The Daily - The Summer of Delta

Episode Date: September 8, 2021

This summer was supposed to be, in the words of President Biden, the “summer of freedom” from the coronavirus. What we saw instead was the summer of the Delta variant.The surge driven by Delta — which has seen rises in cases, hospitalizations and deaths across the United States — has underlined that we are far from being done with the pandemic.Guest: Apoorva Mandavilli, a science and global health reporter for The New York Times.Sign up here to get The Daily in your inbox each morning. And for an exclusive look at how the biggest stories on our show come together, subscribe to our newsletter. Background reading: The Delta variant retreated unexpectedly in Britain and India but has begun to rebound. The United States may take an even bumpier path, according to scientists.Here’s what we know about booster shots — why Americans may need them and when they should get them.For more information on today’s episode, visit nytimes.com/thedaily. Transcripts of each episode will be made available by the next workday.

From The New York Times, I'm Michael Barbaro. This is a daily. Today, in the United States, the worst of the pandemic was supposed to be over by now. Why it's not? An update on the state of the virus with my colleague, Apoorva Mondavili. It's Wednesday, September 8th.

Hello, Michael. Yes. Hello. I'm sorry that I'm unconscionably late. That's okay. I really was. I think I was late because my cat vomited on the carpet, which he does constantly. Cats, kids, interruptions. Your kids vomit? Well, not anymore, no. But they just interrupt. Apoorva, we are talking to you right after the Labor Day holiday in the U.S., which traditionally marks the end of the summer. And this summer was supposed to be the summer of liberation from COVID, the summer of freedom from the pandemic, as President Biden called it. It doesn't seem that that's what it's become.

But that's what it's become. So let's talk about what this summer was, in theory, going to look like, what it might have looked like, and what it turned out to be. Well, let's begin by talking about what it could have been. The summer could have continued to be the summer of liberation. We could have continued to see rising vaccination rates and a variant that responded beautifully to the vaccines and continued on this lovely path toward being free of the pandemic. Instead, what we've had is a summer of Delta. And I think Delta, more than anything else, has really shown us that this virus cannot be underestimated. It's a lesson we knew already, but I think Delta has delivered it with a really tough punch

and shown us that we are really far from being done with this virus. So let's talk through the data from this summer. The infection rates, the hospitalization rates, the death rates, and where those ended now that the summer is over and how they contrast with what we would have expected when the summer began. You know, when you want to see what you think the country is going to do, what some of the experts that I talk to do is look at Florida.

Florida has been this bellwether throughout the pandemic. And so some experts that I talked to were saying as far back as January that Florida was going to have a wave in the summer. What I think they didn't expect, and what ended up being the story all over the country, is how high those numbers went. At one point this summer, Florida accounted for one in five cases throughout the country. The numbers just kept going up.

And then we started to see those increases everywhere else, all over the country. The numbers just kept going up. And then we started to see those increases everywhere else, all over the South. Louisiana had the very worst time it's had in this pandemic this summer. Alabama, Georgia, Texas, Arkansas, all of those places started to see very big numbers. But what was really startling about these increases was also the numbers of hospitalizations. What experts had told me for months and months before is that we might see the numbers go up in terms of cases, but that we would not see full hospitals again and overflowing ICUs the way we did in January. And that has really not been the case. We have seen hospitals overflowing.

Even now, even when most southern states are starting to see slight drops, Alabama, Georgia, Texas, Florida, they're still all using more than 90% of their ICU beds. Wow. some unusual surprises here, like Oregon, which has, you know, 58% of its population is fully vaccinated and the hospitals in Oregon are full. Really, the numbers are going up almost everywhere. In 44 of the states, the numbers are still going up. At the beginning of the summer, we were seeing just about 10,000 to 15,000 cases a day. Now, we have 10 times that number. We have something like 160,000 cases a day. Wow. Debts are also really high now.

We are averaging about 1,500 deaths a day compared to about 300 at the beginning of the summer. So all in all, it was not just a squandered summer when it comes to where we started in those data points, but a kind of crisis summer. It really has been. And as I mentioned, for some states, this has been the worst part of the pandemic. And that was really not supposed to be the case. So based on your reporting, what is behind these very grim summer numbers? And why do you think that even at the level of the president, that there was a presumption that the worst was behind us?

