Category Archives: Infection Control Plan

‘Distancing isn’t helping you’: Indoor COVID-19 exposure risk same at 6, 60 feet, MIT researcher says

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Community Spread, Coronavirus, Coronavirus Mutation, Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Personal Protective Equipment (PPE), Public Health, Social Distancing, World Health Organization (WHO) • Leave a comment
https://www.beckershospitalreview.com/infection-control/distancing-isn-t-helping-you-indoor-covid-19-exposure-risk-same-at-6-60-feet-mit-researcher-says.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=2893H2397267F7G
Risk of COVID-19 indoors is the same at 6 feet and 60 feet apart even when wearing a mask | Daily Mail Online

People who maintain 60 feet of distance from others indoors are no more protected than if they socially distanced by 6 feet, according to a peer-reviewed study published April 27 in the Proceedings of the National Academy of Science of the United States of America.

Cambridge-based Massachusetts Institute of Technology professors Martin Bazant and John Bush, PhD, developed a model to calculate indoor exposure risk to COVID-19 by factoring in the amount of time spent inside, air filtration and circulation, immunization, variant strains, mask use, and respiratory activity such as breathing, eating or talking.  

“We argue there really isn’t much of a benefit to the six-foot rule, especially when people are wearing masks,” Mr. Bazant told CNBC. “It really has no physical basis because the air a person is breathing while wearing a mask tends to rise and comes down elsewhere in the room so you’re more exposed to the average background than you are to a person at a distance.”

As with smoking, even people wearing masks can be affected by secondhand smoke that makes its way around the enclosed area and lingers. The same logic applies to airborne droplets of the virus, according to the study. However, the study did note that mask use by both infected and susceptible people reduces “respiratory plumes” and thus increases the amount of time people may safely spend together indoors. 

When crafting guidelines, the CDC and World Health Organization have overlooked the amount of time spent indoors, Mr. Bazant claims.  

“What our analysis continues to show is that many spaces that have been shut down in fact don’t need to be,” Mr. Bazant said. “Oftentimes, the space is large enough, the ventilation is good enough, the amount of time people spend together is such that those spaces can be safely operated even at full capacity, and the scientific support for reduced capacity in those spaces is really not very good.”  

Opening windows or installing new fans to keep air moving may be just as effective or more effective than purchasing a new filtration system, Mr. Bazant said.

The CDC currently recommends staying at least 6 feet away from other people and wearing a mask to slow the spread of COVID-19, citing the fact that the virus spreads mainly among people who are in close contact for a prolonged period.  

“The distancing isn’t helping you that much and it’s also giving you a false sense of security, because you’re as safe at six feet as you are at 60 feet if you’re indoors. Everyone in that space is at roughly the same risk, actually,” Mr. Bazant said. 

After three rounds of peer review, Mr. Bazant says he hopes the study will influence social distancing policies.

Turning to primary care for vaccine distribution

Posted on by • Posted in Access & Quality of Healthcare, Coronavirus, Coronavirus Mutation, Health System, Hospital, Hospital Industry, Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Primary Care, Public Health, Urgent Care, Vaccination, Vaccine, Vaccine Distribution, Vaccine Efficacy, Vaccine Hesitancy Rate, Vaccine Safety, Vaccine Skepticism, Vaccine Supply • Leave a comment

https://mailchi.mp/da8db2c9bc41/the-weekly-gist-april-23-2021?e=d1e747d2d8

U.S. Starts Vaccine Rollout as High-Risk Health Care Workers Go First - The New York Times

Now that we’ve entered a new phase of the vaccine rollout, with supply beginning to outstrip demand and all adults eligible to get vaccinated, we’re hearing from a number of health systems that their strategy is shifting from a centralized, scheduled approach to a more distributed, access-driven model. They’re recognizing that, in order to get the vaccine to harder-to-reach populations, and to convince reticent individuals to get vaccinated, they’ll need to lean more heavily on walk-in clinics, community settings, and yes—primary care physicians.

For some time, the primary care community has been complaining they’ve been overlooked in the national vaccination strategy, with health systems, pharmacy chains, and mass vaccination sites getting the lion’s share of doses. But now that we’re moving beyond the “if you build it, they will come” phase, and into the “please come get a shot” phase, we’ll need to lean much more heavily on primary care doctors, and the trusted relationships they have with their patients.

As one chief clinical officer told us this week, that means not just solving the logistical challenges of distributing vaccines to physician offices (which would be greatly aided by single-dose vials of vaccine, among other things), but planning for patient outreach. Simply advertising vaccine availability won’t suffice—now the playbook will have to include reaching out to patients to encourage them to sign up.

There will be workflow challenges as well, particularly while we await those single-dose shots—primary care clinics will likely need to schedule blocks of appointments, setting aside specific times of day or days of the week for vaccinations. The more distributed the vaccine rollout, the more operationally complex it will become. Health systems won’t be able to “get out of the vaccine business”, as one health system executive told us, because many have spent the past decade or more buying up primary care practices and rolling out urgent care locations. Now those assets must be enlisted in the service of vaccination rollout.

Health systems will have to orchestrate a “pull” strategy for vaccines, rather than the vaccination “push” they’ve been conducting for the past several months. To put it in military terms, the vaccination “air war” is over—now it’s time for what’s likely to be a protracted and difficult “ground campaign”.
 

Entering a new phase of the vaccine rollout

Posted on by • Posted in Coronavirus, Coronavirus Mutation, Herd Immunity, Infection Control, Infection Control Plan, Infectious Virus, National Strategy, Pandemic, Public Health, Scientists, Vaccine, Vaccine Development, Vaccine Distribution, Vaccine Efficacy, Vaccine Hesitancy Rate, Vaccine Safety, Vaccine Skepticism, Vaccine Supply • Leave a comment

https://mailchi.mp/da8db2c9bc41/the-weekly-gist-april-23-2021?e=d1e747d2d8

Why some Americans are hesitant to receive the COVID-19 vaccine - Vital Record

With more than 222M Americans having received at least one dose of COVID vaccine, and 27.5 percent of the population now fully vaccinated, we are now nearing a point at which vaccine supply will exceed demand, signaling a new phase of the rollout.

This week, for the first time since February, the daily rate of vaccinations slowed substantially, down about 11 percent from last week on a seven-day rolling average. Several states and counties are dialing back requests for new vaccine shipments, and the New York Times reported that some local health departments are beginning to shutter mass vaccination sites as appointment slots go unfilled.

On Friday, the White House’s COVID response coordinator, Jeff Zients, said that the Biden administration now expects “daily vaccination rates will fluctuate and moderate,” after several weeks of accelerating pace. In every state, everyone over the age of 16 is now eligible to be vaccinated, but experts expect that demand from the “vaccine-eager” population will run out over the next two weeks, necessitating a more aggressive campaign to distribute vaccines in hard-to-reach populations, and to convince vaccine skeptics to get the shot.

Vaccine hesitancy, like so many other issues related to the COVID pandemic, has now become starkly politicized—one recent survey found that 43 percent of Republicans “likely will never get” the vaccine, as opposed to only 5 percent of Democrats. Another 12 percent of those surveyed, regardless of party identification, say they plan to “see how it goes” before getting the vaccine, a subset that will surely be unnerved by continued doubts about the safety of the Johnson & Johnson (J&J) vaccine.

An expert advisory panel on Friday recommended that use of the J&J shot be resumed, but advised that a warning be included about potential risk of rare blood clots in women under 50. The first three months of the COVID vaccination campaign have been a staggering success—but getting from 27 percent fully vaccinated to the 80 percent needed for “herd immunity” will likely be a much tougher slog.

U.S. lifts pause on Johnson & Johnson’s coronavirus vaccine

Posted on by • Posted in Coronavirus, Coronavirus Mutation, Food and Drug Administration (FDA), Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Scientists, Vaccine, Vaccine Development, Vaccine Distribution, Vaccine Efficacy, Vaccine Hesitancy Rate, Vaccine Safety, Vaccine Skepticism • Leave a comment
https://www.axios.com/johnson-johnson-vaccine-resume-fda-70b69ac5-14d2-404a-8cee-fe8693728f39.html?stream=health-care&utm_source=alert&utm_medium=email&utm_campaign=alerts_healthcare

The CDC and FDA on Friday lifted the recommended pause on use of Johnson & Johnson’s coronavirus vaccine, saying the benefits of the shot outweigh the risk of a rare blood clot disorder.

Why it matters: The move clears the way for states to immediately resume administering the one-shot vaccine.

  • The Johnson & Johnson shot had been seen as an important tool to fill gaps in the U.S. vaccination effort. But between the pause in its use and repeated manufacturing problems, its role in that effort is shrinking.

Driving the news: J&J shots have been paused for about two weeks, in response to reports that they may have caused serious blood clots in a small number of patients.

  • Only six people had experienced those blood clots at the time of the pause. The CDC said Friday that there have been nine additional cases.
  • Regulators said the number is small enough to safely resume the use of J&J’s vaccine.

What they’re saying: “Safety is our top priority. This pause was an example of our extensive safety monitoring working as they were designed to work — identifying even these small number of cases,” said acting FDA Commissioner Janet Woodcock.

  • “We’ve lifted the pause based on the FDA and CDC’s review of all available data and in consultation with medical experts and based on recommendations from the CDC’s Advisory Committee on Immunization Practices,” she said.
  • “We are confident that this vaccine continues to meet our standards for safety, effectiveness and quality.”

What’s next: Regulators said health care providers administering the shot and vaccine recipients should review revised fact sheets about the J&J vaccine, which includes information about the rare blood clot disorder.

  • That heightened attention is important because the standard treatment for blood clots can make this particular type of clot worse.

Yes, but: J&J was already a relatively small part of the overall domestic vaccination effort, in part because the company missed some of its early manufacturing targets.

  • Multiple problems have since emerged at a Baltimore facility that makes a key ingredient for the vaccine, which could sideline production for weeks.

Blood Clots, FDA Approval, and the AstraZeneca Covid Vaccine

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Clinical Research, Clinical Testing, Clinical Trials, Coronavirus, Coronavirus Mutation, Food and Drug Administration (FDA), Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Scientists, Vaccine, Vaccine Development, Vaccine Distribution, Vaccine Efficacy, Vaccine Hesitancy Rate, Vaccine Safety • Leave a comment
Blood Clots, FDA Approval, and the AstraZeneca Covid Vaccine
Blood Clots, FDA Approval, and the AstraZeneca Covid Vaccine - YouTube

There’s a lot of anxiety about the AstraZeneca vaccine thanks to recent reports of incomplete data, as well as reports on blood clot risks. Let’s take a look at both issues in context, understanding the efficacy data before and after numbers were updated, and understanding blood clot risk in relation to other common situations where blood clots are a potential concern.

India’s devastating outbreak is driving the global coronavirus surge

Posted on by • Posted in Community Spread, Coronavirus, Coronavirus Mutation, Crisis, Crisis Management, Infection Control, Infection Control Plan, Infectious Virus, Mortality, Out of Control, Pandemic, Personal Protective Equipment (PPE), Public Health, Vaccine, Vaccine Development, Vaccine Distribution, Vaccine Supply, World Health Organization (WHO) • Leave a comment
https://www.washingtonpost.com/world/interactive/2021/india-covid-cases-surge/?utm_campaign=wp_main&utm_medium=social&utm_source=facebook&fbclid=IwAR2ioiN-lCdZpfSX_lS2ZJo-sgct3VuMsx–a8j8Ar0NfQOzlUuqygMvWmY
India's covid surge is bringing its healthcare system to the brink - Washington Post

NEW DELHI — More than a year after the pandemic began, infections worldwide have surpassed their previous peak. The average number of coronavirus cases reported each day is now higher than it has ever been.

“Cases and deaths are continuing to increase at worrying rates,” said World Health Organization chief Tedros Adhanom Ghebreyesus on Friday.

A major reason for the increase: the ferocity of India’s second wave. The country accounts for about one in three of all new cases.

It wasn’t supposed to happen like this. Earlier this year, India appeared to be weathering the pandemic. The number of daily cases dropped below 10,000 and the government launched a vaccination drive powered by locally made vaccines.

But experts say that changes in behavior and the influence of new variants have combined to produce a tidal wave of new cases.

India is adding more than 250,000 new infections a day — and if current trends continue, that figure could soar to 500,000 within a month, said Bhramar Mukherjee, a biostatistician at the University of Michigan.

While infections are rising around the country, some places are bearing the brunt of the surge. Six states and Delhi, the nation’s capital, account for about two-thirds of new daily cases. Maharashtra, home to India’s financial hub, Mumbai, represents about a quarter of the nation’s total.

Mohammad Shahzad, a 40-year-old accountant, was one of many desperately seeking care. He developed a fever and grew breathless on the afternoon of April 15. His wife, Shazia, rushed him to the nearest hospital. It was full, but staffers checked his oxygen level: 62, dangerously low.

For three hours, they went from hospital to hospital trying to get him admitted, with no luck. She took him home. At 3:30 a.m., with Shahzad struggling to breathe, she called an ambulance. When the driver arrived, he asked if Shahzad truly needed oxygen — otherwise he would save it for the most serious patients.

The scene at the hospital was “harrowing,” said Shazia: a line of ambulances, people crying and pleading, a man barely breathing. Shahzad finally found a bed. Now Shazia and her two children, 8 and 6, have also developed covid-19 symptoms.

From early morning until late at night, Prafulla Gudadhe’s phone does not stop ringing. Each call is from a constituent and each call is the same: Can he help to arrange a hospital bed for a loved one?

Gudadhe is a municipal official in Nagpur, a city in the interior of Maharashtra. “We tell them we will try, but there are no beds,” he said. About 10 people in his ward have died at home in recent days after they couldn’t get admitted to hospitals, Gudadhe said, his voice weary. “I am helpless.”

Kamlesh Sailor knows how bad it is. Worse than the previous wave of the pandemic, like nothing he’s ever seen.

Sailor is the president of a crematorium trust in the city of Surat. Last week, the steel pipes in two of the facility’s six chimneys melted from constant use. Where the facility used to receive about 20 bodies a day, he said, now it is receiving 100.

“We try to control our emotions,” he said. “But it is unbearable.”

Could Dollar General help dramatically expand vaccine access?

Posted on by • Posted in Access & Quality of Healthcare, Centers for Disease Control & Prevention (CDC), Health Equity, Health Inequity, Health Policy, Infection Control, Infection Control Plan, Infectious Virus, Public Health, Retail Clinic, Retail Healthcare, Retail Pharmacy, Rural Health, Social Determinants of Health, Vaccination, Vaccine, Vaccine Distribution, Vaccine Hesitancy Rate, Vaccine Safety, Vaccine Skepticism, Vaccine Supply, Vulnerable Populations • Leave a comment

https://mailchi.mp/94c7c9eca73b/the-weekly-gist-april-16-2021?e=d1e747d2d8

CDC in Talks With Dollar General to Expand Vaccinations

For some time, we’ve been focused on the efforts of Walmart to launch and grow a care delivery business, especially as it has piloted an expanded primary care clinic offering in a handful of states. We’ve long thought that access to basic care at the scale that Walmart brings could be transformative, given that more than half of Americans visit a Walmart store every week. Along those same lines, we’ve always wondered why Dollar General and Dollar Tree—each with around four times as many retail locations as Walmart—haven’t gotten into the retail clinic or pharmacy businesses.

(Part of the answer is ultra-lean staffing—this piece gives a good sense of the basic, and troubling, economics of dollar stores.) Now, as the federal government ramps up its efforts to widely distribute the COVID vaccines, it turns out that the CDC is actively discussing a partnership with Dollar General to administer the shots.

A fascinating new paper (still in preprint) from researchers at Yale shows why this could be a true gamechanger. The Biden administration, through its partnership with national and independent pharmacy providers, aims to have a vaccination site within five miles of 90 percent of the US population by next week. Compared to those pharmacy partners, researchers found, Dollar General stores are disproportionately located in areas of high “social vulnerability”, with lower income residents and high concentrations of disadvantaged groups. Particularly in the Southeast, a partnership with Dollar General would vastly increase access for low-income Black and Latino residents, allowing vaccine access within one mile for many, many more people. And the partnership could form the basis for future expansions of basic healthcare services to vulnerable and rural communities, particularly if some of the $7.5B in funding for COVID vaccine distribution went to helping dollar store locations bolster staffing and equipment to deliver basic health services. We’ll be watching with interest to see if the potential Dollar General partnership comes to fruition.

Young Men Not Immune to Getting COVID Twice

Posted on by • Posted in Antibodies, Coronavirus, Coronavirus Mutation, Immunity, Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Public Health, Reinfection, Vaccine, Vaccine Distribution, Vaccine Efficacy • Leave a comment
https://www.medpagetoday.com/infectiousdisease/covid19/92113?xid=fb_o&trw=no&fbclid=IwAR1Qd6XX3DniAFqt7yFWvyidRmDud6LBsCo8-X6RPUPKtgnJLVmzKtZAelk

— Study in U.S. Marines stresses importance of vaccination, author says

Young adult men who were previously infected with COVID-19 were not completely protected against reinfection, a study of U.S. marines found.

Among 189 Marines who were seropositive but free of current SARS-CoV-2 infection at baseline, 10% tested positive for SARS-CoV-2 via PCR during a 6-week follow-up period, reported Stuart Sealfon, MD, of Icahn School of Medicine at Mount Sinai in New York City, and colleagues.

Not surprisingly, viral loads were about 10 times lower compared with initially seronegative participants who tested positive, and those who tested positive again were more likely to have a weaker immune response, Sealfon and colleagues wrote in Lancet Respiratory Medicine.

Participants were nearly all men, and most were ages 18-20. Notably, only three of 19 seropositive Marines were symptomatic.

The question of natural infection conferring immunity has been central in the discussion over whether to vaccinate previously infected people. Sealfon’s group said most individuals do mount a “sustained serological response” after initial infection, but prior research found that about 10% of individuals with antibodies to SARS-CoV-2, with a weaker immune response, failed to develop measurable neutralizing activity.

They noted that a high proportion of young adults are infected asymptomatically and “can be an important source of transmission to more vulnerable populations.”

“As vaccine rollouts continue to gain momentum, it is important to remember that, despite a prior COVID-19 infection, young people can catch the virus again and may still transmit it to others,” Sealfon said in a statement. “Immunity is not guaranteed by past infection, and vaccinations that provide additional protection are still needed for those who have had COVID-19.”

Sealfon and colleagues examined data from the COVID-19 Health Action Response for Marines (CHARM) study, in which U.S. Marine recruits had a 2-week unsupervised home quarantine, followed by a Marine-supervised 2-week quarantine on a college campus or in a hotel. They were then assessed for baseline SARS-CoV-2 IgG seropositivity and completed a questionnaire that included demographic history, risk factors, medical history, and symptoms. Participants were tested via PCR at weeks 0, 1, and 2 of quarantine and completed follow-up questionnaires about symptoms since last visit.

After quarantine, those testing negative for current SARS-CoV-2 infection entered basic training, and were tested for new infections every 2 weeks for 6 weeks and completed a follow-up symptom questionnaire. Baseline neutralizing antibody titers were performed on all newly infected seropositive participants and selected seropositive uninfected participants.

From May 11 to Nov. 2, 2020, 3,076 participants were followed up after quarantine for 6 weeks. There was a higher proportion of Hispanic and Black participants in the seropositive group.

Nineteen of 189 seropositive participants had at least one positive PCR test for SARS-CoV-2 (1.1 cases per person-year), as did 1,079 seronegative participants (6.2 cases per person-year), for an incidence rate ratio of 0.18 (95% CI 0.11-0.28).

When examining immune response within the seropositive group, Sealfon’s group found a strong link between lower titers of IgG antibodies to full-length spike protein and a subsequent positive PCR test. They also found neutralizing activity above the limit of detection in 83% of seropositive participants who never tested positive again, and in 32% of participants who were reinfected.

“Overall, these results indicate that COVID-19 does not provide an almost universal and long-lasting protective immunity, unlike that seen in measles, for example,” wrote Marìa Velasco, MD, PhD, and Carlos Guijarro, MD, PhD, of Hospital Universitario Fundación Alcorcón in Madrid, in an accompanying editorial.

However, they offered some caveats to the study, namely that a positive PCR test is most likely a new infection, but could also be “viral persistence with reappearance of virus in mucosae, or non-viable viral debris.”

“In the absence of viral sequencing with phylogenetic analyses, viral cultures, or information regarding different SARS-CoV-2 variants, a positive PCR test cannot be assumed to represent new viral infections in all settings,” the editorialists wrote, though they added that strict scientific criteria may also be underestimating the real rate of reinfection, and suggested a “pragmatic approach” for classifying cases as either reinfection, relapse, or “PCR re-positivity.”

Sealfon’s group noted that despite the closed setting, the population is representative of U.S. men ages 18-20, though it is unclear how generalizable it is to young women or older adults.

Other limitations include potential missing data, such as infections occurring between sampling every 2 weeks. The authors added that the study is also likely underestimating risk of reinfection, as the seronegative group “included an unknown number of previously infected participants who did not have significant IgG [titers] in their baseline serum sample.”

Mona Lisa getting her Covid-19 Vaccine

Posted on by • Posted in Coronavirus, Coronavirus Mutation, Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Public Health, Scientists, Sign of the Times, Vaccine, Vaccine Distribution, Vaccine Efficacy, Vaccine Hesitancy Rate, Vaccine Safety, Vaccine Skepticism • Leave a comment
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Mona Lisa getting her Covid-19 Vaccine.

A quarter of the country won’t get the coronavirus vaccine

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Coronavirus, Coronavirus Mutation, Herd Immunity, Infection Control, Infection Control Plan, Infectious Virus, Misinformation, Misinterpret, Mislead, Misleading, Mistake, Mistrust, Mortality, National Strategy, Pandemic, Partisanship, Personal Protective Equipment (PPE), Politics, Public Health, Public Opinion, Public Perception, Vaccine, Vaccine Distribution, Vaccine Hesitancy Rate, Vaccine Skepticism • Leave a comment
https://www.washingtonpost.com/politics/2021/04/12/quarter-country-wont-get-coronavirus-vaccine-half-them-trust-trumps-medical-advice/?utm_campaign=wp_main&utm_medium=social&utm_source=facebook&fbclid=IwAR1kpNhAWCSUDwfB4Z2gejGqGRIfTH7OXyyLhdrSnoXgM2J4SGHyC6posEI

We’re a year into the coronavirus pandemic, so the math that undergirds its risks should by now be familiar. We all should know, for example, that the ability of the virus to spread depends on it being able to find a host, someone who is not protected against infection. If you have a group of 10 people, one of whom is infected and nine of whom are immune to the virus, it’s not going to be able to spread anywhere.

That calculus is well known, but there is still some uncertainty at play. To achieve herd immunity — the state where the population of immune people is dense enough to stamp out new infections — how many people need to be protected against the virus? And how good is natural immunity, resistance to infection built through exposure to the virus and contracting covid-19, the disease it causes?

The safe way to increase the number of immune people, thereby probably protecting everyone by limiting the ability of the virus to spread, is through vaccination. More vaccinated people means fewer new infections and fewer infections needed to get close to herd immunity. The closer we get to herd immunity, the safer people are who can’t get vaccinated, such as young children (at least for now).

The challenge the world faces is that the rollout of vaccines has been slow, relatively speaking. The coronavirus vaccines were developed at a lightning pace, but many parts of the world are still waiting for supplies sufficient to broadly immunize their populations. In the United States, the challenge is different: About a quarter of adult Americans say they aren’t planning on getting vaccinated against the virus, according to Economist-YouGov polling released last week.

That’s problematic in part because it means we’re less likely to get to herd immunity without millions more Americans becoming infected. Again, it’s not clear how effective natural immunity will be over the long term as new variants of the virus emerge. So we might continue to see tens of thousands of new infections each day, keeping the population at risk broadly by delaying herd immunity and continuing to add to the pandemic’s death toll in this country.

But we also see from the Economist-YouGov poll the same thing we saw in Gallup polling earlier this month: The people who are least interested in being vaccinated are also the people who are least likely to be concerned about the virus and to take other steps aimed at preventing it from spreading.

In the Economist-YouGov poll, nearly three-quarters of those who say they don’t plan on being vaccinated when they’re eligible also say they’re not too or not at all worried about the virus.

That makes some perverse sense: If you don’t see the virus as a risk, you won’t see the need to get vaccinated. Unfortunately, it also means you’re going to be less likely to do things like wear a mask in public.

Or you might be more likely to view as unnecessary precautions such as avoiding close-quarter contact with friends and family or traveling out of state.

About a quarter of adults hold the view that they won’t be vaccinated when eligible. That’s equivalent to about 64 million Americans.

Who are they? As prior polls have shown, they’re disproportionately political conservatives. At the outset of the pandemic, there was concern that vaccine skepticism would heavily be centered in non-White populations. At the moment, though, the rate of skepticism among those who say they voted for Donald Trump in 2020 and among Republicans is substantially higher than skepticism overall.

That shows up in another way in the Economist poll. Respondents were asked whose medical advice they trusted. Among those who say they don’t plan to get the vaccine, half say they trust Trump’s advice a lot or somewhat — far more than the advice of the Centers for Disease Control and Prevention or the country’s top infectious-disease expert Anthony S. Fauci.

If we look only at Republican skeptics, the difference is much larger: Half of Republican skeptics say they have a lot of trust in Trump’s medical advice.

The irony, of course, is that Trump sees the vaccine as his positive legacy on the pandemic. He’s eager to seize credit for vaccine development and has — sporadically — advocated for Americans to get the vaccine. (He got it himself while still president, without advertising that fact.) It’s his supporters, though, who are most hostile to the idea.

Trump bears most of the responsibility for that, too. Over the course of 2020, worried about reelection, he undercut containment efforts and downplayed the danger of the virus. He undermined experts such as Fauci largely out of concern that continuing to limit economic activity would erode his main argument for his reelection. Over and over, he insisted that the virus was going away without the vaccine, that it was not terribly dangerous and that America should just go about its business as usual — and his supporters heard that message.

They’re still listening to it, as the Economist poll shows. One result may be that the United States doesn’t reach herd immunity through vaccinations and, instead, some large chunk of those tens of millions of skeptics end up being exposed to the virus. Some of them will die. Some may risk repeat infections from new variants against which a vaccine offers better protection. Some of those unable to get vaccinated may also become sick from the virus because we haven’t achieved herd immunity, suffering long-term complications from covid-19.

Trump wants his legacy to be the rollout of the vaccine. His legacy will also probably include fostering skepticism about the vaccine that limits its utility in containing the pandemic.