Coronavirus / COVID-19 Information

Sonya · Sep 3, 2021

Nevada COVID-19 updates for 9/3:

Test positivity (note, w/ 7-day lag) is slightly up: 12.26% (+0.04%)
Hospitalizations are fluctuating but up: 1,133 (+7)
Cases are fluctuating but up: 1,148 (+17)

Clark County cases are slightly up: 634 (+7)
Washoe County cases are slightly down: 295 (-2)

https://thenevadaindependent.com/coronavirus-data-nevada

Coronavirus Contextualized, 56th Edition:
https://thenevadaindependent.com/article/coronavirus-contextualized-57th-edition-cases-hospitalizations-continue-to-rise-in-northern-nevada-as-numbers-improve-in-the-south

Below, we take at the worsening situation in Washoe County, with the Nevada Hospital Association announcing this week that many hospitals, particularly in the north, are nearing 100 percent capacity.

Meanwhile, state officials announced this week that conventions will be able to apply for a mask exemption similar to the one allowed for large events that will allow fully vaccinated attendees to shed their masks so long as all attendees are required to present proof of vaccination at the door.

Cases

Statewide case numbers continue to fluctuate, the result of the number of new reported cases each day decreasing in Clark County while increasing in Washoe County and other parts of the state.

As of Thursday, 1,131 new cases were reported on average each day over the previous seven days, slightly down from the highest point of the current wave so far, 1,160, which the state hit Aug. 24. For context, that peak is just below the highest point of last summer’s wave, 1,176 on July 20, 2020, but a little less than half of the fall and winter wave case record, 2,736 on Dec. 10, 2020.

In Clark County, which was hit early and hard by the latest wave of the virus, cases have been steadily decreasing for the last nine days, hitting 627 on Thursday. The highest point of the current wave, which the state hit on Aug. 1, was 917. That peak is below both the high point of the 2020 summer wave — 1,072 on July 20, 2020 — and the fall and winter wave, when Clark County hit its highest seven-day case average ever of 2,092 on Jan. 12.

Compare that to the situation in Washoe County, which barely even saw a summer wave last year, peaking at 98 on July 30, 2020, but has seen cases steadily and sharply rise day over day for the last month and a half. On Thursday, it hit a seven-day case average of 295, which is a little more than half of its record high point of 532 on Nov. 27 during the fall and winter wave.

Adjusted for population size, Washoe County has a case rate that is more than double Clark County’s. As of Thursday, Clark County was seeing 28 cases reported per 100,000 residents each day over the previous seven days, compared to 62 in Washoe County.

“We started our surge here several weeks later than Clark County did,” Washoe County District Health Officer Kevin Dick said on Wednesday. “They’re now coming down from the highest levels that occurred with transmission in Clark County, and I’m hopeful that happens here sometime before too long. But we’ve been lagging behind them with the rise we’re seeing.”

Dick said that wildfire smoke may also be playing a role in the continued, sharp increase in cases in Washoe County. A study released earlier this year found a strong association between persistent wildfire smoke and increased rates of COVID-19 in Reno last summer.

“With that exposure to wildfire smoke we have inflammation occurring in our lungs and our airways which may allow COVID-19 easier opportunity to infect us,” Dick said. “Additionally, with all of the particulates that are in the air from these wildfires, those are particles the virus can attach to that also can then transport that virus into our airways to infect us.”

Across the rest of the state, almost every other county is seeing elevated or increasing case numbers as well.

According to the Nevada State Public Health Lab’s weekly lineage report, the Delta variant was responsible for 93.8 percent of sequenced COVID-19 cases over the last five days. A new variant of interest the World Health Organization announced it was monitoring this week, called the Mu variant, was responsible for 0.8 percent of sequenced cases in Nevada over the last 30 days, representing eight cases, according to the state lab.

Since the beginning of the pandemic, there have been 393,186 COVID-19 cases confirmed statewide, meaning 1 in 8 Nevadans has tested positive for the virus. Nearly 9 percent of those cases, 34,256, have been diagnosed in the last month, and a little more than 2 percent, or 7,916 cases, have been reported in the last week.

Test positivity

The statewide test positivity rate, which looks at the percentage of tests coming back positive out of the total tested, continues to steadily decrease.

It is not possible to independently calculate the test positivity rate based on test encounters because the state only publicly reports the number of positive cases, not the number of positive test encounters. However, the state does provide this number, calculated as an average over a 14-day period with a seven-day lag. As of Tuesday, that number was 12.2 percent, down from a recent high of 16.4 percent on Aug. 13.

Candice McDaniel, deputy director of programs for the Department of Health and Human Services, on a Thursday press call attributed the decreasing test positivity rate, at least in part, to a significant uptick in testing in the last two weeks. She said that the number of tests taken has increased nearly 23 percent over that timeframe.

The test positivity rate is also more than double the World Health Organization’s recommended 5 percent threshold but less than the peak test positivity rate of 21.3 percent the state saw in mid-January.

Since the beginning of the pandemic, nearly 1.9 million people — 61 percent of Nevadans — have been tested for COVID-19, and there have been more than four million individual testing encounters.

Vaccinations

The pace of vaccine distribution in Nevada remains relatively steady after several weeks of steadily increasing vaccination rates as the state worked to boost efforts to get shots in arms this summer and those nervous about the Delta vaccine finally decided to get the jab.

As of Wednesday, about 7,900 vaccines were reported administered each day over the last seven days, slightly down from 8,400 last week but up from a low point of 5,200 on July 13.

