The highly contagious delta variant is widespread in the Bay Area. Cases increased 10-fold then leveled off; hospitalizations continue to rise. Unvaccinated people are still much more likely to be hospitalized and die from the delta variant. While the delta variant can cause infections (mostly mild) in vaccinated and previously infected people, vaccines remain highly effective against severe COVID-19 and death.
Getting vaccinated and wearing a mask are necessary to get the delta surge under control.
On August 12, the FDA authorized a third mRNA vaccine dose for people “who have undergone solid organ transplantation, or who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise.” About 3% of the US population falls into this category. Studies of people with solid organ transplants show a significant lack of immune response in this population with two doses, and a randomized trial showed benefit with a third mRNA vaccine dose.
Active treatment with high-dose corticosteroids or other drugs that may suppress your immune response
Verification of immunocompromised status is not required, so people can self-attest and get their third dose anywhere mRNA vaccines are available. However, Alameda County recommends that residents discuss getting third doses with their providers first. Clinicians have leeway to assess immune status and help people think through getting a third dose.
What about people who got the J&J vaccine? There is no official clinical or public health guidance on this yet. People who received a J&J vaccine may also discuss getting a supplemental mRNA shot with their providers. SF General has been offering these supplemental shots since early August.
The US Health and Human Services Department (HHS) has announced a plan to offer booster shots beginning September 20 for other people 8+ months out from their second dose, which will start with people who received second doses in January 2021. Pfizer submitted booster dose data on August 16 showing significantly higher immune response after the booster, including against the beta and delta variants. Vaccine data from Israel through August 12 shows waning protection from severe disease in older populations who were vaccinated 6+ months ago. Israel has approved a third dose for everyone ages 50 and over.
Universal indoor masking is required in the Bay Area: On August 2nd, Bay Area Health Officers urged immediate vaccination and issued orders requiring the use of face coverings indoors to prevent the spread of COVID-19, given the sharp increase in cases from the delta variant. Click here for the Alameda County press release. Click here for the San Francisco press release, which includes strong recommendations to also wear masks in crowded outdoor spaces and in indoor gatherings in private homes with people from multiple households.
The delta variant is widespread in the Bay Area. COVID-19 cases in the Bay Area have leveled off in the past two weeks after rapidly increasing 10-fold since California’s reopening on June 15. Hospitalization and ICU rates continue to increase. Bay Area coronavirus cases and hospitalizations have surpassed last summer’s peak when people were unvaccinated but stricter precautions (masking, distancing, capacity limits) were still in place. Deaths remain lower that previous surges, thanks to people getting vaccinated. The delta variant was 99% of the COVID cases sequenced in the US by August 14.
In the old California color-tier system, this would have put us in the purple “widespread” tier. This rapid rise in cases is likely due to reopening more activities, reductions in mask use, people not yet fully vaccinated, and the highly contagious delta variant.
Get vaccinated now! Vaccination our best protection against severe illness. Vaccines remain highly effective against serious disease and death from the delta variant. Surgeon General Murthy said, “One fact that has been proven time and time again during this past year is that vaccines save lives. That’s why 99.5% of COVID-19 deaths are among the unvaccinated. It’s also why nearly every death from COVID-19 is a preventable tragedy.” We must continue supporting everyone eligible to get vaccinated as soon as possible.
“We must act now to protect ourselves, our loved ones and our community. If you are eligible to get a COVID-19 vaccine and have not yet done so, please do not wait any longer,” said Dr. Chris Farnitano, health officer for Contra Costa County and EBGTZ steering committee member. “During July the number of hospitalized COVID-19 patients in our county increased 400%. Four out of five of the COVID patients we see are not vaccinated, even though only one out of five Contra Costa adults are not vaccinated.”
Starting August 11, hospitals, skilled nursing facilities, and intermediate care facilities are required to verify that visitors are fully vaccinated or have tested negative for COVID-19 in the prior 72 hours before indoor visits.
Dr. Aragón also released a public health order mandating vaccinations on July 26 for all state employees and all workers in homeless shelters, retirement homes, jails and prisons. Workers in these settings are required to show proof of vaccination or agree to mask and wear PPE and test at least weekly.
Dr. Tomás J. Aragón issued a health order on August 11 requiring all CA school workers to get fully vaccinated and provide proof of vaccination or undergo at least weekly COVID-19 testing. On August 10, Oakland Unified School District announced a vaccination requirement for all school district staff, contractors and volunteers, with vaccination or weekly testing required by September 7.
Full FDA approval for the Pfizer and Moderna vaccines is expected in September.
