This is a very recent update (08/19/21) from Yale Medicine and useful pointers on communicating with people on the Covid-19 Virus

1. The predominant COVID-19 strain has put the focus back on prevention
2. 3 Common COVID Vaccination Objections & How to Debunk Them: Prof Emma Frances Bloomfield, a UNLV communication studies professor who specializes in strategies for countering misinformation about science
3. How to talk to someone you believe is misinformed the Corona Virus: Prof Emma Frances Bloomfield

Velandy Manohar, MD.,

Distinguished Life Fellow, Am. Psychiatric Assoc.

Medical Director-CT Aware Recovery Care

 

I.

5 Things To Know About the Delta Variant > News > Yale Medicine

 

The predominant COVID-19 strain has put the focus back on prevention

[We are on the right Track, with vaccination, Masking, and other Infection control measures at Aware Recovery Care. VM]

[Originally published: June 28, 2021. Updated: August 18, 2021.]

Even as people began to feel some hope—or at least cautious optimism—early this summer that the pandemic could recede to the background, there was still the threat that new mutations of the COVID-19 virus could bring it back, and it might be even stronger.

A major worry right now is Delta, a highly contagious SARS-CoV-2 virus strain, which was first identified in India in December. It swept rapidly through that country and Great Britain before reaching the U.S., where it is now the predominant variant. 

The Centers for Disease Control and Prevention (CDC) described Delta as more transmissible than the common cold and influenza, as well as the viruses that cause smallpox, MERS, SARS, and Ebola—and called it as contagious as chickenpox in an internal document, a copy of which was obtained by and reported on in The New York Times. The highest spread of cases and severe outcomes is happening in places with low vaccination rates, and virtually all hospitalizations and deaths have been among the unvaccinated, the CDC says. But the CDC released data in July that showed vaccinated people also can transmit Delta, which officials did not believe to be the case with other variants, and which led the agency to make a prompt revision to its masking guidelines.

Inci Yildirim, MD, PhD, a Yale Medicine pediatric infectious diseases specialist and a vaccinologist, isn’t surprised by what’s happening. “All viruses evolve over time and undergo changes as they spread and replicate,” she says. 

From what we know so far, people who are fully vaccinated against the coronavirus continue to have strong protection against COVID-19 compared to those who aren’t. But anyone who is unvaccinated and not practicing preventive strategies is at high risk for infection by the new variant, doctors say.

Here are five things you need to know about the Delta variant.

1.Delta is more contagious than the other virus strains.

One thing that is unique about Delta is how quickly it is spreading, says F. Perry Wilson, MD, a Yale Medicine epidemiologist. Around the world, he says, “Delta will certainly accelerate the pandemic.” The first Delta case was identified in December 2020, and the variant soon became the predominant strain of the virus in both India and then Great Britain. By the end of July, Delta was the cause of more than 80% of new U.S. COVID-19 cases, according to CDC estimates.

The July CDC report on Delta's transmissibility came after an outbreak that occurred in Provincetown, Mass., after a crowded July 4 weekend, which quickly turned into a cluster of at least 470 cases. While the number of reported breakthrough cases in general has been very low in the U.S., three quarters of those infected in Provincetown were people who had been immunized. According to the CDC, even people with “breakthrough cases” carry tremendous amounts of virus in their nose and throat, and, according to preliminary reports, can spread the virus to others whether or not they have symptoms.

The CDC has labeled Delta “a variant of concern,” using a designation also given to the Alpha strain that first appeared in Great Britain, the Beta strain that first surfaced in South Africa, and the Gamma strain identified in Brazil. (The new naming conventions for the variants were established by the WHO as an alternative to numerical names.)

“It’s actually quite dramatic how the growth rate will change,” says Dr. Wilson, commenting on Delta's spread in the U.S. in June. Delta was spreading 50% faster than Alpha, which was 50% more contagious than the original strain of SARS-CoV-2, he says. “In a completely unmitigated environment—where no one is vaccinated or wearing masks—it’s estimated that the average person infected with the original coronavirus strain will infect 2.5 other people,” Dr. Wilson says. “In the same environment, Delta would spread from one person to maybe 3.5 or 4 other people.”

