While new novel coronavirus cases, hospitalizations and deaths are on pace to hit monthly lows not seen in a year, variants are again a top concern for health officials in Northeast Tennessee, particularly the rapidly spreading delta variant — the most transmissible variant yet.
The delta variant (B.1.617.2), first identified in India, is estimated to be more than twice as contagious as the alpha (B.1.1.7) variant that quickly became the most prevalent strain in the United States earlier this year, and may cause more severe illness in those who haven’t been vaccinated against the virus. Dr. Anthony Fauci, the nation’s top infection disease expert, said during a White House briefing on Tuesday that the variant accounts for a fifth of new infections nationwide and “is currently the greatest threat in the U.S. to our attempt to eliminate COVID-19.”
Tennessee has reported at least 19 cases of the delta variant thus far, according to the Tennessee Department of Health, compared to 3,958 diagnosed cases of the alpha variant. Both totals, however, are likely significant undercounts, as there is not widespread genetic sequencing of the virus occurring across the state.
Ballad Health Chief Infection Prevention Officer Jamie Swift said the original strain of COVID-19 had an r-naught (the number of people infected by each case) of around two, while early studies of the delta variant show its r-naught could be up to five or eight, “and that’s significant,” Swift said, noting that the variant appears to be spreading through casual exposures, such as an infected person passing somebody in a grocery store.
And while vaccines provide strong protection against the delta variant, many people in Northeast Tennessee have not been vaccinated.
According to data from the TDH, about 40% of the region’s population has received at least one dose of the vaccine, with 36% fully vaccinated. Demand for the vaccine has also fallen off considerably in recent months, with about 10,000 people having been vaccinated so far in June — down from a high of 60,344 in March.
“That’s a lot of people that are not fully vaccinated that, if these variants start to spread as we move back indoors and summer comes to an end — it seems like it could be a perfect storm,” Swift said.
East Tennessee State University’s College of Public Health Dean Dr. Randy Wykoff said it’s at least theoretically possible that the combined number of people with natural immunity from infection and those who’ve been vaccinated could have the region nearing herd-immunity, but that doesn’t mean Northeast Tennessee is out of the woods.
“There’s all sorts of possibilities, but it doesn’t behoove any of us to let up and say all is back to normal,” said Wykoff.
“The truth is nobody knows what’s going to happen. At this stage, you could come up with models that say it’s going to tail off and go away, there’s models that say this will become an annual recurring infection like influenza, and then there’s models that say ... we’re going to have cyclical disease that may not be seasonal but it will be cyclical,” he said. “So we’ll just wait and see.”
Following a bump in infections in April, likely due to the alpha variant, new cases have been on the decline over the past month-plus, with 1,715 infections reported in May — the fewest since June 2020. Thus far in June, the region is on pace to see yet another drop in infections, which likely won’t surpass the thousand mark. Hospitalizations and deaths are also on pace to fall to their lowest total since last June after rising slightly in May following April’s new case increase.
“Currently, right now, absolutely the numbers have been encouraging, we continue to see that active case count decrease, our hospitalizations have decreased — obviously that’s great news, and while my ultimate goal is to get it to zero, we’re certainly in a better place than we were just a few months ago,” said Swift. “I credit a lot of that to vaccines, so we had that initial push and we’ve got some of our region vaccinated, so that has helped.
“Unfortunately, I can’t stay in that comfort (zone) because every indication that I’m reading, that I’m studying, that I’m researching and following the path of the delta variant, I have great concern for our region for when the delta variant does get here,” Swift continued.
And while the delta variant could lead to an increase in new cases in Northeast Tennessee, it’s highly unlikely any increase would come close to matching the region’s devastating winter surge, which saw 32,229 people infected, 776 hospitalized and left 648 dead from Nov. 1 to Jan. 31. Still, Swift cautioned that any increase in hospitalizations could further stress a healthcare system that’s grappling with a nursing shortage worsened by the pandemic’s physical and mental toll on healthcare workers.
“I do not expect us to be at 400 cases inpatient, I don’t. We have enough vaccine coverage that we’re not going to see a surge like the surge at Thanksgiving and Christmas,” Swift said. “But from a health care standpoint, the national nursing shortage continues to grow, continues to be an issue. Burnout from the pandemic response is a huge issue in health care right now, so even increasing our census from 30 back up to 100, that’s going to place a significant burden on our health care system.”
As of Wednesday, Ballad was treating 33 patients for COVID-19 across its hospitals, with seven in intensive care and five on ventilators. Swift said the “overwhelming majority” of those being hospitalized with the virus are those who haven’t been vaccinated or who haven’t been fully vaccinated, and though there have been a few breakthrough hospitalizations in those who have been vaccinated, “the vaccine is keeping people out of hospitals,” Swift said.
“As worried as I am about the delta variant, we can prevent a lot of the things I’m worried about by getting good vaccine coverage in the region before the delta variant gets here,” Swift said, also saying “I just want people to know, with the delta variant, if they’re not vaccinated, their risk is increasing.”