Delta Transmission Among U.S. Unvaccinated

Crowds on Bourbon Street in New Orleans in late July. The Delta coronavirus variant is driving record-breaking case counts in Louisiana and other states.  Kathleen Flynn/Reuters

"The bottom line is this: We have the scientific tools we need to turn the corner on this pandemic."

"Vaccination works and will protect us from the severe complications of COVID-19."

Centers for Disease Control Director Rochelle Walensky 

"This moderate decline [diminishing effectiveness against hospitalizations among adults 75 and older] should be interpreted with caution and might be related to changes in the virus that causes COVID-19, weakening vaccine-induced immunity as more time passes since vaccination, or a combination of factors."

Centers for Disease Control and Prevention report

"We've been patient."

"But our patience is wearing thin and your refusal [to be vaccinated] has cost all of us."

U.S. President Joe Biden

"The vaccines remain very protective against severe disease."

"I think we set our expectations too high for vaccines, thinking they were going to prevent people from getting infected and transmitting the virus."

William Moss, executive director, International Vaccine Access Center, John Hopkins Bloomberg School of Public Health

Medical staff treat a COVID-19 coronavirus patient at a hospital   AFP via Getty Images

 

The CDC estimates that the highly transmissible Delta variant is accountable for over 99 percent of new coronavirus infections. But this is a reality not only in the United States, but globally, where new waves of mass infections are bedevilling government agencies and medical communities who had speculated that with the mass inoculation of populations vulnerable to contracting the novel coronavirus, spread of the virus would decelerate and come to a halt, the viral spread coming under control.

Even countries like Australia and New Zealand which had formerly served as an aspirational success story in stopping the spread of the virus by stern lockdown measures that not all countries were prepared to emulate, are now in the throes of spreading waves of COVID-19, straining their abilities to cope. Neither country however, was in the forefront of mass vaccinations. The toll of the virus in the United States has been spectacularly awful.

Over 650 thousand Americans have died from having contracted COVID-19, racking up an average 1,500 daily deaths in the past several weeks. Over 99 percent of new coronavirus infections are now attributed to the Delta variant. Those Americans who shunned full vaccinations were seen to be over ten times likelier to be  hospitalized, eleven times more likely to die of COVID-19 than those fully vaccinated. This from a newly-released study published by the Centers for Disease Control and Prevention.

The largest study to date of the effectiveness of the three vaccines cleared for use in the U.S. involving 32,000 patients from hospitals, emergency departments and urgent care clinics across nine states assessed the Moderna coronavirus vaccine to be moderately more efficacious in preventing hospitalization than Pfizer-BioNTech's and Johnson & Johnson's. Collectively, the study indicated, all three were 86 percent effective but a significantly higher rate was seen among Moderna vaccine recipients (95 percent) than Pfizer's (80 percent) or Johnson & Johnson (60 percent).

 

Sweeping vaccine mandates were announced by the Biden administration mandate to curb the surging infection rate of the Delta variant. A rate of infection expected to increase and with it the pressure exerted on the tens of millions of Americans resisting vaccination. Most federal government employees are required by mandate to be vaccinated. Large employers are mandated as well to have their workers inoculated or to be tested weekly. A regulation that would impact close to two-thirds of all U.S. workers.

 

Concerns of waning immunity and the efficacy of protection through the vaccines against a more contagious variant are uppermost in mind within the U.S. medical community, reflected by the recently released CDC studies, reflecting broadly consistent data whose findings from other studies are that the vaccines continue to provide strong protection for most people against hospitalization and death, Delta surge included. With the exception of adults in the highest age brackets, those in particular with underlying medical conditions.

 

These concerns have led the CDC to advise the administration now preparing to roll out boosters, awaiting the word of the health authorities advising government. The first brand approved as a booster by the Food and Drug Administration is Pfizer, given its timely submission of data on the safety and effectiveness of boosting its two-shot regimen with a third shot, with other vaccines' approval expected to follow.  

