U.S. Provincetown Outbreak Shows Delta Can Spread Among Vaccinated, But Cases Are Mild

Ernie Mundell and Robin Foster wrote . . . . . . . . .

The Cape Cod resort town of Provincetown draws big crowds every summer. In July, those largely vaccinated crowds — packed into bars, restaurants and private homes — were the genesis of an outbreak of the Delta variant that could be a sobering model for the nation.

New data on the outbreak, released Friday, shows there were a known total of 469 COVID-19 cases “associated with multiple summer events” among Provincetown revelers. Three-quarters (74%) of those cases occurred among people who’d gotten their COVID vaccinations an average of almost three months before.

In 89% of those cases, the highly contagious Delta variant was implicated, concluded a team led by Dr. Catherine Brown of the Massachusetts Department of Public Health.

There was some good news, however: While many of the 346 cases among vaccinated individuals might have made them feel miserable for a time — coughs, headache, sore throat, aches and fever being the major symptoms — there were only four cases (1.2%) in this group that required hospital care.

In all four of those hospitalized cases, patients had underlying medical conditions that upped their odds for severe COVID-19, the researchers found.

A fifth case requiring hospitalization occurred in an unvaccinated patient, Brown’s team noted, and that case also involved an underlying medical condition.

There were no deaths linked to the outbreak.

The researchers noted that it’s not surprising that three-quarters of cases in the Provincetown outbreak occurred among the vaccinated, because a full 69% of the town’s vaccine-eligible residents have gotten their shots — a number that’s much higher than the national average.

Equal viral loads

However, given the increased transmissibility of the Delta variant, Brown’s team believe their findings “suggest that even jurisdictions with substantial or high COVID-19 transmission might consider expanding prevention strategies.”

Those strategies should include “masking in indoor settings regardless of vaccination status, given the potential risk of infection during attendance at large public gatherings,” they said.

The Provincetown findings also confirm that, unlike its predecessor, the Delta variant appears to produce high viral loads in people’s systems, upping transmission risks.

“Specimens from 127 vaccinated persons with breakthrough cases were similar to those from 84 persons who were unvaccinated,” the research team noted.

That finding helped drive the CDC’s decision this week to reverse course on its masking advisory. The agency now recommends that even the vaccinated once again don masks in many indoor settings, to lessen the odds they might transmit SARS-CoV-2 to others.

It also adds new energy to federal, state and local efforts to get more Americans vaccinated.

However, one leading infectious disease expert stressed that the one thing the Provincetown report should not do is lessen the average American’s faith in the power of vaccines to protect against what’s most important: Severe illness.

“The new data should not alarm anyone, but reinforce that vaccinations are the solution to the pandemic,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security in Baltimore.

A return to masking indoors

“That severe breakthrough infections were rare is testament to the vaccines, which limit the harm an infection can do in a fully vaccinated person,” he said. “It’s also important to remember the breakthroughs that occurred in this situation are likely not completely applicable to the everyday life of the vaccinated, as the intensity and nature of exposure was in the context of a large public gathering.”

Another expert said the implications of the findings are clear.

“At this time, even fully vaccinated people need to consider large gatherings as a potential place to contract the virus,” said Dr. Teresa Murray Amato, chair of emergency medicine at Long Island Jewish Forest Hills, in Queens, N.Y. “This also means that for Americans that are not yet vaccinated,” they should strongly consider doing so.

Adding to the Provincetown findings, a new internal federal government document also finds the Delta variant can cause more severe illness than earlier coronavirus variants, especially among the unvaccinated, and spreads as easily as chickenpox.

In laying out the evidence that this variant looks like the most dangerous one yet, the document urges health officials to “acknowledge the war has changed,” the Washington Post reported.

The document mirrors the data in the Provincetown study, finding that vaccinated people infected with Delta have viral loads similar to those who are unvaccinated and infected with the variant, the Post reported.

CDC scientists were so alarmed that the agency changed masking guidance for vaccinated people earlier this week, even before making the new data public, the newspaper said.

CDC Director Dr. Rochelle Walensky said in a statement on Friday that the Provincetown investigation “is one of many CDC has been involved in across the country and data from those investigations will be rapidly shared with the public when available.”

The Provincetown study was published in the CDC journal Morbidity and Mortality Weekly Report.

Source: HealthDay

How Much Should the Delta Variant Worry You?

Dennis Thompson wrote . . . . . . . . .

The Delta variant (B.1.617) of COVID-19 is upending any return to normalcy in some parts of the United States, with locales like Los Angeles County urging vaccinated folks to once again don masks indoors.

