Failing to fund the U.S. covid response bodes trouble for the entire world

Atul Gawande leads global health and is co-chair of the Covid-19 Task Force at the U.S. Agency for International Development.

Nearly a year ago, President Biden announced that the United States would be the “arsenal of vaccines for the world,” just as America served as an arsenal for democracies during World War II. With the president’s leadership and the consistent bipartisan support of Congress, the United States has delivered more than half a billion coronavirus vaccines to 114 lower-income countries free of charge, a historic accomplishment. This example spurred contributions from other wealthy nations and contributed to vaccination of almost 60 percent of the world.

But the global battle against covid-19 is not done. Instead, the challenge has changed. The lowest-income countries, where vaccinations have reached less than 15 percent of people, are now declining free vaccine supply because they don’t have the capacity to get shots in arms fast enough.

We must therefore not just provide an arsenal; to protect our allies against future variants, we must also provide the support they need to ramp up their vaccination campaigns. That effort requires money, and despite generously funding our covid-19 response up to this point, Congress is now failing to provide the resources we need.

I am writing to say: This bodes serious trouble for the world.

Despite a period of relative calm here at home, we’re again seeing cases and hospitalizations spike in Europe and Asia, even in places with higher levels of vaccination than the United States. These surges are due to the more-transmissible BA.2 subvariant of the already highly infectious omicron strain. Without additional funding, we risk not having the tools we need — vaccines, treatments, tests, masks and more — to manage future surges at home. And no less troubling, if we don’t close the vaccine gap between richer and poorer countries, we will give the virus more chances to mutate into a new variant.

Since the virus first emerged, the package of tools we’ve developed to fight it has proved resilient against all coronavirus variants. But there’s no guarantee that will remain true. A new variant that evades our defenses might once again fuel new surges of severe illness and batter the global economy. Helping all countries protect their populations by supercharging vaccination campaigns is our best hope to prevent future strains from emerging and ending this pandemic once and for all.

Turning vaccines into actual vaccinations has been difficult even in wealthy countries, where capable health systems, state-of-the-art cold chains and public awareness campaigns mean that anyone who wants a vaccine can get one. In countries without strong health infrastructure — without enough freezers and refrigerated trucks to keep vaccines from spoiling or enough health-care workers to reach rural populations living miles from the nearest health facility — it’s much tougher. We’ve also seen the same vaccine myths and disinformation that swirl through our media ecosystem spread just as rapidly through social media and hurt public trust abroad.

But we’ve also learned how to successfully tackle these challenges. In December, the Biden administration launched an initiative called Global VAX to help low-income countries train health workers, strengthen health infrastructure and raise vaccine access and awareness. While vaccine coverage in those countries remains far below the global average, the rapid progress we’ve supported in places such as Ivory Coast, Uganda and Zambia show what is possible when governments that are committed to fighting covid-19 have the global support they need.

Without more funding, we would have to halt our plans to expand the Global VAX initiative. The United States would have to turn its back on countries that need urgent help to boost their vaccination rates. And many countries that finally have the vaccines they need to protect their populations would risk seeing them spoil on the tarmac.

We can’t let this happen. It not only endangers people abroad but also risks the health and prosperity of all Americans. The virus is not waiting on Congress to negotiate; it is infecting people and mutating as we speak.

Over the past two years, both parties in Congress have repeatedly stepped up to fight covid-19 in an inspiring show of bipartisan unity. Now, we need our leaders to come together once more. With an effective strategy in place and the tools to transform covid-19 from a killer pandemic to a manageable respiratory disease, the United States has the expertise and capabilities the world needs to win the fight against this virus. We need Congress to let us take the fight to the front lines.

Coronavirus Updates

As parents await an approved vaccine for children under 5, Moderna said on Wednesday a study had found its two-dose pediatric vaccine to be safe for young children, toddlers and babies. Its effectiveness, however, was complicated by the spread of the coronavirus’s omicron variant. While the pediatric vaccine generated an immune response equivalent to that of young adults before the highly transmissible variant emerged, those immune defenses were less strong in the face of omicron. In children, the pediatric vaccine was about 40 percent effective, Moderna said. The company plans to submit the data to the Food and Drug Administration for consideration in the coming weeks. 