 

Amir Hamja ... Bloomberg ... Getty

"After a steady decline in cases earlier this year, Delta caused a troubling rise in cases of COVID-19 and an increase in hospitalizations around the country. The variant has turned out to be more than twice as contagious as previous ones, and studies have shown that it is more likely than the original virus to put infected people in the hospital, according to the Centers for Disease Control and Prevention (CDC). People who are not vaccinated are most at risk, and the highest spread of cases and severe outcomes is happening in places with low vaccination rates."
"In the U.S., there is a disproportionate number of unvaccinated people in Southern and Appalachian states including Alabama, Arkansas, Georgia, Mississippi, Missouri, and West Virginia, where vaccination rates are low. (In some of these states, the number of cases is on the rise even as some other states are lifting restrictions because their cases are going down)."

Yale Medicine

Sweden's Best-Laid Plans

"The curves look to be slowly but surely pointing downwards, but there is still a lot of strain on all parts of the healthcare sector."
"This is something [misleading to focus on the death toll over a single week] we should look at when it's all over."
"We never really calculated with a high death toll initially, I must say. We calculated on more people being sick, but the death toll really came as a surprise to us."
"I am not saying we are successful in all different ways. I mean our death toll is really something we worry a lot about."
"It's very difficult to keep the disease away from there [nursing homes]. Even if we are doing our best, it's obviously not enough."
"We are not putting anybody's lives above everybody else's lives — that's not the way we're working."
"We really thought our elderly homes would be much better at keeping this disease outside of them then they have actually been."
Anders Tegnell, state epidemiologist, spokesman, Swedish coronavirus strategy

"You want to support your own government and strategy."
"But Sweden is going against the whole world [in its coronavirus open-society strategy]."
Frode Forland, Norway's state epidemiologist 

"Norway, Denmark and Iceland have managed to stabilize their situation, but in Sweden the situation is more alarming."
Maria Ohisalo, Finnish interior minister

Sweden kept pubs and restaurants open while neighboring opted for more stringent measures (ALI LORESTANI/TT News Agency/AFP via Getty Images)

Alone among Nordic nations, Sweden had decided to keep their schools open, as well as bars and restaurants, while gatherings of up to 50 people were allowed. Swedes went about their normal daily routines with few disruptions. The determination to behave as though nothing out-of-the-ordinary was occurring despite the presence of COVID-19 infecting people, causing deaths, was one the government gambled would pay off in the end, by establishing herd immunity, and the Swedish population appeared more than willing to be part of this experiment.

The reasoning went that while Sweden would initially experience more cases of COVID than its locked-down neighbours, and there would be more deaths as a result of its open-for-business decision meant to save its economy from total ruin, as was being experienced globally, the other nations would eventually relax their closed policies, and their cases and deaths would increase as a result. The disparity between Sweden's cases and death toll and that of its neighbours would then disappear, but Sweden's herd immunity would ensure its toll stopped rising, and its economy would be intact.

Swedish PM Stefan Lofven,  Picture: EPASource:NewsComAu

The best-laid plans of mice and men do often go astray, as the famous saying goes, and in this instance, it appears to have gone quite awry, with Sweden now overtaking the U.S., Italy, U.K. and Belgium with the distinction of having the highest coronavirus per capita death rate in the world. The avoidance of lockdown doesn't look too sterling a decision, after all. The Our World in Data website has Sweden with 6.08 deaths per million people daily on a seven-day average between May 13 and 20.

The world's steepest, beating that of the United Kingdom, Belgium and the U.S. with their own specifics of 5.57, 4.28 and 4.11 respectively, even though over the course of the pandemic Belgium, Spain, Italy, the U.K. and France are still ahead of Sweden in their total case numbers and deaths. Sweden's state epidemiologist is none too impressed however, arguing the figures attached to a single week are simply misleading.

 Picture: AFP/GettySource:NewsComAu

Swedes appear to be satisfied, their government's decision had high approval from among the population at large. And globally, populations anxious to see an end to restrictions over fears of COVID have been cheering Sweden's choice, pointing out the country would now be in better shape to ward off the worst of a second wave, given their acquired herd immunity status. Norway, Denmark and Finland have chosen to criticize their neighbour, all of whom had placed their populations under much tighter restrictions, and consequently saw much fewer deaths.

