Masks, vaccinations, delta: Why we are at a ‘critical point’ in the pandemic

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• Hari Sreenivasan:

  For more on the spread of the delta variant and the potential risks, I recently spoke with Jessica Malaty Rivera, an infectious disease epidemiologist and research fellow at Boston Children's Hospital.

  I began by asking her about how employers or leaders should be thinking about minimizing risk.

  So, Jessica, most people are concerned about the new news that this variant is something that can be passed on even from people who are vaccinated and the policy repercussions of that, what kinds of things should employers and businesses and parks and anybody else that has people or hosts people, what should they do?

• Jessica Malaty Rivera:

  Right. I do think that this is a critical point in the pandemic where risk is kind of greater for everybody, but they're not equal risks. Right. We know that the vaccine is protecting even vaccinated people from having the worst of it. It's keeping them out of the hospital and keeping them from dying. And so because of that, what we're trying to do is just slow the cycles of transmission in the population. And that's why even the vaccinated need to be exercising extreme caution right now by wearing their mask in public indoor gatherings, when there are places with poor ventilation, because we need to slow the amount of virus that is in our communities. Right. In order for all of us to be safe, it's kind of a balance between low transmission and high vaccination. And until we get those two variables kind of in a good balance, we're all going to have to exercise caution, especially places where people congregate, parks, offices, large gatherings, banquet halls, conferences, et cetera.

• Hari Sreenivasan:

  Put this in perspective for us. How much more contagious is this than the one that we sort of got used to?

• Jessica Malaty Rivera:

  Right, great question. It's significantly more contagious. There are estimates that people who contract the Delta variant have about a thousand times more virus in their bodies. Now, I think people hear that and they get very alarmed. It doesn't mean it's a thousand times more deadly, doesn't mean it's a thousand times more likely to do something bad to you. It just means that your viral load is very high. And what we know about viral load is that the higher the viral load, the more likely it is that you could have infectious virus to spread to other people and cause them to be infected. And so because of that, it makes the person who carries the Delta varient much more likely to be infectious for possibly a longer period of time to more people. Unfortunately, we are seeing even higher viral loads than we anticipated among the vaccinated, but we don't know if it's actually the same. Right. And the presence of virus doesn't necessarily mean the presence of infectious virus, but all that to say, there is a higher viral load in an infected person.

• Hari Sreenivasan:

  Now, we've got another few weeks of summer left here, at least for school age kids. And that's got parents very concerned about what they should do if there is a more contagious version and they've got kids that can't be vaccinated again.

• Jessica Malaty Rivera:

  Right. I empathize. I am a parent. I have two young children. My kids are not eligible for vaccination yet because there are only three and four years old and they are hoping to go back to preschool in the fall. And that was our hope. And I think that now that they're kind of anticipation of vaccination for kids under 12 closer to midwinter, it does cause a lot of parents to pause and wonder, what does that look like for their kids going back to school? And I think that that's why the CDC had to change their policies, unmasking and recommend universal masking in the context of school for all students and teachers and administrators, regardless of vaccination status, because until then, that's really the bare minimum. That's the best thing we can do to kind of, like I mentioned earlier, keep those cycles of transmission as low as possible.

• Hari Sreenivasan:

  What about both the mask mandates as well as the vaccine mandates? I mean, we've seen kind of fits and starts depending on where you live, depending on where you work. Your employer could say, hey, listen, we want you to have a vaccine.

• Jessica Malaty Rivera:

  You know, we've seen for the last several months that employers are absolutely within their right to mandate vaccines for coming back to work, and that's partially because we have to consider occupational hazards for both employers, employees and the people that they serve depending on the industry. And so I think we're going to be seeing a lot more employers require vaccination to do some of their work. I have seen a number of production companies require it for actors and people in the performance zone. I've seen hospital groups starting to do that, and I think it's actually quite critical that all health care personnel are required to be vaccinated. So I think we are probably going to see more of that. I think you'll probably increase once the vaccines are fully approved by the FDA, which could happen any time between August and January.

• Hari Sreenivasan:

  This also brings into light the global nature of this. I mean, the Delta variant started somewhere else, right? The Lambda variant started elsewhere. I mean, there could be a variant that starting in the United States, it's all interconnected. I mean, if there are still pockets of the world and right now the majority of the world does not have access to vaccines, has not beat this 100%, there's still the likelihood that the possibility mathematically that this thing keeps going.

• Jessica Malaty Rivera:

  Absolutely. I mean, viruses evolve. They mutate as they replicate and they replicate inside people's bodies. So that's why I keep saying that we could outsmart these variants. We could outsmart SARS-COV-2 by giving the virus less opportunities to infect bodies and less opportunities to change and create new variants. We know that the Delta variant emerged in India where they were just absolutely overwhelmed there. And that was in the context of not having vaccines. We have a huge advantage, at least here in the United States, of having tons of vaccine available. And we can outsmart these variants and kind of get to a point of pushing it down and preventing new variants from emerging by having less susceptible bodies around. I don't think that Delta will be the last bad variant. I mean, I don't know where Lambda is going to eventually turn out, and I think that we will probably see some more. But we have a huge opportunity here to kind of interrupt the evolution of this virus.

• Hari Sreenivasan:

  How do we sort of frame our, not just a response, but I guess ourselves for the idea that this could be the new normal, that we should brace ourselves for different variants, whether it's this coronavirus or something else, that this might just be part of life now.

• Jessica Malaty Rivera:

  I do think that we should be prepared for SARS-COV-2, the virus, becoming endemic. That is a possibility. And endemic doesn't necessarily mean disruptive. Right. H1N1 became a endemic flu virus that circulates now quite often with the flu seasons. And so I think that it's something that we can have an advantage over. So it doesn't cause these major kind of interruptions in our life, in our work and our education. If we get to that right balance of a mostly vaccinated, protected population so that there are less opportunities for the virus to kind of infect and disrupt and then overwhelm our health care systems.

• Hari Sreenivasan:

  There are people that hear the news about how contagious this Delta variant is, and they say, you know what, that's pretty bad, but it's really just going to hit the unvaccinated people. They're really the only ones that are going to suffer from this. And at this point, they've had all this opportunity. They should have gotten the vaccine. I feel fine. I've got my vaccine. But there is still a threat to these folks and the folks around them that are vaccinated.

• Jessica Malaty Rivera:

  Absolutely, I mean, the vaccines don't work perfectly, but they are very, very effective and vaccines in the history of vaccines are really primarily to do two things: keeping you out of the hospital, keeping you alive. Right. And they do that. But there are people who are still succumbing to the disease, getting very sick, even if they're vaccinated. And we have to remember, too, that we don't just get vaccinated to protect ourselves. We get vaccinated to protect other people. And we also wear masks for those same reasons, too. So it's imperative that people who are vaccinated continue to exercise caution because people around them are relying on it. When we talk about the unvaccinated, that is not a monolith, right? There are people, including our children, who are in that population who are relying on the vaccinated, still try to slow down the transmission of this virus. And if they happen to get a break through infection, which is rare, if they have it, they could still present a risk to other people, including people who are not eligible for vaccination, people who are medically fragile, people who are immunocompromised, people who are still struggling to make the decision to get vaccinated. So I think it's much, much bigger than the individual's choice when they think about it that way.

• Hari Sreenivasan:

  Jessica Malaty Rivera, infectious disease epidemiologist and research fellow at Boston Children's Hospital. Thanks so much for joining us.

• Jessica Malaty Rivera:

  Thanks for having me.