Pandemic Chronicles: A perennial contagion?

UPDATE, JULY 28: A renewal of Nevada’s mask mandate goes into effect on Friday, July 30. The CDC lists Washoe County in the “High Transmission” range on its COVID-19 Data Tracker. As of July 28, the county has reported: four Delta variant-related deaths since July 1, all were unvaccinated; 26 hospitalized Delta variant cases, 22 of those cases were not vaccinated and seven were in the Intensive Care Unit; and 100 patients with active Delta cases that have yet to recover.

Vaccines eradicated polio and smallpox, but with such a large percentage of unvaccinated people in the population, COVID-19 may devolve from a world-wide crisis to annual epidemics.

Unvaccinated people continue to spread the contagion, scientists agree, and they serve as incubators for more variants of the disease. Densely-populated Clark County is getting hammered by Delta and cases of that variant have doubled each week in Washoe County. Absent a large-scale adoption of the vaccine, more dangerous variants, “hot spots” of infection and yearly outbreaks requiring new vaccines could become the new normal.

“The virus will be circulating largely in unvaccinated people, with increasing amounts in vaccinated people, in a form beyond Delta,” said Dr. Mark Pandori, director of the Nevada State Public Health Laboratory, who was asked what the future of the outbreak may look like.

 “We will be talking about getting additional vaccines, specific to variants. Philosophical questions will arise regarding the ongoing response — such as whether this virus should now just be viewed as ‘another influenza’ and life goes on in an altered form,” Pandori wrote in an email to the Reno News & Review.

At the start of the pandemic in the spring of 2020, researchers estimated that about 70 to 90 percent of the population would have to be immunized to reach herd immunity, the point when a large part of the population is immune to a virus and curtails its spread. Current vaccines so far have proven to be effective against the more-contagious Delta variant of the virus, but that mutated form of COVID-19 is causing a surge in cases in Nevada and throughout the country.

“Only modest differences in vaccine effectiveness were noted with the delta variant as compared with the alpha variant after the receipt of two vaccine doses… This finding would support efforts to maximize vaccine uptake with two doses among vulnerable populations.”

– Study published in the New England Journal of Medicine, July 2021.

Clark County has reinstated a mask mandate for employees, but not visitors. The Centers for Disease Control and Prevention, which has warned that the nation could see nearly four times the current rate of Covid-19 cases in the next four to six weeks, on July 27 recommended that young children and fully-vaccinated people begin wearing masks indoors again in places with high COVID-19 transmission rates..

Surges and hot spots

Nationwide as of July 26, about 49% of those eligible have been fully vaccinated against COVID-19. In Nevada, 44% have received both shots. About half of eligible residents (people 12 and older) have gotten the injections in Carson City; 51% in Washoe County; and 40% in Clark County. Although the state has ample supplies of the vaccines, immunizations have leveled off in most areas of the state, according to health officials. As of July 24, the variant has been identified in 10 of Nevada’s 17 counties, including Washoe, Clark, Elko, Carson City and Nye.

The state laboratory does gene sequencing on samples from COVID-19 testing to determine the form of the virus. During the 14 days prior to June 23, the Delta variant accounted for 74% of all positive cases. In Washoe County, the variant accounted for 218 cases, an increase of 100 cases from the week prior. So far, four county residents who tested positive for Delta have died; all were unvaccinated.

Of the 218 cases, 19 remained hospitalized as of July 23. Of those, 17 weren’t vaccinated. Sixty six of the Delta patients had yet to recover from the effects of the virus.

Getting shots into arms

The resistance to the vaccine is a source of frustration to health workers and officials.

“Vaccine is the tool we should be relying on,” said Dr. Nancy Diao, division director of Epidemiology and Public Health Preparedness at the Washoe County Health District. “We’re lucky in that we have all the vaccine doses we need, unlike some of the other parts of the world, and we should not waste that advantage. Make use of this tool to protect us. If we can increase that percentage (of vaccinated people), we’re hoping that will fall off a little more.”

The county has recently had an increase in people getting their first doses of the two-shot vaccines, Diao said, a positive sign that “more people are encouraged by our efforts to bring more doses to the community.”

Residents interviewed over the last few months who have declined to get the inoculations often cited “personal choice” as a justification for avoiding the shots. But scientists and doctors agree that shunning the vaccine affects everyone that an unvaccinated individual encounters. It doesn’t help that there’s a correlation between people who won’t get a vaccine and those who rebel against wearing face masks.

“Any decision a person takes involves risks. Vaccines should be up to us,” — Katrin Ivanoff, a Las Vegas resident addressing the Clark County Commission July 20.

