As others chill, L.A. County sounds alarms over Delta variant
For many this year, the Fourth of July marks a special independence day — one free of coronavirus restrictions after 15 months and with a sense that a new post-pandemic normal is at hand.
Across the nation, businesses are open, crowds are gathering, masks are coming off and, for the vaccinated at least, much of the fear of contracting COVID-19 is fading.
But in Los Angeles County, a sudden rise in coronavirus cases and hospitalizations has put a damper on the holiday spirit.
L.A. County public health officials are breaking with many other health departments, asking even inoculated residents to modify their behavior amid a concerning uptick in coronavirus transmission and the circulation of the highly contagious Delta variant.
In recommending that all residents wear masks in public indoor spaces — regardless of whether they’ve been vaccinated for COVID-19 — the nation’s most-populous county is an outlier. Neither state nor federal health officials have taken that step.
Officials attribute the increase of cases and hospitalizations in L.A. County to the Delta variant spreading among the region’s unvaccinated population. About 51% of L.A. County residents are fully vaccinated, well behind most counties in the San Francisco Bay Area. There are some 4 million in L.A. County who have not had a single dose, including 1.3 million who are not yet eligible.
Two warning signs emerged in the past few days, showing how dramatically fortunes can change: Coronavirus cases in L.A. County have more than doubled in the last week, and hospitalizations are up by 30% — trends that are significantly worse than those observed nationally.
The increase is particularly notable among L.A. County’s Black residents, who are vaccinated at lower rates than other racial and ethnic groups. COVID-19 hospitalizations among Black residents rose by 11% between mid-May and mid-June.
“We have enough risk and enough unvaccinated people for Delta to pose a threat to our recovery. And masking up now could help prevent a resurgence in transmission,” said L.A. County Public Health Director Barbara Ferrer. “This is a precautionary recommendation, given that we don’t have all the information we wish we had.”
Among the biggest questions is whether Delta — which may be twice as transmissible as other coronavirus strains — poses a greater risk of infection for vaccinated people.
Though she’s quick to point out that all three vaccines available in the U.S. are “extraordinarily effective at preventing serious illness and death against the various strains of COVID and variants of concern,” Ferrer said there’s “increasing evidence that a very small number of fully vaccinated individuals can become infected with the Delta variant and may be able to infect others.”
Israel is experiencing a surge of infections of the Delta variant, including among a significant number of those fully vaccinated — who represent 60% of the country — according to Ferrer.
And in India, healthcare workers fully vaccinated with the AstraZeneca COVID-19 vaccine — which is not being used in the U.S. — “showed evidence of transmitting the Delta variant to others,” Ferrer said.
“Both the [World Health Organization] and the Israeli government recommend that until more is known about the variant, individuals should add a layer of protection by wearing face masks,” she added.
Ferrer’s concerns were shared by Illinois Gov. J.B. Pritzker, who recently told reporters, “From my own perspective, if you’re going into a heavily crowded area, you don’t know if somebody is not vaccinated, and so you should just bring your mask with you and keep safe.”
On the other hand, Dr. Anthony Fauci, the U.S. government’s top infectious-diseases expert, maintained that COVID-19 vaccines are highly effective against all known variants, including Delta.
“If you are vaccinated, you have a high degree of protection — so you need not wear a mask, either indoor or outdoor,” Fauci said of the federal guidance, while adding that local health authorities are free to offer different recommendations or mandates.
California’s leading health officials echoed Fauci.
“The data is clear: Nearly all new COVID-19 hospitalizations and deaths are preventable. The vaccines work and they protect us,” California Health and Human Services Secretary Dr. Mark Ghaly said in a statement Friday.
In the same statement, the state Department of Public Health said there are “enough people vaccinated against COVID-19 that the [healthcare] system is not at risk of being overwhelmed if cases increase.”
L.A. County’s data show that if you’re fully vaccinated, you’re at very little risk of becoming seriously ill or dying. Countywide, 99.8% of people who have died from COVID-19 since December were not vaccinated.
“But the big unknown is: Can you become infected, have mild illness and go ahead and spread that infection to others? And we are looking for the answer to that question,” Ferrer said.
The use of masks, she added, “will help press pause on viral transmission while we learn more.”
L.A. County started seeing increases in the Delta variant in early April, and cases are rising. In May, the county had fewer than 20 identified cases per week, but by June, there were 60 to 80.
