Podcast: New threats from highly contagious delta variant | Washington University School

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This episode of ‘Show Me the Science’ focuses on how a variant of the COVID-19 virus is wreaking havoc in Missouri and around the country and what we can do to slow this new wave of infections

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A new episode of our podcast, “Show Me the Science,” has been posted. At present, these podcast episodes are highlighting research and patient care on the Washington University Medical Campus as our scientists and clinicians confront the COVID-19 pandemic.

As patients infected with the delta variant of the COVID-19 virus fill hospitals in parts of Missouri, and the virus spreads new infections around the country, Washington University data scientists and infectious diseases specialists are urging people to mask up again, regardless of vaccination status. The researchers say that although vaccination remains remarkably effective, masking and other public health practices that slowed the spread prior to the availability of vaccines are necessary again. Clay Dunagan, MD — a professor of medicine, senior vice president and chief clinical officer for BJC HealthCare and a member of the Metropolitan St. Louis Pandemic Task Force — says that as case numbers rise, public health measures have become more important. Dunagan and fellow infectious diseases specialist Hilary M. Babcock, MD, a professor of medicine and medical director of infection prevention and occupational infection prevention for BJC HealthCare, say that even if more people get vaccinated, it will be weeks before they are protected, and during those weeks, people will need to turn back to the practices that protected them before vaccines became available. Meanwhile, Philip R.O. Payne, PhD, the Janet and Bernard Becker Professor and director of the Institute for Informatics, associate dean for health information and data science and the chief data scientist at the School of Medicine, says computer models his team has created continue to predict a rapid increase in infections in St. Louis and in the surrounding area. And he says those models don’t show a peak yet, meaning we could be in the current wave of infections for quite some time.

The podcast, “Show Me the Science,” is produced by the Office of Medical Public Affairs at Washington University School of Medicine in St. Louis.


Transcript

Jim Dryden (host): Hello and welcome to “Show Me the Science,” conversations about science and health with the people of Washington University School of Medicine in St. Louis, Missouri, the Show-Me State. As we continue to detail Washington University’s response to the COVID-19 pandemic, we look in this episode at the return of mask mandates, breakthrough infections and rising hospitalizations linked to the delta variant of the coronavirus.

Clay Dunagan, MD: Cases here are rising exponentially in some new populations. The spread among younger age groups is much higher than it was before. And in a disconcerting way, we’re now seeing the return of this virus in a very active way to underserved areas of the city. Infection rates in African Americans are four to five times what they are among other citizens in St. Louis County, as an example.

Dryden: That’s Dr. Clay Dunagan, an infectious diseases specialist at Washington University School of Medicine and BJC HealthCare’s chief clinical officer, as well as a member of the Metropolitan St. Louis Pandemic Task Force. Dunagan says the rise in cases is very concerning and already has overwhelmed hospitals in other parts of the state of Missouri. And the number of those hospitalized in St. Louis also has been rising rapidly, according to Dr. Hilary Babcock, another infectious diseases specialist at Washington University and the medical director of infection prevention and occupational infection prevention for BJC HealthCare.

Hilary M. Babcock, MD: Clearly, we didn’t reach a vaccination level that was high enough to prevent the spread of this newer variant. And this delta variant is more transmissible and can cause more significant disease. And we’ve seen the impact of that now over the last few months in southwest Missouri. And we’re now starting to see the impact of that here in our community as well.

Dryden: In addition to Babcock, we speak in this episode with Philip Payne, the School of Medicine’s chief data scientist and director of the Institute for Informatics. During the months of the pandemic, Payne and his colleagues have worked with data and computer modeling to track the progress of COVID-19. And Payne says the computer modeling didn’t predict this new wave.

Philip R. O. Payne, PhD: At the very beginning of the pandemic, when we started to build these models and think about, you know, “What should we expect? What does the surge in patients in front of us look like?” we always hypothesized that there were sort of three scenarios. So, one was a relatively sort of low rate of change, and we would have a virus that just sort of simmered in the community. The second was a model where we sort of had this rapid acceleration and a huge peak at the beginning of the pandemic. And the third scenario was basically a series of waves. And as much as we hoped for sort of the low simmer and we feared the rapid acceleration to that gigantic initial peak, we always guessed that the multiple waves was the more rational explanation for what would happen. And we’ve seen three of those waves so far in our models. We’ve been really accurate with those models. And now I think the challenge in front of us is to try to figure out what does it look like next? Because if you look at the models, there is a rapid upward trajectory, and there’s no clear peak. So we will have to change something — either our behavior or the uptake of vaccine or the model — in order to see a peak and a decline. And my money is not on changing the model. My money is on changing the behaviors in the vaccine uptake.

Dryden: One thing that is occurring to me these last few days is a line that’s often quoted, where Michael Corleone says in The Godfather III, “Just when I thought I was out, they pull me back in.” Dr. Babcock, I know that’s not really a question, but I’d like your thoughts.

Babcock: It does definitely feel like we’ve been pulled right back into where we were before, deja vu all over again. So I definitely sympathize with Michael Corleone on that, and maybe only that, point. Definitely, with this surge that we’re seeing now, I don’t think was something certainly that I had predicted. I have a little more optimistic outlook, but clearly we didn’t reach a vaccination level that was high enough, and this delta variant is more transmissible and can cause more significant disease, and we’ve seen the impact of that now over the last few months in southwest Missouri, and we’re now starting to see the impact of that here in our community as well. And I’m hopeful that the slope of the increase will be a little blunted here in our area as our vaccination rates are higher, but the projections of what’s going to happen in our hospitals is scary and is going to put us back very close to where we were before.

Dryden: One of the things that I’ve heard is that in this region, the delta is sort of traveling east along Highway 44, northeast. And I’m really wondering if it’s possible to track movement like that and whether or not that sort of idea is really accurate.

Payne: I think it’s a really interesting question, because, as we were talking about earlier, the behavior of this virus in some ways is predictable but in other ways has exceeded our understanding of how a virus like this would spread in a large population. One of the things that’s always been interesting to me is, as we’ve looked back historically with the data that we had, this virus was probably in our community long before we realized it, potentially all the way back into sort of December or January, before the…

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