The groundhog dug a perfectly round hole for its perfectly round body and deposited a perfectly conical pile of sandy brown dirt on the sidewalk in front of our house. We shoveled the soil into a child’s red wagon and found a home for it elsewhere in the yard.
Two days later, another pile of dirt on the sidewalk, another wagonload removed from the municipal right of way. (We live on a busy road).
Two days later, same scenario. Groundhog Day? To be sure.
We have given the groundhog a name: Delta. After all, delta is a deposit of sediment as well as a symbol of change – and now, alas, a truly nasty virus.
The Delta coronavirus variant is like the groundhog: We are done with it, but it is not done with us. Just when we think we have the pandemic on the run, just when we think we can shed our masks, just when we start to gather in crowds again (envision 60,000 celebrating the Milwaukee Bucks’ NBA championship in the Deer District by the arena)… the virus reminds us that it’s not going to be that easy. And dumps another pile of dirt on our sidewalk.
The words “next phase of the pandemic” are not the ones we want to hear right now, and yet they are the words jumping off the pages of our newspapers and the screens of our smart phones and TVs. Also jumping off those pages and screens with increasing frequency: Clarion calls for vaccination mandates for healthcare workers, government employees and perhaps more.
The Department of Veterans Affairs on Monday became the first federal agency to announce a COVID-19 vaccination mandate for its health workers, some 115,000 of them. The VA has lost 146 healthcare employees to COVID-19 since the pandemic began. CNN reports that President Biden is expected to announce a policy giving federal employees a choice between vaccination or regular testing and mitigation measures.
As of July 22, 16 months into the pandemic, 35% of counties in the U.S. were experiencing high levels of community transmission of COVID-19, according to the Centers for Disease Control and Prevention (the numbers are rising as we speak, to 46%), and case reports were increasing in nearly 90% of jurisdictions. At this point, it’s all the work of Delta and other Greek-letter variants, the original version of the SARS-CoV-2 virus nowhere to be found in the latest round of genomic sequencing.
As COVID-19 cases, hospitalizations and deaths rise in hot spots, a number of questions continue to burn:
· With half the country vaccinated and half not, what messages and strategies will move the needle? What questions and concerns about the vaccines – medical, personal, practical, philosophical – need to be understood and addressed?
· Should vaccination be mandatory for healthcare workers? Public employees? College students? Anyone else?
· Will we need booster shots? If so, when and for whom?
· Should we put our masks back on in public? In schools?
We are getting partial answers to these questions every day. As vaccination rates plateau and as Delta presses on, the movement toward mandates is gaining momentum, most notably in healthcare. On Monday, the American Medical Association, American Nurses Association and more than 50 fellow organizations of doctors, nurses, pharmacists and other health professionals joined in a call for mandatory COVID-19 vaccination of their colleagues. The signees included Leading Age, which represents more than 5,000 nonprofit providers of services to the aging, from nursing homes and assisted living facilities to adult day care and independent living communities.
In another group effort, the American Hospital Association and four other hospital organizations issued a statement “strongly urging” vaccination of all healthcare personnel, in order “to protect themselves, their patients and peers.” Alicia Lasek has more on the AHA viewpoint in McKnight’s Long-Term Care News.
Vaccine mandates started with Houston Methodist on March 31 and are gathering steam. Sanford Health, headquartered in Sioux Falls, South Dakota, recently announced its mandate to a workforce of more than 47,000 in 46 hospitals and 200-plus Good Samaritan Society senior care facilities in 26 states and 10 countries. Randy Bury, president and CEO of Good Samaritan, told McKnight’s Kimberly Marselas that the mandate will help rather than hinder employee recruitment.
Meanwhile, two regional systems covering the Southeast and headquartered in North Carolina, Atrium Health (70,000 employees) and Novant Health (35,000 employees), announced vaccination mandates, as did JEA Senior Living, based in Washington state with 40 communities in 18 states.
RWJ Barnabas, one of the largest health systems in New Jersey, fired six supervisory or higher-level employees who declined vaccination and did not obtain an exemption or deferral. Barnabas is now expanding its mandate to all 35,000 employees. More than 1,000 employees of the health system fell ill with COVID-19 last year and nine died. Two other large health networks in New Jersey, Hackensack Meridian Health (35,000 employees) and Virtua Health (14,000 employees) are implementing vaccination mandates with deadlines of November 15 and September 15, respectively.
Now add the Mayo Clinic to that list, with more to follow.
Beyond the realm of healthcare, some municipalities are putting vaccination mandates in place for their workers. California’s Santa Clara County, which headquarters Google, Apple and Facebook along with the campuses of Stanford and San Jose State, will require vaccination for its workforce of 22,000. San Francisco is poised to follow suit for its 35,000 employees once the Food and Drug Administration grants full approval to COVID-19 vaccines currently available under emergency use authorization.
