Dr. Dave Neely works at Northwestern and has fielded a wide variety of COVID-19 related questions from patients over the last year. He has shared some of the information originally geared for his patients here.

The Delta Variant 

Delta has forced us to change the rules again. Almost all covid in the US is now delta. It is MUCH more contagious than good old 2020 covid was. Delta with vaccinated people in the past two months is almost as contagious as covid with unvaccinated people last year. The BIG difference is that vaccinated people do not die from delta.

Cases are exploding across the country in the vaccinated and unvaccinated. Florida, Louisiana, and Mississippi, some of the least vaccinated states, have more daily cases now than ever! For comparison, Illinois only has 25% of the cases we had during our peak last November. Imagine what it would feel like if we had more cases than November now. YIKES.  This is likely due to more vaccines and more mask wearing. However, it is concerning that even in highly vaccinated states, like Oregon and Hawaii, the covid cases are rising.  

Fortunately, there are very few hospitalized fully vaccinated patients. 

However, the sad and frustrating news is that delta seems to be quite contagious even among the vaccinated, when indoors.

Outside is still amazingly safe. 350,000 mostly vaccinated, mostly young people at Lalapalooza-200 cases of covid, no one hospitalized. Baseball games have been safe. Beaches have been safe. I don’t wear a mask outside.  

But indoor weddings, indoor worship services, indoor parties, even if all vaccinated now have significant risk for spreading covid. I think worship can be safe, because we can all wear masks. But people do not wear masks at parties. So the wedding can be safe-every one masked except the bride and groom. The party afterward, is no longer safe. This is a huge change from June (before delta) Many weddings indoors, few outbreaks. Now in August there are reports of indoor weddings of 200 vaccinated people that produce 25 covid positive cases.  Vaccinated people will not get super sick but they can still get fevers, lose their sense of smell, get long haul symptoms and spread covid to other vaccinated and unvaccinated people. 

Masks still work great. We are tired of wearing them, but flying is safe because everyone is wearing a mask. Most people on public transportation are wearing masks.  Most importantly, you should wear a mask on public transportation.  

I think everyone should wear masks in public indoor spaces. 

I think teachers should all be vaccinated, and students should wear masks. Lunch time is complicated. I would send my kids to elementary school with a mask. 

I don’t think bars are safe. 

I do not dine inside at restaurants. I was just travelling. Everyone on the plane and in the terminal and in security were wearing masks. Then there were 50 people crammed in a restaurant, no one with a mask. That seems like magical thinking to me.     

Unvaccinated people are still dying. In addition, unvaccinated children are getting sicker with delta. 

For the vaccinated the biggest problem with becoming covid +, is the 10-day quarantine and the number of unmasked people you might have infected. Because many people are not wearing masks with family and friends, the number of possible exposures can blossom quite quickly.     

 Boosters

1. We have very thin evidence about boosters for immunocompetent people. There is a study showing the likelihood of breakthrough is higher for people who were vaccinated 8 months ago. We do not have strong evidence that a booster reduces delta infection.  I don’t believe there is any data showing that people who were vaccinated 8 months ago are dying from delta more than people vaccinated more recently.

   What is clear to me is that the vaccine companies have been pushing boosters for several months. This is a HUGE financial gain for them. So much more money in giving Americans a booster vs sending vaccine to Africa. 

   And Biden wants to DO SOMETHING.

   So it now seems like we will start giving boosters to people who received their vaccine 8 months ago. The details are not clear. Is there an age cut-off? Will there be medical categories, like obesity and Diabetes? I think you will be invited, like you were for the first round.  I still think the best long term strategy is to send my booster to countries that have vaccine rates of 10%. That is where the next worrisome variant is likely to come from. Delta seems to have come from India. However, if the booster is offered, I will take it, because I have no confidence that the vaccine I refuse will go to a poor country. ( Similar to the reason I eat the food in front of me, rather than “send it to starving children”)

2. We do know that immunocompromised people do not respond as well to the vaccines as immunocompetent people. Immunocompromised people develop more antibodies after a third shot, so the FDA has just approved the idea of giving a third shot to immunocompromised people. The studies were done in organ transplant patients. The definition of immunocompromised in other groups is being worked out.

   Here are the major categories so far: 

• Have cancer and are receiving treatment

• Have had an organ transplant 

• Are taking medicine to suppress the immune system, such as high dose corticosteroids or rituxan or other biologics that are immunosuppressive

 At Northwestern, we are inviting people who qualify. I am not sure what other institutions are doing.

If you have any questions for Dr. Neely, email Lucas at lsweitzer@lasallestreetchurch.org or message us on the LaSalle Facebook page. Feel free to ask questions that Dr. Neely might address in future posts. But, he will not be available to answer all medical questions. Please contact your own doctor for advice on your specific medical situation.