In recent weeks, U.S. coronavirus case data — long a closely-watched barometer of the pandemic’s severity — has sent some encouraging signals: The rate of newly recorded infections is plummeting from coast to coast and the worst surge yet is finally relenting. But scientists are split on why, exactly, it is happening.
Some point to the quickening pace of coronavirus vaccine administration, some say it’s because of the natural seasonal ebb of respiratory viruses and others chalk it up to social distancing measures.
And every explanation is appended with two significant caveats: The country is still in a bad place, continuing to notch more than 90,000 new cases every day, and recent progress could still be imperiled, either by new fast-spreading virus variants or by relaxed social distancing measures.
The rolling daily average of new infections in the United States hit its all-time high of 248,200 on Jan. 12, according to data gathered and analyzed by The Washington Post. Since then, the number has dropped every day, hitting 91,000 on Sunday, its lowest level since November.
A former director of the Centers for Disease Control and Prevention endorsed the idea that Americans are now seeing the effect of their good behavior — not of increased vaccinations.
“I don’t think the vaccine is having much of an impact at all on case rates,” Tom Frieden said in an interview Sunday on CNN’s “Fareed Zakaria GPS.” “It’s what we’re doing right: staying apart, wearing masks, not traveling, not mixing with others indoors.”
However, Frieden noted, the country’s numbers are still higher than they were during the spring and summer virus waves and “we’re nowhere near out of the woods.”
“We’ve had three surges,” Frieden said. “Whether or not we have a fourth surge is up to us, and the stakes couldn’t be higher.”
The current CDC director, Rochelle Walensky, said in a round of TV interviews Sunday morning that behavior will be crucial to averting yet another spike in infections and that it is far too soon for states to be rescinding mask mandates. Walensky also noted the declining numbers but said cases are still “more than two-and-a-half-fold times what we saw over the summer.”
“It’s encouraging to see these trends coming down, but they’re coming down from an extraordinarily high place,” she said on NBC’s “Meet the Press.”
Researchers at the University of Washington’s Institute for Health Metrics and Evaluation, publisher of a popular coronavirus model, are among those who attribute declining cases to vaccines and the virus’s seasonality, which scientists have said may allow it to spread faster in colder weather.
In the IHME’s most recent briefing, published Friday, the authors write that cases have “declined sharply,” dropping nearly 50 percent since early January.
“Two [factors] are driving down transmission,” the briefing says. “1) the continued scale-up of vaccination helped by the fraction of adults willing to accept the vaccine reaching 71 percent, and 2) declining seasonality, which will contribute to declining transmission potential from now until August.”
The model predicts 152,000 more covid-19 deaths by June 1, but projects that the vaccine rollout will save 114,000 lives.
Nearly 40 million people have received at least their first dose of a coronavirus vaccine, about 12 percent of the U.S. population. Experts have said that 70 percent to 90 percent of people need to have immunity, either through vaccination or prior infection, to quash the pandemic. And some leading epidemiologists have agreed with Frieden, saying that not enough people are vaccinated to make such a sizable dent in the case rates.
A fourth, less optimistic explanation has also emerged: More new cases are simply going undetected. On Twitter, Eleanor Murray, a professor of epidemiology at Boston University School of Public Health, said an increased focus on vaccine distribution and administration could be making it harder to get tested.
“I worry that it’s at least partly an artifact of resources being moved from testing to vaccination,” Murray said of the declines.
The Covid Tracking Project, which compiles and publishes data on coronavirus testing, has indeed observed a steady recent decrease in tests, from more than 2 million per day in mid-January to about 1.6 million a month later. The project’s latest updateblames this dip on “a combination of reduced demand as well as reduced availability or accessibility of testing.”
“Demand for testing may have dropped because fewer people are sick or have been exposed to infected individuals, but also perhaps because testing isn’t being promoted as heavily,” the authors write.
They note that a backlog of tests over the holidays probably produced an artificial spike of reported tests in early January, but that even when adjusted, it’s still “unequivocally the wrong direction for a country that needs to understand the movements of the virus during a slow vaccine rollout and the spread of multiple new variants.”
Where most experts agree:The mutated variants of the virus pose perhaps the biggest threat to the country’s recovery. One is spreading rapidly and another, known as B.1.351, contains a mutation that may help the virus partly evade natural and vaccine-induced antibodies.
Fewer than 20 cases have been reported in the United States, but a critically ill man in France underscores the variant’s potentially dangerous consequences. The 58-year-old had a mild coronavirus infection in September and the B.1.351 strain reinfected him four months later.
No matter what’s causing the current downturn in new infections, experts have urged Americans to avoid complacency.
