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Appalachia Health News tells the story of our health challenges and how we overcome them throughout the region. 

What To Know About COVID-19, Delta in W. Va.

School nurses confront the coronavirus.

Almost two years into the COVID-19 pandemic, things seem as uncertain as ever before.

The Centers for Disease Control and Prevention compiles projections that predict the coming weeks of the pandemic. But when you plot them on a graph, the lines are going every which way. And this is not confidence-inspiring for people who are seeking answers.

“I think you can read the one that sort of makes you feel better on any given day,” said Dr. Kara Willenburg, who oversees infection prevention at various Marshall Health facilities.

The immediate trajectory of new infections shows no signs of slowing down. In West Virginia, active COVID-19 cases have increased tenfold in about six weeks, according to state data. Hospitalizations have increased sixfold in that same time.

It will take time for cases to rise even more, peak, and fall again.

Some states hit earlier and harder by delta have hit their peak in recent weeks.

Comparing West Virginia to other states

The situation in West Virginia is nowhere near as dire as places like Mississippi, which is currently reporting the most cases per capita of any state. Based on that metric, West Virginia ranks 18 out of all 55 states and territories studied by Harvard's Global Health Institute.

But West Virginia is poised to move up that list. According to the New York Times, West Virginia has had the largest percent increase in cases over the past two weeks than any state besides South Dakota and the territory of Guam.

Vaccinations

West Virginia was an early leader in the nation’s race to vaccinate people. It was the first state to offer vaccines to all nursing home residents.

But once the state’s most eager recipients had already gotten a shot, vaccine supply began to outweigh demand. West Virginia was in the bottom 10 states as far as vaccination rates this summer.

Data shows more people are opting to get a shot every day. Vaccinations hit a low point in early July, when on average 700 West Virginians were getting their first dose daily. It took one month for that rate to double, where it’s held steady for the time being. Half of West Virginians have been fully vaccinated.

The virus we have now

The delta variant is causing almost all COVID-19 infections in the U.S. State health officials have said it can spread as easily as chicken pox, though that might be an overstatement.

This variant is spreading faster than previous strains.

“With the previous variants, initially, one person could spread it to around two people. But now this number has been reported to over four people,” Mehta said.

To understand how delta can consume large populations of unvaccinated people, Mehta said we can look at what it does in a single person’s body. Mehta points to a Chinese study that found those infected with delta had 1,000 times more copies of the virus in their body than someone might have had with the original strain.

Data has shown that vaccinated people can carry as much viral load of the virus in their noses as unvaccinated people.

“We do know that people who are infected with the delta variant tend to carry a higher viral load,” Mehta said.” “And the data is also suggesting that this delta event can cause more severe illnesses in unvaccinated individuals.”

Unvaccinated people will contract most new infectious and almost all COVID-19-related illnesses. But vaccinated people are able to carry the delta virus and spread it. This is why the CDC reversed its previous decision and recommended masking indoors, even among vaccinated people.

Still, Mehta said vaccinated people are still less likely to spread the virus.

“People who are fully vaccinated, they tend to be infectious for a shorter period of time than those who have not been vaccinated,” said Mehta “They're really clearing this virus faster than unvaccinated individuals.”

Breakthrough cases and vaccine efficacy

A breakthrough case is defined as when a vaccinated individual contracts the virus more than two weeks after receiving all recommended doses.

Moderna displays a bit more protection than Pfizer against the delta variant. Less than 1 percent of those that receive Johnson & Johnson will experience a severe COVID-19 illness, one study shows.

All three vaccines authorized in the U.S. prevent infection, but to a lesser degree than clinical studies originally estimated.

A study out of New York said more vaccinated people are catching the virus now than they did just a few months ago. But the same study says protection against hospitalizations and deaths has remained the same.

“We're still waiting on more data to know exactly when these vaccines are going to wane and when they might not be as effective against some of these really severe adverse outcomes,” said Mehta.

International studies show the Pfizer vaccine loses some of its protection over time.

Based on UK data, this vaccine went from 92 percent effective to 78 percent effective in 90 days. This goes for preventing infection, not serious illness, which the vaccines are still powerful at preventing.

Breakthrough cases are becoming more common, but nowhere near compared to the rise of cases among those who are unvaccinated. Breakthrough cases account for 3 percent of total cases reported over the course of the pandemic in West Virginia. Breakthrough deaths make up about 2.5 percent of all COVID-19 deaths.

Though breakthrough cases have been reported among all age groups, a majority have been among nursing home residents, according to West Virginia officials. They also say of the more than 60 breakthrough deaths, most are among older people and those with other serious health issues.

Booster

Federal and state leaders want vaccine boosters available to the general population, with nursing home residents and those older 65 first in line, as soon as possible.

“Our elderly folks, our nursing home residents, those are people it's important to protect,” said Willenburg.

Currently only those with cancer, organ transplants and who take immune suppressing medications are recommended by the FDA and CDC to get an additional dose.

That’s why President Joe Biden and Gov. Jim Justice are already preparing to get boosters out this fall.

But scientists and other health experts are debating if that’s the right move right now. Some even worry booster plans send a message that undercuts just how effective vaccines are at preventing illness. Or that to prevent the next highly contagious variant, extra vaccine doses might best be sent abroad to countries that don’t have them. Biden has responded that the U.S. can offer booster domestically and still offer vaccines worldwide.

In reality, it’s not a politician's decision to sign off on boosters anyway.

“It seems as though the decision on these boosters is a done deal, but I'm not so sure it is,” said Willenburg.

Health agencies like the CDC and FDA will make that call.

Doctors like Willenburg have faith that federal health officials will make the right decision, whatever that is, even if it doesn’t meet the president’s Sept 20 deadline.

“I think it will happen at some point. And I think it probably is going to be necessary at some point. But I do think the vaccines are still working very well now with the current series,” Willenburg said.


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