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September 2021

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COVID-19 variants: What you need to know

The Delta variant. Breakthrough infections. Vaccine boosters. How can you sift through all the latest information about COVID-19? Richard Martinello, MD, medical director, Infection Prevention at Yale New Haven Hospital, answers some frequently asked questions.

How many variants are there?

Around the world, there are about a dozen different variants tracked by the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC). All of these variants are in Connecticut. The Delta variant is currently the dominant strain and accounts for more than 90 percent of known cases in the country, according to the CDC COVID Data Tracker

WHO designates Delta as a “variant of concern.” Another variant, the Lambda variant, is emerging in the U.S. WHO designates Lambda as a “variant of interest.” 

Is the Delta variant more dangerous?

Two factors make the Delta variant a concern. It’s more contagious and it poses greater severity than the original strain. Its spread is contributing to higher case counts, hospitalizations and deaths attributed to COVID-19, especially in pockets of the country where vaccination rates remain relatively low.

The Delta variant also seems to be more effective at evading vaccines, although vaccination still offers significant protection against illness. In mid-July, CDC Director Rochelle Walensky, MD, said more than 97 percent of Americans who are being hospitalized for COVID-19 are unvaccinated.

What are the symptoms of the Delta variant?

In general, the symptoms are the same as other COVID-19 strains: fever, dry cough, shortness of breath, temporary loss of taste or smell, flu-like respiratory and digestive problems, muscle aches and fatigue. 

Does the vaccine protect against the Delta variant?

So far, the COVID-19 vaccine remains highly effective, even against the Delta variant. Vaccination is the single most important thing we can do to protect others and ourselves against COVID-19. As more people get vaccinated, the better protected we will all be. If another wave due to new variants hits, vaccinations may also help reduce the number of people who need to be hospitalized. 

On Aug. 23 the Food and Drug Administration granted full approval to Pfizer-BioNTech's two-dose vaccine for ages 16 and up, making it the first Covid-19 vaccine to pass this final regulatory hurdle. Moderna has also applied for full approval. Johnson & Johnson has not yet applied for full approval and remains in use under emergency authorization.

Learn more about how to get a COVID-19 vaccine.

I’m vaccinated. Should I worry about breakthrough infections?

No vaccine is 100 percent effective at preventing disease. A “breakthrough” means that a vaccinated person tested positive for the virus --not that they will become ill or transmit the infection to someone else. Most vaccinated people who are infected do not have symptoms; those that do tend to have mild illness.

Recent reports show that more fully vaccinated Americans have been diagnosed with COVID-19 -- but that doesn't mean COVID-19 vaccines don't work. The vaccines authorized in the U.S. to help reduce COVID-19 are pretty close to foolproof— especially when it comes to preventing severe illness and death, which is what they were designed to do. Less than 1 percent of fully vaccinated individuals have been hospitalized with, or have died from, COVID-19, according to the latest data tracked by the CDC.

Fully vaccinated people who are hospitalized with COVID-19 generally are older than 60, have underlying conditions like diabetes or asthma or require immunosuppressive treatment. 

If I’m vaccinated but become infected with the Delta variant, can I spread the virus?

Possibly. Based on a recent outbreak in Massachusetts, the CDC now believes vaccinated people who become infected with Delta can have as much of the virus in their nose and throat as unvaccinated people. That means vaccinated people may be able to spread the strain to those who are unvaccinated or medically vulnerable. 

However, others researchers think vaccinated people who get a breakthrough infection are less likely to transmit COVID-19 to others. That’s because most breakthrough infections among vaccinated people will result in a strong immune response that will quickly control and clear the infection. 

Should I wear a mask even if I’m vaccinated?

Mask wearing is just one tool we can all use to help protect against the spread of this virus. According to the CDC, vaccinated people should wear a mask to prevent transmission of the virus in enclosed public places in parts of the U.S. that have substantial levels of new COVID-19 cases. Mask wearing can also help prevent a vaccinated person with a breakthrough infection from spreading the virus to the unvaccinated. 

How long will the vaccine protect me? Will I need a booster shot? 

