Category Archives: Asymptomatic Transmission

After a Steep Plunge in Virus Cases, Every State Is Seeing an Uptick

Posted on by • Posted in Asymptomatic Transmission, Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Opinion, Public Perception, Public Safety, Public Schools, Scientists, Social Distancing, Vaccination, Vaccine, Vaccine Efficacy, Vaccine Hesitancy Rate, Vaccine Safety, Vaccine Skepticism, Vaccine Supply • Leave a comment

https://www.yahoo.com/news/steep-plunge-virus-cases-every-120859155.html

After a Steep Plunge in Virus Cases, Every State Is Seeing an Uptick

The number of new coronavirus cases is increasing in every state, setting off a growing sense of concern from health officials who are warning that the pandemic in the United States is far from over, even though the national outlook is far better than during previous upticks.

The 160 million people across the country who are fully vaccinated are largely protected from the virus, including the highly contagious delta variant, scientists say. In the Upper Midwest, the Northeast and on the West Coast — including in Chicago, Boston and San Francisco — coronavirus infections remain relatively low.

But the picture is different in pockets of the country where residents are vaccinated at lower rates. Hot spots have emerged in recent weeks in parts of Missouri, Arkansas and Nevada, among other states, leaving hospital workers strained as they care for an influx of coronavirus patients. Less than a month after reports of new cases nationally bottomed out at around 11,000 a day, virus cases overall are increasing again, with about 26,000 new cases a day, and hospitalizations are on the rise.

The country is at an inflection point, and experts said it was uncertain what would come next. While nationwide cases and hospitalization numbers remain relatively low, more local hot spots are appearing and the national trends are moving in the wrong direction. Many of the oldest, most vulnerable Americans are already inoculated, but the vaccine campaign has sputtered in recent weeks.

“This will definitely be a surge,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “It won’t be as big as what happened in January. But we still have 100 million people in the United States who are susceptible to COVID-19.”

Intensive care beds in hospitals have become scarce in parts of Missouri, where officials in Springfield on Wednesday asked for an alternative care site. In Mississippi, where cases are up 70% over the past two weeks, health officials have urged older adults to avoid large indoor gatherings even if they have been vaccinated. And in Los Angeles County, officials said Thursday that masks would once again be required indoors, regardless of vaccination status, because of the spread of the delta variant.

The slowdown of the vaccination effort has amplified concerns. About 530,000 people are now receiving a vaccine each day, a sharp decrease from 3.3 million shots a day in April. Less than half of the United States population has been fully vaccinated.

Still, the country’s prognosis remains better than at previous points in the pandemic. The vaccines are widely available, cases and hospitalizations remain at a tiny fraction of their peaks and deaths are occurring at some of the lowest levels since the early days of the pandemic.

Yet daily case numbers have increased in all 50 states, including 19 states that are reporting at least twice as many new cases a day.

Mayor Quinton Lucas of Kansas City, Missouri, where cases are increasing but remain far below levels in other parts of the state, said he worried that the outbreak in southwestern Missouri would keep spreading, given low vaccination rates there. He said strong recommendations for mask wearing — or even new mandates — may become necessary if his city’s outlook continued to worsen.

“I think when you start to see Springfield-level hospitalizations here in the Kansas City metro, then we’ll have to very seriously consider whether it’s time to return to previous restrictions,” Lucas said.

In a string of news conferences this week, public health officials pleaded with people who have not gotten shots to change their minds, urging them to consider that coronavirus vaccines are safe, free and available to anyone ages 12 and older.

“To any who have been hesitating about being vaccinated, please, I implore you to hesitate no longer,” Dr. Kiran Joshi, the senior medical officer for the Cook County Department of Public Health, which serves suburban Chicago, said Thursday.

Even in places in the United States that have not yet seen a significant uptick in infections, governors and public health officials worried that their states were vulnerable to an outbreak.

“I hope and pray that it doesn’t come to West Virginia and just absolutely runs across our state like wild,” said Gov. Jim Justice, whose state has recorded relatively few cases recently but has a low vaccination rate. “But the odds are it will.”

Few places are more worrisome than in Missouri, where a surge among unvaccinated people has left hospitals scrambling to keep up.

Just two months ago, when there were only 15 active coronavirus cases in his southwestern Missouri county, Larry Bergner, the director of the Newton County Health Department, had hoped the end of the pandemic might be in sight.

That has not happened.

As the delta variant has spread across the country, it has sent case totals spiking in Newton County, where less than 20% of residents are fully vaccinated. Bergner’s county now has a higher rate of recent cases than any state.

“It does give, I guess, some depression to think that we thought we were coming out of it, now here we go again, how high are we going to get,” Bergner said.

In Milwaukee County, where 48% of residents are fully vaccinated, the health department has tried to push the number higher by setting up a vaccine site outside the Fiserv Forum, where the Milwaukee Bucks are playing in the NBA Finals. Fewer than two dozen people have received a vaccine each day the site was in place, said Dr. Ben Weston, the director of medical services for the Milwaukee County Office of Emergency Management.

“In March, people flooded to our vaccination sites — all we had to do was open a door,” Weston said. “Now we have to go out and find people.”

As case numbers slowly rise, a sense of worry has begun to creep in for some Americans, even those who are fully vaccinated.

Vince Palmieri, 89, who gets around Los Angeles on public transportation, said he worried when he saw fellow riders not wearing masks as required. Though per capita case rates remain relatively low in Los Angeles County, they have grown sharply in recent weeks. The county is averaging about 1,000 new cases a day, up from fewer than 200 a day in mid-June.

