Tompkins Co. Medical Director, Dr. Klepack, On the Delta Variant And Breakthrough Infections

[Jimmy Jordan]: So COVID cases have risen quickly after a period of relative calm and Tompkins County. The total active cases reported by the health department for today, Friday, August 5, are 90.  So given what's being reported in the national news, it's easy to jump to the assumption that this is a result of the Delta variant. The Health Department hasn't confirmed that yet. Do you have a sense of how close we are to confirming the Delta Variance'  s prevalence in Tompkins County?

 

[Dr. William Klepack]: In terms of its prevalence? I think the best benchmark that we can use is the data that we know from national studies of variants and from state studies, and that would imply that the Delta variant is at least 83% of the cases that are arising. So while on these cases that you mentioned, we don't have a specific breakdown of them at this point in time, we think we're safe in presuming that the vast, vast majority of them are due to Delta. 

 

When you ask about factors that are leading to the rise, in cases that we're seeing, as is always true, it's a combination of factors.  So on the one hand, we have the Delta variant, we know this is a variant that infects more people more easily than the United Kingdom grant that we had just a little while ago, or going back to the beginning of the pandemic, the original variant. We know that for any person infected with Delta, that somewhere between five and eight other people will become infected if they are susceptible. So that's an important point: if they are susceptible. If you're vaccinated, your chances of becoming infected are far, far fewer than if you are unvaccinated.  And just to put that into context, if you're vaccinated, the chance out of 1000 people that you would become infected is only somewhere between one and four in 1000. Those are excellent odds, but not so good if you're not vaccinated. So the vaccine status is very important. 

 

Other factors, besides the trust the fact that this Delta is so much more contagious, or what people are doing so many of our cases, amongst the vaccinated as well as the unvaccinated people who are traveling, not necessarily international traveling, but a lot of them are domestic. So within our state, or too other states, where the problem is even more prevalent than it is in our region. You don't have to look very far to find some very risky places you could go.  And in addition, if you're getting together for gatherings -- say it's a birthday, a wedding, who knows what -- these are highly correlated with outbreaks of cases,and we've seen that with our local data. Very likely that there was travel involved, very likely that there were a gatherings involved.

 

And so that can tell people how they can keep themselves safe, both unvaccinated as well as vaccinated. The other things that we know that are factors in the rising cases are whether or not people are using masks, whether or not they are distancing. If they're in a situation where the risks may be high, then are they using those masks are the distancing? And I would urge everyone that if they're in a situation whether they're vaccinated or not, if they perceive that, 'Oh, I don't know if the people around me are as careful as I am; Oh, I don't know if some of them are unvaccinated; Oh, I don't know where these people have traveled to,' and you're close enough to them to be a risk, consider using those masks and consider changing things so as to lessen your risk.

 

[JJ]: So, I want to go back to something you said before about vaccinated people and virus transmission. You know, there was data coming out of Israel and Los Angeles that has begun telling a concerning story about the vaccine's efficacy against it spreading among vaccinated people. And the CDC confirmed last week that breakthrough infections have similar viral loads to infections in unvaccinated people. And so can you break that down for me?

 

[WK]: Yes, and let me -- let me address it. In the most recent situation, I know the best. And that's the Provincetown, Massachusetts situation where large numbers of people over the Fourth of July long weekend were gathered together. A lot of them were vaccinated individuals. And we saw a large number of cases amongst the vaccinated in that group. But that that was a situation that violated what I was talking about before in terms of taking precautions in situations that are risky.  These are large numbers of people. It was a somewhat rainy weekend. So a lot of people crowded indoors, but even on the streets. People were very crowded together. 1000s of people were gathered for this fourth of July weekend. And so there was an element of crowding, gathering together, not using masks, etc, and a large number of vaccinated individuals were found to be infected. 

 

And of course of doing that study, they did look at the PCR tests that were done on these individuals, and what they found was that in doing the PCR test, they could get an appreciation of how much of the molecule being tested for was present in the nasal passage or the saliva sample from these individuals. That remarkable study showed that for the vaccinated individuals compared to unvaccinated that they were quite similar, and this was a departure from what had been known before. This delta variant, it seems to be the cause of these unusual levels. Now, this molecule that is found -- and this gets a bit technical forgive me if I get too far into the weeds -- but this molecule that's been found can imply infectiousness, but it may not. It's yet to be determined how infectious actually that is.  

