. because of the large population of unvaccinated people here.
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| peterschreiber.media, iStock/Getty Images Plus |
Some are expecting to see a surge in hospitalization rates coming in the fall. The issue is not that the Delta variant is a more aggressive virus, it is just more transmissible, which makes it easier to catch. Last year, even the people who were not necessarily full believers in what the Centers for Disease Control and Prevention was saying had things in place that kept them safe in ways they did not even realize. Without the mandates we were previously under — masking, no mass gatherings and businesses shut down — health-care workers fear that the variant will cause surges.
The discussion is once again going back to precautions we can take to keep each other safe. Vaccinated people have had a taste of no mask life, but is that really what we should be doing?
There is evidence that suggests a vaccinated person can get the Delta variant. However, those who have gotten it have had a mild infection. Even if you are vaccinated, if you are attending mass gatherings, or have someone in your immediate circle who is immunocompromised, the best solution is to wear a mask. If we’ve learned anything from Covid-19, it is much better to air on the side of precaution when dealing with your health. And if you haven’t yet, get your Covid-19 vaccine!
Becky Dutch, Ph.D., is a virologist and the vice dean for research with the UK College of Medicine; Vince Venditto, Ph.D., is an assistant professor of pharmaceutical sciences in the UK College of Pharmacy; Dr. Ashley Montgomery-Yates is UK HealthCare chief medical officer for inpatient and emergency services; and Dr. Aaron Grubbs is an infectious-disease physician and UK HealthCare assistant medical director of infection prevention and control.
Beshear asks vaccinated Kentuckians to talk to their unvaccinated friends about getting immunized; Delta 'spreading like wildfire'
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| State Dept. for Public Health graph, relabeled by Ky. Health News; for a larger version, click on it. |
By Melissa Patrick
Kentucky Health News
In a press conference focused on getting Kentuckians vaccinated for the coronavirus, Gov. Andy Beshear made a special plea for those who are vaccinated to talk to others about their experience, again acknowledging that anyone who might listen to him has already gotten their immunization.
"I need every single Kentuckian who's gotten vaccinated . . . to talk to somebody who hasn't because your friends, your loved ones are more at risk than they have ever been," Beshear said Monday. " So if you haven't had that tough conversation yet, and I get why you might not have, I really need you to now because you might be the only person that they trust, that they will listen to. And you might be the only person that can break through and get them that protection."
A recent Kaiser Family Foundation poll found that friends, family and health-care providers have the most influence in getting vaccine-hesitant individuals to get vaccinated.
Schools: Monday was the first day of school for many Kentucky students, and schools are the other big battleground of the pandemic. The Carter County School District, one of many that decided not to require masks, delayed classes due to a large number of infected school-age children.
Asked about that, Beshear said he wasn't sure what parents were supposed to do with that information and "I really hope smarter heads prevail."
He said Kentucky's guidance follows Centers for Disease Control and Prevention guidance and calls on schools to require masking for all students, staff and visitors, regardless of their vaccination status. He said schools that do not follow this guidance "are doing it in contradiction of all public-health advice."
The latest research from the CDC says vaccinated people are about as capable of getting and transmitting the virus as unvaccinated people. That's what prompted its new guidance to wear masks indoors in areas where infection is substantial or high, which includes almost every county in Kentucky.
Mandates: Asked about restoring the indoor mask mandate he lifted in June, Beshear said would not take that possibility off the table. He said things that would influence such a mandate would be virus-transmission rates and hospital capacity.
"Again, if we just get vaccinated, we can tear off the masks and go back to our regular lives," he said.
He also said the state is not considering any vaccination mandate. He asked, "Do you think one would work? When people have dug their heels in already in the face of all the information? We've got to think about effectiveness.. . . What makes something effective? It's the step that you're taking times the number of people who will follow it."
Beshear and Health Secretary Eric Friedlander announced that universal masking will be required in all state-run health facilities, including veterans' nursing homes, and all unvaccinated staff in the facilities will be required to be tested at least twice a week.
Daily numbers: The state reported 1,052 new cases of the coronavirus on Monday, with 231 of them in those 18 and under. That brings the seven-day rolling average up to 1,394, more than double what it was 11 days ago.
Kentucky hospitals reported 796 Covid-19 patients; 250 of them in intensive care units; and 98 of those on a ventilator. Those figures are also doubling every 11 to 12 days.
