Two-in-three Americans will celebrate this Thanksgiving with friends or family outside their immediate households, and about half of those say their gatherings could include unvaccinated people, according to the latest installment of the Axios/Ipsos Coronavirus Index.
Why it matters: Vaccinations and booster shots are giving more people confidence to resume traditions like sitting around a packed table with masks off. But many are doing so with heightened awareness of what they don’t know when it comes to their holiday companions.
This year, 31% see a large or moderate risk in seeing friends or family for Thanksgiving — way down from 64% a year ago.
People’s assessment of overall risk of returning to their normal pre-COVID lives is also down, with 44% seeing it as a large to moderate risk this year compared with 72% last year.
But when Americans are asked how concerned they still feel about the virus, the numbers haven’t diminished all that much: 69% compared with 85% a year ago.
What they’re saying: “We’re just in a holding pattern,” said Cliff Young, president of Ipsos U.S. Public Affairs.
“They’re going to Thanksgiving because they have to, they have to see their family and friends, it’s human nature,” Young said. “But Americans are still deploying mitigating strategies.”
Ipsos pollster and senior vice president Chris Jackson said the vaccines “have attenuated some of that risk. But there’s a larger sense of anxiety or concern that hasn’t been dealt with.”
By the numbers: 67% of U.S. adults surveyed said they’ll see friends or family outside their households. That’s 73% of Republicans, 70% of independents and 63% of Democrats.
30% of them said the guests will include unvaccinated people, and another 17% said they don’t know whether other guests will be vaccinated or not.
38% said they’ll be with people who don’t regularly wear masks outside the home, while another 21% said they didn’t know if their guests regularly wear masks.
4% said they’ll be seeing people who’ve been exposed to COVID-19 in the last two weeks; another 28% aren’t sure if people at their gatherings have been exposed.
Between the lines: There’s a modest partisan gap around openness to returning to the communal Thanksgiving table — but a gulf around who you’re willing to sit with.
41% of Republicans expect to spend the holiday with someone who’s unvaccinated, compared with 17% of Democrats.
When we asked unvaccinated respondents, 56% of those who will celebrate Thanksgiving with friends and family outside the home expect the guests to include other unvaccinated people.
The big picture: This week’s findings show overwhelming support (86%) for every vaccinated American who wants a booster being able to get one. But only about one in four respondents said they knew much about an anti-viral COVID-19 pill awaiting FDA approval.
23% hadn’t heard about the pill at all, and half had heard of it but said they didn’t know much about it.
When the unvaccinated were asked whether they’d rather get a shot to prevent the virus, or wait to catch the virus and then take an approved pill to treat it, the pill drew a slight edge (17% versus 12%) and 15% had no preference, while a majority — 53% — said they’d prefer to take neither.
That suggests the pill won’t be a silver bullet — and offers more evidence that there is a segment of American society that doesn’t trust science or government to tell them what to do.
Federal officials waited months before making all American adults eligible for a COVID-19 booster shot — meaning millions of Americans may not have the strongest possible protection as they head into holiday travel.
Why it matters: Critics say the confusing process undermined what has now become a critical effort to stave off another wave of the pandemic.
Most vaccinated people, even without a booster, still have very strong protection against serious illness or death. But a third shot drastically increases people’s defenses against even mild infections, which could in turn help reduce the virus’ spread.
And some vulnerable vaccinated adults are at risk of serious breakthrough cases.
What they’re saying: “We have a consensus. Boosters are very important in maintaining people’s defenses against COVID. We need to get as many people vaccinated and boosted [as possible] as the winter sets in,” David Kessler, the chief science officer of Biden’s COVID response, said in an interview.
Context: Preliminary data released months ago suggested a significant decline in the vaccines’ effectiveness at preventing infection, although they held up well against severe disease.
Based on that data, the Biden administration had hoped to begin allowing booster shots in September for any American adult who was at least eight months removed from their second dose.
The CDC and the FDA opted instead to only authorize boosters for seniors, people with high-risk medical conditions and people at high risk of infection, before opening them last week to everyone at least six months out from their initial shots.
In the meantime, red and blue states alike decided to ignore the CDC and open up booster eligibility on their own, and breakthrough infections have become increasingly common.
