Delta Essentially a New Coronavirus

Behind the CDC's messaging debacle.

WaPo (“‘The war has changed’: Internal CDC document urges new messaging, warns delta infections likely more severe“):

The delta variant of the coronavirus appears to cause more severe illness than earlier variants and spreads as easily as chickenpox, according to an internal federal health document that argues officials must “acknowledge the war has changed.”

The document is an internal Centers for Disease Control and Prevention slide presentation, shared within the CDC and obtained by The Washington Post. It captures the struggle of the nation’s top public health agency to persuade the public to embrace vaccination and prevention measures, including mask-wearing, as cases surge across the United States and new research suggests vaccinated people can spread the virus.

The document strikes an urgent note, revealing the agency knows it must revamp its public messaging to emphasize vaccination as the best defense against a variant so contagious that it acts almost like a different novel virus, leaping from target to target more swiftly than Ebola or the common cold.

It cites a combination of recently obtained, still-unpublished data from outbreak investigations and outside studies showing that vaccinated individuals infected with delta may be able to transmit the virus as easily as those who are unvaccinated. Vaccinated people infected with delta have measurable viral loads similar to those who are unvaccinated and infected with the variant.

“I finished reading it significantly more concerned than when I began,” Robert Wachter, chairman of the Department of Medicine at the University of California at San Francisco, wrote in an email.

CDC scientists were so alarmed by the new research that the agency earlier this week significantly changed guidance for vaccinated people even before making new data public.

The data and studies cited in the document played a key role in revamped recommendations that call for everyone — vaccinated or not — to wear masks indoors in public settings in certain circumstances, a federal health official said. That official told The Post that the data will be published in full on Friday. CDC Director Rochelle Walensky privately briefed members of Congress on Thursday, drawing on much of the material in the document.

That the “science” keeps changing is unsurprising. We only know what we know when we know it. It’s what makes a “novel coronavirus” novel. But the messaging has been awful, with policy recommendations seemingly out of sync with what’s being said about the virus. And the CDC is well aware of this:

The document outlines “communication challenges” fueled by cases in vaccinated people, including concerns from local health departments about whether coronavirus vaccines remain effective and a “public convinced vaccines no longer work/booster doses needed.”

The presentation highlights the daunting task the CDC faces. It must continue to emphasize the proven efficacy of the vaccines at preventing severe illness and death while acknowledging milder breakthrough infections may not be so rare after all, and that vaccinated individuals are transmitting the virus. The agency must move the goal posts of success in full public view.

If in fact vaccinated folks are transmitting the virus at nearly the same rate as the unvaccinated, the new masking guidance makes sense. Given that speed is of the essence, I even understand why CDC issued its rapid about-face earlier in the week. But it should certainly have been accompanied by this new information.

But, yes, the messaging seems mixed:

  1. Vaccination is essential to stop the transmission of this disease
  2. Vaccination does little to stop the transmission of this disease
  3. Regardless, vaccinated people are much les likely to suffer severe symptoms if they’re infected

And it gets worse:

The CDC’s revised mask guidance stops short of what the internal document calls for. “Given higher transmissibility and current vaccine coverage, universal masking is essential to reduce transmission of the Delta variant,” it states.

The document makes clear that vaccination provides substantial protection against the virus. But it also states that the CDC must “improve communications around individual risk among [the] vaccinated” because that risk depends on a host of factors, including age and whether someone has a compromised immune system.

Now, again, this is incredibly complicated. Public health policy isn’t just about science but also about politics. The CDC has to balance its messaging with the political reality that huge swaths of the public are reluctant to get vaccinated, for a whole variety of reasons, and that there is massive resistance to masking and other preventative measures. But they’re not helping themselves:

The internal document contains some of the scientific information that influenced the CDC to change its mask guidance. The agency faced criticism from outside experts this week when it changed the mask guidance without releasing the data, a move that violated scientific norms, said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center at the University of Pennsylvania. “You don’t, when you’re a public health official, want to be saying, ‘Trust us, we know, we can’t tell you how,'” Jamieson said. “The scientific norm suggests that when you make a statement based on science, you show the science. … And the second mistake is they do not appear to be candid about the extent to which breakthroughs are yielding hospitalizations.”

Again, speed was of the essence. It’s quite possible that CDC reached its conclusions before it had fully vetted the report for public release. But they could certainly have released an Executive Summary with a promise that the full report would follow in a matter of days. As it was, the guidelines appeared to come out of nowhere and, indeed, contradict the CDC’s own messaging.

A related NYT report (“Behind the Masks, a Mystery: How Often Do the Vaccinated Spread the Virus?“) adds:

People with so-called breakthrough infections — cases that occur despite full vaccination — of the Delta variant may be just as contagious as unvaccinated people, even if they have no symptoms.

That means fully immunized people with young children, aging parents, or friends and family with weak immune systems will need to renew vigilance, particularly in high-transmission communities. Vaccinated Americans may need to wear masks not just to protect themselves, but everyone in their orbit.

That’s sobering but seems to contradict this:

It’s still unclear how common breakthrough infections are and how long the virus persists in the body in those cases. Breakthroughs are rare, and unvaccinated people account for the bulk of virus transmission, Dr. Walensky said.