Beshear said he was not worried about the increase because hospital capacity remains stable, but is concerned with how sick the Covid-19 patients are.
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| Dept. for Public Health graph |
From March through July, 94% of new coronavirus cases, 91.5% of Covid-19 hospitalizations and 88.7% of Covid-related deaths were Kentuckians who were unvaccinated or only partially vaccinated.
Beshear stressed that fully vaccinated people are protected against severe illness and death, and he is asking vaccinated people to wear masks because of the latest research showing they can spread the virus.
Two of the state's 10 hospital readiness regions were using at least 80% of their intensive-care beds: the easternmost region, from Lee to Pike counties, was at 85%, with 24% of ICU capacity used for Covid-19 patients; Lake Cumberland, was at 87%, with 29% of ICU capacity used for Covid-19 patients.
The statewide rate of daily new cases over the last seven days is 29.64 per 100,000 residents. Counties with double that rate are Clay, 104.8; Jackson, 89.0; Laurel, 70.5; Floyd, 69.4; Hart, 68.3; Letcher, 61.6; and Muhlenberg, 59.7. Of the state's 120 counties, 74 are considered to have what the state calls a "critical" level of virus transmission. The CDC's critical level is lower than the state's.
And while all of these numbers are concerning, Beshear stressed that the difference between now and the beginning of the pandemic, when the state took more extreme measures to slow the virus, is the vaccines.
The state reported five Covid-19 deaths Monday, bringing the toll to 7,348.
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| Dept. for Public Health graph shows that unvaccinated Kentuckians are five times as likely to get infected as their vaccinated neighbors. |
Kentucky has not seen a spike in vaccinations like a few states, but Beshear said the trend is going in the right direction. He said more than 40,000 Kentuckians got vaccinated last week, which was half the number vaccinated in the month prior to that.
"The Delta variant is spreading like wildfire," he said. "If you are unvaccinated, you are at significant risk. Please, go get vaccinated."
Kentuckians under 40 continue to have vaccination rates under 50%, with 18-to-29-year-olds at 37%. "That's far, far too low," said Beshear. "This Delta variant is coming for you."
Statewide, 52% of the state's total population has received at least one dose of a vaccine and 63% of adults have.
Beshear gave a shout out to Kentucky Health News' editor-publisher Al Cross for his request that local news media and medical professionals collaborate to persuade Kentuckians to get a shot.
"There is no more immediately pressing public interest in this country or this state than persuading people to get vaccinated," Cross wrote in his weekly Kentucky Health News update to news media.
Hospitals seeing many more Covid-19 cases, and more of them in younger people; two systems have required employee vaccination
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| Kentucky Health News graph, based on data from state Department for Public Health |
When the pandemic resurged in Kentucky last month, Gov. Andy Beshear said he would base his decisions about how to deal with it partly on the number of hospitalizations, "what the outcomes are, and how sick individuals are."
"Outcomes" mean recovery, death or something in between, such as the lingering illness known as "long Covid." Death is a lagging indicator of the pandemic, and Covid-19 deaths in Kentucky remain low, averaging less than four per day. But there is a rising level of sickness, as measured by Covid-19 hospitalizations, intensive-care cases and mechanically ventilated patients.
On June 28, Kentucky hospitals reported 169 patients with Covid-19. On July 30, they reported 625. Hospitalizations began a steep increase on July 15, and are doubling about every 12 days.
Almost all the new admissions are people who have not been vaccinated for the coronavirus, hospitals told Deborah Yetter of the Louisville Courier Journal.
The number of Covid-19 patients in intensive care has increased likewise, from 51 on June 27 to 195 on June 30. Those on ventilators increased from 21 on June 30 to 85 a month later, a slightly faster rate.
Kristy Quinn, spokesperson for Baptist Health Madisonville, told Murray's WKMS that the hospital is seeing more patients who need serious care. “During the earlier surges of Covid, we saw larger numbers of inpatients at times than this, but the proportion of them in critical care was lower,” Quinn said. “To have half of them in [ICU] is significantly different from what we saw previously.”Hospitals told Yetter and WKMS's Dustin Wilcox that they are seeing more young people who need hospitalization for Covid-19, "which they attribute to the much higher rate of vaccination in older Kentuckians who are at the greatest risk of serious illness or death from the virus," Yetter writes.
