The uninvited guest rudely crashing our Thanksgiving festivities was Omicron, the fifteenth letter of the Greek alphabet and now the fifth SARS CoV-2 variant to acquire the World Health Organization status of “variant of concern.” According to the WHO, omicron “has a large number of mutations, some of which are concerning.”
As with its predecessors, this variant will need to come under the microscope. Once again, we must answer two highly pertinent questions: How dangerous is it, and how well do vaccines protect against it? Those are our pandemic versions of the classic Watergate questions: What did the President know and when did he know it?
Once again the race is on, with vaccines pitted against variants. Here’s where we stand, now that more than 232 million people have received at least one dose of COVID-19 vaccine. That sum represents:
• 70.2% of the country’s entire population.
• 74.7% of everyone 5 and older.
• 80.8% of everyone 12 and older.
• 82.7% of adults.
• And (still at the head of the class) 99.9% of seniors 65+.
Overall, 197 million Americans are fully vaccinated (69.4% of everyone 12 and older, 71.1% of adults and 86.3% of seniors). More than 41 million have received a COVID-19 booster (22% of adults and 44% of seniors).
Meanwhile, vaccine manufacturers are busily retooling their booster efforts to address the latest threat. Moderna’s strategies include testing a higher dose of its current booster and fast-tracking an Omicron-specific booster; Diana Ernst has details in MPR. Meanwhile, Pfizer/BioNTech and J&J are pursuing their own pathways of investigation and discovery.
In the meantime, the Centers for Disease Control and Prevention has expanded its booster recommendations to include all adults, noting that early data on Omicron suggest increased transmissibility. Pfizer is expected to seek booster approval for 16- and 17-year-olds as well.
CDC Director Dr. Rochelle Walensky added this: “I strongly encourage the 47 million adults who are not yet vaccinated to get vaccinated as soon as possible and to vaccinate the children and teens in their families as well because strong immunity will likely prevent serious illness.” She also urged people who are sick to get tested for COVID-19, which will enable them to navigate their own health status while helping authorities quickly track the spread of the new variant.
The U.S. has restricted travel from southern Africa, where Omicron was first reported. Other nations have imposed similar restrictions.
New York Governor Kathy Hochul declared a state of emergency and issued an executive order designed to increase hospital capacity in anticipation of possible spikes in disease activity. Though no cases of Omicron had been reported in the state as of Wednesday morning, the Governor said, “It’s coming.” No one challenged her on this prediction.
The CDC currently lists only one variant of concern, Delta, in the U.S. So far, no variant has risen to the most ominous category – “variant of high consequence,” which poses unique challenges to the effectiveness of vaccines or any medical countermeasures.
The emergence of a new and potentially troublesome variant underscores the message that public health authorities have been trying to communicate all along: That vaccination is a global effort and that no one is safe until everyone is safe. President Biden on Monday described the latest developments as a cause for concern but not a cause for panic; he promised to detail further strategies this week.
As we have been obliged to say so many other times in the course of this nearly two-year pandemic, stay tuned. It will take a couple of weeks for scientists to sort and sift the data on Omicron to assess what is going on and what it all means.
In the meantime, the vaccination campaign soldiers on, with a renewed call to arms and a fresh sense of urgency.
Vaccinating the children
• One in four parents with kids ages 5 to 11 are not certain about having their children vaccinated against COVID-19, according to research by Civis Analytics on behalf of Made to Save and the de Beaumont Foundation. Intent to vaccinate 5- to 11-year-olds was strongest among Asian parents (58%), followed by 49% of white parents and 48% of Black parents. Just 27% of Hispanic or Latino parents planned to have their young children vaccinated, while 44% were undecided.
• The most effective communications with parents, the research found, focused on three messages. One, preserving health: COVID-19 is one of the top 10 causes of death among children. Two, protecting the community: Vaccinating children will help protect family and friends, especially those at high risk. And three, having fun: Being vaccinated will help kids be kids, safely taking part in the activities they enjoy.
• Based on these findings, the Public Health Communications Collaborative has developed a two-page handout on Talking to Parents about COVID-19 Vaccines for Children.
• As for 12- to 17-year-olds, 60% have received at least one shot and 50% are fully vaccinated, the American Academy of Pediatrics reports. The comparable figures for adults, who had a five-month head start on adolescents 15 and younger, are 82% and 71%, respectively.
• The National Institutes of Health has launched a study tracking the impact of COVID-19 on the physical and mental health of up to 1,000 children and young adults over a three-year period. The study will also try to identify risk factors for complications and genetic factors that could affect the response to infection.
• The WHO has mixed feelings about vaccinating children and adolescents. The agency acknowledges the importance of protecting the youngest against disease while curbing transmission across generations and minimizing school disruptions. At the same time, in the interest of global equity, “Countries that have achieved high vaccine coverage in their high-risk populations should prioritize global sharing of COVID-19 vaccines… before proceeding to vaccination of children and adolescents who are at low risk for severe disease.”
Getting it done
• Would Tennesseans rather karaoke Dolly Parton or Kenny Rogers? Whatever their preferences and differences, they need not be islands in the stream but can agree on getting back to doing the things they miss most. Finding that middle ground – through vaccination, naturally – is the theme of a new set of Ad Council PSAs focusing on states with low vaccination rates. Eric Berger explains it all in PRWeek.