The FDA has authorized a third dose of the Pfizer or Moderna COVID-19 vaccines for transplant recipients and others with severely weakened immune systems to better protect them against the Delta variant. This affects several million Americans who are especially vulnerable because of organ transplants, certain cancers or other disorders. The potential need for a booster shot in those who are fully vaccinated is currently under review by the FDA.

Find more COVID-19 vaccine information on our website.

New Alzheimer’s drug brings hope – and questions

The Food and Drug Administration recently approved a new drug called Aduhelm for the treatment of Alzheimer’s disease. It’s the first therapy approved for the disease since 2003. But will it provide the relief that patients and their families are seeking? 

According to Yale New Haven Hospital and Yale Medicine geriatrician Gerard Kerins, MD, FACP, patients and families may want to hold off on celebrating just yet. 

Alzheimer’s disease, which afflicts more than 6 million Americans, is a progressive and irreversible condition that robs people of their memory and ability to do everyday tasks. Scientists believe a buildup of a sticky plaque called beta-amyloid in the brain is a hallmark of Alzheimer’s. “These clumps of plaque become toxic, which is thought to affect memory and correlate with dementia symptoms,” said Dr. Kerins. 

Most of the handful of medications approved for Alzheimer’s treat symptoms and show modest effects at best. Aducanumab, also known as Aduhelm, is the first drug designed to actually slow the progression of Alzheimer's disease, not just ease symptoms. The treatment is a monoclonal antibody — a laboratory-made protein that can bind to substances in the body — originally derived from the cells of older people who did not have signs of cognitive problems. 

“By binding to the plaque and breaking up the clumps of beta-amyloid, the thought is that Aduhelm will reduce inflammation and slow cognitive decline,” said Dr. Kerins. 

So why isn’t Aduhelm being hailed as a miracle breakthrough? According to Dr. Kerins, there are still a lot of questions that need answers. In two large clinical trials for early-stage patients, the evidence did not convincingly show dramatic clinical benefits. However, the trials indicate that Aduhelm may be effective at removing plaque. The FDA concluded there was a “reasonable likelihood” that a reduction in beta-amyloid would slow disease progression, so it approved the drug using its “accelerated approval” program. That program allows for earlier approval of a drug for a serious or life-threatening illness, even if more study might be needed. Aduhelm is the first Alzheimer’s drug to receive FDA accelerated approval.

“There hasn’t been an effective treatment for Alzheimer’s approved in almost 20 years, so patients and families are understandably anxious for new drugs,” said Dr. Kerins. “There was a lot of pressure on the FDA to approve this.” 

There are challenges associated with Aduhelm, he said. Patients receive the drug by IV transfusion every four weeks, a process that takes about 45 minutes. “Getting Aduhelm is a cumbersome process -- it’s not an easy drug to administer. It’s not a pill that you can take at home,” he said.

Patients must have regular MRI scans because of the possible side effects, which may include headaches, vision changes and hemorrhaging or swelling in the brain. Cost is also a concern. Aduhelm can cost up to $56,000 a year per patient, and there are still questions about whether insurance will cover it.

The biggest challenge may be that the drug was developed only for patients with mild cognitive impairment, not severe dementia. 
“This may limit the number of patients who may actually benefit from it because it takes time to evaluate and assess a patient to determine whether their memory loss issues are caused by Alzheimer’s instead of another type of dementia,” Dr. Kerins said. 

Given concerns over the drug’s benefits as well as potential side effects, Yale New Haven Health has not yet included Aduhelm in its treatment protocol. Further study is needed.
 
Overall, Alzheimer care is best provided via a team-based approach, according to Dr. Kerins. “This includes caring for the caregivers and being available as issues arise. Medications are just one aspect of the care regimen.”
For more information about resources for patients/caregivers, contact the Yale Alzheimer's Disease Research Center

Help us get closer to free!

The 2021 Closer to Free Ride rolls off the starting line on Sept. 11. Given the rise in COVID-19 cases, the ride is virtual again this year. Every dollar raised still directly supports patient care and advanced research at Smilow Cancer Hospital and Yale Cancer Center. More than $21 million has been raised by Closer to Free riders since 2011.

