Delta fears grip economy as cases jump across the country

Covid-19: Delta Variant Reported In 85 Countries; Expected To Become  Dominant Lineage, Says Who

The delta variant of the coronavirus is sweeping through the United States, raising the average number of cases to 30,000-per-day, crowding hospitals in areas with large number of unvaccinated people and spurring questions about the nation’s recovery from the pandemic.

Stocks tanked on Monday, with the Dow Jones Industrial average dropping 725 points after being down more than 900 points at one time.

It was the worst one-day performance in the Dow since last October, and followed losses in markets around the world as investor fears about how the delta virus might slow both the health and economic recovery took hold.

Health officials have described the latest stage of the coronavirus as a pandemic of the unvaccinated while emphasizing that those who have had their shots are relatively safe.

Yet Los Angeles County on Saturday reinstated a mask mandate for indoor public settings, a sign that local communities may decide to reimpose restrictions as a safety measure.

An Olympic gymnast and an Olympic women’s basketball player both announced they had tested positive as they prepared for the Games, which is being held in a state of emergency in Tokyo where the rate of vaccinations is behind the United States.

Canada had also been well behind the U.S. in its vaccination rate but surpassed its southern neighbor on Monday, a sign of how much more slowly the vaccination rate now is in the United States. A big reason is that many people who are unvaccinated do not want to get the vaccine, something the Biden administration has increasingly blamed on social media and some conservative media outlets.

While the 30,000 cases per day on average is more than double the 13,000 average at the end of June, that rate is still well below highs from last fall and earlier this year.

Still, deaths are also ticking back up, at around 240 per day. 

Because vaccinated people are still overwhelmingly protected, especially from severe outcomes, case and death numbers are likely to stay well below the worst of last winter’s surges, before vaccines were widely available. 

But unvaccinated people are at increasing risk, especially given the rise of the highly transmissible delta variant, and the vaccination campaign is hitting a wall, leaving more than 30 percent of adults without any shots and exposed to the full dangers of the virus.

States with lower vaccination rates are seeing the worst outbreaks. Arkansas, Missouri, Florida and Louisiana are the four states with the highest per capita new cases per day, according to data from the Covid Act Now tracking site. The percentage of the population with at least one shot in those states is 44 percent, 47 percent, 56 percent, and 40 percent, respectively. 

In contrast, Vermont and Massachusetts, where the vaccination rate is over 70 percent, are faring much better. 

Vaccine resistance among some leading conservative commentators and lawmakers is raising fears that many of the remaining unvaccinated may never get the shots.

Sten Vermund, a professor at the Yale School of Public Health, said he is “not particularly worried” about COVID-19 for himself, because he is fully vaccinated.

“What worries me is my fellow Americans who for a variety of reasons choose not to get vaccinated; they continue to be in harm’s way,” Vermund said.

In the rare instances where vaccinated people do get COVID-19 cases, symptoms are likely to be much milder.

CDC Director Rochelle Walensky said Friday that 97 percent of people entering the hospital with COVID-19 are unvaccinated, part of why she said it “is becoming a pandemic of the unvaccinated.”

Conservative resistance to vaccination is stiffening. A Washington Post-ABC News poll released earlier this month found that 47 percent of Republicans said they were unlikely to get vaccinated, compared to just six percent of Democrats. Among Republicans, 38 percent said they definitely would not get the shots.

Former President Trump has previously encouraged people to get vaccinated, though he has not made a forceful push, for example by recording a public service announcement or getting his own shots in public.

On Sunday, though, Trump appeared to justify people not taking the vaccine, blaming President Biden.

“He’s way behind schedule, and people are refusing to take the Vaccine because they don’t trust his Administration, they don’t trust the Election results, and they certainly don’t trust the Fake News, which is refusing to tell the Truth,” Trump said in a statement.

Asked if Biden would request Trump film a public service announcement on vaccination, White House press secretary Jen Psaki said “we don’t believe that requires an embroidered invitation to be a part of.”

“Certainly any role of anyone who has a platform where they can provide information to the public that the vaccine is safe, it is effective, we don’t see this as a political issue,” Psaki said. “We’d certainly welcome that engagement.”

She also emphasized, though, that the administration is focusing on local doctors and community leaders to try to boost vaccination rates, not national officials.

The effort is hitting its limits, though. The pace of vaccinations has fallen to around 500,000 per day, down from over 3 million at the peak in April, according to Our World in Data.

“I’m not that hopeful that we’re going to get to people who have refused to be vaccinated,” said Preeti Malani, an infectious disease expert at the University of Michigan.

Experts increasingly say the best remaining hopes of reaching the remaining unvaccinated are school and employer mandates for their workers or students to get vaccinated.

France is experiencing a surge in vaccinations after President Emmanuel Macron announced this month that proof of vaccination, or a negative test, would be required for everyday activities like going to restaurants. The Biden administration has repeatedly ruled out a national vaccine passport in the U.S., though, and Republicans have rebelled against the idea.