The FDA also faces requests to authorize a second booster vaccine dose for adults. But even if they are authorized, Biden administration officials said they lack the funds to purchase those shots. They said they’ve bought enough doses for Americans age 65 and older, as well as the potential initial regimen for children under 5, but can’t buy more doses for people in other age groups unless Congress passes a delayed $15 billion funding package. It’s not yet clear whether additional doses for adults will be necessary, but officials said placing orders for doses ahead of time has been an important lesson of the pandemic. White House officials have expressed worry that vaccine manufacturers will prioritize orders placed by other countries.

That concern comes as omicron’s BA.2 subvariant of the coronavirus now amounts to as much as 70 percent of new infections in much of the United States, according to the genomic surveillance company Helix. That version of the virus has prompted a surge of cases in Europe and fear that the United States will experience its own wave, similarly to how it has mirrored Europe in the past. A broad increase in cases has so far not happened in the United States, and disease experts don’t know for sure whether it will. If it does, it’s unclear whether the pandemic policies of the Biden administration and private institutions would substantially change. 

A program to ensure global vaccine equity was doomed from the beginning to fall short, a Washington Post analysis found. The initiative, called Covax, was meant to convince wealthy and poor countries to combine their money to order vaccine doses in advance and then share them in a way that would protect the most vulnerable people first. But the program’s supporters underestimated the desperation of the wealthier countries, which snatched up doses from manufacturers for their own residents. Covax was also slow to adapt as nations declined to participate. Now, more than one-third of the world has not received a vaccine dose — a result that not only is inequitable, but also makes it easier for new variants to emerge.

In a study published Monday, people who had covid-19 had a 46 percent higher risk of developing Type 2 diabetes or being prescribed medication to control their blood sugar within a year than those who had not had the coronavirus. Greater severity of covid symptoms was associated with a higher chance of developing diabetes, but even people with less severe or asymptomatic infection had an increased risk, according to the study of more than 181,000 Department of Veterans Affairs patients. The study did not prove cause and effect but did show a strong association between covid-19 and diabetes. 

Other important news

Omicron’s BA.2 subvariant has become the world’s dominant form of the coronavirus. The Post created a map and several charts to help you visualize how it’s spreading around the world. 

White House press secretary Jen Psaki said Tuesday that she had tested positive for the coronavirus a second time. She had been scheduled to travel to Europe with President Biden and other administration officials, but canceled her trip.

The Next Big COVID Variant Could Be a Triple Whammy Nightmare

https://www.yahoo.com/news/next-big-covid-variant-could-100250868.html

Getty

Even as daily new COVID cases set all-time records and hospitals fill up, epidemiologists have arrived at a perhaps surprising consensus. Yes, the latest Omicron variant of the novel coronavirus is bad. But it could have been a lot worse.

Even as cases have surged, deaths haven’t—at least not to the same degree. Omicron is highly transmissible but generally not as severe as some older variants—“lineages” is the scientific term.

We got lucky. But that luck might not hold. Many of the same epidemiologists who have breathed a sigh of relief over Omicron’s relatively low death rate are anticipating that the next lineage might be much worse.

The New Version of the Omicron Variant Is a Sneaky Little Bastard

Fretting over a possible future lineage that combines Omicron’s extreme transmissibility with the severity of, say, the previous Delta lineage, experts are beginning to embrace a new public health strategy that’s getting an early test run in Israel: a four-shot regimen of messenger-RNA vaccine.

“I think this will be the strategy going forward,” Edwin Michael, an epidemiologist at the Center for Global Health Infectious Disease Research at the University of South Florida, told The Daily Beast.

Omicron raised alarms in health agencies all over the world in late November after officials in South Africa reported the first cases. Compared to older lineages, Omicron features around 50 key mutations, some 30 of which are on the spike protein that helps the virus to grab onto our cells.

