I understand the concern about elderly parents. I hope that whether people in general continue to mask or not, they will continue to much more careful about symptoms, testing, and not exposing other people when they are ill. With the second part, I certainly don’t know, but virus becoming endemic seems to be a common opinion. It’s not that every person will get infected, but many of us could , at least over the next few years. It is not just getting enough people with immunity in the US that is necessary, but the rest of the world, and that won’t happen quickly. The virus has gotten more contagious, and the vaccines aren’t fully sterilizing. If we know that they aren’t fully sterilizing after just a few months, what happens over time? Given how long it took to get this much uptake for initial vaccination, I think getting even that many people again to get boosters on time to prevent waning immunity (whenever that is) might be a challenge. I thought that even for measles, which does have long-lasting immunity from infection or vaccination- it took until the 21st century (so 25 years) for outbreaks to stop, and that was with only having to vaccinate children, as virtually all older adolescents and adults were immune from childhood infection when the vaccine became available. As with Covid, apparently vaccinated people still catch measles when exposed and can be asymptomatic. It’s just that in the US, exposure is incredibly rare anymore. But there was still plenty of measles around for decades after we had a measles vaccine.

I didn’t say it was less virulent. Someone else wondered about it, upthread. You and I weren’t taking about that, I didn’t think. I would consider that doctor’s statement you bolded an opinion, without cited evidence or any discussion of the opinion in that article. There are many other opinions that say that we don’t actually know this is true. That’s all. The journalist could have found others who would say “we don’t know,” but they like clicks. 🤷‍♀️ Here are some articles to the contrary, if you are interested. They are popular press, too, because according to the virologists I frequently listen to, there isn’t any published evidence yet. The point is that it is still being investigated. The kind of careful studies that would show increased virulence aren’t the sort of thing that happens in a couple of weeks, I’m gathering. https://www.smh.com.au/national/nsw/delta-outbreak-is-twice-as-infectious-but-experts-unsure-if-it-s-more-deadly-20210702-p586dg.html https://www.cnn.com/2021/06/30/health/delta-variant-covid-what-known/index.html https://www.nbcnews.com/think/opinion/covid-delta-variant-hints-bigger-problem-america-ncna1272673 https://news.ucr.edu/articles/2021/06/30/how-concerned-should-we-be-about-delta-variant There are more that state similar uncertainty in medpagetoday (have to subscribe but it’s free), The Atlantic (paywall but allows few free articles), and elsewhere. I thought about not posting because I don’t really want to argue, but I think there is a lot of fear and disinformation promoted by some of the media, and it bugs me. 😆 Something can be a reason for concern without reporting it in more apocalyptic terms with exaggeration about what is known, and lack of nuance.

Nope, there is no published data that proves it is more virulent. Articles in the popular press notwithstanding. Virulence does not include anything about transmissibility. Virulence has a specific definition. eta you can also find articles in the press stating it is not more virulent. So there’s that. Doesn’t mean it is or it isn’t. Data isn’t there. eta2 not so long ago, they said alpha was more virulent. Only it turns out, it isn’t, or at least not anything like what was reported at first. The observational data from England is great and better than what a lot of the world collects, but it has issues and can’t be used to conclude some of the things that are concluded from it, especially at first. Or so I read and hear. 🙂

Do you mean more transmissible? I don’t think there is any evidence it’s more virulent. It makes sense that with more transmissibility and more virus circulating again, plus slight decrease in effectiveness of vaccine, that there are more opportunities for vaccine to fail. For those that continue to mask, I am curious, what is the endgame for you? Wait for the virus to finish running through the population, and then unmask? Continue masking for years? Or, don’t know, wait and see. I think that in some some sense, public messaging has been either confusing or too simplistic. There should never have been an expectation that people would not ever get infected after vaccination. The realistic expectation is that probably most of us will, eventually. We get vaccinated so that it will be mild or hopefully even unnoticeable. I am not sure how the takeaway message from a mostly vaccinated family getting sick even with continued masking would be to continue masking even after vaccination. We can’t conclude much from one anecdote, but if there is a conclusion, it might be that community masking isn’t that useful against an airborne virus.

