In this article five things for pharmacists to know about the COVID Delta variant are discussed.
Authored By: Timothy P. Gauthier, Pharm.D., BCPS, BCIDP
Posted: 25 July 2021
SARS-CoV-2 is the virus that causes the disease called COVID-19. The SARS-CoV-2 virus has several variants in circulation, which are given names by the World Health Organization (details here). The Alpha variant (originally detected in the UK during September 2020 and also called Pango lineage B.1.1.7) once became the predominant variant in the United States, but currently the Delta variant (originally detected in India during October 2020 and also called Pango lineage B.1.617.2) is leading the pack. The Delta variant is a sublineage of B.1.617 and has numerous spike protein mutations.
With the Delta variant having such a profound impact today, I thought it could be good to compose a list of things for pharmacists to know about it. Pharmacists are trusted healthcare professionals who are well-placed to interpret and share accurate information about COVID-19. The goal of this article is to provide information, perspectives, and references about the Delta variant that pharmacists may find helpful.
In this article the SARS-CoV-2 Delta variant will periodically be referred to as the COVID Delta variant for ease of communication, although the appropriate technical term is SARS-CoV-2 Delta variant.
Here are 5 things pharmacists should know about the COVID Delta variant…
1. The COVID Delta variant is the predominant variant in all regions of the United States right now
This is a snapshot of NOWcast provided by CDC, which uses weighted estimates of data they have received, to predict current proportions of variants across the country.
- Dark orange = Delta variant
- Orange = Gamma variant
- Light orange = Alpha variant
- Dark blue = “other” variants
Image source: taken 24 July 2021 from this CDC.gov webpage
As you can see, the Delta variant is not only everywhere in the United States right now, it is also the predominant variant in all regions at well over half of each pie chart.
2. The COVID Delta variant can produce higher viral loads early on in the course
Researchers have found that compared to earlier variants, the COVID Delta variant produces viral loads that are around 1,000 times higher on the day when the virus is first detected. You care read the full data on this here.
Higher viral loads early in the infection’s course can mean more opportunity for transmission, which is likely a driving factor with the success of the Delta variant in out-competing other variants. Since viral replication begins to occur before symptom onset, a takeaway for me is to continue wearing my mask even if I do not have to. If I was to catch the COVID Delta variant, I would hate to potentially unknowingly spread it to others. Masks are not very comfortable and CDC guidance allows for fully vaccinated individuals like myself to relax masking a bit, but I would rather be safe for now and mask-up to protect other people while the Delta variant surges in my area.
3. Full vaccination and practicing infection prevention measures are the best defense against the COVID Delta variant
Just this last week the New England Journal of Medicine published an analysis (available here) looking at the effectiveness of the Pfizer/BioNTech (BNT162b2) and AstraZeneca (ChAdOx1 nCOV-19) COVID-19 vaccines against the COVID Delta variant. The investigators found only a modest difference in vaccine effectiveness with the Delta variant as compared to the Alpha variant, with overall good protection being conferred by vaccination. They also found that the protection was considerably better in individuals fully vaccinated (i.e., 2 doses given) with Pfizer/BioNTech as compared to partially vaccinated people (i.e., only 1 dose given). The big take home data point for me was that the Pfizer/BioNTech vaccine was 88% effective against symptomatic disease caused by the Delta variant for fully vaccinated individuals.
I anticipate that the findings with the Pfizer/BioNTech mRNA COVID vaccine will most likely be consistent with what would be found in an investigation of the Moderna mRNA COVID vaccine. I also expect the J&J COVID-19 vaccine will confer a reasonable degree of protection against the COVID Delta variant. This notion on Moderna and J&J providing protection against the COVID Delta variant is supported by a July 16th White House statement (available here) during which it was stated that this is becoming a pandemic of the unvaccinated.
While it goes without saying that pharmacists can promote COVID-19 vaccines to fight back against COVID, we can also further reduce the risk of transmission by promoting infection control measures such as social distancing, hand hygiene, and masking. Since even vaccinated people can catch the COVID Delta variant, everyone should be mindful to observe reasonable spread mitigation strategies. The CDC provides a webpage on infection control guidance for healthcare professionals about coronavirus here.