Millions of people who weren’t technically eligible for boosters got them anyway, and a large portion of the most vulnerable patients still haven’t gotten one.
Where it stands: Only 41% of vaccinated Americans 65 and older have received a booster shot, as have 20% of all vaccinated adults, per the CDC.
“Some of us were there several months ago. Some wanted more data. In the end, there’s a convergence of opinions. It’s the way an open scientific public health process should work,” Kessler said.
Between the lines: The U.S. drug approval process — with its insistence on high-quality data and careful expert reviews — is the world’s gold standard precisely because it moves deliberately. Regulators have been trying this whole time to figure out how to adapt that system to a fast-moving pandemic.
Some federal officials, as well as many outside experts, said there wasn’t enough data to make a broad booster recommendation earlier this fall.
Early on, many public health experts also argued that it was unethical to give Americans a third shot while much of the rest of the world awaited their first shots.
Israel embraced boosters before the U.S. beginning over the summer, and its emerging data has been key to making the case that boosters are needed and can help bring surges under control. However, experts still don’t know how long the enhanced protection they give will last.
What they’re saying: “Some argued early on that the primary series was good enough and we should conserve doses for the world. What’s emerging is that all people in the world are going to need to be boosted,” a senior administration official said.
“Everyone has a different threshold for how much data they need in making a decision,” the official added. “What made this different is that there’s a pandemic underway, and many saw we were heading into a winter surge.”
Some 30% of U.S. healthcare workers employed at hospitals remained unvaccinated as of Sept. 15, according to an analysis of Centers for Disease Control and Prevention data published Thursday by the Association for Professionals in Infection Control and Epidemiology.
The findings include data from 3.3 million healthcare workers at more than 2,000 hospitals, collected between Jan. 20 and Sept. 15.
Healthcare personnel working in children’s hospitals had the highest vaccination rates, along with those working in metropolitan counties.
Dive Insight:
The vaccination rate for healthcare workers is roughly in line with that of the general population, though the risk of exposure and transmission can be higher in settings where infected COVID-19 patients are treated, Hannah Reses, CDC epidemiologist and lead author of the analysis, said.
When the shots were initially rolled out, vaccination rates climbed among healthcare workers, rising from 36% to 60% between January and April of 2021, the analysis found. But a major slowdown occurred shortly after.
From April to August, vaccination rates rose just 5%. They then rose 5% again in just one month — from August to September — likely due to the delta variant and more systems implementing their own mandates, the report said.
Researchers also found discrepancies in vaccination rates based on the type of hospitals and their geographic locations.
By September, workers at children’s hospitals had the highest vaccination rates (77%), followed by those at short-term acute care hospitals (70%), long-term care facilities (68.8%), and critical access hospitals (64%).
Among healthcare workers at facilities in metropolitan areas, about 71% were vaccinated by September, compared to 65% of workers at rural facilities.
The findings come as health systems work to comply with new vaccination mandates from the Biden administration.
Healthcare facilities must follow the CMS rule, which stipulates employees must be fully vaccinated by Jan. 4 or risk losing Medicare and Medicaid funding. Unlike the Occupational Safety and Health Administration’s rule that applies to businesses with 100 employees or more but excludes healthcare providers, the CMS rule does not allow for a testing exception.
Both agencies’ rules were met with pushback. The attorneys general of 10 mostly rural states — Missouri, Nebraska, Arkansas, Kansas, Iowa, Wyoming, Alaska, South Dakota, North Dakota and New Hampshire — filed a lawsuit on Oct. 10 against CMS for its rule and said the mandates would exacerbate existing staffing shortages.
“Requiring healthcare workers to get a vaccination or face termination is unconstitutional and unlawful, and could exacerbate healthcare staffing shortages to the point of collapse, especially in Missouri’s rural areas,” the state’s attorney general, Eric Schmitt, said in a statement.
But some regional systems that implemented their own mandates have seen positive results.
After UNC Health and Novant Health in North Carolina required the shots, staff vaccination rates rose to 97% and 99%, respectively, according to a White House report.
Among Novant Health’s 35,000 employees, about 375 were suspended for not complying, and about 200 of those suspended employees did end up getting vaccinated so they could return to work, according to the report.