Exactly. I think I am more surprised that anyone is surprised enough that it would make the news, that large numbers of people would catch a contagious virus at a sleep away camp. It’s not like it doesn’t happen without Covid, but Covid is even more contagious than most things that go around. These are kids that not only sleep in the same rooms, but eat together, share bathroom facilities, maybe hugging, etc. Church camps usually have some form of community worship, too, which isn’t necessarily outside. Looking from the links, it’s not really a roughing-it kind of camp, it’s a conference center. They could have been inside for services in one large group, singing, etc.

I don’t think you can really compare IFR’s done via case-catching by PCR (Delta in England) with IFR done by serology (the various other IFR calculation studies). The former is still really a Case Fatality Rate, no? Which will generally be higher, because even with screening asymptomatic people by PCR, it is unlikely you are finding every case. It would be great if Delta has less severity. Also a little ironic, given some of the press about it. I look forward to the day when the world doesn’t have to care so much about the latest variant, just the people who study them and make the vaccines.

https://www.bloomberg.com/news/articles/2021-07-05/singapore-investigates-cardiac-arrest-of-vaccinated-teenager

Case fatality rate depends also on the denominator- how many of the mild cases they are finding or missing. So some of this could be that they are catching more asymptomatic or mild cases now that case counts are lower and more manageable, compared to the alpha surge where numbers of sick people were enormous. Case fatality also depends who is getting infected. If more of the infections are in younger people, whether vaccinated or unvaccinated, the case fatality rate will be orders of magnitude lower. On Delta and schools, some UK experts have pointed out that cases detected by schools due to screening doesn’t mean the infections were contracted in schools, and that some areas have had more intense testing for variants than others, that the report is clear that the precise role of schools isn’t clear. https://threadreaderapp.com/thread/1408445575268294663.html A thread, with an embedded thread from one of the PHE epidemiologists which notes “Since Alpha variant (B.1.1.7), all the subsequent variants have been intensely managed by HPTs, as their small numbers made them containable. This means CIMS data on Alpha variants is not at all comparable to any other variant work, due to Alpha outbreaks not getting onto CIMS. As Delta variant’s case numbers have risen, there are more outbreaks in all settings and some of those settings are prioritised. For example outbreaks related to schools are intensively managed and so will all end up on CIMS.“ ETA and from what I’ve seen, the consensus even in the US seems to be that there isn’t any hard evidence Delta is more virulent, but also, can’t yet say it is LESS virulent, either.

Did someone posts this yet about Moderna? Modest reductions of neutralizing antibody titer in lab compared to wild type and alpha, similar to that seen with Pfizer and J&J, but vaccine should still work. https://www.biorxiv.org/content/10.1101/2021.06.28.449914v1 https://www.bloomberg.com/news/articles/2021-06-29/moderna-s-covid-shot-produces-antibodies-against-delta-variant

Oh, probably. But someone with much more domain expertise knows what is relevant and when, and what to toss. Even infectious disease epidemiologists could have an issue with this when they don’t know as much about immunology and vaccines, when that isn’t their usual area of work. The South African Sisonke trial, where apparently the little vaccination they’ve done has been mostly (or all?) with J&J is supposed to provide some real world numbers today, we’ll see. I’m curious now what the Canadian vaccine files say that might be picking and choosing. Yes, like how mRNA and AZ are both somewhere in the mid-90’s for the latter, despite differences in preventing symptomatic disease. J&J will likely be very high for that metric, also, but hope the info comes soon. But now that we have info for Delta with other vaccines since that model was published, I wonder about its relevancy. I am not as concerned about younger people I know who got one dose (and may be at higher risk from nasty effects from a second dose of either type of vaccine), because any relative risk reduction isn’t going to be such a big problem when the absolute risk from Covid is already so low. But for the elderly or otherwise high risk person who only got one dose, I really hope we get more data soon. ETA- and I wish they would have all used exactly the same definitions for any symptomatic, moderate, severe, etc. It gets a little confusing. Maybe that’s why I tend to think more about hospitalization, too, because it’s a harder endpoint. I hope to avoid even “moderate” illness at home, and sure, I don’t want to catch this even mildly and give it to someone else, but on the practical level, I do not care at all about a functional case of the sniffles and am not worried I will get long Covid from a very mild case while having pre-existing immunity.

