Howard Stern blasts unvaccinated Americans, casting vaccine mandate as ‘freedom to live’

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Howard Stern was reflecting this week on the coronavirus deaths of four conservative talk-radio hosts who had espoused anti-vaccine and anti-mask sentiments when he took aim at those who have refused to get vaccinated.

“I want my freedom to live,” he said Tuesday on his SiriusXM program. “I want to get out of the house. I want to go next door and play chess. I want to go take some pictures.”

The shock jock, who advocated for the coronavirus vaccine to be mandatory, then turned his attention to the hesitancy that has played a significant role in the U.S. spread of the virus, leading to what Rochelle Walensky, director of the Centers for Disease Control and Prevention, has called a “pandemic of the unvaccinated.”He pointed to unvaccinated people who are “clogging” up overwhelmed hospitals, calling them “imbeciles” and “nut jobs” and suggesting that doctors and nurses not treat those who have not taken a coronavirus vaccine.

“I’m really of mind to say, ‘Look, if you didn’t get vaccinated [and] you got covid, you don’t get into a hospital,’ ” he said. “You had the cure and you wouldn’t take it.”

Stern’s comments come after several other celebrities expressed to their large social media audiences their frustration with the ongoing lag in vaccinations when hospitals are being pushed to their limits by the highly transmissible delta variant.

More than 185,000 coronavirus infections were reported Wednesday across the United States, according to data compiled by The Washington Post. Nearly 102,000 people are hospitalized with covid-19; more than 26,000 are in intensive care units. A slight decline in hospitalizations over the past week has inspired cautious optimism among public health leaders.

While there is not a nationwide vaccine mandate, President Biden is expected to sign an executive order Thursday requiring that all federal employees be vaccinated, without an alternative for regular coronavirus testing to opt out of the mandate, The Post reported. The order affecting the estimated 2.1 million federal workers comes as Biden plans to outline a “robust plan to stop the spread of the delta variant and boost covid-19 vaccinations,” the White House said.

Health officials, doctors and nurses nationwide have urged those still hesitant to get vaccinated — and some have gone a step further. Jason Valentine, a physician in Mobile, Ala., informed patients last month that he would not treat anyone who was unvaccinated, saying there were “no conspiracy theories, no excuses” preventing anyone from being vaccinated. Linda Marraccini, a doctor in South Miami, said this month that she would not treat unvaccinated patients in person, noting that her office would “no longer subject our patients and staff to unnecessary risk.”

The summer surge also has led celebrities to use their platform to either call on unvaccinated people to get vaccinated or to denounce them for not doing so. Actor and activist Sean Penn said the vaccine should be mandatory and has called on Hollywood to implement vaccination guidelines on film sets. Actors Benicio Del Toro and Zoe Saldana were part of a vaccine video campaign this year to help debunk misinformation about coronavirus vaccination. When actress Melissa Joan Hart revealed her breakthrough coronavirus case last month, she said she was angry that the nation “got lazy” about getting vaccinated and that masking was not required at her children’s school.

Late-night talk host Jimmy Kimmel suggested Tuesday that hospitals shouldn’t treat unvaccinated patients who prefer to take ivermectin — a medicine long used to kill parasites in animals and humans that has soared in popularity despite being an unproven covid-19 treatment and the subject of warnings by health officials against its use for the coronavirus. After noting that Anthony S. Fauci, the chief medical adviser to Biden, warned that some hospitals might be forced to make “tough choices” on who gets an ICU bed, the late-night host quipped that the situation was not difficult.

“That choice doesn’t seem so tough to me,” Kimmel said. “Vaccinated person having a heart attack? Yes, come right in; we’ll take care of you. Unvaccinated guy who gobbled horse goo? Rest in peace, wheezy.”

Stern has featured front-line workers on his show and has advocated for people to get vaccinated against the coronavirus. In December, the host interviewed Cody Turner, a physician at the Cleveland Clinic, about how the front-line doctor struggled with his mental health while treating infected patients when a vaccine was not widely available.

“We are drowning and we are in hell, and people don’t understand, not only what’s happening to people, you know, but patients across this country,” Turner said.

Stern was a fierce critic of President Donald Trump’s response to the pandemic, saying last year that his former friend was “treasonous” for telling supporters to attend large rallies, despite the risk of infection, in the run-up to the presidential election.

