A 22% surge in US coronavirus deaths is hitting unvaccinated people hardest. Experts worry about the long-term effects for vaccinated people, too.

us 500,000 covid-19 deaths
El Paso County Medical Examiner’s Office staff roll bodies in bags labeled “COVID” from refrigerated trailers into the morgue office on November 23.

  • The US’s daily coronavirus deaths surged 22% in the past week – mostly among unvaccinated Americans.
  • Disease experts worry about breakthrough cases in older people or those who are immunocompromised.
  • Increased transmission could also allow the virus to mutate into a more dangerous strain.
  • See more stories on Insider’s business page.

The US is far removed from the deadliest point in its coronavirus outbreak: The country reported more than 3,000 daily coronavirus deaths in January, compared with less than 275 daily deaths, on average, in the past week.

But average daily deaths surged 22% in the past seven days, following a record low of 30 deaths on July 11. In the past two weeks, average daily deaths rose 33%.

The vast majority these deaths are among unvaccinated Americans: Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, told NBC earlier this month that unvaccinated people represented more than 99% of recent coronavirus deaths. The Centers for Disease Control and Prevention also reported Friday that more than 97% of people entering hospitals with symptomatic COVID-19 hadn’t received shots.

The US is now dealing with a “pandemic of the unvaccinated,” CDC Director Rochelle Walensky said at a press briefing.

“We are seeing outbreaks of cases in parts of the country that have low vaccination coverage because unvaccinated people are at risk, and communities that are fully vaccinated are generally faring well,” Walensky said.

But disease experts worry that allowing the virus to spread among unvaccinated people could give it more opportunities to mutate. That could pose a long-term risk for vaccinated people, too. Already, the Delta variant – now the dominant strain in the US – appears to be more transmissible than any other version of the virus detected so far.

“The worst-case scenario is if Delta mutates into something completely different, a completely different animal, and then our current vaccines are even less effective or ineffective,” Vivek Cherian, an internal-medicine physician in Baltimore, told Insider last month.

Experts also worry that increased transmission could result in more severe breakthrough infections – cases of COVID-19 diagnosed at least two weeks after someone is fully vaccinated – among older people or those who are immunocompromised, since vaccines may already be less effective among these groups.

People over 65 represent about 75% of breakthrough cases that result in hospitalization or death, according to the CDC.

The UK offers insight into what to expect in the US

london UK reopening
Outdoor dining in Soho, London, on April 18.

Disease experts worry that the US could soon follow in the footsteps of the UK, where average deaths have more than doubled in the past two weeks, from 17 to 40 a day. The UK’s average hospitalizations have also increased about 60% during that time, from about 380 to 615 a day.

That’s despite the fact that nearly 70% of UK residents have received at least one vaccine dose.

In the US, about 44% of the population remains unvaccinated. (That includes about 48 million children under age 12, for whom vaccines haven’t been authorized yet.)

The country is now administering as many daily vaccine doses as it was in late December, when vaccines were available only to healthcare workers and residents of long-term-care facilities. Just 384,000 daily doses were given out on average over the past week.

Some Americans, particularly in rural counties, may still struggle to access shots, while others can’t afford to take time off work to get vaccinated. But, for the most part, widespread vaccine hesitancy has slowed down vaccination rates.

About 18% of adults surveyed in a recent YouGov poll said they didn’t plan to get vaccinated, while 11% said they were unsure. These rates were significantly higher among Republicans and people in the Midwest and South.

Most vaccine-hesitant people in the survey said they were worried about side effects from coronavirus shots – though studies have shown that vaccine side effects are generally mild and fleeting. The vast majority of them also said they believed that the threat of the virus was exaggerated for political reasons.

Lifting mask and social-distancing mandates could delay herd immunity

US reopening concert phone picture Instagram
A couple at Madison Square Garden in New York City on June 20.

Despite lagging vaccination rates, most US states have lifted mask and social-distancing mandates. In states such as Delaware, Florida, Missouri, and South Carolina, masks are recommended but not required for unvaccinated people.

Some disease experts said removing these restrictions too soon could send the wrong message about the state of the pandemic.

“The concern is if you’re on the fence, and then you go outside and you see, ‘Hey, things are back to normal,’ that may decrease the chance of you wanting to even get vaccinated,” Cherian said.

For now, experts are hopeful that the US can still vaccinate at least 70 to 85% of its population – a threshold that may allow the country to reach herd immunity. But a new variant that evades protection from vaccines or prior infection could push that goal even further from view, so public-health officials remain determined to vaccinate more Americans as quickly as possible.

“If you get to that situation, then you essentially get us back to a level” that we were in before March 2020, Cherian said, adding: “That’s just not a place that you want to be.”

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Unvaccinated people don’t only risk their own health: Their bodies become ‘variant factories’

covid vaccine
A medical assistant administers a COVID-19 vaccine dose to a woman at a clinic in Los Angeles on March 25, 2021.

