The latest on COVID-19 and the delta variant

The Centers for Disease Control and Prevention issued revised masking guidelines Tuesday after a recent study based on a new cluster of COVID-19 cases among fully vaccinated people shows that the delta variant is more contagious than previously thought. 

While the risk of serious illness among those who are fully vaccinated remains small, those who have experienced breakthrough infections may run the risk of spreading the virus to others, according to CDC director Rochelle Walensky.  

"When we examine the rare breakthrough infections, and we look at the amount of virus in those people, it is pretty similar to the amount of virus in unvaccinated people,” Walensky told reporters at a press briefing.

With prior strains, vaccinations were found to lower the levels of virus in the body, making people less contagious. Still, COVID-19 vaccines are considered highly effective at preventing serious illness, hospitalization and death.

But the newly released information comes as a considerable portion of the United States population continues to question the safety and effectiveness of COVID-19 vaccines, despite data that show the shots are safe for most people and do fend off infections. 

On Monday MPR News host Kerri Miller spoke with two experts about the delta-driven surge in new infections to help sort through what we know and what we don’t.

Guests: 

• Dr. Lisa Maragakis is an associate professor of medicine and epidemiology and senior director of infection prevention at the Johns Hopkins University School of Medicine.

• Bertha Hidalgo is an associate professor in the Department of Epidemiology at the University of Alabama at Birmingham.

The following is a selection of audience questions answered by experts, edited for clarity. Use the audio player above to listen to the full conversation.

A poll released over the weekend shows people who are hesitant will trust messaging coming from their own physician when they distrust it coming from public health leaders or Dr. Fauci in [Washington] D.C. That’s such a challenge, though, to get so many individuals into physician’s offices to have that conversation. What else do you see?

Maragakis: You’re so right. People are more open to messages and information from trusted sources. And of course, their own physician is a very trusted source of information that can be extremely helpful.

But you’ve pointed to the challenge that we have, which is having those one-on-one conversations with each individual takes a great amount of time. There may not be the opportunity to have those conversations right now in a timely fashion.

So other strategies — community leaders, organizations, faith-based groups — can be extremely good partners for public health to disseminate messages and to organize vaccination opportunities. And to share with their communities and their members — accurate information as well as facilitating the opportunity to get those vaccines into arms.

It is confusing when you heard messages about things like hydroxychloroquine from the former president, from other people online and in right-wing media. It’s hard to reverse that kind of messaging months later, even though there's a lot of information or research out there about how these drugs were not very effective. I think that’s what you were suggesting, that it is really difficult to deal with?

Hidalgo: Oh, absolutely. You’re dealing with the fact that in many cases, these are trusted sources for the public. And so, the perpetual messaging of the same idea — for example that ivermectin works or that hydroxychloroquine works — is really hard to dispel.

In addition, that pseudoscience has penetrated many blogs and social media accounts. It is all over TikTok. So when you speak to Gen Z and millennials and other people, you'll hear that there are pockets of the social media platforms where you can get that messaging exclusively, about ivermectin or about hydroxychloroquine. And it has persisted over time, despite the fact that in academic literature, it has been proven to not be effective, that it doesn't work, it doesn't help people and that they should not take and/or seek these drugs.

So when people say, “I don't know who to believe,” they truly don't know who to believe, because the majority of the population in the U.S. doesn't have a scientific method training. And so it's very difficult to learn the scientific method, apply it to all the information that is forthcoming and then make informed decisions for themselves and their families.

Listener question from Dan of Pine River, Minn.: One area I think we're kind of missing that is something that needs to be thought about is those of us that live in rural areas, our experience is somewhat different, perhaps than some of the more urban areas. Many people in my area just aren't as concerned about it because they figure a 99 times 9/10 percent chance that you're not going to die of COVID are pretty good odds… From a sociological standpoint, one of the reasons I think our county has something like a 47 percent vaccination rate is we've seen a lot more damage from loss, businesses, lost jobs, etc, than we have from the disease in our area.

Hidalgo: We have absolutely encountered that, and Dan is right. What I have learned, and what others have as well [is that] we have a very binary thinking when it comes to SARS-CoV-2 and COVID-19: death versus not death is the biggest one.

I think that people forget that infection with SARS-CoV-2 may not be asymptomatic in all individuals. It may lead someone to need to have to take five to 10 days off of work, either because they are sick the entire time or because they have to quarantine. That has an effect on businesses, too.

I think what people also forget is this is about the community. If one out of 1,000 people fall victim to COVID-19, instead of thinking “Well just one person is going to die,” why do we not think “We need to do everything possible to make sure that person doesn’t die”?

Because we’re all neighbors, right? I think that what has been really perplexing to me about this pandemic is the individualistic take on health and that we are unwilling to protect others because we are slightly inconvenienced, and/or because the odds are in our favor.

Listener question from Russ of Lakeville, Minn.: A big obstacle … is the idea that it's emergency use authorization — that it was created fast and FDA has not approved it. So that's one argument floating out there. And so my question is, what if the FDA decides not to approve it? And if the chances of that are zero, then what are they waiting for?

Maragakis: My understanding of the FDA situation is that they are working all hands on deck to get to full approval as soon as they possibly can because they recognize what was just mentioned. That will be a deciding factor for certain individuals in this country who are waiting for that full approval.

