Guidance for the Delta Covid resurgence

We are now almost one and a half years into the Covid epidemic. It is difficult to believe that the Covid virus continues to be a universal menace. In spite of optimistic wishing, we remain surrounded by millions of people who have active Delta infection. Because many of them have mild disease and because testing is not well organized, the number of infected persons is greatly underestimated.

The news about the Covid vaccines remains confusing because there is very little data and a large number of opinions. Although many issues are controversial it is now realized that there are points of general agreement on some important issues. Let me summarize some of the points that most informed people agree upon. These can form the basis of rational action.

1. There are millions of people in this country infected with Covid on any given day. Most of these are Delta virus. Many of these people have been vaccinated or had Covid infections in the past.

2. Many people with immunity from the vaccine or previous infection who are infected with the new Delta variant have mild cases.

3. Thus it is very easy to get an infection from the many infected people running around with infections who feel well.

4. So, it does not matter if you were infected or vaccinated, there are many people who can infect you.

5. People with vaccines or previous infections usually do not end up in the hospital and almost never die, but they can still feel ill for several days to 2 weeks.

6. This has generated the suggestion that people continue to mask. This suggestion is very unpopular and it is unlikely that many people will go back to masking. Most people dislike the masks, and others are frightened of being mocked for wearing masks.

7. Any large gathering of people will have at least several actively infected people in the room during today’s Delta pandemic resurgence. Individuals can choose to avoid these gatherings and protect themselves, without drawing attention to their precautions.

8. The need for a third vaccine (but not a fourth) was dubious until the Israeli data was revealed in August 2021. It demonstrated that people over the age of 60 who received a third vaccine had a much lower incidence of a serious Delta infection than people who only had two vaccines or a previous infection. If this data survives analysis it will be the watershed study in justifying a third dose. The downside of taking a third vaccine is limited to having 2 or three days of flu like symptoms but this does not equal becoming seriously sick or going to the hospital from the vaccine.

9. For reasons that are very foggy we are now seeing serious infections in adolescents, young adults and some children. The numbers are not very high, yet it raises the possibility that those experts who advocated excluding young people from the vaccine programs were wrong.

10. No expert is advocating two vaccines for people who have had two Moderna/Pfizer Covid vaccines or the J and J vaccine or the Covid illness. A single third vaccine is sufficient.

11. Interestingly, one expert interviewed by the Scientific American feels that third vaccines should always be a Pfizer or Moderna and not a J and J vaccine. Another expert feels that in the USA where Pfizer and Moderna vaccines are readily available, their lower side effect profile makes them preferred compared to the J and J vaccine. Personally, although the reasons are too long for this note, I find both these experts positions very convincing.

12. I believe that the press is ignoring two important reasons for a third vaccine or a first vaccine for persons who have had Covid illness.

i) Even if these people get mild infections from Delta they can transmit the infection to others who might become ill and even die. So, in an altruistic sense, to be good to one’s friends and neighbors a person should take the third dose to prevent his/her mild infection from harming someone else.

ii) If it is ever revealed that a mild Delta infection can lead to the long term chronic Covid illness also known as Long Haulers then a third dose could be of great benefit to prevent this from happening. I am the first to admit that this is a theoretical unproven consideration but nevertheless, potentially of great importance to many people.