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Indian Delta Variant - the most dangerous so far

At 15/May/2021, the clear dominant variant in Europe and USA is the UK variant, simply because until now, it has been the most transmissible variant to this point. But the evidence is pointing to the Indian variant being more transmissible. And over the last week (to 15/5/21), the WHO (World Health Organisation) declare the Indian variant a global variant of concern. Why?

  • The WHO is now convinced that the Indian variant has a significant increased transmissibility. And part of the evidence I am sure they are looking for that is what I have provided you below. It looks like the Indian variant is now the MOST TRANSMISSIBLE of all major COVID variants - including the dominant variant in USA and Europe, the UK variant.

  • Add to that, that the Indian variant has 2 genetic mutations that provide "antibody neutralization" capability. i.e. vaccines are likely to be less effective against it.

  • Combining these feature, you have the picture of this Indian COVID variant that could easily be:

    • the most dangerous COVID variant so far AND

    • it may well become the globally dominant variant over coming months.

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Anne de Gheest's 30/Apr/21 update showed how quickly the Indian variant dominated in India, which is currently experiencing an absolutely massive pandemic that has massively overwhelmed their hospital system. Anne de Gheest's slide below

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As you can see from the above slide, in the Indian pandemic, the Indian variant was competing with the UK variant, and the Indian variant clearly won - so that should send a loud warning message to the world.

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More recent updates:

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https://en.wikipedia.org/wiki/Lineage_B.1.617    at 15/May/21

  • "Double mutation" refers to B.1.617's mutations in the gene encoding the SARS-CoV-2 spike protein causing the substitutions E484Q and L452R   dd 

    • "E484Q may enhance ACE2 receptor binding ability and may reduce vaccine-stimulated antibodies from attaching to this altered spike protein"

    • "L452R is a relevant mutation in this strain that enhances ACE2 receptor binding ability and can reduce vaccine-stimulated antibodies from attaching to this altered spike protein."

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The rise of the Indian variant  23/May/21  https://twitter.com/EricTopol/status/1396496192394063876  

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Pfizer and AstraZeneca ‘highly effective’ against India Covid variant  23/May/21

  • https://www.theguardian.com/world/2021/may/22/pfizer-and-astrazeneca-highly-effective-against-india-covid-variant 

  • Both the Pfizer and AstraZeneca jabs are highly effective at protecting people from the strain of the Covid-19 virus first found in India, a study by Public Health England (PHE) has found.

  • The analysis, carried out between 5 April and 16 May, found the Pfizer vaccine was 88% effective against symptomatic disease from the India variant two weeks after a second dose, compared with 93% effectiveness against the Kent strain. For its part, the AstraZeneca jab was 60% effective, compared with 66% against the Kent variant over the same period.

  • The difference in effectiveness between the two vaccines could be due to the rollout of second AstraZeneca doses taking place later than those for the Pfizer jab, PHE said on Saturday. Data suggests that it takes longer for the AstraZeneca jab to reach maximum effectiveness, so the protection it provides could increase further.

  • “This study provides reassurance that two doses of either vaccine offer high levels of protection against symptomatic disease from the B.1.617.2 [India] variant and we expect the vaccines to be even more effective at preventing hospitalisation and death,” said Mary Ramsay, head of immunisation at PHE.

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Eric Topol 28/May/21 "The UK cases were down to pandemic lows until B.1.617.2 hit. This variant has the potential to do the same here (in USA) and many other countries as it becomes dominant. Log plot to show directionality."

UK_and_Indian_variant_210529.jpg

Eric Topol 28/May/21  "The B.1.617.2 variant has now become dominant in the UK, associated with rising hospital admissions. It's also starting to rise in the US. While vaccinations protect against it, the 1st dose has only ~30% efficacy. See @jburnmurdoch 's new https://twitter.com/jburnmurdoch/status/1397995388267810818"  

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The charts above show how quickly the Indian variant can become a major problem. Twice as transmissible as the previously globally dominant UK variant.

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This is what the Indian variant in doing in Japan (in dark green, UK variant in dark brown), threatening many Japanese hospitals with being overwhelmed. 29/May/21   https://covariants.org/per-country 

Japanese COVID_variants_210529.PNG

29/May/21 And this is what Indian variant is causing in Taiwan, which until now has had a truly excellent track record in managing COVID.   This just shows the risk of a CBD quarantine station outbreak of Indian COVID variant is to Australia now.  The is a very real risk that the current outbreak/lock-down in Victoria might become an Australia-wide pandemic.  https://www.worldometers.info/coronavirus/country/taiwan/

Taiwan COVID_infections_210529.PNG

What’s the ‘Indian’ variant responsible for Victoria’s outbreak and how effective are vaccines against it?  27/May/21

Vaccine effectiveness against Indian var

  • https://twitter.com/EricTopol/status/1398298896850243584

    • https://www.nytimes.com/2021/05/28/opinion/covid-vaccine-variants.html

      • “Covid’s Deadliest Phase May Be Here Soon”  May 28, 2021

        • By Zeynep Tufekci  Dr. Tufekci is a contributing Opinion writer who has extensively examined the Covid-19 pandemic. 