Infectious disease experts said these places are acting with an abundance of appropriate caution, given that the Delta variant is more transmissible and potentially more dangerous.

But the danger to any one individual may rely on his or her vaccination status.

Delta doesn’t pose any significant risk of illness to people who are vaccinated, the experts stressed. But there’s a chance they could get a “breakthrough infection” and spread it to others, even if their own infection results only in the sniffles or no illness at all, the experts said.

The Delta variant, which originated in India, is 50 to 80 times more transmissible than the original Alpha strain of COVID-19, according to Dr. Tina Tan. She is a professor specializing in pediatric infectious diseases at Northwestern University’s Feinberg School of Medicine, in Chicago.

So, “even if you are vaccinated or if you had COVID in the past, you might still be able to get this particular infection and transmit it, but you yourself might not get that sick from it,” Tan said.

As for masks, “we know that masking works,” she said.

“It doesn’t matter which variant, we know that masking works, especially in an indoor setting. People need to realize the pandemic is not over,” Tan said. “They need to still continue to be cautious.”

The World Health Organization (WHO) recently reiterated that everyone should wear masks, and countries like Israel have reinstituted mask requirements as infections with the Delta variant increase. Some cities in Australia have initiated fresh lockdowns over the Delta variant, while countries like Malaysia have extended their stay-at-home orders.

The U.S. Centers for Disease Control and Prevention announced in May that fully vaccinated Americans could forgo masks in most settings, and earlier this week its director, Dr. Rochelle Walensky,, stood by that advice in multiple television appearances.

But Walensky also said that local policymakers need to have a free hand in protecting their communities.

“Those masking policies are not to protect the vaccinated — they are to protect the unvaccinated,” Walensky said on NBC’s “Today” show, noting that “everybody should consider their own situation if they would feel more comfortable wearing a mask.”

The evidence suggests that people vaccinated against COVID-19, particularly if they received the Pfizer or Moderna vaccines, will be protected against this new strain, experts said.

“I am not aware of any evidence that fully vaccinated individuals need to wear masks as protection against the Delta variant,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, in Baltimore. “The data supports the notion that fully vaccinated people, especially those vaccinated with the mRNA vaccines, are highly protected against this variant.”

Dr. Vivek Cherian, of the University of Maryland’s St. Joseph Medical Center in Baltimore, agreed that “there’s a very, very low chance of getting breakthrough infections” from the Delta variant in fully vaccinated people.

“If you do, there’s also a very low chance you’re going to be symptomatic and almost zero chance of being hospitalized,” Cherian said.

But Delta’s high level of infectiousness means it poses a greater risk to unvaccinated people, particularly in parts of the United States where vaccination rates have lagged, he added.

Cherian said he’s also concerned about the risk to people who are only halfway through their COVID-19 shots.

“Some people have a sense of security when they’ve only received one of the two doses,” he said. “The coverage isn’t that great with that. There’s still a decent chance you can get infected.”

The muddled mask messaging is due in part to the fact that each individual public health agency is playing to a different audience, Cherian said.

“The WHO essentially has to address the entire world. Every country has different rates of vaccination. Even in the United States, every state and every county has different rates of vaccination,” Cherian said. “So it’s very hard to come out with an overarching recommendation, and if you do come out with one, it’s always best to err on the side of caution.”

Source: HealthDay

COVID-19: What is the Delta Plus Variant?

Bhargav Acharya and Shilpa Jamkhandikar wrote . . . . . . . . .

India said on Wednesday it has found around 40 cases of the Delta coronavirus variant carrying a mutation that appears to make it more transmissible, and advised states to increase testing.

Below is what we know about the variant.

WHAT IS DELTA PLUS?

The variant, called “Delta Plus” in India, was first reported in a Public Health England bulletin on June 11.

It is a sub-lineage of the Delta variant first detected in India and has acquired the spike protein mutation called K417N which is also found in the Beta variant first identified in South Africa.

Some scientists worry that the mutation, coupled with other existing features of the Delta variant, could make it more transmissible.

“The mutation K417N has been of interest as it is present in the Beta variant (B.1.351 lineage), which was reported to have immune evasion property,” India’s health ministry said in a statement.

Shahid Jameel, a top Indian virologist, said the K417N was known to reduce the effectiveness of a cocktail of therapeutic monoclonal antibodies.

WHERE ALL IT HAS BEEN FOUND?

As of June 16, at least 197 cases has been found from 11 countries – Britain (36), Canada (1), India (8), Japan (15), Nepal (3), Poland (9), Portugal (22), Russia (1), Switzerland (18), Turkey (1), the United States (83).

