The Delta Variant: Current Evidence and Literature - COVID-19 | SARS-CoV-2 | Vaccine Efficacy

what's up ninja nerds in this video we're going to be talking about the delta variant this is one of those variants of concern that we're starting to see a lot more cases a lot more hospitalization and death with so what i want to do in this video is talk about the delta variant and along the way while we're going through this utilize articles and data that we provide for you we'll have a document down in the description box click on that so you guys can follow along to all the articles and data that we talk about throughout this video so let's dig in and let's talk about the delta variant all right engineers let's talk about the delta variant one of the variants of concern that's really becoming the more prevalent is becoming this variant that we're seeing a lot more cases of across the world now there's a bunch of different variants of concern and then we have alpha that's the original kind of uk variant we have beta that was one of that south african variants we have gamma which was the brazil variant we have delta now which is becoming the real prevalent one and then we have this epsilon one that we're seeing in parts of california that's starting to kind of also increase but what is it about this variant the delta variant that we're really kind of seeing a little bit more prevalence in well obviously all of these variants of concern they're altering a particular component of that sars cov2 virus and that is this s protein the spike protein there's particular mutations that we're seeing within the spike protein that increases the viruses ability to enter into cells within our body replicate and potentially evade the immune system so this virus in the same way that we talked about in the original kind of cove video it still gets kind of spread through respiratory secretions coughing sneezing touching different surfaces and then someone going on and touching that surface and touching part of their face when it gets spread through the respiratory tract if we were to kind of take let's say it gets spread through the respiratory tract and we zoom in kind of at the cellular level at the alveoli what does it kind of do well we've already talked about this in so much detail but really this virus that sars kovi ii virus particularly in this case the delta variant it utilizes very specific types of proteins to enter into cells in the body and if you guys remember we will talk about this more but that's that ace ii receptor that we're seeing and the virus will bind onto that h2 receptor which will facilitate the entry of the virus into these cells and then what do we know well we know that these cells start to become damaged they start to become injured and what's the problematic issue with this well as they get injured that triggers your immune system to come to the area of where that injury is and so particular white blood cells will come to the area when these white blood cells come to the area of where a lot of this injury is what do they start to do that causes a lot of this nasty issues there's that increased cytokine storm that we talked about before right where they can increase the production of particular cytokines like interleukin-1 they can increase their production of interleukin-6 which seems to be one of the really problematic ones and even increase the concentration of the production of tnf alpha and we know that these cytokines actually cause a significant amount of inflammation they can lead to pneumonia ards multi-system organ failure at the worst case scenario as well as even increasing pro-thrombotic processes now that's kind of the nasty effect of this right but let's take a look here for a second and actually see how does this delta variant what are the particular mutations and what particular components of that rna are mutating that allows for it to easily enter into the cell replicate and then evade the immune system let's come up here for a second what is it really about this delta variant that it's having these mutations that it's making the spike protein a little bit more nasty if you will well if we take a look here let's say that we kind of look at the the viral rna really of this delta variant so let's say that here we have that rna right well rna is going to be utilized to make a particular protein right and then a particular sequence of it will be utilized so that we can make the spike protein okay now the spike protein again is really important because it's what binds to the ace2 it's utilized for the viral entry into the cell so it's a very important protein well we modified in a particular way what happens is there's particular mutations that occur along the way and this happens as more viruses infect more people as that virus continues to replicate more and more and more it has the ability to produce mutations that's just the process of re-increased replication so what happens is we see this l452r and t478k type of mutation and what that's doing is it's modifying the s protein in a particular way where it has very very very specific capabilities what are those capabilities well one of the things that we see here is that they modify the s protein in a particular way where it has increased binding capability to what to the ace2 receptor well here's your as2 receptor right here so that a2 receptor there's increased binding if you increase binding to that as2 receptor because you have a higher affinity of the s protein for it you increase the actual entry of the virus into the cell the other thing is there's increased fury and cleavage there's a very special protein here that helps in cleaving a particular part of the protein and allowing for entry of the virus into the cell and that is called the tmprss2 and this protein right here is designed to be able to cleave particular points and increase entry well this s-protein modification works in a particular way where it increases fearing cleavage and increases the entry of the virus into the cell if the virus is able to get into the cell easier and quicker it then can use the cell's machinery like the different proteins and organelles to make more virus if you make more virus you increase viral replication and if we increase viral replication we can have higher loads of the virus that could potentially be within the body and increase transmissibility potentially severity so on and so forth the other aspect is that when you make more viruses you make more viruses with the modifications in the s protein so now when they get into the body and they start replicating and infecting other different cells in the body there's particular modifications in this s protein and what it's been found to do is you know within our cell we have very specific types of cells called plasma cells and these are really beautiful antibody producing factories if you will when they produce these antibodies what we're seeing is these mutations may allow for antibodies to be less effective at binding and neutralizing the s protein on these viruses but what we don't know is what about the t cells those cytotoxic t cells and helper t cell solar with memory cells we don't know how or if these protein mutations are allowing for an evasion of those aspects of our immune system so that's something that we need more research on but that's the things that i want you guys to understand now let's take a look at some data that we have that supports what we just talked about all right ninja nerds so we're going to take a look here at the literature to support what we were talking about on the whiteboard so in the description box we're going to have a document of all of our references this first one is 0.1 a so this is a table from up to date and it just goes over the variance of concern that we see here that we talked about alpha beta gamma delta and epsilon with the most concerning one that it'll become the most dominant variant is the delta variant also known as b.1.617.2 and what we see that's kind of making this variant a little bit more nasty is these particular mutations in these particular parts of the rna and what that allows for is it allows for the virus to be able to bind to the ace2 receptor quickly it allows for it to have a higher affinity for that more fearing cleavage sites more replication and potentially evade the immune system and as we'll see in a second uh later that there is an increased transmissibility of this variant so much so than alpha potentially 64 which we'll see in a little bit so that covers this first part the second part that we're going to take a look at is the viral load which we'll have a couple points to talk about there all right so we have an idea a little bit about the the delta variant how it's kind of a little bit nastier but what we need to understand is with all that stuff that we just talked about what can that do what's the problem with that and so when we take here and look at the virus and its ability to have higher loads of the virus because there's increased replication there's a lot of things that are increasing the factor of having more of that virus within your respiratory tract what we see is is that viral load is almost a thousand