Delta Variant Questions Answered For NJ Parents As School Resumes

NEW JERSEY — As students prepare to return to in-person learning Monday throughout most of the Garden State, talk about the rising tide of delta variant cases has many parents and educators on edge. But knowing the facts may help.

Patch spoke with a top doctor who works directly with the coronavirus, to answer some tough questions about masking, vaccines and children's immune systems.

Dr. J. Stacey Klutts serves as special assistant to the national director of pathology and lab medicine for the entire Veterans Affairs system, with a specific role in advising on elements of COVID-19 testing for the system.

Klutts sees firsthand how this virus is changing, and he himself became an internet viral sensation when he shared a Facebook post breaking down a few important points about the delta variant. We followed up with him to get some answers of our own.

Why is this variant making the virus much more infectious?

The specific mutations in the spike protein (the knobby parts on the outside of the coronavirus) have essentially made it more sticky — allowing it to better survey the surface of a human cell and to more strongly bind to the surface of the human cell, Klutts said.

It is so sticky that Klutts compares the original variant of COVID-19 to syrup and the delta variant to Gorilla Glue.

"Most people understand that syrup is sticky, but Gorilla Glue is ULTRA sticky and at a completely different level," Klutts said. "I wanted to make sure it was visually clear we are dealing with a sort of a different level of behavior from the pathogen, if you will. It's not like the original version we were dealing with early in the pandemic."

How infectious is this virus?

"If you just take the ability of this virus to infect an unvaccinated person versus a vaccinated person and compare it to the same scenario with the varicella virus which causes chickenpox and its ability to spread from person to person … the chickenpox virus might be a little bit better, but they are both in the same general ballpark. They both have a remarkably high infection rate. It's incredibly infectious," said Klutts.

There are only three diseases that Klutts says have any historical relevance — chickenpox, measles and the coronavirus.

"Those three are up there in kind of their own category," Klutts said. "And measles being even further, more infectious. But again, this virus is amazingly infectious to a very high extent."

What would you say to some who say people or kids should be exposed to this virus to build up their immunity?

"We started vaccinating 20 years ago for chickenpox and 40 or 50 years ago for measles. We don't just let our kids get measles and all of the ramifications and long-term health effects that come with that," he said. "We don't just let our kids get chickenpox anymore with all of the potential side effects that come with that, including shingles and the things that come later in life. We learn from our mistakes in the past and found ways to prevent that level of disease in our population."

Specifically, with children, Klutts said there have been a lot more pediatric COVID-19 patients hospitalized than there were in the earlier stages of the pandemic.

"I think letting this burn through our pediatric population would be horribly tragic. We would have a lot of kids that would suffer and or die," said Klutts.

Does the vaccine help stop the virus?

The vaccine itself does not actually prevent that binding interaction, said Klutts.

"So the virus is in the air, hits the back of someone's throat. The spike protein is then going to find on the surface of the human cells some of those ACE2 receptors — and not every human cell has those receptors — but the cells in the back of the throat do. So it binds to those receptors and gets inside the cell. At that point, the virus does what the virus does, which is basically use human machinery to replicate itself. So you have all this viral replication happening inside the cells at the back of the throat; then at some point the virus gets released to infect other cells in the area and then also to be breathed out to be transmitted to someone else," said Klutts.

However, the very first step is the sticking process. And this is where the vaccine comes in.

"Now what the vaccine can do is that once the virus gets in and gains entry. If you've ever seen a virus before or been vaccinated, your immune system says, 'Wait a minute here. I've seen this spike protein before. This isn't something my body likes. This is foreign.' So you have a preformed antibody response that then just destroys the virus, prevents the virus from spreading in your own body, and actually destroying some of the virally infected cells ... so the virus can no longer replicate."

If the vaccine works, why do we need a third shot?

"Just like with any vaccination, you are eventually going to have immunity that wanes. And how long the immunity lasts to any particular pathogen is going to be dependent on two different factors. One is a host factor. How long does the antibody hang around in the human? And the other is a viral factor. How fast is the virus changing to where the response you got to the vaccine — how long does it stay relevant to the virus that is circulating in the community?" said Klutts.

The hope was the booster would only be given annually to help train our immune systems on how to deal with the virus. But the virus is changing very quickly.

"I can tell you the virus is changing constantly. What we were seeing three weeks ago is a little bit different than what we are seeing now. It's all Delta, but there are these slightly different versions of Delta. They are not mutations that really make any difference, it's not things that have any impact on its behavior of infectivity. But if looking at the entire virus, you can see things that are changing. It's definitely continuing to vary, and it will continue to vary over time," said Klutts.

He noted this is similar to the flu.

"That's why we need to have a different influenza vaccine every year because the virus just mutates and the viruses vary," said Klutts. "We just have to do our best to keep up with them."

If you are vaccinated, why do you still need to wear a mask?

"Because a vaccinated person does not have any way to prevent the short-term infection," said Klutts.

The virus can still cling onto a vaccinated person's cells in their throats for about five days and be spread.

"The difference is the vaccinated person is not getting horribly ill. We are not seeing very many hospitalizations at all in the vaccinated persons. These are all exclusively or a very large percentage of the hospitalized patients, and the patients that are dying of COVID are unvaccinated. So the vaccine itself is doing its job protecting us from the severity of the disease," said Klutts.

The Swiss cheese model?

Layering up the vaccines with masks is the best defense, said Klutts.

He compared it to the Swiss cheese model. In health care, it refers to a series of barriers in place between a person and a hazard. Barriers in this case include social distancing, masking and vaccines. While each has a "hole," the other barriers lower the overall risk. The presence of holes in one of the barriers, or slices of Swiss cheese, does not normally lead to a bad outcome; but when by chance all holes are aligned, the hazard reaches the patient and causes harm.

"Even though we know the masks by themselves aren't perfect, but the vaccine plus the mask just add layers of protection," said Klutts. "They all have some holes, but if you start lining up the different layers, eventually those holes all get plugged."

A tsunami wave lies ahead?

Klutts says he sees a tsunami wave is on the horizon in terms of an increase in coronavirus cases. But says there is time to prevent this.

"We are not too late," Klutts said. "There is a warning signal and being up in the north we are just seeing the very edges of this. It is starting to rise here. We are seeing more and more cases in this part of the country. The idea is simply to blast the tsunami warning and try to get people to that metaphorical higher ground, which is to try and get vaccinated and try to protect themselves from what is almost certainly coming our way."

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