New, Omicron-specific booster shots are publicly available for all American adults who’ve been previously vaccinated. This is the first time our shots actually match the dominant coronavirus variant (BA.5), and possibly the last time that the shots will be covered for free by the federal government.
So… why does it feel like almost nobody knows about them? Since the CDC and FDA authorized these shots, I’ve had multiple conversations with friends and acquaintances who had no idea they were eligible for a new booster. My own booster happened in a small, cramped room of a public hospital—a far cry from the mass vaccination sites that New York City has offered in past campaigns.
This week, the Kaiser Family Foundation (KFF) provided some data to back up such anecdotal evidence. According to the September iteration of KFF’s Vaccine Monitor survey, about half of U.S. adults have heard only “a little” or “nothing at all” about the new boosters. That includes more than half of adults who have been previously vaccinated.
Moreover, the KFF survey found that 40% of previously vaccinated adults (who received the full primary series) are “not sure” if the updated booster is recommended for them. Another 11% said the new booster is not recommended for them—which is not true! The CDC has recommended these boosters for everyone who previously got vaccinated.
Booster eligibility knowledge is even lower in certain demographics, KFF found. That includes: 55% of previously vaccinated Black adults and 57% of Hispanic adults don’t know that they’re eligible for boosters. Same thing for 57% of vaccinated adults with less than a college education and 58% of those living in rural areas.
As of September 28, only 7.6 million Americans have received an updated booster shot, the CDC reports.
Overall, the CDC reports that about 7.6 million Americans have received an updated booster shot as of September 28, including 4.9 million who received a Pfizer shot and 2.7 million who received a Moderna shot. This represents less than 4% of all fully vaccinated adults who are eligible for the new boosters. And we don’t have demographic data yet, but I expect the patterns will fall among similar lines to what KFF’s survey found.
“Clear and consistent messaging accompanied by strategies to deliver boosters is needed to narrow these gaps,” said public health expert Anne Sosin, sharing the KFF findings on Twitter. We need big, public campaigns for the new boosters in line with what we got for the original vaccines in 2021—or else the new shots won’t be very helpful in an inevitable fall/winter surge.
This week, the FDA and CDC authorized new booster shots from both Pfizer and Moderna that are tweaked to specifically target Omicron BA.4 and BA.5. The vaccines will start becoming available at pharmacies and doctors’ offices across the country in the coming days.
Much of the media coverage of these new boosters has focused on the fact that they’re the first COVID-19 vaccines derived from a newer variant, as opposed to the original Wuhan strain. BA.5 and BA.4.6, a sublineage of BA.4, are causing almost all COVID-19 cases in the country right now; some experts hope that a booster campaign targeted to these versions of the coronavirus will lead to actual decreases in transmission, not just severe disease.
While this is an important milestone, I’d like to focus on a couple of reasons these shots are notable from a data perspective. First, the Omicron boosters are the first COVID-19 vaccines authorized in the U.S. without data from human trials. During vaccine development, companies typically start with lab studies, then test the vaccine in animal models, then in humans. Because the BA.4/BA.5 shots were designed so recently, Pfizer and Moderna haven’t had time to test them in humans yet.
From a safety and efficacy perspective, this lack of data isn’t a huge concern because the new vaccines are very close to BA.1 versions that have been tested in humans. As Katelyn Jetelina explained in a Your Local Epidemiologist post about the new vaccines:
Literally the difference of a few amino acids—like a few letter edits on a Word document. We aren’t changing the number of words in the paper (like dosage of RNA), or the content of the paper, or the platform (like Word to Excel). Because of the minimal change, we are confident that BA.1 bivalent safety data will accurately reflect BA.5 safety.
Another important piece of context here is that flu vaccines—which are updated each year to reflect currently circulating versions of the virus—are typically not tested in humans before they’re rolled out in annual flu campaigns. So, the new COVID-19 shots are following an existing process; future vaccine adjustments for new variants going forward will likely happen in a similar way.
Second, the Omicron boosters are the first COVID-19 vaccines authorized in the U.S. before they’ve been tested in other countries. For previous booster campaigns, effectiveness data from countries with better-organized health systems that started using new rounds of shots before we did (such as the U.K. and Israel) have been key for U.S. regulators making authorization decisions.
But the BA.4/BA.5 boosters haven’t been rolled out anywhere else yet. Several other countries (the E.U., the U.K., Canada, Switzerland, Australia) have authorized Omicron BA.1 boosters—those that have gone through more clinical testing. The U.S. is the first to try the BA.4/BA.5 option. It will be interesting to see whether there are significant differences in how these countries’ fall booster campaigns mitigate potential surges.
And third, these boosters are likely to be the last COVID-19 vaccines authorized while they’re still covered by federal funding.Recent announcements from officials like Ashish Jha have suggested that, in 2023, the government will stop buying vaccine supplies in large quantities to distribute for free. Instead, COVID-19 vaccines will start to be privately-purchased, health insurance-mediated products like other vaccines.
While some local governments and large health institutions will likely still organize free vaccine distributions for future rounds of shots, the lack of federal supplies will be a major shift. It will make COVID-19 vaccination harder to access, especially among people without health insurance—likely leading to even lower uptake. We need to make this last free booster campaign count.