But this seems like a rather huge takeaway being buried in the new news:

The new data do not mean that the vaccines are ineffective. The vaccines still powerfully prevent severe illness and death, as they were meant to, and people with breakthrough infections very rarely end up in a hospital.

About 97 percent of people hospitalized with Covid-19 are unvaccinated, according to data from the C.D.C. But scientists warned even last year that the vaccines might not completely prevent infection or transmission. (Immunity from natural infection may offer even less protection.)

The larger takeaway may be even more stark than the short-notice policy change. Back to the WaPo report:

If the war has changed, as the CDC states, so has the calculus of success and failure. The extreme contagiousness of delta makes herd immunity a more challenging target, infectious-disease experts said.

“I think the central issue is that vaccinated people are probably involved to a substantial extent in the transmission of delta,” Jeffrey Shaman, a Columbia University epidemiologist, wrote in an email after reviewing the CDC slides. “In some sense, vaccination is now about personal protection — protecting oneself against severe disease. Herd immunity is not relevant as we are seeing plenty of evidence of repeat and breakthrough infections.”

The document underscores what scientists and experts have been saying for months: It is time to shift how people think about the pandemic.

Kathleen Neuzil, a vaccine expert at the University of Maryland School of Medicine, said getting more people vaccinated remains the priority, but the public may also have to change its relationship to a virus almost certain to be with humanity for the foreseeable future.

“We really need to shift toward a goal of preventing serious disease and disability and medical consequences, and not worry about every virus detected in somebody’s nose,” Neuzil said. “It’s hard to do, but I think we have to become comfortable with coronavirus not going away.”

That the virus would always be with us in some form was, I think, well understood quite some time back. But, yes, mitigating the effects is likely the best we can do if the vaccines don’t stop transmission.

Oh: Delta isn’t the end of it.

WaPo (“Another coronavirus variant has reached Florida. Here’s what you need to know.“):

coronavirus variant discovered in Colombia is showing up among patients in South Florida, increasing infections and putting health officials on alert as calls grow louder for unvaccinated individuals to get inoculated.

Carlos Migoya, CEO of Jackson Health System, told WPLG in Miami earlier this week that the B.1.621 variant has accounted for about 10 percent of coronavirus patients, trailing behind delta, the now-dominant variant in the United States that has been ravaging the nation’s unvaccinated, and the gamma variant. B.1.621 has yet to receive a Greek-letter designation as more prominent variants have.

Migoya told the news station that he speculated B.1.621 is rising in South Florida because of international travel between Colombia and Miami, which serves as a gateway to Latin America.

A person who replied to an email sent from The Washington Post to Migoya’s office said he was unavailable to comment.

Health experts will keep B.1.621 on their radar as the fall season looms and as parts of the country still lag in their vaccination efforts, experts told The Post.

So yay.

FILED UNDER: COVID-19, Health
James Joyner
About James Joyner
James Joyner is Professor and Department Head of Security Studies at Marine Corps University's Command and Staff College and a nonresident senior fellow at the Scowcroft Center for Strategy and Security at the Atlantic Council. He's a former Army officer and Desert Storm vet. Views expressed here are his own. Follow James on Twitter @DrJJoyner.

Comments

  1. Tony W says:

    Science changes recommendations when new information is received. This is anathema to conservatives who take a position, then curate the information to that position.

    The biggest failure here is within our educational system, not the CDC messaging.

    38
  2. Teve says:

    A months ago I wasn’t worried about getting Covid cuz vaxxed. Now I’m pretty sure I’ll get it, but also pretty sure it won’t be a big deal to me.

    In the last 2 weeks Florida new cases have shot upward faster than ever. Gonna be a lotta Trump flags flying at half mast soon.

    4
  3. Scott says:

    @Tony W:

    This is anathema to conservatives who take a position, then curate the information to that position.

    I think it is more than conservatives, it is lawyers who do this. And lawyers make up the vast bulk of our politicians. I notice this of my legislative leaders. They simply can’t keep up with the changes and what they don’t understand. Hence, the public outrage and churn.

    11
  4. grumpy realist says:

    Guess we’re going to have to learn again the hard way that reality doesn’t work like a Disney movie.

    I suspect we’re going to look back at the period between 1960-2018 and say to ourselves “that was a golden age, where we didn’t have to worry about illnesses because we had vaccines…no polio, no measles, no whooping cough, no smallpox, no coronavirus…”

    We’ve been living on borrowed time for a while. It was just obvious that at some point some new virus would pop up and start cutting a swathe through humanity. And we, gullibly, took our protection for granted. The fact that we have very rapidly been able to develop a vaccine for Covid that produces good immunity is due to our technology. And there’s nothing in the world that mandates Covid from mutating again into something that can get around present day vaccines, so yes, I expect at some point we’ll be having yearly boosters to deal with whatever this year’s variant is.

    ….and as for the people who refuse vaccinations? Well, if you want to live dangerously, go ahead…

    5
  5. Scott says:

    @Teve: If your vaccinated, you still probably won’t get it. The issue now is that the delta variant reproduces at a much higher rate and is more transmissible. Both of us are probably delta variant carriers (like we carry rhino viruses, staph, and other pathogens) but our immune systems readily handle it. The unknown question is how much virus spreading are we doing. The unvaccinated are the ones at risk. Have a care about those under 12 and those who are immunocompromised. No sympathy for the rest.