“Once you get on a bus or a train you’re in no man’s land,” said Palmieri, who continues to wear a mask. “Their sneeze could take somebody out, but I’m frightened to talk up about the disease because people get ugly.”

Debora Weems, 63, who lives in New York City, has been following the case numbers closely. Her anxiety about the virus has risen alongside cases. New York City, which averaged fewer than 200 new cases a day in late June and early July, is now averaging more than 400 a day, far below past peaks.

“I’m just afraid we’re going to have to shut down again,” Weems said. Both she and her mother, who is 85, are vaccinated, but now she worries that their protection is not enough.

When the case numbers were at their lowest, she moved through the city more freely, with less thought about whether people nearby were vaccinated. But now she is trying to avoid leaving her neighborhood, and recently put up a new sign on her apartment door with a request: She and her mother are not receiving visitors because of COVID-19.

US’s largest registered nurses union calls on CDC to bring back universal mask guidelines

Posted on by • Posted in Asymptomatic Transmission, Centers for Disease Control & Prevention (CDC), Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Health Policy, Infection Control, Infection Control Plan, Infectious Virus, Nurses, Nurses Union, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Opinion, Public Perception, Public Safety, Public Schools, Public Trust, Scientists, Social Distancing, Vaccination, Vaccine, Vaccine Distribution, Vaccine Hesitancy Rate, Vaccine Mandate, Vaccine Production, Vaccine Safety, Vaccine Skepticism, Vaccine Supply • Leave a comment
https://thehill.com/policy/healthcare/562692-uss-largest-registered-nurses-union-calls-on-cdc-to-bring-back-universal?utm_source=&utm_medium=email&utm_campaign=40669
Nurses' Union Condemns C.D.C.'s New Mask Advice - The New York Times

The largest union for registered nurses in the U.S. called on the Centers for Disease Control and Prevention (CDC) to bring back recommendations for universal masking in public regardless of people’s vaccination status. 

The National Nurses Union (NNU) in a Monday letter to CDC Director Rochelle Walensky requested that the agency reinstitute guidelines for all people to wear masks in public and in close proximity to those outside their household.

NNU Executive Director Bonnie Castillo pointed to a 16 percent uptick in U.S. COVID-19 cases from last week, according to CDC data, as well as rises in case counts in more than 40 states and hospitalizations in more than 25 states as reasons to return to previous, stricter guidelines.

“NNU strongly urges the CDC to reinstate universal masking, irrespective of vaccination status, to help reduce the spread of the virus, especially from infected individuals who do not have any symptoms,” Castillo wrote in the letter. “Our suggestions are based on science and the precautionary principle and are made in order to protect nurses, other essential workers, patients, and the public from Covid-19.”

The union also cited the World Health Organization’s (WHO) call for vaccinated people to continue wearing masks in public amid the spread of the highly transmissible delta variant. Several U.S. officials and experts have said the WHO’s guidance reflects the state of the pandemic worldwide, which overall has seen lower vaccination rates than the U.S.

Castillo acknowledged that COVID-19 vaccines are effective at preventing severe illness and death but noted “no vaccine is 100 percent effective, and the emergence and spread of variants of concern may reduce vaccine effectiveness.”

The NNU in its letter also appeals for the CDC to update its guidance to “fully recognize aerosol transmission,” mandate tracking and reporting of cases among health care and essential workers, and keep records of cases, including mild and asymptomatic infections, among fully vaccinated people to measure the shots’ effectiveness. 

The CDC did not immediately return a request for comment on the letter, but officials have consistently defended the updated mask guidance, saying fully vaccinated individuals are protected against the virus.

The NNU vocally opposed the CDC’s current mask guidance updated in May to permit fully vaccinated individuals to go maskless in virtually all settings. The union has argued that the change in recommendations endangered patients, front-line workers and nurses as the pandemic continues.

In the Monday letter, the union wrote that the CDC’s relaxation of mask guidance “failed to account for” the possibility of fully vaccinated people contracting and spreading the virus. It also said the agency’s guidelines do not protect people, including children, who cannot get the vaccine.

The NNU sent the letter days after the CDC urged schools to reopen for full in-person learning in the fall, saying that fully vaccinated teachers and students do not need to wear masks.

It also comes after Los Angeles County and St. Louis County recommended their residents to wear masks in public indoors.

Delta spreads 225% faster than original virus — this may be why

Posted on by • Posted in Asymptomatic Transmission, Clinical Research, Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Opinion, Public Perception, Public Schools, Public Trust, Scientists, Social Distancing, Vaccination, Vaccine, Vaccine Distribution, Vaccine Efficacy, Vaccine Hesitancy Rate, Vaccine Safety, Vaccine Skepticism • Leave a comment
https://www.beckershospitalreview.com/public-health/delta-spreads-225-faster-than-original-virus-this-may-be-why.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=2893H2397267F7G
Why The Delta Variant Is So Contagious: A New Study Sheds Light : Goats and Soda : NPR

Mounting evidence suggests the delta variant is the most contagious strain in the world, spreading about 225 percent faster than the original version of the virus. A small study published online July 7 may help explain why, NPR reported.

The delta variant, first identified in India, grows faster in people’s respiratory tracts and to much higher levels, according to researchers at the Guangdong Provincial Center for Disease Control and Prevention in China.

They analyzed virus levels in 62 people infected during China’s first delta variant outbreak between May 21 and June 18. They compared their findings to virus levels in 63 patients infected in 2020 by an earlier version of the virus.

On average, viral load was about 1,000 times higher for people infected with delta, compared to those infected with the earlier strain, researchers found. It also took about four days on average for delta to reach detectable levels in study participants, compared to six days for the other strain. This finding suggests people with delta likely become infectious sooner and are spreading the virus earlier in the course of their infection, researchers said. 