“Masks, distancing, ventilation, avoiding gatherings, getting vaccinated when eligible. These are the tools we have to continue the long trip down the tall mountain,” Caitlin Rivers, an epidemiologist at Johns Hopkins University, said on Twitter. “The variants may throw us a curve ball, but if we keep driving down transmission we can get to a better place.”
As both vaccinations and acquired immunity spread, life will likely settle into a new normal that will resemble pre-COVID-19 days— with some major twists.
The big picture: While hospitalizations and deaths are tamped down, the novel coronavirus should recede as a mortal threat to the world. But a lingering pool of unvaccinated people — and the virus’ own ability to mutate — will ensure SARS-CoV-2 keeps circulating at some level, meaning some precautions will be kept in place for years.
Driving the news: On Tuesday, Johnson & Johnson CEO Alex Gorsky told CNBC that people might well need a new coronavirus vaccine annually in the years ahead, much as they do now for the flu.
Gorsky’s comments were one of the clearest signals that even as the number of vaccinated people rises, the mutability of SARS-CoV-2 means the virus will almost certainly be with us in some form for years to come.
Be smart: That sounds like bad news — and indeed, it’s much less ideal than a world in which vaccination or infection conferred close to lifelong immunity and SARS-CoV-2 could be definitively conquered like smallpox.
With more contagious variants spreading rapidly, “the next 12 weeks are likely to be the darkest days of the pandemic,” says Michael Osterholm, the director of the University of Minnesota’s Center for Infectious Disease Research and Policy.
But the apparent effectiveness of the vaccines in preventing hospitalizations and death from COVID-19 — even in the face of new variants — points the way toward a milder future for the pandemic, albeit one that may be experienced very differently around the world.
Details:From studying what happened after new viruses emerged in the past, scientists predict SARS-CoV-2 will eventually become endemic, most likely in a seasonal pattern similar to the kind of coronaviruses that cause the common cold.
That’s nothing to sneeze at — literally, it will make us sneeze — but as immunity levels accumulate throughout the population, our experience of the virus will attenuate, and we’ll be highly unlikely to experience the severe death tolls and overloaded hospitals that marked much of the past year.
Yes, but: The existence of a stubborn pool of Americans who say they won’t get vaccinated — as well as the fact that it may take far longer for children, whom the vaccines have yet to be tested on, to get coverage — will give the virus longer legs than it would otherwise have.
“This will be with us forever,” says Osterholm. “That’s not even a debate at this point.”
What’s next: This means we can expect the K-shaped recovery that has marked the pandemic to continue, says Ben Pring, who leads Cognizant’s Center for the Future of Work.
With the virus likely to remain a threat, even if a diminished one, “those who are more stuck in the analog world are really going to continue to struggle,” he says.
Health security will also become a more ingrained part of daily life and work, which means temperature checks, masks, frequent COVID-19 testing and even vaccine passports for travel are here to stay.
If the inequalities seen in the early phase of the vaccine rollout persist, COVID-19 could become a disease of the poor and disadvantaged, argues Mark Sendak, the co-founder and scientific adviser for Greenlight Ready, a COVID-19 resilience system that grew out of Duke Health.
What to watch:Whether the vaccine rollout can be adapted to reach hard to find and hard to persuade populations.
The Biden administration announced yesterday that it will start delivering vaccines directly to community health centers next week in an effort to promote more equity in the vaccine distribution process.
As the administration rolls out new COVID-19 plans, it needs to “invest in the community health care personnel” who can ensure that no one is left behind, says Sendak.
The bottom line:While SARS-CoV-2 has proven it can adapt to a changing environment, so can we. But we have to do so in a way that is fairer than our experience of the pandemic has been so far.
A family member in her 70s called with the great news that she received her first dose of the COVID vaccine this week. She mentioned that she was hoping to plan a vacation in the spring with a friend who had also been vaccinated, but her doctor told her it would still be safest to hold off booking travel for now: “I was surprised she wasn’t more positive about it. It’s the one thing I’ve been looking forward to for months, if I was lucky enough to get the shot.”
It’s not easy to find concrete expert guidance for what it is safe (or safer?) to do after receiving the COVID vaccine. Of course, patients need to wait a minimum of two weeks after receiving their second shot of the Pfizer or Moderna vaccines to develop full immunity.
But then what? Yes, we all need to continue to wear masks in public, since vaccines haven’t been proven to reduce or eliminate COVID transmission—and new viral variants up the risk of transmission. But should vaccinated individuals feel comfortable flying on a plane? Visiting family? Dining indoors? Finally going to the dentist?
It struck us that the tone of much of the available guidance speaks to public health implications, rather than individual decision-making. Take this tweet from CDC director Dr. Rochelle Walensky. A person over 65 asked her if she could drive to visit her grandchildren, whom she hasn’t seen for a year, two months after receiving her second shot. Walensky replied, “Even if you’ve been vaccinated, we still recommend against traveling until we have more data to suggest vaccination limits the spread of COVID-19.”