    7
  6. Kathy says:

    If you want to cut through all the noise and data and uncertain conclusions, here it is:

    Wearing a mask is harmless at worst and protects you and others from the virus at best.

    20
  7. James Joyner says:

    @Tony W:

    Science changes recommendations when new information is received. This is anathema to conservatives who take a position, then curate the information to that position.

    But this simply isn’t what’s happening here. The CDC recommendations have often been off from “the science.” It gave us the wrong information on masking in order to preserve the supply of masks for medical personnel. It was way overcautious on schools and outdoor spaces long after the science was clear. It way overcompensated on green-lighting the vaccinated to go maskless without a plan in place to ensure that the unvaccinated were identifiable and wouldn’t simply unmask. Now, it is simultaneously issuing guidance that’s more cautious than its own science would indicate and yet announced it days ahead of releasing the explanation. It’s a messaging problem, not a Bayesian adjustment issue.

    14
  8. Daryl and his brother Darryl says:

    It’s just staggering to me how much effort the RepubliQan party is putting into fighting anything and everything having to do with this plague…the plague that their incompetence allowed to run rampant in the first place.
    We have what we need to stop this virus and yet these morons are, judging purely by their actions, only interested in advancing it.
    The RepubliQan party is now almost completely pro-plague, and anti-Constitution.

    6
  9. Jen says:

    This is precisely why some of us were so astonished when the CDC rescinded the mask mandate in May for vaccinated people.

    That was done as a “reward” for people getting vaccinated, essentially a demonstration that we could all get back to normal if we’d only take our shots. It was designed to be an incentive but instead what happened was exactly what those of us who had been paying attention SAID would happen:

    Vaccinated people went without their masks; and
    Unvaccinated people decided this confirmed their beliefs that this was NBD; and
    A new variant took advantage of this.

    Again, a lot of us said that the CDC’s decision in May was premature. We were chided as being too timid, and that people wouldn’t get vaccinated if they couldn’t reap the benefits of a return to normalcy ASAP.

    10
  10. charon says:
  11. Tony W says:

    @James Joyner: I do think the CDC is accustomed to having doctors and other experts interpret and buffer their recommendations, rather than having the public consume their information raw. Most of your examples stem from rapid-fire CDC bulletins that were formerly buffered by their irrelevance to the majority of the population.

    One wonders what would have happened had Trump simply followed the Obama pandemic plan that was so carefully considered. I imagine communication must have been a big part of it.

    6
  12. charon says:

    thread:

    https://twitter.com/PeterHotez/status/1421064235589722114

    Based on the internal CDC document released (leaked) last night, it’s possible we’ll accelerate towards a third mRNA immunization – certainly for those on immunosuppressive Rx and older groups – but also possibly universal for those eligible, that + universal masks.

    1
  13. Kathy says:

    Remember earlier this year India dropped many COVID precautions and experienced an explosive growth in infections, hospitalizations, and deaths? That was the world debut of the Delta variant. There’s no need to figure out how bad it is, we already know.

    The big difference is there had been little vaccination in India at the time. The UK is further along in vaccinations compared to the US, and they’ve had a bad case of Delta as well. Even countries that had contained the virus are experiencing Delta outbreaks now.

    It’s that bad.

    Put on a mask.

    5
  14. Scott says:
  15. Mikey says:

    @charon:

    Based on the internal CDC document released (leaked) last night, it’s possible we’ll accelerate towards a third mRNA immunization

    If Pfizer is accurate in their assessment a booster would be desirable at around six months after initial vaccination, I’d be up for one now. Please figure this out, CDC.

    2
  16. Michael Cain says:

    @Kathy:

    Wearing a mask is harmless at worst and protects you and others from the virus at best.

    Absolutely. But the CDC didn’t dare say that at the beginning, when there was a chance that it would be well received. The US supply chain ran through China (who predictably stopped exports early on) and stockpiles were sized for the routine use of front-line medical staff and industrial workers with dust exposure. When the run on masks happened, we ran out. Then there was all the waffling about homemade cloth masks. I can’t speak for anyone else, but in our household the little stock of medical supplies now includes not only some over the counter meds and first-aid supplies, but a package of 10 unopened KN95 masks.

    The one thing we can unambiguously blame the CDC for was screwing up their test development, so there was no chance of doing widespread testing early on.

    4
  17. Michael Cain says:

    @Mikey:

    If Pfizer is accurate in their assessment a booster would be desirable at around six months after initial vaccination, I’d be up for one now. Please figure this out, CDC.

    FDA’s call, not the CDC’s. It’s unclear, at least to me, whether the CDC has or even can have access to any of Pfizer’s or Moderna’s clinical test data.

    2
  18. Gustopher says:

    @Kathy: And, Delta retreated very suddenly in India, and is doing so in the UK, and we don’t know why — it doesn’t fit with the models*.

    So, a few things we don’t know seem to be good things. It’s bad — really, really bad — but not as bad as we would predict. Yey.

    Vaccines and masks are still the best idea going forward. And those who are immune compromised should just hide out at home and try to skip getting exposed this wave.

