COVID-19 Delta Variant: An Expert Q&A

Editor's Note: What follows is a partial transcript of an Aug. 24 Facebook Live event.

As the deadly and highly infectious delta variant of COVID-19 continues to affect lives across Southwest Florida and the rest of the country, Lee Health wanted to share some frequently asked questions from our community.

As always, Lee Health’s goal is to keep our community safe, informed and empowered – especially in these difficult times.

Our resident public health awareness expert Dr. Stephanie Stovall, Pediatric Infectious Diseases Specialist, Interim Chief of Quality and Patient Safety, shares what you need to know to stay safe.

Q: What is the Delta variant? How is it different?

A: All viruses mutate as they spread through a population, and the coronavirus is no different. The Delta variant appears to spread more quickly than previous iterations of this virus. This is another reason it is important to get vaccinated, as the less chance there is for a virus to spread, the less opportunity there is to mutate.

One reason why we want people to get vaccinated is to slow down this pandemic. Every time a virus replicates, you increase the chance that another mutation or another change can happen. And so the less viral replication, the less chance of a mutation.

We do know that over 98 percent of the strains that are being evaluated in our region of the country are Delta variants. So, it's very likely if you get COVID-19 right now, that's the variant you're going to get.

Q: I am young and healthy; do I need to worry?

A: The coronavirus has been shown to affect people of all ages, and it is impossible to know how sick any individual will get. With the Delta variant, we are seeing many younger patients than we did a year ago.

The Delta variant tends to cause infection faster. It causes people to have higher viral loads. That means that they have higher numbers of viruses in their respiratory tract. The more virus you have there, the more likely you are to spread it to someone else.

The speed with which people get infected with Delta variant means that they're getting high levels of virus really quickly before they recognize that they're sick. Unfortunately, they're spreading the virus before they even know that they have the opportunity to do so. And that's where Delta has become such a problem in our community and in the world.

Q: Are any of the vaccines FDA approved and what does it mean to meet full approval?

A: The Pfizer-BioNTech vaccine is now approved for those who are 16 years old and older. Before this approval, we had three vaccines – Pfizer-BioNTech, Moderna, and Johnson & Johnson – approved under Emergency Use Authorization (EUA).

EAU doesn't mean untested. It doesn't mean experimental. It means that we don't have enough time for all of the data to be collected, processed, and put in a manner such that the FDA can fully approve it. They’re safe and effective. So, all three vaccines have been tested. For people ages 12 to 16, Pfizer-BioNTech is still under FDA EUA. But, again, the FDA has approved the vaccine for people ages 16 and above.

Q: I only received the first shot of the vaccine and the time has run out. Can I still get a shot after a few months?

A: Absolutely. We want you to get that second vaccine. Ideally, it's given either 21 days for Pfizer or 28 days for Moderna after your first dose. But if you are months out from your first dose, you can still get benefit from your second dose. So, you should proceed with that.

Q: How can we feel confident about getting a vaccine if we don't know the long-term consequences of the vaccine?

A: We've been at this for 18 months now and we know some of the long-term effects of COVID-19. We know a lot of the long-term effects of vaccines, in general.

The vast majority of vaccines — when we look at those that are still in use and those that were in use for a while and then fell out of use — we know that most people who have reactions to vaccines get them within the first month or so.

That’s why so much research is done early on. The tens of thousands of patients who have received these vaccines have provided us a lot of excellent information. Historically, mRNA vaccines have been evaluated specifically for over a decade. They've not been used specifically to COVID-19 because it’s new in the past 18 months. But for more than a decade, mRNA vaccine technology has been extensively studied and has never been associated with adverse long-term effects.

So, can we say for a specific COVID-19 vaccine that we have five years of evidence? No, we can't, but we can look historically at the science behind it and predict that we don't anticipate long-term problems with the approved COVID-19 vaccines.

With any therapeutic approach, you always have to look at the benefits and risks. And what we know is the risk of getting COVID-19 is quite significant and it's becoming more significant. We have to weigh that against the known benefit of the vaccine.

Q: What are the benefits of getting the vaccine if you've already had COVID-19?

A: We know from several studies that natural immunity is not as strong as vaccine immunity. And part of that is because if you think about it, when you get a natural infection, the virus comes into your body. Your body makes an immune response to every portion of that virus that it can see. But if we give you a targeted vaccine, then your immune system can essentially pay attention to just that component.

Your immune system can target what it makes the antibodies to, what it triggers the T-cells from. And that targeted immune response tends to be stronger and more durable. So, getting a vaccine actually improves your immunity, even if you've already had natural immunity and you've already been infected.

Q: Can people be diagnosed with COVID-19 more than once?

A: Unfortunately, we've seen that in patients. We've seen that in loved ones and community members who were people who definitely had COVID-19. They had positive antibody responses even before vaccines were available. And then they got COVID-19 again. Delta, unfortunately, has kind of changed that. And it's much easier for that to happen now.

Q: Can you talk about home remedies for patients who are sick and maybe they have tested positive for COVID-19, but they are showing symptoms?

A: There aren't a lot of pharmaceutical at-home remedies that can be recommended currently. There are some things you can do for your health to try to keep yourself from getting sicker. For instance, moving your body. You're probably not going to feel like walking around or repositioning yourself while laying down for extended periods of time. But, if you remain stationary for too long, you are more likely to develop blood clots. You'll be less likely to take deep breaths and to use those parts of your lungs that we want to keep active.