“Because of the math, it grows exponentially and more quickly,” he says. “So, what seems like a fairly modest rate of infectivity can cause a virus to dominate very quickly.” 

2. Unvaccinated people are at risk.

People who have not been fully vaccinated against COVID-19 are most at risk. 

In the U.S., there is a disproportionate number of unvaccinated people in Southern and Appalachian states including Alabama, Arkansas, Georgia, Mississippi, Missouri, and West Virginia, where vaccination rates are low. (In some of these states, the number of cases is on the rise even as some other states are lifting restrictions because their cases are going down).

Kids and young people are a concern as well. “A recent study from the United Kingdom showed that children and adults under 50 were 2.5 times more likely to become infected with Delta,” says Dr. Yildirim. And so far, no vaccine has been approved for children 5 to 12 in the U.S., although the U.S. and a number of other countries have either authorized vaccines for adolescents and young children or are considering them.

“As older age groups get vaccinated, those who are younger and unvaccinated will be at higher risk of getting COVID-19 with any variant,” says Dr. Yildirim.  “But Delta seems to be impacting younger age groups more than previous variants.”

3. Delta could lead to 'hyperlocal outbreaks.'

If Delta continues to move fast enough to accelerate the pandemic, Dr. Wilson says the biggest questions will be about the heightened transmissibility—how many people will get the Delta variant and how fast will it spread?

The answers could depend, in part, on where you live—and how many people in your location are vaccinated, he says. “I call it ‘patchwork vaccination,’ where you have these pockets that are highly vaccinated that are adjacent to places that have 20% vaccination,” Dr. Wilson says. “The problem is that this allows the virus to hop, skip, and jump from one poorly vaccinated area to another.”

In some cases, a low-vaccination town that is surrounded by high vaccination areas could end up with the virus contained within its borders, and the result could be “hyperlocal outbreaks,” he says. “Then, the pandemic could look different than what we’ve seen before, where there are real hotspots around the country.”

Some experts say the U.S. is in a good position because of its relatively high vaccination rates—or that conquering Delta will take a race between vaccination rates and the variant. But if Delta keeps moving fast, multiplying infections in the U.S. could steepen an upward COVID-19 curve, Dr. Wilson says.  

So, instead of a three- or four-year pandemic that peters out once enough people are vaccinated, an uptick in cases would be compressed into a shorter period of time. “That sounds almost like a good thing,” Dr. Wilson says. “It’s not.” If too many people are infected at once in a particular area, the local health care system will become overwhelmed, and more people will die, he says. While that might be less likely to happen in the U.S., it will be the case in other parts of the world, he adds. “That’s something we have to worry about a lot.”

4. There is still more to learn about Delta.

One important question is whether the Delta strain will make you sicker than the original virus. But many scientists say they don’t know yet. Early information about the severity of Delta included a study from Scotland that showed the Delta variant was about twice as likely as Alpha to result in hospitalization in unvaccinated individuals, but other data has shown no significant difference.

Another question focuses on how Delta affects the body. There have been reports of symptoms that are different than those associated with the original coronavirus strain, Dr. Yildirim says. “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,” she says.

Experts are starting to learn more about Delta and breakthrough cases. A Public Health England analysis (in a preprint that has not yet been peer-reviewed) showed at least two vaccines to be effective against Delta. The Pfizer-BioNTech vaccine was 88% effective against symptomatic disease and 96% effective against hospitalization from Delta in the studies, while Oxford-AstraZeneca (which is not an mRNA vaccine) was 60% effective against symptomatic disease and 93% effective against hospitalization. The studies tracked participants who were fully vaccinated with both recommended doses.

Moderna also reported on studies (not yet peer-reviewed) that showed its vaccine to be effective against Delta and several other mutations (researchers noted only a “modest reduction in neutralizing titers” against Delta when compared to its effectiveness against the original virus). 

