How the Delta Variant Overtook Missouri: A Lesson for the Rest of the U.S.

Missouri's struggles to contain the Delta variant suggest that the rest of the U.S. is in for a rough few weeks

How the Delta Variant Overtook Missouri: A Lesson for the Rest of the U.S.
maps tracking the spread of COVID-19 began showing a cluster of cases growing in the middle of the country. The epicenter lay in Missouri, particularly its more rural and remote areas. At the time, Missouri had something that other states didn’t: the Delta variant.

To be fair, the highly transmissible Delta variant had at that point already crept into other states. But it had truly established itself in Missouri. Among the 25 states the U.S. Centers for Disease Control and Prevention (CDC)’s website reported on at the time, Delta was showing up in less than 5% of swab samples in 15 of them. Colorado had the second-highest rate, at 12%. But Missouri was something else: nearly 30% of COVID-positive swabs were linked to the Delta variant. As of July 28, Missouri is reporting a seven-day average of new daily cases of 27.3 per 100,000 people, up from 5.4 during the first week of May, before Delta took hold there.
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In the weeks since, the Delta variant has become, or is on the brink of becoming, the dominant variant in every region of the continental U.S. The CDC is now reporting that Delta is so prevalent in the region encompassing Missouri, Iowa, Kansas and Nebraska that it’s now effectively the only variant, accounting for an estimated 96% cases. These states, and others with high levels of Delta, including Florida, Louisiana and others in the Gulf region, are now seeing overall cases spike.

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As the first U.S. state to suffer a major Delta outbreak, Missouri is a harbinger for other regions of the country that also have low vaccination rates and a mix of rural areas and small towns with a handful of mid-sized cities—which is to say, much of the country. The following charts demonstrate the strength and swiftness of the Delta strain in a state particularly vulnerable to an outbreak—and why our efforts to stay ahead of the virus aren’t working.

Where Delta took hold

Missouri has a relatively low vaccination rate, with 41% of the population fully dosed as of July 26, compared to about 50% nationwide and 67.3% in Vermont, the most-vaccinated state. But Missouri’s vaccinated population isn’t uniformly distributed across the state. Boone County, home to 180,000 people and the state’s largest university, has the highest vaccination rate among Missouri counties at 48%. Places with larger populations like Kansas City (39%), St. Charles County (45%) and St. Louis County (also 45%) help pull the overall state vaccination rate higher.

But in smaller and generally more rural counties—that is to say, most of the state’s geographic area—vaccination rates drop off, leaving residents vulnerable. The below chart, which includes counties and cities with more than 20,000 people (collectively accounting for nine in 10 Missourians), shows that places with the highest COVID-19 case rates tend to be smaller counties with lower vaccination rates.

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What this chart doesn’t show is how much the Delta variant is to blame for Missouri’s high overall case rates. That’s because not all positive COVID-19 test swabs get sent to the lab for genomic sequencing—health agencies use only a random sample of swabs to estimate a variant’s prevalence. So there’s no way to know for sure who had the first Delta case in the state, or to do contact tracing specifically for Delta-infected people.

It ‘hit the gound running’

But there are other ways to track the Delta variant’s spread in Missouri and elsewhere. Marc Johnson, a professor of molecular microbiology and immunology at the University of Missouri, is a kind of COVID-19 detective, tracking where and when variants are popping up around the Show-Me State by analyzing samples from sewersheds across Missouri on a weekly basis. (Sewersheds are land areas that share a common wastewater system, and can be a useful epidemiological tool.) While Johnson can’t identify the first people who carried the Delta variant in Missouri, he knows roughly where they used the bathroom. Wastewater can also be a predictive tool, because the coronavirus can shed genetic material in feces days before an infected person shows symptoms—or meets up with friends at a bar.

On May 10, Johnson’s team found the Delta variant in Missouri for the first time, in a sample taken from a sewershed encompassing the Ozark town of Branson. Branson’s population is only 11,000, but it’s a hotspot for concerts and other summertime amusements that draw more than 8 million visitors annually, according to the city’s Convention and Visitors Bureau. For Johnson, that meant one thing: the Delta variant was in Branson, but it wasn’t going to stay there.

Read more: The 6 Factors That Will Determine the Severity of the COVID-19 Surge in the U.S. This Fall

It’s just a theory at this point that Delta’s intrastate journey was fueled by people visiting and then leaving Branson. But the variant popped up in other sewersheds a week after his team first discovered it there, including up north in Linn County, where the virus “hit the ground running,” says Johnson. With a population of just 12,000, Linn has recorded 250 cases since the beginning of May, accounting for nearly a third of the total cases recorded there since the start of the pandemic 17 months ago.

