Author: Staff Reporter

As Covid-19 cases, deaths and hospitalizations continue to increase among the unvaccinated across the US, top infectious disease expert Anthony Fauci said that the country is “going in the wrong direction”, the media reported.
“If you look at the inflection of the curve of new cases, that it is among the unvaccinated. And since we have 50 per cent of the country is not fully vaccinated, that’s a problem,” Fauci was quoted as saying to CNN on Sunday. The majority of deaths could be, thus, among the unvaccinated, Fauci said.

“So it really is, as (Rochelle) Walensky (Director of the Centers for Disease Control and Prevention) has said many times and I have said, it is really a pandemic among the unvaccinated, so this is an issue predominantly among the unvaccinated, which is the reason why we’re out there, practically pleading with the unvaccinated people to go out and get vaccinated,” said the chief medical adviser to President Joe Biden.

The warning from Fauci comes as the dangerous Delta variant of Covid-19, which has spread to 124 countries, is now sweeping across the US. Health officials are urging Americans to get vaccinated to help curb its spread.

Every state in the US reported more Covid-19 cases in the week ending on July 23 than the week prior, data from the Johns Hopkins University revealed. Thirty states have yet to fully vaccinate at least half of their residents, according to the US Centers for Disease Control and Prevention (CDC).

And as of July 23, the daily average of people becoming fully vaccinated was the lowest it had been since the end of January, the report said. Meanwhile, the CDC is also weighing the option of revising its Covid-19 guidelines to recommend that even fully vaccinated people wear masks in public, Fauci said.

He noted that some local areas where infection rates are surging are already urging individuals to wear masks in public regardless of their vaccination status.

The US continues to be the worst-hit country with the world’s highest number of cases and deaths at 34,443,064 and 610,891, respectively, according to the latest update on Monday by Johns Hopkins University. Health experts have blamed the recent surges on the low vaccination rates and the accelerating Delta variant transmission.

Few places are considering renewals of the policy, but experts suggest it’s wise for everyone—including the vaccinated—to wear masks in public indoor spaces. Despite the predictions of an early fall surge, infections from the Delta variant have soared throughout the country and spread faster than health experts anticipated. In the past few weeks, every state except Vermont has seen a sudden steep climb in cases.

In response to the surge, Los Angeles County has led the way in reinstating a mask requirement for indoor spaces, even for vaccinated people, and the Centers for Disease Control and Prevention has recommended that unvaccinated students—which includes all those under the age of 12 — wear a mask in school. On the state level, the California Department of Public Health has not changed its current guidance, which doesn’t require masks for vaccinated people, and a representative did not indicate whether an update was likely. So for now it’s unclear how many communities may follow L.A.’s example, even as local surges appear around the country.

“We’re seeing it pretty much hit everywhere all at once, which was a bit unexpected,” says Tara Smith, a professor of epidemiology at Kent State University in Ohio. She expected cases to emerge in the South, where people spend more time in air conditioning during the hot months, before moving northward. “That’s the tricky thing about exponential growth,” says Dominique Heinke, a postdoctoral epidemiologist in North Carolina. “It looks like a whole lot of nothing, and then out of nowhere, seemingly it just skyrockets, and getting it under control is going to be that much harder.”

This is especially true as states pour their energies into vaccination outreach while leaving mask mandates behind. Many public health experts believe the CDC jumped the gun in loosening its mask recommendations. The nation’s largest nurses union sent a letter on July 12 to CDC director Rochelle Walensky asking the agency to reinstate the recommendation for everyone to wear masks in public or when physically near people outside their household. During a recent webinar for health journalists, Eric Topol, professor of molecular medicine and director of Scripps Research Institute, and Vaughn Cooper, an evolutionary biologist at the University of Pittsburgh, both said they thought the relaxed guidance was premature.

Smith agrees. “I think the CDC rescinded that too early,” she says. The evidence base conclusively shows that masks substantially reduce the risk of transmitting SARS-CoV-2 to others and reduce the risk of contracting it.

Mask fatigue

“There is a real COVID fatigue, so it’s harder to sell [mask-wearing] today than it was a year ago,” says George Turabelidze, the state epidemiologist for Missouri, which in June became the first state to see a surge hit. He says Missouri, which has never had a statewide mask requirement during the pandemic, is unlikely to issue one because the governor supports decision-making at the local level. Missouri’s cases continue to rise, particularly in rural areas, with a 20 percent increase from last week to this week. “We do not anticipate any improvement anytime soon,” Turabelidze says, adding that it’s hard to justify mandates for everyone.

