Daily cases of COVID-19 are headed back upward, both in Maine and across the country. The seven-day average in Maine has nearly tripled, rising from 20 to 58, in the span of two weeks. And while current averages are still well below the late-spring figures – and a fraction of the worst of the pandemic at the start of the year – they are headed in the wrong direction.

Maine has been faring better than most states due, in part, to a 60 percent vaccination rate that is higher than in all but a handful of other states. Nationally, the seven-day average of new cases jumped 53 percent during the past week, while hospitalizations increased 32 percent and COVID-related deaths are up 19 percent since last week, federal officials said on Thursday.

How much is the delta variant a factor?

The so-called delta variant, a mutation first detected in India that is sweeping across much of the world, is definitely in Maine. The extent, however, to which it is contributing to and/or responsible for the higher local case rates is less clear.

The U.S. Centers for Disease Control and Prevention estimated this week that the delta variant accounts for 83 percent of all new COVID-19 cases in the United States.

The latest report on genomic sequencing of positive cases from the Maine Center for Disease Control and Prevention is more than two weeks old and includes information that is nearly three weeks old. More up-to-date numbers could be available on Friday, a Maine CDC spokeswoman said.

That July 9 report showed just five cases of the delta variant had been verified out of the 4,631 positive COVID-19 cases that had been sequenced by labs for the Maine CDC as of July 3. There were another five suspected but unconfirmed cases.

But NorDx Laboratories operated by MaineHealth has been periodically screening for delta and found that 18 of the 49 tests, or 37 percent, run since July 1 “screened positive” for the variant. Screening is just a preliminary method, however, and any positives in that small subset of positive COVID cases reviewed by the NorDx Lab would have to be confirmed via genomic sequencing.

Either way, health officials say the delta variant is more prevalent in Maine than those numbers suggest because only a small portion of all positive COVID-19 cases are sequenced.

“Our clinical interest (in the delta variant) is less and less because we know it’s here, we know it’s spreading and it doesn’t have a clinical application for the patient in front of you,” MaineHealth spokesman John Porter said.

In other words, infection with the delta variant “doesn’t change the course of treatment” for the patient versus an infection with the U.K. variant (alpha) or the strain of coronavirus that was dominant in the U.S. last year.

Who is catching the virus now?

Unvaccinated people account for the vast majority of new cases, both in Maine and nationally. Unvaccinated people also account for nearly all of the deaths and hospitalizations from the virus, which public health officials say underscores the effectiveness of the vaccines.

Nationally, 97 percent of all hospitalizations are among people who have not been fully vaccinated against COVID-19 and roughly 99 percent of deaths were among unvaccinated individuals, according to federal officials.

The Maine CDC does not report the breakdown of vaccinated versus unvaccinated people in new cases and hospitalizations on a regular basis.

But Dr. Dora Anne Mills, MaineHealth’s chief health improvement officer and a former Maine CDC director, suggested that what the healthcare network is seeing in hospitalizations mirrors the national trend. Those who are hospitalized are trending younger than last year and, unlike a month ago when most were from rural Maine, “are from all over Maine.”

“The one thing they have in common, by far, is that the very, very vast majority of them are unvaccinated,” Mills said on Maine Public radio’s “Maine Calling” program on Wednesday.

“This is now becoming a disease of the unvaccinated and particularly younger individuals,” added Dr. James Jarvis, Northern Light Health’s physician leader for incident command.

What about “breakthrough” cases among vaccinated people? And should I be concerned about catching the virus even though I’m fully vaccinated?

According to the most recent statistics from the Maine CDC, there have been 560 so-called “breakthrough” cases among fully vaccinated people out of nearly 70,000 total COVID-19 cases in the state. Fewer than 10 of the 891 people whose deaths are linked to COVID were fully vaccinated, and all of those individuals had other serious health conditions, Maine CDC Director Dr. Nirav Shah said earlier this week.

“When the pool of vaccinated people grows, the number of breakthrough cases continues to go up, even though the rate is really low,” Shah said. What’s important to remember, Shah said, is that those individuals are at much lower risk of getting a severe case.