Going forward, here are a few questions I’ll be tracking as these boosters get rolled out:
How will public health agencies track the effectiveness of these new vaccines? We’ll want to see how the BA.4/BA.5 shots compare to prior boosters at preventing infections, hospitalizations, and deaths. Data on breakthrough cases is already pretty limited in the U.S., so we may have to rely on specific local health departments and health systems that have better infrastructure for this.
What additional boosters might be needed in the future? As we examine how well these Omicron-specific boosters work, we will need to keep track of the potential need for more shots. Will immunocompromised people or older adults need second rounds of Omicron shots, for example?
What new variants will come on the scene? Also impacting the potential need for further vaccine shots: the arrival of new variants, either continued Omicron mutations or something else entirely. Wastewater surveillance may be particularly helpful for variant tracking as PCR testing continues to be less available.
How will the privatization of vaccines impact tracking? If COVID-19 vaccines are no longer purchased and distributed by the federal government after 2022, will this impact the CDC’s ability to track vaccinations? We’re already seeing more vaccine distribution at private pharmacies and doctors’ offices as opposed to publicly-run clinics; I wonder how this trend may continue.
For more information on the new boosters, check out:
KFF updates COVID-19 vaccine monitor: The Kaiser Family Foundation released a new report in its COVID-19 vaccine polling project this week, marking over a year since the U.S.’s vaccine rollout began. Notable updates from this report include: people are worried about Omicron’s impact on the economy and healthcare system, less worried about its impact on them personally; vaccine uptake “inched up in January” with more people getting their first doses; and gaps in booster shot uptake echo early gaps in vaccine uptake, with white Americans getting boosted at higher rates than Black and Hispanic Americans.
New version of the COVID-19 circuit breaker dashboard: A few weeks ago, I shared a dashboard from emergency physician Dr. Jeremy Faust and colleagues that estimates which U.S. states and counties are facing hospitals operating at unsustainable levels. The dashboard has now been updated, with help from Kristen Panthagani, Benjy Renton, Bill Hanage, and others; this new version includes hospital capacity and related metrics over time for states and counties, estimates of open beds, ICU-specific data, and more.
Biobot’s Nationwide Wastewater Monitoring Network: If you’re looking to monitor COVID-19 levels in U.S. wastewater, Biobot’s dashboard is a great source. The wastewater epidemiology company collects samples from water treatment facilities across the country; their dashboard includes both estimates of coronavirus levels in the U.S. overall and estimates for specific counties in which data are collected. The data are available for download on Github. (H/t Data Is Plural.)
Prisoners released in 2020, DOJ: A new report from the U.S. Department of Justice includes data on state and federal prisons during the COVID-19 pandemic. The number of inmates in these facilities declined about 15% from the end of 2019 to the end of 2020, according to this report. A large cause for this decline was overall disruption in the court system, not compassionate releases due to the pandemic: there was a 40% decrease in prison admissions from 2019 to 2020.
Companies requiring COVID-19 vaccinations: ChannelE2E, a news site covering the IT industry, has compiled this comprehensive list of major companies requiring their employees to get vaccinated. The list includes about 50 companies, and is regularly updated with links to news sources discussing policy changes. (H/t Al Tompkins’ COVID-19 newsletter.)
In January, COVAX set a goal that many global health advocates considered modest: delivering 2.3 billion vaccine doses to low- and middle-income countries by the end of 2021. COVAX (or COVID-19 Vaccines Global Access) is an initiative to provide equitable access to vaccines; its leadership includes the United Nations, the World Health Organization (WHO), and other organizations.
Despite COVAX’s broad support, the initiative has revised its vaccine delivery projections down again and again this year. Now, the initiative is saying it’ll deliver just 800 million vaccine doses by the end of 2021, according to the Washington Post, and only about 600 million had been delivered by early December.
Considering that most COVID-19 vaccines are two-dose series—and boosters will likely be necessary to combat Omicron—those doses are just a drop in the bucket. According to Bloomberg’s vaccine tracker: “The least wealthy 52 places have 5.6% of the vaccinations, but 20.5% of the world’s population.”
Why this access gap? Many scientists and advocates in low- and middle-income nations blame vaccine manufacturers and rich countries like the U.S., I found when I reported a story on this topic for Popular Science.
“We basically have artificial scarcity of vaccine doses,” says Robbie Silverman, a vaccine advocate at Oxfam America. The pharmaceutical companies control “where doses are produced, where they’re sold, and at what price.” The world’s vaccine supply is thus limited by contracts signed by a small number of big companies; and many of those contracts, [Fatima Hassan, health advocate from South Africa] says, are kept secret behind non-disclosure agreements.
While rich countries claimed to support COVAX, the Washington Post reports, “they also placed advance orders with vaccine manufacturers before COVAX could raise enough money to do so.” This practice pushed COVAX to the back of the vaccine line—and then, when rich countries decided they needed booster shots, that pushed COVAX to the back of the line again. India’s spring 2021 surge didn’t help either, as the country blocked vaccine supplies produced at the Serum Institute of India from being exported to other nations.