 

And so, yes, there's a cause of concern. Yes, because we saw such a high number of vaccinated people in this group and we saw other vaccinated people getting infected. Yes, it appears that some vaccinated persons were infected by other vaccinated persons. However, the final story will yet have to unfold, because this molecule that was sampled is not quite the same as being able to show that they had live virus that infected other people. If a person is experiencing a breakthrough case, they should presume they're contagious. And certainly anyone who is a breakthrough infection should isolate, separate themselves from everybody -- that's what isolation means -- until the period of time passes, after which they can be declared not contagious. So anyone who's symptom -- symptomatic with something that could resemble COVID should always isolate right away.

 

[JJ]: What do we know about a symptomatic spread in vaccinated people?

 

[WK]: That is a very good question. And I don't know the final story on that. As you know, it was thought that it was very unlikely to have asymptomatic spread amongst vaccinated people in the past. This data about Delta is a continuing story, and one of the things that maybe it's difficult for her for everybody in the public to Appreciate, because we all want the final word on things all the time, but when you have an evolving situation like this, it's a strength, not a weakness, to continually be looking at what we know, and reacting to it and adjusting. 

 

What we do know is that vaccines are highly effective at preventing infection. And especially, especially severe infection; especially hospitalization; especially being -- have to go on a ventilator, or being in the intensive care unit. In fact, of all the cases we've had, none of them have even required an emergency department visit. If they were vaccinated. All the people in the hospital are unvaccinated.  Just look around you. I urge you and the people in the public who haven't been vaccinated yet. Look at ask your friends, you know, don't so and so ended up in the hospital where they vaccinated, you'll find out they weren't. That should speak volumes to you if you're not vaccinated. 

 

This is a significant disease that not only puts people into the intensive care unit, and unfortunately, people die from it. But there's this phenomenon of long haul COVID, which affects a great number of adults, and can cause you to be disabled and unable to work. It will even affect children. We don't know exactly the percentages for children yet it seems to be fewer than for adults, but still a significant percentage. Somewhere probably between 10 and 20-25%.

 

[JJ]: With your terming this an evolving situation and emphasizing the importance of paying attention to what we know, I think this is a good time to turn to the data that the Tompkins County Health Department released yesterday on the vaccination status of positive cases. 

 

I'm sure you're very familiar with this data already, but I just want to establish some context for listeners.  So here are some of the numbers that the Tompkins County Health Department released. Between May and July. There were 315 known cases of the Coronavirus and Tompkins County, the health department calculates that 27% of those cases were in fully vaccinated people. If we look at the bar chart the health department provided, we can see the total case numbers generally going down through May into June. Now June is when the health department first detected two cases of the Delta variant, although there was no spread found at that time. And as we head through July, we see the number of cases increasing, and among that population that is, you know, getting sick with COVID, there's a lot of -- it may seem like there's a lot of fully vaccinated people. 

 

Last week, the week of July 25 to August 1, Tompkins County saw 71 new cases of the virus 66% of those cases were in fully vaccinated people. But the health department found that the cases in fully vaccinated people was just 0.2% of the fully vaccinated population. So I'm done with my spiel and I'd like to go over to those findings with you. So my first question is, were these the sort of numbers that the medical community in Tompkins County has been expecting to see if the Delta variant were to show up?

 

[WK]: Well, there's a number of different dynamics as our vaccinated population increases, and, and since the numbers that we report, as a health department are of Tompkins County residents, the num -- the number of vaccinated persons who become cases is likely to go up if we had 100% of the population vaccinated than any new case that we had of Tompkins County residents would be a vaccinated person. So you kind of anticipate that you'll see more vaccinated persons in your numbers as the months go by and vaccinated numbers go by, is that a failure of the vaccine? No, you know, vaccines 100% effective. And so, you know, you're going to have some cases that will be unvaccinated persons. 

