Shifting Our Perspective from How to End the COVID-19 Pandemic to How to Manage it

Authors: Sima Sobhiyeh, Ph.D.; Alexander Stemer, M.D. Infectious disease; Joe Kurland, M.P.H., C.I.C.; Anna Foley, Leah Shaffer, Ph.D.; Sarah Ali, M.P.H.; Yasamin Saidi, Falaq Ghafur

As we wait for the COVID-19 pandemic to end, we are beginning to realize that it is probably not going away any time soon. Many countries still have only a small number of their population vaccinated. 

Over 20 countries have vaccinated less than 1% of their population. Over 50 countries, including Egypt, most of South America, Pakistan, South Africa, Thailand, and India, have vaccinated less than 10% of their population. Only 33 countries, including the US, have vaccinated at least half of their population. With these low global vaccination rates and highly contagious variants of COVID-19 quickly becoming dominant, we need to shift our perspective from how to end this pandemic to how to make it a manageable part of our lives. 

COVID-19 testing and vaccination are two critical components of managing COVID-19. With the Delta variant accounting for over 98.8% of COVID-19 cases in the US, the best way to ensure adequate detection and minimize false positives among COVID-19 variant cases is by testing for three proteins using RT-PCR analysis. Vaccination is another critical step in managing COVID-19. Approved vaccines protect against severe disease, hospitalization, and death caused by the Delta variant. However, vaccines have significantly lower effectiveness in preventing symptomatic illness. For example, the Health Ministry of Israel announced that based on close surveillance from June 20 to July 17, the effectiveness of the Pfizer vaccine against infection versus hospitalization was 39% versus 88%. 

This means that vaccination will help keep you alive and out of the hospital, but it will not necessarily keep you from infection, having symptoms, or spreading the virus to others. As a result, we still need multiple layers of safety solutions to provide adequate protection until we reach herd immunity. On the other hand, as vaccination hesitancy lingers and approval for pediatric vaccinations is still in progress, herd immunity remains out of reach.

“Herd Immunity” Now Harder to Achieve with the Delta Variant

The initial COVID-19 strain has evolved many times. Currently, in the US, the Delta strain is the most dominant. The genetic component of the Delta variant is different from other variants as the P681R spike protein in the Delta variant may lead to an increase in viral load in the nose and throat. 

This means those infected with the variant carry an increased amount of the virus, positioning the variant to be more easily released into the air, potentially infecting close contacts. The Delta variant is roughly 100% more transmissible than the original COVID-19 strain and has also led to increased reports of post-vaccination transmission. 

As a result of this higher transmissibility, new estimates suggest that to reach “herd immunity,” about 80%–90% of the population now needs to be vaccinated, rather than the original estimates of 60%–70%.

We Must Adopt Layers of Safety Solutions Against COVID-19

Given the complexity of the situation, it is important to adopt layers of safety solutions against COVID-19. These include limiting contacts with infected individuals via physical distancing and reducing the transmission probability per contact, in addition to testing and vaccination.

Studies show that increased state-level social distancing policies, including prohibiting social gatherings, non-essential business closures, and stay-at-home orders, have been associated with a 29% reduction in COVID-19 incidents and a 35% reduction in COVID-19 mortality.

Moreover, a retrospective case-control study from Thailand and a study on an outbreak aboard the USS Theodore Roosevelt both concluded that consistent masking during high-risk exposures reduces the risk of acquiring infection by over 70%.

Multiple layers of safety solutions are required to control the spread of COVID-19 and the more contagious Delta variant. In addition to vaccination and RT-PCR testing with at least three proteins, preventive measures such as masking, social distancing, and proper air ventilation are needed to keep unvaccinated and younger family members safe until herd immunity is reached.

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