Misinformation

The Delta Variant: What Does It Mean for Vaccinated and Unvaccinated People

What is the Delta Variant?

SARS-COV-2 is an RNA virus which means it’s genetic code is RNA rather than DNA. The genetic code for SARS-COV-2 is a long chain made up of four different bases. We can think of the four bases as an alphabet that consists of only four letters. These “letters” are A (which stands for adenine), C (which stands for cytosine), U (which stands for uracil and G (which stands for guanine).

Normally SARS-COV-2 makes exact copies of itself inside a human cell and these copies go on to make new virus particles. Very rarely the RNA of the virus makes a mistake when copying itself. An A might be substituted for a G, for example. These mistakes are called mutations. Almost all of these mutations make the virus function less well and they quickly disappear. Once in a great while a mutation occurs that makes the virus work better. When this happens viruses with the mutation spread faster and if they make the virus much more infectious, then the virus with the mutation quickly replaces the old form of the virus without the mutation.

That is exactly what has happened with the Delta variant. It is a mutation that makes the SARS-COV-2 virus much more contagious. Instead of each infected person infecting around 2 others, the Delta variant mutation causes each infected person to infect 5 other people. Because it is so infectious it has spread very quickly and is now the dominant form of the virus in the United States. If you get COVID today, there is a very high probability that you are infected with the Delta variant. There therefore is no need to test any individual infected person for the Delta variant.

Fortunately although the Delta variant of SARS-COV-2 is much more contagious, it does not seem to cause any more serious disease than the old form of the virus, but having a lot more people infected means that a lot more people will get very sick and require hospitalization.

I have already had COVID. Am I protected against the Delta variant?

There is some protection, but probably not very much. Even if you have already had COVID you can get infected again with the Delta variant and you might be much sicker than you were the first time.

I have been fully vaccinated. How protected am I against the Delta variant?

All of the vaccines in the United State that have FDA emergency approval (Pfizer, Moderna and Johnson & Johnson) provide about 80% protection from infection with the Delta variant. That means that out of 100 fully vaccinated people exposed to the virus, 20 will likely get infected. Those twenty people will tend to have no or mild symptoms and will not need to be admitted to the hospital. Very rarely a fully vaccinated person will get very sick and might even die. Rarely means about 1 person out of 1000 fully vaccinated people are hospitalized for COVID and nine out of ten hospitalized patients recover.

Being fully vaccinated makes you much less likely to get infected with the Delta variant and if you do get infected you are likely to have no or very mild symptoms. Vaccination means you have 99.99% protection from severe COVID requiring hospitalization. If everyone wears a mask indoors, the rate of infection for vaccinated people approaches zero. Even if most people are not masking indoors (though they should be) vaccinated people should still wear masks indoors because if they are infected with the Delta variant, even if they have no or mild symptoms, they could still pass the virus on to others.

I am not vaccinated. What is my risk of getting infected with the Delta variant?

If you are exposed to an infected unmasked person indoors and you are not wearing a mask then your chance of infection with the Delta variant is close to 100%. If infected you have a 20% chance of being hospitalized and a 1% chance of dying. That means that of 100 unvaccinated people exposed to the virus almost all of them will get infected. Twenty of those people will be so sick that they have to be hospitalized and one will die. Wearing a mask indoors protects you a little bit, but if everyone wears a mask indoors, your chance of being infected is much less. Obviously, you can’t control what other people do, and in states with low vaccination rates, there are also many fewer people who mask indoors. Your best shot at protecting yourself from getting very sick and perhaps dying is to get vaccinated as soon as you can. In the meantime avoid closed indoor spaces, especially where people are talking loudly or singing. Always wear a mask indoors.

Hospitalization rates are very high in states and counties where vaccination rates are low. Hospitals in those states and counties are almost out of ICU beds and are short on staff to care for desperately ill people. That means that those hospitals may not be able to take care of people who have heart attacks, car accidents or other serious illnesses. Some of those people will die because care is delayed. Although these deaths are not directly caused by COVID, these deaths would not happen if hospitals were not overwhelmed with COVID patients. Therefore another reason to get vaccinated is to take some of the stress off hospital workers who are exhausted and burning out.

Do I need a booster shot if I have been fully immunized?

Good immunity from the vaccines lasts for at least 8 months and probably longer. There is some evidence that immunity from all of the vaccines starts to decrease after 8 to 9 months. Booster shots will be available in mid September, and people who had their second vaccine 8 months or more ago probably should get a booster.

