Q&A: What is driving the latest spikes in cases and how concerned should I be?

Daily cases of COVID-19 are on the rise, both in Maine and across the country. The seven-day average in Maine nearly tripled from 20 to 58 in the space of two weeks. And while the current averages are still well below the numbers from late spring – and a fraction of the worst of the pandemic at the start of the year – they are heading in the wrong direction.

Maine is doing better than most states due, in part, to a 60% vaccination rate that is higher than almost every other state. Nationally, the seven-day average of new cases has jumped 53% over the past week, while hospitalizations have increased 32% and COVID-related deaths have increased 19% since last week federal officials said Thursday.

How much of a factor is the delta variant?

The so-called delta variant, a mutation first detected in India that is spreading across much of the world, is definitely in Maine. However, the extent to which it contributes to and / or is responsible for higher local case rates is less clear.

The United States Centers for Disease Control and Prevention estimated this week that the delta variant accounts for 83% of all new COVID-19 cases in the United States.

The latest report on genomic sequencing of positive cases from the Maine Center for Disease Control and Prevention is more than two weeks old and includes information as far back as three weeks. More up-to-date figures could be available on Friday, a Maine CDC spokeswoman said.

That July 9 report showed that only five cases of the delta variant had been verified out of the 4,631 positive COVID-19 cases that had been sequenced by labs for the Maine CDC as of July 3. There were five other suspected but unconfirmed cases.

But NorDx labs operated by MaineHealth have regularly screened the delta and found that 18 of 49 tests, or 37%, had been done since July 1 “screened positive” for the variant. Testing is only a preliminary method, however, and any positive results in this small subset of positive COVID cases examined by the NorDx Lab should be confirmed by genomic sequencing.

Either way, health officials say the delta variant is more prevalent in Maine than these numbers suggest, as only a small portion of all positive COVID-19 cases are sequenced.

“Our clinical interest (in the delta variant) is less and less because we know it is there, we know it is spreading and that it has no clinical application for the patient in front of you” said MaineHealth spokesperson John Porter.

In other words, infection with the delta variant “does not change the course of treatment” for the patient compared to infection with the British variant (alpha) or the strain of coronavirus that was dominant in the United States l ‘last year.

Who is catching the virus now?

Unvaccinated people account for the vast majority of new cases, both in Maine and nationally. Unvaccinated people are also responsible for nearly all deaths and hospitalizations from the virus, which public health officials say underscores the effectiveness of vaccines.

Nationally, 97% of all hospitalizations are to people who have not been fully vaccinated against COVID-19 and about 99% of deaths are to people who have not been vaccinated, according to federal officials.

The Maine CDC does not regularly report the distribution of those vaccinated versus unvaccinated in new cases and hospitalizations.

But Dr. Dora Anne Mills, director of health improvement for MaineHealth and former director of the Maine CDC, suggested that what the health network sees in hospitalizations reflects the national trend. Those who are hospitalized tend to be younger than last year and, unlike a month ago, when most were from rural Maine, “they’re from all over Maine.”

“The only thing they have in common, by far, is that the very, very large majority of them are not vaccinated,” Mills said Wednesday on Maine Public radio’s “Maine Calling” program. .

“This is becoming a disease of unvaccinated people and especially younger people,” added Dr James Jarvis, Northern Light Health’s chief medical officer for Incident Command.

What about “revolutionary” cases among vaccinated people? And should I be worried about catching the virus even though I am fully vaccinated?

According to the most recent statistics from the Maine CDC, there have been 560 so-called “revolutionary” cases among those fully vaccinated out of nearly 70,000 total cases of COVID-19 in the state. Fewer than 10 of the 891 people whose deaths are linked to COVID have been fully vaccinated, and all of those people had other serious health issues, Maine CDC director Dr Nirav Shah said earlier this week.

“When the number of people vaccinated increases, the number of breakthrough cases continues to increase, even though the rate is really low,” Shah said. The important thing to remember, Shah said, is that these people are at a much lower risk of getting a serious case.