    ——
    *: unfounded speculation time! 70% of Indians now test positive for Covid antigens, and the virus retreated despite an R0 high enough that herd immunity should be way above that. I suspect some people might be naturally immune and so we have the wrong denominator — if the virus can’t attach to 25% of the population at all, they would have a roughly 90% antigen rate among the 75% of the population that can get it. India might be close to done, except for reinfections. That would be nice. I think I just want all of this to be over, one way or another.

  19. Just nutha ignint cracker says:

    @Tony W: I’m going to beg to differ with you on that “the problem is with education” thing. I was instructed by my administrators to remind the students I was contacting in classrooms where I was teaching that the fact that infection rates were much lower was not the same as infection being non existent and that the jury was still out about how “non-contagious” the vaccinated were, so students needed to keep their masks on in class and make sure their masks covered their faces correctly. This was late May and early June.

    If there has been a problem with education, it lies in the fact that people pretty routinely suffer from hardness of listening. Even here, our relatively educated and aware commentariat was crowing about going out and licking doorknobs now that we’re vaccinated. Yes, I knew it was hyperbole, but it’s still indicative of people who heard what they wanted to hear, not what was actually said.

    4
  20. Scott says:

    A dubious bright spot.

    It looks like (if India and UK are typical), the Delta variant will blaze very hot but will burn out relatively quickly.

    2
  21. Raoul says:

    I get the impression that removing the first mask guidance a couple months ago was done impulsively and without any deliberation. They could easily waited as the situation was too fluid and infirm. And by removing the guidance for people with shots they made it too easy for anti-vaxxers. Just plain dumb. My quick take on a booster shot – let’s do it. Since the vaccine goes down in effectiveness 10% after six months, a booster shot would have a real life impact. I’m not sure why there is even any hesitation.

    2
  22. grumpy realist says:

    @Gustopher: Do we really know that the Delta variant is going down in India, or is it that they’ve stopped testing?

    When the government doesn’t even bother to collect the correct statistics, why should we believe any of their optimistic comments? (Here’s looking at you, Flori-DUH…)

    1
  23. gVOR08 says:

    @Kathy:

    Wearing a mask is harmless at worst and protects you and others from the virus at best.

    What Kathy said. It seems like a very simple cost/benefit analysis. Cost, essentially zero. Benefit, modest probability of preventing getting or transmitting a potentially deadly disease. What’s the problem here?

    Late yesterday I dropped a comment in the Who Decides American History post quoting a Kevin Drum article for Mother Jones in which he digs into polarization and makes a pretty convincing case that the cause is FOX “News”, end of story. FOX is the problem here.

    5
  24. Kathy says:

    @Just nutha ignint cracker:
    @Raoul:

    Cast your mind back to May and June of 2020, which now seems like paradise as regards cases, and you may recall there was an urge to reopen, and a plan to do so in stages depending on how case numbers went down.

    These plans were not followed. States reopened haphazardly more or less at whim. Remember how they shot up during the summer?

    The problem I see with allowing those vaccinated to remove their masks, aside from the fact that non-vaccinated people just tagged merrily along, is that there shouldn’t be any incentive needed to get vaccinated other than “this will greatly lower your chances of sickness, hospitalization, and death.”

    I don’t mean no other incentives should be offered. But rationally what other incentive do you need in the middle of the worst, deadliest pandemic in living memory? Yes, there will always be covidiots who still think this is a hoax, but even here we had many reasonable people saying “Ok. I got vaccinated, now what benefit do I get?”

    We will be able, eventually, to leave the masks behind. When? When cases drop to very low levels, so catching COVID is unlikely whether you’re vaccinated or not. that’s when. We gain nothing by trying to declare the pandemic over before it’s over.

    3
  25. Mikey says:

    @Michael Cain: My understanding is while the FDA handles the testing and authorization pieces of vaccine administration, the CDC would issue the actual recommendation for a booster. Perhaps I’m incorrect.

  26. Kathy says:

    @Raoul:

    My quick take on a booster shot – let’s do it. Since the vaccine goes down in effectiveness 10% after six months, a booster shot would have a real life impact. I’m not sure why there is even any hesitation.

    It’s not hesitation, but simple lack of knowledge.

    Will a third shot increase immunity? If it does, by how much? Would it be better to develop a Delta specific booster? maybe a multivalent variant specific booster? Would one multivalent or delta variant specific be enough, or would we need two?

    We do have a notion of how this will work, but there’s no substitute for an adequate clinical trial. So we should wait for that.

    Add the fact that vast swaths of the world not only remain unvaccinated, but lack the vaccine doses they need, and just adding a third shot in places with vaccine surplus doesn’t look as good. remember, every dose needed means making 7.5 billion doses for the whole world. Given some vaccines work on one dose, this means around 12+ billion doses or so (likely more). With a third shot needed, that’s at least 7.5 billion more doses on top of that.

    5
  27. KM says:

    @Tony W:
    The conservative mind doesn’t not like change – that’s why they want to conserve what is or was rather than progress to what can be. They like the idea of immutable, unchanging truth which is why fundamentalism is so deeply tied to conservatism – A is A and ever shall it be, only changing if it absolutely must and only after kicking and screaming for decades.

    This is a major reason why conservatives treat science the same way they treat faith and derisively complain it’s “wrong” because it “changes when needed”. It is unsettling that our understanding of the world can shift because we have an incomplete perception of reality; you always exist in a state of potentially incorrect understanding as we are always learning and adjusting our worldview. To be incorrect in your faith is to risk damnation so it’s imperative to follow the proper Way. That scientist can freely admit we’re wrong and this is the new Way is jarring to that mindset – how can you ever be sure you’re “right” other than by faith?

