Many of you may remember playing in the ocean as a kid; if you went out into the waves and turned your back on an incoming wave, it was likely to push you down on your face. But if you strategically dove into it, you championed the wave: "Catch a wave and your sittin' on top of the world." As so it is with life. Turn your back on trouble and it knocks you down; face a problem, and you may not solve it, but you can work it and perhaps change its outcome. This is where we are, 18 months since the pandemic began.

COVID FAQs:

How do variants arise?

When a COVID infection occurs, the virus hijacks the vulnerable cells and replicates up to a billion copies of itself. Often, the replication is not perfect, which becomes the variant. Most of these variants are duds that cannot further replicate but sometimes, a slightly different variant (mutation) emerges, and it survives. The Delta variant, B.1.617.2, is more infectious and contagious but not more lethal. It arose in India during their February 2021 surge (400,000 cases/day). So, think about that: 400,000 cases per day times a billion replications per person. No wonder variants can emerge. A mutation that is more effective at spreading is going to survive, this is natural selection: survival of the fittest.

What is going on in countries where there were recent surges?

The three recent Delta surge areas that have improved are the UK, India, and the Netherlands. And it happened faster than the experts predicted. Why? Out of necessity, people changed their behavior to adjust to the surge. In the UK, most of the elderly population had already been vaccinated; the younger unvaccinated population who became infected during their surge rarely got hospitalized. The unvaccinated infected group also got natural immunity, thus increasing overall herd immunity. This article is a balanced look at the fundamentals behind the short lived surges in these countries and hopefully the same dynamics will occur here.

How infectious is Delta?

Very!! You may remember from earlier emails about the RO-value. This figure reflects how many people can become infected from the primary person infected. With the original strain, it was around 2.0 to 2.5. This Delta variant has a RO-value of 3.5 to 4.0 - close to double the original strain!

If I have cold symptoms, should I get checked for COVID?

Yes, you should since, if you test positive, you must isolate so you don't spread it - the same drill as before we had the vaccine. To be safe, I recommend isolation for at least 7 days.

Do our current vaccines work against Delta?

Yes! They are effective for preventing illness as well as minimizing the chance of needing to be hospitalized with complications. 99.5% of those who get immunized, even if they test positive, will not need to be hospitalized.

What can we do to get through this current surge?

The surges are the barometer that brings people back to the strategies that work. In June, the prevalence of positive cases in Maryland was <1.0%. As of today, we are at 4.16%. Accordingly, we must make changes to beat it down again: use face masks in public, avoid crowds, outside dining and urge vaccine hesitant people to get vaccinated.

We are now reading stories of vaccine regret: the dying 39-year-old man with a family of 5; right before he died, he said "I should have gotten the damn vaccine." There is a "pandemic of the unvaccinated." If you are not vaccinated, get it now! If not for yourself, get it for the people you care about.

What will the fall bring?

With cooler temperature, going indoors means more exposure to aerosolized small particles. One of the most important things I learned from this pandemic is that it is challenging to predict the future direction of COVID. The variables are complex and dynamic. Nevertheless, we understand more than ever about the biology of this virus and our individual behavior has an effect on our community. Working together is our best chance to bring this back down.

So, as a vaccinated person, when you hear about those who refuse to accept the science and not agree to be vaccinated, does that make you mad?

Yes, it is extremely upsetting to me, and I bet to you, too. And when I feel that anger and frustration, I try to channel the negative energy to bolster my persuasive skills to propel others to look at the science and hopefully convince them to "Just Get The Damn Vaccine!"

On a musical note:

Catch A Wave by The Beach Boys:

As a reminder, I'm no longer sending out daily updates and instead, I'm updating you periodically. I continue to enjoy writing these updates. Initially, these were only sent to my patients, however, I've been humbled to learn that, through social media, these writings have been forwarded and re-forwarded to many. This has brought me great joy to know that this simple act of sharing facts, thoughts, opinions, and hopes have touched you in some way. Hopefully I've been able to reassure you, maybe make you smile and laugh, soothe your worries, and comfort you. And maybe, just maybe, I've helped you to be in the moment!

Reach out. Stay connected. Stay home. Save lives. The power of one. Be well.

Feel free to forward this on: spread the word, not the virus.

HAO

24/7

Harry Oken, M.D.

Adjunct Professor of Medicine

University of Maryland, School of Medicine

Office 410-910-7500

Fax   410-910-2310 

Cell   443-324-0823