- So what is the Delta variant and why is there so much concern with this particular variant
of the COVID-19 virus? - The Delta variant is just
a new version of coronavirus that's mutated, and it has
become much more transmissible than the original agents of COVID-19. We think the Delta variant is
two times as likely to spread from person to person. It's just as deadly we think and so the problem is that you're gonna get that many more cases and that can reach that much more quickly to vulnerable people and lead
to increasing hospitalizations and death rates like
we're seeing in many areas around the country and around the world. - So let's get into a few scenarios. First just me personally,
I've chosen to be vaccinated. I did that months ago as
soon as I was eligible. My kids have been vaccinated,
most of my family, my friends. But let's say I'm one of those people who's chosen not to get vaccinated. Maybe I'm younger, maybe
I'm in good health, maybe I made it through
the first surge fine and for whatever reasons
maybe I'm not comfortable with the vaccine or I think that herd immunity
is somehow gonna protect me. What would you say to
those types of scenarios or what's the risk there? - The Delta Variant makes me most worried about people who are unvaccinated. Across the United States we've
seen a surge in the number of cases and in
hospitalizations and in deaths and the vast majority, more than 90% of the people
who have been hospitalized and otherwise had severe
disease from the Delta variant, have been people who are unvaccinated. It's really clear that the vaccine does provide protection
from the Delta variant. So the people who are really getting hurt are unvaccinated people. It's also true that the Delta variant is occasionally causing
breakthrough infections in people who are vaccinated. And it looks like it can
probably be transmitted by people who are vaccinated, but neither of those
is quite as scary to me as the huge risk to people
who are not vaccinated. That's who's ending up in our ICUs. - Can you explain a little bit
about how that breakthrough works 'cause I've heard that a lot that this is gonna be a
pandemic of the unvaccinated. And a few of my more
skeptical friends asked me, well, if people are
getting sick or vaccinated, what's the point of that? Why even risk getting a
vaccine that I don't trust, what would you say to that?
- It's a good question. And it kind of comes down
to severity of disease. So if you look the
vaccines across the board offer great protection
from the Delta variant and that protection is not perfect though and so people can get infected,
but be totally asymptomatic or maybe have a mild cold
if they've been vaccinated. The contrast is, you
know, and in rare cases, people who have been
vaccinated can get sicker from the Delta variant that's typically in somebody who's quite
old or immune compromised and maybe didn't mount a
great vaccine response. But in most cases,
people who are vaccinated are getting mild disease of anything. That's different with people
who are not vaccinated. That's who's getting hospitalized,
that's who's in the ICU, that is who's dying. So those skeptics need
to look at the numbers and realize that these
are life saving vaccines than poo-pooing saving
of lives makes no sense. - Okay, great. Thank you. We've got a quick question
from Brandy on Facebook. I think this is in response
to your first comments. So the Delta variant is
more dangerous because it spreads more and is
more easily contagious? Is that the gist? - Yeah. That's the way to think of it. You know, you can imagine
if you have a 100 people who get infected, a certain small percentage of those people are gonna get really sick. That percentage of people
who get really sick is double if it's 200 people who get
sick and triple if it's 300. Since the Delta variant
can reach so many people so much more quickly, it
causes more severe disease just through brute numbers. - I see. This reminds me of something
we spoke about earlier. How small of a contact does
it take to spread Delta? I've heard it described
that just walking by someone for an instant. Delta can spread that way. - Yeah, that's right. I mean, we know that the
original version of SARS-CoV-2 usually takes some time to transmit it. That there are examples of people who have very glancing contacts. You know, that person who was
30 feet away in a restaurant for just a few minutes. So that did happen with the original, with the alpha variant. But generally speaking, he had to be in the room
for a little bit longer. There are some alarming reports of increasing numbers of
people whose transmission resulted from incredibly brief and slight contact with somebody and it looked like the Delta variant's increased transmissibility
was to explain for that. We see that people who
have the Delta variant have much more virus in
their respiratory tract. And so it's probably just that
much easier for each breath or each needs to spread the
virus to somebody else nearby. - Wow. Okay. We've got another, a follow-up
question from Facebook from Rebecca. Can't you take ivermectin
