HJNO Sep/Oct 2021

DIALOGUE 16 SEP / OCT 2021 I  HEALTHCARE JOURNAL OF NEW ORLEANS at, the risks of not getting vaccinated far, far exceed any risk of getting vaccinated. Editor Senator Cassidy, MD, said in a recent ABC interview when asked about the low vaccine rate in Louisiana that we’re not talking about the immunity rates that exist because of people already having COVID. Why is the vaccine being pushed over anti- body testing? Kanter The best evidence at this point sug- gests that the COVID-19 vaccines provide more robust and more durable protection against infection than natural immunity does. But that’s just looking at the data that’s out there and that’s compiled by the CDC. The other thing to say is people generally overestimate the degree of exposure that is out there. The CDC does routine surveil- lance for most states, looking at antibody tests amongst a representative sample of blood draws, and they publish this regularly every month or so. Louisiana has consis- tently been around 10–12% or so of people who are antibody positive for COVID. I think most people that think natural protection is going to save us here would have estimated that number to be higher. The other thing to say is a lot of folks a month, month and a half ago, who believe that natural protec- tion is all we need, assumed that we were out of the woods, and look what happened with Delta. So, I think we want to believe that we’ve had more exposures than we have and that that’s going to protect us, and that’s going to be all we need to return to normal lives and be safe in doing so, but the evidence at hand suggests otherwise. And, I would caution people against putting their family at risk to try and prove that point. Editor Isn’t the vaccine we are giving created for a variant of SARS-CoV-2 that is genera- tions-old in viral years? Even with its “warp speed” creation, do you think the current vaccines are the solution to herd immunity? Is it possible to have herd immunity for a virus of this nature? Kanter Well, I think it is, and we’re going to watch very closely what happens in Ver- mont. Vermont has about 80% vaccina- tion coverage right now, and the data just doesn’t seem like they’re experiencing any- where close to the surge of Delta that we are down here. I think we’re going to watch to see what happens. I don’t think they will, but we will watch, and we will pay atten- tion. It is true that viruses mutate, COVID is no different, and every time the virus rep- licates it mutates slightly, and these vari- ants are natural phenomenon with any viral propagation. But, the truth remains that the three vaccines we have available in the U.S. are still good matches for COVID, even the currently circulating Delta variant. Are they perfect matches? Do they provide 100% protection? Of course not. No vaccine provides 100% protection, but upward of 80 or 90% protection, they do. And that’s a fortuitous thing. There’s no guarantee that a future variant will remain a goodmatch for the vaccines. At the moment, that’s what keeps a lot of people up at night: what do we do when the next variant is not a good match to the vaccine? That’s scary stuff, but that’s not where we are now. The Delta variant remains a good match for the three vaccines that we have now, but that only benefits us if we take advantage of those vaccines. The more people that get vaccinated now, the less transmission there will be, the less opportunity there will be for new variants to arise. Editor Do you think that the current COVID- 19 vaccines could actually be creating a super strain? Then what do we do? Kanter No. There’s no evidence to suggest that, in fact, it’s quite the opposite. Trans- mission of the virus itself is what allows for new variants. The more the viral transmis- sion is left to occur, uncontrolled, the more that cases go up, the more likely it is that a future variant will arise, and by chance, there might be a future variant that is not a good match for the vaccine. It’s viral trans- mission itself that allows for more virulent strains to arise. Vaccinations reduce trans- mission and reduce the opportunity for new variants. Editor Can you speak to the Lambda variant for a moment? Kanter The Lambda variant was first iden- tified in Peru. We do have it in Louisiana. We’ve identified at least four patients that have Lambda. I’m sure we have many more that we just haven’t formally identified yet, as we have a number of other types of vari- ants here. One of the challenging things with these variants is it’s oftentimes diffi- cult to predict ahead of time what the vari- ant is going to do, or how much of a prob- lem it’s going to be. We were concerned about what was called then the UK variant, or B117, and now it’s called the Alpha vari- ant. We were concerned about variants from Brazil and South Africa, and those cause small increases in our transmission but not anything overwhelmingly substantial. For whatever reason, the Delta variant was dif- ferent, but I don’t think we knew that until we started seeing evidence of that. So, we do have Lambda, we have other variants and we’re going to have more in the future. Unfortunately, sometimes you can’t predict how significant a variant is going to impact your transmission until you start seeing what it actually does. Editor Louisiana got hit first and hard in the first wave. I think the second, Seattle may have been first, but it’s one of the first places to really get hit. Do you think that this Delta variant is just a continuation of Louisiana being first? Kanter It’s a continuation of our misfor- tune. But at this point, to some degree, we have done this to ourselves. But we had the misfortune of being on the leading edge of the nation’s initial COVID-19 outbreak back in March 2020. Unfortunately, we find ourselves back on the leading edge right now. Today, we have more cases per capita than any other state in the country, and we