Breakthrough infections are inevitable with any vaccine because no vaccine is 100 percent effective. The Pfizer and Moderna have proven to be roughly 95 percent effective against the virus and the single-dose Johnson & Johnson vaccine has been found to be roughly 85 percent effective against severe disease.

But because vaccines help the body fight off an infection, vaccinated individuals are dramatically less likely to develop severe symptoms or die from COVID-19 than unvaccinated people.

“Being fully vaccinated gives you a high degree of protection against infection and an even higher degree of protection against severe illness, hospitalization and death,” Dr. Rochelle Walensky, director of the U.S. CDC, said Thursday during a briefing of the White House’s COVID-19 response team. “This is what these vaccines are designed for and what the clinical trials studied, and the vaccines generally do their job quite well. These vaccines are some of the most effective that we have in modern medicine.”

Do certain vaccines provide better protection against the delta variant than others? And will I need a booster shot?

Medical researchers have been racing to gauge the various vaccines’ effectiveness against the delta variants (as well as the earlier variants of concern) in recent months.

The most recent study, published this week in the New England Journal of Medicine, found that two doses of the Pfizer vaccine were 88 percent effective against developing symptomatic disease because of the delta variant. An earlier study out of Israel pegged the Pfizer vaccine at 64 percent effective against the variant.

There have been fewer studies of the two-shot Moderna vaccine, although a Canadian study found it was about 72 percent effective against symptomatic disease from the delta variant.

Johnson & Johnson said this month that its single-dose vaccine was effective against the delta variant as long as eight months after inoculation. But a study released this week – which has yet to be peer reviewed – suggested the J&J shot was less effective than the Pfizer and Moderna vaccines, which use a different technology.

Asked Thursday about potential “booster shots” for J&J recipients, the nation’s top infectious disease specialist, Dr. Anthony Fauci replied: “The J&J vaccine … is a very effective vaccine. There is no reason to believe right now that people who have taken the J&J vaccine have any need for a booster shot.”

With cases rising, should even vaccinated people consider wearing masks again when in public?

That’s a question a lot of people are asking in Maine and across the country.

Los Angeles County, for example, reimposed mandatory masking in public indoor settings earlier this month as cases rose again. In fact, indoor masking is now recommended (but not required) in one-third of California’s counties, the Los Angeles Times reported.

And the American Academy of Pediatrics issued new guidance this week saying everyone over 2 should wear masks inside schools regardless of their vaccination status in order to protect children who are not yet eligible for inoculation.

Unvaccinated individuals are still supposed to be masking up inside stores or in crowded settings. But a resurrection of mask mandates for everyone appears unlikely in Maine or most states any time soon given public (and political) opposition.

During Thursday’s White House COVID team briefing, Walensky, with the U.S. CDC, was asked several times whether fully vaccinated people should consider wearing masks again because of the surge in cases overall and the inevitable increase in breakthrough cases.

“If you’re unvaccinated, you should absolutely be wearing a mask,” Walensky said. “If you are vaccinated, you have exceptional levels of protection from that vaccine and you may choose to add an extra layer of protection by putting on that mask. And that is a very individual choice.”

Mills, the former Maine CDC director who is now with MaineHealth, acknowledged that she still carries a mask with her everywhere and will put it on in some situations, such as entering a crowded grocery store where some people may be unvaccinated. She and Jarvis with Northern Light Health said vaccinated individuals also should consider masking when around immunocompromised individuals or children too young to be inoculated.

Mills, who is Gov. Janet Mills’ sister, compared the current situation to Maine’s notoriously erratic weather: even if it was hot today, it’s best to look at the forecast to see whether you’ll need a coat tomorrow.

“I think we have to kind of get used to figuring (out) what is happening in our state and in our community: where am I going to be and who am I going to be encountering?” Mills said on “Maine Calling.” “Am I going to be encountering people who are immunocompromised or are too young to get the vaccine?… So even if you’re vaccinated, there are times you may want to consider wearing extra layers of protection like masking, physical distancing and making sure you are in a well-ventilated place.”


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