It’s hard to imagine we won’t see a wave now that the B.1.617 Indian/Delta variant is spreading in the U.S. and less than half the population remains fully vaccinated. But it feels newsy that a Trump alum like Bossert would sound a discouraging note after Republican opinion has already shifted to “the pandemic’s over, everyone take off your masks.”

Note that Bossert’s not predicting a disaster, just a rise in cases of some degree. Studies show that the mRNA vaccines work against the Indian variant; we also know from CDC data that more than three-quarters of senior citizens have been fully vaccinated. The most vulnerable people won’t be washed away by the next wave that crashes down on the U.S.

But some adults who remain unvaccinated will. It’s only a question of how many. Watch the last few minutes of this clip then read on.

Even some vaccinated people will get infected by B.1.617 (and other strains, of course). But doctors who work in hospitals have noticed that their patients lately nearly all have something in common.

“I haven’t had anyone that’s been fully vaccinated become critically ill,” said Dr. Josh Denson, a pulmonary medicine and critical care physician at Tulane University Medical Center in New Orleans.

It’s been the same for Dr. Ken Lyn-Kew, a pulmonologist in the critical care department at Denver’s National Jewish Health: “None of our ICU patients has been vaccinated.”

Unvaccinated children, too, seem to be at increased risk for severe illness.

“In our local hospitals, the kids that are getting sick are the ones that are not vaccinated,” said Dr. Natasha Burgert, a pediatrician in Overland Park, Kansas, and a national spokesperson for the American Academy of Pediatrics.

More than one doctor interviewed for that piece said that the few fully vaccinated patients who ended up in their ERs were on immunosuppressants due to unrelated illnesses. It may be the case that whatever wave gathers this summer and fall may end up being a “casedemic” in which lots of people get infected and test positive but, because most of the vulnerable have been immunized, relatively few die. The UK is already seeing that play out, in fact, as B.1.617 tears through the remaining unvaccinated population:

The two key facts about the Delta variant:

1. It seems to be both more contagious and more severe than other versions of the virus.

2. Vaccines work extremely well against it, virtually eliminating death. Check out the recent trends in Britain:https://t.co/LJJtxI1Fyh pic.twitter.com/DvfdiOs9r2

— David Leonhardt (@DLeonhardt) June 14, 2021

We’re seeing it here too although less dramatically. Cases in the U.S. fell every day between mid-April and the start of June but have been stable over the last 10 days, which may be the first bit of evidence that Bossert’s wave is on its way. On the other hand, hospitalizations and deaths are still declining. Possibly that’s because those two metrics are lagging indicators that typically follow trends in cases by a few weeks. But it may be that our wave will be a true casedemic, with severe cases low and stable even as positive tests tick upward.

Or … it may not be. The Indian variant has reached China and is beginning to wreak havoc there too:

Covid patients infected with the Indian variant are getting sicker more quickly than in previous waves, doctors in China have claimed.

In the city of Guangzhou, where the mutant strain is known to be spreading, medics say about 12 per cent of patients become severely ill within four days of symptoms starting.

The proportion had previously been as low as 2 or 3 per cent with the original Wuhan virus and the variant which first emerged in Kent and went on to become world-dominant…

Guan Xiangdong, director of critical care medicine at Sun Yat-sen University in Guangzhou, said the amount of Indian variant virus detected in the body rises to higher levels and declines more slowly than with previous strains.

The more we learn about B.1.617, the easier it is to understand why India’s outbreak was so apocalyptic.

Dr. Bob Wachter is worried about the fact that the Indian variant isn’t just the most contagious yet discovered, it’s also harder for the immune system to handle. Fortunately, two doses of an mRNA vaccine is still protective against it. But anything less than that — maybe including natural immunity — is a risk.

11/ Why is Delta scarier? First, it appears to be even more infectious than the Alpha variant, probably by a similar amount (~40% more infectious than Alpha.)(h/t @EricTopol for @BBC table below) This means the same exposure that a person might have had last year is now about… pic.twitter.com/wjMkpuDSIL

— Bob Wachter (@Bob_Wachter) June 13, 2021

13/ …data are reassuring, in a way: the efficacy of 2-doses of Pfizer is 88%, only a smidge lower than the 95% we’re used to, and still great.
But the first dose data is concerning. Normally, a few weeks after dose 1, you’re about 80% protected (this was the argument for…

— Bob Wachter (@Bob_Wachter) June 13, 2021

15/ …degree of vaccine/immune escape. And – though this isn’t proven – I’d worry that a fully vaccinated elder, or someone whose immunity stems from an infection >12 mths ago, won’t be sufficiently protected over time, if immunity falls below a threshold needed to thwart Delta.

— Bob Wachter (@Bob_Wachter) June 13, 2021

Wachter recommends that even vaccinated people start wearing masks indoors again if B.1.617 becomes prevalent in their community. But any precautions from now until fall will have to be voluntary, as it’s hard to imagine governors, particularly Republicans, ordering any new restrictions to limit summer fun barring a truly ferocious wave. To find a conservative willing to do that, you need to cross the ocean.

I’ll leave you with the latest news regarding B.1.617, a Scottish study indicating that it’s twice as likely to send people to the hospital as the B.1.1.7 British variant. We might not have a “casedemic” after all.