if you get COVID? - We've actually got a really high quality studies coming out
suggesting the ivermectin is not beneficial in the
prevention or treatment of COVID. It's one of the things that
there was a lot of sort of internet chatter about, but the really good
quality clinical trials have shown no signal. - Okay. Thank you. Another question from Nancy on Facebook, my 21-year old had COVID in
February, 2021, he was fine. Just lost his sense of taste
and smell for about two days. He did not get the vaccine. Can he still become infected now? - Yeah, so we know that being
infected with SARS-CoV-2 itself can offer some protection
from getting it again. We think that it's partial protection. A recent study was suggesting that there was about 75%
protection from a future infection if you've been infected, you
know, by the virus itself as compared to from the mRNA vaccines. In that same study it
was closer to 85, 90%. So it looked like the vaccine
was better at protection. One of the big unknowns is that each of those things
probably varies over time and we don't know because
it's so early in the pandemic, how long does protection last
after getting the infection versus how long does infection last after getting the vaccine? So that's being actively
studied right now. What we know is that people
who got infected by the virus, but then got the vaccine appear to have better immune responses. And there are some hints
that they might have additional protection
although the data on that is much less strong than people
who have never been infected and got the vaccine. So what I most care about is people who have never been
infected get the vaccine, most people who have
been infected don't know. So I'd say get the vaccine, it's safe to get if
you've been prior infected and that might give you extra protection. We're just not quite as sure as for people who haven't been infected. The quality of the evidence
isn't quite as high. - So to boil that down, even if you have some
protection with an infection, you're getting a much
higher level of protection and a much more predictable
level of protection when you get vaccinated. - Yeah, the way to think about it is, you know, for most people,
if they were gonna choose get protection via having
infection versus get protection from getting the vaccine,
no brainer, right? Like you don't want the risk
of long COVID, the risk of, you know, being out of work, the risk of a very bad thing happening including death from infection. And so pick the vaccine, of course. Let's say you know for sure you had it, meaning a doctor did a
test and it was positive, do you have some protection
on the basis of that alone? Yeah, probably. Is it complete? Definitely not. Could a vaccine make it
better? We think it might. - Okay. Another question from Facebook from Jamie, I heard that the risk is less than 0.1% that a fully vaccinated
person could transmit COVID. Is this true? - Well, how do you say this? It's a complicated thing. We know that getting a vaccine protects people from transmission. The best estimates of how
much it protects people from transmission are complicated 'cause it kind of has to do
with like how exposed they are and all that and how many other people
around them are vaccinated. But we think that it's probably
80, 90% protective against even getting infected and
therefore, so you can't transmit. Not that they can't transmit
at all, it's just unlikely. We also think that might be
changing with the Delta variant. This has been a driver of recent changes in the CDC guidance. Is that there's some data
coming out of Israel, of chains, of transmission
of vaccinated person to vaccinated person to vaccinated person transmitting Delta variant. So, they're still protected
from severe disease, but might that virus still
leap from person to person to person despite vaccination, it's looking like that's the case. So that's part of why the
recommendations are changing. - So would that also
bolster arguments for why, it sounds like the Delta
variant got a foothold in a lot of communities
through unvaccinated folks and that's stressing and otherwise more protected population. Does that sound about right? - Yeah, the way to think of it is that the way the virus mutates
is that it copies itself. Every time the virus
makes a new copy of itself inside somebody's body, it has a chance for its copying mechanism to make a genetic error. That's how it mutates and sometimes it can
become the Delta variant or some other variant. So the less we have a transmission, the more we either wear
masks or when appropriate or we get vaccinated, the
less mutation the virus can do and the less that can
escape our immune systems or escape a drug or escape a vaccine. So that's why scientists really
wanna lock the virus down so that we can get back to our lives and not have some new variant that makes the vaccines not
work as well for instance. - I'm gonna switch gears a
little bit for Alison who asks, can you talk about the
risk of Delta to children who aren't old enough
to be vaccinated yet? And I know that's something that's been, it sounds like who's being