times higher of an actual viral load with delta and compared with like the ancestral strain and maybe even with alpha so let's take a look at some data that supports that statement all right so we talked about viral load and how viral load is much higher with the delta variant in comparison to the alpha variant if we actually look here from some literature from up to date this is actually going to be 2a within that that document that we have for in the description box we can see here that an unpublished study of an outbreak in china suggested that the initial respiratory tract viral rna levels are about 1 000 times higher with the delta than were observed with the ancestral virus circulating during the first phase of the pandemic and so that's pretty significant to think about the viral loads being that much higher what's interesting is that this could actually be in those who are vaccinated or unvaccinated and so that's another interesting point to take away from this all right so that covers viral load for the 2a let's use the other aspects of the literature from 2b and 2c all right we're so we're looking at this next thing here which is the leak cdc report we'll be referring to this a lot but if we take a look here again this is going to be covering 2b and 2c for that part in the description box for that document of references so if we scroll down here we're going to see a part here where it discusses how the delta variant infections are associated with much higher viral load and duration of shedding and this is based upon all the published evidence that we see here okay so that takes care of that so now let's go ahead and move on to the next thing that we want to talk about here which is the transmissibility which is going to be in the third part of that references that we're going to discuss the other thing that we need to understand is because we have more of this viral load and this virus is really really nasty it may have the ability to be more transmissible and contagious and spread to other people we actually see that it's about 64 more transmissible than the alpha variant and what else can support this if we take a look here if you guys remember we talked about this within the original kind of a sarsko v2 covet video was that there's something called the reproductive ratio so how quickly this virus can spread and transmit to other individuals i think this gives us a pretty good idea of how transmissible this virus this delta variant is if we look here let's say that there's just one person in pink here right it has the ability this delta variant has an r naught from five to nine let's go with the max just to really give the significance of this that means that this individual can infect but if he becomes infected with a delta variant he can infect up to nine people those nine people if they're around a crowd of people they can infect another nine people so we could go with one person infecting upwards of 81 individuals that's very significant so we see that are not a five to up to nine almost as transmissible or contagious as chickenpox if we compare that to what the original r naught was it was about two to three so one person can affect up to three individuals that's a significant jump here let's take a look at some data that supports this all right so we're taking a look now at the third part within that references document which is talking about transmissibility so we already discussed that it's about 64 more transmissible um and so if we look here at uh a b and c within our references document we're going to go down to about page eight and on page eight there's a nice little statement that we have highlighted here for you within the discussion that again shows that the study found a 64 increase in odds of household transmission associated with the delta variant compared to alpha after they adjusted for vaccination status and sex and ethnicity and so on and so forth so this is a pretty interesting kind of result that we see here with transmissibility all right let's take in one more look let's go back to that leaked cdc report at 3d and again just provide some more support for this increased transmissibility with the delta variant all right so let's take a look back at this leaked cdc report so as we come down here and the cdc report here we see the transmission of delta variant versus like the ancestral and other kind of infectious uh diseases so if you look here in this nice little beautiful graph we have a y-axis and this kind of gives us the fatality rate of these viruses are infectious kind of pathogens and as we go up it's obviously more deadly and as we are on the x-axis this is kind of just telling us the average number of people that can be infected by each person and so this is kind of just showing the spread or transmissibility of the virus and as you can see here they have kind of a blanket statement here that delta variant is way more transmissible than all these other viruses here on that left side and if you kind of look at the reproductive ratio that we can kind of say based on the x-axis it goes here at five all the way to about probably nine so we can say that the delta variant has an r naught or a reproductive ratio of about five to a max of nine meaning that one person can infect up to about nine individuals and this makes this about as transmissible or contagious as the chickenpox which is pretty intense if you compare that here so again this is just again supporting the data that we have there on the whiteboard so now let's go ahead and talk about severity in the next part where we'll talk about how nasty this delta variant can be in comparison to the other variants of sarsko v2 so not only do we understand the viral load the transmissibility but what about severity we see that there's a thought that this could be potentially higher cytokine storms it's very contagious it can cause more severe infections we have some data that we're going to take a look at that shows that it could actually have an increased hospitalization rate compared to the other variants of about 2 to 2.5 times higher hospitalization rate and death rate so it does seem that it can be more severe infections whether that's related to the cytokine storm or some of these other factors evading potentially the antibody or immune system that's something that we have to elucidate more so let's take a look at some data that supports this all right so now we're going to talk about severity we talked about this a little bit within the whiteboard again let's provide some evidence to really support this from the leak cdc report again this is going to be at point 4 within that document we're going to be looking at 4 a b and c here and again this is just kind of supporting our data here that the delta variant may cause more severe disease than the alpha are all the other ancestral strains and there was some published evidence from canada singapore and scotland that again as we see here higher odds of hospitalization admission icu admission and death we see higher odds of oxygen requirements so potentially more pneumonia arts kinds of cases icu admission or death and higher odds of hospitalization with the delta variant could this be related to again that increased transmissibility the increased viral load or maybe just more cytokine storms less effectivity of our therapies it's not completely sure yet but again as we come down to the summary we have a nice blanket statement here that is again just telling us that the delta variant is likely more severe than all the other ancestral strains all right so now we take a look at 4d just again to provide us some more data to support this severity of the delta variant compared to the other ancestral strains all right so back to our table 1 from up to date but again this is going to be 4d within that references document again we're talking about the delta variant also known as b.1.617.2 and if we come over here to again the known attributes we just see here this blanket statement of potential increased severity based upon the associated hospitalization rate that we see with the delta variant particularly in comparison to the other ancestral strains so that covers this part let's move on to another one 4e within that document that again supports the severity of delta variant so here is another article from the lancet um this is again 4e within your uh references document and if we come over here we're talking about the delta variant of concern in scotland it shows here that the cox regression analysis for the time to hospital admission found that the s gene positive cases again this was particularly for the delta variant were associated with an increased risk of covid19 hospitalization admission a hazard ratio of 1.85 so almost two times that of someone else who had another type of ancestral strain we see that this is almost two times higher risk of hospitalization rates in comparison to the other ones and then you can you can see when we compare to the sg negative cases after all the adjustments that they provide so again definitely some support there for increased severity with delta variant so let's move on to the next part of this 4f to again provide a little bit more documentation