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Should we worry about Delta variant, life expectancy drops and vaccine for adolescents?

Health and Benefits|Wellbeing
COVID 19 Coronavirus

By Jeff Levin-Scherz, MD | June 29, 2021

We should not say, “The Delta variant represents a huge danger.” We should say, “A large number of unvaccinated individuals represents a huge danger.”

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About our “The COVID-19 Crisis” series

“The COVID-19 Crisis” series is a weekly update by Dr. Jeff Levin-Scherz covering the latest developments related to the COVID-19 pandemic in the U.S. Explore the entire blog series.

Another good week of data from the U.S., where vaccinations continue apace, and we continue to see a decrease in the number of new COVID-19 cases each week. New daily COVID-19 rates are under 12,000 a day, the lowest since the beginning of the pandemic. We continue to administer an average of about 750,000 doses of vaccine daily, and while we won’t reach President Biden’s target of 70% of adults by July 4, we are already at 65% of adults with at least the first shot and 55% fully vaccinated. This has helped suppress new outbreaks and supported the robust reopening of the economy.

We continue to watch the rise of the Delta variant (see specific update, below). The state of Missouri has the highest growth in coronavirus infection in the U.S. and also has the highest proportion of Delta variants in the U.S. at 29% of the virus.

Cautionary notes from other countries

Chile (56%), Seychelles (72%), Bahrain (66%) and Mongolia (54%) all have vaccination rates even higher than the U.S. (53% of total population). Yet each is having terrible outbreaks. How can that be?

Each of these countries has been solely or mostly dependent on vaccination with Coronavac (made by Sinovac, a Chinese company.) It appears that the real-world efficacy of these vaccines is quite low.

Researchers have published full peer-reviewed data showing efficacy and safety of the U.S.-approved vaccines (Pfizer, Moderna, Johnson & Johnson), the European-approved vaccine (AstraZeneca/Oxford) and the Russian vaccine (Sputnik V). Sinovac published limited Phase 2 trial data (with a few hundred volunteers), but not complete data from Phase 3 trials (with tens of thousands of volunteers). This demonstrates the importance of independent review of biopharmaceuticals and is a severe blow to public health efforts in countries that have been depending on Coronavac.

There are a few countries that have used vaccines other than Coronavac that are also having an increased rate of new COVID-19 infections. This includes the U.K. (56% at least one vaccination) and Russia (11% vaccinated).

In Russia, the problem is likely low vaccination rates. Ironically, domestic take-up of the Sputnik V vaccine, which has proven quite effective, is very low. In the U.K., the culprit is likely the Delta variant (B.1.617, initially identified in India). This represents 90% of the current cases in the U.K., and is about 50% more contagious and causes twice as many hospitalizations. The Delta variant appears more likely to infect those who have only had one of two AstraZeneca shots (33% protection versus 90% protection from both shots.) The U.K. has been delaying second shots, which leaves more partially vaccinated people at risk. Canada is in a similar position.

The Delta variant will become dominant in the U.S. in July, but being fully vaccinated will protect us

The Delta (B.1.617) and Gamma (P.1) variants are currently increasing at a concerning rate.
Estimated biweekly proportions of variants

Source: CDC, June 24, 2021

The Delta variant is likely to become the dominant strain in the U.S. over the coming weeks, so those who are not vaccinated will be at higher risk. It was 2.7% of strains just a month ago and was 21% three weeks later. Protection from the Delta variant for those two weeks after their final vaccination remains excellent. We should not say, “The Delta variant represents a huge danger.” We should say, “A large number of unvaccinated individuals represents a huge danger.

Life expectancy dips severely in the U.S., especially among Black and Hispanic people

Life expectancy in the U.S. has declined overall, with decreases over twice as much for Blacks and Hispanics.
Life expectancy in men across populations

Source: BMJ, June 24, 2021

Even though deaths from COVID-19 are now under 300 per day in the U.S., the impact of the pandemic on life expectancy has been stark. BMJ (once known as the British Medical Journal) published research last week showing that average life expectancy in the U.S. declined by almost two years during 2020. This was 8.5 times worse than the average of six peer countries (Denmark, Finland, New Zealand, Norway, South Korea and Taiwan). This largely reflects deaths from COVID-19, but also continues a trend that was occurring before 2020 with increased deaths from conditions like cardiac disease and drug overdoses.

From the study:

In the U.S., decreases in life expectancy in Hispanic and non-Hispanic Black people were about two to three times greater than in the non-Hispanic white population, reversing years of progress in reducing racial and ethnic disparities, and lowering the life expectancy of Black men to 67.73 years, a level not seen since 1999.

Adolescents should be vaccinated despite rare cases of myocarditis

Reports of rare instances of myocarditis especially in young men have left some parents wondering whether they should vaccinate their adolescents. The CDC’s Advisory Committee on Immunization Practices (ACIP) met on Wednesday and emphatically said that adolescents should get vaccinated. Here’s a slide that tells the story. Yes, if we give a million doses of vaccine there will be cases of myocarditis. But we will prevent more cases of intensive-care admissions than we will cause myocarditis, and the vaccine-induced myocarditis cases are mild. It also appears all who have had the condition have fully recovered. Vaccination prevents far more harm than it causes.

Females 12-17 years 8,500 COVID-19 cases prevented 183 hospitalizations prevented 38 ICU admissions prevented 1 death prevented 8-10 myocarditis cases Males 12-17 years 5,700 COVID-19 cases prevented 215 hospitalizations prevented 71 ICU admissions prevented 2 deaths prevented 56-59 myocardities cases Hospitalizations, ICU admissions and deaths based on data for week of May 22, 2021.
In those aged 12 to 17, it is estimated that the vaccine has prevented between 5,700 to 8,500 cases (per million) of COVID-19, while myocarditis case were under 10 (per million) in females and under 70 in males (per million) of this age group.
Predicted cases prevented versus myocarditis cases for every million second-dose vaccinations

Source: CDC ACIP, June 2021

Author

Population Health Leader, Health and Benefits, North America

Jeff is a practicing physician and has led Willis Towers Watson’s clinical response to COVID-19. He has served in leadership roles in provider organizations and a health plan, and is an Assistant Professor at Harvard Chan School of Public Health.


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