And some major hospital chains across the country are joining suit with the looming deadline, including HCA with its 183 hospitals and more than 275,000 employees.
The chain is requiring employees be fully vaccinated by the CMS deadline on Jan. 4, a spokesperson said in an email statement.
At the same time, this year’s flu season is difficult to predict, though, “the number of influenza virus detection reported by public health labs has increased in recent weeks,” Reses said.
“The CDC is preparing for flu and COVID to circulate along with other respiratory viruses, and so flu vaccination therefore will be really important to reduce the risk of flu and potentially serious complications, particularly in combination with COVID-19 circulating,” Reses said.
The Austrian government has ordered a nationwide lockdown for unvaccinated people starting at midnight Sunday to combat rising coronavirus infections and deaths.
The move prohibits unvaccinated people 12 and older from leaving their homes except for basic activities such as working, grocery shopping, going for a walk — or getting vaccinated.
Authorities are concerned about rising infections and deaths and that soon hospital staff will no longer be able to handle the growing influx of COVID-19 patients.
“It’s our job as the government of Austria to protect the people,” Chancellor Alexander Schallenberg told reporters in Vienna on Sunday. “Therefore we decided that starting Monday … there will be a lockdown for the unvaccinated.”
The lockdown affects about 2 million people in the Alpine country of 8.9 million, the APA news agency reported. It doesn’t apply to children under 12 because they cannot yet officially get vaccinated.
The lockdown will initially last for 10 days and police will go on patrol to check people outside to make sure they are vaccinated, Schallenberg said, adding that additional forces will be assigned to the patrols.
Unvaccinated people can be fined up to 1,450 euros ($1,660) if they violate the lockdown.
Austria has one of the lowest vaccination rates in Western Europe: only around 65% of the total population is fully vaccinated. In recent weeks, Austria has faced a worrying rise in infections. Authorities reported 11,552 new cases on Sunday; a week ago there were 8,554 new daily infections.
Deaths have also been increasing in recent weeks. On Sunday, 17 new deaths were reported. Overall, Austria’s pandemic death toll stands at 11,706, APA reported.
The seven-day infection rate stands at 775.5 new cases per 100,000 inhabitants. In comparison, the rate is at 289 in neighboring Germany, which has already also sounded the alarm over the rising numbers.
Schallenberg pointed out that while the seven-day infection rate for vaccinated people has been falling in recent days, the rate is rising quickly for the unvaccinated.
“The rate for the unvaccinated is at over 1,700, while for the vaccinated it is at 383,” the chancellor said.
Schallenberg also called on people who have been vaccinated to get their booster shot, saying that otherwise “we will never get out of this vicious circle.”
As booster shots become available in the United States, many Americans are scrambling to get them. But are these shots the best use of our resources? Who really benefits from them and what is the most prudent way to use our vaccine supplies?
A first COVID shot will give kids some protection, but none of them will be fully vaccinated until the beginning of December.
For many, many months now, 7-year-old Alain Bell has been keeping a very ambitious list of the things he wants to do after he gets his COVID-19 shots: travel (to Disneyworld or Australia, ideally); play more competitive basketball; go to “any restaurants that have french fries, which are my favorite food,” he told me over the phone.
These are very good kid goals, and they are, at last, in sight. On Tuesday evening, about as early as anyone in the general public could, Alain nabbed his first dose of Pfizer’s newly cleared pediatric COVID-19 vaccine. The needle delivered “a little poke,” he said, but also a huge injection of excitement and relief. Since his father, a critical-care physician, was vaccinated last December (the first time I interviewed Alain), “I’ve been impatient,” Alain said. “I really wanted to get mine.” Now he is finally on his way to joining the adults. When he heard on Tuesday that his shot was imminent, he let out a scream of joy, at “a pitch I have never heard him use before,” his mother, Kristen, told me.
There’s an air of cheer among the grown-ups as well. “It’s cause for celebration,” says Angie Kell, who lives in Utah with her spouse and their soon-to-be-vaccinated 6-year-old son, Beck. Their family, like many others, has been reining in their behavior for months to accommodate their still-vulnerable kid, unable to enjoy the full docket of post-inoculation liberties that so many have. Once Beck is vaccinated, though, they can leave mixed-immunity limbo: “We might have an opportunity to live our lives,” Kell told me.
The past year has been trying for young children, a massive test of patience—not always a kid’s strongest skill. And there’s yet another immediate hurdle to clear: the plodding accumulation of immunological defense. Alain has another 15 days to go until his second dose; after that, it’ll be two more weeks before he reaches a truly excellent level of protection. Only then, on December 7, will he count as fully vaccinatedby CDC standards and be able to start adopting the behavioral changes the agency has green-lit. In the intervening weeks, he and the many other 5-to-11-year-olds in his position will remain in a holding pattern. Their wait isn’t over yet.
The timing of this semi-immune stretch might feel particularly frustrating, especially with the winter holidays approaching: At this point, essentially no young kids are slated to be fully vaccinated by Thanksgiving or Hanukkah, except the ones who were enrolled in clinical trials. One shot can offer a level of protection, but experts advise waiting to change behavior for a reason—the extra safeguards that set in about two weeks after the second shot really are that much better, and absolutely worth sitting tight for.
“It takes time for immune cells to get into a position where they’re ready to pounce,” Gigi Gronvall, a senior scholar at the Johns Hopkins Center for Health Security, told me. COVID-19 vaccines teach immune cells to thwart the coronavirus, a process that, like most good boot camps, takes many days to unfold. The second shot is essential to clinch the lesson in the body’s memory, encouraging cells to take the threat more seriously for longer. Immune cells also improve upon themselves over time—the more, the better in these early stages. Gronvall’s own 11-year-old son is also about to get his first shot, and she doesn’t want to risk stumbling so close to the finish line. “I can’t know exactly what his immune system is going to do” after the first dose alone, she said.
Evidence from Pfizer’s original clinical trial, conducted only in adults, hinted that a first, decent defensive bump takes hold after the first shot. Kit Longley, Pfizer’s senior manager of science media relations, pointed to those data when I asked how kids at various points along the vaccination timeline should be approaching behavioral change. “Protection in the vaccinated cohort begins to separate from the placebo arm as early as 12 to 14 days after the first dose,” he told me.
The adult clinical-trial data were collected last year, though, long before the rise of the Delta variant. A more recent study, conducted in the United Kingdom, showed that one dose of Pfizer reduced the risk of symptomatic COVID-19 by only 35.6 percent when the cause was Delta, and by only 47.5 percent with Alpha. (And remember that those numbers apply best on a population scale—not for a single, individual child.) After adding a second dose, though, effectiveness rocketed up to about 90 or 95 percent against either variant. “You really need two doses for adequate, good protection,” Samuel Dominguez, a pediatric-infectious-disease specialist at Children’s Hospital Colorado, told me.
Immunity is so far looking strong in young kids: In a recent trial of thousands of children ages 5 to 11, Pfizer’s vaccine was more than 90 percent effective at blocking symptomatic cases of COVID-19, including ones caused by Delta. Longley said Pfizer expects that the timing of protection will be similar between children and adults—a first dose should lower everyone’s risk to some degree. But the company’s pediatric trial picked up only a few COVID-19 cases; none of them occurred until about three weeks after the first dose was given, or later. So it’s hard to say anything definitive about when “enough” immunity really kicks in for kids.
Some parents are counting on a level of early protection from one shot, including my cousin Joanne Sy, whose 8-year-old son, Jonah, received his first injection on Friday. “He will have good immunity after one dose,” she told me, hopefully enough to guard him on a trip they’re taking to New York for Thanksgiving two weeks from now. “We’re still going to be cautious,” Sy told me: They’ll be watching the Macy’s Thanksgiving Day Parade from a hotel room rather than the streets, and wearing masks, at least on the plane. “But we just need to move forward.”
The calculus is playing out differently for Christy Robinson of Arlington, Virginia, who will again be “hunkering down” with her husband and two daughters, June and Iris, 7 and 5, respectively, this Thanksgiving. The kids got their first Pfizer shot on Saturday, setting their household up for full, full vaccination by mid-December, just in time to hold an indoor gathering with their aunts, uncles, and cousins for Christmas. (Some quick arithmetic: To be fully vaccinated by December 25, a kid would need their first dose by November 20.) June’s also eager to “see my friends inside, because it’s cold outside,” she told me—plus go to movie theaters, and Build-A-Bear, and a trampoline park, and IHOP, and the nail salon.