impacted most right now is a much younger age group versus the first waves that we saw. - Yeah, this is a big question and I think there are some
question marks still left, but I can give you a
sense of the state of VR. So, some background. So, it turns out if you look now at who's getting really
sick from the Delta variant, it's younger people, the average age of people
who are in the hospital or otherwise getting
severe disease is lower. And that makes sense because
a much greater percentage of our elderly population is vaccinated. And so they have more protection than say people in the 30s. Children in general, through this pandemic have been much less likely
to get really severe disease and them it's more often
a cold or asymptomatic. And that remains true
of the Delta variant. What's also true is that
the more transmissible Delta variant can infect many more kids. And so even if you have like
this really small percentage of kids who get long
COVID or severe disease, perhaps because they're medically frail, if you get lots and lots and lots of kids, in fact who are Delta variant and they're vulnerable to
having that thing happen and of course, nobody wants the kid with, you know, difficult to treat diabetes or the kid who had leukemia to, you know, end up in the hospital. Nobody wants that. And so partly we're
trying to protect that kid through vaccination. A challenge in young kids under 12 is that there is no indicated
vaccine for them yet. Those studies are still
happening and we don't know yet if they should be vaccinated. That means that the way we protect them is by getting the people who
can get vaccinated vaccinated so that they're surrounded with
a wall of vaccinated adults and teenagers who protect
them from getting infected. That I think is the most
important way we keep young kids in school and able to learn and be able to have social experiences even though they can't be vaccinated. - Okay, great. So that leads me to another question which I'm gonna broaden. Jana asks, any advice for families with children too young to be vaccinated? But I'm gonna dovetail
that into just in general. What tips could you give
for staying safe right now if you're a family with maybe children who can't be vaccinated all the way up to, you know, if you haven't vaccinated, it sounds like Delta is
just a lot more aggressive. What things should we be doing right now that could keep us safe? - That's a great question. And I think the answer is
different from place to place around the country. So since the best
protection for young kids from the Delta variant is vaccination of the people who can be vaccinated, right now the important thing is to increase our population
level of vaccination rate. The reason why it's better
to be a kid in Vermont today than it is in Florida, for
instance or Missouri is that our population vaccination rates are among the best in the world. So that is protection for our kids. And the more of us that do it, the better. I think a lot of people
have questions about, well, should they be doing extra things? You know, should they
be back to wearing masks in the grocery store or otherwise
taking extra precautions? I don't think that that's
absolutely necessary right now. I go to the grocery
store without a mask on and I think that's still a
reasonable thing for people to do if they're not like specially
medically vulnerable. It's possible if the case
rates in our area go up that we may need to go that extra distance to be able to protect kids. But the hope is that so many
people will be vaccinated, that transmission will
be sort of stalled out so that it doesn't reach the kids. The only way to know I think
is to watch the numbers. If our case rates skyrocket particularly as kids get back into school, then we have to adjust like we have for the last couple of years. Just looking at the data, changing the plan of the data changes. - Okay, great. I have a great question from
Facebook from Rebecca again. She says she hasn't gotten the vaccine yet and is on the fence. Her comment, the shot scares me. She's heard about deaths
and severe reactions. Is it worth the risk? And I get this all the time, but I would love to hear your thoughts about that in particular. - Yeah. That's a great question. And I think it's good for people to approach the question that way. What's in the pros column
for getting a vaccine, what's in the cons column? And I think one of the challenges is it's hard to compare
those to pros and cons 'cause they're sort of different things. So here's how I think about it. In the pros for the vaccine
there's protection from death, and these deaths are common. So 612,000 Americans have died and there have been 4
million global deaths. And we think the deaths
in areas like India and Sub-Saharan Africa are
massively undercounted. So that's a huge death toll that vaccines reduce dramatically. So in Vermont, our death
rates have just plummeted from vaccination. There are side effects of vaccines. They're quite rare, but they happen. You know, so many people like I did have an uncomfortable day after the vaccine, but it's no big deal. I took some ibuprofen. I
