Renee Kinder

Life over the past few weeks has felt a little too normal.

Would you all agree?

Like we have all just been waiting for the ball to drop, and it has, with the recommendations from the CDC on Tuesday related to increased protections needed with new evidence on the B.1.617.2 (Delta) variant currently circulating in the United States.

I have recently been able to grocery shop without a mask, attend an indoor concert, see three movies with my kiddos, and finally — yes FINALLY — return to more consistent work travel.

Conference season is upon us, meetings and greater engagement with therapy teams have opened, and return to air travel has been a welcome reminder of normalcy.

With air travel, however, comes airports, and with airports comes Atlanta and the masses of folks navigating ATL (the airport there). ATL terminals A, B, C, D, E and F — like the SARS-CoV-2 variants alpha, beta, gamma, and delta — are different. 

One is not the same as the other. If you have a flight in Terminal B and are in Terminal C you will miss your flight. 

This week I encountered an individual lost in terminal translation. He walked up to me obviously stressed, was unable to fully communicate in English, and simply pointed to his ticket.

 “B” he said over and over “B” with an inflection in his voice as if to ask, “Where in the world is “B”?

I pointed up to the sign above us and shook my head left to right, no “C.” We are in “C.” Then I pointed to the left and the right up and down the terminal.  All of this is “C.”

He looked down, a bit sad at this point. “B” he said again.

Don’t fret, the story ends well. I took him to the train, got him on the track headed to “B” and made sure he was safely on his way. As the doors closed another traveler said, “Don’t worry I’ve got him, we will make it to “B.”

Similar to the peril associated with being lost in an airport while unable to effectively communicate, if we don’t understand the differences in the current SARS-CoV-2 variants of concern (VOC) we cannot fully protect our communities and the patients we serve.

The current VOCs include Alpha, Beta, Gamma and Delta. What is a VOC?

Per the World Health Organization, the working definition is as follows:

A SARS-CoV-2 variant that meets the definition of a Variant of Interest (VOI) and, through a comparative assessment, has been demonstrated to be associated with one or more of the following changes at a degree of global public health significance: 

  • Increase in transmissibility or detrimental change in COVID-19 epidemiology; OR
  • Increase in virulence or change in clinical disease presentation; OR
  • Decrease in effectiveness of public health and social measures or available diagnostics, vaccines, therapeutics.  

VOCs differ from VOIs, which currently include: Eta, Iota, Kappa and Lambda. (It might start to sound like it, but this is not like fun with college sororities or fraternities!)

The WHO defines a variant of interest (VOIs) as a SARS-CoV-2 variant:

  • With genetic changes that are predicted or known to affect virus characteristics such as transmissibility, disease severity, immune escape, diagnostic or therapeutic escape; AND 
  • Identified to cause significant community transmission or multiple COVID-19 clusters, in multiple countries with increasing relative prevalence alongside increasing number of cases over time, or other apparent epidemiological impacts to suggest an emerging risk to global public health.

B.1.617.2 (Delta) is a variant of concern (VOC), hence the recent “Interim Public Health Recommendations for Fully Vaccinated People” which was updated July 28, 2021 by the CDC.

  • Updated information for fully vaccinated people given new evidence on the B.1.617.2 (Delta) variant currently circulating in the United States.
  • Added a recommendation for fully vaccinated people to wear a mask in public indoor settings in areas of substantial or high transmission.
  • Added information that fully vaccinated people might choose to wear a mask regardless of the level of transmission, particularly if they are immunocompromised or at increased risk for severe disease from COVID-19, or if they have someone in their household who is immunocompromised, at increased risk of severe disease or not fully vaccinated.
  • Added a recommendation for fully vaccinated people who have a known exposure to someone with suspected or confirmed COVID-19 to be tested three to five days after exposure, and to wear a mask in public indoor settings for 14 days or until they receive a negative test result.
  • CDC recommends universal indoor masking for all teachers, staff, students and visitors to schools, regardless of vaccination status.

What do we know about the vaccination and Delta? 

Some good news, actually.

A July 14, 2021, publication titled “Study Suggests Lasting Immunity After COVID-19, With a Big Boost From Vaccination” from the Journal of the American Medical Association (JAMA) reported the following: 

“Unvaccinated health care workers appeared to have less protection against the delta and beta variants compared with alpha about a year after they recovered from mild COVID-19. While 88% of this group had neutralizing antibodies against alpha, only 47% neutralized delta.”

However, recovered health care workers who had received 1 dose of the AstraZeneca, Pfizer, or Moderna vaccines had a marked increase in neutralizing antibody levels against all 3 of these variants compared with their unvaccinated peers. 

“Vaccination of convalescent individuals boosted the humoral immune response [against delta] well above the threshold of neutralization,” the authors wrote. “These results strongly suggest that vaccination of previously infected individuals will be most likely protective against a large array of circulating viral strains, including variant [d]elta.”

In closing, if we have all learned anything over the last 18 months it is the importance of staying well informed and that “normal” these days is expecting the truly unexpected.

Mutations, we must remind ourselves, are unfortunately what IS normal for a virus.

Hoping you all have been able to soak up some normal and the pleasures of summer. 

Remember to take care of you and yours and let us all brace and prepare for the alphabet soup of variants that may still come our way. 

Renee Kinder, MS, CCC-SLP, RAC-CT, is Executive Vice President of Clinical Services for Broad River Rehab and a 2019 APEX Award of Excellence winner in the Writing–Regular Departments & Columns category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association’s (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty and is an advisor to the American Medical Association’s Relative Value Update Committee (RUC) Health Care Professionals Advisory Committee (HCPAC).

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.