On his eponymous program this week, Stern referred to four conservative talk-radio hosts who bashed the vaccine and eventually died of the virus: Marc Bernier, 65; Phil Valentine, 61; Jimmy DeYoung, 81; and Dick Farrel, 65. In the weeks and months leading up to their deaths last month, all four men had publicly shared their opposition to mainstream public health efforts when coronavirus infections were spiking.

“Four of them were like ranting on the air — they will not get vaccinated,” Stern said Tuesday. “They were on fire … they were all dying and then their dying words were, ‘I wish I had been more into the vaccine. I wish I had taken it.’ ”

After he played a clip of Bernier saying he would not get vaccinated, Stern suggested that the coronavirus vaccine be considered as normal as a measles or mumps vaccine.

“When are we going to stop putting up with the idiots in this country and just say it’s mandatory to get vaccinated?” he asked.

Industry pushes for more time before surprise billing ban enforced

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As the healthcare industry gears up to fall under the requirements of the No Surprises Act that bans balance billing, hospitals and insurers said they need more time and information to abide by the requirements.

Payers are asking for a safe harbor until 2023 calling the Jan. 1 start day is too soon for plans to determine payment amounts to out-of-network providers and as it seeks clarification on the resolution process.

Safety net hospitals represented by America’s Essential Hospitals want implementation to be delayed until six months after the public health emergency for COVID-19 ends, saying staff and resources are spread too thin dealing with the pandemic and especially the spread of the delta variant.

HHS released the first interim final rule to implement the No Surprises Act in June — one of multiple expected to be released this year — including those from the Departments of Treasury and Labor.

A major and much-debated aspect of the law is how qualifying payment amounts — the amount paid to providers who are not in network but are providing care at an in-network facility — are calculated.

Later rules are expected to provide more detail on the key issue of how the independent dispute resolution process will be conducted.

Payers and providers both argued in their comments that without more information on that process, it is hard to prepare. 

The ERISA Industry Committee, which lobbies for large employers, said that as the resolution process is developed, deviation from QPAs “should be limited to extenuating circumstances.” That’s in direct contrast to the American Hospital Association, which requested the department not overly weigh the QPA as a factor in consideration.

When Congress debated a ban on surprise billing, whether a dispute resolution process would be used or whether rates for out-of-network providers would be based on a set rate was perhaps the most hotly contested aspect. In the end, providers got the win with the arbitration clause.

In comments on the rule, both AHA and payer lobby AHIP called for a multi-stakeholder group to advise on issues such as what provisions fall under state and federal jurisdiction and other operational challenges.

The hospital lobby requested clarification on a number of aspects of the rule, such as how good faith estimates of costs should be calculated on consent forms patients may sign to waive balance billing protections and when a provider can bill a patient if their claim is denied by the plan.

In multiple instances, the group asked the department to confirm that the initial payment should not be the QPA unless both the plan and provider agree to that circumstance.

The country’s largest hospital lobby is also concerned that the act won’t do enough to ensure network adequacy from insurers and will not institute enough oversight on plans’ compliance.

AHA said it is “deeply concerned that the existing oversight mechanisms are insufficient to monitor plan and issuer behavior and a more robust structure is needed to enforce the QPA requirements.”

The Federation of American Hospitals expressed similar concerns, particular regarding “abusive plan practices” like inappropriate claims denials and downcoding. The group urged the departments “to expand their oversight of plans and issuers to prevent and address unlawful and abusive plan practices.”

AEH, meanwhile, asked for assurances that administrative burdens like the notice and consent documentation would be fairly split with insurers.

Under the rule, the QPA is to be decided by a plan’s median in-network contracted rate for a geographic area. It must have a minimum of three contracted rates to use this method. If that is not available, the payer can use an independent claims database.

FAH, in particular, asked that the rule strengthen conflict of interest regulations for these databases and have their eligibility determined by the departments instead of the insurers themselves.

AHIP’s most immediate concern is the timeline for implementation. It asked for the good faith safe harbor request to develop QPA methodologies, create the infrastructure to transmit notice and consent forms with providers and for it to receive the forthcoming information on the arbitration process.

“Health plans and issuers have responsibility for developing work streams; updating information technology; creating forms, notices, and other communications; training employees; and other operational measures necessary to effectuate obligations” in the rule, the group wrote.

CMS provides additional ARP funding to states to promote insurance affordability

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Nigerians can now get paid in US dollars while working from home - Punch Newspapers

States with 1332 reinsurance waivers will have more pass-through funding to implement the waivers.

The Centers for Medicare and Medicaid Services and the Biden Administration have earmarked $452 million in federal funding through the American Rescue Plan for efforts to lower costs and improve health insurance access in 13 states.

