Delta Means Change

Contagion, Contagion, August 2021 (Vol. 06, No. 04), Volume 6, Issue 4

"Humans dislike change, especially when it is rapid, unexpected, or negative. Delta is all 3."

I cannot tell you how much I was hoping to write about something other than COVID-19 this issue. In June, things were very different. In the US, cases, hospitalizations, and deaths were the lowest they had been in 2021. Vaccinations drove this change, and while they never reached an ideal number of Americans, over 69% of adults have received at least 1 dose. The CDC responded by changing guidance to state that fully vaccinated people did not need to wear face masks. I went on vacation (to Florida, no less!). Things were looking grand.

In July, a pivot occurred. The delta variant of concern that had already become dominant in other parts of the world did the same in the US at a pace that is hard to grasp. At the end of May, the delta variant was responsible for 3.1% of infections, while the alpha variant was 69.1%; at the midpoint of July, delta had caused 83.2% of infections and alpha was 8.3%. That is an enormous swing in under 2 months. In the competitive world of viral mutations, the delta variant has won.

With this rapid shift to this hyper-transmissible variant, our approach needs to change as well. The paths that we have charted for the rest of the year need to be adjusted. As I write this, it has been reported that CDC is moving to recommend masking indoors again for many vaccinated people. The American Academy of Pediatrics already recommends masks for all school-aged children. These represent changes from policies at many places that were established when cases were diminishing this spring.

Another organization that needs to react to change is the FDA. The full approval of the vaccines granted emergency use authorizations (EUAs) needs to be FDA’s No. 1 priority. It may not seem obvious because they have been available by EUA since December 2020, but a lack of full approval has kept many other organizations, including those in higher education and health care, from mandating vaccination for their employees and students. It seems that after a few months of lotteries and free beer that we have run out of carrots. One of the common tropes of unvaccinated people is that the vaccines are “experimental” and “unapproved.” After 8 months, hundreds of millions of doses administered, and an impressive safety record, what more is there to learn about them? It is time for FDA to complete the job.

Humans dislike change, especially when it is rapid, unexpected, or negative. Delta is all 3. We need to shift our own course to catch up with it.