More than 58 percent of Nevadans have now been either partially or fully vaccinated against COVID-19 — including 48 percent fully vaccinated — and about 29 percent of Nevadans eligible for the vaccine have yet to receive it.

Since vaccinations started in December, nearly 1.8 million people have received at least one dose of the COVID-19 vaccine and nearly 1.5 million Nevadans have been fully vaccinated.

Since the Centers for Disease Control and Prevention recommended immunocompromised people get an extra dose of the vaccine, 8,130 people in Nevada have received their third shot, according to the Department of Health and Human Services. That represents about 9 percent of the estimated 92,000 immunocompromised individuals in Nevada.

Among the counties, Carson City continues to have the highest percentage of residents fully vaccinated against COVID-19 at 54.9 percent, followed by Washoe County at 52.1 percent, Douglas County at 47.7 percent and Clark County at 43.4 percent. Tiny Storey County has still vaccinated the least, with only 16.2 percent of its residents partially or fully vaccinated.

Nationally, Nevada ranks 31st among the 50 states for percentage of its population fully vaccinated, at 48.1 percent, behind all of its neighbors except Utah and Idaho, which come in at 33rd and 47th, respectively.

Breakthrough cases

There have been 7,084 breakthrough cases — fully vaccinated individuals who have tested positive for COVID-19 — in Clark County as of Aug. 26, meaning that 0.7 percent of fully vaccinated individuals have contracted the virus. In Washoe County, there have been 1,129 breakthrough cases as of Thursday, representing 0.45 percent of fully vaccinated people in the county.

As of Aug. 26, there were 349 breakthrough hospitalizations in Clark County and 104 breakthrough deaths, meaning that 0.03 percent of vaccinated individuals in Clark County have been hospitalized and 0.01 percent have died.

Of the people hospitalized with breakthrough infections, 66 percent had underlying conditions, 72 percent were those 65 years or older and 60 percent were men.

For more on how breakthrough cases are identified and the limitations of available breakthrough data in the state, check out the 56th edition of “Coronavirus Contextualized”.

Deaths

The number of new COVID-19 deaths reported on average each day increased this week after a brief drop.

As of Wednesday, 24 COVID-19 deaths were being reported on average each day over the prior seven days, up from 20 last week and exceeding the peak of last summer’s surge, when an average of 21 deaths were reported on Aug. 20. During the peak of the fall and winter surge on Jan. 17, 45 people were dying on average each day.

Over the last seven days, 167 new COVID-19 deaths have been reported across the state — up from 128 last week — including:

128 in Clark County

23 in Washoe County

5 in Nye County

4 in Carson City

2 each in Douglas and Humboldt counties

1 each in Churchill, Lyon and White Pine counties

Since the beginning of the pandemic, there have been 6,565 deaths from COVID-19. In the last month, 647 deaths from COVID-19 were reported statewide, nearly 10 percent of the deaths reported statewide since the beginning of the pandemic.

Hospitalizations

The number of people hospitalized with COVID-19 statewide has started to decrease, again the result of differing trends in different parts of the state. In Clark County, hospitalization numbers are decreasing while they continue to increase in Washoe County.

As of Wednesday, there were 1,126 people hospitalized with confirmed or suspected cases of COVID-19 across the state, down from 1,251 last week and this wave’s peak of 1,317 on Aug. 10. The peak of last summer’s wave was 1,165, which the state hit on July 31, 2020, and the peak of the fall and winter wave was 2,025, on Dec. 13, 2020.

Chris Lake, executive director of community resilience for the Nevada Hospital Association, said during a Thursday press call that hospitals continue to experience significant strain from staffing shortages, which prevent them from being able to operate as many beds as they are licensed to run.

“Like much of the country, Nevada hospitals are experiencing a severe shortage of nurses and other practitioners,” Lake said. “This shortage has created a situation whereby many hospital beds cannot be adequately staffed at this time. Due to this, the hospitals in Nevada are experiencing extreme occupancy loads when compared to the number of staffed beds.”

Lake added that many hospitals, particularly in Northern Nevada, are “close to 100 percent of available bed capacity.”

That strain, he said, is being exacerbated by the number of unvaccinated patients who continue to require hospital and ICU-level care and, to a lesser degree, the evacuation of hospital patients from South Lake Tahoe because of the Caldor Fire.

County by county

Eleven counties are considered by the state to be at elevated risk for the spread of COVID-19 as of Wednesday: Washoe, Carson City, Douglas, Lyon, Churchill, Humboldt, Elko, Lander, Eureka, Nye and Clark.

Counties are considered at risk for elevated spread of COVID-19 if they meet two of the following three metrics:

The average number of tests per day per 100,000, calculated over a 14-day period. If this number is less than 100, a county could be considered at risk.

The case rate per 100,000, calculated by taking the number of cases diagnosed and reported over a 30-day period. If this number is greater than 200, a county could be considered at risk.

The case rate per 100,000 and the test positivity rate, calculated over a 14-day period with a seven-day lag. If the case rate is greater than 50 and the test positivity rate is greater than 8.0 percent, a county could be considered at risk.

The state continues to align its mask mandate with federal guidance, however, meaning it is using the CDC’s community transmission tracker to determine which counties are at substantial or high risk for the spread of COVID-19 and therefore required to abide by indoor mask mandates for vaccinated and unvaccinated individuals alike.

