EDITOR’S NOTE: This article has been edited for clarity.
RAPID CITY — As the COVID-19 Delta variant sweeps through the country, the Black Hills has not been immune to its affects; however, Dr. Shankar Kurra, vice president of Medical Affairs with Monument Health said there is a way to stem the spread of the deadly virus.
“Please go get the shot,” he said.
What do we need to know about the Delta variant?
“Well it’s one very clear fact: it’s emerging across the nation. It is highly transmissible, twice as transmissible as the Alpha variant, and as a result we’re seeing steep increases across the country and now here in South Dakota, West River as well. That’s not the surprising part, right, because it’s R-naught, or reproduction number, is twice that of the Alpha variant, the slope of the increase is going to be straight up versus a little more gradual rise. And that’s what you’re clearly seeing if you look at the numbers. It’s what we call and inverted “V” when you have a fast-rising variant, everything goes fast up and fast down because it runs through the population really fast.”
What is it that makes this variant different from other variations of COVID-19?
“So the original variant was the Chinese variant that started (in Wuhan Province) and then when it got to Europe, it formed the Alpha variant, which (was referred to as) the United Kingdom variant. All these variants basically arise every time the virus has a chance to replicate through millions of people. When we saw the Alpha (variant) spreading rapidly in the United Kingdom, that dominated most of last year, but now this year we saw the new variant coming predominately out of India because that’s where we had millions and millions of people infected and this Delta variant emerged, and it not only emerged, it’s very quick as you can see. Every time the coronavirus enters the body it has to make copies of itself. It makes mistakes, very minor, we’re just talking about 10 or 12 changes out of 30,000. When it makes those mistakes the vast majority of them don’t give it any advantage, but the rare time, in this case Delta, that change in its spike protein allows it to more quickly impact human beings. So the rate of infection is more rapid because of this small change. That’s what’s bad about the Delta; it’s twice as fast in spreading as the Alpha variant. In some ways it is slightly more dangerous than the Alpha variant. It puts more people in the ICU. What, anecdotally, you’re seeing in the hospital here … when we had the Alpha variant last year about 10% of people or so ended up in the ICU of those admitted to the hospital, now we’re seeing almost 50% of those folks requiring ICU level of care. That’s anecdotal and that’s what we as doctors here taking care of the sick are seeing, and that kind of gives you an idea how bad this is.
That is why we keep saying we need to vaccinate folks. It’s a race against time. As long as you have people that are not vaccinated they form a fertile breeding ground for new variants. The bright spot is that all of the vaccines, the Pfizer BioNTech vaccine, Moderna vaccine, and the Johnson and Johnson vaccine are still effective against the Delta variant in one specific feature. You could get an infection, which we are seeing a small — we’re talking about breakthrough infection rates — anywhere from 1% to 2% of people who are vaccinated getting the infection. But that 1% to 2% don’t require hospitalization and definitely don’t die. This is why vaccinations still work, it’s never (too) late, and it’s the only thing we have that can truly stop this. We can do all these other things like masking and distancing and not gathering in close spaces but those are not the real answer. We need to get more people vaccinated so this virus doesn’t replicate and therefore form new variants.”
Early on, as the vaccine began to be distributed, cases and hospitalizations and deaths dropped dramatically. Now we’re at the point where we’ve given out a lot of vaccinations, but a lot more people are getting sick again. Is that just due to the nature of the variant, or is there something else at play?
“The Delta variant is twice as transmissible as the Alpha, which was the predominate variant prior to the Delta. So you’re talking about how many people can one infected individual spread the disease to. The highest number in all of the history of viruses is measles; so one person with measles can spread it to 15 others. In the case of the Alpha variant one person can spread it to two others maybe max, three others depending on the conditions. With the Delta, it is double that, so we think anywhere from six to eight people can get it, so it’s almost half as bad as measles. That’s a big, big change. And that’s why the CDC called it a change in the game and came up with new mask guidance’s again.”
Is there a specific group that you are seeing more of these kinds of effects targeting?
“What we’re unfortunately seeing is younger age groups. Our median age of people infected with COVID most of last year was in the 69-70-age-range. Right now it’s around the 59-60-age-range. When we say ‘median’ we mean half of those folks are below the age of 59 and half are above the age of 59 so there’s a large group that’s in that 20-30-40-age-group that’s really ill, and requiring ICU level of care. So that is the frightening part about this time around for this rise. Because last year, in August after the Rally we saw a surge, it wasn’t as bad as what we’re seeing today in terms of people requiring ICU level of care.”
So we’re already seeing an effect from the Rally?
“Yeah, if you just looked at last year and this year — last year after the Rally you saw a rise in numbers, and we’re seeing the same now, only this rise is steeper, and we’re not sure where the peak will be. That will let us know when it will start to trend down, right now it’s all in the upward climb.”
Are you seeing any significant affect on the K-12 age groups?