India said on Wednesday around 40 cases of the variant have been observed in the states of Maharashtra, Kerala and Madhya Pradesh, with “no significant increase in prevalence”. The earliest case in India is from a sample taken on April 5.

Britain said its first 5 cases were sequenced on April 26 and they were contacts of individuals who had travelled from, or transited through, Nepal and Turkey.

No deaths were reported among the UK and Indian cases.

WHAT ARE THE WORRIES?

Studies are ongoing in India and globally to test the effectiveness of vaccines against this mutation.

“WHO is tracking this variant as part of the Delta variant, as we are doing for other Variants of Concern with additional mutations,” the World Health Organization (WHO) said in a statement sent to Reuters.

“For the moment, this variant does not seem to be common, currently accounting for only a small fraction of the Delta sequences … Delta and other circulating Variants of Concern remain a higher public health risk as they have demonstrated increases in transmission,” it said.

But India’s health ministry warned that regions where it has been found “may need to enhance their public health response by focusing on surveillance, enhanced testing, quick contact-tracing and priority vaccination.”

There are worries Delta Plus would inflict another wave of infections on India after it emerged from the world’s worst surge in cases only recently.

“The mutation itself may not lead to a third wave in India – that also depends on COVID-appropriate behaviour, but it could be one of the reasons,” said Tarun Bhatnagar, a scientist with the state-run Indian Council for Medical Research.

Source: Reuters

COVID-19 Variant of Interest vs. Variant of Concern: What Does It Mean?

Melissa Couto Zuber wrote . . . . . . . . .

A variant that appears to be wreaking havoc in India has been detected in Canada and sparked a temporary ban on direct passenger flights from India and Pakistan on Thursday. But experts say it’s too early to know how concerning this new version of the COVID-19 virus is.

The variant — named B.1.617 — has so far been classified as a “variant of interest” by the World Health Organization, rather than a “variant of concern,” the term attached to the variants first detected in the United Kingdom, Brazil and South Africa.

Raywat Deonandan, an epidemiologist with the University of Ottawa, said Thursday that a variant of interest is one that is “suspected” to either be more contagious than the initial strain, cause more severe disease, or escape the protection offered by vaccines.

A variant of interest can become a variant of concern if more evidence emerges that it does one or more of those things, he added.

India is dealing with massive surges in COVID-19 activity — there were 300,000 new cases reported Wednesday with 2,000 deaths linked to the virus — but the Indian government has not confirmed the new variant is fueling the current wave.

Deonandan said the variant appears to be responsible for about 60 per cent of cases in India’s most populated region, which would suggest a higher transmissibility.

He said it’s “probably around 20 to 30 per cent,” more contagious, but added that experts still don’t know if the variant causes more severe disease.

“It may be a little less bad than B.1.1.7 (the variant first detected in the U.K.),” Deonandan said. “But our biggest concern is: If it becomes common here, are we then fighting off essentially another B.1.1.7?”

Dr. Zain Chagla, an infectious disease expert with McMaster University, said it’s important to flag this variant as one of interest because it does seem account for more and more of India’s caseload.

But, he added, other factors — including the country’s densely populated urban centres and mutligenerational homes with poorly ventilated spaces — may be contributing to how quickly it’s spreading there.

“Is it because of situations that lead to high levels of transmission and super spreading, or is there something biologically different about this variant?” Chagla said. “Or is it some combination of the two?”

Alain Lamarre, an immunology and virology professor at the Institut national de la recherche scientifique in Quebec, doesn’t think the new variant of interest is more concerning than the variants first detected in South Africa and Brazil.

He said he’s more concerned about the variant first discovered in the U.K., which is “clearly more transmissible and more virulent.”

WILL CURRENT VACCINES WORK AGAINST THE NEW VARIANT?

The variant first detected in India has a double mutation on the spike protein gene, which our current COVID-19 vaccines target. But experts say there’s no evidence right now that the approved vaccines won’t work against it.

Deonandan said the variant may diminish vaccine efficacy, “at least a little bit,” because that’s what we’ve seen with the variants of concern so far.

But, he added, that doesn’t mean efficacy will drop from 95 per cent to zero, for example.

Deonandan likened the coronavirus’s spike protein to the license plate on a car, with vaccines giving our cells that plate number so they know to keep it out when they see it.

“But if the license plate has changed, will the cell still recognize the car?” he said. “So the question is: Has an entire digit on the plate changed, or is it just a smudge on the corner?”

Deonandan added that the mRNA vaccines seem to be adept at catching different versions of the virus by targeting many aspects of the spike protein.