Swedish virologist, Lens Einhorn, one of a group of 22 Swedish scientists and researchers who right from the beginning challenged the country's strategy, commented how frustrated they feel that despite the outcome of Sweden's 'experiment' in chance leading to a high infection and death rate, Mr.Tegnell and his group adamantly refused to change the strategy, irrespective of the growing evidence of failure in the government's trust that its decision to keep society open and the economy running failed to meet expectations so spectacularly.

On the other hand, polls leave the impression that the Swedish population at large was more overtly concerned over the impact on employment had the country closed down as its neighbours did. Swedes appear to have placed the economy and national welfare on a firmer footing of agreement over the government decision, than the fall-out of deaths that occurred, in majority form among the institutionalized elderly and health-impaired.

The strategy that the Swedish government chose, based in large part on voluntary measures with respect to social distancing and basic hygiene has seen criticism by many outsiders as a potentially dangerous experiment, gambling with peoples' lives. It did, however, appear to have gained approval in one significant area of authority, with the World Health Organization seemingly prepared to view Sweden as a future model approved by the WHO.

People outside in Stockholm on April 22.

ANDERS WIKLUND/TT NEWS AGENCY/AFP via Getty Images

World Health Organization Unresponsive to Queries on COVID Recommendations and Timelines

"We haven't any alternative pitched to us [from the World Health Organization] at all. There could be perhaps an alternative pitch, which we would consider."
We asked for him [Canadian Dr.Bruce Aylward, WHO senior advisor] just to show up for an hour knowing that his time is valuable, but just one hour knowing that we would work around his time zone."
Canadian Member of Parliament Matt Jeneroux

"WHO has stated its strong commitment to a timely review of the global response in a transparent, independent and comprehensive manner."
"We are in the initial phase of the most complex and time-sensitive public health response in the history of the organization and our single-minded focus is thus on working with countries in the fight against the [global SARS-CoV-2] pandemic."
Canadian House of Commons Committee letter to WHO 

"To me this is not about politics. I am not there [on the committee] to delve into the politics of the WHO. I am purely interested in their information and the way they responded to the COVID-19 crisis."
"I don't understand the difference. If he is prepared to come forward and on the record answer questions, why wouldn't he want to do that with our committee."
Member of Parliament Don Davies

Bruce Aylward of the World Health Organisation (WHO) attends a news conference of the WHO-China Joint Mission about its investigation of the coronavirus outbreak in Beijing, China, Feb. 24, 2020. Thomas Peter/Reuters

The World Health Organization has been criticized for giving the impression by its actions and statements clearly in favour of the Chinese response to the novel coronavirus, that its behaviour toward the Chinese Communist Party leadership is simply too deferential when its mandate is meant to be strictly objectively scientific in orientation, ensuring its guidance and advice to the world's nations is without bias, based strictly on medical science and factual evidence.

Not only has its chief, Tedros Adhanom Ghebreyesus, come under suspicion for the perceived unctuousness he displays toward China's Xi Jinping but that suspicion has now extended toward the former assistant director general of the World Health Organization who led an expert group examining the coronavirus' emergence in China. Dr.Aylward, in an interview with a television station out of Hong Kong where the issue of Taiwan was raised, terminated the interview rather than respond.

And because the WHO through Dr.Tedros initially praised the Chinese response and parroted its findings on human-to-human transmission, and played down the impending seriousness of the growing infection and death rate just as China did, leading to the international community being lulled into a state of complacency when a state of immediate alert should have been mandated, many countries' authorities have questions they would like answers to from the WHO.

