Listen to Austin 360 Radio

A year after Austin's July 4 COVID-19 surge, the Delta variant and unmasking threaten the unvaccinated

Nicole Villalpando
Austin American-Statesman
Last summer, people took to Barton Creek near Barton Springs Pool to cool off just before July Fourth as a surge of coronavirus cases was hitting Central Texas. This year, Central Texas is no longer experiencing a surge, but doctors are seeing younger people with severe cases because they are not vaccinated.

Last July 4 weekend, the intensive care units at many Austin hospitals were filled with COVID-19 patients. Austin was in the middle of a coronavirus surge that began at the end of May with Memorial Day weekend and continued through the summer. At its peak last summer, hospitals saw 75 new admissions a day and had 150 people in intensive care units, 110 on ventilators. 

This summer is a different story. This week, the Austin metro area is seeing an average of nine new admissions a day; 61 people are hospitalized with COVID-19, 24 are in area ICUs, and 12 are on ventilators.

What is very different about what's happening now versus last year is not just the numbers. It's who is being infected, who is hospitalized and the level of their illness.

Preparing for Delta:Austin area health leaders concerned by highly contagious Delta coronavirus variant, urge residents to get vaccinated

"It's kind of disturbing what's going on," said Dr. Brian Metzger, medical director of infectious diseases at St. David's HeathCare. "As far as the cases go, the frequency is still down, but when they do come in, they are really sick." 

Metzger said what he's seeing in his ICU is the same as what other colleagues are reporting in Central Texas and elsewhere. 

Who is at risk for COVID-19?

In the ICU at St. David's are a handful of COVID-19 patients, but they might not be who you would think they would be. One patient is a 36-year-old mom who just had a baby and has been struggling with COVID-19 for more than a week and is now on a ventilator.

Another patient is a 30-year-old. Another is 29. 

One of them had a mild case of COVID-19 in December but now is having a severe case the second time. 

They are all unvaccinated.

"It's young people," Metzger said. "It's people who thought they were young enough that they thought they would escape bad consequences from COVID." 

More:First cases of Delta coronavirus variant found in Williamson County, officials say

At St. David's Medical Center, the cases of COVID-19 have dramatically dropped, but the hospital is seeing younger patients who are very sick.

Younger than ever

Locally, the Austin area doesn't have the spread of COVID-19 experienced last summer or winter. That is because 59.8% of the population of Travis County ages 12 and older (the ages that can be vaccinated) are fully vaccinated, according to the state health department.

The people who were the most vulnerable last year, those who were 65 years old and older, are getting vaccinated: 77.3% of that age group are fully vaccinated, and 87.2% have at least one dose, according to the state health department.

"With every younger decade there's a lower vaccination rate," Metzger said, "which is why we are seeing younger patients." 

He calls these cases "the expected cases." The federal Centers for Disease Control and Prevention has started calling these cases, which could lead to death, "entirely preventable." 

"We're just not seeing vaccinated people coming in," Metzger said. "It looks like the vaccine works well." 

As of the end of April, the CDC has reported 10,262 breakthrough cases among the fully vaccinated, meaning about 0.01% of fully vaccinated people have become infected.

Vaccines in real life:How effective are COVID-19 vaccines in the real world? Two studies offer 'stunning' results, doctor says

Bracing for the Delta variant

The virus is continuing to circulate among unvaccinated people. Metzger attributes that to two things.

First, people are no longer wearing masks.

"That's great for the vaccinated," he said. People, according to the CDC, no longer have to wear masks once they are two weeks post-full vaccination, unless they have a compromised immune system.

"For the unvaccinated, that level of protection has been removed," he said.

Going maskless:Yes, fully vaccinated people can skip the mask, says Austin infectious disease doctor

The other factor: "The 800-pound gorilla is the Delta variant," he says. "We don't have a great handle on it, but it's here and it's growing."

Metzger said he and his colleagues in the hospital are not being asked to test for which variant the hospitalized patients have. They are being asked to give specimens only if someone comes in with COVID-19 who has been vaccinated.