By the end of this conversation, Robinson looked amused and maybe a little regretful that my question had prompted such an extravagant list. As their mother, she’s especially excited for the possibility of no longer having to quarantine her daughters after viral exposures at school. Heftier decisions are ahead too. She and her husband are still weighing whether to bring their daughters into closer, more frequent indoor contact with their grandparents, who are vaccinated but could still get seriously sick if someone ferries the virus into their midst.
And that risk—of transmitting the virus—is worth keeping in mind, with so much SARS-CoV-2 “still circulating around,” cautions Tina Tan, a pediatrician and infectious-disease specialist at Northwestern University. Immunized people are at much lower risk of picking up the virus and passing it on. There still aren’t enough of them, though, to reliably tamp down spread; uptake of shots among young kids, too, is expected to be sluggish in the months to come. Even fully vaccinated families won’t be totally in the clear while our collective defenses remain weak.
That doesn’t mean Thanksgiving has to be a bust—or even a repeat of 2020, before the vaccines rolled out. The Bells will be cautiously gathering with a few loved ones; all the adults in attendance will be immunized and everyone will get tested beforehand. “Then they can come inside the house, mask off,” Taison Bell, Alain’s father, told me. None of those measures is completely reliable on its own; together, though, they’ll hopefully keep the virus out.
The road ahead might feel a little bumpy for Alain, who’s celebrating his 8th birthday at the end of November, a few days after his second shot. (He’s getting the gift of immunity this year, his father joked.) The Bells will do something special “around when he hits full vaccination,” Kristen said, “with something Alain hasn’t gotten to do in the last two years.” But Alain, who has asthma, which can make COVID-19 worse, knows that his own injections won’t wipe the slate clean for him, or those around him. Some people in his neighborhood have caught the virus even after getting vaccinated, and he understands that he could too.
Alain will keep masking, and treading carefully at school, and even a bit at home. His 3-year-old sister, Ruby, hasn’t yet been able to get a shot. (I asked her how she felt about Alain’s vaccine; she responded, almost imperceptibly, “Jealous.”) Until another regulatory green light comes, she will still be waiting, which means that her family will be too.
The number of COVID-19 hospitalizations among older Americans dropped significantly since the vaccine rollout at the start of the year, new federal data show.
Why it matters: The vaccines have worked extremely well for one of the most vulnerable demographics. Roughly 97% of people 65 and older have at least one vaccine dose, and more than 85% of that age group is fully vaccinated, according to the CDC.
Yes, but: Certain portions of the Medicare population continue to be more susceptible to severe COVID-19 and hospitalization than others.
People who are covered by both Medicare and Medicaid — the poorest demographic, who often are in nursing homes — are 2.5 times more likely to be hospitalized, according to federal data.
Medicare enrollees who have kidney failure and compromised immune systems also are significantly more likely to be hospitalized from COVID-19 than old or disabled Medicare enrollees.
COVID-19 cases have declined nationwide for the fourth consecutive week, according to the CDC’s COVID data tracker weekly review published Oct. 15.
Nine numbers to know:
Reported cases
1. The nation’s current seven-day case average is 84,555, a 12.5 percent decrease from the previous week’s average.
Hospitalizations
2. The current seven-day hospitalization average for Oct. 6-12 is 6,659, an 8.8 percent drop from the previous week’s average.
Vaccinations
3. About 218 million people — 65.6 percent of the total U.S. population — have received at least one dose of the COVID-19 vaccine, and more than 188.3 million people, or 56.7 percent of the population, have gotten both doses.
4. About 9.3 million booster doses in fully vaccinated people have been reported.
5. The seven-day average number of vaccines administered daily was 841,731 as of Oct. 14, a 11.3 percent decrease from the previous week.
Variants
6. Based on projections for the week ending Oct. 9, the CDC estimates the delta variant accounts for more than 99 percent of all U.S. COVID-19 cases.
Deaths
7. The current seven-day death average is 1,241, down 13.4 percent from the previous week’s average. Some historical deaths have been excluded from these counts, the CDC said.
