Dr Sheri Fanaroff
Translation from the Greek:
Alpha – First identified in the UK (B.1.1.7)
Beta – First identified in South Africa (B1.351)
Gamma = First identified in Brazil (P.1)
Delta = First identified in India (B.1.617.2)
RECENTLY the massive spike in Covid cases and exponential growth are being driven by the Delta variant that originated in India.
Tulio De Oliviero, from KRISP, where genome typing takes place, announced that the Delta variant had become the dominant strain in several provinces in South Africa and had displaced the Beta variant (which originated in South Africa).
At the time, randomly selected samples over a large area, show 48 out of the past 68 genomes typed, over a wide area, were the Delta variant. The available data was about two weeks behind, and showed the Delta variant in 75% of samples in KZN, and around 53% of samples in Gauteng.
IS THE DELTA VARIANT MORE TRANSMISSIBLE?
The Delta variant is highly transmissible, more than all other variants and it spreads far more easily among people. It is 30% to 60% more contagious than Beta and 100% more than the original strain. We are usually seeing whole households of people becoming infected, not just one or two people.
It may spread very quickly – in other words, close contact does not necessarily need to be for longer than 15 minutes for someone to get infected. Any close contact, especially in a closed room, or any contact without masks, is significant.
People who have been infected with the Beta variant are susceptible to Delta (in other words, people who had Covid prior to April/May this year might still be able to get Covid again). However, they should have some immunity, particularly if they had severe disease.
DOES THE DELTA VARIANT CAUSE DIFFERENT SYMPTOMS?
There is not yet evidence that it causes more severe disease than other variants. However, in this wave in Johannesburg, we are seeing people staying sicker for longer periods, and also people deteriorating to significant lung disease at a later stage than previously. We need to monitor some patients longer than the typical 10 day isolation period.
The symptoms may be a bit different with the most prominent reported symptoms being:
- Headache
- Sore throat
- Runny nose, sneezing, congestion
- Loss of taste and smell are less common than with Beta variant (but we do still see this)
- Cough
- Body pains
- Fever
ARE VACCINES EFFECTIVE AGAINST THE DELTA VARIANT?
The data looks promising:
- The Pfizer vaccine showed a 33% effectiveness against Delta after a single dose of vaccine (compared to 49% against Alpha).
- Pfizer showed an 88% effectiveness after two doses of vaccine (compared to 93% against Alpha).
- Pfizer showed high levels of protection against hospitalisation with the Delta variant (94% effective after a single dose and 96% after two doses).
- It was reported that J&J seems effective against the delta variant. There is not enough data on this yet. Please notify Sisonke ASAP if you develop Covid-19 infection and received a J&J vaccine as part of the Sisonke trial for health-care workers. Here is the link to report Covid infection after a J&J vaccine on the Sisonke trial: https://is.gd/sisonke_bti
In the past two weeks, I have had nine patients who developed Covid-19 infection after having the J&J vaccine more than four weeks ago. Of these, most have mild infection, but one is in hospital. I have had several patients who have developed mild Covid within three weeks of a single Pfizer vaccine, of which two had pneumonia, but were not hospitalised.
Keep in mind that the third wave is expected to continue to escalate. It is accelerating in Gauteng but other provinces are likely to follow. With all the cases reported in Gauteng and hospitals full, we can expect more and more pressure on medical services to the point where they cannot cope.
The Delta variant driving this wave is highly transmissible, and there is a significant risk of reinfection if you have previously been infected with another variant.
Although it has not been shown to be more severe, the sheer numbers of people infected means that there will be a higher number of hospitalisations. Lack of resources (oxygen, hospital beds, emergency services) will mean that the morbidity and mortality rate will be higher.
Vaccines are proving to be effective against severe illness, hospitalisation and death. Remember to remain cautious even if vaccinated while the community infection rates are so high.
If you have been exposed to someone with Covid-19, you need to quarantine for 10 days, regardless of getting a negative test result. Vaccinated people and those previously infected are not exempt from quarantine and isolation as they can transmit the virus and may be able to get infected.
You do not want to get infected at this time when hospital bed availability is at its lowest. Stay home, stay safe and sanitised. Protect yourselves and your loved ones.
The Covid protocols remain the same in every interaction, but it should be more stringent:
* Wear a good well-fitted three-layer mask, covering your nose and mouth when you leave home.
* Double masking is a good idea (cloth mask with a surgical mask over, or two surgical masks).
* A visor or glasses will give extra protection.
* Ensure you sanitise your hands regularly.
* Maintain physical distancing - at least 1.5m away from others. Don’t eat with anyone outside your bubble.
* Stay in ventilated spaces (outdoors is preferable if you need to meet someone, but masks must be worn).
* Dr Sheri Fanaroff is a family physician in Melrose, Johannesburg. She is a member of the Gauteng General Practitioners Collaboration. This is an edited version of an article that first appeared on that Facebook page.