From a public health perspective, this may be correct, but for an individual, it falls flat. This senior has followed all the rules—if the vaccine doesn’t enable her to safely see her grandchild, what will? It’s easy to see how the expert guidance could be interpreted as “nothing will change, even after you’ve been vaccinated.”
Debates about masking showed us that in our individualistic society,public health messaging about slowing transmission and protecting others sadly failed to make many mask up.
The same goes for vaccines:mostAmericans are motivated to get their vaccine so that they personally don’t die, and so they can resume a more normal life, not by the altruistic desire to slow the spread of COVID in the community and achieve “herd immunity”.
In addition to focusing on continued risk,educating Americans on how the vaccinated can make smart decisions will motivate as many people as possible to get their shots.
Over the weekend I realized that my son Henry, born in June 2019, has lived more than half of his life in the pandemic era. He’s too young to be cognizant of it, of course, but my wife and I are acutely conscious of the experiences his older brother had already enjoyed by the time he was Henry’s age, things that are impractical or impossible in the moment.
He’s not alone in that, of course. Most Americans are experiencing some ongoing deprivations because of the pandemic. (Most of those for whom the pandemic is not imposing unusual restrictions are, ironically, probably contributing to the pandemic’s extent and duration.) Just about everyone in the United States is eagerly scanning the horizon for signs of normalcy — as we have been for months, occasionally spotting oases that too often turn out to be mirages.
So when will we return to some semblance of normal? It’s hard to say with certainty. The best tool we have to reach that point, though, is the broad deployment of the vaccines approved for emergency use by the government. But even the existence of those vaccines can’t completely answer the question.
For example, the rate at which the vaccines are deployed makes a massive difference. A pace of 2 million shots per day as opposed to 1 million seems like a subtle distinction but, obviously, means achieving immunity for recipients twice as fast.
What level of immunity is necessary is a question of its own. Do we need 70 percent of the country to have been immunized? Or, as infectious-disease expert Anthony S. Fauci has recently said, is the figure closer to 80 or 85 percent?
When doing this calculation, do you include the 26 million Americans who have already had coronavirus infections? What about young people? The vaccine trials included only those age 16 and over. Those younger have constituted about a 10th of the total infections. And what vaccine are we talking about? The Pfizer and Moderna iterations require two shots; the vaccine from Johnson & Johnson requires only one.
All of these factors affect how we can figure out when the country might hit the herd-immunity mark. If we assume that young people will be included among those needed to be vaccinated — a complicated question on its own — the calculator below will allow you to figure out when immunity might be achieved at various immunization rates.
At this rate, the country would reach 70 percent herd immunity through vaccinations by Nov. 10
How we calculate this: There are about 330 million Americans, meaning that we need 231 million to be resistant to the virus to hit 70 percent immunity. We can take out the 5.8 million Americans who’ve already been vaccinated. That leaves 211.3 million people to be vaccinated.
From there the math is straightforward: doing two-shot vaccinations at a rate of 1.5 million shots per day means it will take 282 days to complete the job.
Bear in mind that sliding the little bar to determine how quickly shots are administered is far easier than actually scaling up the infrastructure to do so. President Biden’s original target for daily vaccinations was 1 million; he recently increased it to 1.5 million. At that rate, we’re still months from resolution. But because administering the vaccine is more complicated and requires more tracking than vaccinations such as that for the seasonal flu, it’s necessarily trickier to scale up.
At this point, the more urgent concern is the efficacy of the vaccine against any variants of the virus that might emerge. Manufacturers have already noted that the vaccine works less well against a virus variant first identified in South Africa, though the vaccines are still broadly effective, particularly at protecting the recipient from severe illness or death after infection.
Well, that and the fact that a fifth of Americans said in a recent Kaiser Family Foundation poll that they won’t get the vaccine or would do so only if it was required. Happily, more Americans are now saying they’re eager to get a vaccine.
The faster we get people immunized, the better we protect against the emergence of new mutations that prove less able to be controlled by the vaccines. The faster we get shots in arms, as the phrasing has it, the faster we get back to normal.
Which would be nice for all of us, including my 1-year-old.
Tucked in the shadow of the Tetons, the town of Jackson, Wy., and surrounding Teton County is home to less than 25,000 fulltime residents, but annually hosts over 2.5 million visitors. The valley’s natural beauty attracts an influx of tourists, who in turn are responsible for roughly 30% of the region’s jobs and over $1 billion in annual revenue, but this year, visitors came with an unwelcome price tag for locals: “Every time in this pandemic that we’ve had an influx of visitation, whether that’s second homeowners, or people just coming for a weekend, it follows with an uptick in cases and hospitalizations” says Dr. Jeff Greenbaum, medical director at the Emergency Department for St. John’s hospital and the Jackson Hole Mountain Ski Resort (JHMR) ski patrol.