    They think changing information should not lead to changing protocols because we should have had it right from the start. That we were failable and struggling to make sense of a brand-new pandemic doesn’t matter – A is A and you can’t tell them this is the new Way.

    7
  28. Cheryl Rofer says:

    @James Joyner: For those of us who understand exponential functions, there is no such thing as overcautious. Hit it hard and hit it early, when the nonmathematical think there’s no problem. If there is a single mistake that has made, and keeps making, the pandemic worse, thinking that there is such a thing as overcaution is it.

    Graphic here to illustrate.

    7
  29. Gustopher says:

    @grumpy realist:

    Do we really know that the Delta variant is going down in India, or is it that they’ve stopped testing?

    India has poor testing data due to access and availability issues — the 70% number is from a sampling around the country, for instance.

    But, India has pretty good data on hospital admissions and deaths in hospitals (deaths outside of hospitals… not so much).

    And, we are beginning to see the same decline happen in the UK, where they have better testing and reporting.

    So, I’m mildly hopeful that the fine folks in India have gone through the worst of the pandemic. (I would certainly hate for them to have to go through worse…)

  30. Andy says:

    There’s a lot of unpack here, but I’ll just touch on the high points.

    Covid is an endemic disease. This was always the most likely conclusion but if this data is accurate, then it is certain. The strategic goal of beating or eliminating the virus must therefore change to reflect reality.

    We appear to be in a situation where vaccines provide excellent immunity against the effects of the virus but do not prevent catching or transmitting the virus. This situation has the following implications IMO:

    – Vaccination is no longer about herd immunity. If vaccinated people can catch and transmit the virus to others, then herd immunity is impossible. Therefore, vaccination is about protecting individuals.

    – An endemic virus that can be transmitted by vaccinated people makes masking less relevant as a tactic to combat the virus and not more relevant. The only reason a general masking recommendation makes sense now is to slightly lower the curve and buy some time for the unvaccinated to get the shot, or to prevent overcapacity of medical resources such as hospital beds. Masking will, of course, still be relevant in specific situations such as medical, elder care, and similar facilities as well as among the immunocompromised. But people also need to realize that masking is not a shield, especially given the way most regular Americans are wearing masks.

    – The CDC recommendations for general masking in areas with a high number of cases seems particularly useless akin to closing the barn door after the horses have already escaped. It makes more sense, to me at least, to institute masking in the areas that aren’t yet overrun with Delta for reasons that I think should be obvious, but that’s not what the CDC has done.

    – There needs to be much more focus on the FDA and the process for the full approval for the vaccines. I continue to be perplexed by the lack of attention to this since it is such a key requirement, particularly for the legality of any government vaccination mandate. We hear many people talk about the need for mandates, including on this blog, but few seem to go any further than that as if such sage advice will magically manifest out of the ether. The reality, to paraphrase Don Rumsfeld, is that you go into a pandemic war with the bureaucracy you have, not the bureaucracy you might want or wish to have at a later time.

    The FDA should be regularly updating the public on the status of the licensing process along with estimates for when the requirements will be completed. The Biden administration, similar to what was done with Operation Warp Speed, needs to clear the runway and ensure that the licensing requirements proceed as quickly and smoothly as practicable. Unfortunately, there does not seem to be any sense of urgency on this score, but perhaps things are happening behind the scenes. It would be nice if our incurious news media would take a greater interest in this instead of handwaving about mandates and focusing on every culture war angle regarding this pandemic.

    Full licensing of the vaccines is the most critical goal right now. With full licensing, the government will have the authority to mandate vaccines for government employees and especially workers who serve vulnerable populations.

    Everyone else can choose to reject the vaccine and gamble their own lives and suffer the consequences. At this point, I don’t feel the need to try to protect idiots from themselves.

    6
  31. Kathy says:

    @Andy:

    An endemic virus that can be transmitted by vaccinated people makes masking less relevant as a tactic to combat the virus and not more relevant.

    Exactly the contrary.

    The main reason to wear masks is that asymptomatic and presymptomatic people can transmit the virus. Prior to Delta, transmission from vaccinated individuals was low to nil. Now it’s not. We must make an effort to reduce or stop transmission, therefore we should all wear masks.

    8
  32. Andy says:

    @Kathy:

    The main reason to wear masks is that asymptomatic and presymptomatic people can transmit the virus. Prior to Delta, transmission from vaccinated individuals was low to nil. Now it’s not. We must make an effort to reduce or stop transmission, therefore we should all wear masks.

    That only makes sense if Covid is not endemic, unless you expect people to mask forever. Because this virus is not going away. Stopping the transmission of a virus that is as contagious as chickenpox and can be carried and spread by vaccinated people is a fantasy.

    We need to start treating our management approach to this disease more along the lines of the flu – a persistent and endemic threat and not like we are attempting to eradicate smallpox or measles. Eradication is hopeless at this point with the tools we have available.

    4
  33. grumpy realist says:

    I think a lot of the hesitation w.r.t. boosters and things like that is we’re very much peering into a glass darkly. Is the Delta variant the one we really need to protect ourselves from? Or is there another, even nastier one just about to pop out on the scene that we should be girding up for? And how quickly does this bloody virus mutate, anyway?

