Just two months ago, it was a time of celebration in the state. In June, 70 percent of all residents over 18 had received at least one COVID-19 vaccination. But as the summer heads into the home stretch, the highly infectious delta variant and its ability to infect even the vaccinated has caused renewed anxiety and changed guidelines on mask-wearing by the Centers for Disease Control and Prevention.
“Things were looking so good for a while,” said Dr. Shira Doron, a Tufts Medical Center epidemiologist. “The delta variant is contagious. It really has derailed progress we have made.”
Experts attribute the delta variant to the Provincetown outbreak during the tourist season in July in which almost 75 percent of about 900 people who tested positive for the virus were vaccinated.
Dr. Camille Kotton, the clinical director of transplant and immunocompromised host infectious diseases at Massachusetts General Hospital, explained that the delta variant contains “more virus in each individual person who has it. That’s why we see a lot of person-to-person spread of the disease.”
Yet, she added, “vaccinated people who are infected do not go to the hospital. They may have mild to moderate [infections] at most. Ninety-nine percent of people in the hospital are unvaccinated.”
“Vaccines are working right now,” Kotton said. “It’s especially a time now, more than ever, to vaccinate.”
It’s also a time for increased mask-wearing, according to new guidelines released July 27 by the CDC and its director, Dr. Rochelle Walensky, the former head of the Infectious Diseases Division at MGH. The CDC now recommends wearing masks in public indoor settings, and that all students, teachers, and staff wear masks when schools reopen in the fall.
The new guidelines for vaccinated people applies to communities with “substantial” or “high” transmission rates, which currently applies to all Massachusetts counties except Hampshire.
Doron cited three main reasons for the change in guidelines: rising cases, missing the vaccine target, and analyses of who developed breakthrough infections.
Kotton compared the change in policy to the always-changing New England weather.
“Certainly it’s a shifting landscape,” she said, noting that for the previous CDC guidelines, “at that point we had very low rates of disease in Massachusetts and nationally. [Walensky’s] recommendations were based on the science and data at the time.”
Currently, Kotton said, “there’s a lot more disease active. We know with the delta variant, there’s a much higher risk of transmission to vaccinated people.”
There are multiple things the public can do to meet the challenge, with one at the top of the list.
“The general advice is absolutely nothing even comes close as being as important as vaccination,” Doron said. “There are things we talk so much about – distancing, hand hygiene … They’re just nowhere near the miracle solution that vaccination is. If you want to be nearly completely assured of protecting your life against COVID-19, vaccination is how you do it.”
Similarly, Kotton said, “the best practice, you know, I think is just vaccination. For those who are vaccinated, I would encourage mask-wearing indoors, especially in crowded locations. We can all do our part to decrease transmission, especially connected to a delta strain that has many vaccinated people getting infected.”
The doctors each voiced concern over reports of individuals who have already gotten a two-dose vaccine pursuing a third dose, which is currently prohibited.
“Some people show up at a vaccine clinic for an additional shot,” Doron said. “They shouldn’t. It’s not legal to knowingly give somebody an additional shot.
“I don’t recommend it. I don’t see a need for it. It would be way better if doses of vaccines went to countries that have not received their first dose to tamp down surges of the variant than given around as a third, fourth, fifth-time vaccine to potentially prevent some mild respiratory infection.”
“It’s a challenging position,” said Kotton, who was quoted about the issue in The Washington Post. “Licensed physicians don’t recommend actually doing this.” She did say that “as soon as we have FDA approval, I believe in the next month or two, they could do things” such as “a booster for vulnerable populations, the immunocompromised, the elderly, who may not have robust protection from prior vaccine series.”
As for when the virus will become eradicated, Doron said, “I don’t know … I think the best-case scenario is, it becomes a nuisance. It’s quite a far ways away.”
In what remains a challenging time, Kotton cited the Jewish principle of pikuach nefesh (saving a life).
“There’s a principle in Jewish practice that we can and should do anything you can do to save a human life,” she said. “A person who vaccinates can save lives of their loved ones, many lives in the community, can help save many American lives. Right now, with the Jewish principle to save lives, we can all participate and make sure we are all vaccinated.”