According to Our World in Data, low-income nations have administered about 60 million doses total, while high-income nations have administered more than 300 million booster shots. At times this winter, there were more booster shots administered daily than first and second doses in low-income countries.
Even taking booster shots into consideration, there should be enough vaccine supplies produced by the end of this year to vaccinate 40% of the world’s population by the end of this year, meeting WHO targets, according to STAT News’ Olivia Goldhill. The world is on track to manufacture about 11 billion vaccines in total this year, Goldhill reports, while about 850 million doses are needed to get all countries to a 40% vaccination benchmark.
But again, rich countries pose a problem: the countries currently focused on administering booster shots have stockpiled hundreds of millions of doses, and are unwilling to send their stockpiles abroad. From STAT News:
“That number can be redistributed from what high-income countries expect to have by the end of this year. So it’s not an overall supply challenge,” said [Krishna Udayakumar, founding director of Duke’s Global Health Innovation Center]. “It’s very much an allocation challenge, as well as getting high income countries more and more comfortable that they don’t need to hold on to hundreds of millions of doses, for contingencies.”
The vaccine shortage for low-income countries is less than the surplus vaccines within the G7 countries and the European Union, according to separate analyses from both Duke and Airfinity, a life sciences analytics firm that is tracking vaccine distribution.
While leaders in the U.S., the U.K., and other nations with large stockpiles maintain that they can both administer booster shots at home and send doses for primary series shots abroad, their true priorities are clear. The U.S., for example, has pledged to donate 1.2 billion doses to other countries, but about 320 million—under one-third—of those doses have been shipped out so far.
Another challenge is the type of vaccines being used in wealthy nations, as opposed to low- and middle-income nations. Wealthy nations have been particularly eager to horde Pfizer and Moderna’s vaccines, which are more effective against Omicron and other variants of concern. On the other hand, many low-income nations have relied on Sputnik, CoronaVac, and other vaccines which are less effective.
“We’re now entering an era of second-class vaccines for second-class people,” Peter Maybarduk, director at the DC-based nonprofit Public Citizen, told me in October, discussing these differences in vaccine effectiveness. As Omicron spreads around the world, this concern is only growing.
Wealthy countries have hoarded mRNA vaccines, so we urgently need to learn how well viral vector vaccines, like AZ & Sputnik, and inactivated virus vaccines, like China's CoronaVac, protect against Omicron.
The more the coronavirus spreads across the world, particularly in regions with less immunity from vaccines, the more it can mutate and create new variants. Delta and Omicron provide clear examples, demonstrating the need to vaccinate the world in 2022.
And there are some reasons to hope that this goal may be feasible. COVAX’s global supply forecast shows major jumps in vaccine supplies in the first three months of 2022. At the same time, vaccine companies are increasing their production capacity, and donations from the U.S. and other countries are expected to kick in. In South Africa, an mRNA vaccine hub is working to train African companies to manufacture COVID-19 vaccines similar to Pfizer and Moderna’s, without violating patents.
Still, additional variants—and the need for additional booster shots—could be a major hurdle, as vaccine companies continue to prioritize wealthy nations. These companies continue to refuse to share their intellectual property with other manufacturers, even as they make patents for COVID-19 antiviral drugs widely available. And, once vaccines are delivered, getting them from shipments into arms will be a challenge.
It’s been about a month since the FDA and CDC authorized a version of Pfizer’s vaccine for children ages five to 11. Those kids whose parents immediately took them to get vaccinated are now eligible for their second doses, and will be considered fully vaccinated by Christmas.
Despite widespread availability of the shots, vaccine uptake has varied wildly: the share of children ages five to 11 who have received at least one dose ranges from almost 50% in Vermont—to under 4% in West Virginia. In Idaho, so few children in this age range have received a vaccine dose that the CDC has yet to report a number of children vaccinated.
As you can see from the map (which uses data as of December 9), vaccination rates for kids are falling pretty much along partisan lines, with states in the Northeast and West Coast vaccinating more than those in the South and Midwest. This is unsurprising yet troubling, as the states with lower vaccination rates among kids are also those states with more lax COVID-19 safety measures in schools—suggesting that they’re exactly the kids who could use that protection.
A new report from the Kaiser Family Foundation’s COVID-19 Vaccine Monitor provides context on slowing vaccination rates among children. According to KFF’s polling, three in ten American parents—both of teenagers and younger kids—say they will “definitely not” get their children vaccinated. Concerns about safety and potential long-term side effects abound, even though all data so far have suggested that the vaccines are very safe for children.
While the overall data are troubling, we lack information in one key area: demographic data. Without breakdowns of child vaccination rates by race and ethnicity, it’s difficult to say whether the racial gap in vaccinations that we saw for adults earlier in 2021 has persisted for younger Americans. This data absence makes it difficult for policymakers and health advocates to address the potential need for vaccine messaging tailored to families of color.
Ohio is one of just eight states reporting demographic data for booster shots administered in the state. Screenshot taken on November 7.
It’s now been over a month since the FDA and the CDC authorized third doses of Pfizer’s COVID-19 vaccine for a large swath of the U.S. population, and a couple of weeks since the agencies did the same thing for additional doses of Moderna and Johnson & Johnson’s vaccines. In that time, over 20 million Americans have received their boosters.