Also, you can try sleeping on your stomach. We recommend self-proning to some patients who come to the emergency department. Self-proning means you lay on your stomach while resting, which will help your lungs inflate better.

Keep yourself well hydrated, too. Overall, the most important thing you can is to monitor your health. If you're having difficulty breathing, if you're having a hard time keeping fluids down, you should definitely seek medical care.

Q: Is Lee Health offering COVID-19 monoclonal antibody treatment?

A: Yes. Lee Health is utilizing monoclonal antibody treatment for COVID-19 patients who have mild-to-moderate symptoms and are at high risk of developing severe symptoms or the need for hospitalization. You can find out more on Lee Health’s website.

Q: Are Lee Health employees required to be vaccinated?

A: At this time, Lee Health employees are not required to be vaccinated. Lee Health strongly urges its staff and every eligible individual to receive the COVID-19 vaccine to protect themselves, our patients and the community. The vaccine has been proven to build the necessary antibodies that reduce the risk of contracting and spreading the coronavirus and its variants.

Q: Are masks required at Lee Health?

A: Yes. Per CDC guidelines, masks are required to be worn by anyone entering a Lee Health facility, regardless of vaccination status. They must be worn at all times when in the facility unless eating or drinking. Visitors are required to leave their masks on even when in a patient room. As an operating health system, the safety of our patients, staff and visitors is our top priority. By requiring masks, we are limiting the risk of spreading COVID-19 in health facilities and ensuring that we can continue to effectively provide care for all who need it. To preserve personal protective equipment for staff, we ask that the public bring their own masks. 

Q: Why is Lee Health advocating for wearing a mask in public even if someone is vaccinated?

A: Lee Health follows CDC recommendations for masking, and when an area is considered a hotspot, that usually means recommending masking in public indoor places, regardless of vaccination status. It is possible to carry the virus if you are vaccinated, so wearing a mask provides an extra layer of protection.

Q: I am fully vaccinated; can I get a booster shot?

A: At this time the booster is only for people who are immunocompromised. We expect additional guidance from the ACIP and the FDA in the next couple of months outlining who and when other people (besides the compromised) need another dose of vaccine. You can visit LeeHealth.org to schedule your third shot if you meet these criteria.

Q: Should my children be masked at school?

A: The CDC and American Academy of Pediatrics recommend that students K-12 be masked during school this year. The CDC also recommends that all people be masked in areas of substantial and high transmission of COVID-19 regardless of vaccination status.

Q: Why is Lee Health advocating for wearing a mask in public if someone is vaccinated?

A: We continue to follow the CDC guidance during the pandemic. The CDC has been a good source of information for us in terms of looking at the data that's out there and helping us make informed recommendations.

So, the first answer is that the CDC recommends it for areas that have high transmission of the virus, such as in Lee County.

We know that vaccines aren't 100% effective at preventing infection. But, remember they can prevent severe disease, hospitalization, and death. So, even if everybody who was eligible was vaccinated, we’d still see transmission of the virus among the vaccinated because of our high numbers right now.

Masks help reduce transmission. They prevent that in two ways: they protect you by keeping me from spreading a virus I don't know I have. They also protect me from a virus you may not know you have.

If everybody's doing their part by wearing a mask, we can shut down that high transmission rate. We recommend it for our community for those reasons and because the science supports it.

Q: Is Lee Health still performing elective surgeries?

A: Lee Health is temporarily suspending some elective procedures. Procedures that require an overnight stay that can be postponed without causing patient harm are being rescheduled or not scheduled. Patients who need an elective outpatient surgery and who will go home the same day are not impacted by this change.

We understand this decision may be disappointing news for our patients, but it is necessary to safely manage our hospitals at a time when COVID-19 is spreading rapidly throughout our community, placing an extraordinary demand on our ability to manage our hospitals’ bed capacity. We will reevaluate this change when the number of COVID-19 patients begins to decline.

Q: Should I get the vaccine if I am pregnant?

A: Yes. Both the CDC and American College of Obstetricians and Gynecologists recommend pregnant women get the vaccine. It is always advisable to discuss vaccination with your obstetrician before being vaccinated.

Q: If a woman is pregnant and does get COVID-19, does her baby absorb some of the antibodies?

A: That depends upon gestational age. Generally, an antibody doesn't cross until usually near the third trimester when all antibodies start to cross the placenta. Because the vaccine itself will not transmit into the placenta, it won't cross to the baby. However, if mom has enough time to build antibodies, and if enough time passes gestationally for the baby to absorb those antibodies through the placenta, there can be protection.

There also has been shown to be some antibody protection that crosses in breast milk. So, vaccinated lactating mothers who are breastfeeding can also help their babies that way.

Q: Do any of the COVID-19 vaccines lead to infertility?

A: The current vaccine studies have not indicated any fertility-related complications due to the COVID-19 vaccination.

Q: When should I get vaccinated at a hospital rather than a retail pharmacy?

A: If you have a history of adverse reactions to other vaccines or medications or have an underlying health condition, you may feel most comfortable getting your vaccination in a hospital setting where urgent and emergency care is nearby. At Lee Health, we administer vaccines to the community at Gulf Coast Medical Center and are ready to provide any care needed after vaccination.

We monitor all vaccine recipients for 15 minutes after the inoculation.