Due to the changes made to the ARP, states with 1332 reinsurance waivers will have more pass-through funding to implement the waivers, and may also have their own state funding available to pursue further strategies to promote insurance affordability. 

This funding, said CMS, might otherwise have been spent on 2021 reinsurance costs.

The “pass-through funding” is determined on an annual basis by the Department of Health and Human Services and the Department of the Treasury. They’re available to states with approved section 1332 waivers that have also lowered premiums to implement their waiver plans.

WHAT’S THE IMPACT?

State-based reinsurance programs created through section 1332 waivers are designed to improve health insurance affordability and market stability by reimbursing issuers for a portion of healthcare provider claims that would otherwise be paid by some consumers and by the federal government through higher premiums. 

As a result, said CMS, these programs hold the potential to lower premiums for consumers with individual health insurance coverage, and may increase access to coverage and provide more health plan options for people in those reinsurance states, without increasing net federal costs.

The additional funds announced by CMS range from $2.5 million to $139 million per state – varying based on factors such as the size of the state’s reinsurance program. The funds are the result of expanded subsidies provided under the ARP, which will result in new people enrolled, and will cover a portion of the states’ costs for these reinsurance programs.

States with approved section 1332 state-based reinsurance waivers have experienced reduced premiums in the individual market, CMS said. Overall, from plan years 2018 to 2021, states that have implemented section 1332 state-based reinsurance waivers for the individual market have seen statewide average premium reductions ranging from 3.75% to 41.17%, compared to premiums absent the waiver, according to the agency’s internal data. 

For example, in 2021, statewide average premium reductions due to the waiver were 4.92% in Pennsylvania, 18.47% in Colorado, and 34% in Maryland, compared to a scenario with no waiver in place.

Beyond reduced premiums, it’s expected that section 1332 state-based reinsurance waivers may help states maintain and increase issuer participation, and may increase the number of qualified health plans available in each county in such states from year to year. For example, states like Colorado, Wisconsin, Alaska and Maryland have seen additional issuers enter or re-enter the individual marketplace since their state reinsurance programs have been implemented.

The agency’s current thinking is that stronger issuer participation in the individual market may increase competition and translate to consumers having more opportunities to obtain affordable health insurance coverage. Nationally, on average, there are more QHP offerings in 2021 than in 2020, and in states with section 1332 state-based reinsurance waivers, the average number of QHPs weighted by enrollment increased by 30.6% from 2020 to 2021. 

The states, and their pass-through funding amounts, include Alaska ($43,827,328), Colorado ($49,892,498), Delaware ($10,821,203), Maine ($8,562,238), Maryland ($139,159,548), Minnesota ($64,969,985), Montana ($7,129,995), New Hampshire ($8,820,847), North Dakota ($5,798,044), Oregon ($18,948,114), Pennsylvania ($28,558,672), Rhode Island ($2,590,540) and Wisconsin ($63,408,562). New Jersey’s pass-through funding amount will be announced at a later time.

THE LARGER TREND

In April 2021, the departments announced a total of $1.29 billion in pass-through funding for the 2021 plan year and posted a FAQ that noted that the departments would inform states of additional pass-through to account for the ARP.

ON THE RECORD

“This investment is a testament to our administration-wide commitment to making healthcare more accessible and affordable,” said HHS Secretary Xavier Becerra. “This funding from the American Rescue Plan will reduce monthly healthcare costs for consumers, increase coverage, and provide more options. We will continue to work with states to strengthen the healthcare system as we respond to the COVID-19 pandemic.”

“Reducing a family or individual’s average monthly health coverage costs frees up that money for other needs,” said CMS Administrator Chiquita Brooks-LaSure. “The Biden-Harris Administration continues to work with states to reduce costs and deliver more affordable health coverage options. This is another example of how the American Rescue Plan is helping more people meet their healthcare needs.”

75% of U.S. adults have now received at least one COVID-19 shot, says CDC

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https://www.healthcarefinancenews.com/news/75-us-adults-have-now-received-least-one-covid-19-shot-says-cdc

More than 73% of those ages 12 to 18 have received one shot, while 92.4% of those older than 65 have received at least one dose.

The U.S. hit a new milestone this week as 75% of adults over the age of 18 have received at least one dose of a COVID-19 vaccine as of Tuesday, according to data from the Centers for Disease Control and Prevention.

Among the over-18 set, almost 194 million Americans have received a first dose, while close to 165 million people are fully vaccinated, good for 64.3% of that population.