This weekend, I set out to see what data are now available on these booster shots. I updated my vaccination data in the U.S. resource page, which includes detailed annotations on every state’s vaccine reporting along with several national and international sources.
The majority of states (and national dashboards) are now including booster shots in their vaccine reporting, I found. But in most cases, the reporting stops at just one statistic: the total number of residents who have received an additional dose. A few states are reporting time series information—i.e. booster shots administered by day—and a few are reporting demographics—i.e. booster shot recipients by age, gender, race, and ethnicity—but these metrics are lacking across most dashboards.
Demographic information, particularly race and ethnicity, should be a priority for booster shot data, as it should be for numerous other COVID-19 metrics. At the beginning of the U.S.’s vaccine rollout, Black and Hispanic/Latino Americans lagged behind white Americans in getting their shots, but limited data hindered the public health system’s ability to respond to this trend. (Now, the trends have evened out somewhat, though Black vaccination rates still lag white rates in some states.)
Will we see the same pattern with booster shots? Considering the immense confusion that has surrounded America’s booster shot rollout in the last couple of months, it would not be surprising if disadvantaged communities are less likely to know about their potential need for a booster, or where and how to get those shots.
But so far, we don’t have enough data to tell us whether this pattern is playing out. The CDC has yet to report booster shot data by race or ethnicity, though the agency is now reporting some figures by age and by state. Note: the CDC still has yet to report detailed vaccination data by race and ethnicity, period; the agency just reports national figures, nothing by state or other smaller geographies.
At the state level, just eight states are reporting booster shots by race and ethnicity. 13 states are reporting some kind of time series (boosters administered by day or week), and three are reporting doses administered by vaccine manufacturer.
Here are all the states that I found reporting booster shot data, with links to their dashboards:
Wyoming: Total boosters and doses administered by manufacturer.
Local reporters: If your state is reporting demographic data, I recommend taking a look at those numbers. How does the population receiving booster shots compare to the overall population of your state, or to the population that’s received one or two doses? And if your state is not reporting demographic data (or any booster data at all), ask your public health department for these numbers!
An excellent article in the Financial Times, published this past Monday, illuminates one major challenge of estimating a vaccine campaign’s success: population data are not always reliable. Health reporter Oliver Barnes and data reporter John Burn-Murdoch explain that, in several countries and smaller regions, inaccurate counts of how many people live in the region have led to vaccination rate estimates that make the area’s vaccine campaign look more successful—or less successful—than it really is.
Why does this happen? It’s actually pretty challenging to get a precise count of how many people live somewhere. Think about the U.S. Census, for example: this program attempts to count every person living in the country, once every ten years. But it may miss people who don’t have a straightforward living situation (like college students, the incarcerated, and people living in shelters); it may have confusing messaging that discourages some people (like undocumented residents) from filling out the necessary form; and some people may simply choose not to give information to the government.
When the Census is inaccurate, the inaccuracies ripple out to different government analyses—including analyses of how many people have been vaccinated. Here’s a quote from the Financial Times article:
“The average person would be surprised that governments don’t know how many people are actually in the country,” said Stian Westlake, chief executive of the UK’s Royal Statistical Society. “But this great unknown can cause a whole host of data glitches, especially when responding to a health emergency.”
The Financial Times provides several examples of these data glitches leading to incorrect vaccination estimates.
In England: Overestimates of the unvaccinated population, based on data from the U.K.’s Health Security Agency, suggest that case rates are lower among unvaccinated Brits than they actually are.
In several EU countries: Underestimates of the senior population lead to vaccination rates inaccurately suggesting that over 100% of certain age groups in Ireland, Portugal, and other countries have received at least one dose of a vaccine.
In Miami, Florida: A number of ZIP codes have senior vaccination rates that appear to be over 100% of seniors, due to retirees (who do not have permanent residence in Florida, and therefore aren’t counted in the state’s population) getting vaccinated in Miami during their winter vacations.
Incorrect vaccination rates can cause issues for public health agencies leading vaccine campaigns, the Financial Times reports. If you think you have vaccinated 100% of seniors in your county due to population underestimates, you likely aren’t looking out for the seniors who in fact remain unvaccinated—leaving those seniors still vulnerable to COVID-19.
At the same time, data glitches can provide fodder for anti-vax groups. “Worst of all, anti-vaxxers and Covid deniers feed on the daylight between reality and the incomplete data we currently have as evidence of a grand conspiracy or bureaucratic incompetence,” Jennifer Nuzzo, epidemiologist Jennifer Nuzzo told the Financial Times.
I recommend reading the Financial Times article in full. But you can also check out this Twitter thread from John Burn-Murdoch for more highlights:
NEW: people obsess over vaccine uptake stats, eagerly comparing one country to others to see which has jabbed the highest share of its population, but what if I told you many — perhaps most — of those stats are wrong?
Time for a thread on bad Covid data and how it can cost lives
The Delta surge is waning. Will this be the last big surge in the U.S., or will we see more? This question and more, answered below; chart from the CDC.