With just one major hospital and eight emergency room physicians serving Teton County, any increase in COVID-19 cases is cause for concern. And in January, following the Christmas and New Year’s tourism rush, COVID-19 cases in Teton County skyrocketed to some of their highest levels since the pandemic began. Despite these developments, the ski resort, hotels, bars and restaurants remain open in the town. And Greenbaum remains optimistic that with the right strategies and precautions, the small hospital will not be overwhelmed by cases and skiing can stay open during the season for both visitors and locals. “The nightmare scenario is if the patients are stacking up in the emergency room and we don’t have enough personnel to treat them,” says Greenbaum. “But we’ll see that coming in advance, and we are not there yet.” The local hospital still has over 50% of its ICU beds unoccupied and has no COVID-19 patient on a ventilator. JHMR is similarly optimistic that it can stay open the entire season, trusting in the protocols it has put in place to protect both guests and staff.
Teton is the wealthiest county in the U.S., with a per capita income of over $250,000. At the start of the pandemic, a flurry of private jets landed at the Jackson Hole Airport, sometimes with a private ventilator in tow, as second homeowners and new buyers escaped to this rural paradise. Greenbaum posits that part of the reason why St. John’s hasn’t been overrun by cases is that many of the tourists that get COVID-19 in Teton County might not stay to get treatment in Teton County. At a time when millions of Americans are out of work, when daily infection rates are at an all-time high, and when thousands across the country are dying daily from the virus, should the wealthy indulge in an après ski, looking out onto the beautiful Teton mountains, all while potentially shuttling COVID-19 into and out of Jackson?
“This place is pretty much a gigantic country club, relying on second homeowners and tourism for its revenue,” says Jesse Bryant, a doctoral candidate in American Sociology at Yale University and creator of Yonder Lies, a podcast exploring the history of Jackson Hole. “But Jackson has to balance the ultra-wealthy with the real reality of people eking out a living here.” Teton County has the largest income gap of any county in the U.S., with the top 1% making almost 150 times more than the other 99%. From mountain guides to house cleaners to bartenders, much of the employment in Jackson cannot easily be transitioned to remote work, meaning that Jackson’s working class are among the most susceptible to unemployment from the pandemic. All across America the costs of the pandemic are being born by the poorest members of society; a Pew Research Center survey from September found that about 50% of low-income Americans say they or someone in their household has lost employment or had take a pay cut due to the pandemic, and similarly about 50% of low-income Americans reported having trouble paying their bills since the pandemic started.
During the spring and summer, the Coronavirus Aid, Relief, and Economic Security Act passed by the federal government at the start of the pandemic had provided $600 in additional unemployment payment per week, assuring many local and seasonal workers that their livelihoods were safe even if their jobs weren’t. But almost a year into the pandemic, Jackson’s working class are left with far fewer options: federal unemployment relief dropped to $300 and state unemployment benefits in Wyoming, although extended by 13 weeks, dry up after 39 weeks. “Many of the workers here don’t have a six-month buffer saved up,” said one restaurant worker who wished to remain anonymous for risk of losing their job, “so, while tourism presents a risk, we’re willing to take it to keep our paychecks coming in.”
This is the predicament that America has put herself in: a country with a limited safety net during the pandemic forces her workers to choose between the risk of getting sick, or losing their livelihoods. The mountain and the town are left trying to find a balance between keeping the economy open for tourists, and keeping COVID-19 out. As the second largest employer in Teton County, JHMR takes center stage in this unfolding drama. The resort is responsible for the livelihood of around 2,000 seasonal and local workers, and if the mountain were to shut down, many of the ancillary services in the town, like hotels, restaurants, rental shops, clothing stores and other retailers, would likely shutter their doors as well. In 2017, when the resort had to close for five days because of a power outage, the net economic impact to the local economy topped $5.5 million. “What’s happening in Jackson isn’t just a story of wealthy people coming into the rural west and getting the locals sick,” says Bryant. “This place has become more like a symbiotic relationship.”
One particularly vulnerable population is the Latino community, a significant number of which is undocumented, that lives in Jackson, and in the neighboring towns of Victor and Driggs. While it’s difficult to get exact numbers of their contribution to the economy, these workers keep Jackson running by filling jobs in all sectors, from house cleaners and construction workers to cooks and waiters.