I have wondered about some things this blogger writes that seem to be at odds with what others are saying, at least overstating things. She got her PhD a few years ago, and her dissertation was on bullying; her degree is in Violence and Injury epidemiology. She is very knowledgeable, but she is not an infectious disease epi., and so many specialists are publicly sharing info these days, that IMO there are better sources of info for these things, YMMV. (We can see with someone like Eric Feigl-Ding that being an epidemiologist doesn’t mean your Covid information isn’t as inaccurate as some of the conspiracy theorists, LOL, not that this blog is anything like that). Anyway, she bases the 60% on a paper that was published six weeks ago and does not specifically address any variant, so maybe it’s useful, but I am not worrying about a number based on it. https://www.nature.com/articles/s41591-021-01377-8

That 60% is based on a model, not real data. This is the discussion from the neutralization study. Since it did have a high effectiveness against the most severe outcomes with Beta and Gamma, and Delta doesn’t seem to reduce the neutralization as much as those (similar to results with other vaccines), this seems positive. ETA in trial, 64% symptomatic disease for S Africa (almost all cases beta), 68% Brazil (69% of cases P1). So theoretically should be slightly better numbers, or at least higher 60’s, for Delta.

https://www.nytimes.com/2021/07/01/health/delta-variant-covid-england.html https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/998393/Weekly_Flu_and_COVID-19_report_w26_v3.pdf

Some published numbers will reportedly be released tomorrow, and word is that something else about J&J and Delta will be published shortly.

Report on J&J breakthrough infections in South Africa, mostly Delta and Beta variants. Press release, study pending. https://www.samrc.ac.za/media-release/vast-majority-breakthrough-infections-vaccinated-health-workers-are-mild

Here’s the direct link for anyone else who wants to look. https://covid.viz.sg It doesn’t seem to say anything about household vs out of household, though they must know that. It’s also clear, and I’m sure obvious given how most are asymptomatic, that they are missing a decent number of infections. Last year I remember reading that even wIth great contact tracing, it can be difficult to assume who gave it to whom, especially in households, because incubation periods can vary so much. The person who has symptoms first may not be the person who was infected first and gave to others.

So does anyone know from that chart with the green dots, what the actual rate of transmission from asymptomatic vaccinated are, and do they say anything about where it is occurring? It seems like with their detailed level of contact tracing, it would give some idea of whether masks were helping prevent transmission, and how much.

I don’t know. How many of the asymptomatic vaccinated people actually gave it to someone else? I didn’t spend a lot of time on the figure up further in the thread, didn’t see an explanation of how to interpret it. Even the studies that showed lower transmission weren’t 100%. I can’t remember the numbers. Was it proven to be more than 5 or 10% in Singapore? The studies that show that vaccinated people don’t transmit were all done pretty shortly after vaccination, I think. I wonder if sterilizing immunity is only a function of variants, or also of time from vaccination and some decline of antibody levels. I don’t know if there will be much further information on this from the US or not, since testing of asymptomatic vaccinated people isn’t recommended. Does everyone still mask everywhere in Singapore?

CDC director confirmed the advice today that vaccinated people in the US don’t need to mask. Singapore has only 3 people in the ICU in a country of nearly 6 million. Hope it stays that way or improves, but seems like a success when the few vaccinated infections are nearly all asymptomatic. Looking through the report, I sort of wished we could have seen that level of data in states, or at least counties, here. As it is, we saw no justification for some of the restrictions that were put in place, since they public health for the most part did not show us where infections where occurring. But from another perspective, I am really glad we don’t have that level of data made public, because of privacy concerns. In this country, naming streets, places of worship and names of businesses could lead to stigma.

It’s pretty high. https://www.moh.gov.sg/covid-19/vaccination Population 5.9 million 2.1 mil full 3.3 partial as of June 28. ETA the numbers are also on the report Arcadia linked, in one of the graphs.

I read through parts of it a few times and read another article about it. I need an immuno-translator, LOL. If it is significant maybe they will discuss on TWiV or Immune. But I’m not sure it can be concluding the above, or what I said before, either, because most of the other work discussed and referenced was in animals or cell cultures, as far as I can tell. Maybe there is significance in the study beyond what it says about SARS-CoV2 vaccines. I guess the good news takeaway is that vaccine-induced immunity should last a long time without need for boosters anytime soon, which parallels nicely with everything they have learned so far about persistence of immunity with T-cells, memory B-cells, antibodies following infection.

