How to Stay Safe as the Delta Variant Spreads

John Whyte, MD; William Schaffner, MD


August 10, 2021

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JOHN WHYTE: Welcome, everyone. You're watching Coronavirus in Context. I'm Dr. John Whyte, the Chief Medical Officer at WebMD. Cases are way up. In many areas of the country, hospitalizations and deaths are up.

How do you keep yourself safe, and does it differ, whether you're vaccinated or not? Joining me today is Dr. William Schaffner. He is a professor of preventive medicine and a professor of medicine in the Division of Infectious Disease at Vanderbilt. Dr. Schaffner, thanks for joining. It's nice to see you again.

WILLIAM SCHAFFNER: Always good to be with you, John.

JOHN WHYTE: You know, just so folks know, I mentioned to Dr. Schaffner, I've been talking to him over these past 16, 18 months. I didn't think we'd still be talking about increase in number of cases. Does that surprise you, Dr. Schaffner? Did you think we'd be further along than where we are today?

WILLIAM SCHAFFNER: Well, John, a few months ago, we were all celebrating, because cases were going down. And as a consequence, hospitalizations were also waning. We thought we were, finally, getting ahead of this virus, and along came Delta. And Delta, which is just extraordinarily contagious, I think, has just changed the whole ballgame, you might say. It's changed the whole environment.

It is spreading so intensely among, particularly, unvaccinated people and all over the country, including right here in my own Vanderbilt Medical Center. Cases are increasing. We're not a hot spot. Missouri, Louisiana, Florida -- those are the real hot spots. But our cases are going up. There are more people in our intensive care units.

One of the impressive things is it's really unusual for a vaccinated person to wind up in our hospital, let alone our intensive care unit. Those folks usually are immunocompromised or very old with several underlying illnesses. So the vaccines are keeping vaccinated people out of the hospital.

The other interesting thing is that, if you look at the people hospitalized, they're younger than they used to be. Because, obviously, we've vaccinated a lot of older people, and now, this contagious Delta variant is zooming in. It's homing in on younger persons in their 40s, 30s, and 20s. And even in our children's hospital, we're seeing more admissions now for COVID.

JOHN WHYTE: Well, that leads me to ask you, and this is what, I think, people want to know: How do you keep yourself safe? Should everyone just wear a mask for a while?

WILLIAM SCHAFFNER: So John, I'm going to tease you, because, you know, I don't like to use that four-letter word, safe. Because it implies complete safety. We're adults here. What we like to do is use that other four-letter word, risk, and we're trying to reduce our risk.

I think the equation is pretty simple. Get vaccinated. That's number one. And even if you are vaccinated, put back your mask on when you go to large, group gatherings indoors. And for people who are immunocompromised, older, and frail with underlying illnesses, time to social distance again.

Think very carefully about any gathering that you intend to attend. Is everybody there going to be vaccinated? How close are you going to be? Adjust your risk accordingly, because this is a very, very contagious virus.

JOHN WHYTE: Now, you said, large, large gatherings. You know, people are going to follow up and say, “What does that mean, Dr. Schaffner? Is that 10 people? Is that 50 people?” Give us a sense of what you're talking about. I know it depends, but I'm going to push you a little.

WILLIAM SCHAFFNER: Well, it's fair, because people are trying to take the 50,000-foot recommendations and bring them down to their lives. Weddings, funerals, barbecues are usually outdoors. That risk is much, much lower, right? But I would think that you could gather to play bridge with friends, if everybody is vaccinated, and take off your masks.

JOHN WHYTE: You've been an advocate for more testing, and I haven't been hearing enough of that. We remember when there weren't enough tests to go around. Now, there's an abundance of tests in many places, and we don't see people getting tested. Have we forgotten about the role of testing, and what about in home tests? You know, I have to tell you, I've been telling people.

You know, everyone wants a thermometer. Well, everyone should be getting, like, a pulse ox, right? So that'll really help your oxygenation when you're concerned about might this be COVID, but should you get one of those at-home tests, just in case?