“It was on national news how bad it was there,” says Johnson. “I was looking at whether that was going to be the same in other places. And it generally was. Almost everywhere where the Delta appeared—there was sometimes a delay, sometimes it was three weeks later—but then, pretty much without exception, it did eventually lead to this big increase.”

Jessica Rinaldi—The Boston Globe/Getty ImagesA performer spreads his arms out to those seated in The South as he divides the room of diners at Dolly Parton’s Stampede into factions of North and South which will cheer on their teams as they compete in various events like barrel riding, chicken chasing, and pig races in Branson, Mo. on July 17, 2021.

Given that the earliest upticks were happening in more rural and less vaccinated areas, Johnson initially thought that the virus was “picking and choosing” places to infect based on vaccination rates. But by early June, Delta appeared in more populated hubs like Springfield and Joplin, which have relatively higher vaccination rates—and local cases then ticked up.

The chart below shows all of the places where Johnson’s team is testing. Although the individual lines are hard to track, the trend is clear: once Delta rolls into town, it spreads fast, even in some places with relatively higher vaccination rates.

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For example, Boone County, Missouri’s most vaccinated, is now reporting an average of 32.6 new daily cases per 100,000 people, compared with just 2.2 on Memorial Day. The city of Joplin had knocked its average daily count down to 3.4 cases per 100,000 in late March, but hasn’t dropped below 40 in the last month.

To Johnson, the spikes in even relatively highly vaccinated parts of Missouri are a reminder that, while the shots can reduce COVID-19’s severity, they can’t prevent 100% of infections. “People need to understand that the vaccines are extremely good at keeping people out of the hospital, at keeping people alive, but they’re not armor,” he says. “You can still be infected and can still infect other people. That doesn’t mean you can’t live your life, but if you don’t want to get sick, you can still use the easy precautions of wearing a mask if you’re in a crowded place, or avoiding indoor venues where people are screaming without masks on.” Indeed, the CDC’s newly revised mask mandate is based on thinking similar to Johnson’s.

Vaccinations are not keeping up

When COVID-19 vaccines started rolling out in the U.S. last winter, a pattern developed in Missouri, as it did elsewhere: each time the state expanded eligibility, eager people who were waiting to qualify would rush in. Then the numbers would drop off until eligibility expanded again. The last such bump was just after May 13, when people between the ages of 12 and 15 first became eligible.

But in early June, the number of people getting their first shot had fallen to levels not seen since the earliest days of the rollout, when supply was limited and appointments were hard to come by. In part, that’s because the virus appeared to be under control, reducing people’s sense of urgency. Missouri was at that point reporting fewer than 300 new cases a day, giving the appearance that the virus was being snuffed out—even though Delta was already circulating.

As the chart below shows, Missouri’s vaccinations are on the rise again. And this time, it’s not because of expanded eligibility—it’s because people who have been eligible for months yet remained on the fence are finally coming around, possibly out of fear of the Delta variant.

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A closer look at the summertime uptick shows that people all over the state are now getting their first shots—including in places with lower vaccination rates and higher case rates. While that’s good news, it’s not entirely a reason to celebrate. Even given the recent uptick, the gap between Missouri’s most protected and least protected areas remains staggeringly wide; the counties with above-average case rates have lower initial vaccination rates than counties with below-average case rates had two months ago.

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For now, Delta is hammering some pockets of the U.S., like Missouri and nearby states, far more so than others. But cases are rising across the country, suggesting we may be in the midst of yet another wave, especially in under-vaccinated areas. And when the virus is allowed to spread, it has an opportunity to mutate into new strains, which could prove even more capable of evading our vaccines. The Delta surge is also unlikely to die out before the school year, when millions of children—many of them unvaccinated—will be mingling together in classrooms. More and more employers, meanwhile, are demanding remote workers return to the office, though some are mandating vaccines or testing. With so many factors in flux, it’s impossible to predict how the U.S. Delta surge will play out. But if Missouri offers any lesson for the rest of the country, it’s that it’s far from time to let our guard down.

Source : Time More   

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‘It changes your relationship with food’

After suffering a severe leg injury, a Michigan man turns to a culinary medicine cooking class to focus on his health.

‘It changes your relationship with food’

In February 2020, while running through the Atlanta airport to catch a flight, Steve Johnson noticed a severe pain in his calf.

“I had 22 minutes to get between the gates in Terminal A and Terminal D,” Johnson said. “I made it, but I had some challenges in the process.”

The New Era, Michigan, resident journeys extensively for his job, so he’s well accustomed to the rigors of travel. But as he boarded this particular flight and took his seat, he couldn’t ignore the leg pain.

Later, he met with a doctor.

“’You’re going to be down for at least six weeks’—that’s what the orthopedic surgeon said,” Johnson said. “And he was right almost to the day.

“My weight reached 250 pounds and I wasn’t able to work it off with exercise. I was literally down for six weeks with the calf injury.”