Last week, I asked readers to fill out a survey designed to help me reflect on the COVID-19 Data Dispatch’s future. Though the Delta surge—and the pandemic as a whole—is far from over, I’m considering how this publication may evolve in a “post-COVID” era. Specifically, I’m thinking about how to continue serving readers and other journalists as we prepare for future public health crises.
Thank you to everyone who’s filled out the survey so far! I really appreciate all of your feedback. If you haven’t filled it out yet, you can do so here.
Besides some broader questions about the CDD’s format and topics we may explore in the future, the survey asked readers to submit questions that they have about COVID-19 in the U.S. right now. In the absence of other major headlines this week, I’m devoting this week’s issue to answering a few of those questions.
Should I get a booster shot? If so, should it be a different one from the first vaccine I got? When will my kids (5-11) likely be eligible?
I am not a doctor, and I’m definitely not qualified to give medical advice. So, the main thing I will say here is: identify a doctor that you trust, and talk to them about booster shots. I understand that a lot of Americans don’t have a primary care provider or other ways to easily access medical advice, though, so I will offer some more thoughts here.
As I wrote last week, we do not have a lot of data on who’s most vulnerable to breakthrough COVID-19 cases. We do know that seniors are more vulnerable—this is one point where most experts agree. We know that adults with the same health conditions that make them more likely to have a severe COVID-19 case without a vaccine (autoimmune conditions, diabetes, kidney disease, etc.) are also more vulnerable to breakthrough cases, though we don’t have as much data here. And we know that vaccinated adults working in higher-risk locations like hospitals, nursing homes, and prisons are more likely to encounter the coronavirus, even if they may not necessarily be more likely to have a severe breakthrough case.
The FDA and CDC’s booster shot guidance is intentionally broad, allowing many Americans to receive a booster even if it is not necessarily needed. So, consider: what benefits would a booster shot bring you? Are you a senior or someone with a health condition that makes you more likely to have a severe COVID-19 case? Do you want to protect the people you work or live with from potentially encountering the coronavirus?
If you answered “yes” to one of those questions, a booster shot may make sense for you. And, while you may be angry about global vaccine inequity, one individual refusal of a booster shot would not have a significant impact on the situation. Rather, many vaccine doses in the U.S. may go to waste if not used for boosters. But again: talk to your doctor, if you’re able to, about this decision.
Currently, Pfizer booster shots are available for people who previously got vaccinated with Pfizer. The FDA’s vaccine advisory committee is meeting soon to discuss Moderna and Johnson & Johnson boosters: they’ll discuss Moderna on October 14 and J&J on October 15. Vaccine approval in the U.S. depends upon data submission from vaccine manufacturers—and vaccine manufacturers have not been studying mix-and-match booster regimens—so coming approvals will likely require Americans to get a booster of the same vaccine that they received initially. We will likely see more discussion of mix-and-match vaccinations in the future, though, as more outside studies are completed.
As for when your kids will likely be eligible: FDA’s advisory committee is meeting to discuss Pfizer shots for kids ages 5 through 11 on October 26. If that meeting—and a subsequent CDC meeting—goes well, kids may be able to get vaccinated within a week of that meeting. (Potentially even on Halloween!)
Why don’t people get vaccinated and how can we make them?
I got a couple of questions along these lines, asking about vaccination motivations. To answer, I’m turning to KFF’s COVID-19 Vaccine Monitor, a source of survey data on vaccination that I (and many other journalists) have relied on since early 2021.
KFF released the latest round of data from its vaccine monitor this week. Here are a few key takeaways:
The racial gap in vaccinations appears to be closing. KFF found that 71% of white adults have been vaccinated, compared to 70% of Black adults and 73% of Hispanic adults. Data from the CDC and Bloomberg (compiling data from states) similarly show this gap closing, though some parts of the country are more equitably vaccinated than others.
A massive partisan gap in vaccinations remains. According to KFF, 90% of Democrats are vaccinated compared to just 58% of Republicans. This demonstrates the pervasiveness of anti-vaccine misinformation and political rhetoric among conservatives.
Rural and younger uninsured Americans also have low vaccination rates (62% and 54%, respectively). Both rural and uninsured people have been neglected by the U.S. healthcare system and face access barriers; for more on this topic, I recommend this Undark article by Timothy Delizza.
Delta was a big vaccination motivator. KFF specifically asked people who had gotten their shots after June 1 why they chose to get vaccinated. The most popular reasons were, in order: the increase in cases due to Delta (39%), concern about reports of local hospitals and ICUs filling with COVID-19 patients (38%), and knowing someone who got seriously ill or died from COVID-19 (36%).
Mandates and social pressures were also vaccination motivators. 35% of KFF’s recently vaccinated survey respondents said that a big reason for their choice was a desire to participate in activities that require vaccination, like going to the gym, a big event, or traveling. 19% cited an employer requirement and 19% cited social pressure from family and friends.
The second part of this question, “how can we make them?”, reflects a dangerous attitude that has permeated vaccine conversations in recent months. Yes, it’s understandable to be frustrated with the Americans who have refused vaccination. But we can’t “make” the unvaccinated do anything, and such a forceful attitude may put off people who still have questions about the vaccines or who have faced discrimination in the healthcare system. To increase vaccinations among people who are still hesitant, it’s important to remain open-minded, not condescending. For more: read Ed Yong’s interview with Dr. Rhea Boyd.