took a nap and I was fine. But it is true that rare
side effects happen. And there have been news reports of clotting with one of the
vaccines or with another one, myocarditis in young
adolescent boys with another. But it's really important to point out that those are extremely
rare side effects. A few 100 of this, a handful of that. So in balance I say, do I wish that vaccines
had zero side effects? Absolutely. But how do they compare
to cholesterol medicines and blood pressure
medicines than other things? Incredibly safe? So when I got vaccinated,
when my wife got vaccinated, when my 22 and 17-year
old sons got vaccinated, I lost no links of sleep
worrying about their safety. In fact, I felt relieved
because they were safe. - How many vaccines
worldwide at this point have been administered? - Yeah, this is a really important thing when you're thinking about
the safety of the vaccines. I think one thing that I
hear from my patients is they're wondering if the vaccine is new and whether that means
that they should wait till people know more about it. The thing I clarify for them is that certainly when something's new, you know, you can find
out something new later, but you have to think that this vaccine, these vaccines have been given
to 4 billion people this year under the most intense global scrutiny any vaccines have ever received. So we know a lot about this vaccine. I have a hard time keeping
up with all the papers that are coming out so quickly. Incredible scrutiny. As you may have seen the public, you know, CDC tribunals that they held to evaluate each vaccine that was recommended in the United States. So we know a huge amount about these and that's what's the
reassuring to me, the published, the publicly discussed, the
actively Twitter debated stuff, it's out there and really good. - Okay. Another question about
kids from Hope on Facebook, what are your suggestions
for families with children that are too young to get
vaccinated but want to travel? Should we hold off? - Yeah, that's a great question. It gets into those gray areas of like, how far would you push? So, I think the answer to the question depends a little bit on
where are you traveling to and your medical risks
and your risk aversion. So I'll try to boil it down. But I think as with
lots of things in COVID, there's no one simple answer. So, where are you traveling
makes a big difference. You know, if you're going
to someplace in new England, for instance, where case
rates are pretty low and vaccination coverage is really good, that's going to be safer than
going someplace like Florida where the vaccination
rates are pretty bad. That matters because you can
kind of think of the vaccine that you've received as a
goalie, a soccer goalie. And so it's a great goalie. It protects lots of the
goals from happening, but it's not perfect. So if you have one case
you're exposed to a couple, that's a couple, you know, four words
taking shots on the goal. What if you were in a place like Florida where you might be surrounded
by lots and lots of cases? That's a whole bunch of people
kicking balls at the goal and the goalie could get tired or just not be able to
protect you from all of them. You know, some people are
a little less likely to get protection from the vaccine if somebody is immune
compromised, for instance. That can do it. Kids are at risk because they can't be vaccinated under the age of 12, but generally a pretty low
medical risk if they're healthy. But, you know, let's say the kid had, you know, bad lung disease
or immune compromised. That's something to take into account. I think the other piece has
to do with risk aversion. So, you know, I go to the grocery store and I don't wear a mask and
that's because I'm vaccinated and I don't have a reason not
to respond to the vaccine. And also, although I know
the vaccine's not perfect, I'm willing to take that low risk 'cause I really wanna get
that normal life back. Some people either have medical illnesses that makes them wear a mask
or otherwise take precautions, or they're just really risk averse. That small risk of infection that's not a risk they wanna take. So that you can factor
that in to this too. For me, I would travel
for something important. I'm looking forward to
seeing my parents in Utah for the first time in
a long time next week. I know there's a little
bit of risk with that. I'm gonna mitigate it by wearing a mask and I'm willing to take that risk. If it was a not important
trip to someplace where there are lots of infections, I might wait for a little bit. But maybe have a little
bit less risk averse. Maybe I'd do it. I think it's in that gray
area that you can feel out as a person and as a family. - Next question from Walter,
this one about testing. How is UVM Medical
Center testing for Delta with the new change in PCR? - That's a good question. So it turns out that
the usual clinical tests do not tell which variant virus is causing somebody's infection. They just say that SARS could
be the agent of COVID-19 is there. Public health labs and other