Under the CDC’s metrics, counties are considered at risk for “high” transmission if they have more than 100 cases per 100,000 residents in the last seven days, “substantial” if they have between 50 and 100, “moderate” if they have between 10 and 50 and “low” if they have less than 10.

As of Tuesday, when the state reevaluates CDC data for purposes of making changes to its masking guidance, all Nevada counties except Mineral were considered at “high” or “substantial” risk of transmission. As of Friday, all counties except Eureka will be required to follow universal indoor masking precautions for both vaccinated and unvaccinated individuals.

If Eureka, which was flagged as having a “high” transmission rate this week, continues to see high or substantial transmission next week, it, too, will be subject to the mask mandate starting Sept. 10. Mineral, which was determined to have “low” transmission this week, will have its mask mandate removed on Sept. 10 if it continues to have low or moderate transmission.

“If you look at the CDC tracker, you will see that now, nationwide, 94 percent of counties have a high transmission rate, 2.7 percent are substantial and just about 100 communities nationwide are showing a low or moderate transmission rate,” McDaniel said.

Counties can have mask mandates put in place if they have two weeks of “substantial” or “high” transmission; those mask mandates will automatically be removed after two weeks of “low” transmission.
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Southern Nevada Health District Has Breakthrough Case Data:

The SNHD has put together a web page for Breakthrough Case Data.

You can find the information here - https://covid.southernnevadahealthdistrict.org/cases/breakthrough/

This graphic shows the percentage of cases that are breakthrough cases by month:

June: 11.59%
July: 15.71%
August: 17.43%
Sep. (so far): 0%

From the link above, you can also look at individual reports. They breakdown the demographics of vaccinated and unvaccinated cases, hospitalizations and deaths. They also have information on the underlying medical conditions of those who were hospitalized or died.

It's a lot of data and information on a topic we haven't seen a lot of data on so far. This is a great thing. Please go take a look around if you're a data nerd like myself.

Bottom line, you're a lot better off being vaccinated in Nevada than you are to be unvaccinated.

Experts Asking People Traveling for Labor Day Weekend to "Mitigate Your Risk"
https://www.king5.com/article/news/local/state-health-labor-day-travel-strained-hospital-system-covid-pandemic-coronavirus/281-77213f13-5d3b-48b1-82da-8539282c1f14

Washington State health officials are asking people planning to travel for Labor Day weekend to rethink plans, whether vaccinated against COVID-19 or not, expressing concern for holiday travel amid the pandemic.

"Anytime you have holidays and you still have a pandemic that's raging and people want to enjoy themselves, rightfully so. We just want to make sure people are doing it with the mindset that we are still in the pandemic," said Washington Secretary of Health Dr. Umair Shah.

Dr. Shah's main concern is the spread of the delta variant in Washington, which currently makes up 98% of all cases. But the concerns don't stop there.

Officials said while COVID-19 cases are starting to plateau, it's between 10-14 days after a big travel weekend that we see the impact on hospitals, which are nearing full capacity for the first time ever.

Acting Chief Science Officer Dr. Scott Lindquist said his biggest concern is the risk people take while on vacation.

"I don't know how to say this as clearly as possible. Please mitigate your risk this weekend. That means, for me, I'm not going away for the weekend, I'm not going water skiing," he said. "I'm not going to do things that are risky behaviors because that backup, that safety net is so strained right now."

Sea-Tac International Airport saw long lines at ticket counters Friday morning as people were heading out for the long weekend.

The Centers for Disease Control and Prevention is asking unvaccinated people not to travel at all this weekend.

For people that are traveling over the holidays and in the coming weeks, Shah said to rethink not just if you're going, but also where you're going.

"If there are places where you are planning on traveling where you have seen an impact either because of the storms or the pandemic, we want to make sure you're thinking about your plans," he said.
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The Share Of U.S. Adults Willing To Get Vaccinated Ticks Up
https://www.npr.org/2021/09/03/1033750072/the-share-of-u-s-adults-willing-to-get-vaccinated-ticks-up-a-new-poll-finds

The share of adults saying "no" to getting the COVID-19 vaccine dropped 5 percentage points in a month, according to a new NPR/PBS NewsHour/Marist poll conducted after the Food and Drug Administration granted full approval to Pfizer's vaccine.

The survey, which was in the field from Aug. 26 through Tuesday, found 19% of U.S. adults now say they do not intend to be vaccinated. That's down from 24% in a Marist poll from the end of July.

The number of Americans who say they have gotten or will get a COVID vaccine is up to 79%, a 5-point improvement in a month.

"Part of it has to do with the passage of time, part of it has to do with the [FDA] approval," said Lee Miringoff, director of the Marist College Institute for Public Opinion.

The slight rise in receptiveness to the vaccine also comes as the delta variant has driven a surge of new coronavirus cases, and as an increasing number of employers and universities are mandating vaccination. The decline in people refusing the vaccine was most pronounced in the South and West, where there were double-digit drops in the shares of survey respondents who said they would not get vaccinated.

Those regions have been hit particularly hard by this summer's delta surge.

"I think that people are hearing more about the difference between whether you are vaccinated and whether you're not vaccinated in terms of severity and in terms of the incidence of catching COVID," Miringoff said.

There's been a drumbeat of messaging about the perils of being unvaccinated. Some who had been vaccine-hesitant cited in surveys the lack of full FDA approval as a reason to hold off on inoculation. But it isn't clear how big a factor the approval really is.