The percentages increase the older the population subset. Slightly more than 73% of those ages 12 to 18 have received one shot (with 62.3% fully inoculated), while 92.4% of those older than 65 have received at least one dose. Among that age group, 82.1% are fully vaccinated.

The data also highlighted which states are faring better in terms of total doses administered per 100,000 people. Vermont leads the nation, with other New England states – Maine, Massachusetts, Rhode Island and Connecticut in particular – following closely behind.

The South and Midwest show the lowest rates of vaccination.

The Pfizer-BioNTech vaccine, which was the first to receive full approval from the Food and Drug Administration, leads the pack in terms of total doses administered with more than 214 million shots delivered as of September 7. Moderna comes in second with 147 million-plus doses administered, followed by Johnson and Johnson, which has seen more than 14.5 million total doses administered.

The vaccine hierarchy holds true when examining the number of people fully vaccinated, with Pfizer at almost 96 million, Moderna at about 66 million and J&J at roughly 14 million.

WHAT’S THE IMPACT?

The numbers should come as some encouragement to the nation’s hospitals and health systems, which have been beleaguered by an influx of coronavirus patients, driven in large part by the highly transmissible Delta variant. 

These new surges are once more resulting in operational pressure for nonprofit hospitals in the U.S., which will likely affect margins in the near term, according to an August analysis from Fitch Ratings.

Operations and resources in these new coronavirus hotspots are being stretched more than at any prior time during the pandemic, according to the ratings agency, with hospitalization rates exceeding prior peaks and ICU beds at full capacity in some states.

And while some areas are worse than others, there are no regions that are unaffected: Hospitalizations are trending upward in all states.

What this means for hospitals, and nonprofits in particular, is that additional staffing and supplies will be needed to handle the new influx of COVID-19 patients. The greater number of patients is resulting in a self-induced postponement of nonemergent surgical cases, resulting in lower hospital revenues.

Additionally, hospitals and skilled nursing facilities are competing for a limited supply of nurses, including more expensive contract nursing staff.

THE LARGER TREND

The Pfizer/BioNTech offering received full FDA approval in August, and is now marketed as Comirnaty. 

The vaccine has been approved for the prevention of COVID-19 for those 16 years old and older. The vaccine also continues to be available under emergency use authorization, including for those 12 to 15, and for the administration of a third dose in certain immunocompromised patients.

Just last week, Moderna submitted data to the FDA for evaluation of a booster shot for its mRNA vaccine. 

The yet-to-be peer-reviewed data comes from a study of 344 individuals who received a third dose of the Moderna vaccine six months after their second shot. Moderna found that their antibodies had “waned significantly” before getting the booster shot, but the additional jab increased antibodies to an even higher level than the previous round.

Heightened protection was observed across age groups, but particularly in adults over the age of 65, according to Moderna. It also offered protection against “all variants of concern,” including the Delta variant.

Moderna’s vaccine received emergency use authorization last December and showed to be 94.1% effective in preventing symptomatic COVID-19 in its clinical trial.

The 7 Stages of Severe Covid-19

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67 financial benchmarks for health system executives

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35 financial benchmarks for healthcare executives | HENRY KOTULA

Health system leaders use benchmarking as a way to determine how their organizations stack up against both local and regional peers.

Below are 67 financial benchmarks, including key ratios for health systems, as well as revenue and margin metrics, broken down by rating category.

Key balance sheet metrics, ratios:

Source: Fitch Ratings’ “2021 Median Ratios: Not-for-Profit Hospitals and Healthcare Systems” report. It was released Aug. 3. 

1. Cash on hand: 255 days

2. Accounts receivable: 44.6 days

3. Cushion ratio: 29x

4. Current liabilities: 95 days

5. Cash to debt: 169.9 percent

6. Cash to adjusted debt: 161.1 percent

7. Operating margin: 1.3 percent

8. Operating EBITDA margin: 6.7 percent

9. Excess margin: 3.1 percent

10. EBITDA margin: 8.5 percent

11. Net adjusted debt to adjusted EBITDA: -2.6 percent

12. Personnel costs as percent of total operating revenue: 55 percent

13. EBITDA debt service coverage: 3.9x

14. Operating EBITDA debt service coverage: 3.2x

15. Maximum annual debt service as percent of revenues: 2.2 percent

16. Debt to EBITDA ratio: 4.4x

17. Debt to capitalization: 35.2 percent

18. Average age of plant: 11.4 years

19. Capital expenditures as percent of depreciation expense: 110.1 percent

Margins, revenue financial benchmarks broken down by rating category: 

Source: S&P Global Ratings “U.S. Not-For-Profit Health Care System Median Financial Ratios — 2019 vs. 2021″ report.” The report was released Aug. 30.