Peak infections are inevitable with any vaccine because no vaccine is 100 percent effective. Pfizer and Moderna have been shown to be around 95% effective against the virus, and the Johnson & Johnson single-dose vaccine has been shown to be approximately 85% effective against serious illness.

But because vaccines help the body fight infection, vaccinated people are considerably less likely to develop severe symptoms or die from COVID-19 than unvaccinated people.

“Being fully vaccinated gives you a high degree of protection against infection and an even greater degree of protection against serious illness, hospitalization and death,” Dr. Rochelle Walensky, director of the US CDC, said on Thursday. a White House COVID briefing. -19 intervention team. “That’s what these vaccines are designed for and what the clinical trials have looked at, and vaccines generally do their job quite well. These vaccines are among the most effective we have in modern medicine. “

Do some vaccines offer better protection against the delta variant than others? And will I need a reminder?

Medical researchers have been rushing to assess the effectiveness of various vaccines against delta variants (as well as worrying earlier variants) in recent months.

The most recent study, published this week in the New England Journal of Medicine, found that two doses of the Pfizer vaccine were 88% effective against developing symptomatic disease due to the delta variant. An earlier study in Israel found the Pfizer vaccine to be 64% effective against the variant.

There have been fewer studies of the two-shot Moderna vaccine, although a Canadian study found it to be about 72 percent effective against symptomatic delta variant disease.

Johnson & Johnson said this month that its single-dose vaccine was effective against the delta variant for as long as eight months after inoculation. But a study published this week – which has yet to be peer reviewed – suggested the J&J vaccine was less effective than the Pfizer and Moderna vaccines, which use different technology.

Asked Thursday about potential “booster shots” for recipients of J&J, the country’s leading infectious disease specialist, Dr Anthony Fauci replied: “The J&J vaccine… is a very effective vaccine. There is no reason to believe at this time that people who have taken the J&J vaccine need a booster. “

With the increase in cases, should even vaccinated people consider wearing masks in public again?

It’s a question a lot of people are asking in Maine and across the country.

Los Angeles County, for example, reimposed mandatory masking in indoor public places earlier this month as cases rose again. In fact, indoor masking is now recommended (but not required) in a third of counties in California, the Los Angeles Times reported.

And the American Academy of Pediatrics this week released new guidelines saying that anyone over the age of 2 should wear masks inside schools regardless of their immunization status to protect children who are not yet. eligible for vaccination.

Unvaccinated people are still expected to hide inside stores or in crowded places. But a resurrection of mask mandates for everyone seems unlikely in Maine or most states anytime soon given public (and political) opposition.

During the White House COVID team briefing Thursday, Walensky, along with the US CDC, was repeatedly asked whether fully vaccinated people should consider wearing masks again due to the overall increase in cases and of the inevitable increase in breakthrough cases.

“If you are not vaccinated, you absolutely have to wear a mask,” Walensky said. “If you are vaccinated you have exceptional levels of protection against this vaccine and you can choose to add an extra layer of protection by putting on this mask. And that’s a very individual choice.

Mills, the former director of the Maine CDC who is now at MaineHealth, admitted that she always wears a mask with her everywhere and that she will put it on in certain situations, such as walking into a crowded grocery store where some people may not be. vaccinated. She and Jarvis of Northern Light Health said those vaccinated should also consider masking themselves when in close proximity to immunocompromised individuals or children too young to be inoculated.

Mills, who is Governor Janet Mills’ sister, compared the current situation to Maine’s notoriously erratic weather: Even though it was hot today, it’s best to look at the forecast to see if you’ll need a coat tomorrow.

“I think we kind of have to get used to understanding what’s going on in our state and in our community: where am I going to be and who am I going to meet? Mills said on “Maine Calling”. “Am I going to meet people who are immunocompromised or too young to get the vaccine?… So even if you are vaccinated, there are times when you might want to consider wearing extra layers of protection like a mask. , physical distance and making sure you are in a well ventilated area.

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