To view the full study, click here.

More than 3,997,000 people have died from the coronavirus worldwide

Posted on by • Posted in Asymptomatic Transmission, Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Opinion, Public Perception, Social Distancing, Vaccination, Vaccine, Vaccine Distribution, Vaccine Efficacy, Vaccine Hesitancy Rate, Vaccine Safety, Vaccine Supply • Leave a comment
https://www.washingtonpost.com/graphics/2020/world/mapping-spread-new-coronavirus/?wpmk=1&wpisrc=al_news__alert-politics–alert-national&utm_source=alert&utm_medium=email&utm_campaign=wp_news_alert_revere&location=alert&pwapi_token=eyJ0eXAiOiJKV1QiLCJhbGciOiJIUzI1NiJ9.eyJjb29raWVuYW1lIjoid3BfY3J0aWQiLCJpc3MiOiJDYXJ0YSIsImNvb2tpZXZhbHVlIjoiNWI2M2EzNDJhZGU0ZTI3Nzk1NTBjYTFiIiwidGFnIjoid3BfbmV3c19hbGVydF9yZXZlcmUiLCJ1cmwiOiJodHRwczovL3d3dy53YXNoaW5ndG9ucG9zdC5jb20vZ3JhcGhpY3MvMjAyMC93b3JsZC9tYXBwaW5nLXNwcmVhZC1uZXctY29yb25hdmlydXMvP3dwbWs9MSZ3cGlzcmM9YWxfbmV3c19fYWxlcnQtcG9saXRpY3MtLWFsZXJ0LW5hdGlvbmFsJnV0bV9zb3VyY2U9YWxlcnQmdXRtX21lZGl1bT1lbWFpbCZ1dG1fY2FtcGFpZ249d3BfbmV3c19hbGVydF9yZXZlcmUmbG9jYXRpb249YWxlcnQifQ.H_bZQ-MxFNKZ0GjBIR1_Y5jUdLtPyWfWxZlA-0_1wUE
Coronavirus Outbreak: Live Updates and News for Apr. 10, 2020 - Bloomberg

The coronavirus has killed nearly 4 million people since it first emerged in Wuhan, China, in 2019, according to data compiled by Johns Hopkins University.

New confirmed cases of covid-19, the disease caused by the virus, remain high, and the world struggles with unequal vaccine rollouts and new threats posed by fast-spreading variants.

“The pandemic is a long way far from over,” World Health Organization Director General Tedros Adhanom Ghebreyesus warned in May. “It will not be over anywhere until it’s over everywhere.”

Some countries have already found that the spread of the virus is outpacing their vaccination plans, especially in the face of proliferating variants. In India, new daily cases topped 400,000 in early May — a global record but probably an undercount.

China now leads the world in the number of vaccine doses given out, though some other nations have vaccinated far more of their population. The vaccines were developed and rolled out at record speed, and studies show most have impressive efficacy.

More than a billion doses have been administered around the world, far more than the number of confirmed cases of the coronavirus since the start of the pandemic — though a large number of cases were likely never recorded, experts caution.

But the vaccine rollout has been persistently unequal, with problems with global supply and pockets of opposition in many nations. Covax, a program to distribute vaccines fairly backed by the World Health Organization, only belatedly began distributing doses to low-income nations.

“I can’t say it’s surprising,” said Thomas J. Bollyky, a senior fellow at the Council on Foreign Relations. “In every previous pandemic where we have our global health crisis, where there has been limited supplies of medical intervention, wealthy nations have hoarded.”

The United States, which continues to have the highest cumulative number of confirmed cases and deaths globally. More than 590,000 deaths from covid-19 have been recorded across the country.

Though cases dipped after January, a new wave began only a few months later, prompting President Biden to urge governors to reinstate mask mandates and other virus-related restrictions. “This is deadly serious,” Biden said in March.

Behind the United States, India, Brazil, France and Turkey have the largest number of cases.

India’s record-setting surge this spring meant the country accounted for about 1 in 3 of all new confirmed cases. The spike, which has been blamed on complacency and the lifting of restrictions, along with the spread of variants, has seen the country’s health-care system overwhelmed amid widespread oxygen shortages.

Even after the spike in new cases subsided in mid-May, India still set records for the number of new daily deaths with more than 4,500 deaths from covid-19 reported in a single 24-hour period.

In India, as in Britain and Brazil before it, some of the spread of the virus has been blamed on fast-spreading variants rampant in the country.

The variant widespread in India, known by the name B.1.617.2, has spread far beyond its borders. In May, British officials warned that it would likely become dominant across Britain unless more was done to control its spread.

Sharon Peacock, director of the U.K.’s Covid-19 Genomics Consortium, told reporters that a fast-spreading variant such as B.1.617.2 had “a biological passport for international travel and global spread” — making its spread difficult, if not impossible, to fully contain.

Some countries have seen success at controlling the virus.

In New Zealand, which closed its borders and ordered people to stay home as a first wave hit in the spring of 2020, confirmed infections went down to zero for a time. Taiwan and Singapore have kept their outbreaks far smaller than those in other parts of the world, which some experts attribute to their early responses and sophisticated tracking and tracing.

China, the early epicenter of the crisis, has seen much of daily life return to normal. In the early months of the outbreak, it reported more cases than any other country. Its tally of new infections peaked in mid-February of 2020 and approached zero by mid-March, although questions surround the accuracy of its data.