 

And as you point out, the number of absolute cases compared to our unvaccinated population, 0.2%, that means that I've seen is highly effective in protecting people against acquiring the disease. So it's in general, the bigger picture is reassuring the vaccine is successful. And secondly, that the phenomenon of seeing some rise in vaccinated cases is not to be unexpected. It is something we would expect.  But then I would also say to people, these are -- these are small numbers, it may seem like big numbers. But in the larger scheme of things, when you're looking at seeing if something is what they call, statistically significant, these numbers are relatively small. But I also wanted to point out that in addition to the rise in the vaccinated cases, that a high percentage of them were people who had traveled, people have been to gatherings. We don't have data on what those gatherings were like. Undoubtedly, some of them were met to hang out undoubtedly some of them were in more risky situations.

 

[JJ]: How do you how do you think the Delta variant is going to challenge our understanding of the pandemic, as it has taken shape over the last 16 months?

 

[WK]: I think that it does not challenge our understanding in this sense...vaccination is highly effective. It is succeeding in work its major mission is or preventing serious disease and death. It also is able to cut down on the transmission of disease. And that is the recipe for stopping this pandemic. That's what our goal is: stop the pandemic. And my plea to the people who have been hesitant to get vaccinated, is look around you and see who is getting hospitalized and who is unfortunately dying of this pandemic. And it's not the vaccinated people. The unvaccinated are bearing the burden of this. 

 

And the way we stopped the pandemic is for more of the unvaccinated people to become vaccinated. The vaccines are key to stopping the pandemic and our understanding of that has not changed, even with a Delta Variant. And, I hasten to point out, that other variants could arise, the longer we go without stopping the pandemics on a global basis, the more of the risk is that a variant could come up, that starts to become resistant to our vaccines. We have not seen that, it is not true with a Delta variant, but that's our risk. And so time is of the essence, and stopping that pandemic. To prevent us from seeing a truly terrible variant from coming about.

 

[JJ]: What you're saying is that what's hedging on the global access to the vaccine is the ability for everyone to be safe from COVID. Do you think that -- I mean, this is a very hard question to answer -- but how tenable do you think that the suppression of the disease is?

 

[WK]: Yes, I would, I would say converting the SARS-CoV-2, the pandemic or currently dealing with, transi -- transitioning it from something we fear, to something we know we have in control, to something where it would be extremely unlikely for people to become seriously or serious...very unlikely to have to suffer long COVID syndrome that is within our reach for sure. And...and the key to that is the use of the vaccine for people who are not vaccinated yet to become vaccinated. And in the meantime, while we're still struggling to get that vaccine level for all of us, vaccinated or unvaccinated, when we're indoors, or even sometimes outdoors and feel like we're in a risky situation. Use those masks. Use those mitigation measures that we know work. 

 

Masks are strong adjunct to vaccination in prevention of disease. And so if you have a choice that you're you're you're doing something you're maybe planning something, keep your gathering small. Do it outdoors if possible. Try to ensure that everybody's vaccinated. Consider using those masks. Hand washing, etc. Remember that the Delta Variant is still the same kind of virus we've been dealing with -- mostly airborne transmission. We think that surface transmission is is very, very seldom the cause of people getting infected. It's good to handwash. That's important. Disenfect, when you feel the need to, but particularly the airborne transmission is the major route. So while it's concerning because it transmit spreads from person to person far more readily. It is, in many respects, very similar to the other variants that we've had to deal with. And that's what I hold out as hope for people. We know how to deal with this virus. We know what works. We just need to do it.

 

Jimmy Jordan  20:54

A poll out of Monmouth University this week found that Americans are split on a return to mask wearing: 52% of Americans support reinstating the measure 48% oppose it. And there is a political divide in those numbers: 84% of Democrats favoring reinstating mask wearing, 73% of Republicans opposing it. Speaking to a vaccinated person in Tompkins County, who may be hesitant to start wearing a mask again, why should that person put the mask back on?

 

[WK]: Well, I think they need to look at what the risks are, if they should become infected. You know, the -- one of the vulnerable populations in our in our population is the people who are immunocompromised. They comprise about 3% of adults. So we have about in our county of 100,000, we have about 3000 adults, who even if they get vaccinated, can't be sure they're as protected as if they weren't immunocompromised. Many of us have somebody in our family friend group, who's in that category. Maybe we don't even -- maybe we're not even aware of it, because some people say for example, who have certain types of arthritis, rheumatoid arthritis as one example, are on immunosuppressive drugs. 