  • Unvaccinated people can be a driving force for new variants, an infectious disease expert told CNN.
  • “Unvaccinated people are potential variant factories,” infectious disease expert Dr. William Schaffner said.
  • Mutations that replicate can become variants and unvaccinated hosts more easily allow for that.
  • See more stories on Insider’s business page.

People who have not been vaccinated against COVID-19 not only risk their own health but are “variant factories,” an infectious disease expert told CNN.

“Unvaccinated people are potential variant factories,” Dr. William Schaffner, a professor in the Division of Infectious Diseases at Vanderbilt University Medical Center, told CNN.

“The more unvaccinated people there are, the more opportunities for the virus to multiply,” he added.

Variants evolve in the body of a person who is infected with the coronavirus.

“When it does, it mutates, and it could throw off a variant mutation that is even more serious down the road,” Schaffner said.

Viruses, including the coronavirus that causes COVID-19, endure mutations, and while some mutations may harm the virus, others could help it. For example, a mutation could help a virus be more transmissible.

When the virus spreads to another person, the mutation will replicate and also spread, and if it’s successful and continues to spread, it becomes a variant.

Unvaccinated people provide the opportunity for the mutation to continue to replicate, CNN reported.

“As mutations come up in viruses, the ones that persist are the ones that make it easier for the virus to spread in the population,” Andrew Pekosz, a microbiologist and immunologist at the Johns Hopkins Bloomberg School of Public Health, told CNN.”Every time the viruses changes, that gives the virus a different platform to add more mutations. Now we have viruses that spread more efficiently.”

Essentially if a virus can’t spread, it can’t mutate.

There are already several variants of the coronavirus, including four called “variants of concern” by the World Health Organization,

These four include Alpha, first discovered in the UK, Beta, first discovered in South Africa, Gamma, first discovered in Brazil, and Delta, first discovered in India, pose risks because they are either more transmissible, cause worse disease, or can evade immune protection.

These variants were also discovered in a period where cases of infection were high.

Public health experts are specifically already concerned about the risks the Delta variant poses even for those already vaccinated. While vaccines have been found to be effective against the variants, they may not be as effective against some. Two doses of Pfizer’s vaccine for instance have been found to be 88% effective at preventing symptomatic cases of COVID-19 from the Delta variant.

In the US, however, experts are worried the variant can spread and cause breakthrough cases especially in communities with low vaccination rates. The fewer people that are vaccinated, the more chance there is for the virus to hop from one person to the next.

“Currently, approximately 1,000 counties in the United States have vaccination coverage of less than 30%. These communities, primarily in the Southeast and Midwest, are our most vulnerable. In some of these areas, we are already seeing increasing rates of disease,” CDC Director Dr. Rochelle Walensky told a White House briefing Thursday. “As the Delta variant continues to spread across the country, we expect to see increased transmissions in these communities, unless we can vaccinate more people now.”

Experts are urging more Americans to get vaccinated to stop the spread.

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The CDC stopped tracking most COVID-19 cases in vaccinated people. That makes it hard to know how dangerous Delta really is.

coronavirus testing
A nurse administers a COVID-19 test at a testing site in Suffolk County, New York, on December 18, 2020.

  • The CDC stopped monitoring non-severe COVID-19 cases among vaccinated people in May.
  • It’s hard to assess Delta’s risk without knowing what mild breakthrough cases look like – or whether they’re becoming more common.
  • Vaccines still seem highly effective against the variant, though.
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It was great news: From January to April, just 0.01% of vaccinated Americans – around 10,000 out of 100 million people – got breakthrough infections, or cases of COVID-19 diagnosed after they were fully immunized.

That’s according to a report from the Centers for Disease Control and Prevention, which also indicated that certain coronavirus variants were to blame for most of these breakthrough cases. However, the CDC only had genetic sequencing for around 5% of the post-vaccine infections, and the report didn’t include data about the Delta variant. That strain, first detected in the US in March, might pose the greatest challenge to vaccine efficacy.

But before more data could be collected to answer these lingering questions, the CDC stopped tracking breakthrough infections that resulted in asymptomatic, mild, or moderate cases. Since May 1, the agency has only reported and investigated coronavirus infections among vaccinated people that resulted in hospitalization or death.

Sequencing efforts in the US haven’t ramped up much, either: The country is still only sequencing about 1.4% of its coronavirus cases, according to data from GISAID, a global database that collects coronavirus genomes.

That means it’s difficult to tell exactly how much of a risk the Delta variant poses to vaccinated people. Researchers still don’t know whether Delta makes breakthrough cases more common, or what the typical symptoms of a breakthrough infection caused by Delta look like. As a result, vaccinated people may have a hard time weighing the risks of returning to normal social activities or knowing what to expect should they develop a rare breakthrough case.

In a recent blog post for Harvard Health Publishing, Robert Shmerling, an associate professor of medicine at Harvard Medical School, called the CDC’s decision not to track all breakthrough cases “surprising” and “disappointing.”

“By tracking only cases requiring hospitalization or causing death, we may miss the chance to learn how people with ‘milder’ disease are affected by Delta or other variant infections, such as how long their symptoms last and how the infection may disrupt their lives,” Shmerling told Insider.

