Editor’s Note: We contacted Northern Westchester Hospital for guidelines on the latest news surrounding COVID, for thoughts on breakthrough infections, vaccinations and mask wear. Here, expert insights and advice from Debra Spicehandler, M.D., Co-Chief, Division of Infectious Diseases, Northern Westchester Hospital
By Debra Spicehandler, M.D.
To mask or not to mask? That is just one of the questions generating confusion as the CDC tries to nail down current COVID recommendations as the very contagious Delta strain gains traction. We continue to learn more, but the Delta variant appears to cause more severe illness and may spread as easily as chicken pox. In addition to a growing number of breakthrough infections among the fully vaccinated, it appears that symptomatic vaccinated people can also spread the Delta variant.
During the past few weeks, New York seemed to have pushed COVID back to the point when people felt comfortable eating in restaurants, attending weddings and going back to the office. Not so fast. Almost overnight, the Delta variant has become the dominant COVID strain, and we are seeing rates of infection rise especially among the unvaccinated.
Here is what we know:
Being vaccinated is key, but vaccine hesitancy persists, and there is discussion about mandating vaccines among certain groups, including healthcare workers.
We are now seeing breakthrough infections even among people who are vaccinated as a result of the now dominant, highly contagious Delta variant. The good news is that breakthrough infections among the vaccinated seem mild, in most cases, and do not require hospitalization. It is unclear whether people with breakthrough COVID cases will have any of the long-term effects we’ve seen that include cardiac issues, long-lasting fatigue, lung problems, joint pain, and brain fog.
Though we have not seen definitive data, federal health officials announced both vaccinated and unvaccinated people who contract the Delta variant of COVD may carry similar levels of viral load and spread the disease even when asymptomatic. A recent New England Journal of Medicine study of 1,497 vaccinated Israeli healthcare workers found 39 breakthrough infections with three quarters of those people showing a high viral load.
This information raises other questions: if we are seeing more breakthrough infections, is it because the Delta variant is more efficient, or does the efficacy of the vaccine wane over a certain period of time? And, if so, how long do vaccines last?
It is beginning to look as though people who have been vaccinated will soon need booster shots.
As COVID rates rise, the CDC recommends that even fully vaccinated people wear masks indoors where transmission of the virus is high, such as New York City and surrounding suburbs, including Westchester. Since the virus is rising in New York, I recommend caution. It is still okay to be outside without a mask if you are vaccinated, but it looks like indoor masking should be reinstituted, and people should follow the most updated guidelines on the CDC website. This is an evolving situation. Even if we know people have been vaccinated, we cannot be sure that someone has not been exposed to the Delta variant.
For the vaccinated, COVID symptoms can be extremely mild. But if you are concerned that you may have COVID–especially if you have other co-morbidities–then get tested.
Patients who test positive and are at high risk for developing a severe infection may be eligible for infusions of monoclonal antibodies. This risk group includes people 65 and older, who have diabetes, high blood pressure, cardiac disease, obesity, asthma or who are immunocompromised.
Because recommendations are changing so quickly as we learn more, check the CDC website for the most current information. And, if you think you may have COVID, check with your physician. For more information, visit Northwell’s Digital Resource Center.