Full approval of the vaccines from the Food and Drug Administration, as opposed to the current emergency authorization, could also help assuage some people’s fears, and some experts have called on the FDA to move faster on issuing a full approval.

The Biden administration has stepped up its calls for Facebook and other technology companies to do more to fight vaccine misinformation on their platforms.

Biden on Friday said social media companies are “killing people” with misinformation. On Monday, though, he dialed the criticism back down, instead pointing to 12 people responsible for much of the disinformation.

“Facebook isn’t killing people, these 12 people are out there giving misinformation,” Biden said.

“My hope is that Facebook, instead of taking it personally, that somehow I’m saying Facebook is killing people, that they would do something about the misinformation, the outrageous misinformation about the vaccine,” Biden added. “That’s what I meant.”

For its part, Facebook said over the weekend, before Biden’s walk-back, that the administration was “finger pointing” and the company was not the reason the president’s goal of getting 70 percent of adults at least one shot by July 4 was missed.

Los Angeles County’s move to return to an an indoor mask mandate, even for vaccinated people,

got mixed reviews from experts, but either way, it is unlikely to be replicated in places that are the hardest hit, given that places that are resistant to vaccines tend to also be resistant to masks.

“Vaccines are really the only way out,” Malani said. “We can’t live in masks forever.”

Virtual care for mental health is here to stay

The uncertainty and isolation of the pandemic has taken a heavy toll on mental health. Over a third of adults are currently experiencing anxiety or depressionmore than three times as many as early last year. And with access to behavioral health services already challenged before the pandemic, many patients have been turning to telemedicine for support.

Health insurer Cigna found that while use of virtual care for both non-behavioral and behavioral healthcare services peaked in spring 2020, consumers have continued to use telemedicine for mental health needs, while demand for other virtual services tapered off. As of December, about 70 percent of behavioral health claims were for care rendered virtually, compared to just 20 percent across all other services.
The recent surge in demand for virtual mental health services has spurred an influx of investment into digital solutions. A recent Rock Health analysis found investments in the space have more than tripled since 2015. The injection of funds extends to both “generalist” companies (focused on a wide range of virtual services, including behavioral health) and “specialist” companies (focused solely on virtual behavioral health solutions). 

Virtual behavioral health not only provides much needed access to care, but patients also prefer the privacy and ready access offered by telemedicine. Moving forward, telemedicine may become the preferred alternative for patients seeking support for mental health needs. 

Economists nervously watching pandemic for signs of further financial impacts

BLINKING RED: This is a critical week in the coronavirus pandemicEconomists are nervously watching as much of the nation experiences a worsening fall wave, with U.S. case counts near 200,000 a day and record hospitalizations in many parts of the country, my colleagues Paulina Firozi, Lena H. Sun and Hannah Knowles report

Whether a crest arrives soon could largely be determined by the Thanksgiving holiday, as the Centers for Disease Control and Prevention and health experts warn against traveling and many of the once commonplace rituals of family gatherings. 

  • Early data doesn’t look great: More than 1 million people went through Transportation Security Administration checkpoints in the nation’s airports on Friday — that’s the second-highest single-day rush since March 16. Meanwhile, nearly 80 percent of epidemiologists surveyed recently by the New York Times said they were having Thanksgiving celebrations with people only in their households or not at all.
  • One bright spotA third vaccine, made by AstraZeneca, is 90 percent effective if administered in two doses (a half-dose followed by a full-dose booster) and is easier to store than vaccines by Pfizer and Moderna, my colleagues reported this morning. 
  • “The Oxford-AstraZeneca vaccine is likely to be cheaper than those made by Pfizer and Moderna, and it does not need to be stored at subzero temperatures but can be kept in ordinary refrigerators in pharmacies and doctor’s offices,” they wrote.

A Season of COVID uncertainty

Illustration of a dead tree with surgical masks on the branches blowing in the wind

The frightening, post-election COVID surge is making everything feel strange, different and unsettled all over again.

Why it matters: With Thanksgiving canceled, doctors quitting their practices and grocers limiting purchase quantities (again), Americans have the ambient sense that our safety net is unraveling. Not only are things not returning to normal, they may not return to normal for a long time.

The people and institutions we look toward for guidance and leadership — like elected officials and medical authorities — seem as flummoxed by the pandemic as we are. They issue new rules day by day (closing schools, restricting shopping, issuing curfews), yet look helpless and flailing as infections rise.

  • Our comforting touch points, like family get-togethers and holiday rituals, are suddenly off-limits.
  • There are fewer entertainments and distractions, with movie theaters closed and our appetites for TV bingeing satiated a long time ago.
  • For those who derive comfort from their faith, remote worship offers less fulfillment.

Strangely, CEOs and corporate America have been serving as a rare anchor in this unmoored reality, attempting to provide some moral suasion and fueling the engine behind the stock market’s rally.

  • Companies like Pfizer and Moderna are looking like the heroes of the day — though their vaccines can’t come soon enough to allay our worst fears.
  • Meanwhile, the restaurateurs and merchants who form the pillars of our communities are suffering with growing intensity before our eyes.