For the week that ended June 19, Delta made up nearly 50% of all cases analyzed in L.A. County; four weeks earlier, it accounted for less than 5%.
As of Thursday, 245 Delta cases had been confirmed countywide — twice as many as last week.
At the same time, average new daily coronavirus cases have more than doubled over the past week.
For the seven-day period that ended Thursday, there were 368 new coronavirus cases a day in L.A. County, a 129% increase from the previous week’s average of 161.
The number of patients sick enough to require professional care has also risen.
COVID-19 hospitalizations in L.A. County hit a record low of 212 on June 12. But as of Thursday, there were 275 hospitalized patients — a 30% increase, though still far below the peak of 8,098 during the worst days of the pandemic.
COVID-19 deaths remain low, at an average of five a day.
L.A. County’s trends are worse than those seen on the national scale. Average daily cases countrywide are up by 10% from the previous week, and daily hospitalizations are down by 1.3%.
Some experts look to Israel and India and draw different conclusions.
The rise in coronavirus cases in Israel may reflect the healthcare system there still testing vaccinated people for coronavirus infection, even if they have no symptoms. It would not be surprising if vaccinated people were found to have the coronavirus in the nose but no symptoms and low levels of virus in their bodies overall, according to Dr. Monica Gandhi, a UC San Francisco infectious-diseases specialist.
“I don’t call that a vaccine failure. I call that a success, because that’s exactly what your vaccine is supposed to do. It’s fighting the infection in your nose and bringing down the viral load, and you don’t get symptoms,” she said.
The data she’s seen indicate that, in general, “there isn’t a lot of transmission that occurs after vaccination if you’re asymptomatic.”
While there are reports about healthcare workers in India getting sick from the Delta variant despite being fully vaccinated, that is due mainly to the massive amounts of virus circulating there, Gandhi said.
“If you’re surrounded by a lot of virus, like you would encounter when community transmission was high in India, then the vaccinated were more likely to get a ‘breakthrough’ infection,” she said.
L.A. County’s mask recommendation has drawn criticism from some corners.
“Los Angeles public health officials just scared off business travelers, conference organizers, tourists and others looking to get back to normal in the United States’ second largest city,” Dr. Marty Makary, surgical oncologist and chief of the Johns Hopkins Islet Transplant Center, wrote in an op-ed in the Washington Post.
Ferrer defended her recommendation Thursday, saying she didn’t think asking people to wear masks would hurt businesses, and there is no request or requirement to reduce operational capacity.
Some epidemiologists said the county’s recommendation is not unreasonable until more information about the Delta variant emerges. The World Health Organization is taking a similar approach, while the U.S. Centers for Disease Control and Prevention is not, with federal officials pointing out that the U.S. has high vaccination rates compared with many other countries.
“It’s kind of a judgment call at the state or local level,” said UC San Francisco epidemiologist Dr. George Rutherford.
What makes sense for L.A. County may not make sense elsewhere.
San Francisco has 68% of its population fully vaccinated, and Santa Clara — Northern California’s most populous county — stands at 66%.
Over a recent seven-day period, San Francisco’s per capita daily coronavirus case rate was half that recorded in L.A. County.
“In the Bay Area, where there’s a lot more people vaccinated, it may not be as necessary,” Rutherford said of the recommendation for vaccinated people to mask up indoors.
There is widespread scientific consensus of the Delta variant’s infectious potential. Some early estimates of the initial coronavirus strains suggested that every infected person, on average, transmitted the virus to 3.5 others, Rutherford said. Each person with the Delta variant could potentially transmit the virus to more than six people.
Given the uncertainties with the variant, “it is prudent to consider ways that we can prevent additional cases occurring in a way that is not disruptive to the economy,” said Dr. Robert Kim-Farley, medical epidemiologist and infectious-diseases expert with the UCLA Fielding School of Public Health.
“It seems to me a reasonably small price to pay” to ask — not require — vaccinated people to mask up indoors, Kim-Farley said. “If we can continue to try to keep new cases down in the face of this variant, as we continue to try to get more and more people vaccinated to the point where we can achieve ‘community immunity,’ then we can all take off our masks.”
Ferrer acknowledged that it can be distressing to hear new warnings regarding Delta.
“We’ve been for 18 months saying, ‘We’re sorry that this information keeps changing,’” Ferrer said. But, she added, she wants to “share the information as it comes in, so that everyone is working on a level playing field — having the same information we have.”