Overwhelmed hospitals are sending Covid-19 patients 500+ miles away for care

Coronavirus: Video Shows Overwhelmed Hospital ICU in Bergamo, Italy

As some states set Covid-19 hospitalization records, many overwhelmed hospitals are outsourcing patients on planes, helicopters, and ambulances to distant cities and states for treatment, Heather Hollingsworth and Jim Salter write for the Associated Press.

Transfers hundreds of miles away

As of last week, the number of Covid-19 patients in most hospitals remained below winter surge levels, Hollingsworth and Salter report. However, Florida, Arkansas, Oregon, Hawaii, Louisiana, and Mississippi recently set pandemic hospitalization records.

And unlike in the winter surge, many hospitals were already strained this summer due to patients catching up on previously deferred care, according to Hollingsworth and Salter.

“We are seeing Covid patients and we are seeing car accidents and we are seeing kids come in with normal seasonal viral infections. And we are seeing normal life come into the emergency department along with the extra surge of Covid patients, so it is causing that crisis,” said Mark Rosenberg, president of the American College of Emergency Physicians.

Amid the influx of patients, many of these overwhelmed hospitals are looking to neighboring cities and states for relief. For instance, in Arizona, a Covid-19 hotline is receiving calls from hospitals in Wyoming, Arkansas, Texas, and California in search of bed space, Hollingsworth and Salter report—although the hotline often cannot provide any help.

In Kansas, officials at the Wilson Medical Center in Kansas had to call 40 other facilities in several states seeking a bed for a Covid-19 patient before finally finding an available bed about 220 miles away. Across the state, according to Motient, a company contracting with Kansas to manage transfers, Covid-19 patients generally have to wait an average of 10 hours before being flown to another hospital location, which could be in Wisconsin, Illinois, Colorado, or Texas.
“That is just the worst day that you can have in the emergency room as a provider,” Richard Watson, Motient’s founder, said, “to be taking care of a patient that you are totally helpless to give them what you know they need.”

Similarly, in Washington state, the 25-bed Prosser Memorial Hospital, doesn’t have an intensive care unit, so critically ill patients are being sent as far as eastern Idaho—600 miles away.

Staffing shortages, low vaccination rates add to the problem

Finding a hospital to take in patients has become more difficult due to recent staffing shortages, according to Robin Allaman, CNO at the Kearny County Hospital in Kansas.

“Most [hospitals] are saying it isn’t that they don’t have an open bed, it is that they don’t have nursing staff to care for them,” he said. Officials at his hospital called health systems in Nebraska, Oklahoma, and New Mexico before one in Colorado Springs, Colo.—200 miles away—agreed to take a recent patient.

Watson said these delayed transfers can have dire consequences for patients, especially those who need to see specialists, who often are available only in larger hospitals. “Imagine being with your grandma in the ER who is having a heart attack in western Kansas and you are saying, ‘Why can’t we find a bed for her?’ We are watching this happen right in front of us. ‘This is America. Why don’t we have hospital bed for her?’ Well, here we are,” he said.

And while experts had hoped that the vaccines would prevent hospitals from becoming overwhelmed again, Justin Lessler, a professor of epidemiology at Johns Hopkins University, said there hasn’t been the reduction in hospitalizations that officials had hoped for. That’s in part because the delta variant seems to be more severe, particularly in younger people, whose vaccination rates are lower.

Steve Edwards—CEO of CoxHealth, whose hospital in Springfield, Mo., is treating patients from as far away as Alabama—added, “Just imagine not having the support of your family near, to have that kind of anxiety if you have someone grow acutely ill.”

A Delta-driven decline in consumer confidence

https://mailchi.mp/c5fab2515162/the-weekly-gist-august-20-2021?e=d1e747d2d8

After a calmer start to the summer, the Delta variant is eroding consumer confidence as COVID-19 surges across many parts of the US once again. Using the latest data from Morning Consult’s Consumer Confidence Index, the graphic above shows the fluctuations in consumer confidence levels across the last year. 

The most recent COVID surge has caused a five-point drop in confidence in the past month and, with cases still rising, we expect this trend to continue into the fall. Notably, with renewed masking guidance and increasing reports of breakthrough infections, confidence has dropped more among fully vaccinated individuals than among the unvaccinated.

Consumers’ comfort levels aren’t only dropping when it comes to daily activities, like grocery shopping or dining at a restaurant, but also with respect to healthcare. A recent survey from Jarrard Phillips Cate & Hancock finds that while consumers feel safer visiting healthcare settings in August 2021 than they did back in January, more than a third of consumers report the current COVID situation is making them less likely to seek non-emergency care, and 44 percent say they are more likely to pursue virtual care alternatives. 

Health systems must be able to seamlessly “dial up” or “dial down” their virtual care capabilities in order to meet fluctuating consumer demand and avoid another wave of missed or deferred care.

CommonSpirit Health mandates COVID-19 vaccination for employees in 21 states

About Us | Serving the Common Good | CommonSpirit Health

CommonSpirit Health is requiring full COVID-19 vaccination for its 150,000 employees, the Chicago-based health system said Aug. 12. 

The requirement applies to employees at CommonSpirit’s 140 hospitals and more than 1,000 care sites and facilities in 21 states. It includes physicians, advanced practice providers, volunteers and others caring for patients at health system facilities. 