Economically, the nation is heading into uncharted territory, with COVID-related uncertainty obliterating all forecast attempts.

  • While many Americans are doing fine financially, it’s hard not to think that a lot of people’s personal finances may be poised to head off a cliff — and the promise of federal help is looking questionable.

Politically, the standoff between President Trump and the rightfully elected new administration has left a vacuum.

  • By all accounts, the situation is thwarting efforts to attack the coronavirus.

Socially, we feel isolated and trapped in our pandemic ruts, not even permitted to savor the promise of holidays we’ve been looking forward to.

  • Doctors say pandemic-induced loneliness will shorten life expectancies.

Culturally and intellectually, the arts, concerts, films and literary output that we rely on to enhance our lives are dampened or depressed by pandemic strictures.

Emotionally, we worry about ourselves, our loved ones and all of our futures. How will the pandemic stunt my child’s education, my career trajectory, my experience of the world? And what if I get sick and there’s no hospital bed available?

  • “Thousands of medical practices have closed during the pandemic,” per the NYT.

What’s next: “Next Thanksgiving will be different,” Anthony Fauci of the National Institute of Allergy and Infectious Diseases told CNN’s Chris Cuomo on Thursday.

  • Americans who persevere through 2021 will, we can all hope, weather this turmoil and see flourishing times ahead.

The Uncertain Future of the Medicare Trust Fund

Medicare trust fund

The COVID-19 pandemic has increased pressures on an already-stressed public health care financing system. This is especially evident when it comes to the financial health of Medicare’s Hospital Insurance (HI) Trust Fund, which finances health care services related to hospital, skilled nursing facility, and hospice stays for Medicare beneficiaries.

In April, using pre-COVID-19 data, the Trustees of Social Security and Medicare projected that the HI Trust Fund would become insolvent in 2026 — meaning that Medicare Part A claims submitted by providers would not be fully reimbursed. The Congressional Budget Office (CBO) made a similar projection when it issued its March 2020 baseline projections. In a September 2020 report, the CBO projected that the date of insolvency had moved up to 2024.

The pandemic has disrupted economic activity in the United States in several ways: a large and rapid rise in unemployment substantially reduced payments to the Trust Fund from payroll taxes, and hospitals experienced unprecedented financial stress from lost revenues because of a dramatic drop in admissions and procedures, along with new costs arising from the pandemic. One way that Congress provided relief to address these economic shocks was to make advance payments. Between $65 billion and $92 billion in advance payments were made to Medicare Part A providers that draw upon the HI Trust Fund. This increased claims on the Trust Fund in 2020 and lowers them for 2021 — assuming they are paid back in 2021. Together these economic dynamics create a situation that requires quick action to prevent insolvency; the margin for error is small.

The duration of the pandemic and the timing and size of an economic recovery remain highly uncertain. While unemployment has declined notably, from 14.7 percent in April to 8.4 percent in August, new spikes in COVID-19 cases across the country continue to dampen economic activity. The recent jobs report also suggested a slowing of employment recovery. Further, there is great uncertainty about the timing, availability, and effectiveness of a potential vaccine. As a result, we are quite unsure when payroll tax revenues will recover or to what degree hospital finances will recover.

The Federal Reserve Bank of St. Louis recently underscored the uncertainty when it issued the following assessment:

“The COVID-19 pandemic — like all pandemics — will come to an end. Of course, nobody knows when that will be. No one also knows whether there will be subsequent waves of the virus that trigger a nationwide resumption of strict social distancing protocols or whether a proven vaccine allows a swift return to pre-COVID norms. Thus, the trajectory of the recovery is the key unknown at this point.”

Together these forces create policy tensions. It is important to continue to support hospitals and nursing homes whose revenues have not yet recovered, and those that continue to incur unusual costs because they are still carrying heavy financial burdens stemming from COVID-19. At the same time state and federal health care financing programs are under extreme financial stress.

Recent legislation negotiated between Congress and the Trump administration would permit hospitals to request an extension for repaying advance payment loans and also reduce the interest rate. Together, these provisions recognize the continued financial stress and provide relief but also introduce new uncertainty. That is, by lengthening the repayment period and reducing the costs of carrying the loans it becomes less certain when they will be paid back in full and returned to the Trust Fund, making the solvency date of the Trust Fund less certain (as specified further in Centers for Medicare and Medicaid Services guidance). In addition, this assumes that the full amounts of the loan will be paid back.

The timing of the COVID-19 pandemic has been especially unfortunate in terms of maintaining the Medicare HI Trust Fund’s solvency. The Trustees issued a warning that action was needed when insolvency was estimated to occur in 2026; it has now been pushed up to 2024. One way to address the uncertainty would be to make a fund transfer from general revenues to the Trust Fund in the amount of the outstanding loans, thereby removing any additional uncertainty around timing of repayment. This could help mitigate risks in a world with highly uncertain economic and epidemiological forecasts but would risk further increasing federal spending during an economic downturn.