How PHINs will steer us safely through the Delta variant surge

August 20, 2021

Our nation’s response to COVID-19 through 2020 to mid-2021 shows us the shortcomings and challenges health systems and public health officials have faced when unable to collaborate in real-time across a centralized system. We are now faced with a rapidly surging Delta variant of concern that is driving increases in COVID-19 cases. “Over 90% of counties in the United States are experiencing substantial or high transmission,” according to the Director of the Centers for Disease Control and Prevention (CDC), Rochelle P. Walensky, MD, MPH, in a White House press briefing on August 12, 2021. 

Healthcare is delivered in a hyperlocal fashion to individual patients, one at a time. We no longer need to operate in a reactive mode based on a generalized approach. Precision Health Insight Networks (PHINs) can ensure health care professionals have relevant, real-time data to make the best decisions for each individual patient and the local community. This targeted focus will be especially helpful in our overall approach to the Delta variant surge. 

To provide a precision medicine approach for each patient, healthcare professionals need to consider multiple variables as the Delta surge advances: 

• Is the patient immunocompromised?
• Are there other immunocompromised people in the home?
• Has the patient received one of the mRNA vaccines (Pfizer-BioNTech or Moderna) or the single-dose Johnson & Johnson’s Janssen vaccine? 
• Has the patient received one dose or two?
• What is the patient’s age?
• What are the patient’s underlying health risk factors…COPD, high BMI, diabetes, etc.?
• What is the prevalence of new COVID-19 cases occurring in the patient’s microcommunities?

In 2021, real-time data access is possible, and we need to do a better job educating healthcare professionals on why using this data works. Through PHINs, health systems and health plans will deliver markedly better outcomes while significantly reducing healthcare costs. PHINs bring all of these variables together. 

What is the Delta variant?

The original severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that caused the original COVID-19 pandemic emerged from China in late 2019 and spread worldwide throughout 2020. It is now referred to as the “wild-type” SARS-CoV-2 virus. The Delta variant is a genetic variant of SARS-CoV-2 and is scientifically termed B.1.617.2 (delta) and has caused a surge in COVID-19 cases in different parts of the world throughout 2021. This variant was noted first in India starting in late 2020 and later in the United Kingdom throughout 2021. The Delta variant is now the predominant virus type causing new cases of COVID-19 in the United States. By the end of July, the Delta variant was the cause of more than 80% of new U.S. COVID-19 cases, according to the CDC COVID Data Tracker.

There are distinct differences in both the type and the intensity of symptoms caused by the Delta variant compared to those caused by the wild-type virus. The Delta variant of COVID-19 has more intense symptoms and is much more likely to put the unvaccinated patients in the hospital. 

In June, a Bloomberg report from India cited doctors who were treating Delta-variant COVID patients who had stomach pain, nausea, vomiting, loss of appetite, hearing loss and joint pain. That same month, the Lancet published a study from Scotland that found that the Delta variant showed up mainly in younger, more affluent groups and had double the risk of hospital admission than the previously dominant Alpha variant. 

“It seems like cough and loss of smell are less common. And headache, sore throat, runny nose, and fever are present based on the most recent surveys in the U.K., where more than 90% of the cases are due to the Delta strain,” says pediatric infectious disease specialist and vaccinologist Inci Yildirim, MD, PhD in a Yale Medicine article published in August.

Is the Delta variant more contagious than other strains?

Yes, this is why the CDC has labeled Delta as “a variant of concern” and why the Delta surge in the U.S. is occurring fast and intensely despite 51% of the total U.S. population being fully vaccinated, and 60% being at least partially vaccinated as of August 18, according to the CDC’s COVID Data Tracker.

The World Health Organization (WHO) has called the Delta version of the coronavirus “the fastest and fittest” and indicates Delta is at least 55% more contagious than the original strain.  This means the rate at which unvaccinated people acquire and spread the new Delta variant is rapidly accelerated compared to the spread of the original wild virus. This fact has CDC director Dr. Walensky characterizing the current surge in the U.S. as a “pandemic of the unvaccinated.” 

The rate of contagiousness within pockets of unvaccinated people will be catastrophic. Whether a pocket of people is a geographically defined community, a racial or ethnic group, or an extended family, the lack of vaccination this late summer and fall will put that community at the highest risk for infection, severe disease, hospitalization, ICU transfer, and death that we have seen since the pandemic started in early 2020. 

What should people do to protect themselves from the Delta variant?

• The most important thing a person can do to protect themselves is to get the full series of an FDA Emergency Use Authorized (EUA) COVID-19 vaccine. Research on the effectiveness of the mRNA-based vaccines (Pfizer-BioNTech and Moderna) against infection from the Delta variant appears to be the strongest. All of the widely quoted studies indicate a reduction in the risk of SARS-CoV-2 infection from the Delta variant and the rate of COVID-19 hospitalization if the full vaccinated series is completed (2 shots for the mRNA type vaccines). This great news indicates that FDA-authorized vaccines are working for those who are already vaccinated. And importantly, the approved vaccines will work for those unvaccinated individuals willing to step forward and protect themselves, their families, and those around them by getting vaccinated. Pay attention to the rapidly advancing announcements of CDC recommendations on which patients should get a COVID-19 booster shot. Preliminary announcements were focused on boosters for the immunocompromised, but now all mRNA-vaccinated individuals are advised to get a third booster at 8 months. See daily updates on the CDC COVID-19 web pages for rapidly changing indications lists. 
• Check out your local community’s COVID-19 data to assist you, your family, or your organization in mounting an action plan to defend against the Delta surge. The CV19 Lab Testing Dashboard provides hyperlocal prevalence rates of positive COVID-19 testing and the trend rates of a rise or fall in positive testing from data across the 20,000 lab ordering sites for the dashboard’s coalition partners. .

Reduce the risk of infection from any virus—be it a COVID-19 variant, a cold, measles, or others—by implementing these general measures:

• Wash your hands regularly throughout the day. 
• Wear a secure mask indoors, especially among crowds. The mask will protect you from the virus riding on the larger droplets of exhaled air or mucous of others. However, typically available masks will not entirely protect you from the aerosolized virus that is carried through gaps around the edges of the mask.
• Avoid indoor environments where large numbers of people are close together.  SARS-CoV-2 viruses can circulate in an aerosolized form  via ventilation systems and hang in the indoor air for hours. Your risk exposure is proportionate to: 
  • the length of time in the room
  • the number of people in the room
  • the size of the room
  • the efficiency of the ventilation system to filter out the aerosolized virus particles. 
• Move activities and gatherings outdoors. Fresh air, sun, and winds disperse the virus quickly.

References   

1.  Planas, D., Veyer, D., Baidaliuk, A. et al. Reduced sensitivity of SARS-CoV-2 variant Delta to antibody neutralization. Nature (July7, 2021): https://doi.org/10.1038/s41586-021-03777-9
2. https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html (July 27,2021.)

About the Author

Peter J. Plantes, M.D. has three decades of experience creating service and delivery solutions that enhance marketplace success and clinical performance for clinical practice groups, academic faculty group practices, hospitals, health systems, and health care organizations. His success stems from his ability to blend and synergize clinical knowledge, operational expertise, financial performance, and collaborative methodology with his deep commitment to serve patients and improve the health of the community. Dr. Plantes has served in CEO & Physician Executive roles for a number of large healthcare clinical delivery networks including regional community networks, academic practices, national hospital networks, international health systems (Chile, Colombia),  and corporate managed care/HMO networks.