Some of the mutations are associated with a virus’s ability to dodge antibodies and thus partially evade vaccines. Others are associated with higher transmissibility. The lineage’s genetic makeup pointed to a huge spike in infections in the unvaccinated as well as an increase in milder “breakthrough” infections in the vaccinated.

That’s exactly what happened. Health officials registered more than 10 million new COVID cases the first week of January. That’s nearly double the previous worst week for new infections, back in May. Around 3 million of those infections were in the United States, where Omicron coincided with the Thanksgiving, Christmas, and New Year holidays and associated traveling and family gatherings.

But mercifully, deaths haven’t increased as much as cases have. Worldwide, there were 43,000 COVID deaths the first week of January—fewer than 10,000 of them in the U.S. While deaths tend to lag infections by a couple weeks, Omicron has been dominant long enough that it’s increasingly evident there’s been what statisticians call a “decoupling” of cases and fatalities.

“We can say we dodged a bullet in that Omicron does not appear to cause as serious of a disease,” Stephanie James, the head of a COVID testing lab at Regis University in Colorado, told The Daily Beast. She stressed that data is still being gathered, so we can’t be certain yet that the apparent decoupling is real.

Assuming the decoupling is happening, experts attribute it to two factors. First, Omicron tends to infect the throat without necessarily descending to the lungs, where the potential for lasting or fatal damage is much, much higher. Second, by now, countries have administered nearly 9.3 billion doses of vaccine—enough for a majority of the world’s population to have received at least one dose.

Omicron Shows the Unvaccinated Will Never Be Safe

In the United States, 73 percent of people have gotten at least one dose. Sixty-two percent have gotten two doses of the best mRNA vaccines. A third have received a booster dose.

Yes, Omicron has some ability to evade antibodies, meaning the vaccines are somewhat less effective against this lineage than they are against Delta and other older lineages. But even when a vaccine doesn’t prevent an infection, it usually greatly reduces its severity.

For many vaccinated people who’ve caught Omicron, the resulting COVID infection is mild. “A common cold or some sniffles in a fully vaxxed and boosted healthy individual,” is how Eric Bortz, a University of Alaska-Anchorage virologist and public health expert, described it to The Daily Beast.

All that is to say, Omicron could have been a lot worse. Viruses evolve to survive. That can mean greater transmissibility, antibody-evasion or more serious infection. Omicron mutated for the former two. There’s a chance some future Sigma or Upsilon lineage could do all three.

When it comes to viral mutations, “extreme events can occur at a non-negligible rate, or probability, and can lead to large consequences,” Michael said. Imagine a lineage that’s as transmissible as Omicron but also attacks the lungs like Delta tends to do. Now imagine that this hypothetical lineage is even more adept than Omicron at evading the vaccines.

2022’s Hottest New Illness: Flurona

That would be the nightmare lineage. And it’s entirely conceivable it’s in our future. There are enough vaccine holdouts, such as the roughly 50 million Americans who say they’ll never get jabbed, that the SARS-CoV-2 pathogen should have ample opportunities for mutation.

“As long as we have unvaccinated people in this country—and across the globe—there is the potential for new and possibly more concerning viral variants to arise,” Aimee Bernard, a University of Colorado immunologist, told The Daily Beast.

Worse, this ongoing viral evolution is happening against a backdrop of waning immunity. Antibodies, whether vaccine-induced or naturally occurring from past infection, fade over time. It’s not for no reason that health agencies in many countries urge booster doses just three months after initial vaccination. The U.S. Centers for Disease Control and Prevention is an outlier, and recommends people get boosted after five months.

A lineage much worse than Omicron could evolve at the same time that antibodies wane in billions of people all over the world. That’s why many experts believe the COVID vaccines will end up being annual or even semi-annual jabs. You’ll need a fourth jab, a fifth jab, a sixth jab, et cetera, forever.

