By Justin HAGER

Los Angeles County’s mask mandate was reinstated on Sunday, just 32 days after Southern Californians celebrated their newfound freedom and declining COVID hospitalization rates. Both Pasadena and Long Beach, which function separately from LA County Health, have indicated that they will align their policies with the rest of the County and issue their own mask mandates.

According to data form the Los Angeles County Dept. of Public Health, the daily average percent positive test rate (the measure of what percentage of tests administered came back with a positive result) was slowly increasing since the end of May. But with more Californians receiving one or both vaccine injections, hospitalizations and deaths due to COVID had been in freefall since mid-April with daily COVID-related deaths declining by more than 90%. Unfortunately, the positivity rate, hospitalization rate, and death rate have both rocketed upward since COVID restrictions were lifted on June 15 with daily hospitalizations more than doubling and daily average deaths more than tripling in the past month, effectively rewinding the pandemic clock in Los Angeles to the same levels of hospitalization and morbidity as the County saw at the end of April.

Infectious disease experts were not completely surprised that the infection rate showed some increases following the lifting of restrictions. Studies showed that the vaccine was only 90% effective at preventing transmission and, with large groups of people gathering without masks again, it was inevitable that the 10% “breakthrough” rate would lead to some new infections. Fortunately, the vaccine provides a second layer of protection by not only preventing infection and transmission of the disease, but also protecting against hospitalization, death and other serious health complications for the small number of people who still contract the virus after receiving the vaccine. In fact, the vaccines were so effective that people who received both doses but still contracted COVID were 94-95% less likely to be hospitalized than people who contracted COVID without being vaccinated.

Despite this data, rising numbers of hospitalizations and deaths across the state have led to some calls for a vaccine booster to ensure continued effectiveness. In a recent interview with Reuters, Pfizer’s chief scientific officer, Mikael Dolsten, MD, PhD, pointed to unpublished data out of Israel that suggested a third dose of the vaccine may be necessary because the efficacy of the vaccine at preventing infection and transmission dropped to only 80%.

“It’s a small data set, but I think the trend is accurate: six months out, given that Delta is the most contagious variant we have seen. It can cause infections and mild disease,” Dolsten said. He was careful to reiterate that, despite the decrease in antibodies, the vaccine remains 94-95% effective at preventing severe disease. And critics have noted that boosters pose both moral and ethical questions as pharmaceutical companies like Pfizer stand to make billions of dollars more in profit from selling boosters to wealthy regions like the U.S. and Europe rather than selling the base vaccine to largely unvaccinated regions of Africa and Southeast Asia.

Less than 24 hours later, the CDC and FDA issued a rare joint statement urging calm and reassuring the public of the efficacy of the vaccines.

“Americans who have been fully vaccinated do not need a booster shot at this time,” the federal agencies said. “We continue to review any new data as it becomes available and will keep the public informed. We are prepared for booster doses if and when the science demonstrates that they are needed.”

Dr. Don Diamond, PhD, is an expert on immunology who is developing a new COVID vaccine for City of Hope in Los Angeles. His vaccine, which is currently being considered for approval by the FDA, aims to help protect immuno-compromised patients and others who may not be eligible for the current vaccines.

“At some point, we’re all going to need a booster, that’s just common sense based on what we know about sub-unit vaccines and childhood vaccinations,” he said in response to a future need for booster shots. “Nobody knows the exact descent of immunity, but we know it is descending; there are people who are becoming infected even though they’ve had the vaccine and it’s becoming more frequent.”

While boosters remain on the horizon for now, data on hospitalizations and deaths since the vaccine rollout points to a combination of vaccine hesitancy and the rise of the much more contagious and transmissible Delta variant of COVID as the primary culprits pushing infections, hospitalizations and deaths upward. According to the CDC, 1,063 people in the U.S. have died due to COVID after being fully vaccinated. While that may seem like a large number, it is an extremely small percentage of the more than 159 million people who have been vaccinated thus far in the United States, and less than .5% of the more than 214,000 Americans who have died of COVID since the vaccine became available in the U.S.

        “The problem is not that there aren’t vaccines, but that people won’t take them,” said Diamond. “If you’re unvaccinated, you’re at terrible risk. The Delta variant is calculated to be about 225% more transmissible than the original Wuhan strain … People don’t realize how vicious this Delta variant is compared to prior variants.”

Data from the Los Angeles County Dept. of Public Health shows that 62% of eligible Los Angeles residents are fully vaccinated, with an additional 8% having received one dose of a two-dose regimen. Unfortunately, that means that more than 2.5 million eligible Angelenos have yet to receive even a single dose. Add to that the nearly 2 million Angelenos who are ineligible to receive the vaccine due to age or preexisting health conditions and that leaves more than four million unvaccinated people, just in Los Angeles County. Even in local communities, only about 75% of La Crescenta, La Cañada, and Altadena and less than 60% of Glendale, Sunland and Tujunga residents have received even a single dose of the vaccine.

Dr. Diamond said that even people who are vaccinated can help keep communities safe by avoiding large gatherings, gathering outside whenever possible, and wearing a mask when inside.

“Large gatherings don’t need to happen right now,” he said. “Stay outside where the likelihood of becoming infected or transmitting the disease yourself is significantly lower. If you are inside, wear a mask because Delta is more transmissible and more deadly.”