“We haven’t seen a huge rise in pediatric cases. What we are noticing is a lot of pediatric cases are RSV, which is a respiratory syncytial virus. It’s a type of virus that we only see in the winter, but now we’re seeing it in this late summer/early fall air, which is very unusual, we don’t usually see that. The best guess is that Delta predisposes, or puts the kids at risk for RSV. So we don’t know the answer to that but that’s what we’re seeing.
What actions would you recommend for schools?
“There are (what’s) called ‘mitigation measures’ and ‘suppression measures,’ suppression is vaccines, that’s the only way you can stop this disease. Mitigation is hand washing, and making sure that when you’re indoors, you’re masked because there is very poor ventilation and we know, we know, that that is the big factor for COVID to spread. And the sad truth is people keep saying, ‘Oh, the kids, they don’t get too sick,’ which is true compared to adults. The reality is, now we know that household transmission occurs through kids. So you’re going to take these kids, gather them in these spaces and if there’s a community-wide outbreak already ongoing — like it is right now — there’s a huge risk when we open schools and colleges and then these (students) take it back to their grandparents or other vulnerable folks who cannot be vaccinated for other reasons and now you’ve got a bigger problem on hand. So there’s a real risk with schools and colleges opening, we saw that last year too when schools opened, so this is again a risk we’re running into in the face of a highly transmissible variant, which is why we’re seeing this new rise in cases everywhere.”
Are the symptoms associated with the Delta variant similar to other COVID-19 variants?
“Symptom-wise there are slight differences, not huge. The original Wuhan and Alpha variants typically presented as symptoms of pneumonia — cough, shortness of breath, (etc.) — Delta is a little more upper respiratory type where you have sore throat, headache, cough, and runny nose.”
Can a fully vaccinated person still be a carrier and a spreader of COVID-19?
“If a vaccinated individual gets the COVID infection they could be having mild or no symptoms and still spread it, (but) if they don’t get the infection then they’re not transmitting to anyone. After 14 days they’re not going to carry it around and spread it, they’re done. Of those 14 days, the first three days is when they’re most infective. But if you’re not vaccinated and you get the disease, what we’ve learned is during that 14 days, you’re not just infective for those first three, but you could be up to the first five to 10 days, so they’re more infective, more transmissive longer than those who receive the vaccine.
Is there an advantage to gaining immunity through getting the vaccine versus gaining immunity through contracting the disease and building your own antibodies?
“The advantage of vaccine-based immunity is (that) it is targeted. So the “natural immunity” (immunity gained by contracting the disease and naturally forming one’s own antibodies) develops antibodies to every part of the virus, not just the spike protein, so you’ll have hundreds of different antibodies. But the vaccine-based immunity, it’s training your body to only develop antibodies to the spike proteins. So that difference is why we recommend, even if you’ve had (the disease) to get vaccinated. Because by vaccinating, your immune system is more targeted because the only way the virus can infect is through the spike. If the spike is neutralized by the antibodies that the vaccine makes, there’s no chance for the virus. In “natural immunity,” since you develop antibodies to every part of the virus, the covering of the virus and all the other parts of it, not just the spike, you may sometimes get reinfected and may suffer some more than if you had targeted antibodies. So you’re better off taking the vaccine, because your “natural immunity” may not be enough to protect.
People are still clinging to the idea of herd immunity. Is that something that’s still obtainable?
“So herd immunity is not going to be easy to achieve. Now we’re talking about the higher reproductive rate (of the Delta variant). For measles for instance, at the (transmission) rate of one person spreading to 15 (others), you need 90% of the population to be immunized in order to get herd immunity. So we’re looking at 85% or higher for this in order to be there. And that I don’t see happening, not with the rates we’re seeing currently.”
When we say, “herd immunity” we’re talking about immunity that comes from either contracting the disease and surviving, or getting the vaccine, right?
“Yeah. “Natural immunity” is another way of getting (herd immunity). But unlike vaccination, you actually get admitted to the hospital, you end up suffering long-term damage to your internal organs, mainly your lungs but others as well, and you run a huge risk of blood clots in your brain, in your bloodstream, everywhere. Those risks are not minor.
Has Monument Health seen any severe cases of negative reactions caused by getting the vaccine?
“No we have not, and we’ve been very fortunate, the CDC has the vaccine adverse reaction reporting system. There have been no vaccine related deaths, or deaths directly attributable to the vaccine. Now, obviously everyday people die from stokes, heart attacks, and temporally they may be related. They get a vaccine; a day later they happen to die from something else. It’s not caused by the vaccine, because we know there were underlying probable causes that clearly could be linked to the death. The other thing we have to realize is, in the United States right now, where at least 160 million people have completed a course (of vaccination), … there are no signals that emerge from the entire vaccine adverse reaction reporting system to suggest the vaccine is unsafe.