“AA+” rating

20. Net patient service revenue: $4.16 billion

21. Total operating revenue: $4.43 billion

22. Operating margin: 4.5 percent

23. Operating EBIDA margin: 11.3 percent

24. Excess margin: 5.5 percent

25. EBIDA margin: 12.2 percent

“AA” rating

26. Net patient service revenue: $3.98 billion

27. Total operating revenue: $4.95 billion

28. Operating margin: 3.2 percent

29. Operating EBIDA margin: 8.3 percent

30. Excess margin: 5.8 percent

31. EBIDA margin: 10.7 percent

“AA-” rating

32. Net patient service revenue: $3.08 billion

33. Total operating revenue: $3.41 billion

34. Operating margin: 1.9 percent

35. Operating EBIDA margin: 7.1 percent

36. Excess margin: 4.1 percent

37. EBIDA margin: 9.2 percent

“A+” rating

38. Net patient service revenue: $2.26 billion

39. Total operating revenue: $2.55 billion

40. Operating margin: 3 percent

41. Operating EBIDA margin: 7.1 percent

42. Excess margin: 5.5 percent

43. EBIDA margin: 10.9 percent

“A” rating

44. Net patient service revenue: $2.69 billion

45. Total operating revenue: $3.07 billion

46. Operating margin: 0.7 percent

47. Operating EBIDA margin: 6.6 percent

48. Excess margin: 5.5 percent

49. EBIDA margin: 2.3 percent

“A-” rating

50. Net patient service revenue: $2.08 billion

51. Total operating revenue: $2.69 billion

52. Operating margin: 0.6 percent

53. Operating EBIDA margin: 6.7 percent

54. Excess margin: 2.4 percent

55. EBIDA margin: 8 percent

“BBB+” rating

56. Net patient service revenue: $1.85 billion

57. Total operating revenue: $2.27 billion

58. Operating margin: -0.2 percent

59. Operating EBIDA margin: 5 percent

60. Excess margin: 0.5 percent

61. EBIDA margin: 6 percent

“BBB” rating

62. Net patient service revenue: $2.96 billion

63. Total operating revenue: $4.11 billion

64. Operating margin: -3.2 percent

65. Operating EBIDA margin: 1.6 percent

66. Excess margin: -2 percent

67. EBIDA margin: 2.8 percent

Providence looks to rapidly fill 17,000 jobs

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Providence looks to rapidly fill 17,000 jobs

Providence is investing $220 million to fill open positions and give bonuses to current employees, the Renton, Wash.-based system announced Sept. 3. 

The health system is giving a $1,000 bonus to every caregiver who has been with the organization for at least 90 days. The bonuses, which will be given to workers up to and including the director level, will be paid in two installments in September and December. 

Providence is also making investments to rapidly fill 17,000 job openings. The system said it is offering sign-on bonuses to front-line workers with the goal of filling positions quickly and alleviating the stress and burnout many clinicians are experiencing. Current employees are eligible for referral bonuses of between $1,000 and $7,500. 

“Our caregivers are the core of who we are, and we have been committed to supporting their health and well-being throughout the pandemic,” Providence President and CEO Rod Hochman, MD, said in a news release. “Now, as we enter month 21 of our COVID-19 response, it’s even more imperative to continue to care for and bolster those who make our mission possible.” 

What’s Going On with Delta?

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For much of August, the U.S. South showed up fire-engine red on our map of COVID-19’s spread in the U.S., meaning case counts were shooting up. But now, Florida, Louisiana, Mississippi, Arkansas and Missouri show up in shades of green, meaning cases—while still high—are trending down.

Does that mean the Delta surge is nearing its end?

If covering the pandemic for 18 months has taught me anything, it’s that confident predictions often come back to bite you. But there is reason for cautious optimism. Past U.S. surges have played out in short, intense bursts, and some experts have predicted, based on Delta’s behavior in other countries, that U.S. infections could peak in late August or early September. Covidestim, a modeling project from researchers at Yale, Harvard and Stanford, points to another promising sign: In more than half of states, a person infected with COVID-19 would currently be expected to transmit the virus to less than one other person, in what is perhaps a sign of waning community transmission and/or better population immunity.