Vaccine Side Effects

By far the most common side effects of all COVID vaccines are fatigue, headache, fever and sore arm. These side effects go away within 24 to 48 hours.

Myocarditis and Pericarditis

The Pfizer and Moderna vaccines rarely cause some heart inflammation. This happens in about 12 people per million vaccinated. It is always mild and almost never requires hospitalization. All cases so far have gone away on their own and there have been no deaths.

Central Vein Thrombosis

The Johnson & Johnson vaccine rarely causes blood clots in a central vein in the brain. This happens in about 7 people per million vaccinated. This is the rate for women under 50. Men and women over 50 have an even lower risk. This can cause death, but if recognized in time can be treated and cured.

To put this risk in perspective, your chance of dying every time you drive a car is about one in one hundred. Almost everyone who drives is willing to accept this level of risk, which is way higher than your risk of death or disability from any COVID vaccine

Vaccine Misinformation

COVID vaccines do not cause infertility in women or men. COVID vaccines do not cause or make you more susceptible to getting COVID. COVID vaccines do not change your DNA. COVID vaccines do not put microcomputers in your body. There have been no unsafe shortcuts in the development of any of the COVID vaccines in use in the United States.

Bottom Line

All COVID vaccines available in the United States are safe and effective. They markedly decrease the risk of infection with the Delta variant and while breakthrough infections do occur, they tend to have no or mild symptoms. Current vaccines give 99.99% protection against getting sick enough to need hospitalization. Severe vaccine side effects do occur but are exceedingly rare and all are curable. The risk of infection with the Delta variant in unvaccinated people is very high as is the risk of hospitalization.

Misinformation about SARS-COV-2 and COVID-19 – How to Recognize Misinformation

One more piece of misinformation about masks – Copper

In the last post I did not include one more common piece of misinformation about masks. There are many masks advertised on television that tout the fact that they contain copper. While it is true the SARS-COV-2 does not last as long on copper surfaces, there is no evidence that copper in masks makes any difference. Rather than spending your money on a copper containing mask, focus on finding well fitting masks with a tight weave and multiple layers.

How to recognize misinformation on websites and social media

Here are some organizations/people who consistently provide misinformation

  1. Association of American Physicians and Surgeons. This is an impressive sounding name, but it is actually a right wing group that has promoted a number discredited medical ideas. These include: AIDS is not caused by HIV; being gay reduces life expectancy; abortion is associated with breast cancer; vaccines cause autism (thoroughly discredited by well designed randomized controlled trials).
  2. America’s Frontline Doctors. This group is actually headed by a dentist. They promote treatments like hydroxychloroquine and nutritional supplements to treat COVID. One of the leaders of this group was recently arrested for storming the Capitol. There is actually a legitimate group called America’s Frontline Physicians that promotes evidenced based medical care.
  3. Dr. Joseph Mercola. Dr. Mercola is an osteopathic physician who markets dietary supplements and medical devices, most of which are of questionable health benefit. All of these are marketed through his website and/or through a number of books that he has written. He claims that mRNA vaccines are gene therapy, and also that COVID-19 is not caused by SARS-COV-2.
  4. Fox News, Breitbart and Newsmax often provide misleading information about COVID-19 or downright misinformation

It is not possible, of course to address all the sources of misinformation on the web and social media. We are in the middle of an ‘infodemic’ of misinformation. There are some ways, however to recognize what is likely to be misinformation.

  1. Any website or social media post that promotes a simple cure or prevention for COVID-19 is likely misinformation, especially if the treatment being promoted is a vitamin, a supplement, hydroxychloroquine or azithromycin.
  2. Any website or post that implies that mRNA vaccines are dangerous or are gene therapy is certainly misinformation
  3. COVID-19 is a complex disease and we are learning more about it all the time. Any website or post that makes things sound simple is probably misinformation

Reliable sources of information about COVID-19 and SARS-COV-2

  1. CDC (website cdc.gov). The CDC has the best scientists and epidemiologists in the world. The previous administration tried to censor the information from the CDC and often undermined it. The current administration has stopped this practice. Information changes as we learn more about COVID-19 and SARS-COV-2, but the CDC website has the most up to date science based information and recommendations.
  2. Mayo Clinic (website mayoclinic.org). The Mayo Clinic site has lots of reliable information about COVID-19 and it is presented in a way that is geared for patients and non-physicians.
  3. WebMd (website webmd.com). This website is designed to provide information on many medical conditions including COVID-19. It is easy to search for specific information.
  4. STAT news (website statnews.com). This news service specializes in current developments in health and disease and has many useful and interesting articles on COVID-19 and SARS-COV-2.
  5. Major news organizations, specifically New York Times; Washington Post; Los Angeles Times; Boston Globe.