He added that the US could also miss important information about which vaccines are most effective against Delta, how long vaccine protection against the variant lasts, and whether the timing of a second vaccine dose might determine one’s likelihood of a breakthrough case.

The CDC told Insider that in a substantial proportion of reported breakthrough cases, data on symptoms is missing, “which is one reason why CDC is publicly reporting hospitalized and fatal cases.”

The agency added that its Emerging Infections Program is still working with nine states to obtain sequencing data from breakthrough cases – including asymptomatic and mild ones.

How well do vaccines protect against Delta?

nurses vaccine
RN Janelle Roper, left, administers the Pfizer COVID-19 vaccine to nurse anesthetist Kate-Alden Hartman.

So far, data suggests that vaccines hold up extremely well against Delta: Public Health England analyses have found that two doses of Pfizer’s vaccine are 96% effective at preventing hospitalizations in cases involving the variant, and 88% effective at preventing symptomatic illness. Two doses of AstraZeneca’s vaccine, meanwhile, are around 92% effective at preventing hospitalizations and 60% effective at preventing symptomatic COVID-19 from Delta.

Moderna announced on Tuesday that its vaccine is also highly effective against Delta based on lab studies, though the efficacy was slightly diminished compared to the original strain. And South African researchers recently found that among people who’d received the Johnson & Johnson vaccine, 94% of breakthrough infections were mild – including those caused by Delta.

However, Public Health England found that one shot of either Pfizer’s or AstraZeneca’s vaccines was just 33% effective at preventing symptomatic COVID-19 from Delta. Israeli health officials also reported last week that as many as half of new COVID-19 cases in Israel are among vaccinated people, with the majority of cases being driven by the Delta variant. (However, vaccinated people in Israel appeared to develop milder cases than unvaccinated people.)

Shmerling said that finding out which variants are responsible for most breakthrough cases – whether it’s Delta or another strain – could help vaccine manufacturers learn whether they need to modify their current shots or roll out boosters more quickly.

“It’s possible that tracking the severe cases would give us enough information about which variants are responsible for most breakthrough infections,” he said. “But, again, the more we know about all breakthrough cases, the better we’ll understand how they occur.”

Hilary Brueck contributed reporting.

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1,000 US counties still have vaccination rates below 30% – particularly in the Southeast and Midwest, CDC says

covid vaccine
Maryland National Guard Specialist James Truong administers a Moderna coronavirus vaccine in Wheaton, Maryland, May 21, 2021.

  • 1,000 US counties have vaccination rates below 30%, CDC Director Rochelle Walensky said Thursday.
  • Coronavirus transmission will likely increase in these areas as the Delta variant keeps spreading.
  • But the US is struggling to put shots in arms: Vaccination rates fell 85% in the last three months.
  • See more stories on Insider’s business page.

Nearly half the US population is fully vaccinated, but rates still vary widely from state to state – and even more widely county by county.

Around 1,000 US counties currently have vaccination rates below 30%, Rochelle Walensky, director of the Centers for Disease Control and Prevention, said at a White House press briefing on Thursday.

“These communities, primarily in the Southeast and Midwest, are our most vulnerable,” Walensky said. “In some of these areas, we are already seeing increasing rates of disease. As the Delta variant continues to spread across the country, we expect to see increased transmissions in these communities unless we can vaccinate more people now.”

Delta is the most transmissible coronavirus variant to date, and may be deadlier than its predecessors, so disease experts are particularly concerned about its spread among unvaccinated communities.

An analysis from Public Health England found that Delta was associated with a 60% increased risk of household transmission compared with the Alpha variant discovered in the UK, though more recent estimates suggest the difference is closer to 40%. The Alpha variant is already about 50% more transmissible than the original strain, according to the Centers for Disease Control and Prevention.

covid delta variant
A mobile COVID-19 vaccination center in Bolton, England, on June 9, 2021.

Researchers in Scotland also found that getting infected with the Delta variant doubled the risk of hospital admission relative to Alpha. (Previous studies have suggested that the Alpha variant may be 30 to 70% deadlier than the original strain.)

Vaccines, of course, significantly lower that risk for both variants. The Associated Press recently reported that around 99% of COVID-19 deaths in May were among unvaccinated people, based on government data.

But the US has struggled recently to convince more Americans to get vaccinated, even with incentives like cash prizes, gift cards, and tickets to sports games. Vaccination rates have fallen 85% in the last three months. As of Wednesday, the US was administering less than 430,000 daily doses, on average, compared to a peak of more than 3 million daily doses in April. The nation will likely fall shy of its goal to vaccinate 70% of adults with at least one dose by July 4 – 67% of adults have gotten at least one shot so far.

Meanwhile, Delta is expected to become the dominant strain in the US in a matter of weeks. It currently represents around 25% of the country’s reported cases, Walensky said. In some regions, she added, Delta already represents nearly half of new cases.

