The more highly infectious Delta variant of the coronavirus has been on the rise in Indiana and is linked to deadly outbreaks at four long-term care facilities downstate, according to state health officials.
The rise in Delta variant cases nationally suggest there's a corresponding increase in Northwest Indiana, said Dr. Erica Kaufman West, the infectious diseases medical director for Franciscan Health Hospitals in Northwest Indiana.
"Of course we are concerned about the Delta variant," she said. "We are concerned about all COVID-19 cases, as each one is almost completely preventable with current vaccines that are readily available to Hoosiers. Almost every admitted patient we see now has not been vaccinated, which is a failure of our system to educate and combat misinformation that continues to fuel hesitancy and anti-vax ideologies. Fortunately, most of our Franciscan hospitals have seen a decrease in hospitalizations. However, some are still battling many more cases than they should be."
Indiana State Health Commissioner Dr. Kris Box said the Delta variant now accounts for 55% of all variant cases in the state and is now the dominant variant in the Hoosier state. She said the variant, which has more cold-like symptoms like sore throat, runny nose and headache, can cause more severe illness and spreads more quickly.
"The Delta variant is significantly more contagious, potentially twice as contagious as the original virus," said Indiana University Northwest Associate Professor of Economics Micah Pollak, who's been statistically tracking the coronavirus pandemic. "Fortunately, the mRNA vaccines (Pfizer and Moderna) continue to be highly effective at preventing severe illness. Although while those vaccinated will be protected from severe outcomes, based on the data we’re seeing coming out of countries with higher vaccination rates than the U.S. (such as Israel), the vaccine may not be as effective at preventing symptoms or halting the spread the virus."
But only about 49% of the state's eligible population of people 12 or older, or 2.9 million Hoosiers, have been fully vaccinated, according to the Indiana State Department of Health.
"For those who are unvaccinated, either by choice or not yet eligible such as kids under the age of 12, and for those for whom the vaccine may not be fully effective, such as those immunocompromised or with weakened immune systems, there is good reason to be concerned about the Delta variant," Pollak said. "For those fully vaccinated with Pfizer or Moderna, there does not appear to be any need for concern for themselves, although there may be greater concern about vaccinated individuals spreading the virus to others."
While it's difficult to determine exactly how widespread the Delta variant is in Indiana, evidence suggests it may already be driving cases back up across the state, Pollak said. Average new daily cases in southwest Indiana have tripled from 51 per week to 179 per week. That's low compared to the last few waves, but the high rate of increase and potential for exponential growth are reasons for concern, he said.
"This should be concerning because other Midwest states, such as Missouri, are seeing rising rates of cases and hospitalizations," Pollak said. "While it’s too soon in these states to see if death rates will rise, based on the rise in hospitalizations it seems likely. The comparison between Missouri and Indiana is especially concerning because Indiana currently has a lower vaccination rate than Missouri, where we are seeing these spikes."
Relaxed guidelines
Indiana's COVID-19 cases have been picking back up slightly after the positivity rate dropped as low as 2.1%. People have been taking fewer precautions like social distancing and wearing masks after the vaccine has been made widely accessible, hospitalizations and deaths have declined, and restrictions and recommendations have been relaxed.
The Centers for Disease Control and Prevention advised Friday that vaccinated teachers and students won't need to wear masks in school buildings when they return to school this fall. The CDC already dropped a recommendation for the use of plastic shields in schools and is now suggesting desks be spaced 3 feet apart, down from its recommendation of 6 feet apart earlier in the pandemic.
A top pediatric doctor, Miguela Caniza, the director of the St. Jude Global Infectious Diseases Program at St. Jude Children’s Research Hospital in Memphis, Tennessee, encouraged parents to get their children vaccinated as soon as possible because of the rapid spread of the Delta variant.
“As the Delta variant continues to spread around the country, it is more imperative than ever to get children ages 12 and up the shot as soon as possible,” Caniza said. "Vaccinating children for COVID-19 is a key component to reaching the two-thirds threshold necessary to obtain herd immunity and stop the pandemic from continuing to spread and mutate. Vaccination is an important step in helping to control this virus in a safe and effective way for a larger percentage of the population."