“There is no scientific evidence proving that someone who is vaccinated and infected could transmit the infection to others,” he says. He explains that there have been indications suggesting it’s possible for vaccinated people to infect others, but no studies so far have clearly shown it’s happening. Without clear evidence that vaccinated people who develop a breakthrough infection can transmit the virus to others, he believes the science doesn’t justify requiring vaccinated people to wear masks. “But because nobody can rule it out, [transmission from vaccinated people] is still possible, probably at much lower level.”

He suspects that such a possibility is L.A. County’s rationale, but it may not be enough for other cities or regions. Still, he says it’s wise for vaccinated people to mask up when around higher-risk people, such as those who are immune-compromised or have underlying medical conditions. Turabelidze and his colleagues have been working hard to counter disinformation about COVID-19 vaccines to increase vaccination rates. Missouri had been lagging most of the country in vaccination rates, but recently surpassed 40 percent of all vaccine-eligible people.

Experts encourage masking, but states won’t require it

In some states, counties can’t require masking, even if they want to. For example, eight states so far have made it illegal to require masks in school, even in lower grades where students are too young to be vaccinated—and even though the CDC has advised all unvaccinated students to wear masks. One of those states is Arkansas, which currently has the second highest cases per 100,000 people in the U.S.

While recent Arkansas legislation prohibits requiring masks in any government spaces, “we are still recommending and strongly encouraging it for people who are not vaccinated, and many people who are fully vaccinated are choosing to wear masks,” says Jennifer Dillaha, the Arkansas state epidemiologist and medical director for Immunizations and Outbreak Response at the Arkansas Department of Health.

Arkansas is making a big push for vaccinations, but it’s difficult in such a rural state. Pharmacies are the only vaccine sites in most communities, but the state will soon offer vaccines at Dollar General stores. One barrier is that many people still don’t know where to get vaccinated, and many lack internet access, so the state is advertising the number 1-800-985-6030 for finding a site. “We’re strongly encouraging people to get vaccinated now, because with the Pfizer and Moderna vaccines, it takes five to six weeks to become fully protected, and they need both doses to be well protected from the Delta variant,” she says.

In Florida, another state seeing a rapid rise in cases, Governor Ron DeSantis is not considering any mask mandates or lockdowns, according to Christina Pushaw, the governor’s press secretary. She says DeSantis predicted a rise in summer cases for months, but he “emphasized that we are in a much better place than we were last summer, with a high rate of immunization among the most vulnerable population—senior citizens—which is reflected in lower hospitalization rates compared to last summer,” Pushaw says.

Instead, the state is focused on increasing immunizations through the state’s online vaccine locator and multiple synchronized messaging campaigns in several languages with statewide billboards and radio, digital, social media, and streaming media, according to WeesamKhoury, the communications director for the Florida Department of Health.

The Delta variant 

The higher transmissibility of Delta and its ability to evade some antibody protection means more opportunities for breakthrough infections, Heinke says. “If you’ve got this variant sending out so many more viral particles, proper mask wearing becomes more important,” she says. While breakthrough cases are rare, they do happen, Smith says, which is particularly concerning for those worried about potentially transmitting the disease to unvaccinated family members.

“I think it’s wise for many of us to continue to mask for those just-in-case scenarios, especially with unknowns about vaccine effectiveness with the Delta variant and others that may emerge,” she says. “At least until everyone in the population has had a chance to get vaccinated, which includes children who aren’t even eligible for the vaccines yet.” Although she doesn’t expect many places to implement mask mandates, she says it’s important to call for them, if only for the historical record. “We need to know some of the places where we erred, and I think this is going to be one of them,” Smith says. “Masks are such a simple intervention that not using them more definitively to protect individuals has been a misstep.”

Mixed mask messaging

As an epidemiologist, Heinke would like to see more places require indoor masking. “I think we’ve let our guard down too quickly,” she says. The CDC’s guidance was that vaccinated people can remove masks indoors. “But with no way to verify that, it pretty much gave permission for everyone to take off their masks indoors, so that means you have a good number of unvaccinated people unmasked in these spaces where SARS-CoV-2 spreads incredibly efficiently.”