Register and get additional ride details at Closer to Free Ride. You can also make a donation to a specific rider, a team or the event itself.  

What’s hiding in your family tree? 

Certain cancers — including colorectal, breast, ovarian, and melanoma — can pass from one generation to the next. Cancer Genetic Counseling, a new frontier in the fight against cancer, provides genetic counseling and testing to people at increased risk for hereditary cancer and helps them to make informed medical decisions.

If you have a family history of cancer on either your mother's or father's side and/or a personal history of cancer, look for the following risk factors:

  • Two or more family members on the same side of your family have had the same cancer
  • A family member was diagnosed with cancer at an unusually young age (e.g. breast cancer at 45 years or younger; colon cancer at 50 years or younger)
  • A clustering of related cancers (e.g. breast/ovarian, or colon/uterine) in the family
  • A family member carries a known genetic mutation (e.g. BRCA1, BRCA2, MSH2, MLH1) 

A genetic consultation includes:

  • A detailed review of your family and medical history
  • A risk assessment of the chance that the cancer in the family is hereditary
  • A discussion of the risks, benefits and limitations of genetic testing
  • An individualized schedule of screening examinations and discussion about cancer prevention

Are you a candidate for cancer genetic counseling?

Genetic consultation is available through the Cancer Genetics and Prevention Program of Yale Cancer Center. For more information about genetic consultation, call 203-200-4362.

Take a walk with YNHH doctors

Take a walk and chat with local healthcare providers as part of Yale New Haven Health’s Get Healthy Walk ‘N Talk with a Doc. Walks are every Saturday from now through Sept. 25 at the Farmington Canal Greenway Trail in New Haven. All ages and fitness levels are welcome. 

Please arrive by 8:45 am on each walk day. Walks begin at the entrance on the corner of Shelton Avenue and Starr Street and last approximately one hour. Masks are required. Walkers will follow social distancing and safety measures. Parking is available at New Freedom Missionary Baptist Church, 280 Starr St., New Haven. For more information, email Andy Orefice or call 203-688-5671. 

Online classes for meditation and yoga 

Yale New Haven Hospital patients can relax, renew and rejuvenate in the comfort of their own home with specially designed classes offered online through Zoom.

The free classes include gentle and restorative yoga, guided imagery meditation, Zumba Gold and T'ai Chi/Qigong. They are designed to guide you through stretching and strengthening exercises, mindful breathing practices and systematic relaxation that results in an overall improvement in health and well-being. No previous experience is necessary.

Classes are held throughout the week. Register on our events page.

Smilow patients should check with their treatment team to see if exercises are appropriate during treatment. 

MyChart: Your medical information in one place

MyChart gives Yale New Haven Health System patients secure, online, 24/7 access to portions of your electronic medical record (EMR). There you can see your medical history, most laboratory and test results, appointment information, medications, allergies, immunizations and other health information. You can schedule appointments with your doctor, request or renew prescriptions, pay your bill, and send and receive secure, confidential electronic messages with your doctor’s office. Sign up by using the activation code on the after-visit summary from your doctor, request a MyChart Activation Code at your next appointment or visit mychart.ynhhs.org and tap or click on “New User?”

Find a Doc at YNHH

YNHH provides free information about and referrals to more than 2,600 affiliated physicians 24 hours a day. Call 888-700-6543 or visit our Find a Doctor feature on the hospital website for information on physician specialties, office hours and locations as well as insurance plans accepted. Many of our physician practices offer telehealth video visits for your convenience. YNHH physicians represent more than 70 medical and surgical specialties and subspecialties, including internal medicine/family practice, obstetrics/gynecology, orthopedics, pediatrics and psychiatry.

Make a lasting impact at YNHH

Help support the mission of Yale New Haven Hospital with a donation! Your contributions support vital programs, services and facilities within the hospital and help keep Yale New Haven at the forefront of innovative treatment. When you make a gift to YNHH, you are part of the advanced medicine and compassionate commitment that touch so many lives in our community. 

Billing questions?

Yale New Haven Hospital offers financial counseling to patients and families. Spanish-speaking counselors are also available. To make an appointment with a financial counselor, call 855-547-4584.