in support of the severity of delta variant all right so let's look at the next document if we look at 4f within our description box you have all those references again we're going to take a look at the public health of england technical briefing 14 we'll be looking at a lot of these technical briefings and again we're primarily looking at the sars cov2 variants of concerns that were under the investigation in england because uk had a pretty significant breakout particularly with the delta variant and if we want to talk about again the delta surveillance and we want to talk about severity we're going to come here to page 46. and so when we look at here the data came coming from england they utilized what's called the cox proportional hazard regression and there was a significantly increased risk of hospitalization within 14 days of the specimen date and again we see here about 2.61 so about almost a 2.6 times increase of hospitalization in those who were potential positive for the delta variant and again you can see here for the delta cases compared to the alpha cases so pretty significant increase in severity when we talk about this variant all right so now what we're going to do is we're going to start talking about the prevalence or the population that was primarily affected by the delta variant so let's go ahead and go into that which is going to be the fifth component or fifth number within the document on the references i'm in our description box lastly what i want to talk about is who is prone to these infections and i think this is an important thing so the delta variant what we're seeing is we don't have a lot of u.s studies to really kind of provide a lot of evidence right now so we're depending upon more international studies especially the uk because they had a pretty decent outbreak or breakthrough infections with the delta variant and what we saw from some of their studies and we'll take a look at them is that we see a very significant increased rate of infections along those that were less than 50 years of age and unvaccinated okay now what's really really important to understand is is that when we actually also look at the data we see that there was also a lot of incidences of those who were greater than or equal to 50 years of old years of age with underlying comorbidities amino suppressed and here's what's really interesting we see that the severity and hospitalization rate for these individuals was about equal regardless if you were vaccinated or unvaccinated so what we take away from that i think we still need some more studies but that's a aspect on prevalence let's look at some data that supports that all right so now we're on the next part here where we're talking about the population affected or kind of like the significant prevalence of this delta variant and we're looking at the next part which is 5a within that document this is looking at the react 1 12 round 12 report and so if we go down here to about page five within this document we see a nice little part here that we highlighted for you guys within the discussion and what it says here is that we observe that the growth was being driven by younger age groups with five-fold higher rates of swap positivity among younger children ages 5 to 12 years old and young adults 18 to 24 compared to those that were aged 65 years and older and here's where it's really interesting there is a 2.5 fold higher rate among those below 50 years of age compared to those with 50 years and above so we're seeing a lot of individuals less than 50 years of age who are actually contracting or you know having being infected by this delta variant which is very very interesting okay so let's go ahead and move on to the next um document here to again support the population the prevalence of this virus which is going to be 5b and we'll take a look at the technical briefing 19. all right so we're taking a look again at this public health of england technical briefing 19. and again looking at the sars cov2 variance of concern in england because again when uk got hit pretty hard by this delta variant and again this is going to be 5b within that document of references so if we come down here to our table of contents we're going to look at variant prevalence okay now it's kind of a little bit weird we have to come up here a couple pages we want to get to this nice little table here on page 18. and if we look here we see table 5. this is basically telling us the attendance of emergency deaths and emergency care and deaths by vaccination status among all of those who tested positive for delta and so if we look here the delta cases particularly again we have variant here we're looking at delta cases we see here the age group less than 50 years of age we had a total individuals here of about 205 549 and if you look at those who actually were infected and unvaccinated what do you see a very large proportion in comparison to those who receive two doses of the actual vaccine potentially phi zero astrazeneca and then again much much more than those who received even one dose or here again one dose so we're seeing a very large individual a number of individuals infected who are unvaccinated in less than 50. and this is again those who are infected if we come down here a little bit and we look at the cases that actually require like hospital admission we see here again less than 50 years of age if we scroll over here from 1529 look how many of these were unvaccinated and compare that to those who were actually vaccinated much much higher and so you do see a significant increase in this number of cases particularly less than 50 and unvaccinated with this delta variant okay so now let's go ahead and move on to the next part which is going to be looking at the cdc's website and talking and again this is 5c again providing more supporting evidence about the prevalence in the population affected by delta all right so now we're looking at 5c within that references document we have for you guys again this is just kind of a blanket statement from the cdc's website and it's just again supports here that some data suggest that the delta variant might cause some more severe illness than previous strains and unvaccinated individuals and we already kind of have an idea from that uk study that it seems to be those less than 50. and again supporting that concept here that unvaccinated people seem to have the highest rate of infection and seem to be the greatest concern and those that are being affected by the delta variant okay so now let's move on to the next study here we're going to look at this article from the new york times really giving us an idea about how unvaccinated individuals seem to be the ones most affected by this delta variant and again that's going to be 5d within that document of references all right engineers so this is a very interesting kind of article from the new york times if you guys go into the document again 5 d you guys will see that there's a link for the new york times we just took some screenshots of some of these graphs so again what we're looking at here is we're looking at five states within the united states with the lowest vaccination rates and we can kind of see here the number of cases and we see here the number of hospitalized if you look here alabama arkansas louisiana mississippi and wyoming have relatively low vaccination rates and again look at the cases you kind of see this sort of exponential growth you definitely see it here in arkansas you see it kind of going up here for louisiana you see it going up for mississippi and again you see this going up for wyoming now again look at the actual hospitalization though look at this you see it going up significantly going up going up we see it going up here and again starting to go up here so what we can kind of assume from this information here is that those with lower vaccination percentages within a population seem to have higher cases of delta variant infections and also higher hospitalization rates to further support this let's look at the actual five states with the highest vaccination rates and again you see connecticut maine massachusetts rhode island and vermont around 60 percent or above with their vaccination status within the population again here's the number of cases and here's their hospitalization rates this is pretty interesting look at the number of cases you don't see that exponential growth that you saw with the low ones you see pretty very low ones here in maine low cases low number of cases and almost have no cases here in vermont with the delta variant and then again look at the hospitalizations it's going down it's not trending back up going down going down and it's not trending back up here so pretty suggestive that again the population that we seem to be affected here is not only those less than 50 years of age based upon the uk study but those who are unvaccinated and in populations that seem to have lower vaccination status okay so now let's look at another study um this is going to be 5e within the documents of references this is going back to that leaked cdc report to again support the population or prevalence of this virus so let's take a look at another um going back to