WILLIAM SCHAFFNER: Well, first of all, I think we're going to be doing a lot more testing. We have kind of put it aside, you know? Our bandwidth has been devoted to vaccination, but particularly, as we begin to approach the influenza season, I think, the need to distinguish COVID from influenza from RSV infection, I think, will increase. So I think we'll be doing more testing.

You know, I could have mentioned testing in this gathering. Because although you have vaccinated people, another thing you could do, it's another layer of protection. It's not perfect, but you could do one of those rapid tests quickly. And if you're negative, then that reduces the risk even more as people gather.

JOHN WHYTE: And we know now the CDC has recommended that, even if you're fully vaccinated, and you come into contact with someone that has COVID, or you think might have COVID, you should get tested in 3 to 5 days from that exposure, whether or not you have symptoms. That's new, so clearly, we have to do more testing.

WILLIAM SCHAFFNER: Yeah, so John, what's happened is Delta, once again, has changed the equation. The CDC, on the basis of a very well-done but small study, actually, has shown that vaccinated and unvaccinated people carry comparable amounts of Delta virus in their nasal pharynx. That surprised all of us, because we really thought the vaccinated people would have a lower amount.

So they're both capable of transmitting this virus. There's some new data coming out to suggest that the vaccinated people actually have a shorter duration of shedding the virus. That's good, but actually, that small study really motivated the CDC to make that recommendation that even vaccinated people indoors should wear their masks. Because, obviously, the CDC would like to reduce transmission as much as possible.

JOHN WHYTE: How long does this Delta variant last? What's your best bet? Some experts are saying it's going to peak in a couple more weeks, and by October, Delta will be gone. There might be some new variant that's a concern. What's your best bet?

WILLIAM SCHAFFNER: Actually, I'm of the expectation that we're really going to have to work hard to get more and more people vaccinated. So I think Delta is going to be around beyond the fall and into the winter. It will be our dominant strain. I certainly hope we don't get other variants that suddenly crop up that will change the equation, yet again, but the Delta now accounts for over 90% of the new infections in the United States. It's the one we're going to have to deal with for the foreseeable future.

JOHN WHYTE: Now, in fairness, you mentioned you're in Tennessee. The South is where we have a large number of new cases, so what's the role of mandates? We have mandates all the time with other vaccinations, especially as children. What's the challenge here if there's such a vociferous reaction to mandates when it comes to we're trying to keep people safe?

WILLIAM SCHAFFNER: Well, actually, it seems to be permissible within the last week and a half or so for people to bring up these words: obligations, requirements, and mandates. And to be quite frank, I think we need to move quite smartly in that direction. I have a couple of simple analogies.

One is we're fighting a war against this virus. And if we think about other wars, we usually can't rely completely on volunteers. We have to draft as people, and I think we need to draft people into the anti-Delta army by obliging them to be vaccinated. The other way to think about it is we've had a lot of pull, all kinds of incentives, answering questions, lotteries, $100 to be vaccinated. That's been the pull.

JOHN WHYTE: Beer, free beer.

WILLIAM SCHAFFNER: You know, driving your car around the Talladega Speedway. I almost moved to Alabama in order to be able to do that, but we've run out of pulls. We now have to push, and we have to push people into vaccination. So I would hope that, increasingly, not only federal employees, but all state employees, all of us here at the Vanderbilt University Medical Center, are going to be obliged to be vaccinated in very short order. The senior leadership already, we're rolling this out to the rank and file.

And as far as the professionals are concerned, I think every health care professional has both a professional and ethical obligation to be vaccinated against COVID. This is a patient safety issue. We don't want to give our infection inadvertently to our patients, and the best way to prevent that is for us to be vaccinated.

JOHN WHYTE: Absolutely. Dr. Schaffner, I want to thank you for taking the time, again, to talk about where we are, and what we need to do to get past coronavirus, and hopefully, see more light at that end of the tunnel. Thanks for taking the time.

WILLIAM SCHAFFNER: My pleasure, John.

This interview originally appeared on WebMD on August 9, 2021

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