Hospitals say the surge makes vaccination imperative. Two major hospital operators, the University of Louisville and Med Center Health of Bowling Green, have told employees that they must be vaccinated by Sept. 1. Med Center Health, which has five Southern Kentucky hospitals, set an earlier deadline for staff in leadership positions, Aug. 9.
Hospitals say the surge makes vaccination imperative. Two major hospital operators, the University of Louisville and Med Center Health of Bowling Green, have told employees that they must be vaccinated by Sept. 1. Med Center Health, which has five Southern Kentucky hospitals, set an earlier deadline for staff in leadership positions, Aug. 9.
Baptist Health, which has seven major hospitals around the state, has a staff that is 75 percent vaccinated but is considering requiring vaccination, Chief Medical Officer Kenneth Anderson told Yetter.
Pikeville Medical Center CEO Donovan Blackburn told Yetter that about 60% of employees have been vaccinated. "Of those who haven't, some express distrust of the vaccine or possible unknown effects" she reports. "Others who are young and healthy don't see the need." The hospital is trying to persuade them.
"I think there's some that are swayable," Blackburn said. "There's some that are dead-set against it."
Sunday, August 1, 2021
Fauci: The vaccinated can be as infectious as the unvaccinated, so they need to wear masks indoors; pandemic will get worse
As Gov. Andy Beshear issued a vaccination-promotion video with one of the latest student winners of the state's vaccine lottery, President Biden's top medical adviser warned that the pandemic will worsen.
“Things are going to get worse” due to the Delta variant of the coronavirus, Dr. Anthony Fauci said on ABC's "This Week" Sunday. “We are looking, not I believe, to lockdown, but we are looking to some pain and suffering in the future because we are seeing the cases go up.”
Fauci, director of the National Institute of Allergy and Infectious Diseases, said “The solution to this is, get vaccinated.”
Fauci and other experts stressed that vaccines are still doing the job even though the Delta variant is infecting some vaccinated people, who can spread the virus without knowing the have it.
“Almost invariably they get minimal symptoms or no symptoms at all,” but new research shows they average about the same level of virus in their nasal pharynx as they unvaccinated, so that's why vaccinated people need to wear masks indoors, Fauci said on CBS's "Face The Nation."
Looking at it another way, the Centers for Disease Control and Prevention says that fewer than 0.1% of the 164 million vaccinated Americans have been infected with the virus, and only 0.001% of the vaccinated have died.
“Things are going to get worse” due to the Delta variant of the coronavirus, Dr. Anthony Fauci said on ABC's "This Week" Sunday. “We are looking, not I believe, to lockdown, but we are looking to some pain and suffering in the future because we are seeing the cases go up.”
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| Anthony Fauci (CBS image) |
Fauci and other experts stressed that vaccines are still doing the job even though the Delta variant is infecting some vaccinated people, who can spread the virus without knowing the have it.
“Almost invariably they get minimal symptoms or no symptoms at all,” but new research shows they average about the same level of virus in their nasal pharynx as they unvaccinated, so that's why vaccinated people need to wear masks indoors, Fauci said on CBS's "Face The Nation."
“If you do get infected, the likelihood of you getting a severe outcome of the infection is very low … so the vaccine is doing what you want it to do: it’s preventing people from getting sick,” Fauci said.
Looking at it another way, the Centers for Disease Control and Prevention says that fewer than 0.1% of the 164 million vaccinated Americans have been infected with the virus, and only 0.001% of the vaccinated have died.
Speaking to the 100 million Americans who haven't been vaccinated though they are eligible, Fauci said, “If you're going to be part of the transmission chain to someone else, then your decision is impacting someone else. It's not only impacting you. And you've got to think about it, that you are a member of society and you have a responsibility.”
Vaccinations are increasing. In Kentucky, the CDC reported Sunday that 15,482 doses were given Saturday, the highest daily number in almost five weeks but still below the levels seen in most of May. The seven-day rolling average is 8,738 doses per day, a third higher than the previous week.
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| Chart by The Washington Post based on Centers for Disease Control and Prevention data |
Special enrollment period for health insurance on healthcare.gov ends Aug. 15; subsidies are bigger, and more people qualify
By Melissa Patrick
Kentucky Health News
Time is running out to sign up for low- or no-cost health insurance through the federal marketplace under the special enrollment created by Congress and President Biden. The deadline to sign up on healthcare.gov is Aug. 15.