Well, I think, first of all, we expected to have better numbers for the percentage of people who were vaccinated. We wouldn't be having this conversation if 90% of the population had been protected. But I think what's also important is that we were really surprised by a bunch of things. One expert I talked to early this spring said to me, I think we've vaccinated our way out of this

pandemic. And I think he said that because he thought that we were going to continue to see the trend in vaccination that was true at the time. And even at the beginning of the summer, you know, President Biden set that goal of 70% of adults being vaccinated by July 4th. Right. It seemed like a totally reasonable goal. We have this amazing vaccine. It's going to protect you. Take it. What we did not expect is the level of vaccine resistance. And this is where actually the numbers coming down may have worked against us. When you say the numbers coming down, what do you mean?

When the infection rate went down so much, I think some people thought, well, why should I bother to take a vaccine? The pandemic is over. Interesting. So we've stalled at something like 53% of the population vaccinated, almost half of the population unprotected, still vulnerable to the virus. That is just not the same picture we were envisioning. So people, we don't know how many, but some meaningful number of people made decisions when the infection rate in this country was 15,000 a day when things looked good to not get a vaccine that may help explain in a pretty meaningful way why we've gone from 15,000 to 150,000 a day. And it makes sense, right? Because those vaccination numbers are going up again. We're now vaccinating more than a million people a day. And at the beginning of the summer, we were vaccinating 500,000. So many more people are now choosing to get vaccinated

because Delta is everywhere, and they're now hearing about hospitals being full, and the cases are sky high. Fear, apparently, is a very good motivator to get people to vaccinate. But that fear is too late to change the course of the summer. But hopefully not too late to change the course of the fall, or the winter, or next spring. Apurva, you talked about hospitalization rates.

And I want to focus on those for a minute because we keep hearing reports, you just mentioned a few of them, of there being no more beds available in hospitals in many states around the country. And it feels like of all the data points that you have talked about, the hospitalization rate is the one that is the scariest. Do we know why the hospitalization rate

is what it is right now? Once again, it turns out that vaccines are really the key here. There is a very clear relationship between the percent of a population who are vaccinated in a state and the number of hospitalizations. If you look at the states with the highest numbers now, Tennessee, Georgia, South Carolina. These are states with low vaccination rates, hovering just around 40% or so. And a much smaller contribution to hospitalizations is that some vaccinated people who are developing breakthrough infections are ending up in the hospital. That is a much smaller proportion, though, and mostly made up of older people

and immunocompromised people. And when you say smaller proportion, though, and mostly made up of older people and immunocompromised people. And when you say smaller proportion, what percentage are you talking about? Well, so this gets a little bit tricky. What you might hear, for example, is that 20% of people in a given hospital are vaccinated. And that sounds very scary, right? Yeah, sounds like a lot, right? That number is misleading, though, because what it's hiding is a lot of detail, a lot of detail that's very important. Probably the most important one is who are those people who are in the hospital? And I think what you'll see in the places that are actually collecting that information is that the vast majority of the vaccinated people who end up in the hospital are older people and immunocompromised people who didn't really respond very well to the vaccines to begin with. Got it. On average, somebody who is vaccinated and has died from a breakthrough infection is 78 years old. So it really is people who are older and have pretty weak immune systems who end up in the hospital

with a breakthrough infection. In other words, the people who were always most susceptible to COVID-19 are the vaccinated people who end up in the hospital. And you're saying that's what gets you to a number like 20% of hospitalizations. That's right. So on the subject of breakthrough infections, when we last spoke with you, we were just starting to wrap our heads around how big a threat they were. Clusters had broken out in places like Provincetown, Massachusetts. You mentioned a wedding in Oklahoma.