Wuhan, the virus’s initial epicenter, ground to a standstill in January 2020 as the coronavirus spiraled out of control. But after months without a confirmed case of domestic transmission, about 1.4 million children in the city returned to classrooms at the start of September, and crowded events have resumed.

Countries that have successfully rolled out vaccines are also seeing important gains. Britain, one of the hardest-hit countries in terms of cases and deaths, has excelled in the distribution of coronavirus vaccines. It was the first country to roll out a fully tested vaccine to the general public in December, when it began distributing the vaccine developed by Pfizer and Moderna.

Data released by Public Health England in March suggested that vaccinations had saved over 6,000 lives among people over 70, if not more.

Israel, which has seen several waves of the virus, had raced ahead of other nations and given the first doses of Pfizer’s two-dose vaccine to more than a third of its population by the end of January. Data from Israel indicated that the Pfizer vaccine was around 94 percent effective at stopping asymptomatic infection.

Early signs from the country suggest that the large scale of vaccinations has had an impact on the spread of the virus.

But global health experts have cautioned that despite the success of vaccines, the virus remains a potent threat and returning to normal life too early could ultimately extend the length of the pandemic and lead to fresh new cases.

Though wealthy countries have taken some steps to ensure vaccines are shared around the world, such as by donating through Covax or supporting waivers on intellectual property such as the Biden administration has done, experts say they are worried by the ongoing level of spread.

“Sadly, unless we act now, we face a situation in which rich countries vaccinate the majority of their people and open their economies, while the virus continues to cause deep suffering by circling and mutating in the poorest countries,” United Nations Secretary General António Guterres said at a meeting of the World Health Assembly on May 24.

Why COVID-19’s Death Toll Will Climb Long After the Pandemic Is Over

Posted on by • Posted in Asymptomatic Transmission, Congressional Research Service (CRS), Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Health Policy, Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Personal Protective Equipment (PPE), Social Distancing, Vaccine, Vaccine Distribution, Vaccine Efficacy, Vaccine Hesitancy Rate, Vaccine Safety, Vaccine Skepticism, Vaccine Supply • Leave a comment

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Covid-19 Cases, Death Rates Are Declining Six Months Into Pandemic - WSJ

If you were anything like my family over the July 4 holiday, there were bowls of potato salad, casseroles of baked beans and platters of hotdogs, hamburgers and chicken all pulled from the grill and served family-style. For a lot of us, it was the first time seeing a wide net of our family in more than a year and we took advantage of ditching the masks, probably wrongly assuming our circles were vaccinated at higher levels than they were and maybe even handing kids lighters for sparklers they shouldn’t be wielding.

Our increasing return to normal makes it easy to believe the pandemic is almost over. Sure, we still had to wear masks on the flights, trains and buses. Grocery markets and big-box stores in some communities still asked that we wear them, too. The staff at Nationals Park here in D.C. and Progressive Field in Cleveland wore theirs as I visited both for MLB games. But the worst of the pandemic feels behind us here in the U.S., as vaccinations are climbing, deaths and new cases are sinking and headlines seem to be shifting to more run-of-the-mill topics like tropical storms.

A new and unusually long report from Congress’ independent think-tank is a stark warning to the U.S. government that even COVID-19 seems over, it actually isn’t, particularly when it comes to Americans’ well being. Released on Friday, the wonks at the Congressional Research Service (CRS) urged officials going into the long holiday weekend to remember amid the celebrations that we still don’t know the final toll of the pandemic, especially when it comes to long-term consequences for behavioral and mental health. Its notes about substance-abuse challenges are particularly worrying, given that lawmakers cannot ignore the already troubling fight against opioids.

Anecdotally, we know the last 18-or-so-months have taken a toll on our friends, colleagues and neighbors. Those of us lucky enough to have been allowed to work from home adapted in fits and starts. My colleagues with children or dependents were stretched to the points of breaking, but most have made it to the other side. Those in complete isolation actually came to look forward to Zoom meetings and telemedicine appointments. And tech-slow people like my grandmother probably wouldn’t have made it through without the good folks at the local public library loading her loans into the trunk through a touch-free lending system.

But you cannot make public policy on anecdotes alone, which is why the CRS report offers a roadmap for lawmakers. Noting upfront that the data is still coming in and comparisons so quickly after—and during, really—a so-recent period are imprecise, there are still warning signs that America has not healed the way we’d like to believe. The share of Americans suffering simultaneously from depression and anxiety grew five-fold, year-over-year, in just the first three-months of the pandemic-mandated lockdown, from April to June 2020, when the death toll still hovered around 120,000. Fatal overdoses grew 11% between March and May last year, and non-fatal overdoses rose 19% during that same short window. In the three months that followed, there were almost equal levels of depression or anxiety among households that had lost jobs and those that had not. No one was spared, but the hit came hardest for less-educated, essential and lower-paid workers.

Why is this Washington’s problem? An estimated 10% to 20% of Americans who needed mental-health services during the pandemic received no treatment. Another survey cited in the report estimates that up to a quarter of adults with depression or anxiety went untreated. As many as 27,000 Americans who survived COVID-19 may end up dead over the next decade as a result of behavioral health-related challenges, and that number may ultimately reach more than 154,000. At the moment, federal law does not require mental health services to be treated on par with treatments for physical health. Not Medicare. Not CHIP. Not even fancy private insurance plans.

There were, believe it or not, a few upsides to the COVID-19 pandemic that the CRS report notes. Under emergency powers granted in one of the relief bills, the Department of Health and Human Services waived the in-person requirement for some treatments, including mental health and substance abuse counseling. For now doctors can be paid for that phone call consultation rather than requiring patients to make a brick-and-mortar visit to qualify for Medicare and Medicaid money. The Department of Veterans Affairs allowed taxpayer dollars to help with mental health services via tech platforms, too. In all, billions of dollars were included in the raft of COVID-19 stimulus plans to shore up mental health and substance abuse programs.