Still, we shouldn’t get ahead of ourselves. The U.S. is recording an average of about 150,000 new diagnoses per day, a number not seen since this past winter’s pre-vaccination spike. And in many states, like South Dakota and West Virginia, the trends are going in the wrong direction—and fast. That suggests Delta may be moving to new states, rather than fading away completely.

The situation may become even messier as the school year gets underway. Far more kids have gotten seriously ill during this wave compared to previous ones, in part because of Delta’s contagiousness and in part because children younger than 12 cannot be vaccinated, whereas older Americans are better protected from infection. In a worst-case scenario, pediatric ICUs nationwide may be heading for a repeat of what the South has seen this summer.

While the virus behaves in mysterious ways, people in the U.S. are not powerless. The Delta variant is indeed extra contagious, but the summer surge also coincided with relaxed mask guidelines and, for many people, a return to indoor activities. In South Dakota, one of the states currently seeing the largest increases in cases, the spike seems to be related to large-scale gatherings at the Sturgis Motorcycle Rally. That suggests our behavior matters just as much as the virus’. Getting vaccinated, wearing masks indoors and avoiding large crowds can all help the Delta surge come to an end.

TODAY’S CORONAVIRUS OUTLOOK

About 445.6 million doses of the COVID-19 vaccine have been shipped to various U.S. states as of this afternoon, of which some 372.1 million doses have been administered thus far, according to TIME’s vaccine tracker. About 52.7% of Americans have been completely vaccinated.

More than 219 million people around the world had been diagnosed with COVID-19 as of this afternoon, and more than 4.5 million people have died. On September 2, there were 631,605 new cases globally.

Here’s how the world as a whole is currently trending:

Here’s where daily cases have risen or fallen over the last 14 days, shown in confirmed cases per 100,000 residents:

And here’s every country that has reported over 4 million cases:

The U.S. had recorded more than 39.5 million coronavirus cases as of this afternoon. More than 643,000 people have died. On September 2, there were 153,143 new cases and 1,588 new deaths confirmed in the U.S.

Here’s how the country as a whole is currently trending:

Here’s where daily cases have risen or fallen over the last 14 days, shown in confirmed cases per 100,000 residents:

All numbers unless otherwise specified are from the Johns Hopkins University Center for Systems Science and Engineering, and are accurate as of Sept. 3 1 a.m. E.T. To see larger, interactive versions of these maps and charts, click here.

WHAT ELSE YOU SHOULD KNOW

The U.S. economy gained only 235,000 jobs in August, according to new data from the U.S. Bureau of Labor Statistics—far below this year’s average of 586,000 per month and economists’ expectations of more than 700,000 in August. The retail and dining sectors lost jobs in August, which suggests the Delta-related surge is again putting the squeeze on customer-facing businesses.

South Africa will no longer export Johnson & Johnson vaccines to Europe, under a deal struck by leaders from South Africa, France and the European Commission. The shots will instead be distributed among people on the African continent, where only about 3% of the population is fully vaccinated against COVID-19, compared to nearly 60% in the European Union. The European Commission will also return shots already shipped to Europe from South Africa to help aid the continent’s vaccination campaign, CNN reports.

The U.S. government will invest $3 billion in the vaccine supply chain, in an effort to help manufacturers churn out more shots and supplies for both the U.S. and the rest of the world. Federal officials have not publicly announced which companies will receive that money, but White House COVID-19 adviser Jeff Zients said yesterday that funding will be channeled toward firms that make materials needed for vaccine production and administration, as well as facilities that fill vaccine vials and those that make personal protective equipment.

Employers and private businesses around the world have begun to mandate COVID-19 vaccination. Now, Italian officials are mulling a population-wide vaccine requirement for anyone old enough to receive a shot, according to Reuters. Such a policy wouldn’t happen until the European Medicines Agency gives the shots full approval, but it would still likely be unpopular in a country with a significant vaccine-hesitant population. At present, about 70% of Italians 12 and older are fully vaccinated.

On the other end of the spectrum, U.K. regulators reportedly may not recommend vaccines for healthy children ages 12 to 15. While shots are recommended for children with underlying conditions that put them at risk of severe disease, U.K. authorities are still assessing whether immunization is necessary for healthy kids, given their relatively low risk of hospitalization or death. The country’s regulators are, however, analyzing whether universal pediatric vaccination may be necessary to maintain safe schools.