the leaked cdc report 5e within that document of references so again we're going to move down here and again this this document is really good at kind of providing a summary of a lot of information right now so if we come here to this nice beautiful table here this gives us here disease incidence so again kind of number of people infected hospitalization and death and here in green we're going to see those that are unvaccinated here in green and then those here in blue we're going to see those that are fully vaccinated and when you look at this my gosh there is an eight-fold reduction in those who actually develop the disease who are vaccinated and then again there is a 25-fold reduction in those who are hospitalized who are fully vaccinated and a 25-fold reduction in death and those that are vaccinated and so another way we can say this is that there is an eight-fold increase in disease and those who are unvaccinated a 25-fold increase in hospitalization and death in those that are unvaccinated now we have to look at all the information we can't just say that it's only those who are unvaccinated that still can actually develop the disease or become infected by this delta variant we are seeing those two that are greater than 50 generally higher age groups with underlying comorbidities who have immunosuppression of some kind we are seeing that those individuals can become infected as well as can have higher hospitalization rates so when we talk about again severity with this condition we can see higher severity higher hospitalization rates in those individuals who are older greater than 50 years of age and again have underlying comorbidities so that is an important thing to take away from this all right so let's talk about the next thing which is the symptoms of covid19 particularly with the delta variant have they changed at all is there any differences within them all right so let's talk about the symptoms so in our original kind of covet 19 video we talked about there was a very wide array of symptoms and it keeps changing depending upon the variant um so one of the things that we're going to talk about is is there any particular symptoms that are different with the delta variant that we're seeing more of than we're seeing with the other variants so when we talk about this symptoms generally one of the worst case scenarios is that if it affects the lower respiratory tract it can start leading to things like pneumonia worst case scenario it actually becomes more inflammatory that it leads to acute respiratory distress syndrome and we even see this thing where there is potentially increased hypercoagulability there's more coagulate coagulation issues to where it increases the risk of forming clots within that pulmonary circulation leading to pulmonary emboli now the other thing is that some of the symptoms that you generally would see in someone with these lower respiratory tract infection types of symptoms is you may see fever but you may also see cough some shortness of breath that may be at rest or on exertion okay the other thing is that we see that the actual virus has the ability to infect particular parts of cells in the in our heart particularly those within the myocardium and within the pericardium and so we start seeing a viral myocarditis and a viral pericarditis which again could lead to some type of pain chest pain but also lead to shortness of breath as well and again you could also see some elevations in like particular enzymes like troponins what we're starting to see though and again we'll look at some data from this from the american society of microbiology that there is primarily more upper respiratory tract infection types of symptoms that seem to be within the mild more uh symptomatic cases and that tends to be headache runny nose sore throat less common that you're seeing with the delta variant is loss of smell anosnia and loss of taste aguisia the other symptoms that we're starting to see which is a little bit more interesting is that we're starting to see maybe some involvement of the inner hair cells leading to hearing impairment also maybe through some type of hypercoagulability or process that we don't understand there also may be some tissue gangrene or necrosis we're also seeing again fever to be relatively common and another one is gi upset the last thing that i want to talk about here is that we have this term called long haulers or long coveted symptoms is there long coveted symptoms possible for someone who gets infected with the delta variant as compared to the other ones this seems that that could be possible but i think we need some more data again to really support that but we define someone who has a long long-covered kind of hauler or symptoms as having these coveted symptoms some of that we talked above with having evidence of covet infection for greater than or equal to about 12 weeks okay so let's look at some data here now to actually support some of these symptoms that we talked about all right ninja so we just talked about symptoms of the delta variant it seems that a lot of them are pretty similar to the ancestral viral strains from of sars cov2 but again if we kind of look at what we talked about how there's particular symptoms that tend to be more common and 6a from the american society from microbiology here we have a question is the delta variant more dangerous than other variants of concern and if we look here we highlighted for you that tends to be fever headache sore throat and runny nose while cough and loss of smell aren't as common so again these tend to be kind of the upper respiratory tract type of infection symptoms seem to be a little bit more common however there can be more serious symptoms including hearing impairment severe gastrointestinal issues and even blood clots leading to tissue death and gangrene but again there's still more research to see is there again more cases of ours is there more cases of pneumonia multisystem organ failure that's still kind of being assessed at this point in time but again as we've seen already there is higher hospitalization rates that we see with the delta variant all right so that covers our symptoms now in the next part we're going to talk about the treatment how is the treatment changed and in seven a and b we'll talk about the treatment particularly in those individuals who have the delta variant how do we treat them whether they are not hospitalized hospitalized and as we go through their severity how does their treatment change all right engineers let's talk about the treatment now regardless of this being the delta variant or some other kind of sars kobe 2 variant that causes covid19 the treatment is relatively the same but there is some slight modest kind of reduction and efficacy in one of these categories but in general if someone has a very mild to moderate kind of symptomatic disease of covid19 one of the biggest things is that if they are not in a high risk category you don't have particular comorbidities or diseases or immunosuppressive conditions that put you at higher risk sometimes the therapy is just very important supportive therapy staying home if you have symptoms utilizing fluids to stay hydrated monitoring your pulse ox monitoring your fever taking tylenol if you have a fever wearing your mask around other individuals optimizing your immune system with vitamin d a lot of these things are very important supportive therapies with a lot of emphasis of really trying to reduce the transmission of it by isolating quarantining and wearing your mask however for those that have that mild to moderate disease they don't need to be admitted into the hospital but they are at high risk of progression of the disease because of particular comorbidities immunosuppressive condition age there is particular therapies that were effective for alpha but are showing to be a little bit less effective with delta there may be some resistance here but there was this monoclonal antibody therapy that we saw relatively effective in high risk groups and those that are mild to moderate symptoms outpatient therapy and these are your monoclonal antibodies that we show here but again what we're starting to see though is that delta is showing some resistance against these and we'll talk about some data in a second let's say that we go to the next part of this where the patient is sick enough that they need to be hospitalized admitted into the hospital but they don't really need to be in the icu because they're not really requiring any oxygen therapy we're just monitoring them what is the therapy there we see again rem deserver could be utilized but again only in those high-risk groups that have a very strong chance of them progressing into more severe case okay eventually leading them to the icu so rem deserver works by what particular way it works by inhibiting do you remember that enzyme the rna dependent rna polymerase which is helpful for making more of those viral copies it may inhibit that process let's go to the next step if we go to the next step here we have those who are hospitalized but are requiring oxygen therapy but it's not like higher levels of oxygen we can utilize things like nasal cannula where you only really