labs can do a special test that looks to see if it's the variant. That is being monitored in Vermont. And so if you look on the
Vermont COVID-19 dashboard, you can see that for the previous month, the Delta variant like around the country is overwhelming the other
variants in our area too. So that's being monitored
in a sort of a small subset of infections, just so we get
a sense of what's circulating in the area and public health facilities all around the country
and around the world are gonna continue to do that because we are watching
to see what comes next after Delta and Lambda and the other ones. - We're getting a couple of
questions about J&J versus the two other COVID-19
vaccines, Pfizer and Moderna. Should those of us who got the J&J shot be thinking differently about
risk and precaution right now? Should we be thinking about travel or anything else differently
if we got Pfizer or Moderna especially if we're going
to areas where there's more vaccination rates
and increasing cases. - J&J like Pfizer and Moderna,
offers good protection from the Delta variant. We have shown very high
levels of protection from severe illness most importantly. We think that the J&J vaccine is a little bit less
likely to protect people from mild disease than
the two mRNA vaccines that's been known for a little bit, but the things you really
care about protection from hospitalization and death. That's excellent as good as they are. It's been an open question
since the immune responses to the mRNA vaccines
are a little bit bigger and since protection from a
mild and asymptomatic disease, a little bit better if maybe
people with J&J who got J&J should get like a booster
with one of the mRNA vaccines. And there's some basic science-y
findings that made people interested in that. And so that's being studied, but it's not something that's
been proven to protect people from clinical disease. And so right now that could
just be a test tube phenomenon that doesn't lead to protection or these studies could
find that it actually is a way to boost protection. So I think we'll find
out in the coming months, but right now I'd say rest easy, you have protection from severe disease and you should have the same
mobility and flexibility of life as the other people. - So that segues nicely into another question from Walter on Facebook. When do you expect us to need boosters? And I know there's been a
little talk about that recently, even this week that
they're starting to see enough trends in the data
that they think they know they're getting a handle on when a booster might be appropriate. - Yeah, this is something that the data are evolving rapidly around. And inevitably whenever
the data's moving quickly you're gonna hear
slightly different stories from different people. Maybe it's just 'cause they're speaking to slightly different days
and the evolution of the data and also different people
have different opinions, but here here's how I look at it. We do not know if a booster vaccine makes people safer from disease. This is not been proven yet. We do know that booster vaccines can boost your immune response, but those test tube findings
have not yet been related to true protection from disease. Those studies were being done and I anticipate the results
are gonna be out fairly soon. And so if I see that boosting the vaccine gives you better protection, then maybe we'll be
excited about doing it. But for right now I'm not
excited about doing it. I wouldn't recommend it
until I see better evidence. Also, I think there's
gonna be a really big, let's say they do show evidence that my mRNA vaccine that I got could have even better
protection if it was boosted, I think there'll be a very big international policy discussion about whether that's a good
use of finite vaccine supplies. There are many countries in Africa that have fewer than 5% of
their population vaccinated. And so it's way, way lower than what US and some of the other
wealthy nations have. If we have just one dose of the vaccine, should we use it to get
somebody from zero protection to 80, 90% protection or should we use it for somebody
else in a wealthy country to go from 80, 90% to 90, 95? I know what I would
choose and I would say, let's get people at least
their first shot first and then go to the boosting. But for now that's all academic. We don't know if the booster
is needed. We'll find out soon. - Okay. Another question. A couple of questions actually now about masking in schools. It sounds like, well, first
somebody had on Facebook asked, do you think masks should be mandated this upcoming school year? I believe that's happened. But there was a second
question we got that, considering mass guidance for schools, the governor hasn't really done that for the general population
yet and why the difference? - Yeah, so this has been a
confusing couple of weeks because the messaging
has really had to change and the messaging has
been different in Vermont compared to US messaging. And so I can clarify why that is. It turns out that before
the Delta variants swept across the globe and rapidly replaced