Dr. Anthony Fauci, the top U.S. expert on COVID-19, added to the back-and-forth on booster shots yesterday, noting that a three-shot regimen will probably become standard for COVID-19 vaccines. He said a three-dose system would likely ensure more “durable” protection against the virus than a two-shot schedule, CNN reports. Ultimately, though, that decision isn’t up to Fauci. It will be decided by regulators at the U.S. Food and Drug Administration, who are set to discuss booster shots at a meeting later this month.

Worried About Breakthrough Infections? Here’s How to Navigate This Phase of the Pandemic.

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Many people are seeking definitive answers about what they can and can’t do after being vaccinated against Covid-19. Is it OK to travel? Should I go to a big wedding? Does the Delta variant make spending time with my vaccinated grandmother more risky?

But there’s no one-size-fits-all answer to those questions because risk changes from one individual to the next, depending on a person’s overall health, where they live and those they spend time with.

The bottom line is that vaccines are highly protective against serious illness, and, with some precautions, will allow people to return to more normal lives, experts say. A recent study in Los Angeles County showed that while breakthrough infections can happen, the unvaccinated are 29 times as likely to end up hospitalized from Covid-19 as a vaccinated person.

Experts say anxiety about breakthrough infections remains pervasive, fueled in part by frightening headlines and unrealistic expectations about the role of vaccines.

“There’s been a lot of miscommunication about what the risks really are to vaccinated people, and how vaccinated people should be thinking about their lives,” said Dr. Ashish K. Jha, dean of the Brown University School of Public Health. “There are people who think we are back to square one, but we are in a much, much better place.”

While the Delta variant is causing a surge in infections in various hot spots around the country, including Florida and Louisiana, there will eventually be an end to the pandemic. Getting there will require ongoing precautions in the coming months, but vaccinated people will have more freedom to enjoy life than they did during the early lockdowns. Here are answers to some common questions about the road ahead.

To understand why there is no simple answer to this question, think about another common risk: driving in a snowstorm. While we know that tens of thousands of people are injured or killed each year on icy roads, your individual risk depends on local conditions, the speed at which you travel, whether you’re wearing a seatbelt, the safety features on your car and whether you encounter a reckless driver on the road.

Your individual risk for Covid after vaccination also depends on local conditions, your overall health, the precautions you take and how often you are exposed to unvaccinated people who could be infected.

“People want to be told what to do — is it safe if I do this?” said Dr. Sharon Balter, director of the division of communicable disease control and prevention at the Los Angeles County Department of Public Health. “What we can say is, ‘These are the things that are more risky, and these are the things that are less risky.’”

Dr. Balter’s team has recently collected surveillance data that give us a clearer picture of the difference in risk to the vaccinated and unvaccinated as the Delta variant surged from May 1 through July 25. They studied infections in 10,895 fully vaccinated people and 30,801 unvaccinated people. The data showed that:

  • The rate of infection in unvaccinated people is five times the rate of infection in vaccinated people. By the end of the study period, the age-adjusted incidence of Covid-19 among unvaccinated persons was 315.1 per 100,000 people over a seven-day period compared to 63.8 per 100,000 incidence rate among fully vaccinated people. (Age adjustment is a statistical method used so the data are representative of the general population.)
  • The rate of hospitalization among the vaccinated was 1 per 100,000 people. The age-adjusted hospitalization rate in unvaccinated persons was 29.4 per 100,000.
  • Older vaccinated people were most vulnerable to serious illness after a breakthrough infection. The median age of vaccinated people who were hospitalized for Covid was 64 years. Among unvaccinated people who were hospitalized, the median age was 49.
  • The Delta variant appears to have increased the risk of breakthrough infections to vaccinated people. At the start of the study, before Delta was dominant, unvaccinated people became infected 10 times as often as vaccinated people did. By the end of study period, when Delta accounted for almost 90 percent of infections, unvaccinated people were five times as likely to get infected as vaccinated people.

While unvaccinated people are by far at highest risk for catching and spreading Covid-19, it’s also possible for a vaccinated person to become infected and transmit the illness to others. A recent outbreak in Provincetown, Mass., where thousands of people gathered in bars and restaurants, showed that vaccinated people can sometimes spread the virus.

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Even so, many experts believe the risk of getting infected from a vaccinated person is still relatively low. Dr. Jha noted that after an outbreak among vaccinated and unvaccinated workers at the Singapore airport, tracking studies suggested that most of the spread by vaccinated people happened when they had symptoms.

“When we’ve seen outbreaks, like those among the Yankees earlier in the year and other cases, almost always people are symptomatic when they’re spreading,” Dr. Jha said. “The asymptomatic, pre-symptomatic spread could happen, but we haven’t seen it among vaccinated people with any frequency.”