“As healthcare providers, we have a responsibility to help end this pandemic and protect our patients, our colleagues and those in our communities —  including the most vulnerable among us,” Lloyd H. Dean, CEO of CommonSpirit, said in a news release. “An abundance of evidence shows that the vaccines are safe and highly effective. Throughout the pandemic we have made data-driven decisions that will help us best fulfill our healing mission, and requiring vaccination is critical to maintaining a safe care environment.”

The compliance deadline for the vaccination requirement is Nov. 1, although the implementation date will vary by region in accordance with local and state regulations. Employees who are not in compliance and do not obtain a medical or religious exemption risk losing their jobs.

The Southern Pandemic

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Any COVID-19 uptick is a tragedy, but the first major U.S. surge since the start of the vaccination rollout has been uniquely painful to watch because it likely could have been prevented. The Delta variant has driven up cases across the country, with the worst outbreaks in southern states where vaccination rates fall far short of that of the country as a whole, which is nearly half vaccinated. A few examples:

  • In Louisiana, 37.1% of the population is fully vaccinated and the seven-day average of new cases is 4,622, up from 1,426 two weeks ago.
  • In Arkansas, 36.6% of the population is fully vaccinated and the seven-day average of new cases has nearly doubled over the last two weeks to 1,900 new cases a day.
  • In Alabama, 34.4% of the population is fully vaccinated and the seven-day average for daily cases has tripled over the last two weeks to 2,400 new cases a day.
  • In Mississippi—which has the country’s lowest vaccination rate, at 34.5%—the number of new cases has nearly tripled in the last two weeks; it’s now reporting a seven-day average of nearly 1,700 daily cases.

These surges have left many people scrambling to protect themselves, with several hard-hit states reporting an increase in vaccine uptake. In Louisiana, for example, about 52,000 doses were administered during the week ending July 31, compared to about 20,000 the week ending July 10. Unfortunately, people getting vaccinated now won’t be fully protected for another two to four weeks, depending on the shot they receive, meaning the virus will likely continue to spread for some time.

At least some southern governors are taking steps to prevent that, turning to tried and true methods like masking to contain viral spread. Louisiana governor John Bel Edwards (D), for instance, issued an order yesterday mandating face masks in many indoor public settings, including businesses, schools and churches. “I cannot in good conscience sit by while our hospitals lose the capacity to deliver life-saving care to COVID patients and non-COVID patients alike,” Edwards said when announcing the new rules, which begin tomorrow and are currently set to expire Sept. 1.

However, the leaders of other badly hit states are not following suit. Mississippi governor Tate Reeves (R), for instance, has rejected the U.S. Centers for Disease Control and Prevention’s (CDC) updated guidance calling for indoor masking in areas with substantial viral spread, calling it “foolish.” The state may continue to pay the price; Mississippi hospitals are reportedly struggling to find enough nurses to care for patients, even as the state health officer warned last week that new hospitalizations are “skyrocketing” (as of July 27, Mississippi’s seven-day average for new hospitalizations was 126, compared to about 20 on July 1).

The best anyone can do in these states now is get vaccinated, mask up, and socially distance whenever possible. Delta burned hot but fast in India and the United Kingdom, and it’s possible it will do the same in the States as well.


TODAY’S CORONAVIRUS OUTLOOK

Over 400.6 million doses of the COVID-19 vaccine have been shipped to various U.S. states as of this afternoon, of which some 347 million doses had been administered, according to TIME’s vaccine tracker. About 49.7% of Americans had been completely vaccinated.

Nearly 198.9 million people around the world had been diagnosed with COVID-19 as of 1 a.m. E.T. today, and more than 4.2 million people have died. On August 2, there were 556,672 new cases and 7,784 new deaths confirmed 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 3 million cases:

The U.S. had recorded more than 35.1 million coronavirus cases as of 1 a.m. E.T. today. Nearly 614,000 people have died. On August 2, there were 127,976 new cases and 451 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:

Are Camps the Canary in the Coal Mine?

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What your kid needs to learn at summer camp

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.

Read more here.

Unemployment claims jumped to 419,000 last week, a sudden increase reflecting an unsettled labor market

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.

A new mandate in Los Angeles county to wear masks indoors has sparked protests and anger from local officials, as other counties where cases are increasing mull similar actions.

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.”

Texas for example, where cases have grown 54 percent in the last week, lead the way with an increase of 10,000 new claims.

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.

Florida, Missouri and Texas now account for 40% of new coronavirus cases in U.S.

https://www.yahoo.com/news/florida-missouri-and-texas-now-account-for-40-percent-of-new-us-coronavirus-cases-172032337.html

NEW COVID-19 HOT SPOTS EMERGE AS DELTA VARIANT CIRCULATES

Just three states are now driving the pandemic in the United States, as the divide between vaccinated and unvaccinated regions of the country becomes ever more stark, as the more transmissible Delta variant of the coronavirus spreads.

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 briefing Thursday.

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.

Gov. Greg Abbott of Texas, also a GOP presidential aspirant, has recently said he will not impose new mask mandates. Both he and DeSantis have also signed measures striking down requirements that people produce proof of vaccination.

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.”

Cartoon – Some things never change, they just recycle. Stupidity has no season nor expiration date.

May be a cartoon of 1 person, standing and text

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

That has not happened.

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

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

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

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

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

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

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

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

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

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

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

Nurses' Union Condemns C.D.C.'s New Mask Advice - The New York Times

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

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

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

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

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

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

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

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

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

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

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

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