Delta illustrates benefits, limits of vaccines

The worrying spread of the Delta variant has vastly changed the landscape around COVID-19 vaccines, putting renewed attention on getting everyone vaccinated while at the same time illustrating the limits of vaccination.

In Massachusetts, where around 64 percent of the population is vaccinated, Gov. Charlie Baker has strongly resisted imposing vaccine mandates or creating a state-level vaccine passport.

Yet Baker announced last week that he will require all staff at nursing homes to get a COVID shot. Health care leaders are increasingly embracing the idea of vaccine mandates for hospital employees – and in some cases for other publicly-facing workers. The Boston Teachers Union came out in support of a vaccine mandate for staff, as did SEIU Local 509, which covers human service and higher education workers.

In the last couple of weeks, the attorney general, treasurer, and auditor have said they will require their employees to be vaccinated.

Some private companies are also starting to impose mandates – sometimes, not only for staff but for customers. Boston gym Row Republic will require all staff and members to be vaccinated. Boston.com has a running list of local bars and restaurants requiring diners to be vaccinated.

Proponents of vaccine mandates say vaccines are the most effective method of stopping the spread of COVID-19 and stopping people from getting seriously ill and dying. Businesses say requiring the vaccine is the best way to keep employees – and customers – safe.

Yet the Delta variant has also illustrated some of the limits of vaccines. While the current vaccines protect people well against serious illness and death, there are an increasing number of breakthrough cases, where vaccinated people are both getting sick and spreading COVID.

Initially, both clinical trials and real-world data showed that the Pfizer and Moderna vaccines were 94 percent effective against infection. The Johnson & Johnson shot was 66 percent effective against infection, though the numbers are not comparable. 

However, with the Delta variant becoming the dominant strain, several studies suggested the Pfizer vaccine is around 88 percent effective against Delta. One study from Israel showed its effectiveness is 64 percent against symptomatic illness, though still 93 percent effective against hospitalization. Studies of Moderna similarly show that it is effective against Delta – but likely not as effective as against the initial virus. There is limited data on Johnson & Johnson.

A back-of-the envelope calculation using Massachusetts data highlights this. For the week ending August 7, the Department of Public Health reported 2,232 breakthrough cases among 4.3 million fully vaccinated individuals – a rate of 51.6 cases per 100,000 people. If the remaining 4,652 cases that week were among an unvaccinated population of around 2.7 million, the rate among unvaccinated people was 171.8 per 100,000. That means a person is more than three times more likely to get COVID if they are unvaccinated, making the vaccines around 70 percent effective at preventing COVID cases.

Vaccines do play a major role in preventing severe illness and death and, accordingly, in preventing the hospital system from becoming overwhelmed. The Massachusetts data for August 1-7 reported 299 new hospital admissions, 50 among the vaccinated – a rate of 1.15 per 100,000 for the vaccinated population compared to 9.19 per 100,000, or eight times higher, for the unvaccinated population – giving vaccines an 87 percent effectiveness rate in preventing hospitalization.

This data are imperfect, the math is approximate, and there are significant differences between the vaccinated and unvaccinated populations – most notably, their ages. Dr. Ashish Jah, dean of the school of public health at Brown University, tweeted Tuesday that the national data show that vaccines prevent 75 to 85 percent of symptomatic infections and 90 to 98 percent of hospitalizations and deaths.

There is no question vaccines are important and effective in combating COVID. But if vaccines are less effective in preventing illness and transmission with the Delta variant, it raises real questions about how the pandemic will end.

Initially, scientists were talking about reaching herd immunity – the level of population protection  at which the virus could no longer spread. Now, the conversation among experts suggests COVID may become endemic – a virus that circulates perennially, which society will have to learn to manage. Using vaccination – one-time or through boosters — to ensure that the virus takes a mild or moderate toll rather than a serious one is likely to be part of that. Natural immunity from infection could play a role. So could more effective treatment. Testing and limited quarantining could be another part. There could be other societal changes, like seasonal masking or improved indoor ventilation.

Harvard public health professor Yonatan Grad argues that past pandemics “have led to massive changes in the way we live that we’ve come to accept as normal.” COVID may do the same.

