The Vaccine Project Newsletter: At ease, at last? Not so fast

This week’s Haymarket Media Vaccine Project Newsletter is 2,420 words and will take eight minutes to read.

(Credit: Getty Images)

The White House has hit the reset button on the nation’s pandemic response, just when many Americans are fast-forwarding into a newly reshaped version of the life they have missed for the past two years.

Few will take the time to read the 97-page National COVID-19 Preparedness Plan – or even its Cliff’s Notes version – released the day after the State of the Union address. The plan is, in fact, an effort to pave the way to a place where COVID-19 exists among us but doesn’t rule with fear and intimidation. The mantra: “We are no longer going to let COVID-19 dictate how we live.”

The four pillars of the plan are to protect against and treat COVID-19, prepare for new variants of the virus, keep businesses and schools open, and continue to vaccinate the world. 

Not everyone is ready to rush ahead to Normalville, however. Various public opinion polls reflect a desire to proceed with caution – is there an app for that? – and a belief that at least some protective measures need to stay in place.

A quarter of the nation remains unvaccinated, including 18 million children under 5 years of age for whom no vaccine is available. Millions of other Americans are vulnerable to the SARS-CoV-2 virus because of advanced age, weakened immune status or chronic health conditions.

It’s worth noting yet again: The protection that vaccination affords against severe disease, hospitalization and death remains compelling. Among adults, for example, rates of COVID-19 hospitalization were seven times higher for the unvaccinated in January, according to the Centers for Disease Control and Prevention.

Fifteen months after the first shot went into the first arms, here’s where we stand:

254 million people in the U.S. have received at least one COVID-19 shot, representing 76.6% of the country’s population and 81.4% of the vaccine-eligible age 5 and up.

• 216 million are fully vaccinated (without boosters). That’s 65.1% of the population and 69.3% of the vaccine-eligible.

• 95 million have had a booster, including 47.5% of fully vaccinated adults. Another 87 million are booster-eligible, including 7 million adolescents ages 12 to 17.

• The pace of vaccination is slowing. The 7-day average of daily vaccinations was 168,000 on March 2, a 47% drop from the week before. Still, 168,000 shots in arms is like vaccinating Fort Lauderdale in a day. Picture it.

Speaking of Fort Lauderdale, we’re ready for a spring break from the virus but differ on how to get there. A Washington Post/ABC poll revealed that 58% of Americans believe it’s more important to control the virus, even if it means restricting some activities. Compare that with the 38% who feel it’s more important to have no restrictions, even if that hinders efforts to stop the spread.

It’s a partisan matter. Among Democrats, 84% vote for some restrictions and just 14% favor removing them. For Republicans, it’s 32% preferring restrictions and 64% wanting to ditch them. Overall, 56% have mostly or completely returned to living the way they did pre-pandemic: 63% of Republicans, 58% of Independents and 44% of Democrats.

This week’s countdown seeks common ground, a modest parcel of terra firma.

10.  Winding it down without winding it up

Hackensack Meridian Health, New Jersey’s largest health network, took out a full-page newspaper ad to announce the shutdown of its vaccination megasite and to thank the community for its efforts in fighting the pandemic. Governor Phil Murphy lifted the state of emergency on March 4, two years to the day after New Jersey’s first recorded case of COVID-19. Before doing so, he asked for a moment of silence for the 30,000 residents who have succumbed to the virus.

Indiana also ended its two-year state of emergency while retaining certain elements, such as allowing children under 12 to receive COVID-19 vaccine outside a doctor’s office. The legislation also requires employers to grant exemptions from vaccination to workers who have “natural immunity,” evidenced by a positive antibody test within the past three months.

Emergency orders are still in place in more than 20 states, but most are set to expire in March or April.

While long lines of cars at megasites are a relic of what seems like the Jurassic period of the pandemic, the numbers of vaccinated have in fact nudged forward since January – just enough to move the partially vaccinated from 78% to 81% of the vaccine-eligible and the fully vaccinated from 66% to 69%. It may not seem like much, but it represents some 9 million people who rang in the new year unvaccinated and have since rolled up their sleeves.