4. Monoclonal antibodies from Regeneron and GlaxoSmithKline are effective against the COVID Delta variant
There are currently 3 monoclonal antibodies for COVID-19 under FDA Emergency Use Authorization (EUA). They are casirivimab/imdevimab (brand name REGEN-COV, from Regeneron), sotrovimab (from GlaxoSmithKline), and bamlanivimab/etesevimab (from Eli Lilly). The Fact Sheets for healthcare providers currently indicate that casirivimab/imdevimab and sotrovimab retain activity against the COVID Delta variant. The Fact Sheet for Healthcare Providers for bamlanivimab/etesevimab currently posted to Eli Lilly’s website does not mention the COVID Delta variant, however there are data suggesting it would be effective (see here, thank you Dr. Pogue!)
Current CDC guidance (available here) states that: “for people who have received one or more doses of COVID-19 vaccine and subsequently experience COVID-19, prior receipt of a COVID-19 vaccine should not affect treatment decisions (including use of monoclonal antibodies, convalescent plasma, antiviral treatment, or corticosteroid administration) or timing of such treatments.”
As vaccinated and unvaccinated people get COVID-19, pharmacists may be able to help increase awareness for monoclonal antibodies as potential therapies. Take note that under current FDA EUA criteria, to qualify for one of these products the patient must have a direct SARS-CoV-2 test (i.e., PCR or antigen), mild-moderate COVID-19, be within 10 days of symptom onset (the sooner the better), and have received the Patient Fact Sheet with agreement to proceed with treatment. There are numerous other clinical considerations not listed here that have to do with these therapies. You can read about them in detail in the respective Fact Sheets for Healthcare Providers:
- Casirivimab/imdevimab Fact Sheet for Healthcare Providers
- Sotrovimab Fact Sheet for Healthcare Providers
- Bamlanivimab/etesevimab Fact Sheet for Healthcare Providers
5. This is unlikely to be the last COVID variant we have to face
Pharmacists can both help to discuss how to manage the challenges of today and also support readiness for the challenges of tomorrow. The Eta, Iota, Kappa, and Lambda variants of interest are sure to make their way into news headlines and generate questions over the coming weeks. There are also 13 other variants that have not been named, but are listed on the SARS-CoV-2 Variants WHO website for further monitoring.
The Alpha variant came, became the predominant variant in circulation, and was over-taken by the Delta variant. If we are not able to stop the continued spread of COVID, it is reasonable to prepare to combat all the issues that will come with future variants. One source of information I have found helpful for tracking all of this is the weekly Public Health England updates that are posted here. There is also a CDC hub webpage for all things COVID variants which may be helpful, here.
Closing Comments
Much to my dismay, it appears that the SARS-CoV-2 pandemic is not going away any time soon. As things evolve, we will need to continue to do what we can to fight back and react to the most current data available. For example, we now know that vaccination can provide a high degree of protection against COVID-19, so will all healthcare providers be required to become vaccinated as a condition of employment? Numerous major organizations now endorse this, including SIDP, IDSA, SHEA, APIC, HIVMA, PIDS, AMDA, and AHA. This is in the face of a first COVID vaccine FDA approval not expected until January 2022.
- Multisociety Statement on COVID-19 Vaccination as a Condition of Employment for Healthcare Personnel
- American Hospital Association Policy Statement on Mandatory COVID-19 Vaccination of Health Care Personnel Approved by the Board of Trustees July 21, 2021
Another data point of interest is the age of persons infected with SARS-CoV-2 who become hospitalized. In the image below it is clear that the demographics are changing. Individuals 18-49 years of age now making up a considerable portion of hospitalized patients. We should keep this in mind as we discuss COVID-19 with others, promote vaccination, and encourage infection prevention measures.
Image source: taken 25 July 2021 from this CDC.gov webpage
The Olympic Games may have just kicked off in Tokyo, but the COVID variant olympics has been an ongoing for many months. Right now the Delta variant is out-pacing the pack, but what will come next? Time will certainly tell, but for now I hope this article has been somewhat helpful.
Disclaimer: The views and opinions expressed in this article are that of the author and do not necearilly reflect those of any past, current, or potential future employer.
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