SHIRA SCHOENBERG

 

FROM COMMONWEALTH

The other crisis: The coronavirus is the story on front pages everywhere, but the “other crisis” — the death toll from opioids — keeps on chugging along. The latest data indicate 1,038 people in Massachusetts died from opioid overdoses in the first six months of this year, down 5 percent compared to the same period a year ago. Read more.

OPINION

Spin on spin: Paul Hattis, a senior fellow at the Lown Institute, offers his spin on Mass General Brigham’s spin of its third quarter financial results. One eye-popping figure — the hospital system’s net worth rose $2.9 billion to nearly $14 billion. Read more.

Vax mandate worked: Stephen Kerrigan, the president and CEO of the Edward M. Kennedy Community Health Center in Framingham, says a vaccine mandate worked well for his organization. Since February 10, when the staff was fully vaccinated, there have been no more COVID-19 cases.  Read more.

 

FROM AROUND THE WEB

 

BEACON HILL

Western Massachusetts lawmakers sign a letter urging the Legislature to impose a new moratorium on evictions. (MassLive)

A decade after the last redistricting exercise, in which minority representation was a big consideration, the Legislature remains much whiter than the state population. (Boston Globe)

MUNICIPAL MATTERS

By a 3-2 vote, the Holyoke planning board rejects a plan to build a Dunkin’ Donuts drive-through operation on Mount Tom. (Daily Hampshire Gazette)

New Bedford’s redesign of an intersection to ward off panhandlers is merciless—and in vain—says columnist Jack Spillane. (New Bedford Light)

The city of Gloucester is ordered by the state supervisor of records to release to the Gloucester Daily Times the full report of its investigation into a hostile work environment created by the Gloucester mayor. (Gloucester Daily Times)

HEALTH/HEALTH CARE

While COVID-19 cases in children rose 31 percent nationwide last week, Massachusetts was spared from seeing the same uptick in sick kids. (WBUR)

UMass Memorial Medical Center reopens its COVID command center to oversee hospital operations in order to deal with the uptick in Delta cases, a nationwide labor shortage, and the closure of beds at St. Vincent’s Hospital. (Telegram & Gazette)

The Department of Veterans Affairs is the latest entry on the list of providers and insurers that are balking on either paying for or administering the recently approved Alzheimer’s treatment aducanumab, developed by Cambridged-based Biogen. (STAT) 

WASHINGTON/NATIONAL/INTERNATIONAL

Hospitals are full of COVID patients in Mississippi, and officials say the system is on the verge of failure. (Mississippi Free Press)

ELECTIONS

Former US senator Scott Brown resigns as dean of New England Law and announces plans to return to politics to “rebuild” the Republican Party. (MassLive)

Boston mayoral candidate John Barros puts Fairmount commuter rail line upgrades — specifically integrating the line into the subway system — at the top of his transportation agenda. (State House News)

Boston mayoral candidates continue to hit Acting Mayor Kim Janey over her reluctance to impose vaccine mandates on city workers and more restrictions on restaurants and other public venues. (Boston Herald)

Democratic gubernatorial candidate Ben Downing visits the Victory Theater in Holyoke, and lauds efforts by the  Massachusetts International Festival of the Arts  to restore it to its former glory. (Daily Hampshire Gazette)

A proposed ballot question would repeal the state’s ban on fireworks sales. (Salem News)

BUSINESS/ECONOMY

US Rep. Seth Moulton says the US Army has awarded a $208 million contract to General Electric Aviation. (Daily Item)

Making marijuana pipes, once considered a criminal act, is now a celebrated art form in New England. (USA Today)

EDUCATION

The Worcester school district becomes the latest district to announce that it will require all students and staff to wear masks in school next year. (Telegram & Gazette)

ARTS/CULTURE

Performance venues in New Bedford and Fall River are relying on funding from the Shuttered Venue Operators Grant program to reopen and hire back staff. (Herald News)

ENERGY/ENVIRONMENT

After a year of bad storms, utility companies want to require customers to pay for last year’s costs over several years. (Salem News)

CRIMINAL JUSTICE/COURTS

Jacklyn Sutcivni, the former top Worcester housing official convicted of fraud last week, is arrested on new domestic violence charges and jailed. (Telegram & Gazette)

PASSINGS

Neil Conan, a veteran radio journalist best known for hosting NPR’s call-in show “Talk of the Nation,” died at age 71. (New York Times