COVID-19 Update – Delta Variant & Vaccine Information
By Dr. Robert Katz
According to the CDC, the Delta variant of COVID-19 is more contagious – more than 2x as contagious as previous variants; some data suggest the Delta variant might cause more severe illness than previous strains in unvaccinated persons; unvaccinated people remain the greatest concern; fully vaccinated people with Delta variant breakthrough infections can spread the virus to others. However, vaccinated people appear to be infectious for a shorter period.
What does this mean for people living with lupus?
Studies have shown that COVID-19 vaccination appears well tolerated in patients with lupus with only a minimal risk of flare (if any) after both Pfizer and Moderna mRNA vaccines. [mRNA (or messenger RNA vaccines) teach our cells how to make a protein—or even just a piece of a protein—that triggers an immune response inside our bodies. The benefit of mRNA vaccines, like all vaccines, is those vaccinated gain protection without ever having to risk the serious consequences of getting sick with COVID-19.]
A large study in lupus showed that the side effects after COVID-19 vaccination are common, but do not impair daily functioning in most cases. No difference was found in the occurrence of side effects after receipt of mRNA vaccines compared to vaccines with other modes of action, which is a reassuring. The number of medically confirmed lupus flares after COVID-19 vaccination was low.
The American College of Rheumatology has issued guidelines for the booster shot for those people who are immunocompromised. That would mean a third shot of the Moderna or Pfizer vaccine.
This third shot might be appropriate for many lupus patients, especially those on immunosuppressant medication. The medications could include high dose steroids, biologic medications, or immunosuppressive medicines such as methotrexate, Imuran, leflunomide and Benlysta. Both the FDA and the CDC have recommended giving the booster vaccine shot to immunocompromised patients including those with lupus on these immunosuppressive medications and/or higher dose prednisone.
Wearing a mask, social distancing, and avoiding poorly ventilated indoor spaces and crowds are recommended.
There have been studies that suggest that those with lupus who contract COVID-19 do not have a worse prognosis, even though there have been a few studies suggesting a higher rate of hospitalization in those lupus patients who get COVID-19. So, the same preventive and control measures in the general population apply to those with lupus; however, now with the booster shot, those on immunosuppressive medication would qualify for that additional vaccine dose.
Older age, higher body weight, cardiovascular disease, diabetes, and chronic lung disease are risk factors for contracting COVID -19.
There are some single center scientific reports suggesting that moderate or high levels of disease activity could put people with lupus at greater risk for COVID-19-related serious illness. There might be an increased hospitalization risk in patients with lupus with active disease, but this has not been a consistent finding in all studies. However, those using higher doses of steroids such as more than 10 mg of prednisone may be at increased risk for hospitalization, but it is difficult to say if the higher steroid dose just reflects more active disease, which makes patients more susceptible, rather than the drug itself.
With the new Delta variant and other COVID-19 mutations that will occur, there needs to be increased scrutiny to see if a new vaccine will be developed.
We do not know whether vaccine-induced immunity and COVID-19 antibody levels will lessen over time requiring periodic booster shots and making high levels of population immunity harder to maintain.
COVID-19 is likely to flare up at different times and places for many years. The latest evidence suggests that mutations like the Delta variant will be here for a while in different forms. Sometimes super spreader events can increase cases, but in places with high vaccination rates, including much of the United States, the worst seems to be over. There will be many breakthrough infections, but most of the vulnerable Americans are fully vaccinated including lupus patients, so the death rate will be much lower than it once was. However, COVID-19 will remain a deadly threat, especially for the unvaccinated. Delta may have a risk of death roughly similar to the flu in those who have received the vaccine.
There is also the question of “long COVID,” a post-viral syndrome difficult to define at this point, but causes continuing symptoms not directly related to active infection from Delta or any other COVID-19 variants. In terms of long-term COVID-19 symptoms, fatigue, shortness of breath, loss of smell or taste, and anxiety were common. Persistent cough and depression also occur reasonably often.
The good news is that the advent of new vaccine technologies, particularly mRNA, has led to much more effective vaccines. Instead of the whole virus that has been weakened, the newer vaccines have only mRNA. The Delta variant contagiousness has led to a resurgence of cases, hospitalizations, and deaths, but as long as people are vaccinated, the chance that a deadly outcome will occur is small, even if you have lupus.
There are other lessons from other epidemics. The HIV pandemic led to safer sexual practices. With COVID-19, there has been a transformation on how people go about their daily lives including Zoom calls rather than in-person meetings. The amount of travel that is thought to be essential is likely to decline when it is related to work events.
Isolation of the sick and quarantines are also measures that may help stop the spread of the Delta variant of COVID-19. This is especially true of those who are exposed to COVID-19 and/or remain unvaccinated. More activities outdoors and being inside but open windows and increased ventilation may be helpful.
Lupus patients are vulnerable, but with the new mRNA COVID-19 vaccines, they are largely protected. A booster shot will be required either now for those who are on immunosuppressive medication or likely in the future because of further changes to the virus. The Delta version is causing a problem, and future mutations of the virus are a threat. Fortunately, vaccine innovation is responding to it.
Robert S. Katz, M.D.
August 18, 2021