Most areas of the country are seeing a new surge in COVID-19 cases as variants of the virus serve as a painful reminder that the pandemic is not over despite eased restrictions. Forty-one states and the District of Columbia have documented an increase in average daily cases over the past two weeks. But nine in particular, including seven in the South, have seen cases at least double in that time period, according to data from The New York Times.

The seven-day-average of new cases was 13,859 as of July 6, up 21% compared to two weeks earlier, according to the Centers for Disease Control and Prevention (CDC). Cases attributed to the most recent days might rise further because of a reporting lag following the July 4 holiday weekend. The spike comes as the Delta variant, which is more transmissible than any previous strain, accounted for around 52% of cases in the two weeks ending July 3, according to the CDC. Despite having among the highest availability of vaccines of any country, America’s immunization campaign has dropped off steeply since April. President Joe Biden narrowly missed his goal of having 70% adults at least partly vaccinated by Independence Day, with the current figure at 67%. Regions in the Midwest and South with lower vaccination rates are experiencing higher case rates than regions with high vaccination rates such as the Northeast, a trend that has become increasingly clear in recent weeks.

A hospital in Springfield, Missouri, ran out of ventilators to treat hospitalized COVID patients over the weekend, local media reported. The city of 160,000’s two hospitals were treating 213 COVID-19 patients as of Monday, up from 168 on Friday and 31 on May 24, the Kansas City Star said. “The trajectory that we’re likely to see is two different flavours of the pandemic in the United States, one in which it’s more of a problem in places where there’s a high level of unvaccinated individuals,” Amesh Adalja of the Johns Hopkins Center for Health Security told AFP.

“In other parts of the country, the pandemic is largely going to be something that’s managed as more of an ordinary respiratory virus,” he added. Mr. Adalja said that even with Delta becoming the dominant strain he envisioned a “decoupling” of hospitalisations and deaths from rising cases in highly vaccinated regions, as has been seen in Israel. “Increasingly, I think we have to start to shift our focus away from cases and really look at hospitalizations, because that’s what the vaccine was designed to do — it was designed to decouple cases from hospitalization,” he said.

Real world data has shown that the Pfizer, Johnson & Johnson and AstraZeneca vaccines have retained high efficacy against severe COVID and the same is almost certainly true of the Moderna vaccine, according to experts. Most areas of the country are seeing a new surge in COVID-19 cases as variants of the virus serve as a painful reminder that the pandemic is not over despite eased restrictions. Forty-one states and the District of Columbia have documented an increase in average daily cases over the past two weeks. But nine in particular, including seven in the South, have seen cases at least double in that time period, according to data from The New York Times.

In Los Angeles County, officials recorded more than 1,000 new cases for three consecutive days this week for the first time since March. Arkansas also reported more than 1,000 new cases for a third straight day Friday. “The majority of states have large swaths of population that are still not protected,” said Amber D’Souza, a professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health. She said that despite tremendous progress on vaccinations, the new data show the outbreaks are mostly hitting areas with lower vaccination rates. Those spikes are due in part to the spread of the more transmissible delta variant and loosened COVID-19 restrictions, D’Souza said.

“We expect to see continuing surges of infection until we are able to bring vaccination rates higher than they currently are,” she added. Overall, the U.S. is now averaging more than 19,000 new cases for the first time since the end of May, marking a 60 percent increase compared with two weeks ago. A third of those cases were documented in five states — Arkansas, Florida, Louisiana, Missouri and Nevada — CNN medical analyst Jonathan Reiner told the network Monday.

Throughout the pandemic, rises in coronavirus cases have typically preceded spikes in COVID-19 hospitalizations and deaths. While the rate of COVID-19 deaths is still decreasing in the U.S., data from the Times shows an 11 percent increase in average daily hospitalizations over the past two weeks. During that same period, vaccination rates have plummeted to an average of 500,000 a day, the lowest level since President Biden took office.

