These posts aren't normally going to be long. But I've gotten a lot of questions about the delta variant of SARS-CoV-2, and I'm clearly not the only one who's feeling uneasy navigating the apparent contradictions in guidelines. So, this will be long. But I'll put some lines in bold if you're extremely tired of reading about this virus (or have already read obsessively about delta) and just want to skim. I understand people are in extremely different states of caring.
The official messages about the "delta" variant of SARS-CoV-2 have been genuinely confusing.
On June 25, the World Health Organization urged people to wear masks and distanceeven if they're vaccinated. "People cannot feel safe just because they had the two doses," WHO assistant director general Mariangela Simao told reporters at the time. "They still need to protect themselves."
That was one of those moments where I froze, worried that I'd been missing something. My understanding has been that, if you're vaccinated, in most of the U.S., you're fine. No, risk doesn't fall to absolutely zero, and there are always exceptions—some high-risk scenarios where you might want a mask (e.g. even vaccinated doctors and nurses wear masks in the hospital while treating people with COVID-19). But as a general rule, unless you're in close proximity to lots of unvaccinated people in unventilated spaces, vaccinated people should enjoy life and not worry about getting sick or spreading the virus.
Now the WHO seems to be saying otherwise. And even for all my hubris, I'm not comfortable going around telling people the World Health Organization says to wear a mask but, trust me, you're fine without one. Still I think their advice is too simplistic and can be misleading. So, here's how I'm thinking about masking and distancing, and summer/fall plans, as a vaccinated person in the U.S.
(I'll update this, and post incremental news on this site, as the situation unfolds.)
The basic facts of the delta variant's spread are, truly, scary. It has swept over the world so quickly that it's almost difficult to comprehend. In a field of very transmissible variants, delta has decisively out-competed the others for space in our airways. It's estimated to spread 50-60 percent more readily than the already-very-transmissible alpha (nee "U.K." variant). The variant was first identified in the U.S. in March, and it has just become the dominant strain in the country. The role that delta seems to have played in India has been devastating, and it's already tearing through many other countries, from Portugal to Malaysia, prompting lockdowns in Australia and Bangladesh, and the return of mask mandates in the highly vaccinated Israel.
At the same time, the advice to go back to masking and distancing feels completely at odds with reality in the U.S. It runs counter to guidelines from CDC, which are essentially: vaccinated people, enjoy your summer. Most of what's been said by Anthony Fauci boils down to this variant is extremely concerning, but I'm vaccinated and we're having a celebration at the White House, but also I'm keeping a close eye on this very dangerous variant. The overall effect of what's reaching many people is a mixed message. Something like: Oh, hey. Before you get in the water, you should know that there are some shark-stingray hybrids around—we don't fully understand them?—but they seem to very rarely attack people like you, and you should probably be fine, it seems, for now. Enjoy your swim.
There's also a chasm between the idea that we should all return to masking/distancing and ... what's actually happening across America. As 150 million people have gotten vaccinated, cases of COVID-19 are accordingly low in much of the U.S. Local regulations reflect that. I've been driving across the Midwest for the past week, and if I'd been frozen for a year and unthawed in Wisconsin, I wouldn't believe we're still in a pandemic. The state's case count's are roughly 1 percent what they were last November, and I've seen almost zero masks. The occasional, lingering, faded signs still telling people to stay 6 feet apart feel like ads for Virginia Slims or Crystal Pepsi, kitschy relics of a time we all desperately want to put fully behind us.
Last week, while I was driving, I did an interview with CNN, and Oliver Darcy asked me about this dissonance—the rift between alarming news stories about the delta variant and the reality of crowded bars and very low case counts. In New York City, where he was, he noted that there are many days where the COVID death counts are in the single digits or even zero (Down from nearly a thousand per day last Spring.) This rosy data doesn’t seem to square with cable news chyrons about a deadly variant taking over the country. Or, at least, the rift leaves people unsure what to do with both sets of facts.
I had hesitated to comment on this, because it's one of those situations where erring on the side of caution is clearly the safest thing for experts. And I understand why WHO might advise as it has, in the spirit of an abundance of caution and a world where very few people are yet vaccinated. There's also a bias among health experts: No one wants to be the one who downplays a risk and then people get hurt. I said that much in our interview, and overall the story implied that Americans might be incapable of admitting that the pandemic is going extremely well for us at the moment, and we should take a breath, enjoy the summer, and try to worry about other things for a moment.
I think this is a case where there isn't actually a contradiction. This variant is extremely bad. Also, things in most of the U.S. are, pandemic-wise, for now, very good. Both things are true. Both deserve to be acknowledged. The circumstances here could change. All the more reason to appreciate them now.
The delta variant has potential that needs to be taken very seriously before it gets out of hand locally. It warrants a very close eye. Even a small increase in transmissibility and/or disease severity can make a tremendous difference in a pandemic, where the number of cases is large. If you think of it like the interest rate on a big loan, even though the difference between 3 and 5 percent might sound trivial, it's not. For $300,000 mortgage, the latter would mean paying an additional $130,000. A similar effect in a virus can mean that even a minor difference in transmissibility can end up severely sickening or killing many, many more people as the spread continues.
And the fact that this is happening is especially tragic because the evolution of this virus could have gone in the direction of being less transmissible and/or less deadly. It's not in the interest of a virus to kill its hosts. So the sequence of variants we've seen emerge over this past year, in the dangerous direction, is extremely unfortunate, concerning, and newsworthy.