Bring on the boosters

Among fully vaccinated Americans, the survey found strong support for COVID-19 booster shots, as 81% say they will, or already have, gotten a booster shot, while 19% of vaccinated adults said they don't plan to get boosters or are unsure.

Last month, the Biden administration announced a plan to provide a third dose of either the Pfizer or Moderna vaccine to adults eight months after receiving their second shot. The program would begin the week of Sept. 20, pending an independent review by a CDC advisory panel and the FDA. The plan calls for the earliest booster shots to go to those who were vaccinated earliest on and at highest risk, including health care providers and long-term care facility residents.

There has been some question about whether people will want to get yet another COVID vaccine shot. This poll indicates an overwhelming share of those who are fully vaccinated are ready to roll up their sleeves once again.
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Study of Long Term Effects of COVID-19 Infection:

There is a new study out that takes an interesting look at the long term effects people infected with COVID-19 are reporting.

You can find the study here - https://www.nature.com/articles/s41598-021-95565-8

Abstract
COVID-19 can involve persistence, sequelae, and other medical complications that last weeks to months after initial recovery. This systematic review and meta-analysis aims to identify studies assessing the long-term effects of COVID-19. LitCOVID and Embase were searched to identify articles with original data published before the 1st of January 2021, with a minimum of 100 patients. For effects reported in two or more studies, meta-analyses using a random-effects model were performed using the MetaXL software to estimate the pooled prevalence with 95% CI. PRISMA guidelines were followed. A total of 18,251 publications were identified, of which 15 met the inclusion criteria. The prevalence of 55 long-term effects was estimated, 21 meta-analyses were performed, and 47,910 patients were included (age 17–87 years). The included studies defined long-COVID as ranging from 14 to 110 days post-viral infection. It was estimated that 80% of the infected patients with SARS-CoV-2 developed one or more long-term symptoms. The five most common symptoms were fatigue (58%), headache (44%), attention disorder (27%), hair loss (25%), and dyspnea (24%). Multi-disciplinary teams are crucial to developing preventive measures, rehabilitation techniques, and clinical management strategies with whole-patient perspectives designed to address long COVID-19 care.
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And this graphic is loaded with information from the study:

You may need to click on the link to see the full sized image to read all the "fine print".

That's it for me this week. Have a wonderful Labor Day weekend, whatever you're doing. I am not sure if we'll get numbers for Nevada on Monday or not, but if we do, I'll post them here.

Sonya · Sep 7, 2021

Nevada COVID-19 updates for 9/7:

Test positivity (note, w/ 7-day lag) is slightly down: 12.26% (-0.04%)
Hospitalizations are fluctuating but up: 1,133 (+48)
Cases are fluctuating but down: 1,027 (-121)

Clark County cases are down: 589 (-45)
Washoe County cases are down: 273 (-20)

*(+XX) reflects change since Friday

https://thenevadaindependent.com/coronavirus-data-nevada

Pediatric COVID-19 Cases Are Surging, Pushing Hospitals—and Health Care Workers—to Their Breaking Points
https://time.com/6092446/pediatric-covid-19-surge/

Aug. 20 was a good day in the pediatric intensive care unit at Children’s Hospital New Orleans. Carvase Perrilloux, a two-month-old baby who’d come in about a week earlier with respiratory syncytial virus and COVID-19, was finally ready to breathe without the ventilator keeping his tiny body alive. “You did it!” nurses in PPE cooed as they removed the tube from his airway and he took his first solo gasp, bare toes kicking.

Downstairs, Quintetta Edwards was preparing for her 17-year-old son, Nelson Alexis III, to be discharged after spending more than two weeks in the hospital with COVID-19—first in the ICU, then stabilizing on an acute-care floor. “Fortunately, he never regressed,” Edwards says from outside Nelson’s room, the door marked with signs warning of potential COVID-19 exposure inside. “He’s progressing, slowly but surely.”

The nurses and doctors who care for the sickest patients at Children’s Hospital New Orleans (CHNO) have to take the good where they can these days. On Aug. 6, Louisiana Governor John Bel Edwards announced that more than 3,000 children statewide had been diagnosed with COVID-19 over the course of just four days. That same week, about a quarter of Louisiana children tested for COVID-19 by the state’s largest health system turned out to have the virus.

Seventy young patients ended up in treatment at CHNO during the 30 days ending Aug. 23. Prior to this summer, the hospital had never had to care for more than seven COVID-19 patients at a time, and usually fewer than that; on any given day in August, that number has been at least in the mid-teens, enough that the facility had to call in a medical strike team from Rhode Island to help manage the surge.

A record high of more than 1,900 children were hospitalized nationwide on Aug. 14—and unlike during previous spikes, infections have so far been clustered largely in states with low vaccine coverage, meaning hospitals in undervaccinated states like Louisiana, Florida, Tennessee, Alabama and Texas are drowning. “Our hospital system across Alabama is beyond capacity. Last week we had net negative ICU beds, and that’s pediatric and adult together,” says Dr. David Kimberlin, co-director of the division of pediatric infectious diseases at Children’s of Alabama. “Doctors are doing CPR in the back of pickup trucks.”

This grim scenario may seem shocking, given one of the pandemic’s long-standing silver linings: that children, for the most part, are spared from the worst of COVID-19. About 400 children nationwide have died from COVID-19 since the pandemic began, and most pediatric hospitals have seen no more than a handful of patients at a time—which makes the current surge in the South and parts of the Midwest especially unnerving.