But those were the bright spots. Not all of Washington’s urgent changes were for the better. The Drug Enforcement Agency allowed doctors to prescribe medicine without a physical appointment, Health and Human Services’ civil rights unit turned a lot of blind eyes to patients’ privacy rights as public health data seemed ubiquitous, and the Small Business Administration shoved piles of cash out the door to health clinics and larger rafts of money to hospitals with minimal upfront scrutiny.

So as Washington turns slowly toward the post-pandemic policies of this country, lawmakers have plenty to consider, especially if it wants to return America to its Before Times footing. As much as it may feel like the United States is rounding a corner—and it’s tough not to when you see big crowds gathering maskless for fireworks and parades—the reality is this: there’s still a lot of trauma under the surface that is all too easy to miss unless D.C. is looking for it.

Delta variant ignites new mask debate

Posted on by • Posted in Asymptomatic Transmission, Centers for Disease Control & Prevention (CDC), Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Infection Control, Infection Control Plan, Infectious Virus, National Strategy, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Opinion, Public Perception, Public Safety, Social Distancing, Vaccine, Vaccine Distribution, Vaccine Efficacy, Vaccine Hesitancy Rate, Vaccine Safety, Vaccine Skepticism, Vaccine Supply • Leave a comment

Delta variant ignites new mask debate

Delta variant ignites new mask debate | TheHill

Health officials are grappling with how to prevent potential COVID-19 outbreaks from the delta variant that is spreading rapidly across the U.S.

Concern over the highly transmissible delta strain prompted Los Angeles County this week to recommend that all people wear masks indoors, even if they’re vaccinated. The World Health Organization (WHO) has also encouraged fully vaccinated people to continue using masks.

But the Centers for Disease Control and Prevention (CDC) has not signaled any plans to revise its mask guidance, with Biden administration officials and some experts say that fully vaccinated Americans are safe from all existing COVID-19 variants.

“If you have been vaccinated, the message we’re conveying is you’re safe,” White House press secretary Jen Psaki said Wednesday. “Vaccines are effective, and that is something we want to be very clear with the public about.”

Still, the move by officials in Los Angeles County raises the prospect that mask recommendations and even mandates could make a return to certain parts of the country.

The CDC projected the delta variant made up more than a quarter of cases in the U.S. in the most recent two-week period, ending June 19 — a jump from 10 percent the previous two weeks.

Los Angeles County issued a statement Monday saying it “strongly recommends” all people wear masks in indoor settings where they don’t know everyone’s vaccination status.

Barbara Ferrer, director of the county’s Department of Public Health, told The Hill that officials want to take time to get more people vaccinated as research is conducted on delta variant transmission from the fully vaccinated.

“While we’re doing that work with building confidence, we’re going to go ahead and offer as much protection as possible for everyone,” she said.

Leana Wen, an emergency physician and public health professor at George Washington University, praised the county’s decision as the “right move,” saying she hopes other jurisdictions follow suit to protect both vaccinated and unvaccinated residents.

“People who are fully vaccinated are still at risk, albeit a low risk, from those who are unvaccinated,” Wen said.

“Fully vaccinated people can be around others who are fully vaccinated without any limitations,” she added. “However, if they’re going to be around unvaccinated people or vaccination status is not being checked, then those could be high-risk settings” where masks should be worn.

For now, Los Angeles County is an outlier as cities and states continue to loosen mask requirements. Washington’s King County, home to Seattle, and Pennsylvania were the latest jurisdictions to end their mandates, taking that step this week.

CDC Director Rochelle Walensky told NBC’s “Today” on Wednesday that the agency’s guidance that fully vaccinated people don’t need masks in most settings has not changed. She said the WHO has given conflicting instructions, saying the international organization is focused on the global community, which has a lower vaccination rate than the U.S.

“We have always said that local policymakers need to make policies for their local environment,” Walensky said. “But those masking policies are not to protect the vaccinated, they’re to protect the unvaccinated.”

So far, the delta strain has not led to any changes in masking policies at the White House or the Capitol.

The White House does not require masks if a person is vaccinated, although the administration is not checking to see whether all maskless people have gotten their COVID-19 shots.

In recent weeks, the House has ended its universal mask requirement, and few people in the Capitol continue to wear them. The overwhelming majority of lawmakers in both parties have shed masks and freely gather in large groups on the House floor.

The Senate, which never had a mask requirement since nearly all senators voluntarily wore facial coverings when it was recommended, has also relaxed its pandemic restrictions.

But the delta variant threat is influencing other activities in the House. Speaker Nancy Pelosi (D-Calif.) announced this week that proxy voting would be extended through Aug. 17, and House Majority Leader Steny Hoyer (D-Md.) said that was due to the global spread of the delta variant.

“As we know, there are some countries in the world that are seeing a virulent resurgence of this new variant of the COVID-19. Israel is a perfect example of that,” Hoyer told reporters, referring to Israel reimposing its indoor mask mandate despite having one of the world’s highest vaccination rates. “But even in Israel, where they have the vaccine available, they’re seeing a resurgence.”

“So, the Speaker correctly, along with the medical advice that she’s gotten, determined that there was still justification for staying on guard,” Hoyer said.

Recent studies have found that COVID-19 vaccines are effective against the strain. Both doses of Pfizer-BioNTech were found to be 88 percent effective against symptomatic disease.