New York City employees – 340,000 of them, including health workers, teachers and police officers – will need to be vaccinated against COVID-19 or agree to weekly testing by September 13, the day schools reopen. The California state government has decided on a similar approach for its employees as well as workers in healthcare and high-risk congregate settings.
Vaccination mandates for schools represent another looming state and local battleground. Requiring COVID-19 vaccination for school attendance is a concept supported by 61.3% of adults (both parents and nonparents), according to the latest survey by the COVID States Project. That figure is up from 54.4% last winter. Mothers are more resistant to the idea than fathers, especially mothers of children 5 and younger.
Those who hesitate are not lost
· The “movable middle” may be shrinking. A solid majority of unvaccinated Americans surveyed in mid-July said they would probably not (35%) or definitely not (45%) get the COVID-19 vaccine. Just 16% said they probably would get vaccinated and only 3% said they definitely would. In the poll, conducted by the Associated Press-NORC Center for Public Affairs Research, nearly two thirds (64%) of the unvaccinated expressed little to no confidence that COVID-19 vaccines are effective against Delta and other variants.
· The New York Times interviewed folks rolling up their sleeves at vaccination sites in eight states last week, and explored why they waited and what convinced them to step forward. It was not one thing. Rather, it was persuasion, and often pressure, from family and friends; a work requirement; a gradual acceptance of the vaccine’s safety’ a $150 gift card; or a suddenly short waiting line.
· Pulitzer Prize winner Ed Yong, in his latest essay for The Atlantic, says that “America is Getting Unvaccinated People All Wrong” and that “they’re not all anti-vaxxers and treating them as such is making things worse.”
· Yong interviewed Rhea Boyd, a pediatrician and public health advocate in the San Francisco Bay Area who has helped create a forum for Black and Latino health workers to provide information and dispel misinformation about COVID-19 vaccines. According to Boyd, “A lot of vaccine information isn’t common knowledge. Not everyone has access to Google…The information gap is driving the vaccination gap… Black folks are one of the least vaccinated groups, in part because they have the least access to preventive healthcare services.”
· Recognizing a gap in information and access, the Department of Health and Human services is channeling another $100 million to nearly 2,000 rural health clinics for vaccination “confidence and outreach” efforts. It’s also guiding $121 million to community-based organizations in underserved areas for “trusted messenger” work.
· Vaccine hesitancy remains an issue for home health workers, predominantly among home health aides but also nurses and therapists, Diane Eastabrook notes in McKnight’s Home Care Daily. William Dombi, president of the National Association for Home Care & Hospice, calls for more peer-to-peer education, adding that some patients are asking agencies to send only vaccinated workers into their homes.
· However, two national home care organizations, including Dombi’s group and the Home Care Association of America, did not sign on to the letter from 50-plus health associations calling for mandatory vaccination.
· The CDC is investigating unvaccinated nursing home staff as a possible source of breakthrough cases of COVID-19 in Colorado, Kimberly Marselas reports in McKnight’s Long-Term Care News.
A carrot attached to a stick
· Incentives are not mandates, but some are more pointed than others. The National Football League has announced that if an outbreak of COVID-19 occurs among unvaccinated players of a team, and a game can’t be played that week or rescheduled within the 18-game season. the team with the outbreak will forfeit and take a loss. And players for both teams won’t get paid.
· The Lollapalooza festival in Chicago’s Grant Park, running from Thursday through Sunday, will require attendees to show proof of vaccination or a recent (within 72 hours) negative test for SARS-CoV-2. The unvaccinated are asked to wear masks and socially distance themselves from people not in their group. Good luck with that: Attendance for the four-day event typically reaches 100,000 a day.
· Starting August 6, Italy will require a “green pass” for admission to restaurants, gyms, museums, movie theaters and other venues. People qualify for a green pass if they can document at least one vaccine dose within the past nine months, have recovered from the disease in the past six months or tested negative in the past 48 hours. The French have taken a similar approach.
Boosters for the immunocompromised?
· The CDC’s Advisory Committee on Immunization Practices reviewed the evidence for COVID-19 boosters in immunocompromised people but did not take a vote at its meeting last Thursday. Formal action will be forthcoming.
· The immunocompromised represent 2.7% of U.S. adults and include people with cancer, recipients of solid organ or stem cell transplants, people living with HIV and patients taking immunosuppressant drugs for chronic conditions such as bowel disease.
· Immunocompromised individuals are more likely to get severely ill from COVID-19, transmit the virus to household contacts, and experience breakthrough infections after vaccination. They also have a less robust response to COVID-19 vaccination than healthy people do.