Interestingly, that the data around safety and efficacy of a vaccine has really already been evaluated and is what led to the emergency-use authorization. So the additional steps that are occurring right now are really more about the entire manufacturing process and all of the things that the FDA does when they work with a company to give full approval to make sure that all of the good manufacturing processes are in place, and that they can essentially sign off that — that they don't need to be as intimately involved in the oversight of all of those processes. So that's what's happening. That's what takes a longer time.

But it is my understanding that within the next month or so, we can anticipate that we might see full approval, obviously, sooner would be better than later. But that is a very accelerated process compared to what normally happens.

Miller: Professor Hidalgo, do you think that is really going to make a noticeable difference in vaccine uptake? I question whether people understand what the differences between FDA emergency authorization and what they're doing right now for full authorization?

Hidalgo: That's a good question, Kerri. I think that we have a portion of the population who has some hesitancy because they have some unanswered questions within that group. I think there are a number of people who do want full FDA approval before they will be willing to consider vaccination. Then you have the other group that is vehemently against getting the vaccine, perhaps even, you know, donning on a mask, etc.

I think within the group that is hesitant or has some hesitancy toward getting vaccinated, that there will be individuals for whom that full FDA approval will make a difference. I'm not convinced that the full FDA approval will shift and/or convince the people that are just, you know, against that from the outset. So I'm not sure it will make a big difference. But I think for some people, it will be a game-changer.

Listener question from Heidi of St. Paul: I have a question about when the doctor is the source of misinformation. I have some family members who live in another state who have been told by their physician that their daughter will become infertile if she gets the COVID vaccine, and also that there’s a history of Lyme disease and that it’s safer for them to come down with COVID than to get the vaccine. We’ve tried to encourage them to get a second opinion. The conversation did not go well. We are super worried about them.

Maragakis: This is a very, very tough problem and one which the medical community really grieves over when we see a physician using their trusted voice to further spread misinformation. This is seen in some other infectious diseases. It's interesting that you mentioned Lyme disease because it is another infectious disease around which there's a lot of misinformation. Quite frankly, many doctors continue to spread — and this has gone on for years — misinformation and unproven treatments regarding Lyme disease.

It's an even more extreme example of what we've been talking about today, in terms of trying to connect with these family members and leverage your relationship with them. Showing compassion, showing… that you care for them, that you have their best interests at heart. At the end of the day, it can be very, very difficult, if not impossible to convince people to change their mind on these things.

But I think you're doing all the right things by encouraging them to seek a second opinion. And just I guess I would just say that a lot of of this, I believe, is driven by fear. And so in these conversations, the more we can recognize and empathize and show compassion for people's fears that have led them to come to some of these decisions — maybe that makes it a little bit easier to open the door for inserting some accurate information.

Miller: We should take on this fertility thing, Professor Hidalgo, because this keeps coming up: There is no science that supports the fact that vaccines affect in any way someone's fertility. Can you say more on that?

Hidalgo: This is a rumor or myth that I have had to dispel for many months. If I’m not mistaken, this rumor began on a Reddit thread when someone said that the spike protein resembles the syncytin-1 protein within the placenta, and that if one was vaccinated, the immune system would attack the placenta… And that has just sort of spiraled out of control.

It's really hard to explain to people, even people with a PhD like me, how immunology works. And the fact that the immune system cannot mistake one protein for another and that it's actually trained to only identify the spike protein from the SARS-CoV-2 virus when it enters your body and would not attack one’s placenta.

And then having COVID, actually, we have some evidence that it may in fact affect fertility, especially for men. And then that women who are currently pregnant have severe adverse outcomes if they become infected with a virus and develop COVID-19. That’s something to worry about.

The messaging I’ve seen becomes very convoluted, and it’s very difficult for people to understand that there are some effects, severe effects, that are due to the disease, and what they’re hearing about in terms of severe outcomes… that it’s actually the vaccine that’s causing this. And I think that leads people to become very fearful, especially, I would say, women who are wanting to have babies or are currently pregnant or breastfeeding. Because all they want to do is protect their baby, right? And/or the ability to have a child. It’s a very stressful period as it is, and then to add the uncertainty that they feel relates to the COVID-19 vaccine can seem very scary.

But that's really where that rumor began was on some random Reddit thread, with someone saying that these two things seemed very similar and people should be worried.

Miller: Can you speak to these breakthrough infections that are occurring after people get the vaccines, small incidents, but also to the misunderstanding of the science of the vaccine?

Hidalgo: I think there is some misunderstanding about how the vaccine works. I think that people have some confusion about what mRNA technology means. And so when people hear vaccine, especially in the context of COVID-19, I think early on, a lot of people thought that there would be sort of this magical forcefield that was formed around each individual that was vaccinated, and then that the virus would just bounce off and there was no way the virus could enter one's body.

So the communication was that the vaccine would prevent against severe illness, hospitalization and death. And it is proven to do that. And so I think that the headlines about breakthrough infections need to be communicated in a way that say, “Look, the vaccine is working. If you become infected, you may be asymptomatic. You may be mildly symptomatic. [The vaccines] are protecting against the things we knew they would protect against, which is severe disease, hospitalization and death.”

Use the audio player above to listen to the full conversation.

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