The spread of Delta has corresponded to a roughly 10% increase in weekly average of new coronavirus cases in the US. In the last two weeks, 19 states have seen their average daily cases rise. Missouri – where roughly four dozen counties have vaccination rates below 30% – has seen cases increase 55% during that time. In Arkansas – where more than 20 counties have vaccination rates below 30% – cases have risen 63%.

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The original coronavirus strain has almost disappeared in the US. One chart shows how variants took over.

covid delta variant
A mobile COVID-19 vaccination center in Bolton, England, on June 9, 2021.

  • Coronavirus variants have largely replaced the original strain, rendering it essentially obsolete.
  • The Alpha variant took over as the US’s dominant strain in April. Delta could replace it soon.
  • Scientists aren’t sure whether more contagious variants will evolve from the dominant ones.
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Viruses will do what it takes to survive – even if it means killing off an older, weaker self and replacing it with a more transmissible strain.

For the first several months of the pandemic, however, the coronavirus had no need to become more dangerous: The virus was doing a good job of spreading, with each new infected person passing it to an average of two to three others. At the time, scientists hoped that the original strain of the virus, known as the “wild type,” was already contagious enough that it wouldn’t evolve further.

But as the pandemic swelled and more people got infected, the coronavirus had more opportunities to replicate, and therefore mutate, incurring small, random changes in its genetic sequence. Most mutations are harmless, but every so often a distinct set yields new properties – a variant.

Scientists now estimate that variants have almost completely replaced the original strain in the US, rendering it essentially obsolete.

“Pretty much all the virus that’s circulating right now has one of these variants that make it differ from the original strain that first took off across the world,” Tyler Starr, a postdoctoral research fellow at the Fred Hutchinson Cancer Research Center, told Insider.

The chart below shows how a few variants have dominated the US since February. More than 200 less prevalent strains, including the original version of the virus, are listed as “other.”

The Alpha variant, first identified in the UK in September, became prevalent in the US from February to April, going from 27% to 70% of all circulating strains. It’s about 50% more transmissible than the original strain, according to the Centers for Disease Control and Prevention. Meanwhile, the share of other coronavirus strains (including the original) fell from 20% to 4%.

By May, Alpha had a strong competitor: Delta. An analysis from Public Health England found that the Delta variant was associated with a 60% increased risk of household transmission compared to Alpha, though more recent estimates suggest that difference is closer to 40%.

From May to June, Delta grew from less than 3% of all circulating strains in the US to more than 20%. It’s poised to become the US’s dominant strain within weeks.

“Basically everywhere, once Delta gets there, it does overtake something like the Alpha variant,” Starr said. “That is evidence that, to some degree, it is more transmissible.”

Could an even more contagious variant replace Delta?

variant lab
Researchers sequence coronavirus samples at the University Hospital of Badajoz in Spain on April 15, 2021.

So far, Starr said, coronavirus variants – even Delta – aren’t fundamentally different from the wild type.

“These mutations might be slightly modifying things like transmissibility,” he said, but “that trait was there in the original virus and it’s just being altered slightly.”

In fact, some scientists wonder if the virus is nearing “peak fitness,” the point after which it no longer mutates to become more infectious.

Delta is by far the “fittest” variant to date, according to the World Health Organization. In addition to being more transmissible than other strains, it may also be deadlier: Researchers in Scotland found that getting infected with Delta doubled the risk of hospital admission relative to Alpha. (Previous studies have suggested that the Alpha variant may be 30 to 70% deadlier than the original strain.) Vaccines, of course, significantly lower that risk for both variants.

“Delta is absolutely going up the fitness peak – whether it’s at the top, I think that’s very hard to say until we just don’t see any further change,” Andrew Read, who studies the evolution of infectious diseases at Pennsylvania State University, recently told Insider.

“If Delta takes over the world and nothing changes,” he added, “then we’ll know in a while – a year or two – that it is the most fit.”

But Starr thinks the virus probably won’t ever stop mutating.

“As people continue to get immunity, the virus will continue to evolve to be able to transmit and infect people,” he said. “But at the same time, we’ll have that low-level immune reaction that makes it a much less severe thing over time.”

It’s still possible that an entirely new lineage might replace Delta as the dominant variant, or that two variants – Delta and Alpha, for instance – could combine mutations to produce an even more infectious strain. In the worst-case scenario, the virus could evolve into a “variant of high consequence” – one that’s far more distinct than the variants currently circulating and highly resistant to vaccines. That hasn’t been observed yet.

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Surging coronavirus cases and deaths in Russia show the Delta variant’s havoc on a largely unvaccinated population

russia covid tests
People wait to get tested for COVID-19 in Omsk, Russia on June 28, 2021.

  • Russia’s daily coronavirus cases have more than doubled in the last month.
  • Deaths are climbing, too, as the Delta variant becomes more widespread.
  • It’s a lesson in what happens when Delta strikes a mostly unvaccinated country, experts said.
  • See more stories on Insider’s business page.

Nearly a year after becoming the first nation to authorize a coronavirus shot, Russia has fallen behind in the global vaccine rollout. Just 15% of its population has received at least one dose.

