NEW YORK (NYTIMES) - The Delta variant is much more contagious, more likely to break through protections afforded by vaccines and may cause more severe disease than all other known versions of the coronavirus, according to an internal presentation circulated within the Centres for Disease Control and Prevention (CDC).
Dr Rochelle Walensky, director of the agency, acknowledged on Tuesday (July 27) that vaccinated people with so-called breakthrough infections of the Delta variant carry just as much virus in their nose and throat as unvaccinated people, and may spread it just as readily, if less often.
But the internal document lays out a broader and grimmer view of the variant.
The Delta variant is more transmissible than the viruses that cause the Middle East respiratory syndrome, the severe acute respiratory syndrome, Ebola, the common cold, the seasonal flu and smallpox, and it is as contagious as chickenpox, according to the document, a copy of which was obtained by The New York Times.
The immediate next step for the agency is to "acknowledge the war has changed", the document said. Its contents were first reported by The Washington Post on Thursday evening.
The document's tone reflects alarm among CDC scientists about the Delta variant's spread across the country, said a federal official who has seen the research described in the document.
The agency is expected to publish additional data on the variant on Friday.
"The CDC is very concerned with the data coming in that Delta is a very serious threat that requires action now," the official said.
There were 71,000 new cases a day on average in the United States, as at Thursday. The new data suggests that vaccinated people are spreading the virus and contributing to those numbers, although probably to a far lesser degree than the unvaccinated.
Dr Walensky has called transmission by vaccinated people a rare event, but other scientists have suggested it may be more common than once thought.
The agency's new masking guidelines for vaccinated people, introduced on Tuesday, were based on the information presented in the document.
The CDC recommended that vaccinated people wear masks indoors in public settings in communities with high transmission of the virus.
But the internal document hints that even that recommendation may not go far enough.
"Given higher transmissibility and current vaccine coverage, universal masking is essential," the document said.
The agency's data suggests that people with weak immune systems should wear masks even in places that do not have high transmission of the virus. So should vaccinated Americans who are in contact with young children, older adults, or otherwise vulnerable people.
There are roughly 35,000 symptomatic infections a week among 162 million vaccinated Americans, according to data collected by the CDC as at last Saturday that was cited in the internal presentation.
But the agency does not track all mild or asymptomatic infections, so the actual incidence may be higher.
Infection with the Delta variant produces virus amounts in the airways that are tenfold higher than what is seen in people infected with the Alpha variant, which is also highly contagious, the document noted.
The amount of virus in a person infected with the Delta variant is a thousandfold more than what is seen in people infected with the original version of the virus, according to one recent study.
The CDC document relies on data from multiple studies, including an analysis of a recent outbreak in Provincetown, Massachusetts, which began after the town's Fourth of July festivities.
By Thursday, that cluster had grown to 882 cases. About 74 per cent were vaccinated, local health officials have said.
Detailed analysis of the spread of cases showed that people infected with the Delta variant carry enormous amounts of virus in their nose and throat, regardless of vaccination status, according to the CDC document.
"This is one of the most impressive examples of citizen science I have seen," said Dr Celine Gounder, an infectious disease specialist at Bellevue Hospital Centre in New York.
"The people involved in the Provincetown outbreak were meticulous in making lists of their contacts and exposures."
Infection with the Delta variant may be more likely to lead to severe illness, the document noted. Studies from Canada and Scotland found that people infected with the variant are more likely to be hospitalised, while research in Singapore indicated that they are more likely to require oxygen.
Still, the CDC's figures show that the vaccines are highly effective in preventing serious illness, hospitalisation and death in vaccinated people, experts said.
"Overall, Delta is the troubling variant we already knew it was," said Dr John Moore, a virologist at Weill Cornell Medicine in New York.
"But the sky isn't falling and vaccination still protects strongly against the worse outcomes."