Even so, about one in six folks surveyed in February by the Kaiser Family Foundation continue to say they definitely will not get vaccinated. That number has hovered between 13% and 16% ever since December 2020.

9. Keepin’ it country?

COVID-19 vaccination rates are significantly lower in rural counties than in urban ones and the gap is acres wide, the CDC reports. Coverage with the first dose was 75.4% in urban counties but just 58.5% in rural counties at the end of January. The gap has more than doubled since April 2021.

COVID-19 cases and deaths are higher in rural areas, a trend that has persisted throughout the Delta and Omicron invasions of our countrysides and cityscapes. A number of factors are at work.

One, access to health care may be a challenge in rural areas. Two, hesitancy for all types of routinely recommended vaccines has historically been higher in rural America. In addition, as the Kaiser Family Foundation reports, 35% of parents in rural areas say their healthcare provider did not recommend COVID-19 vaccine for their 5- to 11-year-old children. Only 8% of parents in urban communities had the same experience.

8. Seeking info on misinfo

The U.S. Surgeon General and the Department of Health and Human Services are asking for research, data and personal experiences on the impact of health misinformation. “The speed, scale and sophistication with which misinformation has been spread during the COVD-19 pandemic has been unprecedented,” the request for information states.

Federal health officials are trying to understand how misinformation, especially in the digital realm, has undermined trust in the healthcare system and affected the morale and safety of healthcare workers. On the positive side, they want to know how access to trusted and credible information during a public health emergency can influence life-saving decisions.

A campaign using social media to deliver a pro-vaccine message is the winner of the gold award in the Young Spikes Digital Competition sponsored by Gavi, the Vaccine Alliance. As Jessica Goodfellow reports in Campaign, Shin Nakamura and Ayane Arita used artificial intelligence to create a video of someone who died of COVID-19 (with the family’s permission), asking young people to rethink their reasons not to receive the vaccine.

7. Baseball is on hold but political football is always in season

We may live in green, yellow or orange counties, based on the CDC’s new color-coded map of COVID-19 activity. But we still live in red and blue states, where policies flow from the dictates of government officials. Check your local listings for the latest on masks, vaccines and the vanishing art of social distancing.

The Surgeon General of Florida says the state will be the first to recommend that healthy children not get vaccinated against COVID-19. That flies in direct opposition to the recommendations of the CDC and American Academy of Pediatrics.

Nationally, disagreements on public health policy are endemic. Senate Republicans voted to end the nation’s official state of emergency, but President Biden says he’ll veto the measure if it reaches his desk. Senate Republicans also voted to end the federal mandate for healthcare workers. As Danielle Brown explains in McKnight’s Long-Term Care News, that mandate will remain in place barring a rare convergence of minds in the legislative, executive and judicial branches of our government. 

6. The youngest kids are on hold as well

A COVID-19 vaccine for children under 5 is still weeks if not months away. Pfizer/BioNTech are periodically submitting clinical trial data to the Food and Drug Administration on the first two doses. A three-dose primary series will likely be needed to provide optimal protection; three-dose data should be in hand by early April.

As for the eventual administration of those vaccines, the Kaiser Family Foundation’s February survey finds that just one in five parents of kids under 5 intend to have their child vaccinated as soon as a product is available. A majority (57%) feel they don’t have enough information, while 39% say the messages from federal health authorities are just plain confusing.

5. Healthcare workers have never been on hold

The Dr. Lorna Breen Health Care Provider Protection Act, a piece of legislation that folks on both sides of the aisle could agree on, has cleared both houses of Congress.

Dr. Breen was an emergency room director in New York City who died by suicide at the age of 49 in the early days of the pandemic. She was on the front lines of care, fell ill with COVID-19 herself, then returned to work to face the daily onslaught of suffering and death.

“Lorna thought she was going to lose her license to practice medicine in New York because she got mental health treatment one time in her life,” her brother-in-law, Corey Feist, told the Washington Post. Feist and his wife Jennifer, Lorna’s sister, founded the Dr. Lorna Breen Heroes’ Foundation. They gathered heartfelt stories and support from healthcare workers across the country, and teamed with key players in Congress to craft the legislation.