There is “less data” on how Johnson & Johnson performs, Walensky said Wednesday, but “right now we have no information to suggest that you need a second shot after J&J, even with the delta variant.”

Jen Kates, senior vice president and director of global health & HIV policy at the Kaiser Family Foundation, said research shows the CDC guidance “still stands,” although she acknowledged the agency needs to be prepared to adjust.

Kates expressed concern that the resurgence of the mask debate could affect the vaccination effort, noting the variant is spreading mostly among unvaccinated people.

“The worst outcome, I think, is that people choose not to get vaccinated because they think the vaccines aren’t as effective against variants,” she said.

As most Americans have gotten vaccinated, COVID-19 cases, hospitalizations and deaths have declined significantly. But the U.S. is expected to fall short of President Biden’s goal to have 70 percent of adults receiving at least one vaccine dose by the Fourth of July.

The White House still plans to move forward with Independence Day festivities. The administration sent 1,000 invitations for people to gather at 1600 Pennsylvania Ave. on Sunday, with vaccinated people allowed to go without masks. All guests were instructed to get tested one to three days before arriving.

“We certainly feel comfortable and confident moving forward with our event here at the White House and individuals having barbecues in their backgrounds this week to celebrate the Fourth of July,” Psaki said on Wednesday.

More hospitals poised to require COVID-19 vaccines

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It’s “a trickle that will become a torrent,” Ashish Jha, dean at Brown University’s School of Public Health, tweeted.

More hospitals are likely to require employees receive a COVID-19 vaccine, experts said, to further protect the sick and vulnerable patients who rely on them for care.

A Houston-area hospital captured headlines after taking a firm stance on requiring vaccines that prevent severe illness of the coronavirus, which has killed more than 600,000 in the U.S. and ravaged the economy.

Houston Methodist employees who refused the vaccine were either terminated or resigned. A judge earlier this month sided with the hospital and tossed out an employee lawsuit that was seeking to block the mandated inoculation. The ruling may give other hospitals the green light to require the jab, and as more facilities put a similar policy in place, others are likely to follow, experts said.

It’s “a trickle that will become a torrent,” Ashish Jha, professor and dean at Brown University’s School of Public Health, posted Thursday on Twitter.

3 large health systems in Massachusetts to require all workers to be vaccinated.

Given the critical need to protect vulnerable patients, its critical all hospitals do this.

Leading systems will do it soon.

Laggards will get there eventually.

Joining the growing tide of vaccine mandates are a variety of systems and hospitals, including Mass General Brigham in Boston, BJC Healthcare in St. Louis and Inova Health System in Virginia.

Some of the nation’s largest health systems have yet to mandate the shot, including Kaiser Permanente and CommonSpirit Health.

“Vaccination will only be required for Kaiser Permanente employees if a state or county where we operate mandates the vaccine for health care workers,” the company said in an email.

The American Hospital Association continues to hear that a growing number of its members are requiring the vaccine, with some exemptions. However, many member hospitals are waiting until the FDA grants full approval, a time when more safety and efficacy data will be made available.

“Getting vaccinated is especially critical for health care professionals because they work with patients with underlying health conditions whose immune systems may be compromised,” AHA, which has not taken on stance on the requirement, said in a statement.

The mandates raise ethical questions, some say, pointing to the profession’s promise to “do no harm.”

Arthur Caplan, head of medical ethics at New York University School of Medicine, said the codes of ethics that doctors and nurses says to put patients first, do no harm and protect the vulnerable.

“Of course they should be vaccinated,” he said. “If they don’t want to get vaccinated, I think they’re in the wrong profession.”

The Equal Employment Opportunity Commission said employment law does not prohibit employers from requiring the jab, essentially giving the green light to employers to put incentives and requirements in place for their workers. The EEOC is the federal agency tasked with ensuring that workplaces do not discriminate.

Some states are going against the tide and signing legislation that bars vaccine mandates, including Florida. The city of San Francisco will require hospital employees and workers in high-risk settings to get the vaccine. San Francisco, like other employers and universities, will require all city workers get inoculated.

The differing policy stances across the country creates additional hurdles for corporations with a large footprint.

More than 99% of US Covid-19 deaths are among unvaccinated patients

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Almost All of the Current COVID-19 Deaths Are Among Those Unvaccinated

As the delta variant of the coronavirus spreads, especially among the unvaccinated, the Biden administration is gearing up for a new push to vaccinate the so-called “movable middle”—and some public health experts say FDA could advance that goal by fully approving Covid-19 vaccines.

Analysis reveals toll of US Covid-19 deaths among unvaccinated patients

According to an analysis by the Associated Press, nearly all recent Covid-19 deaths have occurred in unvaccinated individuals.

The AP analysis is based on data from CDC, although CDC has not itself released estimates of the share of Covid-19 deaths among unvaccinated patients.

According to the AP analysis, just 0.8% of Covid-19 deaths in May were among the fully vaccinated. Meanwhile, the share of hospitalized patients who were fully vaccinated was just 0.1% in May, with fewer than 1,200 fully vaccinated people hospitalized out of more than 853,000 hospitalizations.

Meanwhile, according to CDC, 54% of the U.S. population, including 66% of American adults, have received at least one dose of a Covid-19 vaccine, while 46.1% of the total population and 56.8% of American adults have received all required doses.

The U.S. COVID-19 Outbreak Is Still Bad—And It Could Get Worse

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The U.S. COVID-19 Outbreak Is Still Bad—And Could Get Worse | Time

In many places across the United States, COVID-19 feels over. Unmasked citizens run rampant. New York City is planning an August mega-concert in Central Park. I’m as hopeful as the rest of us, but I think we may be suffering from memory loss.