    There was all the fuss about the P-1 variant from Brazil a few weeks back, and now we’re all worried about the Delta variant instead. It’s a fluid situation, and it’s not like it’s something where you can go look up the answers in a book–it depends on the gathering and analysis of statistics, which in turn are only as good as the testing.

    2
  34. R. Dave says:

    James Joyner (OP):

    A related NYT report (“Behind the Masks, a Mystery: How Often Do the Vaccinated Spread the Virus?“) adds:

    People with so-called breakthrough infections — cases that occur despite full vaccination — of the Delta variant may be just as contagious as unvaccinated people, even if they have no symptoms….

    That’s sobering but seems to contradict this:

    It’s still unclear how common breakthrough infections are and how long the virus persists in the body in those cases. Breakthroughs are rare, and unvaccinated people account for the bulk of virus transmission, Dr. Walensky said.

    I don’t think that’s technically contradictory, even if it is ripe for misunderstanding. Basically, if you’re vaccinated, you’re still much less likely to get infected, but if you do get infected, you’re just as capable of transmitting Delta to others as someone who is unvaccinated. So, more unvaccinated people overall get infected in the first place and thus still account for most of the transmission that’s occurring.

    3
  35. Kathy says:

    @Andy:

    The point is to stop the outbreak, which has been going on for almost 20 months now. If you had like dozens of new cases daily and nothing more, if they don’t grow exponentially, then, yes, you can drop the horrid masks at long last. While there are tens of thousands of daily case, no.

    We need to start treating our management approach to this disease more along the lines of the flu – a persistent and endemic threat and not like we are attempting to eradicate smallpox or measles.

    Flu doesn’t kill half a million people per year in America alone. COVID is not flu or the common cold.

    7
  36. Andy says:

    @Kathy:

    Flu doesn’t kill half a million people per year in America alone. COVID is not flu or the common cold.

    I never said that Covid was like flu. I’m talking about the management strategy over the long term, and am not making any comparison of the kind that you are suggesting.

    The point is to stop the outbreak, which has been going on for almost 20 months now.

    The most important element to achieving that is getting as many people vaccinated as possible. There are pretty much zero issues related to vaccine access, so the problem is convincing people to get the shots. Everything else is secondary. Yeah, we are still having an outbreak despite 20 months of masking and lockdowns and other things. And the outbreaks are not going to stop until many more people are vaccinated, particularly since this virus is regularly mutating. Masking was always an interim strategy to delay spread because we lacked a vaccine or other tools to address the outbreak.

    The solution is vaccination and there’s a limit on how much accommodation we should give to those who refuse to get vaccinated.

    3
  37. Jen says:

    @Andy:

    We need to start treating our management approach to this disease more along the lines of the flu – a persistent and endemic threat and not like we are attempting to eradicate smallpox or measles. Eradication is hopeless at this point with the tools we have available.

    Adding to Kathy’s point that this isn’t the flu–it’s clearly killed more people–you might be underestimating the impact of long covid issues. So far, there are signs that:

    Covid is linked to cognitive decline similar to Alzheimers (link)

    Almost half of the kids that recover from covid have lingering health issues (link)

    We know that there’s no link to covid illness severity and the severity of long-haul health problems. In fact, some people have found out that they had asymptomatic covid cases when they went to the doctor after post-covid issues surfaced.

    Adding to that, we don’t know what happens with variants–some are more serious (delta)–so what’s next? Super-delta? Will omicron be delta with a higher death toll? Will tau cause sudden strokes in half of those infected? Etc.

    It’s a bit optimistic (or arrogant?) to say we just have to live with it at this point when we aren’t sure what’s next.

    6
  38. charon says:

    @Jen:

    We know that there’s no link to covid illness severity and the severity of long-haul health problems. In fact, some people have found out that they had asymptomatic covid cases when they went to the doctor after post-covid issues surfaced.

    Not true, there is a strong correlation between severity of illness and likelihood and severity of knock on effects.

    1
  39. Kathy says:

    @Andy:

    If vaccinated people are spreading Delta, then vaccinated people need to wear masks in order to stop spreading Delta. This would still be true even if 100% of the population were vaccinated.

    5
  40. Andy says:

    @Jen:

    Adding to Kathy’s point that this isn’t the flu–it’s clearly killed more people–you might be underestimating the impact of long covid issues. So far, there are signs that:

    Covid is linked to cognitive decline similar to Alzheimers (link)

    Almost half of the kids that recover from covid have lingering health issues (link)

    As I said to Kathy, I did not make the comparison you think I made. Yes, Covid is deadlier than the flu, I never suggested otherwise. The point is about the model to manage the virus, and I made no other direct comparison. I stated clearly that Covid is almost certainly endemic – meaning we are not going to ever get rid of it.

    Adding to that, we don’t know what happens with variants–some are more serious (delta)–so what’s next? Super-delta? Will omicron be delta with a higher death toll? Will tau cause sudden strokes in half of those infected? Etc.

    It’s a bit optimistic (or arrogant?) to say we just have to live with it at this point when we aren’t sure what’s next.