But the properties of a virus are only part of the story. The very existence of a dangerous variant doesn't change the day-to-day risk calculations for vaccinated people, living in highly vaccinated places, where the virus is not widely spreading. Variants don't determine our fate; people around us do. This is not a new virus, only a powerful reminder not to get complacent in the fight that never ended. The differences between variants are in degree, not nature. We know how to beat them.
When it comes to determining risk and making decisions about when to mask and distance, variants are a part of the picture. But no business, city, or school should base plans on the mere existence of a variant. The fact that delta is spreading in one population doesn't mean it will affect others with the same severity—especially given the dramatic disparities in vaccination status around the world. The fact that the other, objectively dangerous variants didn't cause huge surges in the U.S. is testament to the power of mass vaccination. My hope is that the same holds true for this variant.
The reason that stories about especially dangerous variants are worth knowing about because they should inform how we respond when we start to see a plateau or small uptick in cases. The more we know about how different variants spread—how they may affect vaccinated people, how severe the disease is—the more appropriately we can interpret early upticks in cases if and when they arrive. Local regulations will ideally reflect this variant's capacity to spread more quickly than other strains among unvaccinated people.
Vaccines may yet prove to be less effective against this variant compared to others. But, as best we know so far, vaccines are holding up very well in the ways that matter most: preventing severe disease. A WHO report from Tuesday found that the Pfizer mRNA vaccine protected people well against delta. On Thursday, a study in Nature found the same. Though it also said that the virus seems able to evade some antibodies that we produce in response to both vaccination and infection. And people who received only one dose of these vaccines seem much less likely to be adequately protected, underscoring the fact that it's very important to get both doses.
The value of distancing and masking is totally dependent on the amount of virus in your area, and the number of susceptible people. This same principle will guide us for the rest of the pandemic: The need for precautions will depend on the levels of virus and vaccination. The danger of any given variant cannot itself be quantified outside of that context. The aforementioned shark-stingray may be dangerous in the water, but not at all on land. In India, while the delta variant was wreaking havoc, some two percent of people were fully vaccinated. Similarly low levels of vaccination are still the case in much of the world, where people should be on high alert. In those places, especially when viral levels are high, precautions like masks and distancing will save more lives than they would be expected to in, say, New York City. Given all these variables, it will be nearly impossible for a global health entity to advise the entire world to wear masks (or not to). Advice should become more and more tailored to local situations.
At an individual level, the value of precautions will differ in the same way. Personally, I think about my own risk calculations as involving three things: the nature of the virus, level of exposure, and level of protection I have. I wouldn't mess around with more than one of those things at a time. In other words, you can have a very dangerous virus spreading around the world (which we do), but as long as you have good protection and low exposure, you don't panic. The reason the delta variant isn't changing my personal plans (yet) is that I already knew that SARS-CoV-2 is an extremely dangerous, highly transmissible virus. I've already been expecting a fall/winter surge. For now, I should have reliable protection via vaccination, as do my close contacts, and we live in places with high vaccination rates and very little virus. I go to restaurants and bars, but I'd stop doing that if those circumstances changed. Even as a healthy, vaccinated person, I don't plan to hang out breathing virus-laden air if it's possible not to. For now, the only thing delta changes is my level of concern about others, especially in places with low rates of vaccination.
Stories about dangerous variants will keep happening as long as the virus spreads widely around the world. And so the attendant level of uncertainty and less-than-total freedom from concern will linger, even among vaccinated people, if others don't get the shot. The process of vaccination isn't complete until it is ubiquitous. The goal is to drive the virus to such low levels that its evolution slows, and if new variants do arise, we're able to contain them before they've spread all over the world. But with each new variant, the story will always be fundamentally the same: Delta and other dangerous variants are a global threat because so many people around the world don't have access to vaccines, or are unwilling to take them.
I'm ready and willing to wear a mask in whatever situations it's helpful to anyone. But I understand it's also really nice not to have to. Especially after doing it for a year and a half. And part of the reason I think it's unwise to tell everyone to mask and distance now, even if they're vaccinated, is that we need to be careful about the overall effect of warnings. Especially when hesitant/skeptical people were just told that getting vaccinated would get them back to normal life, and may now see this as a contradiction, or may feel lied to. This messaging is tricky and, in the worst-case scenario, could cause people to throw up their hands and ignore future warnings, when they may matter much more.
I do worry that experts and news media have created and/or fed a numbness and indifference to COVID-19 by raising alarms about new variants before there is any actionable information to be conveyed. We absolutely need as much information to be available as possible, and people should be aware of how this virus is evolving and affecting the world. But stories shouldn't be framed as warnings or advisories when what people need is nuanced science coverage and non-alarmist context about what this may mean for them, both now and down the road.
In sci-fi movies, a virus "mutates" once and the world freaks out. Now it feels like that same dramatic narrative turn is happening every few weeks. At this point, I worry that if we discovered a new variant tomorrow that's 10 times more transmissible than delta, people may not have enough left in our adrenal glands to greet that news with anything more than an eye roll or a sigh. I doubt that even such catastrophic news would move people to get vaccinated who are set against it.
Oh, and: We need a universal COVID vaccine that protects against many or all possible variants. I've written about that already, and great work is being done in that area of research, but the concept still isn't getting enough attention. Each new variant of concern is a reminder.
Okay, I hope this was useful. Let me know what I've left out or if you see things differently. I'll add shorter update posts to this site as the story goes on, and I'll include links to them in the weekly newsletter (subscribe for free). If something urgent happens I may send it via email. If you know people who you think would like the letter, I'd appreciate if you'd share or tell them about it. Take care.
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