        • “If world leaders don’t act now, the end of the Covid pandemic may come with a horrible form of herd immunity, as more transmissible variants that are taking hold around the world kill millions. There’s troubling new evidence that the B.1.617.2 variant, first identified in India, could be far more transmissible than even the B.1.1.7 variant, first identified in Britain, which contributed to some of the deadliest surges around the world. In countries with widespread vaccination, like the United States and Britain, we can expect that Covid cases, hospitalizations and deaths will continue to decline or stay low, especially because lab tests and real world experience show that vaccines appear to defend recipients well against the severe effects of both variants. For much of the rest of the world, though, this even more transmissible new variant could be catastrophic.”

    • BB comment: Given that at 30/May/21, Australia was ranked a lowly 77th in the world https://ig.ft.com/coronavirus-vaccine-tracker/ from as far as % of population COVID vaccinated, Australia could become one of those countries where the Indian variant might be catastrophic over coming weeks or months - as a result of one of these CBD hotel quarantine "leaks".

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28/May/21 Anne de Gheest COVID Clinical update https://www.youtube.com/watch?v=8bI7V4lkKs4  

  • Indian variant has rapidly become dominant in the UK.

  • The worry is that this new more dangerous variant will rapidly become globally dominant including in the USA.

  • So far, the Indian variant has only dramatically taken off in a few parts of the UK , and has already become dominant in the UK.   So it is easy to see how the Indian variant could start a major new wave of COVID in UK, and then in the USA etc. We are in this continuing race between vaccines and variants.

  • Also notice how in the UK, with the Indian variant, a  much greater percentage of new infections are among the young (less vaccinated) who until now have felt that fairly safe re COVID.  

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https://twitter.com/EricTopol/status/1400584977012584451  4/Jun/21

  • "Just published  @TheLancet  Neutralizing antibody (nAbs) in response to B.1.617.2 (delta) after mRNA vaccination in 250 people (median age 42, healthy) Immune-evasiveness is similar to B.1.351 (high) 2 doses of vaccine -> high levels of nAbs"     BB: This is not good - this confirms that Indian variant is most dangerous yet. It is the most transmissible major variant by a significant margin and has the immune-evasiveness of the worst of the majors (South African and Brazilian variants)

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Victoria COVID cases: Melbourne outbreak takes a dangerous turn with mystery variant cases (afr.com)   4/Jun/21

  • Epidemiologists warned about the infectivity of the new variant.       “Delta (B.1.617.2  Indian variant) is in another league,” Professor Catherine Bennett, the Chair of Epidemiology at Deakin University warned.   Her warning came as an update from Public Health in the UK found the delta variant is associated with a 2.61 times higher risk of hospitalisation within 14 days of being tested positive than the alpha (UK) variant.

  • “The vaccine still works against the delta strain, but the battle is against that level of transmissibility and the concern that there is also potentially greater severity.”  

  • Melbourne University professor Tony Blakely said the emergence of the delta variant was a real setback. “This is currently, as best we know, the most infectious virion around the world and it’s taking over places like the UK. “It is roughly twice as infectious as last year’s variant.

  • “There are some anecdotal reports of greater severity of illness in children, as well as potential increased transmissibility in children, so we’ve got concerns for that reason,” Victorian chief health officer Brett Sutton said.

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Vaccination quashes lethality of COVID’s delta variant, UK says (afr.com)  8/6/21

  • London | Britain’s vaccination program has “broken the link” between COVID-19 infections and the rate of hospitalisation and death, even for the new India-origin delta variant, the British government said.   Data revealed by Health Secretary Matt Hancock in parliament on Monday (Tuesday AEST) signalled that the country’s breakneck vaccination rollout will potentially allow the British government to manage COVID-19 in the same way it manages persistent diseases such as flu - in contrast to Australia’s lockdown-based approach.  “The vaccination brings us hope,” Mr Hancock told MPs. “The vaccine is breaking that link between infections, hospitalisations and deaths - a link that was rock solid back in the autumn.”