Let’s start from this time last year, when many Americans were exuberantly returning to newly reopened beaches, parks and restaurants after a seemingly eternal three months—three whole months!—of quarantine. Universal observance of safety guidelines was surely going to be sufficient to limit viral spread.

We know how that turned out. By mid-June 2020, there were already signs that our bleary-eyed re-emergence was premature. On June 22, 2020, the number of new daily cases of COVID-19 (33,485) surpassed the high-water mark hit on the worst day of the horrific first surge, when that figure peaked at just over 32,000.

A year later, the daily case count is not as foreboding—nor is it nearly as low it may appear.

You’ll notice that this graph covers only the past 12 weeks, while virtually every chart you’ll find (including the one on TIME’s dashboard) graphs COVID-19 cases from the beginning of the outbreak. This is intentional. The toll of the pandemic in the U.S. has persisted for so long, and reached such catastrophic heights in the first weeks of 2021, that patterns such as this one are nearly impossible to see on the typical chart. Here’s what the same graph looks like against that backdrop:

The U.S. COVID-19 Outbreak Is Still Bad—And Could Get Worse | Time

My fear is that the pandemic remains much more deadly than how it looks on the page. Yes, deaths remain on a steady decline, having recently sunk below 300 people a day on average for the first time since March 24, 2020, right around the time that many offices were shuttering. But a surge in cases, particularly among the large number of unvaccinated Americans, could quickly reverse that decline.

As you can see, it has been less than a month since the 2021 case count sunk below the year-over-year figure, on May 26. The massive nationwide vaccine rollout is undoubtedly a major factor, but it’s difficult to quantify the impact of vaccination on the currently low case and death figures. There are only weak correlations between states’ vaccination rates and some key indicators, like the rate at which cases have risen or fallen in recent weeks.

What we can quantify is that, in the 27 days since the lines crossed, the vaccination rate in the U.S. has only crawled upward, from 39.7% to 45.3% of Americans who have received a complete dosage. While the official vaccination rate applies to the entire population, data from the U.S. Centers for Disease Control and Prevention (CDC) also includes percentages for several age groups. By TIME’s calculations, there are 97.4 million adults age 18 and over who have been eligible for vaccination for two months but who have not yet received even a first dose. This group trends heavily younger, with those 65 and over representing only 7.8% of the unvaccinated population. (These figures do no include those under 18, who constitute a small portion of the eligible population.)

On May 13, two weeks before daily case numbers in 2021 fell below the year-over-year figures from the same day in 2020, the CDC issued guidance liberating fully vaccinated individuals from wearing masks in many scenarios. I do not have conclusive proof that any of the country’s 97.4 million unvaccinated adults have abused this privilege. All I can state with confidence is that, based on the number of people I’ve seen not wearing a mask in places like stores, which often have signs imploring those who are not fully vaccinated to continue to mask up, it is mathematically almost certain that more than a few have done so.

Which is to say: the situation today, if one can momentarily rewind to Memorial Day of 2020, feels very familiar. There appears to be a lambent light at the end of the tunnel, yet cavalier attitudes towards the pandemic, particularly among younger people who, as a group, are under-vaccinated, resembles what we saw last summer just before the second wave.

Watching these trends, I grow more concerned every day that the country is positioned for yet another surge in cases, despite our defensive upgrades in the off-season. I hope I’m wrong, but the numbers are not nearly as comforting as they first look. The fact that the Delta variant, which is both more transmissible and appears to cause more severe disease, is on pace to become the dominant form of COVID-19 in the U.S. in the coming months is further reason for alarm. Moreover, some states have significantly higher vaccination rates than others, leaving those with less protection more vulnerable to future spikes.

Forgive me for being a buzzkill, but unless we can institute a functional vaccine passport system, which appears unlikely, I do not think it is wise to assume that every unmasked individual is fully dosed. Short of a passport system, and with dangerous variants competing for dominance and the duration of vaccine protection still unclear, we ought to continue to ration physical space in public areas—a policy that is hastily being relaxed at places like Major League Baseball parks. I love baseball and eagerly look forward to buzzing up to Philadelphia to take in a game at Citizen’s Bank Park, which is operating at full capacity. But not while the policy is that “Unvaccinated fans are strongly encouraged to wear their masks in all indoor and outdoor areas in and around the ballpark.”

I also think there might be a backdoor to a digital passport system. Based on polling data, it appears there is a substantial population of people who aren’t categorically opposed to vaccination, just unmotivated to get around to it—what we’ve termed vaccine “meh-sitance,” not hesitance. My proposal is that bars, restaurants and other popular venues merely require each person who enters to verbally affirm that they are fully vaccinated.

This might sound about as effective as asking passengers in the exit row to individually verify that they listened to the instructions. But while it’s one thing to ignore a sign at the grocery store, it’s another to lie in front of your friends. Peer pressure is a powerful motivator, and if even a fraction of the unvaccinated would take the time to resolve that dissonance, or risk missing out on trivia night, it could substantially push up the percentages. I call this the “FOMO method,” and though we are still a long, long way from eliminating the disease altogether, it could help us avert a fourth wave this summer.

The Worst-Case COVID-19 Predictions Turned Out To Be Wrong. So Did the Best-Case Predictions.

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http://www.reason.com/2021/06/22/

CrystalBallDoctorDreamstime

An argument for humility in the face of pandemic forecasting unknown unknowns.