So that is saying that mRNA has a timeline of germinal center development similar to adjuvanted vaccines? I have seen comments by immunologists and virologists suggesting that the lipid particle may be acting as a kind of adjuvant.

There are higher numbers for hospitalization. https://khub.net/web/phe-national/public-library/-/document_library/v2WsRK3ZlEig/view_file/479607329?_com_liferay_document_library_web_portlet_DLPortlet_INSTANCE_v2WsRK3ZlEig_redirect=https%3A%2F%2Fkhub.net%3A443%2Fweb%2Fphe-national%2Fpublic-library%2F-%2Fdocument_library%2Fv2WsRK3ZlEig%2Fview%2F479607266 I did see something else on an article and some feed that said personal communication with the authors showed analysis of the 33% after dose one was higher after 14 days, but maybe they meant something else, or I am confused. I don’t see it in the paper. But there is this unpublished from India that showed workers had about the same percentage of infections after one dose as they did after two doses.https://www.aninews.in/news/national/general-news/covid-vaccines-provided-protection-in-over-95-pc-of-vaccinated-healthcare-workers-says-study20210616200420/ From this report, though, with alpha there was only 49% effectiveness of first dose, but I didn’t seem to hear as much concern then about the one dose strategy. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/997418/Variants_of_Concern_VOC_Technical_Briefing_17.pdf page 38-39.

I also read that it is a bit more effective at 60 days than at 14 or 28 days. There is this laboratory study indicating activity against alpha, beta, and gamma, and we know from the original phase 3 trial results that it showed effectiveness against beta and gamma. https://www.nature.com/articles/s41586-021-03681-2 I read that someone is doing a study on this vaccine and Delta. I would expect it would be similar to results from Pfizer and AZ, still expected to be effective against hospitalization and death. Unfortunately, the number that keeps going around is that 33% after dose 1 of Pfizer, but that’s only when they counted any case occurring after first dose. For more than 2 weeks after first dose, it gets up in the 90’s percentiles, and overall numbers are apparently not much different for Pfizer and AZ than they are for alpha variant. Given that, I am not sure why some reports are still saying you need two doses of mRNA for Delta. Maybe they mean for symptomatic disease, and not hospitalization? I’m not sure. There are questions about whether people who got J&J should get an mRNA booster shot because of Delta, or just because it’s one dose, and mixed opinions with no data. Andy Slavitt said he asked several experts and some said wait for data, while others said you could get a booster if you want. I don’t know how feasible that is to do if you are already in a registry as having been vaccinated. I saw an article about studies that should allow for updated recommendations about this in a couple of months. Some people seem to wonder about this just because AZ is two doses, but there are some major differences in the vaccines.

I can both of these POV for sure. They were very slow to admit vaccination reduces transmission and that vaccinated people don’t need to wear masks. I expect they could be slow again if it looks like there is reason to put the masks back on. However, I don’t see that anything major has changed since they gave the masks-off advice; in fact, cases have continued to go down since then, with a few exceptions. It’s too bad, in a way, that our eyes have been open to the ways our institutions work sometimes, and we are left not knowing which ones to trust. Why should I think your state health org has it right while the CDC doesn’t? That estimate of 1000 lives saved is based on what data, exactly? These epis have made so many models that have been wrong. Or, what about the WHO? —- see below I saw that, too, but then, the WHO has to advise the entire world, the majority of which has very very low rates of vaccination. And it isn’t like most of our country has followed most of what the WHO has said: 1 m (not 6 feet); slower to recommend masks; no masks under age 5 and limited, not required, for under age 12; more cautious about vaccination recommendations in pregnancy and teens; recommended against school closures. I can see why some think we should all still mask. I see some people still masking indoors and that’s fine. I will do it again indoors for another fall or winter if cases do indeed go up a lot again. Otherwise, I am happy to be out of masks. It’s hot. We get acne and rashes. They are unhygienic: once you are not wearing them constantly, you realize how gross it can be, especially when taking on and off. So much bacteria, lint, dust, and yuck to have over your face. Using a new disposable for each use is somewhat cleaner, but not environmentally friendly. Switching out clean cloth several times per day is cleaner (but still potentially fibers getting into respiratory system) but probably not so effective. And it is so hard to hear people and have them hear you. There is a risk-benefit calculation to them that comes into play where there isn’t much virus around.