The Vaccine Project Newsletter: Just like starting over?

This week’s Haymarket Media Vaccine Project Newsletter is 2,352 words and will take you seven minutes to read.

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The breaking news over the weekend – outside of Ukraine – was the great unmasking, with the Centers for Disease Control and Prevention announcing new criteria based largely on local hospital numbers as well as new cases of COVID-19. From that perspective, some 70% of the population can now unmask indoors, including in schools, if they haven’t previously done so. Call it the 70% solution, although the numbers reflecting “COVID-19 community level” of low (green), medium (yellow) or high (orange) activity will surely change from week to week.

You might say the CDC is following the math as well as the science and paying close attention to the national CFI (COVID Fatigue Index). Some say the new criteria are more complicated than they need to be – and they would not necessarily be wrong. Across the land, authorities are shedding mask mandates like so many autumn leaves, just as spring approaches. If that sounds out of whack, welcome to the world of coronavirus.

While masks dominate the headlines, key messaging broadcast around the planet since December 2020 should not be lost in the ether: COVID-19 vaccinations save lives. Another key message: The unvaccinated remain at higher risk of COVID-19 complications, hospitalization and death.

People are still being hospitalized and people are still dying, albeit at lower rates. Cases: around 68,000 a day (seven-day moving average), down from more than 10 times as many just a month ago. Deaths: about 1,800 a day, down from 2,600 a month ago. Current hospitalizations: just under 42,000, down from a peak of 146,000 in mid-January.

Some people are even getting vaccinated for the first time, or heading back for their booster shot. Here’s what the dashboard tells us at the beginning of March.

253.6 million people in the U.S. have received at least one COVID-19 shot. That’s 76.4% of the country’s population and 81.2% of the vaccine-eligible age 5 and up.

• 215.7 million are fully vaccinated (sans boosters), representing 65% of the population and 69% of the vaccine-eligible.

• 94.4 million have received a booster, including 47% of fully vaccinated adults. Another 86 million are booster-eligible.

This week’s countdown proceeds with all due caution toward a conclusion.

10. Harbingers of a spring thaw

In announcing its new recommendations, the CDC uttered the words we’ve been waiting to hear: “With current high levels of vaccination and high levels of population immunity both from vaccination and infections, the risk of medically significant disease, hospitalization and death from COVID-19 is greatly reduced for most people.”

The CDC was quick to add that the elderly, the immunocompromised, and people with disabilities continue to be at higher risk for serious illness “and face challenging decisions navigating a world with COVID-19.”

With the caveat in mind, the CDC emphasized yet again: “Vaccines are highly protective against severe disease, and continuing to expand vaccine coverage and ensuring people are up to date with vaccination is essential to protecting individuals against hospitalizations and deaths.”

“Up to date” is just another way of saying “boosters included.”

9. Timing isn’t everything but it is something

In case you missed it, the CDC has also revised its advice on the intervals between first and second COVID-19 shots with the Pfizer/BioNTech or Moderna vaccine. The agency is now saying the interval can be up to eight weeks, rather than three or four weeks, for anyone 12 to 64 years of age, especially guys ages 12 to 39. Possible benefits: one, generating a more robust immune response; and two, reducing the risk of the rare vaccine side effect of heart inflammation in boys and young men.

The originally recommended interval of three to four weeks is still preferred for seniors, moderately to severely immunocompromised individuals and others who need a rapid ramp-up of protection.

8. Masks aren’t disappearing…

• The CDC’s new guidance still recommends masks for people who have COVID-19 symptoms or have tested positive for SARS-CoV-2, as well as those who are exposed to someone with the infection.

• The revised masking recommendations guidance didn’t change the status quo for healthcare settings, Danielle Brown notes in McKnight’s Long-Term Care News. Leaders of nursing homes and senior living facilities want to know what’s next for them. Brown and Lois A. Bowers of McKnight’s Senior Living analyze what the new guidance means.

• The president of the American Medical Association, Dr. Gerald E. Harmon, said, “I personally will continue to wear a mask in most indoor public settings, and I urge all Americans to consider doing the same, especially in places like pharmacies, grocery stores or on public transportation – locations all of us, regardless of vaccination status or risk factors, must visit regularly.” Dr. Harmon, a family physician in Pawleys Island, South Carolina, emphasized the importance of protecting the millions who remain vulnerable to COVID-19 because they are immunocompromised or too young to be vaccinated.

