With August just around the corner, COVID-19 cases surging and the U.S. Centers for Disease Control and Prevention (CDC) again recommending indoor masking for many vaccinated people, parents and health officials are gearing up for tough choices around school reopening.
My colleague Tara Law has a new story on an issue that may foreshadow what’s to come for schools: COVID-19 outbreaks at summer camps.
Tara focused on a camp in Galveston County, Texas, which has been linked to 157 COVID-19 cases. The camp, which was for kids in grades six through 12, reportedly did little to enforce social distancing and few campers wore masks—even though pediatric vaccination rates in the area are low. The outbreak was likely the result of “a partially vaccinated group of people all getting together and everyone acting…like they were all vaccinated,” one expert told Tara.
That statement has big implications for schools trying to reopen this coming fall. With vaccines still not authorized for children younger than 12, and less than half of 12- to 17-year-olds nationwide fully vaccinated, there will be millions of unprotected children returning to school soon.
With the Delta variant spreading, the CDC and the American Academy of Pediatrics say all students and staff should wear masks in school. (The CDC initially said in guidance published July 9 that vaccinated people could go without masks, but the agency reversed that decision yesterday.) But, as camp outbreaks show, it can be difficult to enforce those policies to the letter, particularly in states—like Texas—where elected officials have barred public schools from requiring any students to wear masks.
“Because actually following rules is an important piece of prevention, schools have the advantage of being more controlled environments than camps,” Tara says. We’ll see this fall how well they do.
The month of July has seen Covid-19 cases in the United States increase at the fastest pace since last winter, marking the start of the latest wave of infections to afflict the nation. A new STAT analysis of Covid-19 case data reveals this new wave is already outpacing the spring and summer waves of 2020.
There are many metrics that governments, scientists, and media outlets have used to try and reckon with the Covid-19 pandemic. One of the most popular ways of visualizing Covid data has been to track the weekly average of new cases. This is pictured below.
J. EMORY PARKER/STAT
The number represented by the line could be thought of as the velocity of cases in the U.S. It tells us how fast case counts are increasing or decreasing and does a good job of showing us the magnitude of each wave of cases.
The chart, however, fails to show the rate of acceleration of cases. This is the rate at which the number of new cases is speeding up or slowing down.
As an analogy, a car’s velocity tells you how fast the car is going. Its acceleration tells you how quickly that car is speeding up.
Using Covid-19 case data compiled by the Center for Systems Science and Engineering at Johns Hopkins University and Our World in Data, combined with data from the Centers for Disease Control and Prevention, STAT was able to calculate the rate of weekly case acceleration, pictured below.
J. EMORY PARKER/STAT
In this chart, we see how quickly the weekly average of new cases is changing. When the values are positive, new case counts are increasing, and when the values are negative, new case counts are falling. Highlighted in red, we can see each previous wave’s intensity and duration.
Looking at the data this way is useful because the rate at which cases increase is a reasonable indicator of how intense that wave might be and how long it might last. For example, case acceleration in the U.S. reached a peak in November 2020, closer to the start of the nation’s deadly winter wave than to when cases reached their zenith in January of 2021.
This view of the data reveals that the United States is currently in the midst of a fifth wave of cases and that this new wave is growing faster than the first and second waves from spring and summer of 2020.
STAT also calculated case acceleration rates for each state and major territory in the U.S., revealing where cases are increasing the fastest.
J. EMORY PARKER/STAT
In the last two weeks, new case counts in Louisiana accelerated the fastest in the nation at an average rate of 444 cases per week per day (2.38 cases per 100,000 people per week per day). Only 36% of the state’s residents are vaccinated, making it among the least vaccinated in the country.
J. EMORY PARKERJ. EMORY PARKER/STAT
By looking at the state’s case acceleration rate, we can see that cases in Louisiana are currently increasing faster than they did at the start of last winter’s wave.
Likewise, in the state of Florida, the case acceleration rate has outpaced that state’s 2020 summer wave.
J. EMORY PARKER/STATJ. EMORY PARKER/STAT
In Florida, about 48% of residents are fully vaccinated against Covid-19.
Cases are increasing in nearly every region of the country, but they are not increasing at the same rate everywhere. Vaccination rates likely help explain these variations.
The five states where cases are accelerating the fastest all have vaccination rates below the national average. But consider the state of Massachusetts, where about 63% of the population is fully vaccinated.
The New York Times’ Covid Dashboard reports the state has an alarming 351% increase in cases over the last 14 days, the highest such percentage change in the nation. Looking at Massachusetts’ case acceleration paints a different picture.
J. EMORY PARKER/STATJ. EMORY PARKER/STAT
While cases in Massachusetts are increasing, the rate at which case reports are accelerating is much lower than it has been for any of the state’s previous waves, and is below the national average for case acceleration.
State governments, private businesses and even part of the federal government are suddenly embracing mandatory coronavirus vaccinations for their employees.
Why it matters:Vaccine mandates have been relatively uncommon in the U.S. But with vaccination rates stagnating and the Delta variant driving yet another wave of cases, there’s been a new groundswell of support for such requirements.
Driving the news: Monday was a turning point.
The VA became the first federal agency to require its employees to be vaccinated.
More than 50 medical groups called for mandatory vaccinations of all health care workers, WaPo first reported.
California announced that state employees and health care workers must show proof of vaccination or get tested regularly.
New York City brought all municipal workers — including teachers and police officers — under a vaccine requirement that had previously only applied to health workers.
Even the SF Bar Owner Alliance hopped onboard, announcing that the 500 San Francisco bars it represents will require indoor customers to show proof of vaccination or a negative test.
The big picture: Vaccine requirements are also gaining steam internationally.
France has required health workers to get vaccinated. Members of the public must also have a vaccine or a negative test to enter most indoor venues.
Although the measure has sparked protests, it’s also encouraged millions of people to get vaccinated, per the NYT.
The bottom line:Vaccine mandates have been unpopular in part because they’ll inevitably create a backlash.
But the vaccination effort seems to have run out of carrots to incentivize more people to get a shot, and with rates remaining as low as they are in light of a worsening domestic situation, resorting to sticks has clearly become a more attractive option.
Experts are warning that the greatest threat to the pandemic recovery in the United States are the large swaths of Americans who remain unvaccinated.
Over the past few weeks, the U.S. has seen a surge of coronavirus cases across the country in the wake of the highly infectious delta variant. The new strain has particularly wreaked havoc in states with low vaccination rates.
The state of Missouri has recently become a U.S. hot spot, averaging more than 2,100 cases per day over the last seven-day period, according to data from The New York Times. About 41 percent of the state population is fully vaccinated.
Florida, Arkansas, Louisiana and Nevada have also seen an increase in coronavirus cases.
The nationwide vaccination rate has also dropped following the mad dash for the vaccine earlier in the year. Health experts warn that unvaccinated individuals pose a risk to the country, and could spread the disease until other, vaccine-resistant strains arise.
Some say the U.S. has missed its chance at outrunning the delta strain.
“I think we probably could have done that here in the U.S., if we hadn’t slowed our vaccination rates so much,” Andy Pekosz, professor of molecular microbiology and immunology at Johns Hopkins University, told The Hill.
“But I think it’s important also to emphasize that variants will emerge anywhere the virus is replicating in people to a great degree. And globally, there are so many places where this virus is just freely infecting people and replicating and it’s those situations that are going to be generating variants at a higher frequency.”
The delta variant isn’t even the only variant to worry about.
The lambda strain, first detected in Peru, is now present in the U.S. The World Health Organization (WHO) has designated this strain as a “variant of interest,” the designation beneath that of a “variant of concern,” like that of the delta variant.
Jen Kates, director of global health and HIV policy for the Kaiser Family Foundation, and Pekosz told The Hill that data on the lambda variant is limited at the moment, but what information is available suggests that it is similar to delta in that it is more transmissible than previously dominant strains like the alpha and beta variants. They added that vaccines should still offer protection against it.
At the same time, the lambda variant is not spreading as quickly as the delta variant.
“There’s a lot that we do not yet know about the lambda variants, including compared to the delta,” said Leana Wen, an emergency physician and public health professor at George Washington University.
“Is it more contagious? This is a really important question, because when there is a new variant, and it’s more contagious, it displaces the previous variant. But if there is already a very contagious variant and you have other variants that are appearing as they are all the time, they probably are not going to take over,” Wen said.
Wen, who previously served as Baltimore’s health commissioner, expressed frustration that vaccinations have not been properly incentivized even when she warned earlier in May that the window for intervention was quickly narrowing.
“If we had tied vaccinations to reopening policy, we had a much higher chance of achieving the kinds of immunity that we needed,” Wen said.
Pekosz opined that if the U.S. had reached a 90 percent vaccination rate earlier this year, the nation could have avoided the current situation.
“We stalled at a place where essentially half the population has immunity and half doesn’t and that’s a really awful place to be from a vaccine perspective,” Pekosz said.
According to the most recent data from the Centers for Disease Control and Prevention, around 69 percent of adults in the U.S. have received at least one dose. The country has still yet to reach President Biden‘s 70 percent vaccination goal, weeks after his initial July 4 deadline.
All health experts who spoke with The Hill agreed that the biggest challenge that the U.S. faces to overcome the pandemic is vaccine hesitancy.
The large groups of people holding out from vaccinations pose a significant threat because they are not immune, and are still capable of spreading COVID-19 and new variants. They added another major issue is that unvaccinated people are behaving as though they were vaccinated, going without masks in public and attending large indoor and outdoor gatherings that they should avoid.
However, Pekosz added that the progress that has been made is substantial.
“I always want to emphasize the positive, which is right now the vaccine seems to be working well against the delta variant. And that should be something that people are using to get motivated to get the vaccine,” he said. “I think that’s the critical thing to get across to everybody.”
Here’s our personal bellwether for how the Delta variant is impacting health systems:we’ve had three different, in-person leadership retreats cancel across the course of the past week, due to COVID concerns. Three very different parts of the country, on both coasts and in the heartland.
Case counts are up, hospitalizations are up, and clinical leaders are (rightly) becoming more skittish about large, in-person meetings. As many have noted, this latest wave of infections is unevenly distributed across the country, primarily affecting the unvaccinated but also putting vaccinated people at risk of transmitting the virus or becoming ill.
As frequent business travelers who thrive on meeting face-to-face with our members, we had just begun to get comfortable being back out “on the road”—but now that’s changing, too. The recent cancellations are a good reminder that we’re still in a fluid situation in this pandemic, and that being flexible and adaptable will continue to be critical for the foreseeable future. (Thank goodness we’re not in the conference business—that’s got to be a nightmare right now.)
Just as we always check the weather forecast for places we’re traveling to, we’ve started checking the number of cases per 100,000 and the test positivity rate as well—over 10 per 100,000, or over 5 percent, and we’ll think twice about visiting.
And our masks have gone back on. We’ll hope to see you out there soon, but in the meantime—stay safe and get vaccinated!
With the Delta variant now accounting for more than 83 percent of all new COVID cases in the US, daily new case counts more than quadrupling across the month of July, and hospitalizations—particularly in states with low vaccination rates—beginning to climb significantly, we appear to have entered a new and uncertain phase of the pandemic, now being dubbed a “pandemic of the unvaccinated”.
Welcome news, then, that this week the American Hospital Association (AHA) publicly encouraged its members to put in place vaccine mandates for their employees. While several large health systems have taken the lead in implementing vaccine mandates, including Trinity Health, the Livonia, MI-based Catholic system that operates hospitals across 22 states, Phoenix, AZ-based Banner Health, Houston Methodist in Texas, and the academic giant NewYork-Presbyterian, others have been more reticent to compel employees to get vaccinated, citing concerns over employee privacy and the potential for workforce backlash.
The New York Timesreports that a quarter of all hospital employees remain unvaccinated nationwide, with many facilities reporting that more than half of their healthcare workers have not gotten the COVID vaccine. In our discussions with health system executives, one consideration frequently cited is the desire for full Food and Drug Administration (FDA) approval of the new vaccines before mandates are put in place.
In a CNN town hall meeting this week, President Biden suggested that approval could come as soon as the end of August, although other reports point to likely approval much later, potentially not until January of next year. Facing a new variant of the virus that is much more transmissible and possibly more virulent than earlier strains, hospitals—and their patients—can’t afford to wait that long.
For safety’s sake, hospitals should quickly put in place vaccine mandates, with appropriate exceptions.
Unemployment claims jumped last week, as the delta variant of the coronavirus sparked rising caseloads around the country and renewed fears about the potential for more restrictions and business closures.
The number of new claims grew to 419,000 from 368,000, the third time in six weeks that they had ticked up, according to data from the Department of Labor.
Economists said the uptick was concerning but cautioned that it was too early to tell whether it was a one week aberration or telegraphed a more concerning turn for the labor market.
“The unexpected bump in claims could be noise in the system, but it’s also not hard to see how the rise of the covid-19 delta variant could add thousands of layoffs to numbers that already are double what they were pre-Covid,” said Robert Frick, corporate economist at Navy Federal Credit Union.
Overall, unemployment numbers have been falling gradually from the peaks at other stages of the pandemic, but they are still well above pre-pandemic averages.
The jobless numbers have provided a jarring catalogue about the economic devastation wrought by the pandemic — spiking to records as the pandemic unfolded in March 2020, and remaining at historic high levels throughout most of 2020.
The coronavirus surge last fall helped precipitate a rise in claims that saw the labor market, as seen in the monthly jobs report, slide backward too.
But until recently, the last few months been marked by strong jobs growth and a sense of optimism as vaccinations picked up, giving economists hope that the country was back on track to recovering the nearly 7 million jobs it is still down from before the pandemic.
Now, the delta variant is driving an alarming increase in covid-19 cases around the country, according to public health officials: the number of new cases increased more than 40 percent in the last week, sending jitters through the stock market, and is raising questions about whether state and local health authorities will reinstitute restrictions to slow the virus’ spread.
Frick said that the report showed the potential for unemployment claims to start trending upward after months of steady declines.
“There’s definitely a correlation, however loose, that the rise in covid does cause a rise in claims,” he said. “My fear is that the rise in the delta variant could cause claims to go back up…Certainly one week doesn’t show that. But I wouldn’t be surprised if we start to see claims rise.”
However, there are also lots of signs that the economy continues to rebound despite rising caseloads.
The more than 2.2 million people that the Transportation Security Administration said it screened at airports on Sunday was the most since late February 2020 — and nearly three times the amount it was on the same day last year.
Restaurant dining has largely rebounded in recent months, at times surpassing the levels from before the pandemic — on Saturday the number of diners was 1 percent higher than the same day in 2019, according to data from Open Table.
Last week, some 12.5 million claims were filed for unemployment insurance overall, according to the most recent numbers — down from 32.9 million filed at the same point last year.
Nevada, Rhode Island and California topped the list of states with the highest number of people on unemployment, the Labor Department said.
Economic concerns in recent months have been more focused on the ways that workers are still held back from filling some of the more than 9 million job openings in the country, than unemployment, with high hopes that school re-openings in the fall will help many parents get back into the labor force.
Forty percent of all new cases this week have been recorded in Florida, Texas and Missouri, White House pandemic response coordinator Jeff Zients revealed at a press briefingThursday.
Florida alone accounts for 20 percent of all new cases nationally, Zients pointed out, a trend that has stretched into its second week.
Zients added that “virtually all” hospitalizations and deaths — a full 97 percent — are among unvaccinated people. “The threat is now predominantly only to the unvaccinated,” he said. A few vaccinated people do experience so-called breakthrough infections, but they tend to experience only mild COVID-19 illness, or no illness at all.
Encouragingly, Zients said the five states that have experienced the most significant rise in infections — Arkansas, Louisiana, Florida, Nevada and Missouri — all also saw vaccination rates beat the national average for a second week in a row. But because immunity takes two weeks to develop, and the Delta variant spreads so rapidly, the benefits of the increased uptake of vaccinations may not be evident right away.
Singling out the three states where infections are now spiking could have the effect of putting pressure on elected officials there to do more to encourage vaccinations.
Florida’s governor, Ron DeSantis, is a Donald Trump loyalist who is widely expected to seek the presidency in 2024. His handling of the pandemic is coming under new scrutiny with the recent rise in cases.
As the pandemic has surged back in parts of the country, other Republicans have deviated from that approach. The governor of Arkansas, Asa Hutchinson — a Republican who, like DeSantis and Abbott, is rumored to have presidential ambitions of his own — has recently pushed for more vaccinations in his state.
Rep. Steve Scalise, a member of Republican leadership in the House of Representatives and a close Trump ally, rolled up his sleeve last Sunday and was vaccinated. Scalise represents a district in Louisiana, another state with a low rate of vaccination that is experiencing a surge in new cases.
There were 46,318 new cases of the coronavirus reported nationwide on Tuesday, Centers for Disease Control and Prevention Director Rochelle Walensky said at Thursday’s briefing. That is a marked increase from the lows of late May and early June. Hospitalizations and deaths are also rising, after plummeting earlier this summer.
“If you are not vaccinated,” Walensky said, “please take the Delta variant seriously.”
With every passing day, the United States appears more likely to be on the cusp of a dreaded fourth wave of COVID-19 infections, even as the percentage of fully vaccinated Americans inches toward 50%. In the past two weeks, the number of average new daily cases has more than doubled, from 13,200 on July 4 to more than 32,300 on July 18, a surge that harbors grim reminders of the fronts of the second and third waves in the summer and fall of 2020.
But on closer inspection, this surge looks significantly different than those we have seen in the past—and may very well be worse than it looks on the page.
The coronavirus pandemic has never, even in its worst heights last winter, struck the U.S. uniformly. Instead, it has wandered from eruptions in specific urban areas to suburban and rural counties and then back again, like a persistent hurricane. Now, as the gap between states’ completed vaccination rates widens—Alabama has vaccinated just 33.7% of residents, compared to nearly 70% in Vermont—the per capita rate of new cases has clustered in a handful of regions where a majority of adults remain unvaccinated even as reopening continues apace.
To draw on my amateur oceanography, the current crest resembles less a wave than a rip tide, with surges of current inundating several hotspots while the remainder of the country remains blissfully unaware (or unwilling to admit) that the pandemic is not remotely over. The upshot is that local data, rather than state- or nationwide-level figures, now paint the most accurate picture of the current state of the outbreak.
“State-wide cases don’t tell the entire story. We need a finer-toothed comb,” says Jennifer Nuzzo, the lead epidemiologist for the Johns Hopkins University Testing Insights Initiative.
As Nuzzo notes, the most recent documented outbreaks are more concentrated in rural areas than those of the worst spikes over the past 16 months (though the virus didn’t spare any corner of the country). What appears to be different now, even within more rural regions, is a blossoming of outbreaks that are at the moment highly clustered, particularly along the border between Arkansas and Missouri as well as northeast Florida and southeast Georgia.
But any such observation comes with the same caveat that we on the Numbers Beat have been striving to communicate since the beginning: The number of cases is contingent on the number of people being tested for the virus, a figure that can only underestimate the true picture, not exaggerate it.
Let’s recall: A year ago, COVID-19 skeptics, including then-Vice President Mike Pence, were attributing a spike in cases at the time to an increase in testing, a claim that was easily debunked. Now we face the opposite question: As the number of weekly tests has plummeted, taking a back seat to vaccination, and with the sense of urgency abating (for now), is the situation in fact worse than it appears?
“I don’t worry that we are missing the severe cases,” including when a patient is hospitalized, Nuzzo says. “It’s everybody else I worry about. We have turned our telescope to a different part of the sky.”
Murray Côté, an associate professor of health policy and management at Texas A&M University, agrees. “I still think we’re missing a chunk” of positive cases, he says. “It’s a confluence of things. We don’t have the testing facilities we used to have [earlier in the pandemic].” That chunk, both Côté and Nuzzo say, is likely made up of people who are experiencing mild or no symptoms, but can still be part of a transmission chain.
I last spoke with Côté in June 2020 when unwinding Pence’s claim that the summer surge was a product of more testing. Our conversation this time felt both reversed, as we were discussing a possible under-calculation of reality, as well as strangely familiar, because a year ago, we were seeing a new surge amid a widespread relaxation of safety measures—not unlike the freedom from safety measures like maskless dining we currently enjoy.
“We’re behaving exactly the same way as we did last year,” Côté says. To refresh your memory: Around this time in 2020, the U.S. had a brief moment where cases began to drop. Some Americans started to ease their social distancing and mask wearing, and it led to both a summer surge and, after another lull, the massive winter spike that turned out to be the worst stretch of the global outbreak to hit any country in the world. What’s different now is that this time we have highly effective vaccines—but, while inoculation can protect individuals, vaccination rates in many communities across the U.S. remain too low to prevent fresh outbreaks.
In the heady days of spring, 2021, many states began reducing the frequency of their reports on new cases to every few days or once a week. That was a foolish mistake when, even with a massive reduction in testing, the seven-day rolling average of new cases never dipped below 10,000 at the national level. Given that the best-case scenario—even before the emergence of the Delta variant—was a reduction of cases and deaths to endemic levels for years to come, states must pair their desperate attempts to vaccinate more individuals with a renewed focus on surveillance and contact tracing.
For now, the best way to prevent the current spikes from becoming a proper fourth wave is vaccination (which, even if cases continue to rise, can help prevent hospitalizations and deaths), increased surveillance, and a return to mitigation measures. Indeed, Los Angeles County on Sunday reinstituted mandatory mask-wearing in businesses and public areas, a major rollback after the U.S. Centers for Disease Control and Prevention said on May 13 that fully vaccinated individuals could shed their masks in many scenarios. Unless states can rapidly revive widespread and easily available testing, L.A. will be far from the last county to ask residents to mask up once again.
HENRY KOTULA 