The second thing is, worldwide there have been over a billion of these vaccines given and the same results hold. So its astonishing that we still have this conversation around the safety of the vaccine when these are a miracle of modern medicine that you have (a vaccine that is) highly safe and also 98% effective in preventing death and hospitalizations. We’re talking astonishing numbers and for me it’s strange to have a conversation repeatedly over the safety and efficacy of these vaccines when if (this) were the case with any other medicine we would be singing its praises.
To give you an example, penicillin, which is a well-known antibiotic that we’ve used forever and still saves lives, it has more of, what I would call a safety profile, that is about 100 times worse compared to the (COVID-19) vaccine but we don’t talk about that. It’s the nature of vaccines that people have a visceral reaction. But in fact they cause very little harm because the coronavirus is causing more harm. It’s just amazing how we fail to see the threat. Risk assessment by human beings is very flawed. We can see an earthquake, or a volcano and see the threat, but we can’t see COVID and we can’t see a threat.
My mantra is, ‘get people to get the shot,’ and this shot is the most amazingly affective and the most amazingly safe medicine, but then I hear people asking me if I can get Ivermectin, which is a horse drug used against parasites, which is extremely dangerous. But look at the level of public understanding that we have, vaccines are immediately tainted as something harmful, while people are willing to take unproven medications like Ivermectin and go to great lengths to get it. It’s just astonishing that we are marching out this amazing miracle of medicine and telling folks, ‘hey, it’s very safe, it’s also going to prevent you from dying or hospitalization by 98% or a 25-fold reduction,’ and people won’t take it.”
So you’ve actually had people ask you if you could get them the horse medicine?
“Absolutely. Absolutely. They’ll call and say, ‘Hey doctor, what about Ivermectin?’ So I tell them — very calmly — ‘I can give you a better medicine, it’s called the vaccine, please go get it.’”
Why are people so against this vaccine?
“One of the sad truths is in the 80s vaccines took a hit with a false study by a doctor who got published, then retracted it because he had doctored all of the evidence, claiming that measles vaccines cause autism, and ever since people have had this bad image of vaccines. So it’s very difficult in this day and age when we have the amazing researchers who spend all their effort to make these vaccines so effective and so safe that we can’t get the message across.
What about the possibility of needing a Booster shot?
“Two things: one, you only will need the booster if you’re immunocompromised. That is less than 3% of the U.S. population; 2.7% actually, of adults. That’s roughly about 7 million adults in the United States that could benefit from a booster. You only need it if you didn’t mount a response (to the first dose). The other group that could likely benefit is anyone over the age of 65, some of those folks, not all of them don’t mount an immunoresponse and that’s just the nature of that age group. In the end what I would recommend is: based on evidence, based on the scientific evidence, the booster doses are best for those who are immunocompromised or immunosuppressed, or have autoimmune disease, or have reasons that their doctor would say that they cannot mount and immune response. If you are one of those people, you benefit from the booster, if you’re not one of those people you already have a great immune response and all the studies so far show you’re well protected, you don’t have to go chase another booster shot.”
How would someone know if they didn’t mount an immune response to the first dose of the vaccine?
“My recommendation is to go see your doctor. So I’m an internist, if a patient came to me I would talk to them, take a medical history, see what kind of disease they’ve had, how they have in the past responded to infections, and that’s how I would make the choice.”
Should we be taking the same steps now that we were taking before the vaccine such as wearing masks, and social distancing?
“Absolutely. This is a pandemic. COVID is a real threat. And the only way to stop it is to vaccinate yourself. Now, if you haven’t vaccinated yourself, or you’re unable to then your best bet is to wear a mask, to wash your hands, keep your distance, don’t gather in closed spaces because ventilation is the key, and more importantly don’t gather in crowds, which is kind of the story we’re seeing repeatedly everywhere in the country and the world.”
That you know of, did you or any of your colleagues at Monument Health ever have to turn anyone away during last year due to lack of beds or staff?
“We never turned away people. First, as a doctor, our ethical considerations far outweigh anything. We’ll do anything to accommodate any patient that walks in and asks for our help. What I would say is, last year, there where a lot of folks who delayed care on their own because they were worried about getting COVID. Nationally, hospital stroke and heart attack rates went down, and that’s not natural. This is another reason why I’m baffled when I say to folks, ‘please get the vaccine, you’re saving others.’ We’re talking about non-COVID savings, because you’re saving lives of people that would otherwise have gotten care for their heart disease, for their stroke, for all the other things that they need to depend on the health system (for). COVID, by putting this extraordinary strain on the health system really limits care. That’s what a pandemic does, and it’s been studied, this is not a new phenomenon, it’s well known, and it’s what we saw last year and that’s my worry right now, my biggest concern is that these rising numbers, it scares off folks who other wise would have come to the hospital to get care.”
In closing, what else would you like to say, what else do you think people need to know; by the numbers, by the science, what do you recommend?
“As long as we can reach one more person, I think we succeeded. My final words would be: Please go get the shot; it’s the only way to save your life and others lives. Vaccines are safe, vaccines are highly effective.”
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