go up to like six liters or like a non-re-breather mask okay or other kind of low oxygen therapies not as much high-flow oxygen therapies what are some of the drugs that we've seen to be relatively effective here well generally there's two parts here where you only use rem desevere or you only use dexamethasone but the combination of them seems to be the best effectiveness seems to show the most effect of efficacy against these individuals who are hospitalized and requiring oxygen but either way if you're only getting rem deserve you have to have very low o2 requirements you're not requiring much of these actual therapies to actually maintain a particular oxygen saturation or lower your work of breathing and again ram deserve works by inhibiting the rna-dependent rna polymerase the other drug is dexamethasone this is a corticosteroids corticosteroids are very good at reducing just a lot of that cytokine storm that we see and so it may be inhibiting a lot of those cytokines that we were talking about before really reducing a lot of effects of the cytokine storm but again you only use this by itself when the combo isn't actually possible okay but the best combination is actually giving rem deserve and dexamethasone to this category of group along with supportive oxygen therapy that we talk about here one quick point before we move on to the next aspect of the treatment algorithm is that when individuals are starting to require more oxygen therapy they're hospitalized and they have positive covered pcrs their risk of hypercoagulability increases right so where they can develop pulmonary embolisms and so because of that generally as people start to progress to the point where they're actually requiring more high flow they're getting to this point where they need to be ventilated mechanically we start kind of incorporating anticoagulation to reduce the risk of them developing pulmonary embolisms and so utilizing things like low molecular weight heparin or if they can't utilize that fonda paranox is another type of heparin kind of analog that you can utilize here so now after we've anticoagulated them let's go on to the next part of this therapy regimen all right so the next aspect where those who are hospitalized right they're requiring higher levels of oxygen particularly high flow or what's called non-invasive positive pressure ventilation what does that mean well high flow oxygen is your particularly there's different types like optiflow but you're giving a very high you can give a very high concentration of oxygen you can give up to a hundred percent fio2 on this one but it just gives a very large portion of it you can give it up to 50 to 60 liters per minute the other option is what's called bipap and this is a non-invasive positive pressure ventilation where you can give again 100 of oxygen you can give them also peep positive and expiratory pressure really helps to recruit and open up those alveoli and people who have pneumonia are starting to progress into ards and it also gives you some good pressure support to allow for helping to get air into the lungs and really opening up those airways so and people that are requiring this there is particular medical therapies that we can institute one of those is you can give rem deserve generally you don't give rem deserve on its own you could also and again rem deserve works by inhibiting the rna-dependent rna polymerase you can also give a couple other medications dexamethasone again don't you don't really give this one by itself tosalisimab embarrassing nib you can add those on so toss the liver map and bear acid nib you can add on what is the best kind of treatment when a person is on that therapy what we've seen is a particular combo one is remdezavir and dexamethasone but if someone has a contraindication to being on dexamethasone steroid you give them rem deserver and bear city nib now either way with one of these combos rem deserver and dexamethasone or rem deserver and bear cytonib sometimes you can add on that tosalisimab okay so again this is the therapy that we need to utilize in those that are hospitalized and requiring higher levels of oxygen what about those that don't get here they have increased work of breathing they're still hypoxic they're starting to have some issues and this therapy is failing we start to get into the worst case scenario where someone has to be mechanically ventilated or put on ecmo extracorporeal membrane oxygenation so whenever we get to mechanical ventilation it's important that these patients can develop ards acute respiratory distress syndrome there's an ards net protocol that says how we should effectively and big important thing here protective wise prevent lung injury and someone who has ours and so we use tidal volumes that are a little lower six to eight cc's per kilogram per uh predicted body weight plateau pressures you want to keep those relatively low less than 30 centimeters of water and ideally is to keep those alveoli stented open and recruitable we want to keep peep greater than five centimeters of water if this doesn't work and the uh particular score called the mcmurray score is actually going to be increased we can do what's called ecmo extracorporeal membrane oxygenation and that may be an indication for putting someone on ecmo and ecmo is basically you're taking blood from them usually from a venous structure oxygenating it via an oximizer and then sending it back to their actual blood circulation via like the superior vena cava so that you can pump more oxygen to blood through the body okay now if someone is receiving these types of ventilation strategies what are the drugs that we can generally give dexamethasone seems to be the best one but you can also add in tosylisimab which again is that interleukin-6 inhibitor if it's within 24 hours of advent these two drugs seem to be the ones that have been shown to reduce mortality more than a lot of the other ones particularly dexamethasone okay so now that we have all this information let's take a look at some data from the nih as well as up to date to really support all this that we're talking about so now we're on uh the seventh part of our document within the references we're talking about treatment right and again we're looking at um two of these articles well two points within the article from the nih the national institutes of health and it gives us the therapeutic management of non-hospitalized individuals and those who are hospitalized and again it's based upon disease severity as you can see here so i want to draw your attention to this particular one here which is the outpatient management those aren't that are requiring any oxygen therapy but particularly individuals that are high risk of disease progression there's a bunch of factors and comorbidities and particular things that puts people in this high risk category we're not going to go through that but if they fit into this high-risk category there's particular monoclonal antibodies that you can see here m-abs is how i like to remember if you guys want to play hang man and never lose just use these guys i don't think anybody will ever guess them but as you can see here the bamlinivumab plus this other guy here anything that ends in imab these tend to be relatively effective against the previous ancestral strains of the sarsko v2 and again particularly those who are at high risk what we're seeing now though and we'll provide some data for this is that these monoclonal antibody therapies may actually not be as effective in the delta variant there may be some resistance to these monoclonal antibodies with the delta variant but again these right here tend to be kind of the first line therapy for those at high risk of disease progression i'm an outpatient as we go to those who are hospitalized again you have this disease severity as we go down those that are hospitalized but don't really require any oxygen there's a very high level of recommendation for dexamethasone a steroid and there's insufficient evidence but sometimes there can be the utilization of ram deserve now those who go uh to requiring some type of supplemental oxygen maybe a nasal cannula a non-rebreather we can provide remdezavir dexamethasone by itself but the desired combo is dexamethasone plus rem deserver and then again as we go to hospitalized that are starting to require potentially bipap or high flow nasal cannulas we potentially like to use dexamethasone or again dexamethasone plus remdezavir and then as their oxygen requirements begin to go up we add on these other particular molecules here like tosalisimab or baracetinib and then as you go to the last part here and those that are hospitalized requiring mechanical ventilation arsenate ventilation or extracorporeal membrane oxygenation ecmo we generally likes to use dexamethasone but generally those within 24 hours of admission to the icu dexamethasone plus this interleukin-6 inhibitor tosalisimab and again this is kind of just supporting all the stuff that we talked about on the whiteboard let's take a look though about this monoclonal antibody from up to date and how there is a potentially increased resistance against this therapy um in outpatient studies so let's take a look