There is no evidence that the Delta variant is causing more severe disease than previous strains, says Dr. Sean O’Leary, vice chair of the American Academy of Pediatrics (AAP) committee on infectious diseases. Less than 2% of children who have caught COVID-19 during this wave landed in the hospital—roughly the same percentage as during earlier phases of the pandemic, according to a TIME analysis of AAP and U.S. Department of Health and Human Services data. An even smaller percentage of children die from the disease, though some have gone on to develop complications like the inflammatory condition MIS-C.

The difference seems to be that the highly contagious Delta strain is tearing through all demographic groups at a furious clip, currently contributing to the more than 140,000 infections reported in the U.S. on any given day. It’s a depressing numbers game: If 100 children become infected, one or two might end up in the hospital. Push the caseload up to 180,000—the number of kids diagnosed with the virus nationwide during the week ending Aug. 19—and at least 1,800 are likely to get sick enough to need hospitalization.

Children have also drawn a short straw. Viruses are wily, seeking out and infecting vulnerable hosts at all costs. Without authorized vaccines for people younger than 12, any child who has not previously been infected has no immunity against SARS-CoV-2, meaning the virus effectively has free rein among America’s 50 million youngest residents. Even among older children who can get vaccinated, rates are low: just 35% of 12- to 15-year-olds and 45% of 16- and 17-year-olds are fully vaccinated, according to U.S. Centers for Disease Control and Prevention data.

While each individual child has a low chance of developing severe disease, the current pediatric surge, which has been compounded by an off-season spike in RSV and parainfluenza cases, has grave implications for health care networks. Even before the pandemic, health care access was a struggle in parts of the South and Midwest. In Arkansas, for example, there is only one pediatric hospital system to serve the state’s more than 3 million residents. A rural hospital could have fewer than 10 ICU beds, meaning even a small coronavirus surge could push it beyond its limits. “Down here in the deep South, we are getting slammed to the point where, honestly, our health systems may collapse,” Kimberlin says. “What that means is, if you have a stroke, you die at home.”

There’s a reason pediatric ICUs are dangerously full in Tennessee and Texas but, at least at the moment, not Maryland and Massachusetts. In each of the latter two states, more than 60% of residents are fully vaccinated; in the former, about 41% and 46%, respectively. States with high vaccination rates also tend to be more aggressive about other precautions, like indoor mask mandates.

There are exceptions—pediatric hospitalizations are ticking up in California (151 admissions this week vs. 68 a month ago) and New York (46 vs. 20 a month ago), two states with high vaccine coverage—and no one can predict what the virus will do in the future. But it stands to reason that more kids are getting sick in states like Louisiana, where only about 40% of the population is fully vaccinated and more than 4,600 new diagnoses are being reported among its 4.6 million residents each day. “Kids don’t tend to drive what’s going on; they tend to reflect what’s going on in the surrounding community,” O’Leary says.

That children are largely at the mercy of the adults in their communities is one of the cruelest quirks of this surge. “It’s hard, because you don’t want to be judgmental” of people who haven’t gotten the shot, says Dr. Michael Blancaneaux, an emergency medicine physician at CHNO.

But it’s also clear, he says, that the decisions of unvaccinated adults are endangering the lives of children who couldn’t be vaccinated even if they wanted to be. While many CHNO staff members are careful to say vaccination is a personal choice, there’s a discernible subtext beneath their politeness: they wish more people in the community would choose to vaccinate themselves and their families. For the doctors who treat young patients—and who are exhausted from worrying about COVID-19 for, as Blancaneaux says, what feels like forever—learning that their families are unvaccinated, or failing to take other precautions, is a bitter pill to swallow, and one that makes it difficult to keep going about their essential work unfazed. Indeed, a sign hanging in CHNO’s emergency-department bathroom directs staff to “wipe away tears” before returning to work.

“How do you try to tell someone why they should care about the life of a child?” Alabama’s Kimberlin asks. “I don’t know.”

Paul Decerbo has been a member of the Rhode Island-1 Disaster Medical Assistance Team for more than 10 years, long enough to become the squad’s commander. Three months out of each year, when there’s an emergency anywhere in the U.S., Decerbo knows he may have to prepare himself and a team of on-call medics, nurses and doctors to ship out to the scene of the crisis for two weeks. Sometimes, that’s the site of a natural disaster. For the last 18 months, it’s mostly been wherever COVID-19 cases are surging and local hospitals are at their breaking points.

Decerbo deployed six times last year. But when he got a call from CHNO this summer, asking for people who could help treat emergency-department patients, he faced a new challenge. He’d need an entire team of people ready to treat COVID-19 patients and trained in pediatrics—something not required during prior coronavirus surges, when the vast majority of patients were adults. Ultimately, he had to look beyond Rhode Island and assemble a squad of health-care workers from multiple states to meet that need.

CHNO’s resident staffers weren’t quite prepared for the uptick in pediatric cases, either. “It was a shock,” Blancaneaux says. After a year of few-and-far-between cases in the pediatric hospital, “All of a sudden, eight out of the 20 patients I saw [in a day] were COVID positive.” It’s gotten to the point, he says, where doctors assume any patient who comes in with flu-like symptoms has COVID-19.

The hospital’s quiet atmosphere hides the work happening behind the scenes to keep pace with that increase. CHNO has implemented an incentive program to encourage current staff nurses to pick up extra shifts, and has hired about 150 new nurses to help manage the patient load.