• Unions of flight attendants are urging an extension of the federal mask mandate, due to expire on March 18, for people traveling on commercial airlines and other forms of public transportation.

• Individual comfort levels may not be rising at the same rate mask mandates are falling. As the CDC notes, “People may choose to mask at any time.” The text I received from the cardiologist’s office compelled me to wear a mask to this week’s visit and to answer the usual litany of COVID risk questions.

7. …and mandate battles aren’t going away, either

• A coast-to-coast truck convoy protesting vaccination mandates is rolling toward the nation’s capital.

• In off-road action, the New Jersey Hospitals Association asked Governor Phil Murphy for a 90-day extension of a February 28 deadline for booster shots for healthcare workers. New York has already delayed its booster mandate for healthcare employees for three months beyond a February 21 deadline.

• One reason to buy time: Hospitals everywhere are struggling with staffing shortages. The vacancy rate for registered nurses in New Jersey hospitals rose from 8.2% in 2020 to 13.4% in 2021, the NJHA reports.

• Nearly a third of RNs across the country are considering leaving their positions in patient care, according to research firm McKinsey, as Kimberly Marselas notes in McKnight’s Long-Term Care News.

6. Face it: It’s just going to be like this

• The Nebraska legislature passed a measure requiring employers to accept exemptions from vaccination for health or religious reasons. Employers can require the unvaccinated to wear masks or undergo periodic testing, at the boss’s expense.

• Nine states already have laws in place requiring exemptions from vaccine mandates, according to the National Academy for State Health Policy. They are Alabama, Arizona, Arkansas, Florida, Kansas, North Dakota, Texas, Utah, West Virginia,

• Fans of the Chicago Bulls and Blackhawks don’t need to wear masks inside the United Center – but they’ll still need proof of vaccination or a negative test to get in the door, the Chicago Tribune reports.

• Meanwhile, Boston Mayor Michelle Wu lifted the city’s proof-of-vaccination requirement for indoor venues based on three criteria: a community SARS-CoV-2 positivity rate of less than 5%, fewer than 200 hospitalizations for COVID-9 per day and fewer than 95% of ICU beds occupied. The American Academy of Dermatology has now dropped its COVID-19 vaccination requirement for those attending its annual meeting in Boston later this month.

5. COVID-19 vaccines – but wait, there’s more

Sanofi and GSK are ready to submit data for their COVID-19 vaccine to regulatory authorities in the U.S. and Europe. In a collaboration reminiscent of Gimbels and Macy’s (see under: Miracle on 34th Street), the companies announced that “Sanofi provides its recombinant antigen and GSK contributes its pandemic adjuvant, both established vaccine platforms that have proven successful against influenza.”

• Canada is the first country in the world to authorize a plant-based COVID-19 vaccine. It’s a product of Medicago, in partnership with GSK, and will be used in adults ages 18 to 64.

Novavax, awaiting a green light for its COVID-19 vaccine from U.S. authorities, has the go-ahead from Canada and the 27-country European Union.

• Needle-phobic? Researchers are working on COVID-19 vaccines delivered by a skin patch or by nasal spray.

4. Treatments on the near and far horizon

The new era of pandemic vigilance is brought to you by a trifecta – a public health hat trick – of vaccines, tests and treatments. Think about it: Nearly two years ago, when the World Health Organization declared a global pandemic, we had none of the above. All were glimmers that now gleam.

• In MM+M, Marc Iskowitz takes inventory of the current medicine chest of treatments for COVID-19 and details the advantages and drawbacks of each. He also takes a look at five new drugs in development that “could shift the treatment paradigm in the next couple of years as COVID-19 becomes more endemic.”The next-gen therapeutics are coming from companies such as Shionogi, Enanta, Pardes Biosciences, Atea, Aligos, Gilead and Molecular Partners AG/Novartis.