Another study from Singapore looked at vaccinated and unvaccinated people infected with the Delta variant. The researchers found that while viral loads in vaccinated and unvaccinated workers are similar at the onset of illness, the amount of virus declines more rapidly in the vaccinated after the first week, suggesting vaccinated people are infectious for a shorter period of time.

In many cases it will be safe, but the answer depends on a number of variables. The risk is lower with a few close family members and friends than a large group of people you don’t know. Outdoor gatherings are safer than indoor gatherings. What’s the community transmission rate? What’s the ventilation in the room? Do you have underlying health issues that would make you vulnerable to complications from Covid-19? Do any of the vaccinated people have a fever, sniffles or a cough?

“The big question is can five people sit around a table unmasked if we know they’re all vaccinated,” Dr. Jha said. “I think the answer is yes. The chances of anybody spreading the virus in that context is exceedingly low. And if someone does spread the virus, the other people are not going to get super sick from it. I certainly think most of us should not fear breakthrough infections to the point where we won’t tolerate doing things we really value in life.”

For larger gatherings or even small gatherings with a highly vulnerable person, rapid antigen testing using home testing kits can lower risk. Asking people to use a test a few days before the event, and then the day of the event, adds another layer of protection. Opening windows and doors or adding a HEPA air cleaner can also help.

Children under 12 probably will not be eligible for vaccination until the end of the year. As a result, the best way to protect them is to make sure all the adults and older kids around them are vaccinated. A recent report from the C.D.C. found that an unvaccinated elementary schoolteacher who didn’t wear a mask spread the virus to half of the students in a classroom.

Studies show that schools have not been a major cause of Covid-spreading events, particularly when a number of prevention measures are in place. A combination of precautions — masking indoors, keeping students at least three feet apart in classrooms, keeping students in separate cohorts or “pods,” encouraging hand washing and regular testing, and quarantining — have been effective. While many of those studies occurred before the Delta variant became dominant, they also happened when most teachers, staff and parents were unvaccinated, so public health experts are hopeful that the same precautions will work well this fall.

Dr. Balter noted that masking in schools, regular testing and improving ventilation will keep children safer, and that parents should be reassured by the data.

“The level of illness in children is much less than adults,” she said. “You do weigh all these things, but there are also a lot of consequences to not sending children to school.”

In many cases it will be relatively safe for vaccinated people to spend time, unmasked, with an older relative. But the risk depends on local conditions and the precautions the visitor has taken in the days leading up to the visit. In areas where community vaccination rates are low and overall infection rates are high, meeting outdoors or wearing a mask may be advised.

If you’re vaccinated but have been going to restaurants, large gatherings or spending time with unvaccinated people, it’s a good idea to practice more social distancing in the days leading up to your visit with an older or vulnerable person. Home testing a few days before the visit and the day of the visit will add another layer of protection.

Gregg Gonsalves, an assistant professor of epidemiology at the Yale School of Public Health, said he recently visited his 87-year-old mother and did not wear a mask. But that is because both of them are vaccinated and he still works mostly from home, lives in a highly vaccinated area and has low risk for exposure. He is also investing in home testing kits for reassurance that he is not infectious.

“If I just came back from a big crowded gathering, and I had to go see my mom, I would put on a mask,” he said.

The answer depends on the precautions your workplace has taken. Does the company require proof of vaccination to come into the office? Are unvaccinated people tested regularly? What percentage of people in the office are unvaccinated? What steps did your company take to improve indoor air quality? (Upgrading the filters in ventilation systems and adding stand-alone HEPA air cleaners are two simple steps that can reduce viral particles in the air.)

Offices that mandate vaccination will be safer, but vaccination rates need to exceed 90 percent. Even an 85-percent vaccination rate is not enough, Dr. Jha said. “It’s not going to work because one of those 15-percent unvaccinated is going to cause an outbreak for every single person in that room,” he said. “You do not want a bunch of unvaccinated people running around your offices.”

The people who have the most to gain from booster shots are older people, transplant patients, people with compromised immune systems or those with underlying conditions that put them at high risk for complications from Covid. People who received the single-dose Johnson & Johnson vaccine may also be good candidates for a second dose.

But many experts say healthy people with normal immune systems who received a two-dose mRNA vaccine from Pfizer or Moderna won’t get much benefit right now from a third shot because their vaccine antibodies still offer strong protection against severe illness. That said, the Biden administration appears to be moving ahead with offering booster shots to the general public starting as soon as the week of Sept. 20.