  • BB Comment: Hancock is being too arrogant and confident in his statement comparing COVID to Flu, because epidemiologists have been warning of the potential for even more immune-evasive variants and clearly we could also get more transmissible variants, though this Indian Delta variant seems extremely transmissible - seemingly from even a casual brief aerosol contact.      Mankind has not defeated COVID until we have  - and that means according to the experts controlling COVID in the developing world as well as the developed world, because only when COVID is defeated in the developing world, can the proliferation of new variants be dramatically reduce.    And there is still Long-COVID which is getting far too little attention.

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https://twitter.com/EricTopol/status/1402340123417583618  9/June/21

  • "When the delta (B.1.617.2) variant evolved, unlike the other 3 major variants of concern (alpha, beta, gamma), it took a unique path w/o the N501Y mutation to get to very high transmissibility (≥40% alpha) & immune evasion (~ = beta). The virus is showing us new ways to evolve and harm" 

Evolution of Indian_Variant 210609.jpg

https://twitter.com/EricTopol/status/1402345591791779840  9/Jun/21

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https://twitter.com/EricTopol/status/1402346372687302656  9/June/21

  • "And the Financial Times analysis of 1st dose vaccine efficacy vs. delta looks better than the original ~30% calculation"

FT_Effectiveness_of_AstraZeneca_1_dose_2

https://twitter.com/EricTopol/status/1402463801421664262  9/June/21

The Rise_of_Delta_variant_in_USA_210609.

https://twitter.com/EricTopol/status/1402620602406428674   10/June/21

  • "Delta is the new pandemic problem" By editorial board, washingtonpost

  • "The threat of delta should prompt vaccine doubters to rethink" "Do you want to meet delta in a dark alley? If not, get a shot."
Delta_is_THE_new_pandemic_problem_210610

https://twitter.com/EricTopol/status/1403017858347532288   11/6/21

  • The delta (B.1.617.2) variant is "an epidemic among the unvaccinated and partially vaccinated populations in the UK”—@timspector 

  • https://twitter.com/timspector/status/1403019838126186498  

    • Rates of new covid-19 now doubling every 5-6 days according to ZOE covid study - but as you see nearly all infections are in young and unvaccinated. Mainly first dose only still susceptible. This will get worse before it improves.

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https://twitter.com/EricTopol/status/1403343280377516040  11/June/21

  • The UK and US have the same 43% of their populations fully vaccinated. In the UK, cases went up from 12,131 to 42,323 week to week, >90% delta. Latest  @PHE_uk  : delta is 60% more transmissible than alpha, 2.2X hospitalizations 

  • https://twitter.com/EricTopol/status/1403345669587234819   11/June/21

    • Coronavirus: Novavax says variant-adapted vaccine effective against several Covid-19 strains  11/June/21

      • Novavax says that its Covid-19 vaccine targeted at the Beta variant is effective at protecting against several strains of the disease, adding to hopes that existing adaptations of the virus can be managed with booster shots. 

      • Novavax tested the jab on mice and found that they produced antibodies and were protected against both the Alpha and Beta variants — those first detected in the UK and South Africa, respectively.  Its tests of a booster shot on baboons that had been immunised 12 months ago proved high and durable antibody levels against both strains while the third test on humans delivered a “modest reduction” in neutralising capacity against the Beta strain. “These data suggest that not only could one booster dose of this variant-directed vaccine potentially provide a robust, protective immune boost after vaccination against the [original] virus, but also the potential to provide broad protection against various virus strains if used as a primary vaccine regimen,” said Gregory Glenn, president of research and development at Novavax.

    • https://www.gov.uk/government/news/confirmed-cases-of-covid-19-variants-identified-in-uk 11/June/21

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https://twitter.com/EricTopol/status/1404095178621669376  14/June/21

  • Why did the UK and Israel, 2 countries with very high vaccination rates, have such different results? Israel currently 0.2 cases/100,000 people without lockdown, UK 10/100K, delaying reopening. One reason is the delta variant

  • There are many other potential explanations including: Tight border control of Israel Higher fully vaccinated rate (60+ vs 43%) and rate of rise Exclusive use of  @BioNTech_Group (Pfizer) vaccine in Israel    [BB comment: In the UK, they have relied almost exclusively on AstraZeneca which is significantly less effective against Delta variant - see chart above from   https://theconversation.com/whats-the-indian-variant-responsible-for-victorias-outbreak-and-how-effective-are-vaccines-against-it-161574  ] 

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https://twitter.com/EricTopol/status/1404790585219719170  15/June/21

  • Delta is a superspreader variant, the worst version of the virus we've seen. Fortunately, in the US we have 44% of the total population fully vaccinated & protected which will blunt its impact. We're at ~12% infections d/t Delta and it'll be dominant (>50%) in the next few weeks