“I’ve lived in Jackson for 25 years and used to go back to Mexico every winter because it was just too cold,” says Jorge, an undocumented construction worker in the town. “But then I got used to the cold and began skiing every single day.” Asked whether opening up the resort is worth the risk of bringing more COVID-19 into Jackson, Jorge says that by and large the Latino community welcomes the tourism with open arms, because it means job security. This lines up with findings from a survey undertaken by the Yale School of Environment this past summer, showing that Latino residents in the rural West had some of the highest rates of COVID-related unemployment in the country. “My wife and I work hard, her as a house cleaner, me in construction,” said Jorge. “The resort opening up and tourists coming to town is how many of us make our living.”
For its part, JHMR has been doing nearly everything within its power to keep COVID-19 from spreading on its slopes, iterating as the situation evolves to try to keep the 2021 season operating. In March of 2020, as the first wave of the pandemic was sweeping across the globe, the Wyoming State Health Officer shut down JHMR for the remainder of the season. The resort reopened in May, first for hikers and then mountain bikers—the summer tourists that in total are only about 10% the size of the winter tourist population. Before reopening for the summer crowd, it tested every single one of its staff members for COVID-19, and the resort’s human resources department transitioned into a contact-tracing team, coordinating with town officials whenever a case arose. While Wyoming didn’t issue a statewide mask mandate until Dec. 7, the resort instituted a mandatory mask policy during the summer. JHMR also learned to be more flexible in its operations: staff are now trained to perform a number of different functions, so they can sub in if there’s a shortage in a department, and shifts function as separate pods, meaning that if a person in one group has been exposed to COVID-19, another totally isolated pod can come in to take its place.
Over the summer and fall, tourists came in droves to Jackson, with as many as 40,000 total visitors in a day. According to the Jackson Hole Chamber of Commerce, both Yellowstone and Grand Teton National Parks—both within a quick drive from of Jackson—had about 50% more visitors in October of 2020 than they did for the same month in 2019. While many of the outdoor activities that bring people to Teton County during the summer—hiking, biking, climbing—have been deemed relatively safe during the pandemic, tourists also flocked indoors to the bars, restaurants and stores that remained open throughout most of the summer and fall. As a result, Teton County experienced large COVID-19 spikes in July and again at the end of October and into November.
Unsurprisingly, workers got sick. In response, Teton County’s Health Officer, Travis Riddell, sent out a series of recommendations pressing citizens to not gather with groups outside of their immediate family, avoid crowded indoor spaces and not congregate at trail heads, parks or other outside spaces. Still, most businesses stayed open as patrons kept coming. Riddell noted that the town had little choice: “Economic disasters are public health disasters,” Riddell said in an interview in July 2020 to National Geographic. “We know that when there are economic downturns, where there is an increase in poverty, an increase in uninsured numbers—that has direct health effects.”
Once JHMR opened for skiing the weekend after Thanksgiving, it was clear that demand for outdoor recreation would carry into winter; even with almost no international travel, JHMR expects demand during the 2021 winter months to be comparable to past years, at least. “If we just opened up [completely], the mountain would be packed, because demand itself is through the roof,” says LaMotte, “but we’ve imposed a maximum daily capacity for the mountain, to keep guests and staff safe.”
On a bluebird day near Christmas, the resort was sold out. It had snowed almost 15 inches the day before, and cars inched into the packed parking lot. Skiers and snowboarders waited in line for the lot shuttle bus, which, despite operating at 25% capacity, still felt uncomfortably full. The restaurants and bars looking out onto the sunny mountain were similarly capped at 25% capacity, and while masks and social distancing were required, patrons waiting for tables escaped the cold by standing shoulder to shoulder in the foyer.
At the resort, the socially distanced lines for the gondola were dangerously compressing. A resort worker cheerfully reminded guests from every corner of the U.S. to keep their distance and their masks above their noses. “We’re going to make it all the way through the season, without closing” yelled the worker, to cheers from the crowds. The lines moved slow—normally eight people fit onto the gondola, but under the new policies there was no mixing between groups, so often times the gondola ascends with just one or two passengers. At the top of the mountain, with views of the valley floor against the backdrop of the jagged Tetons, everyone breathed a bit easier.
Rob Kingwill and Emilé Zynobia, professional snowboarders based out of Jackson, stepped off the gondola into the cold Wyoming air, about 4,000 feet above the valley floor. Both sported COVID-19 masks made by Kingwill’s apparel company, Avalon 7. “I feel like this is almost an essential service, to give people the opportunity to be outside, said Kingwill. “We need this for our mental health.” When JHMR shut down in March of 2020, Kingwill strapped his snowboard to his backpack and hiked up Teton Pass’s infamous 1,300-foot Glory Boot Pack—every day for 77 days until all the snow had melted. But, he points out, most recreational skiers don’t have the knowledge and skills to navigate such technical terrain—and without the money those tourists bring in, Jackson’s working class would suffer. “It seems like the benefits outweigh the costs of keeping the resort open,” agreed Zynobia, as she and Kingwill strapped onto their boards. “Even though this is an activity skewed towards to wealthier people, it is helping a remote economy, and it is getting people outside at a time when we feel caged in.”