Localized outbreaks
New coronavirus cases are likely to be due to the Delta variant, said Dr. Vincent Sevier, senior vice president and chief medical officer at Methodist Hospital.
"The Delta variant is the variant that spread across India and other parts of the globe and has now taken hold in the United States. Its unique feature is that it is much more contagious than the original strain and the Alpha strain which was the dominant strain in the United Kingdom," he said. "The variant is highly contagious, more so than any variant we have seen to this point. It is resulting in new cases in children and resulting in increased hospitalizations."
Overall coronavirus hospitalizations have been down at Methodist Hospitals in Gary and Merrillville. But it's important they stay that way because there's now less bandwidth for an influx of COVID patients, Sevier said.
"When we had our prior surges we had restrictions on other clinical activity in the hospital to accommodate the volumes of COVID patients we were treating," he said. "Presently, we have seen some return of volumes and regular clinical activity. We hope to keep hospitalizations trending lower so that we can continue to manage both populations without disruption."
While a national surge in COVID-19 cases is unlikely with current levels of vaccination rates, outbreaks could occur in some geographic areas where fewer people have inoculated themselves with the vaccine, Sevier said.
"We are at risk for regional surges based on lower rates of vaccination in areas putting them more at risk," he said. "This is of particular concern in Northwest Indiana as we have at-risk populations with lower vaccination rates making them more vulnerable to infection, hospitalization, complications and/or death from COVID."
The Delta variant has different symptoms but can be prevented with any of the coronavirus vaccines that are widely available and free to anyone in Indiana.
"The clinical presentation is different than previous strains. Where the previous strains may have had cough and loss of taste/smell as being more predominant, the Delta strain presents as more headache, sore throat, runny nose, maybe cough and fever," Sevier said. "But most important is that COVID-19 vaccines work against the Delta variant. Those who are fully vaccinated have better protection against getting sick and being hospitalized. This is a clear signal that the vaccine is effective and can be life-saving. It's critical that Hoosiers get vaccinated."
Getting both vaccine shots
Dr. Alan Kumar, the chief medical officer at Community Healthcare System, said the predominant strain in Northwest Indiana was currently the B.1.1.7 variant that's more contagious than earlier strains. He said the Delta variant already overtook the B.1.1.7, or Alpha, variant as the predominant strain statewide, but that vaccines appeared to be effective against it.
"At Community Hospital, St. Catherine Hospital and St. Mary Medical Center, we are down more than 95% from our peak COVID hospitalizations," he said. "Almost every admission to the hospital for patients who are COVID positive is among unvaccinated individuals."
Two doses of the Pfizer or Moderna vaccines are needed to guard against the Delta variant, said Dr. Dylan Slotar, infectious disease physician on staff at Community Hospital in Munster, St. Catherine Hospital in East Chicago, and St. Mary Medical Center in Hobart.
"A single dose of a two-shot series is not sufficient. It is important that eligible unvaccinated individuals start and complete their vaccine series," he said. "The best protection is to get vaccinated as the vaccines in the United States have been shown to be very effective at preventing getting the virus and especially from developing severe disease."
The unvaccinated are at greater risk of contracting coronavirus because the Delta variant has proven to be more contagious than previous strains of the virus.
"Data from the United Kingdom shows that the Delta variant is 60% more transmissible than the Alpha variant, which itself was around 40% more transmissible than previous viral strains," he said.
Community Healthcare System officials are concerned about the "significant increase" in Delta variant cases the Indiana State Department of Health is reporting but not expecting a major surge in hospitalizations in Northwest Indiana.
"Anything that can increase the rate of transmission of the virus is of concern to the health care system. Since the Delta variant is shown to be more transmissible than prior strains of the virus, it is reasonable to expect that case numbers in our community will increase, especially among unvaccinated individuals," Slotar said. "However, the vaccines have effectively broken the link between case numbers and serious illness so we do not anticipate a dramatic increase in hospitalizations in the near future."