COVID-19 restrictions went into effect shortly after his injury, further limiting his ability to stay active.

“I had some challenges during COVID, like everybody,” he said. “I developed bad habits over time. I’ve always been overweight, but I hadn’t been in the Class 1 obesity category before.”

With the leg injury, he didn’t like where things were headed. He knew that if he wanted to keep his weight in check, he’d have to do it by way of diet.

So he enrolled in a culinary medicine cooking class program.

Learning the steps

Johnson, 49, likes to cook.

When he saw information about a culinary medicine cooking class program offered through Spectrum Health Ludington Hospital, where he works part time as a pharmacist, he grew intrigued.

“I took it the first time because it looked like a neat class and I wanted to learn healthier cooking,” Johnson said. “I’ve always enjoyed cooking, but growing up we rarely ate healthy.”

He took the program in the fall of 2020, but missed a class due to travel. He took the program again in the spring of 2021.

In addition to working part time at Spectrum Health Ludington and Gerber Memorial Hospitals, Johnson works full time for a pharmacy management company.

The spring and fall classes were offered virtually, with participants cooking at home during each class. They learned new skills and used ingredients provided through a grant from the local health department.

A registered dietitian and culinary medicine chef led each class, operating from the Spectrum Health Lifestyle Medicine teaching kitchen at the Grand Rapids Downtown Market.

“I absolutely loved it,” Johnson said. “Instead of watching somebody cook in a test kitchen, it teaches you to do all the steps for yourself.”

Many of the class participants experience positive results from the program, said chef Elizabeth Suvedi, manager of the Spectrum Health culinary medicine program.

“It’s pretty cool to hear the participant’s feedback,” Suvedi said. “From feeling more confident with cooking, to understanding the health benefits of eating healthier, it is inspiring to hear stories such as Steve’s.”

The program is also bringing people together.

“We get a lot of feedback that people also enjoy quality family time, being together and the bonding that happens when you’re in the kitchen,” Suvedi said. “Not only the social time, but the cooking skills and health benefits that result for the entire family.”

Positive results

The lifestyle changes—eating right, exercising again—has Johnson feeling great.

“It changes your relationship with food,” he said. “I’ve lost 30 pounds, which is great. And I haven’t really had to give up anything to do that, which is also great.”

At each cooking session, a registered dietitian provides practical information on vital nutrients, portion control, colorful plates and reading nutrition labels.

“The focus is on optimal health and ensuring what you’re eating are things that will help your overall health,” Suvedi said. “It’s being mindful about staying away from processed foods, added sugars, fried foods and red or processed meats.

“It’s learning how to cook with less oil and to incorporate more fruits, vegetables and whole grains into your diet – in a way that’s also delicious.”

Class participants get recipe cards to help them make a variety of healthy dishes.

“There’s no excuse not to put the material into practice,” Johnson said. “Having the recipe cards gives you a quick and easy guide to the program and helps you remember some of your favorite things.”

Top on his list? Bell Pepper and Chicken Skillet.

“This is by far the most awesome recipe from the program,” he said. “It uses so little chicken, but it fills you up. This recipe tastes fantastic. It creates enough to literally feed an army.”

He passed the recipe along to his mom, who now cooks it about once a week.

“Just from me taking the program and sharing the recipe, I think six different people make this dish now and absolutely love it,” Johnson said. “So it has a wide reach in terms of making the community healthier.”

Working ahead

Originally from East Lansing, Johnson lives on a bluff overlooking Lake Michigan—a home previously used as a vacation home by his parents. He often takes an early morning walk along the beach to start his day.

“Every morning I try to walk between two and three miles,” Johnson said. “Exercise is paramount—and not getting injured again is paramount.”

Johnson added an exercise room onto his garage to make fitness a priority.

“I haven’t weighed this little since my freshman year of college,” he said. “The goal for me is overall health, because the weight impacts your knees, it impacts your cardiovascular health. And so if I want to enjoy a healthy retirement, which I do, then it’s important to act now and make some changes so I can.”

He’s now at 219 pounds. His goal is to reach the overweight category versus the obese category, which for him would be 215 pounds.

“I just missed it by a hair,” he said of his last official weigh-in.

Johnson likes to work ahead, prepping meals and sometimes freezing them for quick and easy cooking later to accommodate his busy schedule.

“It’s proof that you can eat and do things that are healthy with a little planning,” he said. “The program helps you to make better choices that are still tasty and delicious.”

Johnson has become an advocate for the culinary medicine cooking class program.

“It’s a phenomenal way to practice skills you already know, most likely, but you’ll pick up a few new things,” he said. “It’s a series of small changes that help you make a big difference in your overall health. The culinary medicine team helps you put all of that together.”

Source : Health Beat More   

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