By the middle of January, Teton County’s COVID-19 cases were skyrocketing.Teton County currently has the highest caseload per capita of any county in the state of Wyoming and the highly contagious U.K. variant of COVID-19 was found to be circulating in the area. While the state of Wyoming had loosened COVID-19 gathering restrictions, the county reissued a series of guidelines on Jan. 25 that kept indoor gatherings capped at 25% and limited outdoor gatherings to 250 guests. At the resort, group ski lessons have been replaced by private lessons (at no extra cost), and the gondolas and lifts are ascending the mountain with minimal group mixing. Still JHMR can only control what happens on the mountain; “My main concern is not skiing itself,” says Greenbaum. “But rather I’m concerned about peripheral activity to skiing that lead people indoors, whether it’s a bar, a restaurant, a hotel lobby, a rental shop, a bus.”
Across the nation cases are surging, and other Colorado mountain towns like Telluride and Crested Butte have had similar spikes, likely due to an influx of winter tourism. The infection ratein Pitkin County, Colo., home to the Aspen and Snowmass ski resorts, was skyrocketing in the middle of January, with an incidence rate of about 3,500 per 100,000 people. In response, the county’s health department shut down all indoor dinning operations, but left the ski resorts open. The results were promising: in the past two weeks the COVID-19 rates for Pitkin County dropped by over 50%. “We’re on pace to be below 700 [cases per 100,000 people] in early February and I don’t think any of us thought that would happen so quickly,” said Josh Vance, the county’s epidemiologist, in an interview with the Aspen Times. “I’ll be honest—I think not having indoor dining plays a role.”
In Teton County, restaurants and bars remain open for indoor operations long as they follow social distancing guidelines. The reliance on the ultra-rich creates an undeniable risk to the livelihood of Jackson residents and workers. In the early days of the pandemic, ski resorts across Europe became super spreaders, with visitors transporting the virus like carry-on luggage, threatening other tourists and locals alike. As a result, resorts have been closed this winter across much of Europe, including in France, Germany and Italy. These precautions protect remote mountain towns from an influx of the virus, but there are other, massive costs associated with closing down. Without government support, there is little option for communities like Jackson but to stay open, follow existing public health guidelines and hope for the best. “When the pandemic first started coming to work felt like entering the lion’s den,” said the restaurant worker from Jackson who wished to remain anonymous. “But by now we’re all used to the risk, and really what choice do we have?”
As a warehouse manager at a Food 4 Less in Los Angeles, Norma Leiva greets delivery drivers hauling in soda and chips and oversees staff stocking shelves and helping customers. At night, she returns to the home she shares with her elderly mother-in-law, praying the coronavirus isn’t traveling inside her.
A medical miracle at the end of last year seemed to answer her prayers: Leiva, 51, thought she was near the front of the line to receive a vaccine, right after medical workers and people in nursing homes. Now that California has expanded eligibility to millions of older residents — in a bid to accelerate the administration of the vaccines — she is mystified about when it will be her turn.
“The latest I’ve heard is that we’ve been pushed back. One day I hear June, another mid-February,” said Leiva, whose sister, also in the grocery business, was sickened last year with the virus, which has pummeled Los Angeles County — the first U.S. county to record 1 million cases. “I want the elderly to get it because I know they’re in need of it, but we also need to get it, because we’re out there serving them. If we’re not healthy, our community’s not healthy.”
Delaying vaccinations for front-line workers, especially food and grocery workers, has stark consequences for communities of color disproportionately affected by the pandemic. “In the job we do,” Leiva said, “we are mostly Blacks and Hispanics.”
Many states are trying to speed up a delayed and often chaotic rollout of coronavirus vaccines by adding people 65 and older to near the front of the line. But that approach is pushing others back in the queue, especially because retired residents are more likely to have the time and resources to pursue hard-to-get appointments. As a result, workers who often face the highest risk of exposure to the virus will be waiting longer to get protected, according to experts, union officials and workers.
The shifting priorities illuminate political and moral dilemmas fundamental to the mass vaccination campaign: whether inoculations should be aimed at rectifying racial disparities, whether the federal government can apply uniform standards and whether local decision-making will emphasize more than ease of administration.
Speed has become all the more critical with the emergence of highly transmissible variants of the virus. Only by performing 3 million vaccinations a day — more than double the current rate — can the country stay ahead of the rapid spread of new variants, according to modeling conducted by Paul Romer, a Nobel Prize-winning economist.