Perhaps more concerning, the current spike began in July, before most schools in Louisiana had started back up. As the school year continues, Delta will almost undoubtedly find new footholds. No one wants to consider what happens if this is the ascent of a bell curve, rather than the peak—particularly since vaccines for the youngest Americans may not be available until late 2021 or early 2022.

Even once the shots are authorized, children too young to consent to treatment will be reliant on their parents’ willingness to get them vaccinated. That’s a troubling prospect since, in a recent Kaiser Family Foundation survey, only 26% of parents with kids ages 5 to 11, and 20% of those with kids younger than 5, said they would vaccinate their children right away.

In some cases, that may be because parents still do not believe young children need to be vaccinated, considering their low odds of dying or becoming hospitalized. But there are always exceptions to rules, and they’re showing up every day in pediatric ICUs. Jordan Ohlsen, a nurse who works on CHNO’s acute-care floor, says some parents don’t realize how serious the virus can be until their child is the one in a hospital bed. “Once the child does get sick, their [parents’] conception of what the virus is [changes],” Ohlsen says. “When they come in and see their kid sick, in their brain it switches to, ‘This is something I should be worried about,’ or ‘I should have gotten them vaccinated.’”

If there is any optimism buried within the current pediatric surge, it’s that perhaps some parents will have that realization before their child gets sick, rather than after. But with vaccine authorization for young children at least a few months away, the immediate battle is in convincing adults to get their shots, thereby hopefully driving down the total amount of virus circulating in each community. Delta seems to be scaring at least some holdouts into action. On average, more than 700,000 people in the U.S. are now getting a COVID-19 vaccine each day, a higher number than the country has reported since June. But there’s a long way to go, and not a lot of time to travel it.

Particularly in areas where infection rates are high, health officials must encourage people to go back to basics, the AAP’s O’Leary says. New Orleans, for its part, has reimplemented mask mandates and now requires proof of vaccination or a negative test from anyone who wants to visit an indoor bar, restaurant or music venue, lending a somewhat subdued air to many parts of the usually buoyant city.

“Use the mitigation measures we know work,” O’Leary says. “Wear masks when you’re around other people, particularly in enclosed spaces….Avoid places where lots of people are congregating.”

Unless and until health officials can convince a tired and disillusioned populace to return to precautions they wanted to leave in the past, COVID-19 will keep spreading. A small number of patients, no matter how young, will land in the hospital. And day after day, health care workers will don their gas-mask-like respirators, gowns and goggles to care for them, many worrying all the while about bringing COVID-19 home to their own children.

The staff at CHNO makes a valiant effort to stay positive and keep smiling beneath their masks—a trait, perhaps, of choosing to work in pediatrics. But Blancaneaux admits it can be difficult this far into a pandemic, when the tools for ending it are in nearly every drugstore in the country. “Everyone is frustrated and worn out and upset,” he says. “You feel unsupported by the public because we keep fighting against it. And a large part of it is preventable.”
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None of this needed to happen. We have science and data that show we know how to control this virus. We need to be getting as many people vaccinated as possible. We need to wear masks when indoors around other people. We may need to mask up outdoors as well, when in a large crowd.

Vegas Valley Doctors Urge Their Patients: Get Your Children Vaccinated:
https://www.reviewjournal.com/life/health/valley-doctors-urge-parents-get-your-children-vaccinated-2433328/

When parents remain on the fence about getting their children vaccinated against COVID-19, Las Vegas pediatrician Todd Zimmerman informs them that his family, including his two teenagers, have all gotten their shots.

“That has helped put people over the goal line,” said Zimmerman, medical director for the emergency room at Sunrise Children’s Hospital.

Conversations such as this have taken on critical importance, Zimmerman and other Las Vegas-area pediatricians say, as they see increasing numbers of cases and hospitalizations involving kids with COVID-19, the sickest of whom are almost always unvaccinated.

These observations mirror findings in a report released Friday by the Centers for Disease Control and Prevention showing that hospitalizations of children with COVID-19 increased fivefold since late June. In kids 12 to 17, the population eligible for vaccination, hospitalization rates for COVID-19 were 10 times higher in those who were unvaccinated.

“From what I have noticed myself, a lot of the ones with the bad pneumonias that tend to be the older adolescents and teenagers, they are not vaccinated,” said Dr. Rita Shah, a pediatric infectious disease specialist who treats patients at UMC Children’s Hospital and other area hospitals.

Shah described what it’s like to see children who likely wouldn’t be in the hospital if they had been vaccinated.

“It’s awful,” said Shah, whose twin 15-year-olds are vaccinated.

“We want our patients to be healthy. We’re here to help them,” she said. “We have been doing our best, as you know, for more than a year and a half. But it’s difficult when certain families don’t want to listen to science, and even when we try to answer their questions, they still are worried about getting a vaccine.”

Dr. Evelyn Montalvo Stanton, a pediatric pulmonologist and chair of pediatrics at the Kirk Kerkorian School of Medicine at UNLV, echoed Shah’s concern.

A couple, both of whom had been hospitalized for COVID-19, did not initially see a need to get their 16-year-old son with asthma vaccinated, she said. She eventually impressed upon them that their son could still catch the virus, even though his parents had already had it, and that he might become sicker than they had been.

“I had to make them understand the seriousness of the disease,” she said.

‘Long COVID’ in kids

Many kids who get COVID-19 will experience mild symptoms often similar to those of a cold, such as a runny nose and cough. Some experience digestive symptoms.

