One step forward, one step back.

That seems to be how it’s going lately with the pandemic.

Hospitals are filling up again and there are steps we all can take to help control this latest surge.

For starters, we all need to start masking again in certain situations. The Centers for Disease Control and Prevention is recommending that people in substantial or high transmission areas – that includes most parts of North Carolina –  wear a mask in public indoor places. Even if you are fully vaccinated, you still need to wear mask. 

Although so-called breakthrough cases are rare, vaccinated people can get COVID-19 and infect others, including children not eligible for vaccines yet. 

Another thing we can all do: Don't come to the ER for COVID-19 testing. We need to preserve this precious resource for emergencies. If you need a COVID-19 test, visit your primary care provider or a Novant Health urgent care or walk-in clinic. This Novant Health coronavirus resource site can answer all your questions, and find nearby testing centers.

Finally, know that recommended third doses, also known as boosters, will become available starting Sept. 20. Getting a third dose will strengthen protection for those already vaccinated. 

Dr. Charles Bregier, Novant Health’s medical director of corporate health answered questions recently about the delta variant. (He’s a big proponent of vaccines.)

“A few months ago, we thought we were in a good place with COVID-19,” Bregier said. “But, within the last month, things have gone in a bad direction again. Infection rates are way up; hospitalization rates are way up – largely because the delta variant is … extremely contagious. COVID is now thought to be about as contagious as chickenpox.”  

What are you personally doing now that the delta variant is spreading so rapidly?

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Dr. Charles Bregier

I'm fully vaccinated. I'm proud to say my whole family is fully vaccinated. I am wearing a mask all the time – whenever I'm indoors, anywhere I go. I'm anticipating going to some sporting events this fall and plan to wear a mask there, even if it's not required.

Are you seeing anything different with this recent surge? 

It's a bit different. Previously, the average hospitalized patient was in their 60s. Now that a lot of higher-risk populations have been vaccinated, the average age of the hospitalized patient at Novant Health has come down from 61 to 45. And it's largely unvaccinated people who are getting ill.

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What about “breakthrough” cases in which fully vaccinated people are getting COVID?

Vaccinations are fantastic at reducing the risk of severe Illness hospitalization and death. But they aren't perfect at preventing breakthrough cases. So, we are seeing that some people who have been fully vaccinated getting COVID-19 and spreading the virus to others. But if you get vaccinated, you are much less likely to become infected and infect others.

Is there any new mask guidance, given how serious the delta variant is?  

We know that medical surgical masks, widely available in drug stores and online, are quite effective in preventing the spread of delta as well as other COVID strains.

We recommend multilayer cloth masks, surgical masks and higher-quality masks. What's really most important is that people wear their masks properly. The mask should completely cover your nose and mouth. It needs to have a tight fit to prevent you from inhaling the virus if it's in the immediate air around you.

Masking is really important, which is why the Centers for Disease Control and Prevention (CDC) has gone back to recommending masking in all indoor public areas. But social distancing and hand hygiene are still really important.

Is COVID mutating faster than you would have expected? Is it mutating because of the unvaccinated population?

Yes, it is mutating faster because of unvaccinated people. This delta variant seems to produce huge amounts of the virus in unvaccinated people.

Novant Health recently mandated that all employees be vaccinated by Sept. 15. But some employees are reluctant.

In health care, it is our duty and our honor to serve our patients and keep them safe. That's why the Infectious Disease Society of America, the North Carolina Health Care Association and many other leading organizations have come out and broadly stated that all health care workers need to be vaccinated.

And from an ethical perspective, it is more compelling for us to protect each other and protect our patients than it is to say, “I have the right to refuse the vaccine.”

The best way to stop the spread and to protect our patients and our team members is to have health care workers vaccinated. (Read more on Novant's Health's decision here. And remember, health care systems across North Carolina are requiring team member vaccinations.)

Is the delta variant more dangerous for children the original strain? And does it spread more easily?  

We're watching that very closely. I have not seen any data that says it's going to cause more severe infections than previous strains of the COVID-19 virus. But we are concerned about the fact that it may spread more widely in younger populations. That's why we're hopeful that the vaccine will be approved for a younger age group soon. We’re hearing that we may be only a couple of months away from being able to safely vaccinate 5- to 12-year-olds.

Some local school systems have decided to make masks optional. Your thoughts on that?

I would encourage all schools to go back to being masked indoors. I'm very much in favor of masking because of what we've seen in the last couple of months. The CDC has come out and said that all schools need to have all people masked all the time while indoors, and as much social distancing as you can manage.

How are vaccinated people spreading the virus?

There is not a lot that’s known about how people who were fully vaccinated are spreading the virus. We have to remember that these vaccines are more effective than most – but they’re not perfect. The flu vaccine is only 40% or 50% effective in reducing the spread of flu. However, we have learned that even that kind of reduction in spread translates to many saved lives and many fewer hospitalizations for the flu.

Keep in mind: Fully vaccinated people tend to have much milder disease. The only way for us to get better protection as a community as individuals is to go ahead and get vaccinated because the rate of spread or risk of spread to fully vaccinated people is much less than unvaccinated people.

Our medical care delivery system is being strained again across the country. We don't want to get to the point where we don't have enough beds to take care of the sickest people. We need to keep an eye on hospitalizations and transmission rates.

We’re not done with this war. We need to do what we can to protect each other.