Forecast: Virus could be with us for many years
The wildly infectious delta variant that has raged across the world and forced the United States into a fourth — and in some places unprecedented — surge has reshaped the coronavirus pandemic into a plague that may take many more years to come to an end, a panel of experts said Thursday at UCSF.
“Pandemics end. They may last X number of years, but they end. The thing is, it’s not going to end the day we want,” said Dr. Carlos del Rio, executive associate dean of the Emory School of Medicine in Atlanta. “You don’t decide, the virus or
pathogen decides, and the immune system.”
Delta, more than twice as infectious as the original coronavirus and nearly as contagious as chickenpox but far deadlier, is proving more challenging to control than public health experts ever expected, even in populations that are highly vaccinated.
The worst of this fourth U.S. surge has hit states in the south with poor vaccination uptake, and in some places — including Florida and Mississippi — coronavirus cases and hospitalizations have surpassed the winter surge. Texas this week sought to borrow health care staff from other states to help manage a spike in COVID-19 patients, even as the governor continued to prohibit mask mandates to help curb transmission.
But even in California and the Bay Area — where public health officials have issued increasingly more aggressive orders to get more people vaccinated and to blunt the delta onslaught — cases have soared. California is reporting more than 10,000 new cases a day on average, a tenfold increase since July 1. COVID-19 hospitalizations have increased more than fivefold during that time for the state and the Bay Area.
On Thursday, San Francisco became the first major city in the U.S. to require customers be fully vaccinated before entering businesses like restaurants and gyms, or large entertainment venues. The previous week, San Francisco joined seven other Bay Area counties in mandating indoor masks for everyone, regardless of vaccination status.
Gov. Gavin Newsom this week ordered that all teachers be vaccinated or face weekly testing. Earlier state and local orders have required health care workers and city and county employees be vaccinated too.
There are early signs that mitigation efforts are slowing down the surge in San Francisco, but cases continue to climb in most of the Bay Area and the state.
“June 1, we had 10 cases a day (in San Francisco). Today, it’s 250,” said Dr. Robert Wachter, chief of the Department of Medicine at UCSF and moderator of Thursday’s panel. UCSF had one COVID-19 hospital patient on June 1, and 41 as of Thursday, he said. “And on June 1, delta made up 3% of cases in the U.S, and now more than 90%.”
Those data points, Wachter said, prompted him to bring back the “COVID grand rounds” panels that he’d hosted at UCSF almost weekly throughout the pandemic. “Back by popular demand, unfortunately,” he said.
With more than 100,000 new cases a day, the U.S. is driving the global pandemic now, mostly due to spiraling infections in a handful of states, said Shane Crotty, a professor at the Center for Infectious Diseases and Vaccine Research at the La Jolla Institute for Immunology.
He noted that Florida alone accounts for one out of every five infections in the U.S. “If Florida was a country, it would have highest rate of any country in the world,” Crotty said. “The U.S. would have issued travel warnings from Florida.”
Florida’s overall vaccination rates are not much lower than California’s — 51% of all residents are fully vaccinated in Florida, compared to 54% in California. But Florida’s government leaders have largely fought mandates to slow down transmission. Delta, though, is the main culprit behind the rapidly climbing cases in Florida, California and just about everywhere else in the U.S.
Because it’s so infectious, it passes much more easily and quickly among the unvaccinated. And it’s becoming increasingly clear that it’s much better able than earlier strains to infect those who are fully vaccinated, though it rarely makes them seriously ill.
Studies from around the world have shown wide ranges in vaccine efficacy at preventing infection — from a low of 40% reported in one Israel study to a high of about 85%. A U.S. study published this week — and which has not yet been peer-reviewed — found the Pfizer vaccine was only about 42% effective at preventing symptomatic illness.
“Nobody’s talking about 95% efficacy anymore,” Wachter said. “We’re debating between 50% and 70% and 80%.”
Importantly, all of the studies find that vaccines hold up well — most of them over 90% — at preventing severe illness that leads to hospitalization and death.
The Food and Drug Administration has approved a third shot for some people with weakened immune systems, such as recipients of organ transplants, in the hopes of boosting their immunity to the virus.
It’s not yet clear how readily vaccinated people who become infected can spread the virus to others. But the breakthrough rates alone make delta a much more challenging virus to control, experts said Thursday. Del Rio cited a recent paper that predicted how well the virus could be controlled in a college campus setting with 90% of people vaccinated and a 50% efficacy rate.
“You can open safely, but it’s going to be ongoing transmission happening,” he said. “That’s what we may be looking at. We need to start shifting our thinking from eradication and disease elimination to more disease management, the way we think about flu.”
The panelists echoed recent comments from public health experts that anyone who is not vaccinated should expect to sometime — sooner than later — become infected. That probably includes children under age 12 who are too young to be vaccinated, though their risk can be lessened by always wearing masks and limiting their time spent in public spaces indoors.
Still, there are hopeful signs that even if this pandemic may not be fading away any time soon, it’s becoming more manageable. The UCSF panelists all noted that the vaccines are proving fairly durable at preventing disease many months after the shots. Boosters may be advised for certain groups — such as people who are immune compromised, or who are age 65 and older — but not for everyone, at least not soon.
Meanwhile, people are figuring out how to coexist with this virus, even with delta. The current wave of infections is frustrating, but it’s not yet causing public health leaders to order new lockdowns.
“Our ability to adapt, change and respond will serve us well,” Dr. Grant Colfax, director of the San Francisco Department of Public Health, said at a briefing Thursday to announce the city’s newest vaccine mandate. “We are now in a new phase of the pandemic, and even as we see a surge in cases, we have the tools to fight this disease and keep ourselves and each other safe.”