Testing
8. The seven-day average for percent positivity from tests is 5.7 percent, down 4.1 percent from the previous week.
9. The nation’s seven-day average test volume for the week of Oct. 1-7 was about 1.49 million, down 5.4 percent from the prior week’s average.
n addition to treating an influx of Covid-19 patients, many hospitals are struggling with what one administrator calls a “triple whammy” of financial burdens—stemming from plummeting revenue, higher labor costs, and reduced relief funds, Christopher Rowland reports for the Washington Post.
Hospitals in less-vaccinated areas face spiking labor costs
In areas with low vaccination rates, particularly in southern and rural communities, hospitals have been overwhelmed with Covid-19 patients, exacerbating labor shortages as workers burn out or leave for more lucrative positions, Rowland reports.
“The workforce issue is just dire,” Stacey Hughes, EVP of government relations and policy for the American Hospital Association (AHA), said. “The delta variant has wreaked significant havoc on hospitals and health systems.”
In Louisiana, Mary Ellen Pratt, CEO of St. James Parish Hospital, said many nurses quit due to the grueling conditions as Covid-19 cases spiked. “I didn’t have any extra money to incentivize my staff to pick up additional shifts,” she said. “This is coming out of bottom-line money I don’t have.”
Separately, Lisa Smithgall, SVP and chief nursing executive at Ballad Health, said the health system—which has 21 hospitals in eastern Tennessee and southwestern Virginia—has faced similar problems retaining staff amid Covid-19 surges.
“We knew we were at risk in our region because of where we live and because of our vaccination rate being so poor,” Smithgall said. “At one point, we were seeing four or five nurse resignations per week. They couldn’t do it again; they emotionally didn’t have it. They were so upset with our community.”
To fill in these growing gaps in their workforce, many hospitals have had to turn to costly contract workers, Rowland reports—a significant financial burden that further strains hospitals’ resources.
For example, Ballad Health went from hiring fewer than 75 contract nurses before the pandemic to 150 in August 2020 and 450 in August 2021. Moreover, according to Smithgall, contract nurses previously made double or triple what permanent staff nurses made, but now Ballad sometimes has to pay up to seven times as much for contract nurses as hospitals compete for workers to fill shifts.
Many hospitals, including those in areas with high vaccination rates, have delayed elective surgeries, a crucial source of revenue, amid nationwide surges in Covid-19 cases, Rowland reports—further compounding financial struggles for many organizations.
On Aug. 26, Ballad Health postponed a long list of elective surgeries—including hernia repair, cardiac and interventional radiology procedures, joint replacements, and nonessential spine surgery—to preserve space in its hospitals and conserve workers. Ballad is now allowing elective surgeries again, but only for a limited number of procedures that do not require overnight stays.
Similarly, St. Charles Health System in Oregon postponed elective surgeries in August “while we responded to a surge that was significantly greater and much more sudden than the surge in 2020,” Matt Swafford, the health system’s VP and CFO, said.
According to Swafford, the health system lost $5 million a week through August and September, around $1 million of which was repayment of emergency advances on Medicare reimbursements from last year.
“I don’t think anybody saw this level of surge coming in 2021 after what we saw in 2020,” he said. “We’re just not equipped to be able to simultaneously respond to the urgent needs of the community [for more typical surgeries and care] at the same time that a third of our beds are occupied by highly infective Covid patients.”
Many hospitals likely to end the year at a deficit
Further compounding the issue, according to Moody’s Investors Service, is that the provider relief funds that previously made up 43% of operating cash flow at nonprofit and government-run hospitals in the United States are now dwindling down.
In addition, the latest portion of provider relief funds to be distributed must be based on expenses incurred by hospitals before March 31, 2021, which don’t account for months of the delta surge, Rowland reports.
Premier, a group purchasing and technology company serving more than 4,000 hospitals and health systems, analyzed payroll data of 650 hospitals and found that U.S. hospitals have spent a total of $24 billion a year during the pandemic to cover excess labor costs, primarily for overtime and contract nurses. This was an increase of 63% from October 2019 to July 2021, Rowland reports, with hospitals in the Upper Midwest and across the South seeing the largest increases.
“It’s going to leave them huge deficits that they are going to have to work out of for years to come,” Michael Alkire, Premier’s CEO, said.
HENRY KOTULA 