Months after Biden declared vaccines were available to all Americans 18 and over, 58.9 percent of adults are fully vaccinated, as are 48 percent of all Americans, according to data from the Centers for Disease Control and Prevention. The vaccination rates of the five states with the highest daily average of new coronavirus cases — Arkansas, Missouri, Florida, Louisiana and Nevada — are all below the national percentages. D’Souza said government officials need to focus on localized data “because within a state often there really are different stories happening with vaccination and therefore with infection.” And even with the recent surge, she said the nationwide case count is not expected to reach 2020 levels, in large part because 79 percent of those 65 and older have been fully vaccinated.

“There are a lot of reasons for hope,” she said. “That being said, things have stalled this past month. We are seeing reduced vaccination and increased infection, and that is the worry of what that forebodes for the fall.” Experts have said that unvaccinated people are more at risk to develop serious illness and die from the delta variant that now makes up a majority of cases in the U.S. Biden’s chief medical adviser, Anthony Fauci, said last week that more than 99 percent of people who died of COVID-19 in June in the U.S. were not vaccinated.

Several polls have shown that Republicans are less likely to get vaccinated than Democrats. The Kaiser Family Foundation found that the vaccination gap between counties that voted for former President Trump in 2020 and those that voted for Biden has nearly doubled in two months. Efforts to narrow that gap face stiff competition from some vaccine opponents.“The government was hoping that they could sort of sucker 90 percent of the population into getting vaccinated. And it isn’t happening,” said conservative author Alex Berenson, drawing applause at the recent Conservative Political Action Conference in Texas.

Some officials are now weighing whether to take action to combat COVID-19 case surges. Los Angeles County and St. Louis County are recommending all people wear masks indoors, even if they are vaccinated. In Mississippi, the state’s Department of Health called on residents aged 65 and older and those with chronic medical conditions to avoid all indoor mass gatherings. On Sunday, Fauci told CNN’s “State of the Union” that there should be more local mandates to prevent COVID-19 spread, calling it a “life and death situation.”

White House press secretary Jen Psaki said during a briefing Monday that the federal government will “certainly support” local leaders if they decide to institute restrictions “to keep their community safe.”Arkansas Gov. Asa Hutchinson (R) told ABC’s “This Week” that he plans to travel to six cities in his state this week in an effort to combat vaccine hesitancy. “We’ve got to overcome that mistrust because it — Republicans, Democrats, we all suffer the same consequence if the delta variant hits us and we’re not vaccinated,” Hutchinson said.

President Joe Biden has appointed an Indian-American health policy expert who served on the leadership of the Biden-Harris transition Health and Human Services (HHS) agency review team. Dr. Meena Seshamani, 43, will be acting as Deputy Administrator and the Director of the US Centre for Medicare. She will lead the Centre’s efforts in serving the people 65 or older, people with disabilities, and people with End-Stage Renal Disease that rely on Medicare coverage.

She received her B.A. with Honours in Business Economics from Brown University, her M.D. from the University of Pennsylvania School of Medicine, and her Ph.D. in Health Economics from the University of Oxford, where she was a Marshall Scholar. She completed her residency training in Otolaryngology-Head and Neck Surgery at the Johns Hopkins University School of Medicine, and practiced as a head and neck surgeon at Kaiser Permanente in San Francisco.

Chiquita Brooks-LaSure, an administrator at the Centers for Medicare & Medicaid Services (CMS), said, “Dr. Meena Seshamani brings her diverse background as a health care executive, health economist, physician and health policy expert to CMS.” Dr. Seshamani also brings decades of policy experience to her role, including recently serving on the leadership of the Biden-Harris transition HHS agency review team.

Brooks-LaSure added, “Providing quality health care to the people who rely on Medicare and advancing health equity as we do it is a priority for CMS. I am delighted to say Dr. Seshamani will bring her unique perspective on how health policy impacts the real lives of patients to her leadership role as Deputy Administrator and Director of the Centre for Medicare,” she said.

Seshamani most recently served as Vice President of Clinical Care Transformation at MedStar Health, where she conceptualized, designed, and implemented population health and value-based care initiatives and served on the senior leadership of the 10 hospital, 300+ outpatient care site health system, a media release said. The care models and service lines under her leadership, including community health, geriatrics, and palliative care, have been nationally recognized by the Institute for Healthcare Improvement and others.

Prior to MedStar Health, she was director of the office of Health Reform at the US Department of Health and Human Services, where she drove strategy and led implementation of the Affordable Care Act across the department, including coverage policy, delivery system reform, and public health policy, the statement said.