That said, we’re now getting a sense of which strategies can increase vaccination: employer mandates, vaccination requirements for public life, and personal experience with the coronavirus. As the Delta surge wanes, it will take more vaccination requirements and careful, open-minded conversations to continue motivating people to get their shots.
What are some things I might say to convince people of Delta’s severity and the need to not relax on masking, distancing, etc?
To answer this, I’ll refer you to the article I wrote about Delta on August 1, as the findings that I discuss there have been backed up by further research.
Personally, there are two statistics that I use to express Delta’s dangers to people:
Delta causes a viral load 1,000 times higher than the original coronavirus strain. This number comes from a study in Guangzhou, China, posted as a preprint in late July. While viral load does not correspond precisely to infectiousness (there are other viral and immune system factors at play), I find that this “1,000 times higher” statistic is a good way to convey just how contagious Delta is, compared to past variants.
An interaction of one second is enough time for Delta to spread from one person to another. Remember the 15-minute rule? In spring 2020, being indoors with someone, unmasked, for 15 minutes or more was considered “close contact.” Delta’s increased transmissibility means that an interaction of one second is now enough to be a “close contact.” The risk is lower if you’re vaccinated, but still—Delta is capable of spreading very quickly in enclosed spaces.
You may also find it helpful to discuss rising numbers of breakthrough cases in the U.S. While vaccinated people continue to be incredibly well protected against severe disease and death caused by Delta, the vaccines are not as protective against coronavirus infection and transmission. (They are protective to some degree, though! Notably, coronavirus infections in vaccinated people tend to be significantly shorter than they are in the unvaccinated, since immune systems can quickly respond to the threat.)
It’s true that rising breakthrough case numbers are, in a way, expected—as more people get vaccinated, breakthrough cases will naturally become more common, because the virus has fewer and fewer unvaccinated people to infect. But considering the risks of spreading the coronavirus to others, plus the risks of Long COVID from a breakthrough case… I personally don’t want a breakthrough case, and so I continue masking up and following other safety protocols.
What monitoring do we have in place for COVID “longhaulers” and their symptoms/health implications?
This is a great question, and one I wish I could answer in more detail. Unlike COVID-19 cases, hospitalizations, and other major metrics, we do not have a comprehensive national monitoring system to tell us how many people are facing long-term symptoms from a coronavirus infection, much less how they’re faring. I consider this one of the country’s biggest COVID-19 data gaps, leaving us relatively unprepared to help the thousands, if not millions, of people left newly disabled by the pandemic.
In February, the National Institutes of Health (NIH) announced a major research initiative to study Long COVID. Congress has provided over $1 billion in funding for the research. This initiative will likely be our best source for Long COVID information in the future, but it’s still in early stages right now. Just two weeks ago, the NIH awarded a large share of its funding to New York University’s Langone Medical Center; NYU is now setting up long-term studies and distributing funding to other research institutions.
As I wrote in the September 19 issue, the NIH’s RECOVER website currently reports that between 10% and 30% of people infected with the coronavirus will go on to develop Long COVID; hopefully research at NYU and elsewhere will lead to some more precise numbers.
While we wait for the NIH research to progress, I personally find the Patient-Led Research Collaborative (PLRC) to be a great source for Long COVID research and data. The PLRC consists of Long COVID patients who research their own condition; it was founded out of Body Politic’s Long COVID support group. This group produced one of the most comprehensive papers on Long COVID to date, based on an international survey including thousands of patients, and has more research currently ongoing.
If you have the means to support Long COVID patients—many of whom are unable to work and facing homelessness—please see the responses to this tweet by PLRC researcher Hannah Davis:
As others have mentioned, people with Long COVID are unable to work & are becoming homeless.
If you have #LongCovid & are struggling, drop your venmo/cashapp/paypal/etc in this thread & I'll retweet.
If you have $ to spare, please support patients in this thread.
Why is the CDC not doing comprehensive high volumes of sequencing on all breakthrough cases at the very least?
I wish I knew! As I wrote last week (and in several other past issues), the lack of comprehensive breakthrough case data in the U.S. has contributed to a lack of clarity on booster shots, as well as a lack of preparedness for the next variants that may become threats after Delta. The CDC’s inability to track and sequence all breakthrough cases—not just the severe ones—is dangerous.
That said, it is very difficult to track breakthrough cases in a country like the U.S. Consider: the U.S. does not have a comprehensive, national electronic records system for patients admitted to hospitals, much less those who receive COVID-19 tests and other care at outpatient clinics. This lack of comprehensive records makes it difficult to match people who’ve been vaccinated with those who have received a positive COVID-19 test. Thousands, if not millions of Americans are now relying on rapid tests for their personal COVID-19 information—and most rapid tests don’t get entered into the public health records system at all.
Plus, local public health departments are chronically underfunded, understaffed, and burned out after almost two years of working in a pandemic; they have little bandwidth to track breakthrough cases. Many Americans refuse to participate in contact tracing, which hinders the public health system’s ability to collect key information about their cases. And there are other logistical challenges around genomic sequencing; despite new investments in this area, many parts of the country don’t have sequencing capacity, or the information infrastructure needed to send sequencing results to the CDC.