here at 7b okay this is going back to table one uh again with an up up-to-date we're back at this and i just wanted to kind of just provide some evidence here of why we're seeing this reduction and efficacy of those outpatient utilization of the monoclinic monoclonal antibodies against the delta variant so again look at alpha for a second here's the alpha variant the uk variant b.1.1.7 and if we come over here to the known attributes we see that there is this minimal impact on neutralization of the monoclonal antibody therapy so remember the imabs all of those there was really no change in their susceptibility you can utilize these relatively effective and those that are high risk if we come down to delta b.1.617.2 come over to the known attributes we're seeing a potential minimal reduction in neutralization by the monoclonal antibody therapy seeing that they're potentially not as effective in those with the delta variant so very interesting thing to see there with this guy all right so now let's move on to the next part which is asking the question are vaccines really good and effective at preventing the infection hospitalization and death with the delta variant all right so now let's talk about a very important point and probably one of the most important points within this lecture on the delta variant and in general with covid19 what seems to be very effective without having to get to this point when someone's really getting sick is vaccination there's a lot of efficacy with these vaccines now granted the data is showing that there is a minimal to almost moderate reduction in the vaccine's effectiveness against like symptomatic diseases like just generally some of those mild symptoms to almost asymptomatic cases and so we'll look at some differences there but what we are seeing though is that the infections okay the number of symptomatic diseases that those who are vaccinated usually they're the vaccine is way more efficacious and compared to those that are unvaccinated so you're seeing more individuals who are actually contracting covid uh the delta variant type regardless who are actually developing symptomatic disease who are unvaccinated in comparison to those that are vaccinated that doesn't completely hold true though in particular age groups like greater than or equal to 50 years of age with underlying comorbidities it actually could be almost equal what is a big thing to take into consideration is the efficacy against hospitalization and death that's what we're seeing we're seeing that these vaccines aren't the best infection blockers but they're very good at acting as a hospitalization and death blocker which i think is very important and profound in effect right so we're seeing a very high efficacy greater than 90 efficacy of these vaccines against these two aspects here way higher than those who are unvaccinated but very important to remember we're again seeing this the data is more suggestive that it's actually in those less than 50 years of age as comparison to those that are greater than equal to 50 years of age with more comorbidities it actually could be almost about the same and again that's going off of some of the uk studies so that's talking about vaccine efficacy let's actually look at the data that actually kind of supports a lot of this all right ninja so we talked about vaccine effectiveness on the whiteboard but let's provide some data to really kind of put some support behind this these blanket statements so again if we look at 8a within the reference documents we provided for you guys we're going to look here at the new england journal of medicine the effectiveness of covid19 vaccines against the delta variant if we come down here and just look at the results from the abstract we can see here that the bnt162b2 which was the pfizer biontec vaccine it showed the effectiveness of two doses of that actual vaccine was 93.7 percent with the alpha variant and again this is actually disease incidence being being infected with the alpha variant but when we compare that it's 88 so went from 93.7 to 88 among those with the delta variant so we see a reduction in efficacy of this pfizer vaccine from 93.7 to 88. so not significant but it's still a reduction and if we look here at this vaccine this is the astrazeneca vaccine and if we look at the effectiveness of two doses it was 74.5 percent among those who were having the alpha variant and 67 percent so we went from 74.5 to 67 among those with the delta variant so again a pretty decent reduction there they're both greater than 50 percent so that's beneficial but again we're seeing a reduction now let's look at some other literature to again provide some support here saying about vaccine effectiveness so let's look at 8b so we're going to take a look here 8b within the references in our document that we provided you guys this is a article that again has not been peer reviewed yet but again it's the effectiveness of covetv 19 vaccines against hospital admission so we looked at the basically the effectiveness of these vaccines against infection and it doesn't seem like they're as as great against infection blocking but they seem to be pretty good against blocking hospitalization and death and so if we come down here into this table one we can see here the estimated vaccine effectiveness against hospitalization so if we look here we're going to have delta here on the right alpha here on the left let's look at the pfizer and particularly let's look at two doses since we talked about two doses for effectiveness against the infection so whenever you got pfizer two doses of it if we carry this all the way over to delta and look at the vaccine effectiveness versus hospitalization holy mama 96 efficacy against hospitalization if we again go over here to astrazeneca look at two doses of astrazeneca track this all the way over here to delta looking at the vaccine effectiveness versus hospitalization you see 92 so these are greater than 90 percent effective at reducing the effectiveness of reducing hospitalization rates when you are vaccinated that's pretty significant and that just goes to show that these vaccines are very good at blocking hospitalization and death much more so than blocking the actual infection whether it be mild or asymptomatic diseases okay so let's go to the next article here which is going to be looking at the leak cdc report 8c again providing some more evidence about vaccine effectiveness all right so we're looking at 8c within that document of references here this is back to that leaked cdc report again and we're going to be looking at a part here going to the delta variant section within that we're going to come down here to look at a nice little graph here this is looking at the pfizer two dose vaccine effectiveness for alpha versus delta and so alpha is going to be in this black color here and then delta is going to be in this red triangle so if we look here at the data from the uk and scotland the data from canada and then the data from israel if we look here on the y-axis this is just telling us the percentage of you know efficacy and if we look here on the x-axis in this case is telling us either confirmed infection symptomatic disease hospitalization or hospitalization or death so again if we look at england and scotland look at the alpha variant here okay and then let's now look at the delta variant what do we see potentially well we see that the actual infection rate is much lower in comparison to the alpha whenever you've gotten two doses of the pfizer vaccine so about 79 okay now if we look at symptomatic disease and this is what we saw within that first article 8a from the new england journal of medicine the symptomatic disease we see that it actually is about 88 effective at preventing kind of the symptomatic mild cases of those in individuals with the delta variant and if you look at hospitalization rate it's still very effective england scotland the pfizer 2 dose of that vaccine showed a 96 efficacy against hospitalization look at canada again 87 percent with the actual two dose pfizer vaccine for symptomatic disease and then if we look at this again for hospitalization or death it's nearly 100 percent effective against hospitalization or death looking at israel we see that the symptomatic disease about sixty-four percent africance that's a pretty significant reduction there but then again look at the efficacy against hospitalization or death two doses of the fiber vaccine was 93 effective against hospitalization or death and so what we're seeing again is this support that these vaccines aren't like the best at preventing infection but they are very good at preventing hospitalization and death and so if we come down here to a nice little summary point that they have we're seeing that vaccines prevent greater than 90 of severe disease but may be less effective at preventing infection or transmission therefore we're going to see more breakthrough more community spread despite vaccination okay so now let's go to the next article here which is going to be talking again 8d looking at the effectiveness of covet uh 19 vaccines so if we look at 8d within the documents of references we're looking at the effectiveness of covid19 