“Are we battling an unprecedented pandemic or panicking at a computer generated mirage?” I asked at the beginning of the COVID-19 pandemic on March 18, 2020. Back then the Imperial College London epidemiological model’s baseline scenario projected that with no changes in individual behaviors and no public health interventions, more than 80 percent of Americans would eventually be infected with novel coronavirus and about 2.2 million would die of the disease. This implies that 0.8 percent of those infected would die of the disease. This is about 8-times worse than the mortality rate from seasonal flu outbreaks.

Spooked by these dire projections, President Donald Trump issued on March 16 his Coronavirus Guidelines for America that urged Americans to “listen to and follow the directions of STATE AND LOCAL AUTHORITIES.” Among other things, Trump’s guidelines pressed people to “work or engage in schooling FROM HOME whenever possible” and “AVOID SOCIAL GATHERINGS in groups of more than 10 people.” The guidelines exhorted Americans to “AVOID DISCRETIONARY TRAVEL, shopping trips and social visits,” and that “in states with evidence of community transmission, bars, restaurants, food courts, gyms, and other indoor and outdoor venues where people congregate should be closed.”

Let’s take a moment to recognize just how blindly through the early stages of the pandemic we—definitely including our public health officials—were all flying at the time. The guidelines advised people to frequently wash their hands, disinfect surfaces, and avoid touching their faces. Basically, these were the sort of precautions typically recommended for influenza outbreaks. On July 9, 2020, an open letter from 239 researchers begged the World Health Organization and other public health authorities to recognize that COVID-19 was chiefly spread by airborne transmission rather than via droplets deposited on surfaces. The U.S. Centers for Disease Control and Prevention (CDC) didn’t update its guidance on COVID-19 airborne transmission until May 2021. And it turns out that touching surfaces is not a major mode of transmission for COVID-19.

The president’s guidelines also advised, “IF YOU FEEL SICK, stay home. Do not go to work.” This sensible advice, however, missed the fact that a huge proportion of COVID-19 viral transmission occurred from people without symptoms. That is, people who feel fine can still be infected and, unsuspectingly, pass along their virus to others. For example, one January 2021 study estimated that “59% of all transmission came from asymptomatic transmission, comprising 35% from presymptomatic individuals and 24% from individuals who never develop symptoms.”

The Imperial College London’s alarming projections did not go uncontested. A group of researchers led by Stanford University medical professor Jay Bhattacharya believed that COVID-19 infections were much more widespread than the reported cases indicated. If the Imperial College London’s hypothesis were true, Bhattacharya and his fellow researchers argued, that would mean that the mortality rate and projected deaths from the coronavirus would be much lower, making the pandemic much less menacing.

The researchers’ strategy was to blood test people in Santa Clara and Los Angeles Counties in California to see how many had already developed antibodies in response to coronavirus infections. Using those data, they then extrapolated what proportion of county residents had already been exposed to and recovered from the virus.

Bhattacharya and his colleagues preliminarily estimated that between 48,000 and 81,000 people had already been infected in Santa Clara County by early April, which would mean that COVID-19 infections were “50-85-fold more than the number of confirmed cases.” Based on these data the researchers calculated that toward the end of April “a hundred deaths out of 48,000-81,000 infections corresponds to an infection fatality rate of 0.12-0.2%.” As I optimistically reported at the time, that would imply that COVID-19’s lethality was not much different than for seasonal influenza.

Bhattacharya and his colleagues conducted a similar antibody survey in Los Angeles County. That study similarly asserted that COVID-19 infections were much more widespread than reported cases. The study estimated 2.8 to 5.6 percent of the residents of Los Angeles County had been infected by early April. That translates to approximately 221,000 to 442,000 adults in the county who have had the infection. “That estimate is 28 to 55 times higher than the 7,994 confirmed cases of COVID-19 reported to the county by the time of the study in early April,” noted the accompanying press release. “The number of COVID-related deaths in the county has now surpassed 600.” These estimates would imply a relatively low infection fatality rate of between 0.14 and 0.27 percent. 

Unfortunately, from the vantage of 14 months, those hopeful results have not been borne out. Santa Clara County public health officials report that there have been 119,712 diagnosed cases of COVID-19 so far. If infections were really being underreported by 50-fold, that would suggest that roughly 6 million Santa Clara residents would by now have been infected by the coronavirus. The population of the county is just under 2 million. Alternatively, extrapolating a 50-fold undercount would imply that when 40,000 diagnosed cases were reported on July 11, 2020, all 2 million people living in Santa Clara County had been infected by that date.

Los Angeles County reports 1,247,742 diagnosed COVID-19 cases cumulatively. Again, if infections were really being underreported 28-fold, that would imply that roughly 35 million Angelenos out of a population of just over 10 million would have been infected with the virus by now. Again turning the 28-fold estimate on its head, that would imply that all 10 million Angelenos would have been infected when 360,000 cases had been diagnosed on November 21, 2020.

COVID-19 cases are, of course, being undercounted. Data scientist Youyang Gu has been consistently more accurate than many of the other researchers parsing COVID-19 pandemic trends. Gu estimates that over the course of the pandemic, U.S. COVID-19 infections have roughly been 4-fold greater than diagnosed cases. Applying that factor to the number of reported COVID-19 cases would yield an estimate of 480,000 and 5,000,000 total infections in Santa Clara and Los Angeles respectively. If those are ballpark accurate, that would mean that the COVID-19 infection fatality rate in Santa Clara is 0.46 percent and is 0.49 percent in Los Angeles. Again, applying a 4-fold multiplier to take account of undercounted infections, those are both just about where the U.S. infection fatality rate of 0.45 percent is now.

The upshot is that, so far, we have ended up about half-way between the best case and worst case scenarios sketched out at the beginning of the pandemic.