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| AARP illustration |
The special enrollment is open to both new and existing customers, including the thousands of Kentuckians who got temporary Medicaid coverage during the pandemic through the state's "presumptive eligibility" program.
About 120,000 Kentuckians lost that temporary Medicaid coverage in July, according to Brice Mitchell, a spokesman for the state Cabinet for Health and Family Services.
Mitchell said the state has told some of those people they would be losing their coverage and encouraged them to check kynect.ky.gov to see if they qualify for traditional Medicaid, or go healthcare.gov to apply for a federally subsidized plan. He said state Kynectors, who help people enroll, will continue the outreach through August.
Dustin Pugel, senior policy analyst at the Kentucky Center for Economic Policy, encouraged Kentuckians who recently lost their temporary Medicaid coverage and are not covered by work or traditional Medicaid to "Run, not walk, to the marketplace to find an affordable option."
Priscilla Easterling, the outreach coordinator for Kentucky Voices for Health and a Kynector, also encouraged Kentuckians without health coverage to explore their options on healthcare.gov, especially those who looked at plans in the past and found them unaffordable at that time.
A federal report says 34% of those who got a subsidized plan since April 1 paid $10 or less a month for their coverage, thanks to the American Rescue Plan's premium reductions. In Kentucky, 32% of new customers and 19% of returning customers were able to find a plan for $10 or less per month.
In the special enrollment period, plans are more affordable due to bigger premium subsidies through tax credits, and no repayments are required if a tax return shows they didn't qualify for the tax credit. Also, more people eligible for the subsidies, and costs are limited to no more than 8.5% of income, down from nearly 10%.
For the first time, the new rules allow those earning more than 400% of the federal poverty level -- about $51,000 for an individual and $104,800 for a family of four in 2021 -- to get a subsidized plan.
This change is especially helpful to older adults with incomes above 400% of the poverty level, because unlike traditional health plans, which are allowed to charge more based on age, special-enrollment premiums are capped at 8.5% of income.
"Compared to current premium payments, a 60-year-old with a $55,000 income would pay 77% less for a bronze plan ($146 vs. $634 per month), 56% less for a benchmark silver plan ($390 vs. $887 per month), and 52% less for a gold plan ($453 vs. $951 per month), on average," says the Kaiser Family Foundation.
"Compared to current premium payments, a 60-year-old with a $55,000 income would pay 77% less for a bronze plan ($146 vs. $634 per month), 56% less for a benchmark silver plan ($390 vs. $887 per month), and 52% less for a gold plan ($453 vs. $951 per month), on average," says the Kaiser Family Foundation.
Also benefiting from this expansion to 400% of the poverty line are self-employed people who have not had access to affordable health insurance. "As wonderful as the Affordable Care Act was to open up affordable coverage for so many people," Pugel said. "It really did leave that group of folks out."
Through the end of June, 13,773 Kentuckians had signed up for health insurance during the special enrollment period, according to a federal report. That's an increase from the special enrollment periods in 2020 and 2019, when 6,747 and 7,041 signed up, respectively.
But fewer than 10% of eligible Kentuckians have taken advantage of the opportunity. Easterling said about 115,000 Kentuckians who qualify for a subsidy under the special enrollment period have not yet signed up.
Nationwide, more than 2 million have signed up.
Open enrollment is usually in effect only six weeks at the end of a year, except for those who experience a "qualifying life event," like getting married or losing a job. After the special enrollment period closes on Aug. 15, open enrollment will re-open Nov. 1.
Biden's American Families Plan would make some of these measures permanent, including the bigger tax credits, coverage to those who earn 400% and above the federal poverty level, and the premium cap of 8.5% of household income. Those measures will stop at the end of 2022 unless Congress makes them permanent.
Neurosurgeon in a county at high risk from the coronavirus gets local paper to share the facts about the virus and the vaccines
In a big Kentucky county with a low coronavirus vaccination rate, a critical infection rate and Covid-19 patients filling its intensive-care beds, a doctor reached out to his local newspaper to voice his concerns.
Neurosurgeon Amr El-Naggar, a native of Egypt, said "he understands the freedom of choice, but wanted every member of the public to truly consider what that freedom means," the Somerset Commonwealth Journal reports.