vaccines against the variance of concerns from canada we're going to go pretty far down here to about table three we have some information that we'll point out here and so what i want to show you guys is again looking at other vaccines so we talked a lot about you know pfizer biantec and we talked a little bit about astrazeneca but what about moderna and then again looking at astrazeneca effect as well and particularly this is in canada okay so what we have here primarily is data after someone received only one dose of moderna or one dose of the astrazeneca and all we're seeing here is their effect against symptomatic infection so if we come all the way over here and look at delta what do we see only getting one dose of the moderna vaccine was 72 percent effective i get preventing like symptomatic infections so not a great but it's still greater than 50 and then again if we look here at the astrazeneca one dose 67 effective again against symptomatic infections if we look here though look at the hospitalization or death that we see with these vaccine effectiveness if we look at the modern after receiving one dose astrazeneca after receiving one dose move over here to the delta variant 96 effective against hospitalization or death with the moderna vaccine one dose of it against delta and then astrazeneca one dose of that move over here 88 effective against hospitalization or death so we see again support behind this data that these vaccines are very good against hospitalization or death not as effective though against the infection and so again this may be the fact we have to potentially change up the vaccines and again that's something that needs further resource research okay so let's look at the next document here we're going to look at 8e looking at a very interesting study coming from the this nature article all right guys so this is a really cool study again within the references the document that we provide for you this is 8e i want you guys to go ahead and click on that again this is looking at the reduced sensitivity of the sars kovi to the delta variant to antibody neutralization and if we come down here again although this is a very interesting thing if you guys remember we talked about the monoclonal antibody therapies and how they're kind of less effective and those who have the delta variant in comparison to alpha look at um nivamab and again here in this kind of blue color here that you see if you kind of look at your little point here here's alpha and this kind of like bluish color here look at the kind of neutralization ability pretty high and then delta's in red whoa so again i think that's where the information from up to date where we talked about the potential minimal reduction and antibody neutralization from these monoclonal therapies came from but again that was pretty cool but if we come down here to figure two we see this very interesting data that i want us to take a look at so we took a screenshot to pick out the biggest points from this data let's take a look at that all right guys so what we did is we took a screenshot of that figure two and then just kind of blew it up with some points here that we really want to kind of hammer away within that article so if we look here at um this first cohort in part a we have here this group that is unvaccinated but had been previously infected and we're looking kind of like 12 months afterwards and looking at their antibody neutralization capability and we measure that via the ed50 the effective dose and so what we can say here is that is the higher the ed50 the higher the neutralization capability and in the vice versa the lower the ed50 the lower the neutralization ability so if we look at those that were previously infected but unvaccinated you see that their neutralization ability is relatively low if we compare that to the group that had been previously infected and then vaccinated we see how high that ed50 is with here with delta it's about how much more about four times more potency right so there's a significant increase in antibody potency whenever there is at least a previous infection and only one dose actually in this group there's only one dose of the vaccine so what we can see is a very significant increase in antibody potency all right so very interesting thing there if we go to this next part of this study where we look at the pfizer vaccine week three and week eight this is looking at only one dose of the pfizer vaccine this is looking at two doses of the pfizer vaccine again look at the ed50 here for delta really really low almost below the minimal effect of dose that we actually want are the lowest effective dose really it's very very low compare that to those who had two doses of the vaccine there's a significant increase in antibody potency after two doses same thing with the astrazeneca what can we see here again this is week 10 so only having one dose this is week 16 two doses we see here that there is a really low ed50 with only one dose and a significant increase in antibody potency whenever there is two doses of the vaccine now here's something to take away if you look at the ed50 here with two doses looking at the ed50 here with two doses of these two vaccines and comparing it with the ed50 of those that had a previous infection only one dose of the vaccine the ed50 is actually higher in those that had a previous infection and only one dose of the vaccine and we can see that here with this big big point here that one dose of the vaccine and a previous infection increases antibody potency more than two doses of the pfizer astrazeneca vaccine so that brings about the question that we'll have to answer a little bit later does having a previous infection provide some natural immunity against the delta infection to the point where it can actually reduce your risk of being reinfected i think one of the big things to take away from this is that antibodies are not the end-all be-all of our immune system we do have other aspects of our immune system that help us to fight off this virus such as our t cells right so again take that into consideration that we have t cells and b cells not just these antibodies that are the components of our immune system to fight off this virus but again very interesting study here all right let's take a look at another article here but particularly looking back at table 1 and up to date that's going to be 8f and let's just kind of make a look at a blanket statement for vaccine efficacy so we're back at table 1 in that up to date uh article that we have here again 8f we see here again delta we have our variant that we've talked about the mutations but what are we really looking at here if we look at that known attributes here look at this here that we've kind of boxed out there's a potential moderate modest to moderate reduction in vaccine effectiveness against what symptomatic covid19 infections but we see that there is a not a significant impact on vaccine effectiveness against severe disease meaning that these vaccines are maybe not as great with blocking infection but they're very good at blocking hospitalization and severe disease which is very important all right that covers the vaccine efficacy let's talk about the next thing which is going to be the 0.9 within the document of references where we'll talk about other ways that we can reduce or prevent this delta variant from continuing to spread through the utilization of non-pharmaceutical interventions the next thing that's important here is that because vaccines aren't as great now at this delta variant right with again reducing symptomatic disease or infection we need to start instituting other levels to prevent the transmission of the virus and what is that level that i think really needs to be reinstituted and more you know mandated is wearing masks non-pharmaceutical interventions wearing masks when you're in large crowds wearing a mask and trying to stay at home when you're actually exhibiting symptoms or when you test positive for covet again those are very important things washing your hands when you're touching a lot of surfaces avoid touching your t-zone to increase the risk of spreading that virus when you're at home try to open up the windows increase the ventilation through the actual house and again trying to maintain a particular social distancing you know acceptable distance of greater than or equal to six feet away from someone else and again optimizing your immune system with vitamin d these things to be things that we should really try to institute and again let's look at some data from the leak cdc report that helps us with this all right so let's talk about here again this is 9a this is a leak cdc report so we talked a lot about how vaccines are again there there's less effectiveness of them against infection you know mild symptomatic disease but they're very good against hospitalization and death well this is where we need other preventative measures so if we go to that leak cdc report we've already talked about a lot of this stuff already but if we come down here to this part here in that leak cdc report we see here that given the increased transmissibility the lower vaccine effectiveness and the current vaccine coverage