“So, your risk is significantly lower than someone who has not been vaccinated and you are safer than you were before you got your vaccines,” Dr. Yildirim says.

But in August, the Biden administration recommended that Americans who received the mRNA vaccines get a booster shot eight months after their second dose. While there still needs to be an FDA determination that boosters will be safe and effective, officials recommended them as soon as September 20. They based their advisory on the spread of Delta and three recent studies from the CDC that suggested vaccine protection against infection is waning. In one of those studies, data from the state of New York showed vaccine effectiveness dropping from 91.7 to 79.8% against infection, although the vaccine continued to protect against hospitalization.

Johnson & Johnson also has reported that its vaccine is effective against Delta, but one recent study, which has not yet been peer-reviewed or published in a scientific journal, suggests that its vaccine may be less effective against the variant, which has prompted discussion over whether J&J recipients might also need a booster. But the first study to assess the Johnson & Johnson vaccine against Delta in the real world reported an efficacy of up to 71% against hospitalization and up to 95% against death. The vaccine’s performance was slightly lower against the Beta variant in the study. This preliminary research was reported in August at a news conference by the Ministry of Health in South Africa, and has not yet been published or peer-reviewed.

There are additional questions and concerns about Delta, including Delta Plus—a subvariant of Delta, that has been found in the U.S., the U.K., and other countries. “Delta Plus has one additional mutation to what the Delta variant has,” says Dr. Yildirim. This mutation, called K417N, affects the spike protein that the virus needs to infect cells, and that is the main target for the mRNA and other vaccines, she says.

“Delta Plus has been reported first in India, but the type of mutation was reported in variants such as Beta that emerged earlier. More data is needed to determine the actual rate of spread and impact of this new variant on disease burden and outcome,” Dr. Yildirim adds.

5. Vaccination is the best protection against Delta.

The most important thing you can do to protect yourself from Delta is to get fully vaccinated, the doctors say. At this point, that means if you get a two-dose vaccine like Pfizer or Moderna, for example, you must get both shots and then wait the recommended two-week period for those shots to take full effect. Whether or not you are vaccinated, it’s also important to follow CDC prevention guidelines that are available for vaccinated and unvaccinated people.

“Like everything in life, this is an ongoing risk assessment,” says Dr. Yildirim. “If it is sunny and you’ll be outdoors, you put on sunscreen. If you are in a crowded gathering, potentially with unvaccinated people, you put your mask on and keep social distancing. If you are unvaccinated and eligible for the vaccine, the best thing you can do is to get vaccinated.”

Face masks can provide additional protection and the WHO has encouraged mask-wearing even among vaccinated people. The CDC updated its guidance in July to recommend that both vaccinated and unvaccinated individuals wear masks in public indoor settings in areas of high transmission to help prevent Delta’s spread and to protect others, especially those who are immuno-compromised, unvaccinated, or at risk for severe disease. The agency is also recommending universal indoor masking for all teachers, staff, students, and visitors to K-12 schools.

Of course, there are many people who cannot get the vaccine because their doctor has advised them against it for health reasons or because personal logistics or difficulties have created roadblocks—or they may choose not to get it. Will the Delta variant be enough to encourage those who can get vaccinated to do so? No one knows for sure, but it’s possible, says Dr. Wilson, who encourages anyone who has questions about vaccination to talk to their family doctor.

“When there are local outbreaks, vaccine rates go up,” Dr. Wilson says. “We know that if someone you know gets really sick and goes to the hospital, it can change your risk calculus a little bit. That could start happening more. I’m hopeful we see vaccine rates go up.”

Yale Medicine News

II.

3 Common COVID Vaccination Objections & How to Debunk Them (newswise.com)

3 Common COVID Vaccination Objections & How to Debunk Them

And what to share with those who keep using them.

