Editor’s Note: Kent Sepkowitz is a CNN medical analyst and a physician and infection control expert at Memorial Sloan Kettering Cancer Center in New York. The views expressed in this commentary are his own. View more opinion at CNN.
In July 2020, the Covid-19 pandemic had quieted down in many areas of the United States, calming the national psyche and introducing some hope for a semi-normal autumn full of social proximity.
But by September of last year, things changed: school resumed, the weather started driving us back indoors and new strains of the virus emerged. Just like that, we were back to square one with no vaccine yet and more trouble ahead.
Fast forward to July 2021 and things are once again quiet in most of the US. Cases are way down, vaccination is way up, and there is much talk of a normal-ish autumn – or at least there was much talk of something normal soon.
Enter the Covid-19 Delta strain, the latest evolutionary hop of the coronavirus to ever more transmissible variants. It is tearing through Europe and Asia, as well as everywhere else, and has established a significant presence in the US, accounting for more than half of all new infections.
Perhaps it is no longer safe to go back into the water.
Even with this latest incursion, the news still shouldn’t be that bad. Studies so far show that the Delta variant is controlled by the current messenger RNA vaccines made by Pfizer and Moderna – but its contagiousness means that everyone – including teens and, as soon as it is proven safe, younger children – must get vaccinated.
This includes the vaccine-hesitant. Perhaps reports of the Delta variant overwhelming lower-vaccinated communities and fears of local spikes may help convince people.
In addition to inspiring more people to receive the vaccine out of self-defense if nothing else, the Delta strain also may pressure the US Centers for Disease Control and Prevention (CDC) into a revision of their current guidance on masks and social distancing, following the lead of the World Health Organization and parts of the US. For example, Los Angeles County has also already reinstated masking in public indoor spaces, regardless of vaccination status.
And as if to drive the point home even further, Israel, with one of the highest vaccination rates in the world – all of it using the highly effective messenger RNA products – reported an uptick in cases as the Delta variant becomes more common. Although most of the cases were seen in young people who had not yet been vaccinated, cases – including serious illness – have also occurred among fully vaccinated adults, leading the government to consider reimposing more onerous restrictions.
The decisions ahead for the CDC are not only difficult, but certain to draw fire. Despite the rapidly changing situation, the CDC, for now, appears to be standing pat, which will upset many who believe aggressive restrictions are needed, and now. But the country and the world have tired of the killjoy life of masks and restrictions. Baseball stadiums are again packed, concerts and theaters are back – and many have resumed their daily routine.
To say that we all have to return to the mole-like existence of masks and super-caution will seem to many like an admission that the CDC has mismanaged the country’s response. And this time, there is no Jared Kushner or Donald Trump bumbling, or even Trump White House interference, to blame.
Indeed, the current CDC, a prime target of the “Shoot the Messenger” club, is being painted already by some as a pack of incompetents, a bunch of chronic bureaucrats marching from pointless meeting to pointless meeting rather than helping the confused citizens sort out how to safely live their lives. Their response is sometimes cast as worse than the disease itself.
But here’s the point – new facts require new responses and new evidence is accumulating every day. In a cloak-and-dagger TV procedural, this new information about the consequences of the Delta variant’s contagiousness would be hailed as a “major breakthrough” – but in the real world of public health guidance, adjusting to new evidence somehow is construed as dithering, wimpy, bureaucratic doublespeak.
To be sure, the Delta variant, the latest in a series of ever more infectious strains of Covid-19, has changed the basics of the pandemic. As we are learning, a highly contagious variant can indeed begin to nibble at the edges of even a well-vaccinated community, as Israel has demonstrated.
This is an example of evolution in action. At the start of the pandemic, the virus fooled experts by demonstrating an unexpected way to spread: Contagiousness before symptoms, plus an unusually high number of people with completely symptom-free but contagious infections. Aggressive testing and cautious congregation along with masking – the first package of advice – helped curb this.
But this approach likely introduced an evolutionary pressure that favored the emergence of the B.1.1.7 or Alpha variant, a swifter-to-spread version that got to the mask and social distancing corner-cutters. This first set of variants in turn were tamed by the introduction of effective vaccines.
Now the vaccines may be applying further pressure on the virus by winnowing the susceptible population, favoring even more contagious strains that are more able to pick off the harder-to-find susceptible person in the crowd.
The Delta variant will likely fizzle out one way or another as it eventually runs out of easy targets. But, by the rules of evolution, it will promote and then be replaced by the next variant as we march through the Greek alphabet. Perhaps these variants will cause milder symptoms, or perhaps a more severe disease before reaching their limit. As long as susceptible people remain, the virus will continue to do its aimless business of switching it up and hopping from here to there.
Indeed, this pattern will repeat whether or not CDC guidance about masks or distancing or returning to work is updated. This guidance is built to be useful for most people, most of the time, but it will never perfectly protect everyone. Frequent updates can sharpen the focus but, even then, public health guidance remains a blunt instrument usually only followed enthusiastically by those who are already on board with taking safety precautions.
Given these limitations, the only way to truly control the pandemic is to vaccinate more and more people. Just as polio and smallpox and measles and countless other infections continued to cause wide sweeps of harm until a vaccine for each virus was available, so too will this coronavirus shadow us until we are just about all immune – by vaccine or natural disease.
Thus far, the death of almost 4 million people worldwide, including 605,000 in the US, has failed to convince a third of the people in the United States to get vaccinated. Despite this, public health authorities continue to tiptoe away from using hard-edge “scare tactic” messages, even though it is certain that these methods work. In fact, one only need to look at the success of anti-vaccination zealots’ fearmongering efforts to see their persuasive power.
Enough already. In our collective interest, I would like to introduce my public service announcement, free of charge, and with apologies to the state of New Hampshire: “America! Live free (of vaccine) and (maybe) die.”