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https://twitter.com/EricTopol/status/1404846282452082692   16/June/21

  • An impressive reflection of vaccinations at work: The UK deaths in face of the Delta variant, average 9 per day (10 today). 1/10th of the current US covid fatality rate, population-adjusted

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https://twitter.com/EricTopol/status/1404859513535012867   16/June/21

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https://twitter.com/EricTopol/status/1406263381774934017    20/June/2021

  • We need to build a Delta immunity wall through more vaccination: 47% Americans haven't even had 1 dose —There has not been any counter-offensive to the anti-vaxx movement —No statement by FDA about full licensure timeline (review should be done by now) and no coverage by media

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https://twitter.com/EricTopol/status/1407708989899431940   23/June/21

  • What @CDCDirector  asserted here is absolutely right, no  less the vast majority of covid hospitalizations.  What a sorry situation to have the powerful means to prevent serious illness, yet blocked by unwillingness for millions of people to be protect themselves and others

    • https://twitter.com/kaitlancollins/status/1407657771630268416

      • https://edition.cnn.com/2021/06/23/health/us-coronavirus-wednesday/index.html    

        • "Nearly every new Covid-19 death is now entirely preventable, CDC director says"

          • (CNN)The dangerous Delta variant poses a risk as the United States works to ease out of the Covid-19 pandemic, but experts say the nation has the tools needed to overcome the threat -- if the public takes advantage of them.

          • "Covid-19 vaccines are available for everyone ages 12 and up," US Centers for Disease Control and Prevention Director Dr. Rochelle Walensky said Tuesday at a White House briefing. "They are nearly 100% effective against severe disease and death -- meaning nearly every death due to Covid-19 is particularly tragic, because nearly every death, especially among adults, due to Covid-19 is at this point entirely preventable."

      • Note: The USA are relying almost entirely on mRNA vaccines.   about 55% Pfizer and about 40% Moderna.

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AFR article 25/June/21 "Delta strain risks spreading ‘like wildfire’ among unvaccinated in US"

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https://twitter.com/EricTopol/status/1408406649224589317   25/June/21

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Anne de Gheest's latest COVID clinical update 25/June/21  https://www.youtube.com/watch?v=77skcFyRWXE

  • Delta Variant will dominate "globally" over the next 4-8 weeks - and a new mutation of delta variant has also been found.   See variant page.

  • Effectiveness of difference vaccines vs Delta variant

  • Look at difference in effectiveness vs symptomatic disease compared to effectiveness vs infection

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Anne de Gheest's latest COVID clinical update 25/June/21  https://www.youtube.com/watch?v=77skcFyRWXE

Anne_de_Gheest_Clinical_upd_new_variants

https://twitter.com/EricTopol/status/1413968623815647235   11Jyly21

  • VaccinesWork vs Delta A summary table I put together for vaccine protection from the Delta variant from publications and preprints. 5 vaccines—neutralizing antibodies well above threshold (lab studies) 3 vaccines—clinical effectiveness will update as more data becomes available

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Latest on effectiveness of current vaccines against delta.

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  • https://twitter.com/EricTopol/status/1423698071112753153  7/Aug/21

  • An update on Delta, vaccination protection and viral loads from the aggregate data available, with new data 1. Delta infections are characterized by very high viral loads (low Cts). When a breakthrough occurs, the load is similar to unvaccinated, but clears more rapidly

Vaccines_vs_delta_210811-2.jpg

  • High risk to double-vaccinated Health Care Workers from delta variant - Community is in danger if we lose vaccinated health care workers to delta.

    • 23-Aug-21       https://twitter.com/EricTopol/status/1429523296349872131    

      • Don't give your vaccination a Delta stress test. (aligns with prior posts that we don't have a true handle on US Delta breakthroughs, and concern Dr. Sauza raises with our healthcare workforce)    https://twitter.com/drmeowza/status/1429221776270135296   

        • "I tested positive for COVID this week, along with 9 of 12 fully vaxxed friends (among others), days after we attended an outdoor wedding (that required proof of vaccination) in 1 of the lowest-risk states in the country. Thankful for protection against bad outcomes but YALL- uncontrolled spread of the more transmissible #DeltaVariant means that even relatively uncommon events are going to happen in significant numbers. I’m worried about its potential to wipe out ranks of HCWs (Health Care Workers), many of us vaxxed > 7 months ago = waned immunity relative to much of the public. It’s depressing, but we need to change behaviors in response to the mounting data showing that delta presents a new level of risk."

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