17-Aug-2021 12:45 PM EDT, by University of Nevada, Las Vegas (UNLV)

The following is an essay by Emma Frances Bloomfield, a UNLV communication studies professor who specializes in strategies for countering misinformation about science. 

A year ago, the misinformation about coronavirus focused on it being an elaborate hoax, rather than a global health crisis. While more and more people now accept that it is a threat, they don’t necessarily accept that vaccines are our best way to counter it.

And sadly, our hospital ICUs are filled with people who have not been vaccinated.

As a researcher interested in science communication and controversies, I study how scientific misinformation spreads and how to correct it.

If you’re faced with a vaccine-resistant friend, first decide if it’s worth your time and energy to correct their misinformation. Sometimes we interact with people who are closed-minded and not willing to listen. You are not obligated to engage them.

However, if your friend is open to learning more, encourage that continued curiosity. Grant them some grace. No matter the topic, people often hear conflicting information and must decide which sources to trust.

Those arguing a point with misinformation often turn to nonscientific sources and blog posts to make their case. Instead of flat-out rejecting those resources, I offer to trade with them. For example, I ask them to share an article with me and I review it. In return, I’ll send an article from the Centers for Disease Control for medical and health information or link to the reputable debunking site Snopes to compare the information. The CDC’s frequently asked questions about the virus is an especially good source.

Here are the three most common, but misinformed, reasons people use to not get their COVID-19 vaccine and how I respond to them.

1.Some people believe that natural immunity is just as good as vaccine immunity.

If they already tested positive for coronavirus, they don’t believe they need the vaccine. Or they assume that because they’re a generally healthy person, they’ll recover easily should they become infected.

As one person I talked to put it, "If I need to hold my pants up, I can use a belt (natural immunity) or suspenders (vaccine), but I don't need both." And they prefer a belt, apparently.

Research does show that natural immunity is good and seems to protect a good amount of people. But, wearing pants pales in comparison to the seriousness of contracting COVID-19. While many people have no symptoms or only mild symptoms, a lot of people experience long-term, serious issues, and even death. The seemingly low death rates hide the chronic, painful issues of COVID "long-haulers," who still have difficulty breathing and may have lost their sense of smell/taste for months after recovering from the disease.

Moreover, natural immunity protection is mostly limited to the same strain, not mutations or variants. On the other hand, vaccine immunity has been shown to be effective against mutations of the virus. This is due to the way the mRNA teaches the body to respond to the crown/spike protein shape of the coronavirus.

Additionally, there is preliminary evidence that reinfection with COVID-19 can be much more serious and life-threatening than the original infection, making increased immunity from a vaccine perhaps even more important for those who have already contracted it and recovered. 

Because individual bodies are different and it's impossible to know which strain you will pick up (a weak one or a serious one), catching COVID-19 is not a safe strategy but getting the vaccine confers similar (and even stronger) immunity. And if you have been infected with COVID-19, getting the vaccine confers extra immunity.

Instead of holding up pants, I would use the metaphor of safe driving: It's good safety practice to wear a seat belt and to use turn signals. Each individually can make your drive safer. Both together is even better.

This is a pervasive and convincing argument. Who wants to take something that is untested? Correcting this requires a better understanding of emergency use authorization (EUA) and the extensive resources that went into developing the vaccines.

Even under an EUA, no vaccines are approved for production and distribution unless they have been tested in multiple clinical trials of increasing numbers. Although the vaccines were developed quickly, they went through full clinical trials where tens of thousands of people were monitored for adverse effects.

In addition, the mRNA within the vaccine "breaks down and is flushed out of your system within hours," so monitoring past a few months is not necessary to identify and measure reactions. Think about taking Advil: It also doesn’t stay in your system long, so any negative reactions are likely to happen immediately.

The EUA required two months of safety tests for the vaccines after they were developed and before they were approved. And now we have nearly a year of tests of millions of people worldwide who have taken the vaccines. 

Operation "Warp Speed" is admittedly, a poor name. The speed of the vaccine development should not be thought of as "rushing" or "skipping steps" or "cutting corners." Instead, the speed should be associated with "prioritization." 