that we have there needs to be more institution of npis non-pharmaceutical interventions to reduce the transmission of this nasa delta variant what does that mean masking when you're in large crowds masking when you're indoors trying to stay away from large crowds social distancing maintaining a six feet distance trying to wash your hands avoid touching the t-zone that we've talked about before ventilating your house opening up the doors and the windows maybe potentially getting more frequent testing and so i think that these are big things optimizing your immune system with vitamin d there's a lot of things that we should be doing that again aid and producing this transmission of the delta variant and that's very very important and again they have kind of a nice little summary statement here that mpis non-pharmaceutical interventions are extremely essential to preventing the continued spread with this current vaccine coverage okay so that's very very important something that we really need to take away from this with preventing the spread and the last thing what i want to talk about is if you've been infected with the sarsko v2 virus potentially maybe one of the original ones like the alpha or one of the other variants is there a risk of being re-infected i think that's a good question to ask and do we have natural immunity against it do we need to actually get vaccinated if we've been previously infected so let's talk about that in the last point point 10 we'll talk about that in the next part here all right so the next question i really think i was curious about is if you've previously been infected with covet so you've had covet you've had some sars cov2 virus whether it was one of the variants that we talked about you've been infected with one of those your immunity that you build up against that virus your natural immunity is it enough that it could prevent you from being reinfected with this nasty variant the delta variant and so what we have seen is some particular articles one article that we'll talk about kind of says i think you'll be good there's a lower risk of reinfection but it's an interesting article that looks at the time period when alpha variant was the more prevalent one and then we'll look at another one that kind of actually does suggest that there is a high risk of reinfection with the delta variant regardless if you've been infected in the past so we'll take a look at that and understand that data let's take a look at that now all right nizhner so now let's talk about a very interesting thing which is basically asking the question does having some natural immunity if you've previously been infected with the sars cov2 virus well depending upon what variant it is do you have some natural immunity that would reduce your risk of being re-infected um and so there's an article here again within that description box the link we provided 10a we're looking at the necessity of covid19 vaccination and previously infected individuals and so this was done at the cleveland clinic and what they did is they took about 52 238 in employees and out of this group there was 1359 subjects who were previously infected but unvaccinated okay and if we look at only that group that were previously infected and unvaccinated how many of these individuals that were previously infected got reinfected with the sars cov2 virus well if we look right here it says zero out of that 1 359 individuals who were previously infected and unvaccinated developed a reinfection of covet 19 or particularly sars cov2 over the duration of this study okay now there's something we have to point out about this when this study was done it was primarily the alpha variant that was the most prevalent during this time period so this statement here does not apply to the delta variant we can't actually say that there is this ability to have you know a reduced risk of reinfection based upon this study because alpha variant was the primary prevalent variant at this point in time but something else that i found again just supporting vaccination is if we look here there was a particular amount of individuals that were not previously infected and were unvaccinated and what do we see with that there was a steady increase in cumulative incidence in other words those who developed either symptomatic disease or became infected with sars cov2 among those that were previously uninfected so they had almost no natural immunity and unvaccinated so just again it supports the fact that you do need to be vaccinated and vaccination does help in some way to reduce incidence of infection okay so again this again one of the big things to take away from this is that reinfection with this kind of article when they're throwing it around it was primarily when the alpha variant was the most prevalent if we look at another article 10b within that link that we provided you that's going to take us to the public health of england technical briefing 19 which provides again some more support though about the delta variant and reinfection so let's take a look here at this public health england technical briefing 19 this is 10b within that description box link we got we gave you guys if you go to the table of contents for some reason this link doesn't work so we're going to click on secondary attack rates here and then just scroll down to page 35. so if we scroll down here there was again this reinfection kind of tab that we're going to be talking about and what we have here is some data where it looks at the adjusted odds ratio of reinfection with the delta variant and what do we see here the adjusted odds ratio of being reinfected with the delta variant there is about an overall 46 percent higher chance of being reinfected with the delta in comparison to alpha and we can see that right here now they also looked at a time frame those that were infected less than 180 days and those that had a prior infection greater than or equal to 180 days so if we compare that that's around you know if we wanted to really take an example here that could be like january of this year if you had been infected again greater than 180 days it'd have been around january but if we look here the risk of reinfection was not elevated for delta if the primary infection was less than 180 days so if we look at the adjusted odds ratio it's really low and so there's not a significant difference here when you compare with alpha but if we look at those that were maybe infected about greater than 180 days ago again around january what do we see we see the adjusted odds rate a ratio of about 2.37 that's about a 237 percent higher chance of reinfection in comparison to alpha and if you remember what was the primary prevalent virus during that time period of a lot greater than or equal to 180 days around january was the alpha variant so there is a pretty high chance of reinfection we see an overall higher chance of about 46 percent to get reinfected with the delta virus and again that is very very important and so this shows that there is a chance of reinfection natural immunity is beneficial but i don't think it's the end-all be-all i think vaccination will definitely enhance your chance in reducing the incidence of symptomatic infection as well as really reducing the chance of hospitalization and death and we see that a lot from the data that we've provided all right ninja nerds so in this video we talk about the delta variant i hope this video sheds some light some understanding on the delta variant how severe it could potentially be and how it seems that it will actually be the upcoming variant that we're going to see being the most significant one in the future here i really urge you i really suggest that you guys go down the description box we'll have a link there that'll take you to a document with all the references that we referred to throughout this video go read those we tried to make it as easy as possible for you guys to be able to click and go exactly where you need on that document but i urge you guys to read through them sift through them if you want to know some more information about the delta variant also i think it's extremely important that you understand a lot of the information that we have on the delta variant is new we need a lot more studies we need to do a lot more things to really truly understand and elucidate some of these significant points that we made about the delta variant so i think that as time comes and goes and we get more studies more understanding of this delta hopefully we'll develop some good strategies prevention and treatment modalities for the delta variant all right ninja nerds stay safe and as always love you thank you until next time [Music] you

Channel: Ninja Nerd

Views: 81,686

Rating: 4.853775 out of 5

Keywords: Ninja Nerd Lectures, Ninja Nerd, Ninja Nerd Science, education, whiteboard lectures, medicine, science, covid, covid-19, delta, delta variant, alpha variant, beta variant, gamma variant, epsilon variant, variants of concern, pfizer, moderna, astrazeneca, SARS-CoV-2, pandemic, outbreak, fauci, CDC, WHO, transmissibility, covid-19 evidence, variant, variants, covid-19 variants

Id: mxTQQD-QVjk

Length: 71min 43sec (4303 seconds)

Published: Mon Aug 16 2021