“But COVID can really affect any part of the body — the lungs, the heart,” said Dr. Rebecca Meyers, who treats patients at the UNLV Pediatric Clinic. “It can even affect children’s brains, giving them a variety of different kinds of neurological symptoms. It can make children tired, give them headaches. It can even cause them to have behavioral problems. So there’s lots of possible consequences of COVID infection in children beyond just what we typically see, which is a cold-like or flu-like illness.”

Just as adults can experience ongoing symptoms from COVID-19 — so-called “long COVID” — so can children. “Some of those kids can definitely have mental health or behavioral consequences,” Meyers said.

Typically, children or adolescents who are hospitalized for COVID-19 have an underlying condition such as obesity or asthma, Shah said. However, a rare condition called multisystem inflammatory syndrome, or MIS-C, can make previously healthy children very sick.

Seventy-nine children in Clark County have been diagnosed with the syndrome, which causes inflammation in multiple organs of some young patients previously infected with COVID-19, according to data from the Southern Nevada Health District.

‘People are scared’

Meyers said the biggest uptick in cases that she’s seeing is in school-age children.

“This surge for everybody, but particularly for children, began really to pick up in July, and is continuing to trend up and up … especially in the school-age group from around 5 years old to 17,” she said.

A vaccine has not yet been authorized for those under age 12, but if parents and others around them are vaccinated, younger children are less likely to become ill themselves, she said.

Data in a second report released by the CDC Friday showed that there were more COVID-19 pediatric emergency department visits and hospital admissions in states with lower vaccination rates, adding to evidence that broad community vaccination protects those who can’t be vaccinated.

As of Thursday, the health district had reported 237 hospitalizations for COVID-19 and four deaths in those ages 5 to 17 in Clark County. In children age 4 and younger, there had been 130 hospitalizations and one death.

“This is a pandemic. People are scared,” Zimmerman said. Adding to parents’ fear is inaccurate information from unreliable internet sources.

“But we keep pushing the same message. … In fact, this is the most studied vaccine ever. And we know it’s safe,” he said. “I follow the CDC very closely. I am always looking at the new studies. If it’s not every day, it’s every week that there’s more studies coming out that not only show the efficacy of the vaccine, but also the safety of the vaccine.”
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Long time Vegas reporter and author John L Smith did a piece this weekend for NVIndy about the Ivermectin/Horse Dewormer "cure". He says it so much better than I ever could.

Amid COVID Confusion, Horse Dewormer Isn't All That's In Short Supply:
https://thenevadaindependent.com/article/amid-covid-confusion-horse-dewormer-isnt-all-thats-in-short-supply-these-days

It was another busy morning at V&V Tack and Feed, where friendly employees help Las Vegas animal lovers stock up on sacks of kibble and chow for their horses, goats, pigs, dogs, and cats. It also offers a variety of equine tack from bridles to leg wraps.

For the record, on Friday the store was out of ivermectin. When it’s in stock, these days the horse dewormer is kept behind the counter like bootleg whiskey or a naughty magazine. It’s been a hot item at V&V, but not because the local equine population has been overwhelmed by redworms, roundworms, or pinworms. Why, even the parasitic flukes appear to be keeping to themselves these days.

As news reports that have now circled the globe have attested, ivermectin is being touted in misinformed parts of the media as the latest “miracle cure” for COVID-19. The fact that ingesting horse dewormer is dangerous and ineffective for coronavirus is not enough to dissuade the true-believers who swear to their souls that the currently available vaccines are part of a larger plot to rob patriots of their freedom and even to implant mind-controlling microchips into the brains of the easily manipulated.

For V&V’s Shelly Smith, who at one point asked customers requesting the dewormer to show a photo of their horse, it’s all a little overwhelming — especially some of the calls she’s received.

“They think we’re killing people by not giving them ivermectin,” she says. “A guy called and threatened to come down and protest in front of the store. It’s ridiculous.”

For many people, the evolving signals sent from the real COVID-19 experts have been hard enough to follow. In a time of extreme misinformation about the virus and vaccine, even the time-tested method of wearing a mask to slow the spread of disease has been hopelessly politicized. Some would rather believe taking horse dewormer makes better medical sense than an FDA-approved vaccine.

The smoke of hysteria and conspiracy continues to billow.

From former President Trump’s harebrained talk of injecting a bleach substance into COVID patients and shining a cleansing light on them, to his effort to tout the anti-malarial drug hydroxychloroquine as a miracle cure for COVID, the snake oil never ceases.

Anyone remember when the misleading reporting that fish tank cleaner containing “chloroquine phosphate” resulted in the death of an Arizona man? He and his wife had had heard the president repeatedly boast of the promise of the drug, and so they ingested chemicals intended to disinfect a fish tank.

Aquarium cleaner has been replaced by horse dewormer with predictable results following a wave of disinformation spread through right-wing media and such medical experts as celebrity podcast king Joe Rogan.

Users of horse-strength ivermectin have been hospitalized with severe stomach issues and have experienced bouts of blindness. But that’s little price to pay for avoiding a vaccine that’s been scientifically tested and used safely by millions.

The phony miracle cures and misleading medical studies that proliferate on the internet are not so different from the sweeping and successful effort to turn mask wearing and social distancing into a Constitution-crushing hill to die for. Last year’s “Stop the Steal” deception has morphed into an unprecedented anti-mask and anti-vax movement that not only serves a political purpose by firing up the Republican base, but threatens thousands of lives and the health of the nation for years to come.

Most troubling is the deceptive idea that the angry disruption of local school districts and other government meetings and the brushfire public protests are somehow examples of organic political action. They are not.

