COVID | July 14, 2021

The Delta Variant: Interview with Dr. Dumyati, July 14, 2021

BY LeadingAge

Dr. Ghinwa Dumyati, an infectious disease physician and Professor of Medicine at the University of Rochester Medical Center, joined the LeadingAge Coronavirus Update call on July 14, 2021. She responded to questions from Joe Franco and from callers.

Q: Can you tell us about your work on infectious diseases with University of Rochester and the CDC?

A: I do two types of work – surveillance for emerging infectious diseases – resistant organisms and then, when the Sars COV-2 virus emerged, we added COVID-19 issues to our work. The good news is that the effectiveness of the Pfizer vaccine in real life is similar to the effectiveness found through the original research. Now we are interested in breakthrough variants among vaccinated people and why they are occurring. I also do work in the area of quality and, specifically, the use of antibiotics in nursing homes.

Q: How common is the Delta variant in the U.S.?

A: The Delta variant is now the predominant strain. The data from July 3 showed the Delta variant accounted for about 57% of cases and we expect that to go higher. In the U.K. the Delta variant now accounts for almost 90% of cases.

Q: Why should we be concerned about this particular variant?

A: The Delta variant is highly transmissible. An infected person can infect many other people. We are currently seeing that most infections are occurring in people who are unvaccinated.

Q: If we are vaccinated, are we still protected against this more contagious variant?

A: Yes, real life experience and data from Scotland and Canada show 80-88% effectiveness. A report from Israel showed lower numbers, but there many have been issues with that study. In any event there is good protection (90+%) against more severe disease that would result in hospitalization or death. Vaccinated people are at lower risk of contracting the disease and have a much lower risk of hospitalizations and death. Some people could be asymptomatically infected and only be discovered as having the virus because of surveillance testing. There have been a small number of particularly vulnerable vaccinated people who have been hospitalized and some few have died, but the numbers are very small.

Q: Should our members talk about the new variant and use that as a new push to get more staff members vaccinated?

A: That could be one of many approaches to address hesitancy. There are many reasons why people are hesitant to receive the vaccine, and we need to address all of them. Misinformation, difficulty of access, lack of paid time off if they have side effects, and many other reasons may be barriers which we need to understand and address. But, certainly the Delta variant adds greater urgency.

Q: What if there are staff or residents who only got one of the two shots? Are they protected?

A: The difference with the Delta variant is that there is lower protection with one dose than with earlier variants. People need to get the second shot to be better protected and we need to understand why they did not get the second shot and try to remove those barriers.

Q: Do you think we will need a COVID-19 booster shot later this year?

A: There would be two reasons for a booster shot: 1) waning immunity over time ( no current evidence of this); and 2) a variant that requires a different vaccine. Right now, the evidence does not support the third dose, but that could be the case in the future.

Q: What can our members do to protect their residents from these new variants?

A: Vaccination is the only way to get good protection. We know from our experience with influenza vaccinations that nursing homes and assisted living communities with higher vaccination rates had fewer outbreaks. If you want to protect residents, trying to get staff vaccinated is the best way. Of course, it is also important to vaccinate residents. Sit down with those who are hesitant and find out why they are not yet vaccinated. It takes time to get people who are hesitant to change their minds. We are now seeing statements from medical societies, including AMDA, suggesting that vaccines be mandated as a condition of employment for healthcare staff to keep those whom they serve safe.

Q: How concerned should we be with the Epsilon, Kappa, Lambda variants?

A: They are currently variants of interest, but not yet variants of concern. This is today, but that may change if there are additional mutations or changes in our experience. Right now, we should worry more about the Delta variant. We know that when prevalence occurs in the community, it also increases in nursing homes and other congregate settings.

Q: With the Delta variant spreading, does the advice that vaccinated people do not need to be tested if exposed to the virus still hold?

A: We are still learning, and I don’t have evidence-based answers to that question. If you are asymptomatic you may not need to be tested, but if there are multiple cases, testing should be considered.

Q: Tell us about your work in improving antibiotic use in nursing homes.

A: I can share a document and website that describes this. I did not mandate anything, rather I worked with medical directors and shared with them the rate of C: difficile in their nursing homes and why we needed to address this. We were concerned about the use of Quinalone. We developed guidelines for UTI treatment, pneumonia and other infections. Medical directors helped to develop the guidelines in a collaborative approach.

Q: Given low rates testing in most communities, are positivity rates a trustworthy measure?

A: I’m not the expert on that and would be hesitant to respond.