Israel, a world leader in global health, is already turning that expectation into policy. Citing multiple studies that showed a big boost in antibodies with an additional dose of mRNA and no safety concerns, the country’s health ministry this week began offering a fourth dose to anyone over the age of 60, who tend to be more vulnerable to COVID than younger people.

That should be the standard everywhere, Ali Mokdad, a professor of health metrics sciences at the University of Washington Institute for Health, told The Daily Beast. “Scientifically, they’re right,” he said of the Israeli health officials.

If there’s a downside, it’s that there are still a few poorer countries—in Africa, mostly—where many people still struggle to get access to any vaccine, let alone boosters and fourth doses. If and when other richer countries follow Israel’s lead and begin offering additional jabs, there’s some risk of even greater inequity in global vaccine distribution.

“The downside is for the rest of the world,” Mokdad said. “I’m waiting to get my first dose and you guys are getting a fourth?”

The solution isn’t to deprive people of the doses they need to maintain their protection against future—and potentially more dangerous—lineages. The solution, for vaccine-producing countries, is to further boost production and double down on efforts to push vaccines out to the least privileged communities.

A sense of urgency is key. For all its rapid spread, Omicron has actually gone fairly easy on us. Sigma or Upsilon might not.

20 Years Since 9/11: Why the U.S. Should Vaccinate the World

When will a coronavirus vaccine be ready? | Coronavirus | The Guardian

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.

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.

How the delta variant took over the US

https://thehill.com/policy/healthcare/567843-how-the-delta-variant-took-over-the-us

3 Things You Need to Know About the Delta Variant - COVID-19, Featured,  Health Topics - Hackensack Meridian Health

The delta variant has overtaken the U.S. in a matter of weeks as it spreads around the world in what President Biden’s chief medical adviser Anthony Fauci called a “global outbreak” of the strain.

The highly contagious variant of COVID-19 is considered at least two times more contagious than the previously dominant alpha strain, and experts say the increased transmissibility has likely fueled the surge in COVID-19 cases, hospitalizations and deaths nationwide.

But much is still unknown about delta as scientists scramble to better understand the strain.

Here’s what we know about the delta strain and how it blunted earlier momentum in the fight against the coronavirus.


Delta is more transmissible than previous COVID-19 strains

Delta’s contagiousness is considered key to its domination, having spread to at least 117 countries after first being detected in India. Like other viruses, COVID-19 is evolving, particularly through unplanned mutations.

A study from the United Kingdom in May suggested the delta strain could be 60 percent more transmissible than the alpha variant, which was already more contagious than the original strain.

But experts are split on that figure, with some saying delta could be more transmissible and others saying it could be less.

“You don’t necessarily want to attribute that all to the virus. You know, a lot of it may reflect the people as well,” said David Dowdy, an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health.

Researchers aren’t certain about what makes the delta variant more transmissible, but there are some clues.

Michael Farzan, head of the Department of Immunology and Microbiology at Scripps Research, said one of the variant’s advantages is that it can more strongly attach to a certain receptor when spreading in the body.

“This is one of the reasons why the virus … in a person gets made at a higher level, meaning that there’s a lot more being spit out or coughed out, meaning that it’s more likely to hit the next person,” he said.

The Centers for Disease Control and Prevention (CDC) has its own figures illustrating how the strain became so prevalent this summer. The agency’s latest projection is that 97.4 percent of all coronavirus cases come from all the different lineages of the delta variant, as of the week ending last weekend.

That marks an astronomical increase from the 1.6 percent estimated at the beginning of May and the 14.1 percent from the beginning of June.

Most people infected with COVID-19 at this point won’t know for sure whether they contracted the delta strain since available testing doesn’t make the distinction between strains — it only shows whether the virus itself is present.


It has a higher magnitude of viral loads

Health experts are examining the delta variant’s viral load, the measure of how much virus a person carries and can potentially transmit, compared to previous COVID-19 strains.

A study from China suggested that the strain’s viral load could be more than 1,000 times higher than the original strain, which Fauci on Thursday said “is a mechanistic reason why you have such a tremendous increase in transmissibility.”

