Experts Address Masking (Again), Delta Variant and Convincing Vaccine Skeptics

Experts Address Masking (Again), Delta Variant and Convincing Vaccine Skeptics
Cameron Wolfe, M.D., and David Montefiori, Ph.D., spoke Wednesday to the media

The rampaging COVID-19 Delta variant has become a lethal threat in the U.S. and elsewhere and threatens to undo much of the progress made over the last several months as vaccines led to a drop in hospitalizations.

With infection rates rising again, two Duke health experts spoke Wednesday about the Delta variant, vaccination efforts, a return to masking, and how to convince skeptics to get the vaccine.

Watch the briefing on YouTube.

Here are excerpts from a virtual media briefing with reporters.


On COVID hospitalizations rising

“At least in the next couple of weeks we would anticipate that number going up.”

“If you look at the hospitalization trend in North Carolina, a couple of days ago we crossed 1,000 people again for the first time in quite a few months. It is baked into the system that number is going to go up for at least a couple of weeks … all of those people who were exposed yesterday for example are not likely to get sick for a couple of days.”

“With the Delta variant, the timeline is condensed a little bit. You’re in fact more infectious more quickly with this, so we’re seeing a hospitalization impact more quickly.”


On the current vaccine technology

“These are not brand new vaccines. They have in fact built on technology that has evolved and built on science that has evolved over decades. Even with relatively newer designs, even they have been building to this point for 10 to 15 years.”

“We didn’t begin this in 2020. This is a road that has come to this point over many, many decades.”


On Delta causing most current hospitalizations

“It’s definitely true that the Delta variant is the most heavily represented in most if not all of our hospitals. It’s more infectious. You get sick a little quicker. And frankly there’s a severity that comes with this variant that is a little more severe. It makes you more sick.”


On masks in schools

“Masking was in fact a very simple and effective strategy in the context of schools.”

“At the end of the day, there’s this unspoken value in having kids back in school. I don’t think anyone doubts that’s the right place for their own education. But we have to be able to do that safely.”

“Again, we got used to masks last year. We were all familiar with how to wear them. We were all capable of wearing them in ways that made school actionable.”


On morale among health care workers

“To see large numbers of unvaccinated people in the hospital, really struggling, and often at that point in their decision-making, quite regretful for the situation they’ve come to find themselves in, that takes a toll. I’d be wrong to say some of my nursing staff, some of my medical staff and colleagues haven’t felt fatigued and internalized some of that struggle. That’s real.”


On virus fatigue and need for patience

“I think we’re all fatigued, to be honest. I think one of the things we tried to tell people very early on, and I hope as this has evolved people have understood, is that we are watching evolution in progress. Because of that, because this is a new virus for us, this will continue to ebb and flow in ways that are hard for us to predict, try as we might. If we’re going to become better at trying to respond, we need to be prepared to have a little bit of give and take in the types of mitigation efforts we have.”

“That flexibility is in fact really important. If we did not have the ability to flex and give and become more stringent or relax when we need to, this would be much more difficult to control.”

“It’s because we globally don’t have this under control … and we have not reached a point where we’ve eliminated it domestically, that we have to have that flexibility. It would be wrong of me not to beg people to be patient with scientists.”


On people being infected, changing opinion on vaccines

“That’s absolutely occurred multiple times. I wish it doesn’t take an infection to change someone’s minds. But you’ve seen this across the country.”

“It does change people’s opinion. There’s no question about that. There’s nothing fun about being hypoxic in a hospital. It’s an awful situation to face.”

“If those people come out of that experience and are proponents for aggressive vaccination campaigns, they can really be influential.”



On the Delta variant

“It’s important to recognize this virus has been evolving since the very start of the pandemic to become more and more contagious.”

“The Delta variant is very rapidly is outcompeting the other variants. It is now at a level where it is much, much more contagious than it was before. Unless we can shut this pandemic down, it’s possible this virus will become more contagious and more of a problem.”