 

That's a lot of people who are affected. We don't want to put them at risk. They -- they're at more risk than people who are not immunocompromised. We have kids who --- for whom they can't be vaccinated yet. So all the kids under 12, we have the people who are older. If you're older, above, you know, 70 your a risk even vaccinated, it is somewhat greater than if, if you were younger. But let me hasten to point out that a lot of young people, 20-30 years of age, are falling ill with the Delta virus -- becoming more seriously open than previously experienced. So if you're young, don't pass it off is this is somebody else's problem, because you can get very sick and long haul COVID, where you can become disabled due to mental fatigue, physical fatigue, difficulty thinking, muscle aches and pains -- there's a long list of long haul and COVID symptoms -- those occur in people who are young, even down into the teen years, as well as older and that can put you out of work for a long time.

 

Jimmy Jordan  23:39

Okay, and so just my last set of questions, is just about, you know, looking forward and how we're going to be trying to make sure this virus doesn't continue to surge. There's something I came across that it concerned me a little the CDC says that they stopped collecting information on breakthrough infections on May 1 of this year. What do you know about that? And what is the current protocol regarding the surveillance of breakthrough infections in Tompkins County?

 

[WK]: So the CDC as of May shifted to monitoring hospitalizations, ICU admissions and deaths with regard to breakthrough infections. So what they were not attempting to monitor was mild cases of Coronavirus and asymptomatic cases. The Kaiser Family Foundation put out a study on the 30th of July I believe it was that looked at state data with regard to all breakthrough infections. Looking at all states that reported such data about something close to half of the states do some do it on a frequent basis, others on a very infrequent basis. And the foundation and looking at all of that data, which took into account reports from the beginning of 2021, through to about mid July, found that breakthrough infections, in general, were extremely uncommon for vaccinated individuals and confirmed those the lack of severity of disease that the CDC has been reporting. So that's an independent study that looks at the breakthrough infections. 

 

That being said, the information -- well, let me back up and just say, the rise of of, of Delta as a variant got really underway in May, and through June and accelerated in July, so that the data that's coming in about breakthrough infections is continually being looked at, as is, in order to take a look at even more about Delta. But so far, even with Delta entering that mix, as it did in the Kaiser data, we know that breakthrough infections in vaccinated people are extremely uncommon. Less than 1%, probably less than point 4%. To put that in context, again, if you have 1000 people, you're talking about something less than four people becoming infected. If those 1000 people had been all vaccinated,

 

[JJ]: If a breakthrough case were to happen, do you know if the county will be sending out alerts like they used to when we would find a case maybe on TCAT or some other public space?

 

[WK]: I would refer you to Sammy Gillson on on that question. We have we issue public releases in all instances where we feel that there is a possibility that persons might be might be exposed unbeknownst to them. If the situation is one in which everything is covered, we know that all the exposed people are made aware, then there's there we don't do a public release. But in all other situations, we do public releases.

 

[JJ]: And my final question and something you've spoken to plenty of but I feel I should ask again, as we continue to live with COVID-19. What should people do to combat these numbers?

 

[WK]: Well, I think, as I mentioned last night in my webinar, I think people should maintain hope. There's every reason to anticipate the end of this pandemic. We just need to do the right thing. And I would particularly urge people to take care of each other. This is a tremendously stressful thing that we're going through. It's causing depression, it's causing anxiety. We unfortunately know that there are suicides. We unfortunately know that it's particularly hard on people who have other issues that they struggle with. Don't,  be there alone. Reach out, help other people. If you're feeling this way, if you're feeling stressed. Talk to your personal physician, talk to your personal practitioner. Give us a call at Mental Health in here in the county. Give us a call at the health department. We'll help connect you to someone who can help you to put this into context to help you forge some coping mechanisms, seek help whenever you need to. But there is hope. This will and we know how to do it. This...we have vaccination. We have masking, we have distancing. We know how to wash your hands. We know how to take precautions, use our common sense, and we can come to the end of this 

 

[JJ]: Dr. Klepack, thank you so much for getting on the phone and speaking with me.

 

[WK]: It's my pleasure and I'm so glad that you're you have an interest in wanting to get such information out to everybody.