Resident doctor Kelvin Lou puts a CVC line into a patient in a COVID suspect room in the COVID-19 intensive care unit at St. Paul's hospital in downtown Vancouver, Tuesday, April 21, 2020. (THE CANADIAN PRESS / Jonathan Hayward)

To that end, the Canadian House of Commons committee looking into the issue had twice invited Dr. Aylward to come before them to respond to a number of queries relating to the novel coronavirus. To each of those invitations, Dr.Aylward responded in the negative. Had he recommended the presence of a senor aid to represent him, who would answer those questions, the committee would have accepted that as a reasonable alternative, but no such offer was forthcoming.

The UN agency's legal counsel responded to the committee by letter following the first invitation when counsel Derek Walton advised the agency is prepared for its decisions to undergo a full review, but not at the present. To which the head of the parliamentary committee, MP Jeneroux pointed out that Dr.Aylward has given time for media interviews, and as such it appears reasonable for him to spare time for an appearance before the committee representing his own government as a citizen of Canada.

That, since the Canadian response to the crisis of this global pandemic that has impacted so heavily around the world as an infectious disease afflicting over a million people worldwide with steadily growing numbers, while 244,000 people have died so far from its complications, the issues are of monumental importance. All the more so that the crisis and its response, driven by recommendations from the WHO, makes it incumbent on that body to be responsible for itself to the very audience so dependent on its guidance.

Dr. Theresa Tam, Canada’s chief public health officer,  Blair Gable / Reuters

The World Health Organization had been unequivocal, recommending against travel restrictions and border closings initially, with a side note that it would be 'racist' to close borders to China. They also advised against the use of protective masks by the public. Recommendations which Canada's chief public health officer, Dr.Theresa Tam, was guided by as she agreed with the WHO's recommendations before eventually changing her opinion over those issues.

Provided by: Public Health Agency of Canada

Seeking Out all Mechanical Vulnerabilities to the Transmission of COVID-19

"We want to save lives, let's cut right to the chase."
"There are so many, many buildings ... This affects absolutely everybody. Billions of people. If we are able to cut down the transmission rate by a percent, that's a lot of people."
"This has been on people's radar for quite a while. Somebody on a different floor sneezes ... The particle can stay airborne long enough to go all the way through the [air conditioning] system and then pop out in somebody else's office." 
"While it’s not the most powerful method of transmission, it’s certainly one that makes people worry because we have a difficult time controlling it."
"People are spending most of their time indoors these days. And for places with air pollution, it’s even more important because the clear air is indoors in these highly-polluted megacities."
Professor Brian Fleck, scientific study, University of Alberta

"It is  highly likely that the SARS-CoV-2 virus also spreads by air, [requiring] all possible [action in response, including modifications in ventilation systems]."
"The fact that there are no simple methods for detecting the virus in the air does not mean that the viruses do not travel in the air."
"We predict that ... failure to immediately recognize and acknowledge the importance of airborne transmission and to take adequate actions against it will result in additional cases."
Chinese and Australian air-quality experts

"[The effort represents a] non-pharmaceutical intervention [that, if successful, could avoid] 
extensive consequences. It’s just as valuable as vaccine research."
"Improving ventilation systems in high-occupancy structures could be a critical way to contain the pandemic… This work has the potential to impact millions of people living and working in these buildings."
"[The research will unfold in three parts: a systematic review of research on air circulation and viruses, determining an effective strategy and then testing out that strategy on buildings at the Edmonton campus] to create a real-world model of what should be done."
Lexuan Zhong, engineering professor, University of Alberta

An African restaurant is closed off along with other businesses in Guangzhou's Sanyuanli area, where a neighborhood is in lockdown after several people tested positive for the novel coronavirus disease (COVID-19), in Guangdong province, China April 13, 2020. - REUTERS/David Kirton

Engineering professor Lexuan Zhong is leading a project involving the university's civil engineers funded by the Canadian Institutes for Health Research at the University of Alberta, consisting of three phases; systematically reviewing literature on air circulation and viruses, determining the strategies that would be effective, and finally conducting a detailed audit of all buildings on the Edmonton campus with the intention of creating a real-world model of what should be done in response to their conclusions.