    The irony in your statement is that variants are a factor that will ensure that Covid persists. And yes, the horse is out of the barn and we will have to live with Covid for a long time, hence the importance of vaccination over dubious, counterproductive half-measures like trying to get the vaccinated to mask up. There would be a good case for masking if vaccines weren’t readily available. But they are readily available.

    @Kathy:

    If vaccinated people are spreading Delta, then vaccinated people need to wear masks in order to stop spreading Delta. This would still be true even if 100% of the population were vaccinated.

    I think that logic dictates that we will be wearing masks forever. Good luck selling that to the public.

    2
  41. Kathy says:

    @Andy:

    You can bring an outbreak to an end and not eradicate the virus in the process. See SARS, MERS, H1N1, polio, measles, rubella, etc.

    4
  42. Scott F. says:

    @Andy:

    The irony in your statement is that variants are a factor that will ensure that Covid persists. And yes, the horse is out of the barn and we will have to live with Covid for a long time, hence the importance of vaccination over dubious, counterproductive half-measures like trying to get the vaccinated to mask up. There would be a good case for masking if vaccines weren’t readily available. But they are readily available.

    I think it‘s both vaccination and judicious masking by anyone with the potential to spread the virus, including those who are vaccinated. If both preventive actions is what it takes to stop the high rate of spread, then both is the right thing to do regardless of how hard it will be to sell to the public.

    If the issue is the difficulty of achieving broad buy-in for the most effective course of action, you don’t reach your desired endpoint by offering a diluted, ineffective solution that will be easier to accept. (See Climate Change: GOP Denialism and its Contribution to Severe Weather Events) Instead, you go after the misinformation and the distributors of such.

    3
  43. Scott F. says:

    Yes, I wish the CDC had mad fewer errors in communication in the 16 months or so we’ve been dealing with the coronavirus, in much the same way I wish unicorns would sing me to bed at night. The CDC isn’t just a scientific organization, as it also has policy making obligations. Balancing science with policy is difficult under normal circumstances, but these are not normal times, when you‘ve got a Republican mouthpiece in good standing like Glenn Reynolds writing this in the NY Post:

    Republicans would be foolish not to capitalize on this well-earned distrust of public health officials, especially among key Democratic constituencies. The Democrats, beholden to the laptop class and to bossy interlopers, are likely to favor extended and intrusive interventions and a long-lasting power grab by health bureaucrats.

    Republicans can extend the inevitable backlash. And all it takes is a simple, consistent message: The pandemic is over. The vaccines have crushed the virus, with deaths and hospitalizations trending down precipitously. Say no to masks, to irrational rules, to the ways Karen and her bureaucratic servants would suffocate ordinary people’s lives, especially working-class Americans who can’t work remotely.

    So, sure, get pissed at the CDC for the handful of mistakes they‘ve made in messaging on COVID over the last year and a half. As for me, I‘m going to focus my ire where it belongs – the death merchants of the GOP who have worked to undermine a coherent public response to the pandemic ever since Trump decided it wasn‘t in his interest to spearhead a unified national front against this virus.

    5
  44. Gustopher says:

    @Andy:

    Vaccination is no longer about herd immunity. If vaccinated people can catch and transmit the virus to others, then herd immunity is impossible. Therefore, vaccination is about protecting individuals.

    This assumes facts not in evidence. We know the following:
    – A infected vaxxed person sheds the same amount of virus and an infected unvaxxed person at a load that is roughly going to lead to R0 being 10 or so (chicken pox levels)
    – A vaxxed person is less likely to get infected

    We don’t have good data for how less likely the vaxxed person is to get infected, just how much less likely they are to end up hospitalized or dead.

    If the vaxxed person is 1/10th as likely to get infected, then the expected R0 for a random exposed vaxxed person is 1, rather than 10 — replacement level. And then any other mitigation brings that below 1 and the outbreak can be contained.

    These numbers are just wild guesses, since we don’t have the data. But, it is too soon to say that vaccines are only to protect yourself, or that vaccinated people shouldn’t mask up.

    Further, we have seen in England and India that Delta spikes quickly and then seems to burn itself out. So, the calculations right now and the calculations in a month are going to be different.

    Right now, your options are isolate, get the vaccine, or get the virus. People who cannot get the vaccine are pretty fucked unless they isolate.

    When Delta is in retreat, the option for those who cannot get the vaccine will hopefully increase, as the effective R0 will drop, and the vulnerable will have less chance to get it. (If Chicken Pox has already gone through a 2nd grade class last year, when the new kid gets Chicken Pox… he’s not infecting the class)

    But, getting the vaccine now isn’t about protecting the Trumpers — they’ve chosen to get the virus instead.

    1
  45. Gustopher says:

    @Jen:

    It’s a bit optimistic (or arrogant?) to say we just have to live with it at this point when we aren’t sure what’s next.

    I mean, obviously we won’t all live with it…

    (It might be that we cannot protect our most vulnerable, but I’m not quite at that level of fatalism yet…. get it… “fatalism”? Because it’s fatal and killing people!)

    4
  46. Kathy says:

    @Gustopher:

    I wonder what the reinfection rate with Delta is.

    1
  47. Andy says:

    @Kathy:

    You can bring an outbreak to an end and not eradicate the virus in the process. See SARS, MERS, H1N1, polio, measles, rubella, etc.