If you receive a post or tweet from a friend that you think might be information, please do not share it with your friends. This is how misinformation spreads like a disease. If you have a question about whether what you are seeing is misinformation, use the comment section of this post to ask about it. I will aggregate these and respond in another post or posts.

Misinformation about SARS-COV-2 and COVID-19 -Misinformation about Masks and Treatment

Misinformation about Masks

Mask Misinformation 1: Masks don’t work, so there is no point in wearing one

This is false, of course. The most recent information is from a review of all the studies about mask use from the Journal of the American Medical Association. The conclusion is that masks decrease the risk of catching COVID-19 by 70%. Masks that fit snugly, have more than one layer, and have a tight weave are the most effective. Masks especially protect other people when they are worn by people who are infected. They also, however, protect the wearer from becoming infected. Since people are most infectious before they develop symptoms, universal mask wearing provides the most protection for everyone. Here is a link to the article in JAMA.

Mask Misinformation 2: Masks can make you sick

The claim is that bacteria build up inside the mask and that can cause infection. There is absolutely no evidence to support this claim. People who wear masks have no higher incidence of any infection than people who don’t wear masks. People who consistently wear masks, though, have a 70% lower chance of catching COVID-19 than people who do not wear masks consistently.

Misinformation about Treatment

Treatment Misinformation 1: Hydroxychloroquine and/or azithromycin prevent and treat COVID-19

This is one of those pieces of information that is like a zombie. No matter how much it is discredited, it never seems to die. There have been a number of very well designed studies to evaluate hydroxychloroquine as both a treatment and for prevention of COVID-19. All of these studies show absolutely no effect of hydroxychloroquine for either treatment or prevention of COVID-19. The same is true of azithromycin. There is no evidence of any effect for treatment or prevention for it alone or in combination with hydroxychloroquine. People who took hydroxychloroquine in these studies had more side effects and actually did worse than the control patients who did not get hydroxychloroquine.

Treatment Misinformation 2: Large doses of vitamin D prevent COVID-19

There is some evidence that people who have below normal levels of vitamin D have a slightly increased risk of serious COVID-19. Low levels of vitamin D are more likely to occur in northern latitudes where there is less sunshine. There is no evidence that people with normal vitamin D levels benefit from taking extra vitamin D for either treatment or prevention of COVID-19. If you live in the north, it might be worthwhile to ask your physician to check a vitamin D level. If you live in the south you are very unlikely to have anything other than a normal vitamin D level, so a test is probably not worth it.

Treatment Misinformation 4: Nutritional supplements such as vitamin C and zinc help prevent and treat COVID-19

Once again, there is no evidence that vitamins and nutritional supplements either prevent or treat COVID-19. A recent article in the Journal of the American Medical Association reported on a randomized controlled trial (the gold standard in study designs) evaluating vitamin c and zinc as treatment for mild COVID-19. The trial showed no effect. Here is a link to that article.

Prevention

The only interventions that have been show to prevent COVID-10 are wearing a well fitted cloth mask with multiple layers, social distancing of six feet or more, and avoiding closed indoor spaces. Vaccines have been shown to prevent serious disease. It is possible that they also prevent infection, but it will be several more months before we can be confident of that.

Treatment

There are several treatments that have proven to be somewhat effective in the treatment of COVID-19:

  1. Remdesivir has a modest effect on decreasing duration of illness.
  2. High dose steroids, such as dexamethasone are helpful in people hospitalized with severe disease.
  3. Monoclonal antibodies (bamlanivimab, casirivimab and imdevimab) are helpful in high risk people who have early COVID-19.

There are no “natural” medicines that treat or prevent COVID-19. Hydroxychloroquine and/or azithromycin are ineffective for treatment or prevention and hydroxychloroquine seems to cause increased harm.

In the next post I will talk about how misinformation spreads on social media and how to recognize it. I will also provide some reliable online sources of real information about SARS-COV-2 and COVID-19.

Misinformation about SARS-COV-2 and COVID-19 – Vaccine Misinformation

Introduction

In this post and the ones that follow I will try to accomplish several goals. I have been fielding a lot of requests to comment on misinformation about COVID-19. This misinformation falls into several categories, so the first thing I will do is to detail each one of these, explain why they are not true, and give the correct information. It will be impossible to respond to all the misinformation out there, because it proliferates sort of like weeds in a garden. A second goal of these posts will be to discuss how misinformation proliferates, primarily on social media. The third goal will be to provide some reliable sources of information that can always be trusted. Here goes!