But low-wage workers without access to sick leave are among those most likely to catch and transmit new variants, said Richard Besser, president of the Robert Wood Johnson Foundation and former acting director of the Centers for Disease Control and Prevention. Because there are not enough doses of the vaccines to immunize front-line workers and everyone over 65, he said, officials should carefully weigh combating the pernicious effects of the virus on communities of color against the desire to expedite the rate of inoculation.
“If the obsession is over the number of people vaccinated,” Besser said, “we could end up vaccinating more people, while leaving those people at greatest risk exposed to ongoing rates of infection.”
The move to broaden vaccine availability to a wider swath of the elderly population — backed by Trump administration officials in their final days in office and members of President Biden’s health team — marks a departure from expert guidance set forth in December, as the vaccine rollout was getting underway.
A panel of experts advising the CDC recommended that the second priority group include front-line essential workers, along with adults 75 and older. The guidance represented a compromise between the desire to shield people most likely to catch and transmit the virus — because they cannot socially distance or work from home — and the effort to protect people most prone to serious complications and death.
People of color and immigrants are overrepresented not just in grocery jobs but also in meatpacking, public transit and corrections facilities, where outbreaks have taken a heavy toll. Black and Latino Americans are three to four timesmore likely than White people to be hospitalized and almost three times more likely to die of covid-19, the illness caused by the coronavirus, according to the CDC.
The desire to make vaccine administration equitable was central to recommendations from the Advisory Committee on Immunization Practices.
“We cannot abandon equity because it’s hard to measure and it’s hard to do,” Grace Lee, a committee member and a pediatrics professor at Stanford University’s School of Medicine, said at the time.
On Wednesday at a committee meeting, Lee said officials need both efficiency and equity to “ensure that we are accountable for how we’re delivering vaccine.”
“Absolutely agree we do not want any doses in freezers or wasted in any way,” Lee said.
But efficiency has won out in most places.
Some state leaders, such as Florida Gov. Ron DeSantis (R) and Texas Gov. Greg Abbott (R), acted on their own, lowering the age threshold to 65 soon after distribution began last year. Others followed with the blessing of top federal officials.
Biden’s advisers have said equity will be central to their efforts, calling access in underserved communities a “moral imperative” and promising, in a national vaccination strategy document, “we remain focused on building programs to meet the needs of hard-to-reach and high-risk populations.” In the meantime, they have similarly encouraged states to broaden vaccine availability to a larger segment of their older populations without providing guidance about how to ensure front-line workers remain a priority.
Experts studying health disparities say prioritizing people over 65 disproportionately favors White people, because people of color, especially Black men, tend to die younger, owing to racism’s effect on physical health. Twenty percent of White people are 65 or over, while just 9 percent of people of color are in that age group, according to federal figures.
“People are thinking about risk at an individual level as opposed to at a structural level. People are not understanding that where you work and where you live can actually bring more risks than your age,” said Camara Phyllis Jones, a family physician, epidemiologist and past president of the American Public Health Association. “It’s worse than I thought.”
The constantly changing priorities have made the uneven rollout all the more difficult to navigate. There is confusion over when, where and how to get shots, with different jurisdictions taking different approaches in an illustration of the nation’s decentralized public health system.
While praising the effort to expand access and speed up the administration of shots, Marc Perrone, president of the United Food and Commercial Workers International Union, said increasing reliance on age-based eligibility “must not come at the expense of the essential workers helping families put food on the table during this crisis.
“Public health officials must work with governors in all 50 states to end the delays and act swiftly to distribute the vaccine to grocery and meatpacking workers on the front lines, before even more get sick and die,” he said.
Mary Kay Henry, president of the Service Employees International Union, said the only way to ensure front-line workers get the vaccines they need is to involve them and their union representatives in decisions about eligibility and access. Unions, she said, could also be tapped to conduct outreach in hard-to-reach communities, including those not conversant in English.
“Essential workers who’ve been on the front lines both in health care but also across the service and care sectors — child care, airline, janitorial, security — face extraordinary risk,” she said.
Leiva, a 33-year member of UFCW Local 770, said the celebration of essential workers should come with recognition of their sacrifice, which is unevenly felt across racial groups. When the virus tore through the grocery store, she said, “every single one of them in that cluster was Hispanic.”
But with hospitals dangerously full in recent weeks, and less than half of distributed vaccine doses administered, many states broadened their top priority groups to include older adults, hoping to lessen the burden on hospitals and expedite vaccine administration.
Protecting people 65 and older, officials say, saves the lives of those who face the gravest consequences and reduces the stress on intensive care units. Risk for severe covid-19 illness increases with age; 8 out of 10 deaths reported in the United States have been in people 65 and older.
