COVID19 update, July 15, 2021: Israel, UK not panicking about delta variant

At present, both the UK and Israel have surging infection rates that (from genome sequencing of samples from confirmed patients) appear to be almost exclusively driven by the delta (formerly “Indian”) variant.

There is no doubt that delta is more contagious than the wild type (“classic COVID”, if you like) or even than the alpha (formerly “British” or “Kent”) variant. Thank G-d, it does not appear to be deadlier.

In fact, in the UK hospitalizations have dropped from over 6% of confirmed cases to less than 2%, and in Israel from 2-4% (depending on the season) to less than 1%. This is likely in large measure an artifact of age distribution: in Israel, over 90% of the population age 50 and over is doubly vaccinated, and over 80% of the 20-49 age bracket. The UK (which uses both the Pfizer mRNA vaccine and the Oxford/AstraZeneca viral vector vaccine) actually leads Israel in percentage of people who got at least one shot, while Israel leads in doubly vaccinated. In both countries, this means that people testing positive now are overwhelmingly very young and unvaccinated, and on account of their age unlikely to develop any complications that require hospitalization. (There is always the rare ‘man bites dog’ exception of a kid without underlying conditions developing severe COVID, but those are news precisely because they are rare and unexpected. Beware of the ‘misleading vividness fallacy’.)

There was considerable fear in the beginning that delta would be an “escape mutation”. As discussed by Stacey Lennox in PJ Media, [Hat tip: Jeff Duntemann.] Israeli data indicate that Pfizer, at least, remains highly effective (over 90%) against severe disease.

According to the Ministry of Health dashboard, we have 5,600 active cases now, but just 54 people hospitalized in severe condition (compared to 1,200 at the peak of the “alpha” wave), and from July 7 to July 14 have seen just 11 (eleven) dead total, out of a cumulative total since the beginning of 6,443.

Some of the dead are unvaccinated people in their forties, but several were elderly patients who had been doubly vaccinated. Now that is less shocking than it may seem: for people in their seventies and up, the vaccination rate is 95% or so, which means that even with a 95% effective vaccine, the absolute number of dead among the vaccinated would be comparable to that among the twenty times smaller unvaccinated group.

In fact, as the head of infectious diseases at [redacted] hospital told me, we saw this also in small numbers during the “alpha” wave: an analysis was just published (peer reviewed, accepted manuscript ahead of publication): Brosh-Nissimov, T.; Orenbuch-Harroch, E.; Chowers, M.; Elbaz, M.; Nesher, L.; Stein, M.; Maor, Y.; Cohen, R.; Hussein, K.; Weinberger, M.; Zimhony, O.; Chazan, B.; Najjar, R.; Zayyad, H.; Rahav, G.; Wiener-Well, Y. BNT162b2 “Vaccine Breakthrough: Clinical Characteristics of 152 Fully-Vaccinated Hospitalized COVID-19 Patients in Israel” Clin. Microbiol. Infect. 2021, EarlyView. https://doi.org/10.1016/j.cmi.2021.06.036

In a nutshell: the article investigates 152 Israeli patients in 17 Israeli hospitals who were hospitalized with COVID despite double vaccination in the period up to 20 April 2021 — about half the total such cases, and to be compared with a cumulative total of over 22,000 unvaccinated severe cases.

Poor outcome was noted in 38 patients and mortality rate reached 22% (34/152). Notable, the cohort was characterized by a high rate of comorbidities predisposing to severe COVID-19, including hypertension (108, 71%), diabetes (73, 48%), C[ongestive] H[eart] F[ailure] (41, 27%), chronic kidney and lung diseases (37, 24% each), dementia (29, 19%), and cancer (36, 24%), and only 6 (4%) had no comorbidities. Sixty (40%) of the patients were immunocompromised.

[emphasis and annotations mine]

Mean age at death was 75±10. Incidentally, all six of the patients without comorbidities survived. Digging deeper into Table 1 of the paper, about a quarter of the immunocompromised were organ transplant recipients, and about half on chemotherapy.

An internal document I have seen rates the probability of another massive hospitalization wave as “low”, and argues that at present there is no need for re-introducing severe restrictions.

Judging from the recent videos by Dr. John Campbell, thinking in the UK healthcare sector is fairly similar, and it appears the July 17 reopening is still on track. Israel too is cautiously taking it easy:

[D]espite the outbreak, ministers decided Tuesday to ease up on restrictions, shortening quarantine to seven days from the current 10-14 days while declining to back a Health Ministry proposal that would have reimposed some limits on gatherings.

Despite that, PM Bennett is telling people that perhaps this isn’t the right time to go on vacation abroad, as “the whole map will turn red anyway”. Predictably, this got him the ire of our travel agencies, which had been on life support all this time and now understandably were hoping they could start recovering some business.

But if I may cautiously state one overall lesson from the UK and Israel grappling with the delta variant, it would be: “the soup isn’t eaten as hot as it is served” (priceless Dutch idiom).

Update: Dr. John Campbell comments on the study