Misinformation about vaccines

Vaccine Misinformation 1. The new vaccines (mRNA vaccines) are not true vaccines because they cause the body to make components of the virus rather than making fragments of the virus in a lab. mRNA vaccines are gene therapy and permanemtly alter your DNA.

First lets talk about the definition of a vaccine. A vaccine is anything that causes immunity to a disease other than being infected with the disease itself.

There can be many ways to do this. One way is to make a weakened form of the virus or bacteria and actually infect people with it. This is called a live attenuated vaccine. Measles vaccine and smallpox vaccine are examples of this. A more common method today is to use a piece of the virus or bacteria that cannot reproduce, so it can’t cause infection. This is called an inactivated vaccine. The inactivated piece of virus or bacterium causes the immune system to make antibodies against the fragment of the virus or bacterium. This allows the immune system to immediately recognize infection with the live virus or bacterium and destroy it before it becomes established in the body.

The old way to make inactivated vaccines required being able to grow the virus in the lab, figure out which part would stimulate the immune system, make lots of copies of that part, and then inject it into people. This was a very time consuming process. The shortest time to develop a vaccine like this was the mumps vaccine, and that took 10 years.

New technology allows us to quickly figure out the entire genetic sequence of the virus. The coronavirus, SARS-COV-2, happens to have a sequence of only RNA, not DNA. In a normal cell, RNA is a “messenger” from the DNA in the nucleus of the cell. The RNA actually makes the proteins that the cell needs. The RNA from SARS-COV-2 takes over the cell machinery and makes viral proteins and more viral RNA that assemble themselves into thousands of new virus particles. The cell eventually ruptures and dies, releasing the thousands of virus particles that go on to infect other cells and repeat the process.

The genius of the messenger RNA (mRNA) vaccines is to use the way the virus RNA makes proteins against it. By injecting only a piece of viral RNA, the muscle cells near the injection site take up the RNA and make thousands of copies of one of the virus proteins, called the spike protein. Since the whole viral RNA is not there, the whole virus can’t be made and no cells can be infected. The immune system makes antibodies against the spike protein made by those muscle cells. Instead of the laborious and time consuming process of making pieces of viral protein in a lab, the body does all the work using the fragment of viral RNA to make the protein that causes immunity. The DNA in the cell is never touched or altered, so this is not gene therapy. Furthermore, the fragment of viral RNA used in the mRNA vaccines is very unstable and falls apart soon after it causes the muscle cells to make copies of the spike protein.

Thus, by the definition of a vaccine mRNA vaccines are true vaccines. They cannot cause infection. They never affect DNA, so therefore are not gene therapy. They fall apart in a few hours. They have been shown to be very safe and effective at creating immunity and preventing illness from COVID-19.

Vaccine Misinformation 2. mRNA vaccines insert nano-computers into your body that can track you

This is probably a misunderstanding of the fact the the mRNA vaccine is enclosed in a little lipid (fat) particle to keep it from being immediately degraded by the body’s enzymes. These little fat globules are very small, so they are called nano particles. There are no computers, nano or otherwise in the mRNA vaccines.

Vaccine Misinformation 3. mRNA vaccines cause infertility

mRNA vaccines are only absorbed by muscle cells near the injection site. They do not circulate in the bloodstream and cannot possibly affect any part of the reproductive system in men or women.

Vaccine Misinformation 4. Covid-19 is a mild disease and side effects from vaccine are worse than the disease.

Eighty percent of people who get COVID-19 have relatively mild symptoms or no symptoms and recover completely. That leaves 20% (two out of every 10 people) who get serious disease many requiring hospitalization. Even if the overall death rate is only 1%, that is 10 times the death rate from influenza. At this point in the pandemic, COVID-19 is the leading cause of death in the United States. Serious side effects from the COVID vaccines are extremely rare. About 1 person in a million gets a severe allergic reaction called anaphylaxis. This always occurs in the first 20 minutes after administering the vaccine and is easily treated with an epinephrine shot. Mild symptoms are common including pain at the injection site, low grade fever, muscle aches, and fatigue. These almost always disappear within 24 to 48 hours.

COVID-19 is a serious, life threatening disease for two out of 10 people that get it. Vaccine side effects are common but mild and self-limited. Serious side effects are very rare and easily treated.

In the next post I will discuss misinformation about mask wearing, the origin of the virus, as well as a few common miscellaneous pieces of misinformation.