the original variants, that the efficacy of
the vaccines was so good and the infection and especially death and
hospitalization rates were dropping so fast that nobody thought that we would need to have vaccines, but being responsible scientists
and doctors and nurses, we kept an eye on the data. And then Delta happened and you could see infection and hospitalization
and death rates rise. - I think when you said
vaccines, you meant masks. - Oh, sorry, masks and vaccines. It was all sort of keeping
the virus under control. But then we started to see, you know, the rates of infection and hospitalizations and deaths go up and response to the Delta variant, mostly in the unvaccinated people, but probably with some transmission among the vaccinated mild disease in them. And so that's what drove the
CDC to switch their guidance and say, well, wait a second. We thought we wouldn't
have to use the mask, but we're starting to see signs. We might have to. One thing that tipped
them over the edge is that they have some data that
are about to be released showing that people who were
vaccinated even can transmit. Like I talked about earlier
on in this Facebook live. So that's leading the national
guidance to be changed and included in that
has been the requirement that school kids above a
certain age wear masks. Nobody's excited about that
because we all know that that sort of makes it so that
social interactions are hard and it can be uncomfortable
and we're all sick of masks. It's also doable for kids and I think we were all a bit surprised at how well kids above a
certain age did with masks, but nobody wants to do it. Naturally though I think
it makes sense to ask whether the local epidemiology suggests that that's necessary. And I think in the parts of the country that are unusually well vaccinated may have a different story to face. In Vermont, we have
seen an uptick in cases. We have really not seen a
big uptick in hospitalization and deaths. So in the UVM health network, there have been one or two or three cases in the entire health network of people hospitalized with COVID. Nobody in the ICU for the last while. So in response to that different reality where it's much better in Vermont than it is on average around the country, Governor Scott and Commissioner
Levine are thinking, well, maybe that national
guidance doesn't apply exactly to unusually epidemiologically
good Vermont. And so I think correctly, they're waiting to see if things change. And it may be that we're
just gonna have to say, you know what? In places where the numbers
look great, here's the guidance. In places where the
numbers don't look great, here's different guidance. That makes common sense to me. - Okay, great. PJ on Facebook asks a question
that I think we covered, but I want to hit this again 'cause it seems like it
causes a lot of confusion, especially for people who are on the fence about getting vaccinated or not. They ask, are we seeing cases of people who are vaccinated getting
infected with the variant? That's true in rare
circumstances but what's, you had mentioned the big difference there is the severity of the
illness they might get is much, much safer than without. - Yeah, super important point is that we are seeing large numbers of
people end up in the hospital and dying from the Delta
variant who are not vaccinated. So it's incredibly very dangerous to people who are not vaccinated. We are seeing some cases, a small number of cases in
people who are vaccinated, those cases are overwhelmingly
asymptomatic or mild. It is really uncommon to
end up in the hospital or dying from the Delta
variant if you're vaccinated. And then the vast majority of people who have had severe disease
like that despite vaccination, they are immunocompromised
or otherwise frail in some way that explains
why their response was not as good as the average person. So, vaccine is absolutely
protected from death and hospitalization and
other bad forms of COVID-19, including from the Delta variant. It's just not absolutely perfect. - You'll also find resources
in the comments here including a Q&A with Dr. Lahey that covers a lot of the same topics that we talked about tonight
as well as how to find and schedule a COVID-19
vaccine if you haven't yet and you've decided that
that's something you want. I certainly hope you do. And thanks again for joining us. Dr. Lahey thank you so much for taking the time tonight to talk. - You're welcome Ryan. And maybe just a quick comment which is, Vermont gets a lot of press for
being the best in the nation for vaccination and also
for its a disease rates. There's another reason
why Vermont, I think, should be getting a lot
of press and that's 'cause instead of polarizing and dividing and yelling at each other, for the most part we're coming together like community should come together and helping each other out
through the uncertainty and the worry and even the
disagreements that we're hearing. And I'm really proud of that. - Yeah. Agreed, agreed. Alright. Thank you so much Dr. Lahey. Thank you all and we'll see you next time.