The influencers on the right and their friends in the long shadows of the Internet continue to spread a dangerous message that tested vaccines aren’t to be trusted, and masks are either unpatriotic or a sign of weakness or creeping socialism.

It’s something that Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, has spent many hours attempting to combat. The respected virologist knows that stopping the spread of COVID-19 not only rests on increasing vaccination rates, but also on efforts to inoculate more people against vaccine disinformation. There’s little time to waste.

Writing in nature.com Hotez argued for an aggressive attack – a counteroffensive – against anti-vax aggression. It’s a stance that many of his colleagues have been reluctant to take. But, he notes, what’s happening isn’t a matter of overcoming vaccine hesitancy, which exists for several understandable reasons.

“Today, the anti-vaccine empire has hundreds of websites and perhaps 58 million followers on social media,” he wrote. “The bad guys are winning, in part because health agencies either underestimate or deny the reach of anti-science forces, and are ill-equipped to counter it.”

Multiple investigations have “described how Russian intelligence organizations seek to discredit Western COVID-19 vaccines,” he observed. “One campaign implies that it could turn people into monkeys. This builds on a longer, well-documented history of Russia-sponsored disinformation, presumably to destabilize the United States and other democratic countries.”

All that disinformation makes it so much easier for snake-oil salesmen to pitch their swill, whether it’s antimalarial drugs, fish tank disinfectant, or horse dewormer. When you’ve been made to distrust vaccines and medical best practices that are the result of an unprecedented effort by scientists to halt the spread of a virus that has now killed more than 4.5 million people worldwide and nearly 650,000 Americans, you’re likely to believe just about anything.

Back at the tack and feed store, Shelly Smith sounds like she misses the simpler times when equine dewormer wasn’t the snake oil du jour.

Sometimes she thinks, “Why even bother? It’s 15 bucks a tube. Why even get into the argument?”

Her actual customers, the ones who know mane from tail, appreciate the convenience.

“I’ve been around horse people my entire life,” Smith says. “You can tell when the person who is asking wants it for their horse. You can tell when it’s a horse person getting it, or not. It’s not like rocket science to tell if it’s a horse person.

“The horse people are super cool about it. They think it’s hilarious.”

You’d think the rest would have better horse sense.
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One in 5,000: The Real Chances of a Breakthrough Infection:

The C.D.C. reported a terrifying fact in July: Vaccinated people with the Delta variant of the Covid virus carried roughly the same viral load in their noses and throats as unvaccinated people.

The news seemed to suggest that even the vaccinated were highly vulnerable to getting infected and passing the virus to others. Sure enough, stories about vaccinated people getting Covid — so-called breakthrough infections — were all around this summer: at a party in Provincetown, Mass.; among the Chicago Cubs; on Capitol Hill. Delta seemed as if it might be changing everything.

In recent weeks, however, more data has become available, and it suggests that the true picture is less alarming. Yes, Delta has increased the chances of getting Covid for almost everyone. But if you’re vaccinated, a Covid infection is still uncommon, and those high viral loads are not as worrisome as they initially sounded.

How small are the chances of the average vaccinated American contracting Covid? Probably about one in 5,000 per day, and even lower for people who take precautions or live in a highly vaccinated community.

Or maybe one in 10,000

The estimates here are based on statistics from three places that have reported detailed data on Covid infections by vaccination status: Utah; Virginia; and King County, which includes Seattle, in Washington state. All three are consistent with the idea that about one in 5,000 vaccinated Americans have tested positive for Covid each day in recent weeks.

The chances are surely higher in the places with the worst Covid outbreaks, like the Southeast. And in places with many fewer cases — like the Northeast, as well as the Chicago, Los Angeles and San Francisco areas — the chances are lower, probably less than 1 in 10,000. That’s what the Seattle data shows, for example. (These numbers don’t include undiagnosed cases, which are often so mild that people do not notice them and do not pass the virus to anyone else.)

Here’s one way to think about a one-in-10,000 daily chance: It would take more than three months for the combined risk to reach just 1 percent.

“There’s been a lot of miscommunication about what the risks really are to vaccinated people, and how vaccinated people should be thinking about their lives,” as Dr. Ashish Jha of Brown University told my colleague Tara Parker-Pope. (I recommend Tara’s recent Q. and A. on breakthrough infections.)

For the unvaccinated, of course, the chances of infection are far higher, as Dr. Jeffrey Duchin, the top public-health official in Seattle, has noted. Those chances have also risen much more since Delta began spreading:

Another way to understand the situation is to compare each state’s vaccination rate with its recent daily Covid infection rate. The infection rates in the least vaccinated states are about four times as high as in the most vaccinated states:

If the entire country had received shots at the same rate as the Northeast or California, the current Delta wave would be a small fraction of its current size. Delta is a problem. Vaccine hesitancy is a bigger problem.

The science, in brief

These numbers help show why the talking point about viral loads was problematic. It was one of those statements that managed to be both true and misleading. Even when the size of the viral loads are similar, the virus behaves differently in the noses and throats of the vaccinated and the unvaccinated.

In an unvaccinated person, a viral load is akin to an enemy army facing little resistance. In a vaccinated person, the human immune system launches a powerful response and tends to prevail quickly — often before the host body gets sick or infects others. That the viral loads were initially similar in size can end up being irrelevant.

I will confess to one bit of hesitation about walking you through the data on breakthrough infections: It’s not clear how much we should be worrying about them. For the vaccinated, