https://mailchi.mp/60a059924012/the-weekly-gist-september-10-2021?e=d1e747d2d8
Declaring that “our patience is wearing thin” with Americans who refuse to be vaccinated against COVID-19, President Biden announced sweeping new plans to implement vaccine mandates on Thursday.
Businesses that employ more than 100 people must require their employees to get vaccinated or face weekly COVID testing, federal workers and contractors must be vaccinated or face disciplinary measures, and all healthcare organizations that receive Medicare or Medicaid funds must ensure 100 percent employee vaccination as a condition of continued participation in those federal payment programs. The healthcare component of the mandate will impact about 17 million workers, including those at hospitals, surgery centers, dialysis facilities, and home health agencies. The Centers for Medicare & Medicaid Services (CMS) already requires nursing home workers to be vaccinated, and yesterday announced plans to release a new regulation by October 1st, implementing the expanded mandate. According to Fierce Healthcare, at least 172 hospital systems have already announced some form of vaccine mandate, but others have expressed concerns that forcing workers to get vaccinated might exacerbate labor shortages and result in employees seeking work elsewhere.
Responding to President Biden’s announcement, the American Hospital Association (AHA) echoed those concerns, citing “the critical challenges that we are facing in maintaining the resiliency of our workforce.” In our view, that concern pales in comparison to the imperative to protect patients by reducing the potential for exposure by unvaccinated caregivers. If anything, the national healthcare mandate should provide cover for those hospitals and care providers that have shied away from mandates, letting other organizations take the lead. Once universal healthcare mandates are implemented, vaccine resistant workers will find few employment alternatives left, significantly dampening the risk of widespread resignations. If you don’t want to take the necessary precautions to keep patients safe, you shouldn’t be working in healthcare in the first place. Yesterday’s mandate announcement, while aggressive, is overdue.
Not a typo: Unvaccinated people are 11 times more likely to die of COVID than those who’ve gotten the shot, the CDC found.
By the numbers: Of 37,948 hospitalizations in 13 jurisdictions studied between April and July, 2,976 patients— or about 8% — were vaccinated, Axios’ Noah Garfinkel reports.
The three vaccines “showed continued robust protection for all adults — greater than 82 percent — for hospitalization, emergency room and urgent care trips,” The Washington Post reports.
Earlier this week, David States and Bill Gardner argued that the U.S. should lead the developed nations in a program to immunize the entire human population. The Washington Post reported that President Biden is expected to call for a global vaccine summit conference.
David and Bill wrote that we should do this because it would save many lives. Perhaps this is all that needs to be said. We also argued that the U.S. stood to benefit if we could substantially reduce the number of global covid cases. This would reduce U.S. coronavirus exposure and slow the rate of evolution of new coronavirus variants. The economic cost to the U.S. of a more severe pandemic could easily be greater than the cost of making and distributing the vaccine. If so, the global vaccination effort would pay for itself.
There is, however, another moral argument for global vaccination, this one tied to 9/11 and the ensuing global war on terror. Since 9/11, the U.S. has engaged in 20 years of warfare in countries across the world.
The consequences of that war have been catastrophic. According to the Watson Institute at Brown University,
At least 801,000 people have been killed by direct war violence in Iraq, Afghanistan, Syria, Yemen, and Pakistan… The U.S. post-9/11 wars have forcibly displaced at least 38 million people in and from Afghanistan, Iraq, Pakistan, Yemen, Somalia, the Philippines, Libya, and Syria. This number exceeds the total displaced by every war since 1900, except World War II.
Of course, much of that violence was committed by al-Qaeda, ISIS, or the Syrian government. Some of the civil wars that have followed 9/11 might have happened anyway. Nevertheless, Americans failed to limit their 9/11 response to the specific individuals who carried out the attacks. This was a principal cause of the ensuing death and displacements.
So now, the U.S. is known not only for baseball and democracy but also for drone strikes and torture. If we led an effort to vaccinate the world, it would be one of the largest humanitarian actions in history. We should do this to set an example and balance the effects of the global war on terror.
The Centers for Disease Control and Prevention (CDC) announced results from a study Friday that found unvaccinated individuals were 11 times more likely to die from COVID-19 than fully vaccinated people.
The research, spanning more than 600,000 people in 13 jurisdictions, also determined that unvaccinated populations were over 10 times more likely to be hospitalized — figures that underscore COVID-19 vaccines protect recipients from deaths and hospitalizations.
The study also showed that unvaccinated people were 4 1/2 times more likely to contract COVID-19 than the fully vaccinated.
The studies come just one day after President Biden announced a new rule that would require private companies with 100 employees or more to mandate vaccinations or frequent coronavirus testing.
The Biden administration as a whole has pushed for the use of vaccines as the best way to combat the pandemic.
CDC Director Rochelle Walensky on Friday made the case for vaccines yet again, citing the study along with two others and stating that COVID-19 shots still work to protect recipients from the worst of the disease amid the rampant spread of the delta variant.
“As we have shown study after study, vaccination works,” Walensky said during the briefing. “CDC will continue to do all we can do to increase vaccination rates across the country by working with local communities and trusted messengers and providing vaccine confidence consults to make sure that people have the information they need to make an informed decision.”
“The bottom line is this: We have the scientific tools we need to turn the corner on this pandemic,” Walensky said. “Vaccination works and will protect us from the severe complications of COVID-19. It will protect our children and allow them to stay in school for safe in-person learning.”
The agency and Biden administration are promoting the data behind the vaccine effectiveness in their bolstered push to get the unvaccinated shots.
The U.S. has made progress with vaccinations, reaching 75 percent of adults who have had at least one dose earlier this week.
But the portion of unvaccinated people continues to affect the U.S.’s trajectory in the pandemic, with the unvaccinated making up almost all of the growing hospitalizations and deaths.
The other two studies in the CDC’s Morbidity and Mortality Weekly Report (MMWR) released Friday focused on the vaccine’s effectiveness against hospitalization.
One involving five Veterans Affairs Medical Centers found the mRNA vaccines’ overall effectiveness against hospitalization reached 86.8 percent.
Another similarly calculated that effectiveness at 86 percent among patients in emergency departments, urgent cares and hospitals across nine states.
However, the studies also provided some evidence that the effectiveness of the vaccines are starting to wane among the older population, prompting the researchers to call for further investigation.
For the patients in emergency departments, urgent cares and hospitals across nine states, the effectiveness among those aged 75 and older was 76 percent, while among those aged 18 to 74, effectiveness reached 89 percent.
But researchers urged caution, with the report saying “this moderate decline should be interpreted with caution and might be related to changes in SARS-CoV-2, waning of vaccine-induced immunity with increased time since vaccination, or a combination of factors.”
The study involving Veterans Affairs facilities determined that the mRNA vaccine effectiveness among those aged 65 and older was 79.8 percent, compared to 95.1 percent among those aged 18 to 64.
More than 82 percent of those aged 65 and older are considered fully vaccinated, according to CDC data.
Surgeon General Vivek Murthy said Friday the administration is aiming to get “as close to 100 percent as possible” through expanded outreach.
“We know that every senior matters in terms of getting them vaccinated as a potential life saved,” he said, adding that booster vaccinations “will likely be helpful” for the older population.
The Biden administration had announced it planned to start administering additional shots to recipients on Sept. 20 beginning eight months after their second shot.
But the plan led to criticism from some experts who said the administration was getting ahead of the review process at the Food and Drug Administration (FDA), although officials say the strategy depends on FDA approval.
Howard Stern was reflecting this week on the coronavirus deaths of four conservative talk-radio hosts who had espoused anti-vaccine and anti-mask sentiments when he took aim at those who have refused to get vaccinated.
“I want my freedom to live,” he said Tuesday on his SiriusXM program. “I want to get out of the house. I want to go next door and play chess. I want to go take some pictures.”
The shock jock, who advocated for the coronavirus vaccine to be mandatory, then turned his attention to the hesitancy that has played a significant role in the U.S. spread of the virus, leading to what Rochelle Walensky, director of the Centers for Disease Control and Prevention, has called a “pandemic of the unvaccinated.”He pointed to unvaccinated people who are “clogging” up overwhelmed hospitals, calling them “imbeciles” and “nut jobs” and suggesting that doctors and nurses not treat those who have not taken a coronavirus vaccine.
“I’m really of mind to say, ‘Look, if you didn’t get vaccinated [and] you got covid, you don’t get into a hospital,’ ” he said. “You had the cure and you wouldn’t take it.”
Stern’s comments come after several other celebrities expressed to their large social media audiences their frustration with the ongoing lag in vaccinations when hospitals are being pushed to their limits by the highly transmissible delta variant.
More than 185,000 coronavirus infections were reported Wednesday across the United States, according to data compiled by The Washington Post. Nearly 102,000 people are hospitalized with covid-19; more than 26,000 are in intensive care units. A slight decline in hospitalizations over the past week has inspired cautious optimism among public health leaders.
While there is not a nationwide vaccine mandate, President Biden is expected to sign an executive order Thursday requiring that all federal employees be vaccinated, without an alternative for regular coronavirus testing to opt out of the mandate, The Post reported. The order affecting the estimated 2.1 million federal workers comes as Biden plans to outline a “robust plan to stop the spread of the delta variant and boost covid-19 vaccinations,” the White House said.
Health officials, doctors and nurses nationwide have urged those still hesitant to get vaccinated — and some have gone a step further. Jason Valentine, a physician in Mobile, Ala., informed patients last month that he would not treat anyone who was unvaccinated, saying there were “no conspiracy theories, no excuses” preventing anyone from being vaccinated. Linda Marraccini, a doctor in South Miami, said this month that she would not treat unvaccinated patients in person, noting that her office would “no longer subject our patients and staff to unnecessary risk.”
The summer surge also has led celebrities to use their platform to either call on unvaccinated people to get vaccinated or to denounce them for not doing so. Actor and activist Sean Penn said the vaccine should be mandatory and has called on Hollywood to implement vaccination guidelines on film sets. Actors Benicio Del Toro and Zoe Saldana were part of a vaccine video campaign this year to help debunk misinformation about coronavirus vaccination. When actress Melissa Joan Hart revealed her breakthrough coronavirus case last month, she said she was angry that the nation “got lazy” about getting vaccinated and that masking was not required at her children’s school.
Late-night talk host Jimmy Kimmel suggested Tuesday that hospitals shouldn’t treat unvaccinated patients who prefer to take ivermectin — a medicine long used to kill parasites in animals and humans that has soared in popularity despite being an unproven covid-19 treatment and the subject of warnings by health officials against its use for the coronavirus. After noting that Anthony S. Fauci, the chief medical adviser to Biden, warned that some hospitals might be forced to make “tough choices” on who gets an ICU bed, the late-night host quipped that the situation was not difficult.
“That choice doesn’t seem so tough to me,” Kimmel said. “Vaccinated person having a heart attack? Yes, come right in; we’ll take care of you. Unvaccinated guy who gobbled horse goo? Rest in peace, wheezy.”
Stern has featured front-line workers on his show and has advocated for people to get vaccinated against the coronavirus. In December, the host interviewed Cody Turner, a physician at the Cleveland Clinic, about how the front-line doctor struggled with his mental health while treating infected patients when a vaccine was not widely available.
“We are drowning and we are in hell, and people don’t understand, not only what’s happening to people, you know, but patients across this country,” Turner said.
Stern was a fierce critic of President Donald Trump’s response to the pandemic, saying last year that his former friend was “treasonous” for telling supporters to attend large rallies, despite the risk of infection, in the run-up to the presidential election.
On his eponymous program this week, Stern referred to four conservative talk-radio hosts who bashed the vaccine and eventually died of the virus: Marc Bernier, 65; Phil Valentine, 61; Jimmy DeYoung, 81; and Dick Farrel, 65. In the weeks and months leading up to their deaths last month, all four men had publicly shared their opposition to mainstream public health efforts when coronavirus infections were spiking.
“Four of them were like ranting on the air — they will not get vaccinated,” Stern said Tuesday. “They were on fire … they were all dying and then their dying words were, ‘I wish I had been more into the vaccine. I wish I had taken it.’ ”
After he played a clip of Bernier saying he would not get vaccinated, Stern suggested that the coronavirus vaccine be considered as normal as a measles or mumps vaccine.
“When are we going to stop putting up with the idiots in this country and just say it’s mandatory to get vaccinated?” he asked.
More than 73% of those ages 12 to 18 have received one shot, while 92.4% of those older than 65 have received at least one dose.
The U.S. hit a new milestone this week as 75% of adults over the age of 18 have received at least one dose of a COVID-19 vaccine as of Tuesday, according to data from the Centers for Disease Control and Prevention.
Among the over-18 set, almost 194 million Americans have received a first dose, while close to 165 million people are fully vaccinated, good for 64.3% of that population.
The percentages increase the older the population subset. Slightly more than 73% of those ages 12 to 18 have received one shot (with 62.3% fully inoculated), while 92.4% of those older than 65 have received at least one dose. Among that age group, 82.1% are fully vaccinated.
The data also highlighted which states are faring better in terms of total doses administered per 100,000 people. Vermont leads the nation, with other New England states – Maine, Massachusetts, Rhode Island and Connecticut in particular – following closely behind.
The South and Midwest show the lowest rates of vaccination.
The Pfizer-BioNTech vaccine, which was the first to receive full approval from the Food and Drug Administration, leads the pack in terms of total doses administered with more than 214 million shots delivered as of September 7. Moderna comes in second with 147 million-plus doses administered, followed by Johnson and Johnson, which has seen more than 14.5 million total doses administered.
The vaccine hierarchy holds true when examining the number of people fully vaccinated, with Pfizer at almost 96 million, Moderna at about 66 million and J&J at roughly 14 million.
WHAT’S THE IMPACT?
The numbers should come as some encouragement to the nation’s hospitals and health systems, which have been beleaguered by an influx of coronavirus patients, driven in large part by the highly transmissible Delta variant.
These new surges are once more resulting in operational pressure for nonprofit hospitals in the U.S., which will likely affect margins in the near term, according to an August analysis from Fitch Ratings.
Operations and resources in these new coronavirus hotspots are being stretched more than at any prior time during the pandemic, according to the ratings agency, with hospitalization rates exceeding prior peaks and ICU beds at full capacity in some states.
And while some areas are worse than others, there are no regions that are unaffected: Hospitalizations are trending upward in all states.
What this means for hospitals, and nonprofits in particular, is that additional staffing and supplies will be needed to handle the new influx of COVID-19 patients. The greater number of patients is resulting in a self-induced postponement of nonemergent surgical cases, resulting in lower hospital revenues.
Additionally, hospitals and skilled nursing facilities are competing for a limited supply of nurses, including more expensive contract nursing staff.
THE LARGER TREND
The Pfizer/BioNTech offering received full FDA approval in August, and is now marketed as Comirnaty.
The vaccine has been approved for the prevention of COVID-19 for those 16 years old and older. The vaccine also continues to be available under emergency use authorization, including for those 12 to 15, and for the administration of a third dose in certain immunocompromised patients.
Just last week, Moderna submitted data to the FDA for evaluation of a booster shot for its mRNA vaccine.
The yet-to-be peer-reviewed data comes from a study of 344 individuals who received a third dose of the Moderna vaccine six months after their second shot. Moderna found that their antibodies had “waned significantly” before getting the booster shot, but the additional jab increased antibodies to an even higher level than the previous round.
Heightened protection was observed across age groups, but particularly in adults over the age of 65, according to Moderna. It also offered protection against “all variants of concern,” including the Delta variant.
Moderna’s vaccine received emergency use authorization last December and showed to be 94.1% effective in preventing symptomatic COVID-19 in its clinical trial.
For much of August, the U.S. South showed up fire-engine red on our map of COVID-19’s spread in the U.S., meaning case counts were shooting up. But now, Florida, Louisiana, Mississippi, Arkansas and Missouri show up in shades of green, meaning cases—while still high—are trending down.
Does that mean the Delta surge is nearing its end?
If covering the pandemic for 18 months has taught me anything, it’s that confident predictions often come back to bite you. But there is reason for cautious optimism. Past U.S. surges have played out in short, intense bursts, and some experts have predicted, based on Delta’s behavior in other countries, that U.S. infections could peak in late August or early September. Covidestim, a modeling project from researchers at Yale, Harvard and Stanford, points to another promising sign: In more than half of states, a person infected with COVID-19 would currently be expected to transmit the virus to less than one other person, in what is perhaps a sign of waning community transmission and/or better population immunity.
Still, we shouldn’t get ahead of ourselves. The U.S. is recording an average of about 150,000 new diagnoses per day, a number not seen since this past winter’s pre-vaccination spike. And in many states, like South Dakota and West Virginia, the trends are going in the wrong direction—and fast. That suggests Delta may be moving to new states, rather than fading away completely.
The situation may become even messier as the school year gets underway. Far more kids have gotten seriously ill during this wave compared to previous ones, in part because of Delta’s contagiousness and in part because children younger than 12 cannot be vaccinated, whereas older Americans are better protected from infection. In a worst-case scenario, pediatric ICUs nationwide may be heading for a repeat of what the South has seen this summer.
While the virus behaves in mysterious ways, people in the U.S. are not powerless. The Delta variant is indeed extra contagious, but the summer surge also coincided with relaxed mask guidelines and, for many people, a return to indoor activities. In South Dakota, one of the states currently seeing the largest increases in cases, the spike seems to be related to large-scale gatherings at the Sturgis Motorcycle Rally. That suggests our behavior matters just as much as the virus’. Getting vaccinated, wearing masks indoors and avoiding large crowds can all help the Delta surge come to an end.
About 445.6 million doses of the COVID-19 vaccine have been shipped to various U.S. states as of this afternoon, of which some 372.1 million doses have been administered thus far, according to TIME’s vaccine tracker. About 52.7% of Americans have been completely vaccinated.
More than 219 million people around the world had been diagnosed with COVID-19 as of this afternoon, and more than 4.5 million people have died. On September 2, there were 631,605 new cases globally.
Here’s how the world as a whole is currently trending:
Here’s where daily cases have risen or fallen over the last 14 days, shown in confirmed cases per 100,000 residents:
And here’s every country that has reported over 4 million cases:
The U.S. had recorded more than 39.5 million coronavirus cases as of this afternoon. More than 643,000 people have died. On September 2, there were 153,143 new cases and 1,588 new deaths confirmed in the U.S.
Here’s how the country as a whole is currently trending:
Here’s where daily cases have risen or fallen over the last 14 days, shown in confirmed cases per 100,000 residents:
All numbers unless otherwise specified are from the Johns Hopkins University Center for Systems Science and Engineering, and are accurate as of Sept. 3 1 a.m. E.T. To see larger, interactive versions of these maps and charts, click here.
WHAT ELSE YOU SHOULD KNOW
The U.S. economy gained only 235,000 jobs in August, according to new data from the U.S. Bureau of Labor Statistics—far below this year’s average of 586,000 per month and economists’ expectations of more than 700,000 in August. The retail and dining sectors lost jobs in August, which suggests the Delta-related surge is again putting the squeeze on customer-facing businesses.
South Africa will no longer export Johnson & Johnson vaccines to Europe, under a deal struck by leaders from South Africa, France and the European Commission. The shots will instead be distributed among people on the African continent, where only about 3% of the population is fully vaccinated against COVID-19, compared to nearly 60% in the European Union. The European Commission will also return shots already shipped to Europe from South Africa to help aid the continent’s vaccination campaign, CNN reports.
The U.S. government will invest $3 billion in the vaccine supply chain, in an effort to help manufacturers churn out more shots and supplies for both the U.S. and the rest of the world. Federal officials have not publicly announced which companies will receive that money, but White House COVID-19 adviser Jeff Zients said yesterday that funding will be channeled toward firms that make materials needed for vaccine production and administration, as well as facilities that fill vaccine vials and those that make personal protective equipment.
Employers and private businesses around the world have begun to mandate COVID-19 vaccination. Now, Italian officials are mulling a population-wide vaccine requirement for anyone old enough to receive a shot, according to Reuters. Such a policy wouldn’t happen until the European Medicines Agency gives the shots full approval, but it would still likely be unpopular in a country with a significant vaccine-hesitant population. At present, about 70% of Italians 12 and older are fully vaccinated.
On the other end of the spectrum, U.K. regulators reportedly may not recommend vaccines for healthy children ages 12 to 15. While shots are recommended for children with underlying conditions that put them at risk of severe disease, U.K. authorities are still assessing whether immunization is necessary for healthy kids, given their relatively low risk of hospitalization or death. The country’s regulators are, however, analyzing whether universal pediatric vaccination may be necessary to maintain safe schools.
Dr. Anthony Fauci, the top U.S. expert on COVID-19, added to the back-and-forth on booster shots yesterday, noting that a three-shot regimen will probably become standard for COVID-19 vaccines. He said a three-dose system would likely ensure more “durable” protection against the virus than a two-shot schedule, CNN reports. Ultimately, though, that decision isn’t up to Fauci. It will be decided by regulators at the U.S. Food and Drug Administration, who are set to discuss booster shots at a meeting later this month.
Many people are seeking definitive answers about what they can and can’t do after being vaccinated against Covid-19. Is it OK to travel? Should I go to a big wedding? Does the Delta variant make spending time with my vaccinated grandmother more risky?
But there’s no one-size-fits-all answer to those questions because risk changes from one individual to the next, depending on a person’s overall health, where they live and those they spend time with.
The bottom line is that vaccines are highly protective against serious illness, and, with some precautions, will allow people to return to more normal lives, experts say. A recent study in Los Angeles County showed that while breakthrough infections can happen, the unvaccinated are 29 times as likely to end up hospitalized from Covid-19 as a vaccinated person.
Experts say anxiety about breakthrough infections remains pervasive, fueled in part by frightening headlines and unrealistic expectations about the role of vaccines.
“There’s been a lot of miscommunication about what the risks really are to vaccinated people, and how vaccinated people should be thinking about their lives,” said Dr. Ashish K. Jha, dean of the Brown University School of Public Health. “There are people who think we are back to square one, but we are in a much, much better place.”
While the Delta variant is causing a surge in infections in various hot spots around the country, including Florida and Louisiana, there will eventually be an end to the pandemic. Getting there will require ongoing precautions in the coming months, but vaccinated people will have more freedom to enjoy life than they did during the early lockdowns. Here are answers to some common questions about the road ahead.
To understand why there is no simple answer to this question, think about another common risk: driving in a snowstorm. While we know that tens of thousands of people are injured or killed each year on icy roads, your individual risk depends on local conditions, the speed at which you travel, whether you’re wearing a seatbelt, the safety features on your car and whether you encounter a reckless driver on the road.
Your individual risk for Covid after vaccination also depends on local conditions, your overall health, the precautions you take and how often you are exposed to unvaccinated people who could be infected.
“People want to be told what to do — is it safe if I do this?” said Dr. Sharon Balter, director of the division of communicable disease control and prevention at the Los Angeles County Department of Public Health. “What we can say is, ‘These are the things that are more risky, and these are the things that are less risky.’”
Dr. Balter’s team has recently collected surveillance data that give us a clearer picture of the difference in risk to the vaccinated and unvaccinated as the Delta variant surged from May 1 through July 25. They studied infections in 10,895 fully vaccinated people and 30,801 unvaccinated people. The data showed that:
While unvaccinated people are by far at highest risk for catching and spreading Covid-19, it’s also possible for a vaccinated person to become infected and transmit the illness to others. A recent outbreak in Provincetown, Mass., where thousands of people gathered in bars and restaurants, showed that vaccinated people can sometimes spread the virus.
Even so, many experts believe the risk of getting infected from a vaccinated person is still relatively low. Dr. Jha noted that after an outbreak among vaccinated and unvaccinated workers at the Singapore airport, tracking studies suggested that most of the spread by vaccinated people happened when they had symptoms.
“When we’ve seen outbreaks, like those among the Yankees earlier in the year and other cases, almost always people are symptomatic when they’re spreading,” Dr. Jha said. “The asymptomatic, pre-symptomatic spread could happen, but we haven’t seen it among vaccinated people with any frequency.”
Another study from Singapore looked at vaccinated and unvaccinated people infected with the Delta variant. The researchers found that while viral loads in vaccinated and unvaccinated workers are similar at the onset of illness, the amount of virus declines more rapidly in the vaccinated after the first week, suggesting vaccinated people are infectious for a shorter period of time.
In many cases it will be safe, but the answer depends on a number of variables. The risk is lower with a few close family members and friends than a large group of people you don’t know. Outdoor gatherings are safer than indoor gatherings. What’s the community transmission rate? What’s the ventilation in the room? Do you have underlying health issues that would make you vulnerable to complications from Covid-19? Do any of the vaccinated people have a fever, sniffles or a cough?
“The big question is can five people sit around a table unmasked if we know they’re all vaccinated,” Dr. Jha said. “I think the answer is yes. The chances of anybody spreading the virus in that context is exceedingly low. And if someone does spread the virus, the other people are not going to get super sick from it. I certainly think most of us should not fear breakthrough infections to the point where we won’t tolerate doing things we really value in life.”
For larger gatherings or even small gatherings with a highly vulnerable person, rapid antigen testing using home testing kits can lower risk. Asking people to use a test a few days before the event, and then the day of the event, adds another layer of protection. Opening windows and doors or adding a HEPA air cleaner can also help.
Children under 12 probably will not be eligible for vaccination until the end of the year. As a result, the best way to protect them is to make sure all the adults and older kids around them are vaccinated. A recent report from the C.D.C. found that an unvaccinated elementary schoolteacher who didn’t wear a mask spread the virus to half of the students in a classroom.
Studies show that schools have not been a major cause of Covid-spreading events, particularly when a number of prevention measures are in place. A combination of precautions — masking indoors, keeping students at least three feet apart in classrooms, keeping students in separate cohorts or “pods,” encouraging hand washing and regular testing, and quarantining — have been effective. While many of those studies occurred before the Delta variant became dominant, they also happened when most teachers, staff and parents were unvaccinated, so public health experts are hopeful that the same precautions will work well this fall.
Dr. Balter noted that masking in schools, regular testing and improving ventilation will keep children safer, and that parents should be reassured by the data.
“The level of illness in children is much less than adults,” she said. “You do weigh all these things, but there are also a lot of consequences to not sending children to school.”
In many cases it will be relatively safe for vaccinated people to spend time, unmasked, with an older relative. But the risk depends on local conditions and the precautions the visitor has taken in the days leading up to the visit. In areas where community vaccination rates are low and overall infection rates are high, meeting outdoors or wearing a mask may be advised.
If you’re vaccinated but have been going to restaurants, large gatherings or spending time with unvaccinated people, it’s a good idea to practice more social distancing in the days leading up to your visit with an older or vulnerable person. Home testing a few days before the visit and the day of the visit will add another layer of protection.
Gregg Gonsalves, an assistant professor of epidemiology at the Yale School of Public Health, said he recently visited his 87-year-old mother and did not wear a mask. But that is because both of them are vaccinated and he still works mostly from home, lives in a highly vaccinated area and has low risk for exposure. He is also investing in home testing kits for reassurance that he is not infectious.
“If I just came back from a big crowded gathering, and I had to go see my mom, I would put on a mask,” he said.
The answer depends on the precautions your workplace has taken. Does the company require proof of vaccination to come into the office? Are unvaccinated people tested regularly? What percentage of people in the office are unvaccinated? What steps did your company take to improve indoor air quality? (Upgrading the filters in ventilation systems and adding stand-alone HEPA air cleaners are two simple steps that can reduce viral particles in the air.)
Offices that mandate vaccination will be safer, but vaccination rates need to exceed 90 percent. Even an 85-percent vaccination rate is not enough, Dr. Jha said. “It’s not going to work because one of those 15-percent unvaccinated is going to cause an outbreak for every single person in that room,” he said. “You do not want a bunch of unvaccinated people running around your offices.”
The people who have the most to gain from booster shots are older people, transplant patients, people with compromised immune systems or those with underlying conditions that put them at high risk for complications from Covid. People who received the single-dose Johnson & Johnson vaccine may also be good candidates for a second dose.
But many experts say healthy people with normal immune systems who received a two-dose mRNA vaccine from Pfizer or Moderna won’t get much benefit right now from a third shot because their vaccine antibodies still offer strong protection against severe illness. That said, the Biden administration appears to be moving ahead with offering booster shots to the general public starting as soon as the week of Sept. 20.
HENRY KOTULA 