Get tested if you are exposed to COVID-19 or have symptoms! Here is California’s guidance on isolation for positive test results and quarantine for people who are exposed. Reports from the UK and this US study show these top 5 symptoms in delta infection:
- Top 5 symptoms in unvaccinated people:
- Top 5 symptoms in vaccinated people: “Feels like allergies or a bad cold.”
Loss of smell/taste
Vaccines and the delta variant
Delta variant data recently obtained by the CDC and reported in The Washington Post on July 29 show that the delta variant is more highly contagious, may cause more severe disease, and suggests that vaccinated people who get infected may spread it as easily as unvaccinated people. Vaccines remain highly effective at preventing severe disease (10x reduction), but less effective at preventing mild or asymptomatic infection with the delta variant (3-5x reduction).
Substantial evidence shows that the delta variant is about twice as infectious as the original variant, which makes the reopening extra risky for unvaccinated people. A study of viral loads in delta infections found viral loads to be 1,000x higher than the original variant. This study from the CDC also demonstrates that the delta variant infects kids and unvaccinated people at higher rates in recreational settings, especially indoors, such as in this gymnastics facility where 20% at the gym were infected and 53% of household contacts became infected.
A CDC study on a July 2021 outbreak in Massachusetts found that viral loads of delta infection in vaccinated people were similar to viral loads among unvaccinated people, and other studies showed that the viral loads in infected vaccinated people reduce more quickly (PCR cycle times >30 in 9 days rather than 18 days). Taken altogether, these studies suggest that vaccinated people are less likely to be infected with the delta variant (3-5x reduction), and when they are infected, they have much milder illness and are infectious for fewer days.
Universal masking and distancing are crucial for reducing spread given current inadequate vaccine coverage. We need to continue to outreach to people to increase vaccination rates to reduce serious illness and death. We will also likely need to learn to live with the virus over the long run and aim to reduce serious illness and death through vaccinations.
COVID and Youth
New evidence from the CDC demonstrates that compared to previous strains, the delta variant infects kids and unvaccinated people at higher rates in recreational settings, especially indoors, such as in this gymnastics facility where 20% at the gym were infected and 53% of household contacts became infected.
While most new infections are mild cases among young, unvaccinated people, there is still a risk of long-term health impacts that we don’t understand yet. A new study from Norway shows that more than half (52%) of young people ages 16-30 had long COVID symptoms.
A large-scale Canadian public health study of 6,280 pediatric cases found that children ages 0 to 3 years had about 40% greater odds of transmitting COVID-19 to household contacts compared with children aged 14 to 17 years, based on pre-delta data collected between June 1 to Dec. 31, 2020.
The delta surge and school reopenings:
California is requiring “All adults and students in K-12 school settings must wear masks indoors.” The American Academy of Pediatrics released updated guidance for schools on July 17 also recommending masks for all people ages 2 and over in school and childcare settings.
Multiple studies from 2020 have shown that schools can safely reopen with fewer transmissions than in the surrounding community when mitigation strategies with masking, distancing, cohorts, capacity limits and ventilation in place. However, current school guidance is based on studies done before the delta variant was prominent. Stricter implementation of these strategies is even more crucial during times of high community case rates and a surge in more infectious variants, like now. In a study from 2020 before Delta was widespread, British researchers found that for every five additional cases per 100,000 people in a community at large, the risk of a school outbreak increased 72%.
A study of a million students in North Carolina March-June 2021 (pre-delta) showed that proper universal masking is the most effective mitigation strategy for prevention COVID transmissions in schools when COVID-19 is circulating and students are ineligible for vaccination or uptake is inadequate. Fewer than 1% of the 40,000 in-school contacts of over 7,000 students and staff with diagnosed COVID-19 became infected while universal mask mandates were in place during a time when statewide case rates were around 15 cases/100k (5-23/100k range).
Other studies of schools in Utah, Missouri and Wisconsin showed that mask mandates were associated with lower transmissions in schools, and a study of a high school in Israel that didn’t use masks led to a large outbreak. Overall, these studies suggest a pre-delta 13% secondary attack rate in schools without masking and <1% secondary attack rate in schools with universal mask mandates.
Wear a mask indoors and in crowded outdoor settings, regardless of vaccination status. Click here for additional state-wide guidance on COVID precautions, including for schools, workplaces, travel and events.
UCSF’s Center to Advance Trauma-informed Heath Care (CTHC) was launched in 2018 to help lead the emerging field of trauma-informed health care. CTHC is an academic program that treats individual patients, innovates clinical models of care, performs research, trains and educates key stakeholders, and changes health policies. They are hiring for a Senior Program Manager. Learn more about the position here.