So, if the CDC were tracking non-severe breakthrough cases, they’d likely miss a lot of the cases. But that doesn’t mean they shouldn’t be trying, in my opinion.
How safe is it to visit my family for the holidays?
This is another place where I don’t feel qualified to give advice, but I can offer some thoughts. If I were you, I would think about the different ways in which holiday travel might pose risk to me and to the people at the other end of my trip. I would consider:
Quarantining beforehand. Do your occupation and living circumstances allow you to quarantine for a week, or at least limit your exposure to settings where you might be at risk of catching the coronavirus, before you travel? Can you get a test before traveling?
Types of travel. Can you make the trip in a car or on public transportation, or do you need to fly? If you need to fly, can you select an airline that has stricter COVID-19 safety requirements? (United recently reported that over 96% of its employees are now vaccinated, for example.) Can you wear a high-quality mask for the flight?
Quarantining and/or testing upon arrival. Can you spend a couple of days in quarantine once you get to your destination? Would you have access to testing (with results in under 24 hours) upon your arrival, or would you be able to bring rapid tests with you?
Who you’re spending time with. Among the family you’d be visiting, is everyone vaccinated (besides young children)? If anyone is not vaccinated, could your potential travel be a motivator to help convince them to get vaccinated? Does the group include seniors or people with health conditions that put them at high risk for COVID-19, and if so, can they get booster shots?
Activities that you do at your destination. Would you be able to have large gatherings outside, or in a well-ventilated space? What else can you do to reduce the risk of these activities?
Like other activities, travel can be relatively safe or fairly dangerous depending on the precautions that you’re able to take, and depending on COVID-19 case rates where you live and at your destination. And, like other activities, your choice to travel or not travel depends a lot on your personal risk tolerance. Nothing is zero-risk right now; each person has a threshold that determines what level of COVID-19 risk they are and are not comfortable taking. Through some self-reflection, you can determine if travel is above or below your risk threshold.
Why are policies so different now than they were at this time last year?
Public health tends to go through cycles of “panic” and “neglect.” Ed Yong’s latest feature goes into the history of this phenomenon:
Almost 20 years ago, the historians of medicine Elizabeth Fee and Theodore Brown lamented that the U.S. had “failed to sustain progress in any coherent manner” in its capacity to handle infectious diseases. With every new pathogen—cholera in the 1830s, HIV in the 1980s—Americans rediscover the weaknesses in the country’s health system, briefly attempt to address the problem, and then “let our interest lapse when the immediate crisis seems to be over,” Fee and Brown wrote. The result is a Sisyphean cycle of panic and neglect that is now spinning in its third century. Progress is always undone; promise, always unfulfilled. Fee died in 2018, two years before SARS-CoV-2 arose. But in documenting America’s past, she foresaw its pandemic present—and its likely future.
During the COVID-19 pandemic, the U.S. took a nosedive into the “neglect” cycle before we were even finished with the “panic” cycle. Congress has already slashed its funding for future pandemic preparedness, while state and local governments across the country restrict the powers of public health officials. As a result, we’re seeing an “everyone for themselves” attitude at a time when we should be seeing new mask mandates, restrictions on public activities, and other safety measures.
Basically, America decided the pandemic was over and acted accordingly—and if you get COVID-19 now, it’s “your fault for not being vaccinated.” This phenomenon has been especially pronounced in rural areas, which struggled a lot (but saw few cases) during spring 2020 lockdowns and are extremely hesitant to do anything approaching a “lockdown” again.
We need an attitude shift—and more investment in public health—to actually end this pandemic and prepare for the next health crisis. Yong’s feature goes into this in more detail; definitely give that a read if you haven’t yet.
When is this going to be over?!?
Unfortunately, this is very hard to predict—even for the expert epidemiologists and computational biologists who make the models. Check out the CDC’s compilation of COVID-19 case models: most of them agree that cases will keep going down in the coming weeks, but they’re kind of all over the place.
Last week, I summarized two stories—from The Atlantic and STAT News—that discuss the coming winter, and kind of get at this question. It’s possible that cases keep declining from their present numbers, and that the Delta surge we just faced is the last major surge in the U.S. It’s also possible that a new variant arises out of Delta and sends us into yet another new surge. If that happens, more people will be protected by vaccination and prior infection, but healthcare systems could come under strain once again.
As long as the coronavirus continues spreading somewhere in the world, it will continue to pose risk to everyone—able to cause new outbreaks and mutate into new variants. This will continue until the vast majority of the world is vaccinated. And then, at some point, the coronavirus will probably become endemic, meaning it persists in the population at some kind of “acceptable” threshold. Just like the flu.
Dr. Ellie Murray, epidemiologist at Boston University’s School of Public Health, explained how a pandemic becomes endemic in a recent Twitter thread:
Everyone keeps talking about covid becoming endemic, but as I listen to the conversation, it’s becoming more & more clear to me that very few of you know what “endemic” means.