Their interest in the possible role that building HVAC systems (heating, ventilation and air conditioning) may play a role in the transmission of the novel coronavirus stemmed from a case in Guangzhou, China detailed in a U.S.Centers for Disease Control online journal. Researchers had reached the conclusion that flow from an air conditioner moved over three occupied tables in the restaurant, carrying virus droplets from an infected patron at the middle table to the far table, then back to diners closer to the air conditioner.

It was a puzzle at first how eight diners at the restaurant all were infected with the coronavirus. A visitor from Wuhan, the coronavirus epicentre, suspected of being the vector had travelled to the Guangzhou region and happened to enter the restaurant. A team of local scientists came to a conclusion that tiny particles of virus had floated around on currents created by the restaurant's air conditioning, despite the prevailing view that the coronavirus is transmitted solely by heavier 'droplets'.

Now, the civil engineers at the University of Alberta have taken up the intriguing concept, one they are familiar with, hearking back to Legionnaire's Disease, a bacterial pneumonia transmitted in a hotel setting through the air conditioning system. Engineers are well acquainted with building ventilation systems as efficient distributors of viruses and other pathogens. They have set out to prove that COVID-19 falls into the same category. What now consumes their interest is conceiving of practical ways to curb infection risk; a "non-pharmaceutical" intervention.

"The HVAC system in most non-medical buildings play only a small role in infectious disease transmission, including COVID-19", responded the American Society of Heating, Refrigerating, and Air-conditioning Engineers, in defence of their product and their livelihood. The smaller, lighter aerosol particles capable of spreading through a ventilation system is still questioned by some: "the truth is that we still don't really know if the (COVID-19) virus can be spread by aerosols", virus expert Matthew Miller at McMaster University responded.

However, in a paper published earlier in the month, Chinese and Australian air-quality experts basing their hypothesis partly on the SARS experience, argued in their own study that as droplets from an infected person begin evaporating, the resulting smaller particles indeed may become airborne; evidence that passengers confined to their cabins on cruise ships was cited such that they may have been infected through the air ducts of the vessels.

Canadian cases

CONFIRMED

50,015

(Today: +1,526)

DEATHS

2,859

(Today: +152)

RECOVERED

19,203

(Today: +922)

782,541 tests administered  (Today: +28,023)

Social Distancing in Closed Environments

"Very early on, we wrote two letters that we posted on social media that got tonnes of attention."
"Our method of protecting ourselves and the public from being infected is social distancing. And if  you can't social distance ... you're just inviting disaster to strike."
"If you've got two people who are in a stadium and you tell them, close your eyes and just start walking around, the odds that they're going to walk into each other are pretty small. But if you have those same two people doing that in a room that's six-by-six metres, there's a pretty good chance that they're going to knock into each other. It's a simple function of the ability or the inability to distance." 
"One of the advantages we have with long-term care facilities is at least we've been able to understand some degree of the problem. Someone's peeled back the scab, so to speak, to look under the bandage and we can see how absolutely horrific what was going on has been."
"The residents in these populations, we're just going to lose them. And that's a scar upon us if we can't protect our vulnerable."
"These are not closed systems. There are people who go and work there. And if we can't protect the healthcare workers, then almost certainly we're not protecting the health-care workers' families and therefore we're not protecting the public that is in contact with the health-care worker and their families and therefore we're not going to be able to get a hold of this whole problem."
Dr.Andrew Morris, professor of medicine, University of Toronto

"I think we're starting to see very quickly that hospitals are not really the front line of this pandemic in Canada."
"I think now people are almost playing a game of catch-up when you start looking at these settings [care homes for the elderly or disabled]."
Dr.Samir Sinha, director of geriatrics, Mount Sinai Hospital, Toronto

The Quebec coronor's office has launched an investigation into a long-term care home in a suburb of Montreal where 31 people have died in a conditions the premier has called "deplorable"

It has now been six weeks and ongoing, where Canadians across the country have been counselled that it is up to everyone to 'flatten the curve'. To remain sequestered in their homes, to go out only on rare occasions when it's absolutely necessary, to remain distant physically from others. Schools closed, non-essential businesses shuttered, public spaces and events off limits, borders closed, travel plans nixed. All well and good, but none of this affected long-term care homes, yet fully 78 percent of all COVID-linked deaths have occurred in long-term care homes.

All of these measures to try to control a hugely infectious and sometimes morbidly-threatening new cornavirus were predicted before the virus entered North America. Dr. Morris, for one, was alert early on that COVID-19 would present an enormous problem to Canada when it arrived, as it surely would. But even he and colleagues of his whose thoughts took a similar track, were unable to visualize just how dramatically the Canadian reality of life-normalcy would ultimately be affected.

The Eatonville Care Centre, where multiple deaths from COVID-19 have occurred, is shown in Toronto on Tuesday, April 14, 2020. THE CANADIAN PRESS/Nathan Denette

He and his colleagues got together to draft several letters outlining the situation that would unfold and their recommendations for an early response to the situation before it became a reality. At the time it seemed so difficult to believe that the country would swiftly be engulfed in a seemingly unstoppable epidemic they scarcely thought their communications would be given the serious consideration it required. Later, it would occur to them that though that attention was forthcoming, they had themselves failed to communicate the extent of the dire conditions that would ensue.

Now that Canadians have embarked on a voyage of countradicting the basic human impulse of sociability in an effort to halt the spread of the virus causing COVID-19, the very enormity of the threat takes on new proportions to our understanding of just how vulnerable we are as a population. But it is a readily identifiable demographic of the population that has borne the brunt of the infections.

Precautions were taken to close schools and daycares to shield children from the SARS-CoV-2 virus, the most readily identifiable group within any population that is given first thought. Fears of overwhelmed hospital emergencies failed to materialize, with hospital admissions and ICU capacity at not only manageable levels, but anxiously awaiting the arrivals of other emergency situations more commonly making use of those facilities that have suddenly disappeared.

People are withholding their presence at Hospital Emergencies, hoping that their worrying symptoms of heart problems, stroke, appendicitis, accidental injuries will somehow abate, rather than subject themselves to the possibility of appearing at a hospital teeming with infectious agents and find themselves infected with the dread virus. And then there is another casualty that few had given prior thought to, but several of Dr. Morris's colleagues had.

The virus that thrives in the company of groups of people in close communion, and sees its opportunities dwindling when people exercise caution to keep physical distances, found its metier when it entered the confines of closed gatherings, where people are placed in situations with tight physical spaces and an abundance of potential targets. Places like nursing homes and long-term care homes, prisons and shelters for the homeless. "Congregate settings", perfect for a virus to thrive.

If more isn’t done to protect shelters, prisons and in other so-called “congregate settings,” advocates warn more mass outbreaks are inevitable. Francis Georgian/Postmedia/File

And in long-term and nursing homes the virus has done precisely that. Shelters and prisons next on the list. "I think we're going to see numbers jump dramatically", Cathy Crowe, a nurse with decades of working with the homeless in Toronto, stated. While many shelters are attempting to implement some elements of social distancing, in their limited spaces it is beyond difficult to adequately achieve.

"It's pretty much impossible to maintain social distancing in pretty much every congregate setting of a shelter or a drop-in, to be perfectly honest", Diana McNally, with her years working in Toronto shelters, offered. "The diagnostic differentiation of COVID among people experiencing homelessness is very challenging", Dr. Naheed Dossani, palliative care physician who often works with the homeless, pointed out.

In prisons and jails outbreaks are beginning to occur. "I'm speaking to senior citizens who are serving prison sentences and telling me, I didn't know this was going to be a death sentence", Paul Champ, a lawyer in Ottawa stated. As for long-term care homes where well over fifty percent of the COVID deaths not only in Canada but globally, have been taking place, the sheer vulnerability of the aged, infirm and health-compromised has shocked the world.

As the coronavirus outbreak continues, Los Angeles has been providing unhoused people with motorhomes and RVs, which allow them to maintain social distance.  Photograph: APU GOMES/Getty Images