Add To Favorites
'Precarious': This is the state of COVID in Indiana right now as delta variant thrives
Indianapolis Star - 7/29/2021
As COVID-19 positive cases continue to climb in Indiana, public health experts say we should brace for worsening infection rates, especially in unvaccinated people, although the situation is unlikely to be as catastrophic as it was for much of 2020.
"We are in a precarious situation," said Ana Bento, an assistant professor at the Indiana University School of Public Health who studies epidemics. "If things were to stay as they are, if we don't vaccinate more people and people are not compliant in terms of mask usage and social distancing, we are going to enter a phase of the year where we're likely to increase the probability of getting infected because of more indoor activities and the delta variant."
Right now, the level of COVID-19 community transmission in Indiana is considered substantial or high for 70 out of 92 Indiana counties, including Marion and the donut counties, according to the Center for Disease Control (CDC) COVID data tracker.
Not likely to get a repeat: Gov. Holcomb unlikely to require masks in Indiana despite latest CDC guidance. Here's why.
A few factors are driving the continued rise of COVID-19 infections, said Bento. First, the delta variant is proving to be highly transmissible, comprising 86.7% of positive tests in Indiana this month. Second, 57% of Indiana remains not fully vaccinated or unvaccinated. Some of these individuals have continued to socialize and spread the COVID-19 virus.
Bento said we should be concerned as the summer ends and we enter the fall because many activities currently happening outdoors will move indoors, where infection rates tend to be higher as people are closer together and ventilation is worse.
Unless more people in Indiana and across the country get vaccinated, fast, public health experts predict a spike in COVID-19 infection rates.
Here's a more detailed look at the current state of things in Indiana:
Over the past month, Indiana's statewide positive test rate has climbed each day— a sign that the COVID-19 virus is increasingly spreading from person to person daily. On June 21, the rate was 1.9%. One month later, on July 25, it was 13.1% (This is a preliminary estimate as data has not been fully gathered for this date).
Indiana's seven-day positivity rate last week — from July 14 to July 20 — was 6.3%. By comparison, the rate at the peak of the pandemic in November 2020 hovered between 13 to 15 percent.
Nationwide, more than 90 percent of infections are in unvaccinated individuals and the rate is similar in Indiana, said Bento.
The delta variant is already highly prevalent and spreading in Indiana, with 86.7 percent of COVID-19 infection samples in July being delta variants. This is a whopping 46.9 percent increase from delta variant infections in June.
"If you think about it as two competing organisms, if one is fitter and faster at transmitting, it will infect other individuals at a higher rate," explained Bento. "Eventually, it will lead the original strain to extinction and it will dominate our state and the whole country and likely, any other countries."
She said we may well reach a point where 99 percent or even all COVID-19 infections are more infectious variants such as the delta variant.
Just 44 percent of Indiana is vaccinated, far below the recommended level that is required to slow the spread of COVID-19. Although many scientists agree that the vaccine coverage threshold — or the proportion of the population that needs to be vaccinated to slow down virus transmission — for COVID-19 is around 70 to 85 percent, Bento said she thinks that even that will be inadequate to bring infection rates down.
The reason is a spillover effect, explained Bento, that happens especially when there is a high degree of commuter traffic in and out of a particular community. Indianapolis and Marion County are transport hubs, and therefore are especially vulnerable to inter-county or inter-state infections.
"We have two neighborhoods: one is vaccinated at 98% and one is 20% but they actually are very connected in terms of mixing between individuals in each neighborhood so we kind of have a spillover of the unvaccinated population onto the seemingly vaccinated community," explained Bento. The vaccination rate must be higher, almost 100%, to make sure no one gets infected, she said.
"The rule of thumb should be let's get everyone vaccinated," Bento said.
Dr John Chandy, the director for the Ryan White Center for Pediatric Infectious Disease and Global Health at the Indiana University School of Medicine, said that "the best way to prevent new variants from coming along is to create a new environment in which the virus is least likely to spread and that is a vaccinated environment, because people who have been vaccinated are less likely to get infection or transmit infection."
However, Bento said that it is important to remember that vaccines are not fully effective against preventing a person from getting infected, even though they are less likely to be asymptomatic if they do.
"The bottom line is let's all get vaccinated as soon as possible, but it's not a silver bullet." said Bento.