So when Russia identified its first cases of the Delta variant in May, the threat loomed larger than in highly vaccinated countries like Israel, the US, or the UK.

In the last month, Russia’s daily coronavirus cases have more than doubled, from around 8,600 to around 19,500. Deaths have ticked up 54% during the same time, from around 375 per day to 575, according to Our World in Data, a research project from the University of Oxford. (It’s possible that these tallies are undercounts, given past discrepancies between Russia’s official COVID-19 death toll and its sharp increase in mortality during the pandemic.)

At the same time, Delta has come to represent around 88% of Russia’s coronavirus cases, according to GISAID, a global database that collects coronavirus genomes.

“Probably lax use of personal protective measures – like mask use, social distancing, avoiding indoor gatherings, and so forth – is part of the problem, but the Delta variant is really the core part of it,” Davidson Hamer, a professor at the Boston University School of Public Health, told Insider.

Delta is the most transmissible coronavirus variant to date, and may be deadlier than its predecessors. An analysis from Public Health England found that Delta was associated with a 60% increased risk of household transmission compared with the Alpha variant discovered in the UK, though more recent estimates suggest the difference is closer to 40%. The Alpha variant is already about 50% more transmissible than the original strain, according to the Centers for Disease Control and Prevention.

Researchers in Scotland also found that getting infected with the Delta variant doubled the risk of hospital admission relative to Alpha, though vaccines lower that risk. (Previous studies have suggested that the Alpha variant may be 30 to 70% deadlier than the original strain.)

Experts say Delta’s spread makes it all more imperative for countries to get residents vaccinated as quickly as possible. Dozens of other nations, including New Zealand, Pakistan, and Venezuela, still have vaccination rates below 15%.

“Given the increased impact of the Delta variant, it’s likely that around 85% of a population will need to be vaccinated into order to cross the herd immunity threshold,” Michael Head, a senior research fellow at the University of Southampton, told Insider. “That’s going to be difficult to achieve in many settings.”

Russia is struggling with vaccine skepticism

russia covid vaccine moscow
Ilya Bachurin receives a COVID-19 vaccine in Moscow, Russia on June 25, 2021.

The Russian government reported vaccine shortages in some areas of the country on Friday, but for the most part it doesn’t suffer from a lack of supply. The country has four domestically made vaccines, the most widely available of which, Sputnik V, has been distributed to the public since December.

But Russia is contending with vaccine hesitancy.

Its approval process for Sputnik V raised red flags last summer when Russia’s health agency cleared the vaccine for distribution before it had completed late-stage clinical trials – and after just 38 people had received the shot. By February, an interim analysis published in The Lancet found that Sputnik V was around 92% effective at preventing symptomatic COVID-19. Sputnik V developers said Tuesday that the shot is also around 90% effective against the Delta variant – but Hamer said to take that with a grain of salt.

“The Sputnik vaccine is an adenovirus vector vaccine, like AstraZeneca and the Johnson & Johnson vaccine, and there’s some evidence that these are a little less effective against some of these more seriously mutated variants of concern, like the South African strain and then now Delta,” he said.

A recent poll from the mobile app Doctor’s Manual found that one-third of Russian doctors still aren’t sure about the effectiveness of Russia’s COVID-19 shots.

“One of the key aspects to building vaccine confidence is openness and transparency around effectiveness and safety,” Head said. “Those attributes are not exactly to the fore in Russia, and perhaps they are suffering from low uptake as a result.”

Russian authorities have tried to boost vaccination rates by offering incentives like grocery items or lottery tickets, but the nation still fell short of its goal to vaccinate 30 million people by mid-June.

So as of last week, vaccines are mandatory for certain service workers in Russia, including hairdressers, taxi drivers, and teachers. They can be suspended without pay if they refuse.

“The same approach is being taken a lot of places to try and enforce people to get the vaccines,” Hamer said. “But in Russia in particular, there may be some people that will be resistant to that – they don’t want to be forced to do things they don’t want to do.”

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The Delta variant is fueling school outbreaks in Israel, leading the country’s cases to tick up

israel kid vaccine
A boy receives the Pfizer COVID-19 vaccine in the Israeli city of Holon, near Tel Aviv, on June 21.

  • The Delta variant seems to be causing an uptick in Israel’s COVID-19 cases, particularly in schools.
  • Vaccinated Israelis may need to quarantine if they’ve been exposed to the variant, officials said.
  • Experts are more worried about kids spreading the variant than getting severely ill themselves.
  • See more stories on Insider’s business page.

On Monday, Israel recorded its highest daily coronavirus tally in two months: 125 new cases, up from around 15 cases at the start of the month.

The Delta variant seems to be to blame: Emerging research suggests that Delta is more transmissible and possibly deadlier than any other coronavirus strain so far. So less than a month after Israel lifted its remaining coronavirus restrictions, the country announced that vaccinated people can be told to quarantine if they’ve been exposed to that variant.

