IU Health specialist: ‘We have an epidemiological situation that is worsening’

The daily number of COVID-19 cases in Indiana has climbed nearly 300% in the past month. COVID-19 hospitalizations across the state recently reached a seven-week high. And a growing number of hospitals, companies and governmental agencies are now requiring that employees get vaccinated.

On Tuesday, the Centers for Disease Control recommended that people should mask up in indoor public spaces—even if they’re fully vaccinated—in communities where the coronavirus has substantial or high transmission, which includes most of central Indiana.

To help make sense of the news, IBJ talked to Dr. Cole Beeler, an infectious disease specialist at Indiana University Health. The discussion has been edited for length and clarity.

Q: Can you explain why the CDC is recommending masks indoors even for people who have vaccinated?

A: The rationale behind it is that the U.S. is predominantly dealing with the delta variant right now. More and more data is coming out showing that breakthrough infections with delta are more likely than any of the other variants.

We have an epidemiological situation that is worsening, with positivity rates going up, with hospitals and ICU stays going up. We need to throw everything that we know that works against the virus so that we can potentially save some lives.

And we’ve had good success with masks in the past. And since even vaccinated individuals can be infectious, I think that masking is a good recommendation at this time.

Q: What are you seeing at Indiana University Health now, as the delta variant continues to spread? Are these cases more serious than the original strain?

A: No, it’s not seeming like it’s more deadly or more morbid at this point than the original strain—at least based on what I’ve been seeing. What I would say is that I think some of our other local hospitals are experiencing very, very sick patients with COVID, almost all of them are an unvaccinated individuals.

And just like prior strains, it can make you very, very sick and kill you. It just doesn’t seem to be any more deadly, I think, than previous strains. But it is still early.

Q: Are you seeing any evidence of this strain is more contagious than the original strain?

A: Yes, it’s very much more contagious. It’s probably twice as contagious [as] the original strain. probably 50% more contagious than the alpha variant from the United Kingdom.

So that’s why we’re seeing this strain dominate across the nation right now. It’s the most common strain in Indiana, because it’s just so much more infectious than all of the other strains that we have so far. And it’s really outcompeted all the other COVID variations that are out there.

Q: It’s mostly affecting the unvaccinated, correct?

A: Yes. A very, very large percentage of the people who are getting sick from this are in the unvaccinated cohort of Hoosiers. And those are certainly the ones that we’re seeing in the hospital.

But that’s not all of them. And we are seeing breakthrough infections from vaccine, even though it tends to be not severe symptoms. There are episodes of reinfection that are happening with this even after natural infection.

And we are seeing it hit age groups that tend to have done previously well. Younger age groups seem to be going to the hospital very sick.

Q: Would you be able to calculate or describe the risk of becoming infected if you’ve been vaccinated?

A: The chance of breakthrough infection with delta after vaccination, I believe, is like 0.1%. So it’s still very low. But it does come with risk. There is a significant amount of the population even when they get infected, that might have something bad that happens after them. It just tends to be a lot rarer in the vaccinated population that they’re going to be hospitalized.

That risk if you’ve been vaccinated, and you have a breakthrough infection with COVID, it’s like 0.005% chance risk of hospitalization. The risk of death would be even lower than that.

So it’s very much worth getting the vaccine because even though breakthrough infections are possible with the vaccine—as is possible with any vaccine—the vaccine still does protect you, it seems, against the most severe manifestations of COVID, which is why it’s never too late to get vaccinated. We want to continue to push that as much as we can.

Q: Are we heading back to the dark days of 2020, with hospitals getting flooded with COVID patients, businesses shutting down and people hunkering down at home?

A: I honestly don’t think so. Thankfully, the vaccine, even though it might not work as well now as it did against previous variants, is still very effective. It’s better than a flu shot and still has retained its effectivity to protect against hospitalizations and ICU.

So I think there’s still a very strong case to be made that if we could get as many people vaccinated as possible, we wouldn’t see really any surge in the hospital cases.

I don’t think we’re going see a huge surge. I don’t think our curves are going to look like what they did over the winter. But I do think that will continue to go up over the next few weeks.

Q: So what can workplaces do right now, aside from continuing to encourage social distancing and mask wearing?

A: As much as they can do to promote the vaccine, I think that’s probably the strongest tool. I don’t think that distancing and masking are even close to the protection that you get from the vaccine.

Q: Less than half of Indiana, about 44%, has been fully vaccinated, ranking us 36^th among all states for per-capita vaccinations. Why are we so low?

A: I think it’s really tough. I think from a public health perspective, we’re all trying as best we can to get information out there.

I do think there’s still a lot of hesitant people that are just going to be tough to convince to get vaccinated. I think the best thing that we could possibly get would be FDA approval for the vaccine, which is taking its sweet time. That, I think, would be the hugest boon.

Q: How do you persuade someone who hasn’t been vaccinated yet to get a shot?

A: I really think the point that we’re at right now is person-to-person conversations. That’s the best way that you’re going to convince someone. It’s not going to be mass communications. It’s not going to be pressuring or belittling people. I think we’re at the point where the people who [are] unvaccinated right now really have to hear from someone that they trust that the vaccine is safe before they’re going to be willing to do it.

Q: IU Health was the first major hospital system to announce that its employees must be vaccinated to protect patients and coworkers. Since then, several other big health systems here have followed suit. Do you expect more hospitals to get on board with this requirement?

A: I do. The dominoes will continue to fall, especially since the big systems are doing it. There have been multiple agencies, and not just governmental agencies but professional medical societies, that have come out saying that the only real thing that you can do from a moral perspective in hospitals is mandate a vaccine for your employees. So I expect with all of the push, we’ll see more and more of our hospitals mandate vaccinations.

Q: What are the most common objections you’re hearing about the need to get vaccinated?

A: A lot of the stuff that I hear come up frequently is: “This is new technology. I need to wait for more time.” The average Hoosier who hasn’t gotten vaccinated, that’s probably their opinion. They don’t want to jump right in in case there’s bad stuff that they’re going to discover.

But what I would say is that the technology for making this vaccine has been used since the 1960s. We have extremely robust data and millions of patients over months and months and months with even this individual vaccine and side effect profile for vaccines, we would have seen it by now.

I think we just have a lot more hesitancy in this state. And I think that we value freedoms, and we value people’s decision [about] what’s going be best for their body.

I think the really challenging thing here is that each person that’s not vaccinated, even though they may do OK, they may unknowingly spread the virus to someone who, despite their best wishes to protect themselves, is not able to maintain an immune response and doesn’t do okay.

Q: The longer this goes on, the more mutations we’ll have to deal with. Right?

A: Yes, and I’m just sick of dealing with the mutations to be honest with you. I feel like it’s only going to be a matter of time [that] the viruses continue to experiment with each vulnerable patient on how to bypass the vaccine.

I think worst case scenario moving into the fall and winter would be us having to do this all over again, trying to figure out how to mass vaccinate, to try and push that education again, deal with overburdened ICUs.

As much as we can squelch this virus with global immunity as fast as possible, the less chance it’s going to be that it’s going to be able to mutate and therefore the less chance it’s going to be that it’s going to overwhelm us.

Q: Any main takeaways?

A: My main takeaway is it’s entirely appropriate to be vaccine hesitant as a Hoosier. I think that’s very fair. But I don’t think it’s OK to be vaccine hesitant and to not ask questions and to not pursue  reliable sources to try and figure out if vaccination is the right thing for you.

So that’s what I would really encourage the reader to do. If you’re uncertain about it, talk to multiple different sources, read as much as you can, use science-based information in order to help make the right decision for you.