It Could Happen Here

O, little town of Binyamina, how still we see thee lie…that’s because of an outbreak of COVID-19 due to the Delta variant in that small Israeli town, an outbreak that prompted the re-imposition of a country-wide indoor mask mandate just two weeks after the original one had been lifted. Just like the fabled town of Bethlehem on the other side of the green line in the West Bank, Binyamina may well foretell hopes and fears for the world.

The fear is of another COVID-19 surge because the Delta variant makes the Coronavirus much more contagious than any of its predecessors, even in a place where the adults are well-vaccinated. The hope is that people, and especially all the young adults who have been waiting to get vaccinated, will take this occurrence seriously and get the shot. In Binyamina, it was people returning from abroad who infected not-yet-vaccinated school students, resulting in a super-spreader event.

In the United States, as elsewhere, the Coronavirus with Delta mutations is a “variant of concern” that has become our dominant Coronavirus strain. With many Americans living in communities that are under-vaccinated, their unvaccinated residents could kindle another surge this fall just when children too young to be vaccine-eligible return to school. After U.S. COVID-19 cases peaked in January, that decrease leveled off in June, and new cases in the U.S. have increased by 140% in the last two weeks. Already in Los Angeles County, the Delta variant’s spread convinced officials to reinstate mandatory masking in public indoor spaces.

The Delta variant is said to be 60% more contagious than the original or “wild” Coronavirus, so it is easier to catch. Early data from Scotland had initially shown it to be more dangerous, with twice the risk of hospitalization compared to previously dominant strains. Subsequent research is showing equal rates of hospitalization from all variants and that currently hospitalized victims are younger than COVID-19 patients were during last winter’s surge.

What is more worrisome locally is that rural counties like ours with low vaccination rates and widespread loosening of public health restrictions will be at the highest risk for outbreaks, as opposed to previous outbreaks in densely populated city centers and in certain high-exposure settings (healthcare, meat-packing, prisons, etc). Physicians report that variants are able to find any gaps in our protection and cite the example of how Delta variant hospital admissions and ICU beds in Missouri’s least vaccinated rural counties have swiftly filled up now, primarily with adults under 40 years old who never got vaccinated. It could happen here.

As the virus continues to reach and infect new people in which to multiply and mutate, the development of even more dangerous variants becomes much more likely. During the first SARS-CoV-2 pandemic year, most cases were caused by the original “wild” type virus. Then came the more infectious variants Alpha, Beta, and Delta in rapid succession. Allowing for successively more deleterious mutations to occur as this opportunistic virus spreads, we may find ourselves with a COVID-19 strain against which none of the currently existing vaccines work at all. Such a transformed variant is probable enough that the Centers for Disease Control and Prevention together with the World Health Organization have created the term, “variant of high consequence,” described as causing “more severe disease and greater numbers of hospitalizations [and] shown to defeat medical countermeasures, such as vaccines, antiviral drugs, and monoclonal antibodies.” We do not want to go there.

The good news is that all COVID-19 vaccines authorized in the United States work well against the Delta variant, but to do so, people must be fully vaccinated, meaning that full protection starts two weeks after the final shot. (Only having one shot of Moderna or Pfizer does not protect adequately against the Delta variant). The bad news is that Delta variant’s spike protein apparently evades even some fully-vaccinated people’s immune responses, leading to more breakthrough infections from the Delta variant than from earlier strains. The literature about this variant also indicates that at least one of the previously authorized monoclonal antibody medications no longer works in treating people with COVID-19 from this strain. We do not want to go there.

As the song proclaims, there are also great, glad tidings, and we have the power to prevent outbreaks in our area. Everyone currently eligible should get the shot now, and people fully immunized in communities where virus transmission is prevalent should consider wearing masks indoors in public places. Long-lasting protection could happen here.

Barbara Hemmendinger, MSS, is a retired clinical social worker and family medicine educator.  She is a member of the Lycoming County Health Improvement Coalition and Let’s End COVID!
Published: 7/24/21

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