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August 5, 2021

The new delta surge crisis 

How best to stay safe during the pandemic has changed in the last few weeks as community levels of COVID-19 infections with the delta variant have surged. The delta variant was first detected in India in December 2020 and arrived in the U.S. in about March 2021. The dramatic spread of the delta variant is due to its ability to replicate (build up in the system) much more rapidly than prior variants, including the U.K. variant now called alpha. Instead of needing six days to build up, it takes half that time for an infected person to pass on the virus. There is a thousand times the load of virus in the nose and upper air passages! Most likely, multiple mutations have resulted in the more infectious and dangerous delta variant. Research is ongoing to understand this process better. 

In the meantime, we must be very alert about this extremely infectious and dangerous virus strain. 

Avoid confusion about guidance: wear a mask 

As information about the delta variant has been coming in during the last several weeks, the CDC has, unfortunately, been slow to give clear guidance. As Dr. Zeynep Tufekci stresses in an essay published this week in The New York Times, in order for the CDC to be successful with messaging, the agency needs to be “first, right and credible.” Dr. Zeynep says there are various reasons the CDC has failed to meet this standard, but the result is that many people are confused about the critical need to wear a mask in light of the new dangers with the delta variant. 

Several things we have learned 

Most delta variant infections are occurring in the unvaccinated. Over 90% of hospitalized patients right now have not been vaccinated. But, although much less likely, some have been vaccinated. Wearing a mask is essential to reduce spread. 

Individuals who have been vaccinated can get infected in part because of the very high virus load in infected individuals and because the delta variant binds more efficiently to cells in the nose. Cells in the nose are not fully accessible to the body’s immune system, which protects the lungs, kidneys, and other internal organs. 

So, there is an early foothold possible in the nose. If neutralizing antibody levels are low—such as in a vaccinated myeloma patient who was on active therapy at the time of vaccination—then the delta variant is NOT rapidly cleared. Infection can then become established throughout the body in a vaccinated myeloma patient. 

To stay safe: 

  • Masks are an essential protective measure for myeloma patients. 
  • Crowded spaces—especially indoors—must be avoided to stay safe. 
  • If the community level of COVID-19 delta variant is high (above 8%), avoid contact with individuals not wearing a mask. Always remember that vaccination status can be uncertain for various reasons—a person may have had only one dose of a two-dose vaccine or may have been vaccinated with the single dose J&J vaccine instead of the more effective two-dose vaccines.

Vaccination and the value of a booster 

Vaccination for myeloma patients is strongly recommended. However, a recent report confirms that neutralizing antibody levels after COVID-19 vaccination can be much lower than hoped for in myeloma patients, even after two doses, and especially those on active treatment. According to the study, indicators of low neutralizing antibody levels are: treatment with anti-CD 38 monoclonal antibodies or BCMA-targeted therapies; or having a low blood lymphocyte count. 

Because of these findings, the Greek research team is currently assessing the value of a booster shot (a third dose of the Pfizer or Moderna vaccines). Those who wish to get tested for neutralizing antibody levels should talk to their doctor. Several excellent reference laboratories are available, such as the FDA-approved Molecular Matrix in Sacramento, California, or the national Labcorp

Preliminary data about boosters 

Preliminary data from several countries have already led to the approval of booster vaccinations in Germany, the UK, France and Israel . In the U.S. there are now hopes that early, full FDA approval of the Pfizer vaccine will give doctors and health care entities the authority to give boosters as appropriate. 

The FDA can also choose to authorize boosters under the current Emergency Use Authorization (EUA) for people with compromised immune systems, such as myeloma patients. It appears that this is also under consideration. 

It is encouraging to note that San Francisco General Hospital will allow administration of “supplemental” mRNA (Pfizer or Moderna vaccines) boosters for this who have previously received the single shot J&J vaccine shot. This can help alleviate concern for this group. 

A crystal ball for the future 

Unfortunately, delta variant levels are surging—not just in areas of the U.S. where vaccination rates have been low, such as Mississippi, but even in countries around the world where COVID-19 infection levels have been very low and apparently under control. In Iceland, for example, where COVID-19 infection levels have been extremely low up to now, there has been a substantial surge in cases. And in China, case levels of the delta variant are on the rise, including in Wuhan, site of the original epicenter of COVID -19 (the original strain) in November-December 2019. As a result of a delta surge, the city has ordered testing of all 11 million of its residents

The coming few months will definitely be challenging. Global communities must come together to maximize vaccination for all countries and enhance protective measures as much as possible. 

A future with challenges, but opportunities

Although the immediate future for the COVID-19 pandemic is challenging, many positive efforts are occurring that can be transformative. For example, despite the pandemic, cancer treatment trials have continued, according to a new report. And though screening projects have decreased, some screening projects, such as the IMF-supported iStopMM screening for MGUS in Iceland, have continued to thrive, producing many new and important observations. 

The economic value of nature 

As we watch huge fires and massive flooding on the news, much work is going on that will have an impact in slowing the progress of climate change. For example, Gretchen Daily, professor of biology at Stanford University, has become a pioneer in a field called “natural capital.” What Prof. Daily does (and has been working on for 30 years) is assess the value to a community, such as a coastal community or forest areas, in protecting the soil, air and water in a way that will bring economic benefits. She has established a group of 250 partners around the world to collaborate on scientific projects, which can help all initiatives to move forward. If that sounds familiar to readers, it is because this is exactly what the International Myeloma Working Group does by bringing top experts together to solve problems together and find a cure. 

Important role of mini forests

Among other inspiring projects is the “Miyawaki method,” a technique for planting mini forests in cities to capture CO2 emissions and help with climate cooling. The miniature urban forests, which were pioneered in the 1970s by the late Japanese botanist Akira Miyawaki, grow more quickly and absorb more CO2 than conventional timber forests. The forests are modeled after the protected areas around shrines and temples, which contain a large variety of resilient and diverse plants and trees. 

Using areas as small as the size of one or two tennis courts, mini forests are growing in popularity, springing up in critical areas like the Amazon and in non-rainforest countries like Belgium, France, and the Netherlands. 

Bottom line 

SO, we need to try to tune out the round-the-clock bad news as much as possible and seek out progress and positive news that can salvage a better future for everyone. 



 


Image of Dr. Brian G.M. DurieDr. Brian G.M. Durie serves as Chairman of the International Myeloma Foundation and serves on its Scientific Advisory Board. Additionally, he is Chairman of the IMF's International Myeloma Working Group, a consortium of nearly 200 myeloma experts from around the world. Dr. Durie also leads the IMF’s Black Swan Research Initiative®.

 

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