• A COVID-19 vaccination mandate for federal workers has not disrupted the workings of the government, the White House reports. As of Thanksgiving, 92% of the 3.5 million strong federal workforce had received at least one shot, including 97.8% in the Agency for International Development, 96.4% in the Department of Health and Human Services and 96.1% at the State Department.
• The definition of “fully vaccinated” may change to include boosters, Kimberly Marselas reports in McKnight’s Long-Term Care News, but for now the term still refers to the primary vaccination series (two shots of Moderna or Pfizer/BioNTech, one of J&J).
• Connecticut has issued fines totaling $19 million to more than 100 long-term care operators for failing to comply with a state COVID-19 vaccination mandate for staff, Kimberly Bonvissuto reports in McKnight’s Senior Living. Most of the fines involve late reporting or non-reporting of required vaccination data.
• In Los Angeles, an ordinance requiring proof of vaccination for patrons of restaurants, bars, theaters, gyms, nail salons and other public venues went into effect November 4. This past Monday was the first day of enforcement.
• LA municipal employees have until December 18 to comply with a COVID-19 vaccination mandate. A city firefighter is on paid administrative leave following a report that he used a vaccination mandate letter as toilet paper.
Bouncing around in the courts (not basketball)
• Federal judges have blocked the COVID-19 vaccination mandate for healthcare workers, James M. Berklan and Danielle Brown have details in McKnight’s Long-Term Care News. The mandate, set by the Centers for Medicare & Medicaid Services, had a deadline of January 4 for full vaccination, with the first shot due by December 6.
• U.S. Supreme Court Justice Stephen Breyer rejected an attempt to block enforcement of an employee COVID-19 vaccination mandate at Mass General Brigham, the largest hospital system in Massachusetts. MGB fired 430 employees for failing to comply with the mandate, the Boston Globe reports, while more than 80,000 complied.
• OSHA’s vaccination and testing rule for businesses with 100 or more employees is hung up in federal court, Kathleen Steele Gaivin reports in McKnight’s Senior Living. OSHA has now extended the public comment period on the emergency temporary standard from December 6 to January 19.
The vaccine dashboard
• The CDC has added a web page summarizing what’s known about COVID-19 vaccine safety and effectiveness, with links to publications from the past year.
• Team Europe will donate nearly 100 million doses of the J&J vaccine to low-income countries through the COVAX global vaccine initiative. The Team includes the 27-member European Union plus Norway and Iceland.
• Novavax is seeking conditional marketing authorization of its COVID-19 vaccine from the European Medicines Agency. The company has received emergency use authorization for its vaccine in Indonesia and the Philippines. It also has several other applications pending around the world, with plans to file with the FDA before the end of the year.
• Afrigen Biologics and Vaccines in Cape Town, South Africa is “racing” to produce a likeness of the Moderna COVID-19 vaccine to help overcome low vaccination rates in Africa (6%) and shortfalls of expected vaccine donations from COVAX.
• As health authorities continue to urge COVID-19 vaccination for pregnant individuals, a recent CDC report covering the period March 2020 through September 2021 finds that stillbirth, although a rare event overall, was more prevalent among the unvaccinated.
• Employers are responding to the Great Resignation, a.k.a. the Great Reckoning, with renewed efforts to retain employees, the Society for Human Resource Management reports. Organizations experiencing high turnover in the past six months are expanding options for remote work and flexible scheduling (42%), adding or improving employee referral incentives (32%) and offering more generous merit bonuses (28%).
• The pandemic has significantly increased the number of people who are trying to hold down a job while caring for a loved one. In the U.K., two thirds of these “working carers” have given up opportunities on the job because of responsibilities at home, Jasmine Urquhart reports in People Management. While a third of the carers said their employers had become more understanding of their situations, 55% felt overwhelmed and 75% were exhausted.
• An FDA advisory committee voted 13-10 to recommend emergency authorization use of molnupiravir, Merck’s pill for treating COVID-19. A Pfizer pill is waiting in the wings.
Omicron is what we call “a developing story.” Come to think of it, isn’t this entire pandemic an endless developing news story? We can look to certain key numbers as though we were performing a diagnostic on our car, and get an idea of where we are on this journey.
How’s the transmission? Well, transmission remains high in 66% of U.S. counties, substantial in 13%, moderate in almost 15% and low in 6%. That’s better than it was a couple of months ago.
The dashboard tells us where we’ve come from but not where we’re going. David O’Connor, professor of pathology and laboratory medicine at the University of Wisconsin-Madison, says that each new infection gives the virus a lottery ticket that can be parlayed into new variants.
As officials worry about a fifth wave of disease this winter, preceded by a cold front of uncertainty, the advice remains pretty much the same: Get vaccinated. Get your booster. Get tested when your situation calls for it. Mask up indoors. And be considerate of others (that one comes from my late parents, survivors of the Great Depression and WWII.)
…and some songs, in tribute to Stephen Sondheim
Welcome to December and thank you for joining us on this bumpy ride. We won’t be merrily rolling along, but we’ll keep moving forward, not into the woods but out of them.