· Emerging data suggest that a third dose of vaccine in immunocompromised patients would increase the proportion who mount a measurable antibody response and enhance suboptimal responses to a two-dose vaccine regimen.
Mask on, mask off?
· The CDC has revised its mask advice yet again and recommends that everyone, including the fully vaccinated, wear masks indoors when in “an area of substantial or high transmission.” That currently describes about 63% of U.S. counties (46% high transmission, 17% substantial).
· A number of local governments (Seattle, Los Angeles, St. Louis and Provincetown, Massachusetts, among others) have already reinstated mask mandates. The Attorney General of Missouri is already suing St. Louis to contest the mandate.
· Looking ahead to the fast-approaching school year, the CDC is now on the same page with the American Academy of Pediatrics in calling for masks for students, teachers and staff, regardless of vaccination status.
· As with all things pandemic, best to check your local listings and listen carefully, as our options have changed. Prior to the CDC announcement, Virginia state departments of health and education were advocating masks for everyone in elementary school, but only for the unvaccinated in middle and high school.
· Stir into this mix the fact that several states have executive or legislative bans or restrictions on local and school mask mandates, including Arizona, Arkansas, Florida, Iowa, Montana, South Carolina, Tennessee, Texas and Utah.
The communications effort
· The best answer to health misinformation on social media might be more information, provided by a medical community willing to engage and educate audiences on these channels. That’s the argument advanced in STAT by Victor Agbafe and Prerak Juthani.
· It’s time public health had a Wikipedia of its own to counter misinformation, Renee DiResta, technical research manager at the Stanford Internet Observatory, writes in Government Executive.
· Alabama Governor Kay Ivey says it’s time to blame the unvaccinated for the state of things, though others take a more empathetic view and emphasize that it’s not about blaming and shaming but protection from infection. That includes protection of the quarterback: The University of Alabama’s national champion football team is “pretty close to 90%” vaccinated in a state where less than half the population can say the same.
Getting back to normal
· PR and creative agencies are treading lightly in bringing people back to the office, Sabrina Sanchez reports in PRWeek. Most are adopting hybrid policies that require showing up at the office two to three days a week. Stephanie Nerlich, CEO of Havas Creative North America, says that “although we’ve proven that we can deliver great creativity apart; magic happens when we are together.”
· PRWeek’s Aleda Stam speaks with Leah Chandler, CMO of the nonprofit Discover Puerto Rico, about sustaining interest in tourism throughout a pandemic. Chandler and team worked with Ketchum and R&R Partners on ad campaigns to convey important safety information and manage expectations regarding current and future travel to the island.
· In one variation on an emerging theme, AbbVie brought workers back to its Chicago area offices this month with different rules for the vaccinated (no masks, no distancing) and unvaccinated (masks, distancing, weekly testing).
The vaccine dashboard
· At the request of the FDA,Pfizer/BioNTech and Moderna are expanding the scope of their vaccine clinical trials in children ages 5 to 11 in order to obtain more safety data.
· A committee of the European Medicines Agency has recommended approval of Moderna’s COVID-19 vaccine (known overseas as Spikevax) for youngsters 12 to 17. Moderna is awaiting an FDA green light in the US for that age group.
· The EMA has also initiated a rolling review of the COVID-19 vaccine candidate developed by Sanofi in partnership with GSK.
· England plans to begin vaccinating youngsters ages 12 to 15 no later than August 23, but only those regarded as “vulnerable,” Nick Bostock reports in GP. That group includes children with neurologic disabilities, immunosuppression, Down syndrome or multiple or severe learning disabilities.
· At its recent meeting, the ACIP reviewed data on the occurrence of Guillain-Barre syndrome in people who have received the J&J vaccine and concluded that the benefits of vaccination continue to outweigh the risks. A warning has been added to the provider and patient fact sheets and the occurrence of GBS in vaccinated patients will be closely monitored through various safety databases..
A research consortium working with the CDC sees the current resurgence in the U.S. continuing until mid-October, complicating the return to work and school. Such statistical projections will be influenced by what happens in real life. Will the vaccine rollout regain its mojo? Will masking and distancing make a wholesale return? What new variants will emerge?
In real life, an estimated 2 million children worldwide have lost a parent or grandparent caretaker to COVID-19, according to researchers at Imperial College London. Parents have also lost children. In Baton Rouge, Betty Antoine organized a vaccine drive at the funeral of her 46-year-old son who died of COVID, and encouraged all mourners to receive their shots.
“Anyone who thinks the pandemic is over because it’s over where they live is living in a fool’s paradise.” – Tedros Adhanom Ghebreyesus, Director-General, World Health Organization, speaking in Tokyo prior to the Olympics
… and some songs
Many thanks as always for joining us in these ever-changing times. See you back here next week. Stay well.