Consider that labs all over the world shifted their full attention to developing this vaccine - the urgency and severity of it garnered unique and unparalleled focus, time, and funds. Resources directed elsewhere were re-routed to studying COVID.

If you have to reorganize a bookshelf, you may touch up a shelf at a time at your leisure between work and childcare and other responsibilities. Alternatively, if I cleared your schedule and gave you $100 to do it, what would have taken a week would perhaps take a few hours. 

This prioritization (coupled with ongoing research in mRNA technology) made the vaccine available while still going through proper protocols faster than we typically think of vaccine development.

2.The vaccine is "experimental" and not proven scientifically.

This is a pervasive and convincing argument. Who wants to take something that is untested? Correcting this requires a better understanding of emergency use authorization (EUA) and the extensive resources that went into developing the vaccines.

Even under an EUA, no vaccines are approved for production and distribution unless they have been tested in multiple clinical trials of increasing numbers. Although the vaccines were developed quickly, they went through full clinical trials where tens of thousands of people were monitored for adverse effects.

In addition, the mRNA within the vaccine "breaks down and is flushed out of your system within hours," so monitoring past a few months is not necessary to identify and measure reactions. Think about taking Advil: It also doesn’t stay in your system long, so any negative reactions are likely to happen immediately.

The EUA required two months of safety tests for the vaccines after they were developed and before they were approved. And now we have nearly a year of tests of millions of people worldwide who have taken the vaccines. 

Operation "Warp Speed" is admittedly, a poor name. The speed of the vaccine development should not be thought of as "rushing" or "skipping steps" or "cutting corners." Instead, the speed should be associated with "prioritization." 

Consider that labs all over the world shifted their full attention to developing this vaccine - the urgency and severity of it garnered unique and unparalleled focus, time, and funds. Resources directed elsewhere were re-routed to studying COVID.

If you have to reorganize a bookshelf, you may touch up a shelf at a time at your leisure between work and childcare and other responsibilities. Alternatively, if I cleared your schedule and gave you $100 to do it, what would have taken a week would perhaps take a few hours. 

This prioritization (coupled with ongoing research in mRNA technology) made the vaccine available while still going through proper protocols faster than we typically think of vaccine development.

3.Some people believe that the vaccine will have serious side effects.

Serious side effects of the vaccine are exceedingly rare. There are people who have died after taking the vaccine, but there is no causal link established between vaccination and dying. In other words, simply because something happens prior to something else, without evidence that one caused the other, you are mistaking correlation for causation. 

It is important to note that some people do experience mild/moderate reactions to the vaccine, but they tend to fade after a few days. These effects are much less disruptive and harmful than contracting COVID-19 itself. Getting the vaccine is thus a minor risk (and one that can be discussed with your personal doctor for a more tailored diagnosis) compared to the potential risks of COVID-19.

As two examples of side effects, some are concerned about the vaccine's effects on DNA and on fertility. While the vaccine does use mRNA, it does not affect any systems in the body besides our immune system and white blood cells, so does not interact with cell nuclei (where DNA is kept) or reproductive systems.

Indeed, current guidelines recommend pregnant women get vaccinated so as to pass antibodies onto children who are not currently approved to get the vaccine themselves. It’s also important to note that pregnant women may be more susceptible to COVID-19 side effects, so getting the vaccine protects both them and their child.

More guidance on countering misinformation

Read Emma Frances Bloomfield’s “How to Talk to Someone Who’s Misinformed about Coronavirus.

III

How to talk to someone you believe is misinformed about the coronavirus (theconversation.com)

How to talk to someone you believe is misinformed the Corona Virus.[March 17, 2020,  8:11 AM

The medical evidence is clear: The coronavirus global health threat is not an elaborate hoax. Bill Gates did not create the coronavirus to sell more vaccines. Essential oils are not effective at protecting you from coronavirus.

But those facts have not stopped contrary claims from spreading both on and offline.