“So, they may say: ‘Look out for all license plates beginning with the letter B,’ rather than this specific license plate,” he said.

Lamarre said adapting mRNA vaccines like those by Moderna and Pfizer-BioNTech to new variants would be faster and easier than altering other types of inoculations.

“The approval process will be quicker as well because the proof of concept has been done and we know that the mRNA vaccines are safe and efficient,” he said.

WHERE HAS THE VARIANT APPEARED IN CANADA?

The B.C. Ministry of Health said Thursday there had been 39 cases of the B.1.617 lineage in the province on April 4, before it was identified as a variant of interest.

Quebec confirmed Wednesday what’s believed to be the province’s first case of the new variant, causing Premier Francois Legault to urge the federal government to tighten restrictions on air travel.

Legault said the premiers of Ontario, Alberta and British Columbia were among those behind a letter sent to the federal government expressing concerns about new variants coming into the country.

Deputy chief public health officer Dr. Howard Njoo said Thursday that Canada will be making adjustments at the border for incoming flights “very soon.”

B.C.’s top doctor Bonnie Henry said some of the 39 cases of the variant in that province were directly related to travel from India, but others had no travel link.

The cases were seen “at different times over the last month-and-a-half to two months,” Henry added.

CAN WE CALL THE VARIANT A “DOUBLE MUTANT?”

While some have dubbed the variant a “double mutant,” Chagla said that’s a misnomer that conjures up false images of a super virus.

The earlier variants of concern don’t have a single mutation, Chagla said, but instead a set of them that change the virus in certain ways.

Having two mutations on the spike protein doesn’t necessarily mean the variant is more dangerous than one that has a single mutation on that gene, Chagla added.

“That’s a terrible term,” he said of the double-mutant label. “When you see double mutations as compared to single mutations people get freaked out, but in reality many of these are combinations of mutations.”

Source : CTV News

COVID Variant First Detected in India Is Found in the U.K.

Seventy-seven cases of B.1.617, which has potentially worrying mutations, reported in England and Scotland

A coronavirus variant with potentially worrying mutations that was first detected in India has been found in the UK.

In total, 77 cases of the variant, known as B.1.617, have been recorded in the UK up to 14 April, according to the latest update from Public Health England (PHE), released on Thursday. Of these, 73 were recorded in England and four in Scotland.

It was the first time PHE had reported the variant in the UK.

It currently has the label “variant under investigation”. If worries about it are borne out, for example if it appears to be more infectious or more resistant to the body’s immune response, then it may be designated a “variant of concern”.

The UK has a handful of “variants of concern”, including ones first detected in Kent, South Africa and Brazil.

These variants contain a different overall set of mutations, although there are some overlaps. For example all three have a mutation called N501Y, which is believed to make the virus more infectious, while the Brazil and South Africa variants both have a mutation called 484K, which is believed to help the virus at least partially evade the body’s immune responses towards coronavirus – including those produced by some Covid vaccines. This mutation later cropped up in the Kent variant, giving rise to a new variant of concern.

The B.1.617 variant was first detected in India, but has since been found elsewhere, including California. It has worried experts as it contains two mutations in the spike protein that, it has been suggested, may boost its ability to escape the body’s immune responses. It is thought the variant may also be able to infect the body more easily.

Prof Paul Hunter, professor in medicine at the University of East Anglia, said the arrival of the India variant was potentially worrying.

“These two escape mutations working together could be a lot more problematic than the South African and Brazilian variants who have only got one escape mutation,” he said. “It might be even less controlled by vaccine than the Brazilian and South African variants.”

However, more research is needed to explore the role of these mutations and the impact they might have.

News of the arrival of the India variant in the UK came as surge testing was expanded in London in an attempt to control the spread of coronavirus variants, with parts of Hillingdon, as well as certain postcodes in Lambeth, Wandsworth, Southwark and Barnet all having testing and contact tracing ramped up. Sandwell council in the West Midlands has also announced it will undertake surge testing.

India is experiencing a devastating wave of coronavirus, although it is not clear whether the B.1.617 variant is helping to fuel the surge. Boris Johnson is expected to travel to India later this month, although his trip has been curtailed as a result of the infections there.

Prof Christina Pagel, director of the Clinical Operational Research Unit at University College London and a member of the Independent Sage group of experts, said the discovery of the variant in the UK was worrying, and tweeted that Johnson should not head to Delhi.

“We don’t know yet whether it can escape existing vaccines but it has several concerning mutations,” she told the Guardian. “It is ridiculous that India is not on the travel red list yet – or many other countries for that matter – when India is seeing 200,000 new cases every day at the moment.”

Source : The Guardian