Older people in the United States have also encountered enormous hurdles in gaining access to the vaccines. Faced with overloaded sign-up websites and jammed phone lines, they have sometimes spent nights waiting in line.
In more than half the states — at least 28, by one count — people 65 and older are in the top two priority groups, behind health-care workers and residents in long-term care facilities. As a result, front-line workers either fall behind the older group or are squeezed into the same pool, according to a Kaiser Family Foundation analysis.
“When you make that pool of eligible people much bigger, you’re creating much longer wait times for some of these groups,” said Jennifer Kates, a senior vice president at the foundation.
Front-line workers often labor in crowded conditions. Some live in multigenerational households. By contrast, many older adults are retired, have greater access to sign-up portals and have more time to wait in lines outside of clinics, health officials said.
“The 65-year-old person who is wealthier and can stay home and isn’t working and is retired and can ride it out for another two months … is less likely to get infected than the person who has to go outside every day for work,” said Roberto B. Vargas, assistant dean for health policy at Charles R. Drew University of Medicine and Science in Los Angeles.
In California, Gov. Gavin Newsom (D) announced Jan. 13 that the state was “significantly increasing our efforts to get these vaccines administered, get them out of freezers and get them into people’s arms” by increasing the number of people eligible to receive shots. “Everybody 65 and over — about 6.6 million Californians — we are now pulling into the tier to make available vaccines.”
On Jan. 25, Newsom said the state would move to an age-based eligibility system after vaccinating those now at the front of the line, including health-care workers, food and agriculture workers, teachers, emergency personnel and seniors 65 and older.
The abrupt changes confused local health officials.
Julie Vaishampayan, public health officer in San Joaquin Valley’s Stanislaus County, said the county had just finished vaccinating health-care workers and was getting ready to reach out to farm laborers at a tomato-packing company and food-processing workers. When the state added those 65 and older, the county had to pivot abruptly,as it faced a quintessential supply-and-demand dilemma.
“There isn’t enough vaccine to do it all, so how do we balance?” she said in an email. “This is really hard.”
In Tennessee, teachers were initially promised access but then were told to wait until people 70 and older got their shots. The state’s health commissioner, Lisa Piercey, said she was moving more gradually through the age gradations so as not to crowd out workers, treating the federal framework as guidance, which is often how officials have characterized it. “It’s not an either/or situation,” she said in an interview this month.
But with vaccine supply sharply limited, priorities had to be narrowed. By vaccinating older residents, she said, the state was also protecting its medical infrastructure by reducing the likelihood that older people, who are more likely to be hospitalized, would fall ill. Once there is more supply, she said, she would be able to amplify aspects of the state’s planning geared toward underserved and hard-to-reach populations. “I can’t wait to manifest that equity plan.”
In Nebraska, the health department in Douglas County, which includes Omaha, prioritized older residents over “critical industry workers who can’t work remotely” after the state expanded eligibility to residents 65 and older, according to a January news release. Meatpacking workers, grocery store employees, teachers and public transit workers were bumped lower in line.
Omaha’s teachers union had wanted its approximately 4,100 members to get shots before the district resumes full-time, in-person instruction for elementary and middle school students Tuesday. Now, they must wait until late spring, said Robert Miller, president of the Omaha Education Association.
“The fear, it goes hand in glove with going back to school five days a week,” he said, despite CDC reports that schools operating in person have seen scant transmission. “We’ve had some teachers who have multigenerational homes, who live in the basement, … and they can’t interact with their parents. We have some teachers who are staying at a different apartment away from their elder loved ones.”
Some state leaders sought to defend broadening eligibility to more of the elderly population, saying it was consistent with efforts to address racial disparities. Illinois had reduced the age requirement to 65, Gov. J.B. Pritzker (D) said recently, “in order to reduce covid-19 mortality and limit community spread in Black and Brown communities.” His office did not respond to a request for comment about how lowering the age threshold would have that effect.
In Massachusetts, state leaders announced Jan. 25 that people 65 and older and those with at least two high-risk medical conditions were next in line, ahead of educators and workers in transit, utility, food and agriculture, sanitation, and public works and public health.
That means Dorothy Williams, who runs a day-care center in a predominantly Black community where the infection rate is among the highest in Boston, has to wait. Her center stayed open throughout the pandemic, caring for children of essential workers, many of them in low-wage jobs in hospitals or nursing homes.
She recognizes the long hours and the exposure risks of those health-care aides. That means “we’re exposed,” she said, “each and every single day.” She has been able to keep the coronavirus at bay, but two weeks ago, she had a scare that forced her to close and get everyone tested after a child became ill. The tests came back negative, but the fear remains.