No matter the topic, people often hear conflicting information and must decide which sources to trust. The internet and the fast-paced news environment mean that information travels quickly, leaving little time for fact-checking.

As a researcher interested in science communication and controversies, I study how scientific misinformation spreads and how to correct it.

Unbiased. Nonpartisan. Factual. This has been my aspirational goal to try to remain Unbiased, Nonpartisan and Factual in my correspondence and dialogues on this Public Health Crisis caused by COVID-19 Virus. [SARS Covid-2  especially the Delta variant

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I’ve been very busy lately. Whether we are talking about the coronavirus, climate change, vaccines, or something else, misinformation abounds. Maybe you have shared something on Facebook that turned out to be false or retweeted something before double-checking the source. This can happen to anyone.

It’s also common to encounter people who are misinformed but don’t know it yet. It’s one thing to double-check your own information, but what’s the best way to talk to someone else about what they think is true – but which is not true?

a.

Is it worth engaging? [If so, engage in a convivial conversation with the eyes at the same level and maintain eye contact.VM]

First, consider the context of the situation. Is there enough time to engage them in a conversation? Do they seem interested in and open to discussion? Do you have a personal connection with them where they value your opinion?

Evaluating the situation can help you decide whether you want to start a conversation to correct their misinformation. Sometimes we interact with people who are closed-minded and not willing to listen. It’s OK not to engage with them.

In interpersonal interactions, correcting misinformation can be helped by the strength of the relationship. For example, it may be easier to correct misinformation held by a family member or partner because they are already aware that you care for them, and you are interested in their well-being.

b.

Don’t patronize [[Never adopt a pointing finger in a conversation about this serious threat to our lives to make a point. VM]

One approach is to engage in a back-and-forth discussion about the topic. This is often called a dialogue approach to communication.

That means you care about the person behind the opinion, even when you disagree. It is important not to enter conversations with a patronizing attitude. For example, when talking to climate change skeptics, the attitude that the speaker holds toward an audience affects the success of the interaction and can lead to conversations ending before they’ve started.

Instead of treating the conversation as a corrective lecture, treat the other person as an equal partner in the discussion. One way to create that common bond is to acknowledge the shared struggles of locating accurate information. Saying that there is a lot of information circulating can help someone feel comfortable changing their opinion and accepting new information, instead of resisting and sticking to their previous beliefs to avoid admitting they were wrong.

Part of creating dialogue is asking questions. For example, if someone says that they heard coronavirus was all a hoax, you might ask, “That’s not something I’d heard before, what was the source for that?” By being interested in their opinion and not rejecting it out of hand, you open the door for conversation about the information and can engage them in evaluating it.

c.

Offer to trade information.[Share information by accessing the information relevant to the conversation especially informative graphics. I wouldn’t use books I would use links and graphics to prepare the framework for taking in all the information that is regarded as important to be addressed for the discussants at the outset. VM]

Another strategy is to introduce the person to new sources. In my book, I discuss a conversation I had with a climate skeptic who did not believe that scientists had reached a 97% consensus on the existence of climate change. They dismissed this well-established number by referring to nonscientific sources and blog posts. Instead of rejecting their resources, I offered to trade with them. For each of their sources I read, they would read one of mine.

It is likely that the misinformation people have received is not coming from a credible source, so you can propose an alternative. For example, you could offer to send them an article from the Centers for Disease Control for medical and health information, the Intergovernmental Panel on Climate Change for environmental information, or the reputable debunking site Snopes to compare the information. If someone you are talking to is open to learning more, encourage that continued curiosity.

It is sometimes hard, inconvenient, or awkward to engage someone who is misinformed. But I feel very strongly that opening we up to have these conversations can help to correct misinformation. To ensure that society can make the best decisions about important topics, share accurate information, and combat the spread of misinformation.

Velandy Manohar, MD.,

Distinguished Life Fellow- Am. Psychiatric Assoc.

Med. Director- CT- Aware Recovery Care