“I became a U.S. citizen 26 years ago, and one of the things that I learned is to appreciate freedom. This is the number one thing that I’m proud of. But I try to use my freedom in a correct way. I choose to live freely. I do not choose to die freely,” he said. “I have the freedom to take the vaccine or not. But I recommend you use your freedom to live and let your children live, and to enjoy the taste and smell of food and flowers. We do not have to give up those things that are gifts from God.”
In Pulaski County, only 40 percent of residents have received at least one dose of a coronavirus vaccine, the county's infection rate has put it in the state's "red zone" and is taxing Lake Cumberland Regional Hospital.
“Two days ago, there were no open beds in the whole, and no ICU beds at all in the hospital,” El-Naggar said. “This condition waxes and wanes, but I’m aware there are big hospitals in the state that do not have any ICU beds at all. Beds are filling up very quickly. Much quicker than we did a year ago.”
“The simple answer, my friend, is that ‘You get to live!’. . . If you are vaccinated, there is a chance you can get a breakthrough infection, but if you do you are going to probably get treated as an outpatient and still have your life. At worst you may be hospitalized for a few days, get treated then released!”
He said all the hospital's Covid-19 patients are unvaccinated, and “Many of them are young, and many are critical!” That's true all over the nation, he said.
“It is a statistical fact that the Moderna and Pfizer vaccines protect you from the virus in the order of 95%. It is also a statistical fact that about 95% of hospitalized Covid patients who require high levels of oxygenation and/or are on ventilators in critical care units are among the unvaccinated.”
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| Dr. Amr El-Naggar |
“I became a U.S. citizen 26 years ago, and one of the things that I learned is to appreciate freedom. This is the number one thing that I’m proud of. But I try to use my freedom in a correct way. I choose to live freely. I do not choose to die freely,” he said. “I have the freedom to take the vaccine or not. But I recommend you use your freedom to live and let your children live, and to enjoy the taste and smell of food and flowers. We do not have to give up those things that are gifts from God.”
In Pulaski County, only 40 percent of residents have received at least one dose of a coronavirus vaccine, the county's infection rate has put it in the state's "red zone" and is taxing Lake Cumberland Regional Hospital.
“Two days ago, there were no open beds in the whole, and no ICU beds at all in the hospital,” El-Naggar said. “This condition waxes and wanes, but I’m aware there are big hospitals in the state that do not have any ICU beds at all. Beds are filling up very quickly. Much quicker than we did a year ago.”
In the interview, El-Naggar explained why unvaccinated people should get vaccinated even though the latest research shows that vaccinated people can still get and transmit the virus.
“The simple answer, my friend, is that ‘You get to live!’. . . If you are vaccinated, there is a chance you can get a breakthrough infection, but if you do you are going to probably get treated as an outpatient and still have your life. At worst you may be hospitalized for a few days, get treated then released!”
He said all the hospital's Covid-19 patients are unvaccinated, and “Many of them are young, and many are critical!” That's true all over the nation, he said.
“It is a statistical fact that the Moderna and Pfizer vaccines protect you from the virus in the order of 95%. It is also a statistical fact that about 95% of hospitalized Covid patients who require high levels of oxygenation and/or are on ventilators in critical care units are among the unvaccinated.”
El-Naggar also debunked myths about the vaccines' use of genetic material known as messenger RNA: “Our DNA, which is the main gene codes of our body, are in the nucleus of the cell. The cell has a nucleus in the middle, and is surrounded by this cytoplasm, sort of like if you have a house and have the big yard or farm around it. The DNA lives in the house, or the core. And it sends the messenger RNA out. The first thing it does is expel it out of the nucleus. It goes into the cytoplasm or the yard. But the messenger RNA does not have the ability to reenter the nucleus. In other words, it goes out into the yard of the farm, and it can never be allowed to enter into the house again.”
The doctor also said there is no evidence that the vaccines affect female fertility, and “People might be surprised to know that it is recommended that pregnant women be vaccinated. If a pregnant woman gets infected with the Covid Delta variant, it puts her at a high risk of developing a severe illness and increases the probability of hospitalization and critical-care needs.”
The doctor also said there is no evidence that the vaccines affect female fertility, and “People might be surprised to know that it is recommended that pregnant women be vaccinated. If a pregnant woman gets infected with the Covid Delta variant, it puts her at a high risk of developing a severe illness and increases the probability of hospitalization and critical-care needs.”