‘Accomplices to the virus’

“As long as we give the virus human beings to infect, then we give the virus the ability to change into something worse,” Pandori said. “So when you are unvaccinated, and don’t wear a mask, you are — whether you realize or intend it or not — an accomplice to the virus and its impact on society. This is because you are providing a potential host to the virus at a much higher probability than a vaccinated person.”

Diao noted that Washoe County has had many small clusters of people infected with Delta, including among people living in the same household. She explained that people infected with the variant have higher viral loads than they would have with the original strain or previous variants.

“There’s a higher transmission rate,” she said. “Instead of infecting one or two people, you are going to infect four, six, eight or even more people. That’s why we’re seeing clusters forming very quickly, spreading very quickly and seeing whole families getting infected.”

Those who shun both vaccines and masks aren’t just risking themselves; they are risking the health of everyone around them. “If you do become infected you can very well pass it on to a vulnerable person who has a high risk of getting very sick, who may end up in the hospital or dying regardless of their age. That’s not a good thing to have on your conscience,” Diao said.

Deadly surge predicted

The most recent projections, based on computer modeling, indicate the current COVID-19 surge in the U.S. will steadily accelerate through the summer and fall, peaking in mid-October, with around 60,000 cases and around 850 deaths each day.

Diao and Pandori said with the surge in Delta cases accelerating, the nation is on track with those projections of a fall surge. A greater percentage of vaccinated people can derail that trend.   

In Washoe County as of July 25, 56% of those eligible had received the first shot of a vaccine and about 50% were fully vaccinated with two shots. That means that about half of the county’s residents remain unvaccinated and should continue to wear masks as recommended by the federal CDC. Even a short drive around the streets of the Truckee Meadows reveals that isn’t happening. The agency July 27 updated its advice to recommend vaccinated people also continue to wear masks indoors in areas that have experienced a surge in virus cases.

No one is bulletproof

Diao said vaccinated people, particularly those with existing health conditions, should take steps to protect themselves when in public settings like special events, especially when they are held indoors. The Delta strain of COVID-19 is so much more contagious than the original form, that people in dense, outdoor crowds are more at risk than they were earlier in the pandemic.

“We should be seeing a lot more masks, but we’re not,” Diao said. “I encourage people to evaluate their risks every time they do an activity. If you are going to an event and will be in contact with many, many people not knowing their status, and if you know you are one of the vulnerable populations, you need to take extra measures to protect yourself.”

“Get the vaccine, wear a mask, wash your hands and try to avoid crowded public settings to reduce those risks. Those (shoulder-to-shoulder crowds) are a breeding ground for the variant if you are not protecting yourself. If you are immune-compromised or elderly, bear in mind that when you have a lot of exposure, the level of viral load also increases.” — Dr. Nancy Diao, Washoe County Health District.

In Washoe County, as of July 24, there have been 229 “breakthrough” cases of COVID-19 detected in people who had been vaccinated against the virus.  That means there’s a small chance that vaccinated people can still be infected with Delta. “You are not home free if you continue to increase your risk just because you are vaccinated,” Diao warned. “You are probably protected from severe disease and from hospitalization, but if you have pre-existing conditions, I would suggest you put on a mask for the extra level of protection.”

“We are seeing is that the virus is extremely infectious, especially in its Delta form.  This will continue to spread and mutate. Most of that will occur in unvaccinated people but a small amount of infection will also occur in vaccinated individuals.” – Dr. Mark Pandori, director of the Nevada State Health Laboratory.

The variants to come

In India, where Delta evolved, a large percentage of the population wasn’t vaccinated. The latest form of the virus, called Lambda, surfaced in Peru last year and has been detected in other areas of South America.

“We’ve not seen Lambda in Washoe County, but we’re watching very closely,” Diao said. “… Every time the virus gets passed on, it has the chance to mutate. At some point, a mutation is going to be able to evade the vaccine.”

Vaccines are the key to stop the spread of the contagion and limit the virus’ ability to mutate, she said. Because people will spend more time indoors when the weather gets colder, more cases would be expected in the fall even without the variant, but “we don’t want to see a similar level of surge that we saw last year,” Diao said.

The pandemic, she said, isn’t over; both vaccinated and unvaccinated people need to understand that.

 “The most important thing people can do is get vaccinated,” she said. “And everyone needs to evaluate their risk. Wear a mask if you are not vaccinated and avoid very public settings.”

EDITOR'S NOTE: This story was updated at 4 p.m. July 27 to include the CDC's latest guidance about vaccinated people wearing masks indoors.