Delta represents around 40% of Israel’s coronavirus cases over the last four weeks, according to the Global Initiative on Sharing Avian Influenza Data. Israel’s health ministry reported that 70% of the 125 new infections recorded on Monday were caused by the Delta variant. Roughly one-third of those new infections were among vaccinated individuals, the ministry said, and half were among children.

Indeed, many of these new cases have been traced to school outbreaks. But disease experts are more worried about kids spreading the variant than getting severely ill themselves.

That’s because severe COVID-19 cases are still extremely rare among children: In the US, kids account for just 1.4% to 3.3% of all COVID-19 hospitalizations and less than 0.23% of all COVID-19 deaths.

So even if you doubled children’s risk of being hospitalized from a Delta infection, it would still be “minuscule,” according to Eyal Leshem, an infectious-disease specialist at Sheba Medical Center, Israel’s largest hospital.

However, children can spread the virus to unvaccinated adults, or perhaps to people who might see a less robust immune response to vaccines – like the elderly or immunocompromised.

Israel is trying to preempt another outbreak

israel vaccine masks
People sit along the promenade in Jaffa, Israel on April 18.

Israel’s schools fully opened in May, masks are no longer required indoors or outdoors, and mass gatherings have been taking place across the country. But the country just started vaccinating kids ages 12 to 15 earlier this month, so only 2% to 4% of that age group has been immunized so far. In televised remarks on Tuesday, Prime Minister Naftali Bennett urged Israelis to “vaccinate your children.”

Israel’s new restrictions go beyond quarantines: Health minister Nitzan Horowitz told the Israeli Parliament on Wednesday that any residents who travel to a high-risk country – Argentina, Brazil, South Africa, India, Mexico, or Russia – could be fined “thousands of shekels.” (One-thousand shekels is around $308.) Masks will also be required at airports, border crossings, and medical facilities.

“What I guess they’re doing is trying to first provide more conservative or restrictive recommendations, see the [epidemiological] curve, see what impact this has, and then loosen the restrictions rather than be more liberal about restrictions and then face 10,000 cases a day,” Leshem said.

In one to two months, Leshem added, public-health experts could have a better idea of Delta’s effects.

“We’re all still observing Israel as a case study of what’s going to happen in a country where 90% of the population at risk is already vaccinated,” he said, referring to the number of adults who have gotten their shots.

“If we see Israel reaching several hundreds of cases a day, even thousands of cases, but we don’t see a substantial increase in the number of severe cases and hospitalizations, then the public-health angle would be to restrict normal life as little as possible,” he added.

Some infections among vaccinated people, experts say, can’t be avoided.

“Surely there will be cases of breakthrough infections among vaccinated people and further transmission,” Dr. Hagai Levine, an epidemiologist at the Hebrew University-Hadassah Medical Center School of Public Health, told Insider. “We need to find the right balance, as quarantine to vaccinated people is a burden.”

Delta’s triple threat

israel travel restrictions
Israelis and vaccinated tourists get tested for COVID-19 upon arrival to Israel’s Ben Gurion airport near Tel Aviv on May 23.

An analysis from Public Health England found that Delta is associated with a 60% increased risk of household coronavirus transmission compared to Alpha, the variant discovered in the UK. Alpha is already around 50% more transmissible than the original strain, according to the Centers for Disease Control and Prevention.

Researchers in Scotland also found that getting infected with Delta doubles the risk of hospital admission relative to Alpha. (Previous studies have suggested that Alpha may be 30% to 70% deadlier than the original strain.)

What’s more, emerging research suggests that a single vaccine dose doesn’t hold up as well against Delta as it does against other coronavirus strains: Recent Public Health England analyses found that two doses of Pfizer’s vaccine were 88% effective at preventing symptomatic COVID-19 from Delta, while a single shot was just 33% effective. That’s compared to 95% efficacy against the original strain, with 52% after one shot.

Young people increasingly represent the majority of new coronavirus cases not just in Israel, but around the world.

The Scotland researchers found that Delta cases were more prevalent among younger age groups. And a study still awaiting peer review found that coronavirus infections in the UK are five times more prevalent among children ages 5 to 12 and young adults between 18 and 24 than among those above 65. Most young people who recently got infected were unvaccinated, according to the study.

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The top Delta variant symptoms reported in the UK are a runny nose and headache – because most people affected are very young or partially vaccinated

people walk past a sign on oxford street in london which encourages 2 meters of social distancing
Oxford Street in central London on June 7, 2021.

  • The Delta variant has taken over in the UK where the most common symptom reported is now a headache.
  • Most people who are getting COVID-19 in the UK are quite young, and not fully vaccinated.
  • Health experts are worried Delta could hit less vaccinated areas of the US very hard.
  • See more stories on Insider’s business page.

The Delta variant first identified in India has taken over in the UK, where it’s now responsible for over 95% of infections. Delta’s also coming for the US fast, already accounting for more than 20% of sequenced cases, with a doubling time of about two weeks.

But King’s College epidemiologist Tim Spector says don’t be surprised if it shows up with different COVID-19 symptoms than those we’ve come to expect.

