Thread by @ASlavitt

COVID UPDATE: What’s changed and what’s stated the same since I wrote the tweet that said vaccinated people have far greater things to worry about then the Delta variant?

And what would I say now? 1/

Let’s look at what’s changed?

We have significant growth in cases. So far those are largely among unvaccinated people. And serious cases are almost entirely among unvaccinated people. 2/

There are areas of the country where there are low vaccination levels that are experiencing the largest growth in cases? Hospitalizations are following.

While we can’t say for sure, the death rates look to be dramatically lower given vaccination protection in the elderly. 3/

Still there are 100 million people estimated to have no immune protection either from a vax or prior infection & we know Delta is twice as contagious.

Delta appears likely to quickly rip through communities largely impacting the unvaccinated. 4/

How many of the unvaccinated will be infected? Not 100 million.

There was an odd effect in India the first to experience Delta. It ripped through quickly and died just as quickly. 5/

We should watch carefully what happens in the UK— where there are vaccination levels close to the US and vaccinated people are so far well protected.

Two doses of the mRNA produces plenty of antibodies & T-cell & B-cell memory. 6/

As awful as Delta is to unvaccinated people, in a weird way, it has helped vaccinated people by out-competing variants thatevade the vaccine. Delta attaches much more easily to cells but it is easier for the vaccine.

So far more contagious has meant easier for the vaccine. 7/

Vaccinated people should view Delta as a slight difference as well. UK studies which are the closest thing we have suggest instead of 95% protection against infection, it may be closer to 88%. 8/

A good way to think about that is it’s 10% less protective.

Here’s a decent analogy. A vaccine is like an umbrella. It keeps us from getting wet. Not perfectly. But mostly. 9/

With Delta, the rain is the slanty kind that makes you 10% more likely to get wet.

Still, bring a little wet is ok. Easy to dry off in this analogy. What you don’t want to be is soaked (or being hospitalized would be the analogy). And the umbrella prevents that. 10/

So what does it mean to be close to 10% more exposed. Should it mean you wear a mask for example?

Well you could always add a rain jacket if it’s really pouring. In other words if indoors around a lot of unvaccinated people for a long while, it could help. 11/

My friend the scientist @EricTopol says it this way: just because the vaccines are great doesn’t mean you need to constantly stress test them.

Plenty of vaccinated people live in areas w lots of unvaccinated people & with case spread. Wearing a mask can’t hurt. 12/

What is not the case is that evidence of breakthrough cases are concerning. They are news because they are surprising to people but in many cases they are found in routine testing without symptoms. 13/

So if you’re in the Olympic village or on a sports team or traveling, you could find you’re testing positive as your immune system fires off. 14/

And that will happen 10% more now. As will mild breakthrough cases. And presumably hospitalizations & deaths.

So instead of 99.3% of people who die being unvaccinated, it could well be 98.5%. 15/

Your chances of being vaccinated & getting sick with COVID are still very very low. Not zero & slightly higher.

Worth taking precautions in areas with COVID & with unvaxxed people in the community. But remarkably low risk. 16/

OK. Maybe vaccinated people are safe but is it possible with Delta that you could be infected, not know it, and pass it along to someone who does get sick?

Not great data on this with Delta but scientists consider that a very infrequent scenario. 17/

So what do I think of my tweet weeks back where I say Delta is very low risk for vaccinated people and the most important thing they can do is begin to get their lives back? 18/

On the one hand, science supports the ability of vaccinated people to get back the most important things in their lives. If Delta is a risk, it is a very low one.

Still…

19/

Still most vaccinated people I know don’t feel like things can feel normal while cases are growing, even if it’s largely among unvaxxed people.

And of course, many people can’t get immune protection right now— kids & people who are immunosuppressed. 20/

Psychologically for those who have it, the feeling of safety after a year of fear is a vital psychological respite. So is hugging our family & returning some of the normal rhythms of life. Delta shouldn’t keep people from any of it. 21/

But there’s also no doubt that the unwillingness of so many to get vaccinated & Delta combined should make us all more cautious.

And getting back to life can be done while wearing the occasional mask & balanced with plenty of empathy & concern for others. /end