On messages to vaccine-hesitant people

“There are multiple reasons why people have hesitancy to get the vaccine. When I talk to people, I first try to find out what their reasons are for hesitancy. Most of the times it’s based on either a lack of information or incorrect information. One of the things I often hear from people is they’re concerned about the new technology. It hasn’t been around for a very long time and they have some fears about it.”

“What I tell these people is vaccines have been around for a long time. As with most technologies, vaccine technology has evolved and improved over the years. We now have relatively new technologies for COVID vaccines that have been administered to billions of people.”

“You can think of these new technologies as new iPhones of vaccines. You want to be one of the first in line to get one while supplies last. Fortunately, supply hasn’t been an issue for COVID vaccines. They’re readily available and they’re free.”

“Most people wouldn’t turn down the opportunity to get a free iPhone or internet service; why turn down an opportunity to get a free vaccine that could save your life or the life of a loved one and help bring an end to this pandemic?”


On how many shots in arms is enough for herd immunity?

“We’re still learning what that number is. When do you reach this so-called herd immunity that you really start to turn things around. What we’re learning from the Delta variant is we haven’t reached that point of herd immunity yet.”

“It looked like we might have before the Delta variant came along, and that changed the dynamics.”

“We need to be more rigorous in our approach to vaccinating people. We need to vaccinate younger people, too.”

“The one nice thing about the Delta variant is that the vaccines still work against it.”

“This Delta variant has evolved to become more contagious. But it has not evolved to the point yet where it’s escaping our vaccines to a substantial degree.”


On breakthrough infections

“They do occur. What we know is that those are mostly mild cases or asymptomatic cases. …  But people who have been vaccinated, there is a chance they can get infected. They tend to be mild cases. But those people are shedding virus and they are capable of transmitting. But they’re shedding less virus than an unvaccinated person and they’re shedding for a shorter period of time. They’re contagious, but far less contagious than a non-vaccinated person.”


On the Delta variant’s danger to kids

“I’m not aware of any data that would suggest (children) are any more susceptible to the Delta variant than adults are.”


On whether people who have had COVID need the vaccine

“Yes, they do. About a third of people who have been infected don’t mount a very strong immune response against this virus. These tend to be people who were asymptomatic or had mild symptoms. They don’t mount a very strong immune response. Once they get the vaccine, their immunity goes up way high. They have really, really strong immunity. I strongly recommend people who have been infected to get the vaccine and to get both doses if it’s a two-dose vaccine.”


How vaccines limit virus outbreaks

“Every time the virus gets transmitted from one person to another, it has an opportunity to mutate, to change. The more we can shut this pandemic down and slow down the spread of the virus, the less opportunities it’s going to have to mutate and change and become more contagious. The mutation rate is dependent on the transmission rate, how many times the virus has transmitted from one person to another. How long it’s been continuing to replicate in the human population. That’s what drives mutations and allows the accumulation of multiple mutations to occur.”


On boosters

“I do think it’s a direction we’re headed to. The question of when to boost and what to boost with is still an open question.”

“I think we’re probably getting very close to a time where we’re going to know if and when a boost is necessary. I believe boosting will be necessary. It very likely going to strengthen the immune response against the variants.”


On likelihood of a more resistant variant emerging?

“Those are questions we’re trying to get answers to. Is it going to be possible for this virus to mutate in a way that it will really, substantially escape our vaccines and still survive?

“No one has identified a variant like that. Hopefully the virus will not be able to evolve to completely evade the vaccines. But it’s an open question that’s being studied extensively right now.”


The experts:

David Montefiori, Ph.D.
David Montefiori is a professor and director of the Laboratory for AIDS Vaccine Research and Development at Duke University Medical Center, where he has been studying the effectiveness of COVID-19 vaccines against new variants of the virus.

Cameron Wolfe, M.D.
Cameron Wolfe is an infectious disease specialist at Duke Health and an associate professor at the Duke University School of Medicine. His areas of study include infectious diseases and biological and emergency preparedness for hospital systems.