After months of decreasing COVID-19 cases coupled with the rollout of COVID-19 vaccines in the United States, the end of the pandemic seemed to be drawing near for most. For perspective, the first United States COVID-19 case was reported on Jan. 21 of last year, making this Saturday 19 months since the virus first arrived in the United States from Wuhan, China. However, in recent weeks, COVID-19 cases in Virginia have been increasing at a rate similar to the holidays, when cases and hospitalizations stressed the University Hospital. As the University is set to bring back students for in-person classes this next week, U.Va. Health experts discuss potential causes for this case uptick and give their thoughts on what the future may hold.
Dr. William Petri, chief of the Division of Infectious Diseases and International Health at the University, expressed his concerns regarding the recent rise in COVID-19 cases. He attributed this increase to the Delta variant, a mutation in the spike glycoprotein of the SARS-CoV-2 virus which causes the virus to be more transmissible than the original strain.
What makes Delta different
“I’m really concerned about Delta,” Petri said on Aug. 4. “The number of cases of COVID in Virginia have gone up 400 percent in the last four weeks. We're seeing all around the country that we're clearly into a fifth wave of COVID-19, and this is due to the Delta variant.”
Petri noted that there are other variants currently in circulation but explained that the Delta variant is the most transmissible and, consequently, the most prominent.
According to Petri, the Delta variant comprises 70 percent of current COVID-19 cases in Virginia and 85 percent of COVID-19 cases in the United States. He added that one month prior, the Delta variant was present in only 1 percent of cases, showing this mutation is more infectious than previous strains.
Dr. Reid Adams, U.Va. Health chief medical officer, specified that over the past eight weeks U.Va. Health has seen an increase in patients requiring hospitalization due to COVID-19. As of Tuesday, the University COVID-19 tracker reported 31 patients hospitalized with COVID-19, and on Saturday, the seven-day average of hospitalizations was the highest it’s been since May 3. He furthered that the health system is prepared for a potential surge in COVID-19 cases, adding that there are several areas of the University hospital — in addition to the hospital tower — that can be repurposed for COVID-19 patients if necessary.
Infectious disease specialist Dr. Patrick Jackson believes that current vaccines remain effective at preventing severe illness and hospitalizations despite the more transmissible variant, noting that the majority of hospitalized COVID-19 patients are unvaccinated.
“On the other hand, if we are asking the question about how effective the vaccines are in preventing any infection from COVID-19 or preventing transmission from person to person, I think there is some reason for concern that the vaccines may be somewhat less effective in the face of Delta,” Jackson said.
Petri cited a recent study in the New England Journal of Medicine, which found that the Pfizer-BioNTech vaccine prevents 88 percent of symptomatic Delta variant infections. He added that the vaccine originally provided 94 percent protection from the United Kingdom, or Alpha, variant.
However, Petri furthered that there is preliminary data from Israel which shows that the Pfizer-BioNTech vaccine is only about 30 percent effective at preventing symptomatic COVID-19 Delta variant infection.
“With the Alpha variant, you probably have like 100 times more antibody than you need to be protected, whereas with Delta, it's only about four times more antibody,” Petri said.
Both experts nevertheless stressed the importance of vaccination, especially as students return to in-person learning in Charlottesville and Albemarle County.
“I think the number one thing we need to do is increase vaccination rates,” Jackson said. “I think anything that the schools can do to encourage vaccination among their staff should be done, including paid time off to recover from the vaccination. Letting people not come into work when they're sick, I think, is equally important.”
The University and Virginia Tech are currently working together to develop a new, broad spectrum COVID-19 vaccine that could protect against many different types of coronaviruses and variants. Additionally, Petri said that his lab is also developing a new COVID-19 vaccine that uses a lipid vesicle to surround the COVID-19 spike glycoprotein. He stated that his vaccine is delivered intranasally and has shown to be 100 percent effective at immunizing mice.
Petri added that there is buzz about potential booster vaccinations to strengthen COVID-19 immunity. On Wednesday, the Biden Administration announced a plan to provide booster vaccinations beginning in late September for individuals who have received either the Pfizer-BioNTech or Moderna COVID-19 vaccine. Moreover, on Aug. 12 the Food and Drug Administration officially authorized Pfizer-BioNTech and Moderna COVID-19 boosters for immunocompromised individuals.
“There's clear data that kidney transplant recipients, or patients with rheumatoid arthritis that are on methotrexate and other immunosuppressive medicines, are not responding adequately to the vaccine,” Petri said. “The idea is, by giving them a booster, there's at least a chance that you'll be able to improve on their antibody response.”
As doctors and health officials work to address the growing issue of the Delta strain, they have also redoubled attention to populations that have been hesitant to receive the vaccine. In Charlottesville, this includes members of the Latinx community. Max Luna is head of the Latino Health Initiative, which has worked to bring health literacy, affordable care and healthcare to the Charlottesvile Latinx community since 2019. In light of the pandemic, the initiative has focused heavily on providing accessible information concerning vaccination to the community, especially given that the Latinx community has the highest risk of infection.
“We are seeking to build trust in the health system, government, doctors, vaccine itself and the sources of their information,” Luna said.
This trust-building has been accomplished via virtual town halls, with anywhere between 300 and 500 listeners per meeting, language and cultural competence at vaccination sites and establishing roots in the community.
Not only have these roots helped achieve greater vaccination rates in the Latino community with more than 60 percent of community members vaccinated with one dose, these connections can also be used to promote other important care like flu shots and cancer prevention.
“It’s a sustainable initiative in the long run,” Luna said.
Moving forward, Jackson emphasized the importance of influenza vaccinations for this upcoming flu season. He stated that the United States saw very little influenza infections this past year due to masking and social distancing, which will likely lead to a worse flu season this year.
“You kind of rely on people having been exposed and recovered the previous year to tamp down on the amount of transmission that flu can run through in a population,” Jackson said. “I do think that in this coming flu season, vaccination is going to be incredibly important, and we're going to need to really ramp up our efforts to vaccinate people.”
A healthier future
Although the pandemic is likely far from over — Petri estimated that it will take at least two to three years before COVID-19 outbreaks subside — Jackson is hopeful that the pandemic will result in an increased focus on more equitable healthcare with expanded public health efforts.
“If you look at the burden of infectious diseases like HIV, sexually transmitted infections, pneumonia and influenza, the burden of disease falls most heavily on people who are most marginalized in socioeconomic terms and in terms of racial and sex inequities in our society,” Jackson said. “I think that this pandemic has really highlighted those disparities for the broader population as well.”
He furthered that every individual’s health is dependent on their neighbor.
“Even if you occupy a relatively privileged place in society, the fact of communicable diseases means that you need to care very deeply about what happens to people who are less well situated than you are, even if all you care about is your own self interest,” Jackson said. “I hope that that message really penetrates and people really understand that we are all in this together and no one is an island unto themselves.”
He explained that he advocates for providers at U.Va. Health to distribute their most effective COVID-19 therapies such as monoclonal antibodies to groups that have been disproportionately impacted by the pandemic.
“I hope that moving forward we will expand that attitude to other treatments that probably have not been rolled out as effectively,” Jackson said.
He is also optimistic that technology discovered during the pandemic will be used as a stepping stone for other illnesses.
“I do think that we have learned quite a bit scientifically about respiratory infections during this pandemic that will be helpful moving forward,” Jackson said. “I think one thing that people may notice is that the mRNA vaccine technology is likely to be expanded to other other viruses and bacteria, so it's likely that more mRNA vaccines will come on the market in the relatively near future. I think that's gonna be a really powerful tool.”