The initiative, designed to remove the stigma that keeps health professionals from seeking help, calls for federal grants to hospitals, medical professional associations and other groups that promote mental health and resiliency. The American Rescue Plan already includes millions of dollars for the Breen programs.

4. Motivate to vaccinate

We’ve been there and done that with million-dollar vaccine lotteries to boost vaccination rates. Results tended toward “meh.”

Another approach is to incentivize the vaccinator. In North Carolina, providers can bill the state Medicaid program for counseling patients (and parents of Medicaid children) about the benefits of getting vaccinated against COVID-19. Conversations of up to 15 minutes qualify as preventive medicine counseling or risk factor reduction intervention.

The policy went into effect last June and has been extended at least through March. Counseling can be provided in person, on the phone or via the wonders of telehealth.

3. “One-stop test to treat” is not so simple

The new pandemic plan includes setting up “one-stop test to treat” clinics in local pharmacies, community health centers, long-term care facilities and Veterans Affairs centers nationwide. Here’s how it works, in theory: Get tested for SARS-CoV-2. Receive immediate results. If the results are positive, go home with antiviral medication.

The San Francisco Chronicle reports that some doctors, pharmacies and long-term care facilities in the Bay Area have been operating this way for a few months, although their efforts have been hampered at times by a short supply of pills. Another important consideration: Assessing drug interactions with other medications the patient is taking.

The American Medical Association made it clear that it was not thrilled with the pharmacy-based clinic component of the program, saying it “oversimplifies challenging prescribing decisions” and “flaunts patient safety and risks significant negative health outcomes.” The AMA wants patients who test positive for SARS-CoV-2 to turn to their doctor to discuss treatment options, based on their known medical history. “COVID-19 is not strep throat,” the AMA notes.

The American Pharmacists Association thinks the program is just fine but is “narrow” and should expand to include every “willing and able” pharmacy in the country.

2. It’s a global pandemic, after all

The U.S. has donated 475 million doses of COVID-19 vaccine to 112 countries, a down payment on an eventual transfer of 1.2 billion doses. We’re not the only generous ones. The European Union has donated more than 300 million doses and nearly 20 other countries have pitched in, according to Our World in Data.

Tedros Adhanom Ghebreyesus, WHO’s director general, says, “The only sustainable way out of the acute phase of the pandemic is to reach high vaccine coverage in all countries. In low-income countries, only 9% of the population has been immunized.”

1. Will the new normal include a return to civility?

Shouting matches at school board meetings. Unruly passengers in the unfriendly skies. Healthcare workers threatened by patients and families. The pandemic has brought out the best and worst in us.

In the U.K., 12% of 3,500 retail workers surveyed said they were physically assaulted on the job in 2021; 64% were threatened by a customer and 90% experienced verbal abuse, Francis Churchill reports in People Management. COVID restrictions triggered half of the incidents of violence and abuse, while masks figured in 18% of them.

The caustic sting of contention need not poison our interactions with one another. That’s something to keep in mind as battles over school vaccination policies loom on the immediate horizon.

Parting shot

COVID-19 cases in the US are down to 40,000 a day, “down” being a relative term in this instance. Deaths are also down to 1,200 a day, half the level of a month ago.

Lest we numb ourselves to the numbers, scientists remind us that this level of mortality is “intolerable” in comparison to the toll typically taken by seasonal respiratory viruses. A group of two dozen doctors and public health experts issued its own 136-page roadmap for living with COVID and warned against “premature triumphalism,” a.k.a. celebrating too soon.

The tools at our disposal – vaccines, tests and treatments, and the masks we keep in a back pocket – are meant to serve as our own surge protectors against future mayhem. The White House plan includes a “surge response playbook” for quickly setting up mass vaccination and testing sites, deploying medical and emergency personnel, and expanding hospital capacity to meet sudden demand.

Let’s hope we don’t need it.

…and some songs

Everybody Wants to Rule the World, Tears for Fears

Easy to Be Hard, Three Dog Night

Easy, The Commodores

Almost Paradise, Mike Reno and Ann Wilson

That’s (almost) a wrap. See you back next week for our last hurrah: The final edition of the Haymarket Media Vaccine Project Newsletter. Thanks!

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