How to live with the Delta variant, according to disease experts

The Delta variant has largely quashed the coronavirus competition.

Delta, over twice as transmissible as earlier coronavirus strains, is the dominant variant infecting people in the U.S. and dozens of other countries. Those infected with Delta can carry 1,000 times more virus than people infected with the original strain. This makes unvaccinated individuals, who are much more likely to contract the coronavirus, quite good at spreading this insidious microbe.

With so much contagious virus now around, Delta is inevitably infecting more vaccinated people, too. Though, crucially, the vaccines still provide robust protection against severe illness and death, according to the CDC, new peer-reviewed research, and clear evidence from local governments.

Pandemics, fortunately, eventually end. When the populace gains widespread immunity (ideally via safe vaccines) against this virus and infection levels are kept low, COVID shouldn’t be a public health menace anymore. Rather, our bodies will either block many symptoms or we’ll have milder effects akin to cold viruses. We’ll be prepared to fight COVID infections, like we do with four other common coronaviruses. Until then, the unvaccinated among us, with naive immune systems, will be targets for new, and at times severe, Delta infections — or potentially infections from future variants. The virus can more easily flourish, mutate, and evolve in very sick bodies.

“If your shields are down, then your likelihood of getting seriously ill is significantly higher,” explained Dr. Thomas Russo, the chief of infectious disease at the University of Buffalo.

Here’s how to live with the troubling Delta variant, both during the current fourth wave of U.S. infections, and after. For the current surge, adjusting to Delta has similarities and differences depending on whether you’re vaccinated, unvaccinated, or immunocompromised.

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The unvaccinated

Dr. Peter Gulick, a D.O. and professor of medicine at Michigan State University, advises his patients that Delta is a worse virus (because of its amped transmissibility) than the variants circulating a few months ago. It’s everywhere.

“Right now Delta dominates,” Dr. Gulick said. “I try to get them to understand how serious it is.”

An infection brings risks of harsh post-COVID symptoms (difficulty breathing, brain fog, chest pains, and beyond), the potential for an aggressive inflammatory response that can severely damage lungs and other organs (called a “cytokine storm”), and air sacs in the lungs filling with fluid (pneumonia).

The preventative solution is obvious, just as it was for the crippling disease polio and the deadly malady smallpox: vaccines. “You should have a plan to be vaccinated as soon as possible,” said Dr. Russo.

“I don’t think there’s any hiding from this virus.”

For those who choose not to protect themselves (and those around them) against a serious respiratory illness, infectious disease experts emphasize they should be profoundly cautious. This means wearing masks indoors around strangers, avoiding crowds, and also wearing masks in crowded outdoor settings, said Dr. Russo.

It also means thinking hard about the impacts a serious infection has on the doctors and nurses treating the many sick. As Vox expertly reported, responding to extreme COVID outbreaks has resulted in unfortunate and traumatic outcomes for those treating floods of patients, including, tragically, suicide.

Today, with a far more transmissible respiratory virus, it will be hard for the unvaccinated to avoid eventually getting, and possibly spreading, disease.

“I don’t think there’s any hiding from this virus,” said Dr. Russo.

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The vaccinated

For the vaccinated, breakthrough Delta infections aren’t exactly rare. They now account for some 18 to 28 percent of reported cases in early data from six states, according to the New York Times. The FDA-authorized vaccines often provide effective protection against symptoms, yet they’re not 100 percent effective (no vaccine is). So if there’s a lot of virus around, the vaccinated have boosted odds of getting infected, but rarely get terribly sick. Over 95 percent of hospitalizations (in some places 99 percent) are from unvaccinated or not fully vaccinated people.

“In vaccinated individuals, the vaccines will be really protective against the Delta variant, in particular for severe illness, hospitalizations, and death,” said Dr. Russo. “There’s a very small chance you could get severely ill.”

So how should the vaccinated adjust to Delta, particularly during COVID surges?

Weigh the consequences for yourself and others. “All life is risk-benefit decisions,” said Dr. Russo. How cautious or cavalier you want to be is largely up to you.

Dr. Russo recently postponed a trip outside the U.S. — not because he’s worried about falling extremely ill (he’s vaccinated) — but because of the currently boosted odds of getting infected. Even a mild infection could mean miserably quarantining in a room, far away from home. If you’re attending a wedding amid a national outbreak, you may want to be careful about who you visit post-gathering. Generally, you may consider being more careful if you live with vulnerable people or the unvaccinated young.

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The vulnerable or immunocompromised

Not everyone who’s vaccinated has a robust immune response. This leaves certain people — those who must take medicines that suppress the immune system, are receiving cancer treatments, and beyond — more susceptible to disease, particularly during outbreaks.

“You should be cautious,” said Dr. Russo, referencing people in areas with high levels of infection.

This means wearing masks, avoiding crowds, and getting a booster shot (as now recommended by the CDC).

The long game

When will COVID be tamed (meaning largely reduced to infections that cause milder symptoms in the populace)? Predictions are challenging.

“Nobody has a crystal ball,” explained Mark Cameron, an immunologist at Case Western Reserve University who previously helped contain the outbreak of another deadly coronavirus, SARS, in 2003.

Yet the past provides guidance. Cameron cites a coronavirus (CoV-OC43 ) that became a dangerous 19th-century global scourge. “It’s suspected to have caused a two-year pandemic in the late 1800s, killing an estimated 1 million people,” he said. Today, this old coronavirus is still around, but our bodies have protection against it — so no pandemic.

“Nobody has a crystal ball.”

What might this history portend for the latest coronavirus (SARS-CoV-2)? It suggests the virus will eventually be tamed, and then likely be with us for decades as a normal cold-like virus, if not forever. But it doesn’t imply the resulting disease is going to soon transition into a non-menacing, milder, common disease (like most strains of the flu virus) by the end of 2021 (which marks around two years of its existence).

We’re simply not yet sure how this pandemic will play out. “Time is going to tell that,” emphasized Dr. Reynold Panettieri, an M.D. and vice chancellor for translational medicine and science at Rutgers University.

For now, we know the U.S. and world aren’t anywhere near mass-immunity, a reality that results in continued extreme outbreaks: On Aug. 18, the Alabama Hospital Association announced it had no ICU beds available.

We’ll have to continue giving this virus, a devious parasite, a healthy amount of respect. We’ll have to evolve as conditions evolve. You may have to show a vaccination card at music venues. The White House now recommends booster shots for Americans, to address some waning immunity. Regional outbreaks may mean local mandates, like L.A. County requiring masks at big outdoor events. “Sleeves up, masks on, vaccinate-boost, and wait, etc., will be the mantra for quite some time I’m afraid,” said Cameron.

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Fewer hosts, fewer mutants

One thing is certain: Delta will have a difficult time evolving into a worse virus — potentially more transmissible or virulent — if it infects far fewer people.

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Viruses, which replicate by the millions and millions inside infected bodies, constantly mutate. That’s how Delta evolved. We can limit the chance for unfavorable mutations with vaccinations and wise decisions (like masking indoors).

“Fewer hosts mean fewer mutants,” emphasized Dr. Panettieri.