• The FDA has authorized a higher initial dose of the monoclonal antibody combination Evusheld to help fight off Omicron subvariants, Brian Park reports in MPR. The new dose is 300 mg each of tixagevimab and cilgavimab, given in two separate and consecutive injections, up from 150 mg each. Evusheld is authorized for prevention of COVID-19 in people who have medical contraindications to COVID-19 vaccine or cannot mount an adequate immune response to it. Anyone who has received the 150-mg doses should return for another.

• Half of the 500 million free COVID-19 tests are still on the shelf, AP reports. A kit with four tests per household is readily available for the asking at Starting next week, each household will be able to place two such orders rather than one.

3. Preventing the next pandemic

A tree grows in Brooklyn, pigs can sometimes fly and bipartisanship is not yet dead in Washington. Senator Patty Murray (from the blue state of Washington) and Senator Richard Burr (from the red state of North Carolina) are co-sponsors of a bill to help prevent the next pandemic while critiquing our response to the current one.

The legislation is called The PREVENT Pandemics Act, the acronym standing for Prepare for and Respond to Existing Viruses and Emerging New Threats. Murray is chair and Burr is ranking member of the Senate Health, Education, Labor and Pensions Committee, with the appropriate acronym of HELP.

The legislation would set up a 9/11-style commission, coordinate pandemic preparedness and response among multiple agencies and keep a tight leash on the CDC, requiring Senate confirmation of the director and a four-year strategic plan vetted by a government watchdog. “The American people have stopped listening to the CDC because of their confusing and conflicting guidance,” said Burr.

2. Vaccine effort winding down? The work is not done

• Across the country, vaccine sites have gone relatively quiet. In Paterson, New Jersey, a mobile van delivering COVID-19 shots and tests is no longer operating on weeknights, only on Saturdays.

• “We will never give up on vaccinating more Americans,” President Biden asserted in his State of the Union message last night.

• Evidence of such: Away from the limelight, Health and Human Services Secretary Xavier Becerra went to Florida recently to promote vaccination, support frontline workers in Jacksonville and host a roundtable with Black Men Engaged, a grassroots organization working to increase vaccine confidence and uptake.

• Another challenge: Kaiser Health News reports that rates of vaccination in Medicaid enrollees are lower than for the general population despite “vigorous outreach” efforts by the government and private organizations. National data are not available, but figures from California, Ohio, Virginia, Washington and Utah show a similar pattern

• “This is a slow slog,” Harley Jones, a senior manager at Project HOPE, told KHN. Jones, helping at free health clinics in Texas, added, “What works is finding the trusted voice for people who is from their community, knows the culture … that one-on-one can take hours or a month to pay off.”

1. The road is long, with many a winding turn

• In an interview with Infectious Disease Advisor’s Devon Cimino, Dr. Erica Johnson takes us along a coronavirus route leading from a busy pandemic highway to a calmer endemic avenue. A return to normal, whatever it may mean, will require vigilance from all, she cautions: “It is ultimately up to us to adopt appropriate control measures quickly when community transmission rates start to rise again.” Dr. Johnson is Chair of the American Board of Internal Medicine’s Infectious Disease Board.

• Dr. Celine Gounder, an infectious disease specialist and epidemiologist in New York, says the toll of COVID-19 can be controlled if we don’t let down our guard when it comes to masking, testing and vaccination. She is not optimistic. People are done with COVID, she writes in STAT, want to get back to normal now and are not inclined to prepare for the future. She characterizes this state of mind as “public health attention deficit disorder.”

• The more things change, the more they stay the same. As MM+M’s Larry Dobrow concludes in describing the “new not-normal”: “We’ve recalibrated our expectations and acknowledged the reality that post-pandemic life might, in many ways, look a lot like pandemic life. Nobody’s waiting for an all-clear siren from COVID central anymore.”

Parting shot

According to Sir Isaac Newton’s first law of motion, objects in motion tend to stay in motion, in a straight line and at a constant speed, unless acted upon by an external force. The pandemic remains in motion although we’re doing our best to slow it down and steer it off course. We stab it with our steely knives but we just can’t kill the beast. Coronavirus is our Hotel California. We can check out anytime we like. But we can never leave.

…and some songs

Already Gone, The Eagles

Hotel California, The Eagles

Starting Over Again, Natalie Cole

(Just Like) Starting Over, John Lennon

Welcome to March. Let us hope there’s not too much more pandemic madness. Be well.

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