Basically a higher viral load can make it more likely that an infected person can “shed” the virus, allowing someone nearby to contract it.

“If a little droplet that you sent out, it has more particles and that means it’s more likely to infect the next person over and it’s more likely to infect the next person over more times,” Farzan said.

Dowdy of Johns Hopkins cautioned that other variables, including people’s behavior, may be influencing how scientists understand delta’s viral load. With more people relaxing their COVID-19 precautions and interacting with others indoors, those same people could contract more of the virus than they might otherwise.

A study of a Massachusetts outbreak indicated that delta led to fully vaccinated people having a similar viral load compared to the unvaccinated, sparking the CDC to update its mask guidance late last month.

The outbreak on Cape Cod, where nearly three-quarters of confirmed cases were among fully vaccinated people, suggested that vaccinated people could potentially transmit and spread the delta variant. But researchers said at the time that microbiological studies would be needed to confirm whether vaccinated individuals can transmit the strain.


Vaccines are still effective against delta

Studies have found that at least five vaccines, including all three used in the U.S., are effective against the delta variant in lab and real-world settings, Fauci said on Thursday.

It was previously unclear whether the Johnson & Johnson vaccine, which requires only one dose instead of two, was equally effective. But a study released last week found the immune response lasted at least eight months, resulting in the first real-world data for the vaccine, Fauci said.

Recent studies have indicated that vaccines may see a very slight dip in effectiveness against symptomatic versions of the coronavirus caused by the delta variant. The COVID-19 vaccines, like any other, are also not perfect at preventing all delta infection and illness.

But scientists agree that studies have demonstrated that the vaccinated population is less likely to get infected and much less likely to be hospitalized or die from the delta variant than the unvaccinated.

“The only reason our case numbers are lower now than they were back in December is because half of our population has been fully vaccinated,” Dowdy said.


Still more to learn
 

Experts acknowledge there is much more to learn about the delta variant.

“A big thing is we still don’t know how much of what we’re seeing is due to the virus versus due to behavior,” Dowdy said. “That makes a big difference because things that are due to the virus, we can’t really change as a society.”

Although there’s a growing number of studies, not all scientists are certain that the variant itself necessarily causes more serious illness among the unvaccinated, leading to more hospitalizations and deaths. It’s also unclear whether the strain is sparking more severe illness among children as pediatric hospital admissions have picked up.

Additionally, scientists have more analysis to do on under-researched mutations that may give the virus more of an advantage, Farzan said.

Driven by the Delta Variant, the Fourth Wave of COVID-19 in the U.S. Could Be Worse Than the Third. In Some States, It Already Is

Why the delta variant is hitting kids hard in the U.S. and how we can  prevent that in Canada | CBC News

Just a month ago, even as signs of a fourth wave of COVID-19 infections in the U.S. were blossoming in the lower Midwest, the memory of a long, miserable winter kept us warm. Even places with burgeoning case rates were far below their catastrophic peaks over the holidays, when a combination of cold weather and defiant travelers contributed to a third wave in infections and deaths that drowned out the previous two spikes in April and July of 2020.

This is regrettably no longer the case. In four states—Hawaii, Louisiana, Mississippi and Florida—the current number of daily new COVID-19 infections, averaged across seven days, has surpassed that winter peak, even with a substantial percentage of the population having received a complete dosage of the COVID-19 vaccine (though not nearly as many as public officials would prefer).

Hawaii is something of an anomaly, as its winter peak was not nearly as high as in colder, more accessible regions. But several other states threaten to join this quartet in the near future. Oregon’s daily rate of new infections is at 36.5 per 100,000 residents, or 99% of the peak value on Dec. 3, 2020. Nationwide, the rate is 37.7, just under 50% of the winter peak of 76.5.

While plenty of states remain far below the winter peaks, as the Delta variant tears across the country, we can expect more and more states to experience a fourth wave that crests higher than the third, even as new outbreaks are inspiring more vaccine holdouts to hold out their biceps and breakthrough infections, while frightening and non-trivial, remain reasonably rare.