    Yes, and the best way to bring the Covid outbreak to an end is vaccination, which is available to almost anyone who wants it. This outbreak is entirely driven by the unvaccinated and can’t be ended by forcing the vaccinated to mask up. We actually don’t have any idea if that will actually accomplish anything, especially when limited to areas where delta is already peaking.

    The outbreak will end when the unvaccinated get vaccinated or, as Gustopher states, the virus burns through the unvaccinated and peters out.

    @Gustopher:

    These numbers are just wild guesses, since we don’t have the data. But, it is too soon to say that vaccines are only to protect yourself, or that vaccinated people shouldn’t mask up.

    – We know who is getting hit with virus and it’s the unvaccinated.
    – We know that vaccination provides very good protection from the effects of the virus.
    – We don’t know how many vaccinated people might be carrying the virus and potentially passing it to others.

    Given those factors, I think it’s completely logical to get the vaccine to protect oneself given the incontrovertible benefits. Masking ~190 million vaccinated people, by contrast, has benefits that are at best theoretical while being counterproductive to the primary goal of promoting vaccination.

    3
  48. Kathy says:

    @Andy:

    You’re just repeating yourself.

    Let’s try something else. Assuming your’e vaccinated, go visit a COVID ward without a mask and let us know how you do.

    6
  49. Jen says:

    @Andy: I definitely misunderstood your point, thanks for clarifying.

    I don’t think masks are at all irrelevant, they may well be our only chance at slowing the rate of variants. IMHO, that alone is reason enough to continue wearing them.

    Of course, convincing those opposed is difficult if not impossible, so there needs to be a distinction between what should be done and what is likely to be accomplished.

    As long as we have bone-headed Republican politicians attempting to build their brands by rejecting common sense, I’m not sure we get anywhere.

    2
  50. Sleeping Dog says:

    @grumpy realist:

    Funny that you bring this up.

    How much worse can the coronavirus get?

    The TL/DR, no one knows.

    1
  51. Kathy says:

    @Sleeping Dog:

    Remember when many thought the trump virus would just grow less virulent and less deadly, and become just a nasty variant of the common cold?

    2
  52. dazedandconfused says:

    @Kathy:

    The reinfection rate is somewhere around 100% of those exposed.

    You’ve got a trick question there. Vaccines do not prevent infection they only greatly speed the immune system response, which usually prevents the disease from doing much damage and greatly shortens the period one is infectious. They do not armor plate all of our cell walls against the virus, they only prime our immune systems to react quickly after-the-fact.

    The dosage one gets of a virus (and most pathogens) is key. The process of converting our cells to virus factories is an exponential progression. You get hit with one virus, it takes some time to get going, and the immune system has time to respond. But if you inhale a couple million and it’s a whole ‘nother ball game.

    3
  53. de stijl says:

    @Teve:

    I highly recommend not getting it. It really sucks.

    I spent November basically asleep. When briefly awake I attended to waste elimination and calorie intake. God bless simple, easy pasta.

    By Thanksgiving I’d lost 20 pounds. I’m fairly skinny naturally. Sport about near to 160 lbs most days. 20 pounds was a marked difference.

    When awake it was deep body aches akin to the flu. Tissue deep down next to my thigh bones and upper arms. Ached like a mother. I was sweaty and semi-coherently groggy.

    The only upside was that I slept through most of it. That and L left me goodie bags on my door step. Ginger ale and Cheetos.

    Try whatever you can do to not get it. It sucks.

    There is no upside. We are all vulnerable to the new variants.

    I suspect strongly that we all will need yearly Covid booster shots.

    8
  54. de stijl says:

    Viruses infect.

    Their raison d’etre.

    Viruses do not care about who you voted for or why. Utterly immaterial. Viruses infect. And sometimes mutate.

    We pretended it was over when it wasn’t over. Third quarter arrogance. Entirely our fault.

    3
  55. Michael Cain says:

    @de stijl:

    I suspect strongly that we all will need yearly Covid booster shots.

    My wife and I will be at the front of the line. The good news is that the mRNA technology seems to be a very substantial step up in breadth of coverage, and as it bypasses all that chicken-egg nonsense, can be scaled to produce a billion doses much faster.

    4
  56. Sleeping Dog says:

    @Kathy:

    Yes, keep in mind there are 2 factors, one mentioned in that article that will mitigate covid’s virulence and transmitability, and they are related. Over time, typically after 2-3 years, the evolutionary pace of newly emergent viruses begins to slow, also, there are a finite number of variations that the can change the virus, some of which can increase the potency others will reduce it. Covid 19 may become the equivalent of the common cold or more likely the seasonal flu, but it will take a long time and many will die without the vaccine and other remediation steps.

    3
  57. Ed B says:

    This is a very lively conversation among people who have the time and inclination to participate. Lots of good points made in a remarkably civil conversation. The communications problem I see in the general population, though, is that people want simple statements they can run with about a moving target that is far from simple. And this does not begin to cover the “I will only listen to arguments that support my beliefs” anti-fact pandemic. Yes, it would be nice if scientific evidence could be shared on an ongoing basis and people would/could read and understand it and then miraculously be of one mind about what to do about it. But in our TLDR and sound bite culture, minds are changed by direct experience and fear, not facts and logic, and messaging to this population gets very complicated. I don’t envy the people tasked with steering us through this obstacle course.

    4