An additional concern is that some individuals cannot get vaccinated due to medical conditions or their age. No COVID-19 vaccines has yet been approved for children under the age of 12.
"Ideally,' Bento said, "what we do is vaccinate everybody as much as possible that can get the vaccine to try and protect and create a bubble around people who are too young to get vaccinated, too ill, or have types of restrictions that don't allow us to get vaccinate. the aim is create that bubble, which is being described as herd immunity."
"The answer to that is yes it's safe," said Chandy. "It's much safer to get vaccinated than it is for that child to get COVID."
There have been some documented cases of inflammation of the heart muscle, or myocarditis, in male children aged 12 years and up, after receiving mRNA COVID-19 vaccinations.
But the risk remains extremely low, said Chandy.
Researchers estimate that for every million doses in males 12 to 17 years of age, we could prevent 5,700 cases of COVID-19, 215 hospitalizations, 71 ICU admissions, and 2 deaths, according to a paper from the Morbidity and Mortality Weekly Report.
By contrast, between 56 to 69 myocarditis cases will occur for every million boys in that age group who are vaccinated.
The highest number of COVID-19 infections in Indiana this month have been in individuals between ages 20-29, followed by individuals in age groups 30-39, 40-49, and 50-59, in that order. However, that is not a reason that the situation should be considered less serious or concerning, experts say.
"That view has become slightly misguided," Bento said, "because we now have a lot of younger individuals, even children, that have developed severe symptoms, been hospitalized, and some have died."
She added that younger people are at higher risk of infection even if they are less likely to die from the disease than elderly individuals.
"Younger age groups have more contact with people, more socially active, they work, they probably are in the age group where some have children," said Bento. "Even if the vaccination coverage is high in a particular age group, if it's not high enough, you still have potentials for infections to occur."
Chandy said we will have to wait and see how effective the vaccines are against the COVID-19 variants. However, he said that even more important than developing a booster vaccine against COVID-19 variants is getting as high a percentage of the world vaccinated against COVID-19 as possible.
If in the rest of the world, people are still getting COVID-19 at a high rate and new variants are developing, it will continue to pose a risk to the health of US residents, said Chandy.
New variants are more likely to develop in unvaccinated populations because viruses are more likely to survive and spread, and mutations more likely to occur.
Marion County has once again recommended everyone wear a mask indoors, regardless of their vaccination status, following hot on the heels of the federal recommendations that both vaccinated and unvaccinated individuals wear face coverings in places with high COVID-19 transmission.
Since July 1, Marion County has lifted all COVID-19 restrictions, meaning that all restaurants, bars, gyms, hairdressers, live music venues, and more, could open at 100 percent capacity.
But epidemiologist Chandy said people need to do more and prepare to stay at home, avoid indoor gatherings, and begin to hunker down as they did before the summer.
"I really regret to say that, but I think that until we know where these numbers are going. It would certainly be wise to avoid crowded indoor settings even if you are wearing a mask, and going back to wearing a mask when you're indoor shopping or going to a grocery store," he said. "The wisest policy would be to completely avoid crowded indoor gatherings and to wear a mask when you're indoors with other."
Indiana had 33% of ICU beds and 78% of ventilators available as of Wednesday. By comparison, IU Health hospitals had 41% of ICU beds and 41% of ventilators available in April last year.
The situation is not nearly as bad as the peak of the COVID-19 pandemic in Indiana last October to this January, when some hospitals faced ventilator shortages and others had less than a quarter of ICU beds available.
Chandy said the fact that at least some people in the state are vaccinated and others are immune from prior COVID-19 infections is likely to protect us from the horrific outcomes last year.
"Right now, it's unlikely we will swamp capacity of our state on ICU beds," Chandy said. "But, if there is more spread and new variants coming in that the vaccine is less effective against, then we'll be in a new place."
"I would like to believe it's not going to get as bad as last year," Bento said, "because, for better or for worse, even though not everybody is getting the vaccine, there are more people vaccinated now in comparison with a year ago."
Chandy said that unless new vaccine-resistant variants emerge we are likely to be able to avoid some catastrophic outcomes we saw last year.
To date, Indiana has reported 767,409 COVID-19 cases and 13,552 deaths.
Contact Ko Lyn Cheang at email@example.com. Follow her on Twitter: @kolyn_cheang.
©2021 www.indystar.com. Visit indystar.com. Distributed by Tribune Content Agency, LLC.