What is perhaps most sobering about this surge is that COVID-19-related deaths, which typically lag behind case surges by about two weeks, are starting to rise again. No state has yet surpassed the winter peak in deaths, but at 65%, Louisiana very well may. That figure is still 15% nationwide, well below the Jan. 13, 2021 peak of 1.04 fatalities per 100,000 people. It is currently at 0.16.

When it comes to the pandemic, no one wants to sound like Chicken Little. The sky might not be falling. But neither is the national case rate, or the number of people dying.

Story of Two Chest X-Rays

Dr. Jesse O’Shea, an infectious disease physician, posted this x-ray showing the difference between two of his patients; one with and one without the vaccination. Very telling and compelling visual, and we wanted to share.

To follow his page, please visit: https://www.instagram.com/jesseosheamd“A Story of Two Chest X-Rays. One patient with a vaccine and one patient without. Version 2—for the crowd that wants specifics without violating patient privacy (these are published cases).

The top picture is a 47-year-old man who received Pfizer vaccine (1) and developed COVID19 2 weeks after. He was overweight (BMI = 29), but without any known comorbidities. He had runny nose, mild body aches, mild cough. His chest X ray is relatively normal.

The bottom picture is a 50-year-old active female patient without obesity and not on medications. Her chest X-ray shows diffuse opacities, consolidations in both lungs with lung damage (all the fluffy white) and a pattern that looks like the worst feared complication of COVID19—acute respiratory distress syndrome (ARDS). She needed intubation, mechanical ventilation, and ECMO (extra-corporal membrane oxygenation) – the most life support we can offer.

The mRNA vaccines are effective at preventing severe disease and death— even with the Delta variant.

Our ICUs are starting to fill up with unvaccinated COVID19 patients again.

“To my fellow healthcare workers, keep your head up!”

Delta fears grip economy as cases jump across the country

https://thehill.com/policy/healthcare/563769-delta-fears-grip-economy-as-cases-jump-across-the-country?userid=12325

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.”

Pandemic of the Unvaccinated

COVID-19 vaccine

COVID-19 cases are up by nearly 70% over the past seven days due to huge spikes of cases in low vaccinated areas, Biden administration officials said Friday.

“This is becoming a pandemic of the unvaccinated,” said Rochelle Walensky, M.D., director of the Centers for Disease Control and Prevention, during a briefing Friday. “We are seeing outbreaks of cases in parts of the country that have low vaccination coverage because unvaccinated people are at risk. Communities that are fully vaccinated are generally faring well.”

The seven-day average of cases was 26,300 per day, an increase of nearly 70% from the last seven-day average, Walensky said.

Hospitalizations are also up to 2,790 per day, an increase of 36% from the previous seven-day period.

Deaths, a metric that has declined since prior surges earlier in the year, have also started to increase. The seven-day average increased by 26% to 211 per day, Walensky said.

“Our biggest concern is we are going to see preventable cases, hospitalizations and, sadly, deaths among the unvaccinated,” she said.

A major driver of the increases has been the highly transmissible Delta variant of COVID-19, but Walensky said that 97% of the patients hospitalized right now with the virus are unvaccinated.

The Biden administration is ramping up efforts to increase vaccinations in areas that have stubbornly low rates. The administration is sending more than 100 people to states to help enhance vaccine access and boost outreach efforts, said Jeff Zients, the White House coronavirus response coordinator, during the briefing.

States with the highest cases are starting to see their vaccination rates go up, Zients said.

“In the past week, the five states with the highest case rates had a higher rate of people getting newly vaccinated compared to the national average,” he added.

He added that so far the CDC and the Food and Drug Administration have not recommended a booster shot for the fully vaccinated.

Infectious disease expert Anthony Fauci, MD, said Friday that the federal government is looking into evidence accumulated on a daily basis on the need for a booster.

“At this particular time right now, we don’t recommend that there be boosters for people,” Fauci said.