His latest research suggests that a headache and a runny nose are now two of the leading indicators of a COVID-19 infection across the UK, especially among the young and the partially vaccinated.

Spector’s research draws on daily illness data from more than a million people across the UK, who log into his ZOE app every day and report on how they’re feeling. ZOE’s research suggests about 19,000 people in the UK now catch COVID-19 every day. Most of them are young, and most are also not fully vaccinated.

“It’s evolved to be more infectious, which is what many viruses do,” Spector said, noting that the Delta variant may be roughly twice as infectious as its early predecessors, with each person who catches it transmitting to about six others.

“There’s no hard evidence yet that it’s more lethal or fatal, but because of that extra stickiness, it’s going to still keep breaking through,” he said.

Milder symptoms

daily new cases of COVID in the UK by vaccination status, with unvaccinated infections increasing

According to ZOE’s latest data, from June 19, the COVID-19 case rate in the UK is now highest in the 20 to 29 age group.

“We’re seeing this mainly in young people who are unvaccinated, they are three quarters of the cases,” Spector said. “There’s hardly anyone who’s over 60 who’s getting it without a vaccine.”

Most of the people who test positive for COVID-19 in the UK are also weathering the traditional signs of a bad cold – headaches, runny noses, and sore throats – rather than the earlier tell-tale COVID-19 symptoms: shortness of breath or loss of taste.

It’s tough to know, though, if the Delta variant is truly becoming a milder disease, or if this is just how COVID-19 presents among the young, the healthy, and those with vaccine protection.

“Our hope is it’ll get milder,” Spector said. “So it will just become like a cold.”

daily prevalence rates by age group for COVID-19 in the UK, with the 20-29 age group skyrocketing
Now that most of the older adults in the UK are vaccinated, COVID-19 is becoming a disease of the young.

The ‘most able and fastest and fittest’ variant

Disease watchers at the World Health Organization agree with Spector – yet another reason to get more of the world’s most vulnerable people vaccinated fast.

“The Delta variant is the most able, and fastest, and fittest,” Mike Ryan, executive director of the WHO’s health emergencies program, said on Monday, stressing that vaccines are still “highly protective against hospitalization and death,” even with variants in play.

“This particular Delta variant is faster, it is fitter, it will pick off the more vulnerable more efficiently than previous variants,” Ryan said. “And we can protect those people now.”

In the UK, nearly three quarters of adults have had both COVID-19 shots, giving them strong armor against severe COVID-19 disease and death. But so far only 16 US states have gotten 70% of adults any vaccine protection.

“This virus isn’t going to give up easily.” Spector said. “I don’t think we can be too complacent, particularly in areas of the US that have high non-vaccination rates.”

CDC Director Dr. Rochelle Walensky stressed in a White House COVID-19 briefing on Tuesday that “nearly every death” from COVID-19 in the US is now preventable. But time could be running out to ramp up protection, and the race with increasingly fitter variants is not over.

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Has the coronavirus reached ‘peak fitness’? Experts wonder if the Delta variant is the worst we’ll see.

coronavirus testing
A nurse administers a COVID-19 test at a testing site in Suffolk County, New York, on December 18, 2020.

No coronavirus variant spotted so far is more concerning than Delta, the strain first identified in India in February. World Health Organization officials on Monday said Delta is the “fittest” variant to date, since it spreads even more easily than other variants and may lead to more severe cases among unvaccinated people.

“Delta is a superspreader variant, the worst version of the virus we’ve seen,” Eric Topol, director of the Scripps Research Translational Institute, tweeted last week.

But it’s possible that Delta is the worst the coronavirus is going to throw at us – that the virus, in other words, has reached what epidemiologists call “peak fitness.”

Topol and Italian virologist Roberto Burioni explore that scenario in a letter published in the journal Nature on Monday. The virus, they wrote, is likely to hit a point after which it no longer mutates to become more infectious. In that case, they said, “a “‘final’ variant will prevail and become the dominant strain, experiencing only occasional, minimal variations.”

It’s too soon to know whether that’s happened, since Delta isn’t yet dominant worldwide. But it likely will be soon -Delta has been detected in more than 80 countries so far and is already dominant in India and the UK.

“Delta is absolutely going up the fitness peak – whether it’s at the top, I think that’s very hard to say until we just don’t see any further change,” Andrew Read, who studies the evolution of infectious diseases at Pennsylvania State University, told Insider.

“If Delta takes over the world and nothing changes,” he added, “then we’ll know in a while – a year or two – that it is the most fit.”

The fittest variants are the best at spreading

coronavirus hug
Seven-year-old Jacquie Carney runs to hug her grandma, Donna Vidrine, upon arrival in Los Angeles, California on November 23, 2020.

The coronavirus is constantly mutating in relatively harmless ways, but every once in a while, a mutation turns the virus into a more menacing threat. A new variant develops that can evade antibodies generated in response to a vaccine or prior infection, results in more serious illness, or spreads more easily.

Emerging research indicates that Delta checks at least two of those boxes.