It seems like at this point now, at the end of the summer, everybody knows somebody who is vaccinated and yet still got one of these breakthrough infections. So now that the summer's over, what's our understanding of how common or how rare breakthrough infections really are? What we know now is that breakthrough infections are not rare. They're not common, but they're not rare either. And they're certainly more common with Delta than they were with the original virus, and more than we expected them to be. they were with the original virus and more than we expected them to be. But it's important to note that we are still much less likely to be infected if you're vaccinated and much, much less likely to get really sick if you're vaccinated. But of course, the answer that everybody really wants to hear

is that breakthrough infections are rare, rare, rare, rare. And you're saying that's not really an assurance we can give. It's not because that's not really what these vaccines were ever thought to do. We always knew that breakthrough infections were a possibility. It's just that they seem to be more common than we thought they would be. It's just that they seem to be more common than we thought they would be. This is also at the heart of the conversation about boosters and a rift that's been developing between scientists and the Biden administration on who should get boosters and when. We'll be right back. So, Apoorva, tell us about this emerging split over booster shots for Americans. You said that there was a disagreement between scientists and the Biden administration.

Let's start with the Biden administration. We know that for the past few weeks, the White House has been talking about the possibility of recommending booster shots for just about everyone around eight months after their last dose of the vaccine. The Biden administration is concerned about some data that they say they've been seeing indicating definitely waning immunity against breakthrough infections, but also some drop in the effectiveness against hospitalizations. What they've said publicly is that they're seeing some hints of a drop in the effectiveness against hospitalizations and that they want to get ahead of that and get people booster shots before people start ending up in the hospital. And what's the source of this data? So the CDC has several cohorts, groups that they've been following. And there's also data from Israel that they're looking at. And they're also expecting some data from the vaccine manufacturers. So there's several

different streams of data. And the data that they've released so far doesn't show this drop. And the data that they've released so far doesn't show this drop. But they've said that they have seen some data, some early signs that the vaccines may be becoming less effective against hospitalizations. And if that's to be believed, it would quite naturally lead to a recommendation of booster shots so that people strengthen their immunity. Is that the thinking? That is the thinking. And that's where the disagreement really lies. So describe the other side of this disagreement.

The other side is a lot of virologists and public health experts who are saying that we always expected breakthrough infections and that the vaccines seem to be doing really well against hospitalizations. They have not seen this data that the CDC and the FDA are talking about. And so they feel very strongly that the booster should be recommended only for older people and immunocompromised people who do have weaker protection against the virus.

And that for the rest of us, there's really no need for boosters yet. So that would be an argument, in summary, that says it's not the worst thing to have a breakthrough infection so long as that breakthrough infection doesn't put you in the hospital. That's right. And the argument that these scientists are making is that there is a large swath of the population worldwide that is yet to receive a single dose of the vaccine. And so that should be our priority so that we limit the spread of the virus, we limit the evolution of new variants, and that the Biden administration should be focusing on getting the vaccine to people who are unvaccinated rather than on boosters for people who already are vaccinated. This is the moral as well as scientific argument we have talked with you and our colleagues

about in the past, which says that so long as vaccinated people are relatively safe, then that third dose should become somebody else's first dose outside the United States. Right. There was a really striking metaphor that somebody from the WHO used, which is saying that what the U.S. is doing is the equivalent of giving new life jackets to people whose life jackets may be a little frayed while other people are drowning. That's a very powerful metaphor. It is, so long as the life jackets continue to work. And what these scientists are saying is that they are still working very well. In fact, some scientists feel so strongly about it, some scientists at the FDA, that it's actually caused them to resign from the FDA in protest of the Biden administration's decision to announce boosters. So which side is likely to win out here, the Biden administration or the scientists? I'm

guessing it's the people who run the White House. So should we expect there to be a pretty widespread booster recommendation in the coming weeks? You would think that the Biden administration would win? They have said many, many times that they will follow the science. What the scientists at the FDA and the CDC are saying right now is that they will review the data and make a recommendation. And some scientists who advise the FDA are going to meet on September 17th. So that's probably when we'll find out what happens. I think we can pretty much guarantee that they will OK the boosters for older people and immunocompromised people, but it's unclear what they'll say about boosters for everybody else. And what do we know about which vaccines

are likely to be recommended for booster shots? Will it be all three of them, Pfizer, Moderna, J&J? Will it be one? Will it be two of the three? Or what? Pfizer is likely to be the first, because that's where the data is the strongest. There is a bit of confusion with Moderna over the dosing. And there's also some more data that needs to be reviewed for J&J. So those two may come later. Got it. We've been talking about booster shots for vaccinated people, but as you told us, Apoorva, this stage of the pandemic is really being fueled by unvaccinated people, and those numbers aren't really budging all that much. So what kind of timetable

does that give Delta to run its course in the United States? In other words, how much longer is Delta going to be inflicting the kind of damage that we saw over the summer? This is anybody's guess at this point. In other countries, like in India and the UK, the numbers went really high, and then they came back down after two or three months. But we are also going into the fall.

We are going into back to school, return to office, and that may keep the numbers high for a bit longer for us than they stayed in other countries. We could be looking at the numbers staying high through mid-October, mid-November, something like that. So would that make Delta a longer living variant than Alpha, the last big variant? It would. And partly that's because Delta is just the most fit virus we've seen so far. It's been the most competitive, and just about every other variant has lost to Delta. So it might stick around longer than all the others, unless we see another new variant

come up that manages to be even more efficient than Delta. Right. And of course, we're now hearing about another worrisome variant of the virus called MU. So what do we know about that? So that's actually mu, the Greek alphabet, which we should all become really familiar with because these variants are going to keep coming. Right. Mu is not something quite enough for us to worry about yet. It's been circulating mostly in South America. The reason that scientists are watching it closely is because it has a couple of mutations that were seen in beta and gamma, which are the variants that made their way around South Africa and Brazil.

are the variants that made their way around South Africa and Brazil. And those mutations cause the vaccines to be slightly less effective against the virus. So that's what makes me a little worrisome. But I think for the U.S., Delta is still the one that we need to keep an eye on. So for the foreseeable future, the focus will be on Delta. And I think that brings me to a question we've asked you many times on this show, which is when we're going to reach what feels like some kind of an end to this pandemic. that the best we could really hope for is a time when the virus is just triggering regional outbreaks, not kind of crisis-level infection rates around the country. And we aren't even at that phase yet. We're still in the crisis phase. So what's your best guess now, given the trajectory of Delta,

given what's happening with breakthrough infections, the debate over booster shots, for when we leave the crisis phase and enter something more manageable and less scary? breakthrough infections, the debate over booster shots, for when we leave the crisis phase and enter something more manageable and less scary. Delta has made me really wary of predictions, so I'm not going to make the prediction. But I do think that the pandemic will end the same way that we talked about before. It will end for us as smaller outbreaks that don't result in hospitals being overwhelmed. But it's going to

take us a lot longer to get there than we thought, mostly because of Delta and mostly because we are still trying to vaccinate so many people in this country. So a lot depends on how many people we can get to. Eventually, we are going to get there simply because most people will be protected either through natural infection or by finally getting the vaccine. But it may take us many months. It could take us till next spring. It could take us till next summer. It really depends on what the virus does, too. You keep saying next spring, next summer. That means well into 2022. Don't hate me, but yes. That means well into 2022.

Don't hate me, but yes. Purva, thank you very much. We appreciate it. Thanks very much. As of Tuesday night, COVID-19 has infected more than 40 million people in the United States and has killed more than 649,000 of them. We'll be right back. Here's what else you need to know today. The Islamic Emirate of Afghanistan wanted to resolve the issue through talks, negotiations and understanding. On Tuesday, the Taliban announced the appointment of an all-male caretaker government that is filled with senior leaders from the Taliban of the 1990s and excludes members of the U.S.-backed Afghan government.

The appointments undercut the Taliban's claim that it will be a more moderate force than it has been in the past. And Mexico's Supreme Court has unanimously ruled that local laws making abortion illegal are unconstitutional, a decision that is expected to pave the way for legalizing the procedure across the heavily Catholic country. The ruling follows years of growing activism by Mexican women seeking greater rights and could make Mexico the largest country in Latin America to legalize abortion.

largest country in Latin America to legalize abortion. Today's episode was produced by Michael Simon Johnson, Robert Jimison, Chelsea Daniel, and Soraya Shockley. It was edited by M.J. Davis-Lynn and contains original music by Alisha Ba'et. And engineered by Corey Schreppel. Our theme music is by Jim Brunberg and Ben Landsberg of Wonderland. That's it for The Daily. I'm Michael O'Brien. See you tomorrow.