According to an internal federal health document, the delta variant of coronavirus seems to cause more severe illnesses than the earlier variants. It spreads as easily and as easily as chickenpox. Officials must admit that the war has changed.The slide presentation was created by the Centers for Disease Control and Prevention and shared with The Washington Post. This document captures the efforts of the nation's top public health agency to convince the public to accept vaccinations and preventive measures such as mask-wearing. The increase in cases across the United States is reflected in new research that suggests that vaccinated individuals can spread the virus.This document is a wake-up call. It reveals that the agency must revise its public messaging to highlight vaccination as the best defense against a variant of the virus. The variant acts almost like an entirely new virus and jumps from one target to the next faster than Ebola or even the common cold.The report cites recent, yet unpublished data from both outbreak investigations and studies outside showing that people infected by delta virus may be as susceptible to spreading the virus as those who have not been vaccinated. People infected by delta virus have similar viral loads to those who are not vaccinated.Robert Wachter, chair of the Department of Medicine at University of California at San Francisco wrote in an email that I was much more worried when I finished it than I was when I started.The new research alarms CDC scientists so much that they changed their guidance on vaccinations for people earlier this week, even though no new data was made public.According to a federal health official, the data and studies in the document were key in revamping recommendations that called for everyone to be vaccinated. According to that official, the full data will be made public on Friday. Rochelle Walensky, Director of the CDC, briefed Congress members on Thursday using much of the information in the document.Continue the storyOne slide states that older people are at greater risk of death and hospitalization than younger people. This is regardless of their vaccination status. Another estimate is that 35,000 symptomatic diseases occur per week in 162 million Americans who have been vaccinated.This document describes communication problems that have been triggered by the cases in vaccinated persons, including concerns from local healthcare departments about whether coronavirus vaccinations are still effective and public belief that vaccines don't work/booster dosages.This presentation highlights the difficult task facing the CDC. The CDC must keep highlighting the effectiveness of vaccines in preventing severe illness, death, and other serious complications. However, it should also acknowledge that milder breakthrough infections might not be as rare after all and that people who have been vaccinated may still transmit the virus to others. The agency must make the public visible its goals for success.The CDC declined comment.Although it is rare, we believe that the virus could spread at individual levels. According to the federal health official who spoke under the condition of anonymity as they are not permitted to speak publicly, the recommendation was updated. Even waiting days to publish data could cause unnecessary suffering, and that is something we as public health professionals cannot accept.Two days earlier, Walensky had announced a reversal of guidance regarding masking for people who have been vaccinated. People were informed that they don't need to wear masks outdoors or indoors if they have been vaccinated on May 13. This new guidance is a strategic retreat from the Delta variant. The CDC stated that even people who have been vaccinated, should use masks indoors when they are in areas with high viral spread or where there are people at risk of infection.This document presents new science, but also suggests a communication strategy. It notes that people may not trust vaccines if they hear or experience breakthrough cases, particularly after officials in public health have said they are rare.Matthew Seeger, a Wayne State University risk communication expert, stated that communication has been a problem about breakthrough infections. Public health officials have stressed the effectiveness of vaccines and it may seem like a betrayal to realize that they aren't perfect.Seeger stated that we have done a tremendous job in telling the public these vaccines are miracle cures. We may have fallen into the trap over-reassurance which is one of many challenges in crisis communication situations.Revisions to the CDC's mask guidance are not in line with what is required by the internal document. It states that universal masking is necessary to reduce the transmission of the Delta variant due to its higher transmissibility and current vaccination coverage.It is clear that vaccination offers substantial protection against the disease. It also stated that the CDC should improve communication about individual risk to [vaccinated] because this risk is dependent on a variety of factors including age and compromised immune systems.This document contains data from the CDC showing that vaccines are less effective in patients with immunocompromised and residents of nursing homes. It raises the possibility that some people at risk may need an additional dose.Note that the presentation contains a disclaimer that the conclusions and findings are the author's and not the official position of the CDC.This internal document includes some of the scientific information that prompted the CDC's decision to update its mask guidance. This week, outside experts criticised the agency for changing the mask guidance without disclosing the data. It was a violation of scientific norms, according to Kathleen Hall Jamieson from the Annenberg Public Policy Center at The University of Pennsylvania.Jamieson stated that public health officials don't want to say, "Trust us, we know, but we can't tell you how." According to the scientific norm, if you make statements based on science you must show it. . . . The second error is that they don't seem to be open about how many breakthroughs have resulted in hospitalizations.According to the CDC briefing, breakthrough cases are expected and will likely increase as a percentage of all cases due to the increased number of people vaccinated. This is consistent with data from other countries, such as highly vaccinated Singapore where 75% of new cases are reportedly caused by breakthrough cases.The CDC document cites public skepticism regarding vaccines as one challenge. One slide in the presentation states that vaccines are no longer working for the public.Walter Orenstein, Emory Vaccine Center associate director, stated that data showed that people who had been vaccinated against delta virus were just as likely to contract the disease as those who hadn't. This slide refers to an outbreak that occurred in Barnstable County (Mass.) where unvaccinated and vaccinated people lost nearly equal amounts of virus.Orenstein stated that he believes this is a very important step in changing the world.One person who worked in partnership with CDC to investigate the delta variant spoke under the condition that anonymity because they weren't authorized to. They said the data was from a July 4th outbreak in Provincetown (Mass). The outbreak was characterized by genetic analysis that showed that people who had been vaccinated were passing the virus on to others. According to the person, the data were deeply troubling and a warning sign for scientists who have seen it.The CDC says that the rules of success and failure have changed over time, even though the war is now over. Experts in infectious-disease medicine said that delta's extreme contagiousness makes it more difficult to target herd immunity.After reviewing the slides from the CDC, Jeffrey Shaman, a Columbia University epidemiologist wrote that the central issue is that vaccinated persons are likely to be involved in the transmission. In a sense, vaccination is about personal protection against severe diseases. We are seeing evidence of breakthrough and repeat infections that herd immunity is irrelevant.This document echoes the views of experts and scientists for months: It's time to change how we think about the pandemic.Kathleen Neuzil, a University of Maryland School of Medicine vaccine expert, stated that while increasing vaccination rates remains a priority, the public might need to shift its relationship with a virus that is almost certain to remain with humanity in the future.Neuzil stated that we need to shift our focus towards preventing serious illness and disability, as well as medical consequences. We should not be concerned about every virus found in someone's nose. Although it is difficult to do, I believe we must accept the fact that coronavirus will not disappear.