Public Health England found that Delta is associated with a 60% increased risk of household coronavirus transmission compared to Alpha, the variant discovered in the UK. Alpha is already around 50% more transmissible than the original strain, according to the Centers for Disease Control and Prevention.

Researchers in Scotland also found that getting infected with Delta doubles the risk of hospital admission relative to Alpha. (Previous studies have suggested that Alpha may be 30% to 70% deadlier than the original strain.)

What’s more, emerging research indicates that a single vaccine dose doesn’t hold up as well against Delta as it does against other coronavirus strains. Recent Public Health England analyses found that two doses of Pfizer’s vaccine were 88% effective at preventing symptomatic COVID-19 from Delta, while a single shot was just 33% effective. That’s compared to 95% efficacy against the original strain, with 52% after one shot.

The best way for the coronavirus to achieve peak fitness, Topol and Burioni wrote in their letter, is to become more contagious. If a variant is already spreading quickly, there’s no urgent need for it to evade the body’s immune response; it can simply jump to another person.

“Increasing rate of transmission from person to person is what we’re looking for,” Read said.

So far, Delta is by far the most transmissible variant. The US’s Delta cases appear to have tripled in just 11 days, from 10% of all cases sequenced in early June to 31% last week, according to a recent estimate from the Financial Times. At that rate, experts predict Delta will become the nation’s dominant strain in weeks.

That doesn’t necessarily mean the coronavirus has reached maximum transmission, though.

Read said Delta could still acquire combinations of mutations that make it even better at spreading (what he called a “Delta-plus” variant). It’s also possible that two separate variants – Delta and Alpha, for instance – could combine mutations to produce an even more infectious strain. Under a third scenario, Read said, an entirely new lineage might replace Delta as the dominant variant.

“The biggest concern at the moment is just the sheer number of people that have the virus and therefore the sheer number of variants that are being generated,” Read said. “Some of those might be the jackpot which are even fitter than Delta.”

Still, vaccines will likely provide at least some protection against whatever strain represents the coronavirus’ peak fitness.

“No human vaccine has ever been undermined by a variant to the point where the vaccine was completely useless,” Read said.

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Biden says the Delta variant – set to become the US’s dominant strain – is ‘particularly dangerous for young people’

biden face mask
Democratic presidential nominee Joe Biden holds up a face mask at The Queen theater on October 28, 2020 in Wilmington, Delaware.

President Joe Biden warned Friday that Delta, a coronavirus variant first discovered in India, poses an increased threat to unvaccinated Americans.

“It is a variant that is more easily transmissible, potentially deadlier, and particularly dangerous for young people,” Biden said at a White House news conference.

His remarks came just hours after Rochelle Walensky, director of the Centers for Disease Control and Prevention, told “Good Morning America” that Delta would likely become the dominant strain in the US in the coming months. (Some experts have even suggested that might even happen within weeks.)

Delta represents just 10% of US COVID-19 cases so far, but it already makes up around 90% of cases in the UK, according to a study from Imperial College London that’s still awaiting peer review. The researchers also found that COVID-19 cases in the UK are doubling every 11 days, most likely as a result of the fast-spreading variant.

Research from Public Health England suggests that Delta is associated with a 60% increased risk of household coronavirus transmission compared to Alpha – the variant discovered in the UK. Alpha is already around 50% more transmissible than the original coronavirus strain, according to the CDC.

Young people may be particularly susceptible to a Delta infection for two reasons: They’re more likely to be socially active and less likely to be vaccinated than older adults.

In the US, fewer adults under 50 have gotten vaccinated than adults ages 50 and older. The Imperial College London researchers also found that coronavirus infections in the UK are two-and-a-half times more prevalent among people ages 5 to 49 than among those ages 50 and older. Most young people who recently got infected were unvaccinated, according to the study.

Experts increasingly worry that young people will be less protected against severe disease caused by a Delta infection: Researchers in Scotland found that getting infected with Delta doubles the risk of hospital admission relative to Alpha.

Emerging research also suggests that a single vaccine dose doesn’t hold up as well against Delta compared to other coronavirus strains. Recent Public Health England analyses found that two doses of Pfizer’s vaccine were 88% effective at preventing symptomatic COVID-19 from Delta cases, while a single shot was just 33% effective by the same standard.

“Please, please if you have one shot, get the second shot as soon as you can,” Biden said on Friday.

So far, less than 45% of Americans are fully vaccinated, while 53% have received at least one dose. US vaccination rates have also fallen dramatically in the last two months, from a weekly average of nearly 3.4 million doses per day in mid-April to fewer than 780,000 doses per day on Thursday.

The more vaccination rates continue to drop, the more opportunities there are for Delta to spread – and therefore keep replicating and mutating.

“The worst-case scenario is if Delta mutates into something completely different, a completely different animal, and then our current vaccines are even less effective or ineffective,” Vivek Cherian, an internal medicine physician in Baltimore, recently told Insider.

Still, Biden said the US likely wouldn’t return to lockdowns because so many people have been vaccinated already.

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