The Delta variant is the variant that was so devastating to India this spring. The Delta variant, Metzger explained, is 50% more transmissible than the Alpha variant, which came out of the United Kingdom. And Alpha was 50% more transmissible than the original COVID-19 virus. 

"The Delta variant is completely dominating the Alpha variant in the U.K.," he said, which is what he expects will happen here.

"I worry about how transmissible it is becoming," he said. "It's going to find the unvaccinated."

So far, vaccines are holding against the variants, including Delta and Alpha.

Julie Chen, 18, receives the Johnson & Johnson COVID-19 vaccine from Sovit Bista at Auro Pharmacy. More people in their teens, 20s and 30s need to be vaccinated, doctors say.

Encouraging vaccination

Metzger is not worried about seeing a level of surge like we experienced last summer or winter because of the level of vaccinated people in Austin. When people come into the ICU with COVID-19, the staff now knows how to treat them and have adequate supplies to do so.

Yet, the levels of vaccination and knowledge are not enough to prevent hospitalizations or deaths.

"It's going to be a smoldering fire for several more months, if not longer, unfortunately, and it doesn't have to be," he said.

The key, Metzger said, is to get more people vaccinated.

That includes people who have already had COVID-19, like that person in his ICU who is on her second round of COVID-19. 

Having COVID-19 gives only a few months of immunity, he said. The vaccine is proving to be effective much longer, possibly for years. 

The vaccine can prevent hospitalization and death, as well as long COVID, also called long-haul COVID, in which the symptoms continue to linger for months.

There are rare side effects to the vaccines. The Johnson & Johnson vaccine has been linked to rare blood clots. The Pfizer and Moderna vaccines have a risk of a rare heart inflammation.

Becoming fully vaccinated:Got another COVID-19 shot coming up? Don't skip your second dose out of fear of side effects

Metzger has not seen either side effect in his hospital. He had one patient who experienced a drop in platelets, but it's not clear if that was caused by the vaccine.

"I'm losing hope that we're going to encourage many more people to be vaccinated," Metzger said. "We've said the message so many times and the data is so clear ... it's still a little discouraging that one-third of adults haven't gotten vaccinated."

For children 11 and younger, who cannot be vaccinated yet, health authorities say the key is going to be continuing to wear their masks and practice social distancing, even when school returns in-person and mask wearing can no longer be required.

Banning mask rules:Texas Gov. Greg Abbott bans public schools, local officials from requiring masks

A fall uptick on the horizon?

For the 11 and younger crowd, who cannot be vaccinated yet, the key is going to be continuing to wear their masks and practice social distancing, even when school returns in-person and mask wearing can no longer be required. 

Masking in schools:As Abbott orders schools to end mask rules, what is the COVID-19 risk?

End of remote learning:Austin ISD requires students to return to campus in August

The first COVID-19 vaccine for kids 11 and younger is not expected to be given emergency use authorization by the FDA until sometime this fall.

Children have so far seemed to have less transmission of the disease and less severe symptoms than adults, but there have been kids with COVID-19 hospitalized in Austin. 

"We don't really know what will happen with these more transmissible variants in an indoor, at best fairly ventilated, classroom and kids not wearing masks," Metzger said.

The hope is that pockets of outbreaks can be contained, he said, but "I'm sure it will happen in some places."

COVID-19 vaccine trials in kids:Austin Regional Clinic to enroll kids 6 months to 11 years old in Pfizer COVID-19 vaccine trial

End of masking:A sign of our return to pre-COVID-19 pandemic life: Austin's kids have colds again

Where to get vaccinated

The vaccine is free and you do not need to have insurance to get it. 

Most pharmacies, including those at Walgreens, CVS, H-E-B, Randalls, Walmart and Target, have vaccines. For people ages 12-17, double-check that the pharmacy has the Pfizer vaccine, the only one approved for that age group. Many pharmacies no longer require an appointment, but you can call ahead to make sure vaccine is in stock and is the type you want.

Go to to find a location near you.