Dr. Murray points out that, even when a disease reaches endemic status, tons of scientists and public health workers will still continue to monitor it. This is the case for the flu—think about all of the effort that goes into a given year’s flu shot!—and it will likely be the case for COVID-19.
In short, public health leaders need to figure out what level of COVID-19 transmission is “acceptable” and how we will continue to monitor it. This needs to happen at both U.S. and global levels. And, thanks to our vaccine-rich status, it’ll likely happen in the U.S. long before it happens globally.
So, yes, our only viable choice left is covid becoming endemic. It didn’t have to be this way, but our leaders MADE a choice.
And now they need to make another choice: They need to choose an “acceptable” level of COVID death & disease.
I was on vacation last week, unable to scour the internet for COVID-19 sources like I usually do. So, here are a couple of old favorites from the archives:
School Survey Dashboard from the Institute of Education Statistics(featured 3/28/21): As part of the Biden Administration’s commitment to reopening K-12 schools across the country, the federal government is now collecting data on how students are receiving education—and releasing those data on a monthly basis. This dashboard draws from surveys of a nationally represented sample including 7,000 rural, suburban, and urban schools, focusing on fourth-graders and eighth-graders. We (still!) don’t have data on COVID-19 cases, tests, or enrollment numbers, however.
Vaccine consent laws by state(featured on 5/23/21): As schools reopen, a lot of teenagers out there may want to know if they can get vaccinated without parental permission. The site VaxTeen provides these kids with information on the consent laws in every state, as well as a guide for talking to your parents about vaccines and other resources.
COVID-19 in ICE detention centers(featured on 11/1/20): Since March 2020, researchers from the Vera Institute of Justice have been compiling data from Immigration and Customs Enforcement (ICE) on COVID-19 cases and testing in immigrant detention centers. The researchers note that ICE replaces previously reported numbers whenever its dataset is updated, making it difficult to track COVID-19 in these facilities over time.
Rural hospital closures(featured on 6/20/21): The North Carolina Rural Health Research Program at the University of North Carolina tracks hospitals in rural areas that close or otherwise stop providing in-patient care. The database includes 181 hospitals that have closed between 2005 and 2021, available in both an interactive map and a downloadable Excel file.
This week, the World Health Organization (WHO) called for wealthy nations to stop giving out booster shots in a push towards global vaccine equity.
These nations should stall any booster shots until at least September, said WHO Director-General Tedros Adhanom Ghebreyesus at a press conference on Wednesday. Instead, excess vaccines should be donated to COVAX, the international vaccine distributor that aims to mitigate COVID-19 in low-income countries. When 10% of the population in every country has been vaccinated, then wealthy countries could resume administering boosters, Tedros said.
I understand the concern of all governments to protect their people from the Delta variant. But we cannot and we should not accept countries that have already used most of the global supply of vaccine using even more of it while the world’s most vulnerable people remain unprotected.
It may seem counterintuitive for a country to not provide its citizens with extra protection when it has the means to do so. But the global numbers are staggering. About 50% of the U.S. population has now been fully vaccinated, and we have doses to spare (some of which are going to waste). Meanwhile, in most African countries, 1% or less of the population is vaccinated. This is even though vaccine demand is actually far higher in low-income nations than in the U.S.
An internal analysis from the World Health Organization (WHO) estimates that if the 11 rich countries that are either rolling out boosters or considering it this year were to give the shots to everyone over 50 years old, they would use up roughly 440 million doses of the global supply. If all high-income and upper-middle-income nations were to do the same, the estimate doubles.
About 3.5 billion people in low- and lower-middle-income countries have yet to be vaccinated, Maxmen estimates. Give one dose to 10% of that number, and you use 350 million doses—less than the 440 million that rich nations would use up with boosters.
The longer that these low-income countries go without widespread vaccination, the more likely it is that new variants will emerge from their outbreaks. This is because, with every new COVID-19 case, the virus has a new opportunity to mutate. We’re already seeing Delta adapt to become even more transmissible and monitoring other potentially-concerning variants, like Lambda.
It’s unclear how much power the WHO has to enforce a booster shot moratorium, especially now that some countries (like Israel) have already gotten started on administering these extra shots. And it’s also worth noting that public health officials in the U.S. are shifting away from using “booster” to describe third shots for immunocompromised people or second shots who for those who received the one-and-done Johnson & Johnson vaccine; they say that these shots rather bring patients up to the same immunity levels as those who received two mRNA doses.
Following the end of the federal public health emergency in May, the CDC has lost its authority to collect vaccination data from all state and local health agencies that keep immunization records. As a result, the CDC is no longer providing comprehensive vaccination numbers on its COVID-19 dashboards. But we still have some information about this year’s vaccination campaign, thanks to continued CDC efforts as well as reporting by other health agencies and research organizations.
This week, the FDA authorized Novavax’s updated COVID-19 vaccine. Here’s why some people are excited to get Novavax’s vaccine this fall, as opposed to Pfizer’s or Moderna’s.
Last week, I asked you, COVID-19 Data Dispatch readers, to send me your stories of challenges you experienced when trying to get this fall’s COVID-19 vaccines. I received 35 responses from readers across the country, demonstrating issues with insurance coverage, pharmacy logistics, and more.
COVID-19 Data Dispatch 