COVID update, variants, and vaccinations

Dr. Bradly Bundrant
Ballinger Memorial Hospital District
Dr. Bradly Bundrant is a physician at Ballinger Memorial Hospital, and the Runnels County Health Officer.

There are a number of elements of COVID-19 that are of great concern. First and foremost is that cases are again on the rise, in Texas and across this country; there is about 10% increase week over week for more than two weeks. Hospitalizations are also increasing. Previous to this we had seen a long period of declines in these numbers, then a plateau, and now a sustained increase over two to three weeks. This is a fact, and facts are stubborn things.

We can’t change population statistics, but we can understand and respond to them. Here is some context: Researchers recently monitored at a group of about 4000 healthcare workers and first-responders in Texas and elsewhere, from December 2020 through April 2021. The results were published in the New England Journal of Medicine and they showed that 172 of these people became sick with COVID during that period. Of these, only 5 were fully vaccinated, 11 had received one of 2 shots and the other 156 people who got COVID were unvaccinated. Looking at these same data in another way the evidence showed that the full vaccination series results in about 91% protection and partial vaccination provided about 81% protection. Also, we know from other sources that almost all of the recent hospitalizations and deaths are in unvaccinated individuals.

Two main types of vaccines

There are two main types of vaccines for COVID-19. The first shots that were available were from Pfizer and then a little later the Moderna vaccine became available.

There is concern about the vaccinations themselves. There are two main types of vaccines for COVID-19. The first shots that were available were from Pfizer and then a little later the Moderna vaccine became available. These are both known as mRNA vaccines, because they consist of an entirely new type of vaccine that uses messenger RNA to directly instruct the body’s own molecular machinery to construct proteins that eventually induce an immune response in the body.

The other vaccine in this country is from the company Johnson & Johnson (J&J, also in collaboration with Jansen), and it uses a more familiar type of technology in which a modified virus is injected into the body to elicit an immune response. Astra-Zeneca is another company that has a similar vaccine which is used widely in other parts of the world, but not in the US.

The best evidence indicates that there are risks associated with these vaccines, as there are for all vaccines and indeed for all medications. We know that the probability of developing a particular side effect depends on the age, sex, genetics and personal history of exposures and medications etc.

Everyone who is hospitalized with COVID has some sort of blood clotting abnormality. The cause of death is often related to abnormal blood clotting.

Explaining risk factors

There is, for example, a risk of a particular blood clotting disorder in women of reproductive age who get the J&J or Astra-Zeneca vaccine. They have a risk of about 1 in 10,000 of suffering this disorder, vs 1 to 2 in 100,000 risk of having the same thing happen without having the vaccine. This should be thought of in comparison to the virtual certainty of having a blood clotting disorder if you become very ill with COVID-19.

Everyone who is hospitalized with COVID has some sort of blood clotting abnormality. The cause of death is often related to abnormal blood clotting. With the mRNA vaccines there appears to be an association with inflammation of the heart muscle (myocarditis) in young men and boys after vaccination with one of these vaccines. However, myocarditis is much more common and severe in COVID in this same population. What it comes down to is that any side effects seen with the vaccines are also seen in COVID-19, and they are at least as common in the disease as they are after vaccination, plus you have all of the other bad things that COVID causes besides!

Alpha and Delta variants

There is also great worry about the variants. The original virus is sometimes called Wuhan-1. That is the variant that caused so much death in Italy and New York. Before we had very many local cases, that variant had been outcompeted by another variant known as D614G. These two types are often lumped together and called original or “wild type.” The D614G variant spread faster (was more transmissible), but did not cause worse disease. That variant was soon replaced in the United Kingdom by another variant know as B.1.1.7, or “alpha.*”

The alpha variant is about twice as transmissible and also caused disease that was about twice as likely to result in hospitalization and almost twice as likely to result in death. That became the predominant strain here, until very recently when the delta variant became predominant.

Delta spreads 2-4 times as fast as the wild type and is at least twice as likely to result in serious illness, hospitalization or death. Research shows, however, that the treatments and vaccines work about as well in the alpha and delta variants as in the wild types. There are two other types that are of potentially greater concern.

Other variants evade vaccine

In South Africa a variant known as beta (aka B.1.351) made headlines when the vaccines provided only 50-70% protection against it, instead of 70-100% protection for other types tested. There is also another variant that appears to have originated in Brazil which has a similar ability to evade vaccines. This one is known as gamma (aka B. or P.1), and in the last month it is responsible for most of the 1.85 million new cases and 50,800 deaths in Brazil. For comparison, India had 1.5 million new cases and 45,000 deaths in the same period. India has 6 times Brazil’s 214 million people.

The good news

The best news in regard to variants is this: Even though vaccines offer only 50-70% reduced chance of illness with beta and gamma variants, the vaccines still offer almost 100% protection against severe disease and death due to these variants. The best news about vaccines is that everyone who needs one – that is everyone 12 y/o and up – can get one. In Ballinger call the Ballinger Memorial Hospital Clinic at (325) 365-5737, and you have your choice of any of the three shots for which you are eligible. Similarly, in Winters, call the North Runnels Hospital Clinic at (325) 754-1317. Supplies may be limited.

* Since the power structure has decided that it is not politically correct to name a virus or variant according to the place it originated, it has been decreed that the UK variant is to be called alpha, the South Africa variant is beta, the Brazil variant is gamma, the variant from India is delta, and the Peru variant is lambda.