AIDS Healthcare Foundation (AHF) is currently hiring for a mid level provider (NP) at their AHF Oakland Wellness Center. This position will be based in a sexual health clinic where the provider focuses on STI treatment and PrEP/PEP. Learn more about the position here.
Tracking California is a program of the Public Health Institute, in collaboration with the California Department of Public Health, and their mission is to mobilize data for public health action. They are hiring for a Program Associate to provide administrative, finance and project support for projects. Learn more about the opportunity here.
The Abundant Birth Project in San Francisco is seeking a program manager to head up the implementation of this innovative income supplement program for pregnant Black and Pacific Islander folks in SF. Learn more about the position here.
California Department of Public Health’s STD Control Branch is recruiting to fill a Project Policy Analyst 2, Program Development Project Specialist, position. Under the supervision of the Chief of the Local Capacity Building (LCB) Section the Project Specialist provides analytical, programmatic, and executive assistance to the LCB section. Learn more about the position here.
Internships, Scholarships, funding and more
Race Forward and T.Rowe Price Foundation have partnered to offer a ‘Building Racial Equity’ training virtually to selected individuals and organizations in the Bay Area at no cost. This training is for individuals and organizations working in the areas of social and racial justice,
organizing or those who work in nonprofit and government institutions seeking to advance racial equity within their institutions and communities. They have two upcoming training sessions available. Please sign up by August 31st for either training: September 15th and September 29th.
The Governor’s Office of Business and Economic Development (GO-Biz) is excited to announce that the California Community Reinvestment Grants (CalCRG) program Grant Solicitation for Fiscal Year 2021-22 is now available. For CalCRG program funding amounts, eligibility, and the application process, please click here.
City of RichmondYouthWORKS Summer Youth Employment Program is now available year-round. They are inviting organizations to apply to become a worksite employer to: 1) Get short term projects completed; 2) Provide mentorship and career training to Richmond youth; 3) Grow your team without increasing payroll costs. . Learn more and apply here.
Events (virtual & in-person):
September 14th, 2pm: Are you new to helping people with HIV enroll in health coverage? Do you want to learn more about how you can support clients as they navigate enrollment in health coverage? Ace TA Center is offering ‘Basics of Health Coverage Enrollment: Strategies and Resources for New Program Staff’, their annual orientation webinar designed to introduce new program staff (or staff with new roles) to the lifecycle of health coverage as well as practical strategies and tools to engage, enroll, and retain Ryan White HIV/AIDS Program (RWHAP) clients in coverage. Learn more and register here.
August 25th, 6:30pm: The Drug Policy Alliance has put together a panel of guests to ask and answer important questions about Fentanyl. The Truth about Fentanyl will discuss What is it? What does it do and how do we help the communities being impacted by this powerful narcotic? They’ll explore the prevailing narratives around the drug by both law enforcement and those seeking to mitigate its impact by working on the ground with those most impacted including the drug user community. Learn more and register here.
August 25th, 12noon: The Center For Disease Control and Prevention (CDC) recently updated their PrEP guidelines to reflect current prevention tools including LA-CAB. Please join the Treatment Action Group and Black AIDS Institute for Community Update: PrEP Guidelines. This will be a conversation with Dr. Dawn Smith to discuss the new changes to the PrEP guidelines. Learn more and register here.
August 24th, 12 noon: Join the UCSF California Preterm Birth Initiative’s August Collaboratory Police Brutality's Impact on Black and Brown Mental Health, which will explore how police brutality is impacting the mental health of Black communities and how communities are coming together to create change. Learn more and register here.
Harm Reduction Coalition is hosting a late summer series of virtual technical assistance workshops. Learn more about the various workshops here.
Resources for your clients
CDPH’s Office of AIDS has released the HIV & Aging Pre-Implementation Feasibility and Fit Stakeholder Survey. They are seeking input through the survey, as well as wanting to expand our reach to stakeholders whose insights can help the Office of AIDS (OA) deliver innovative programs and services for older individuals living with HIV and inform our planning.Survey respondents can participate anonymously or choose to get more involved. Fill out the survey here.
EBGTZ Learning Corner (interesting & relevant resources to further our learning): California Department of Public Health’s Office of AIDS has released their August newsletter. Read it here.
The EBGTZ website will continue to post practice-changing updates, a general EBGTZ newsletter is sent on first Wednesdays and this COVID+HIV newsletter is sent out on third Wednesdays of each month. Please follow and share our Instagram, Facebook and Twitter accounts.
Thank you for all that you do for our communities!
Sophy, Yamini and Sami
Sophy S. Wong, MD, Director
Yamini Oseguera-Bhatnagar, Program Manager
Sami Lubega, MD, Prevention Director East Bay Getting to Zero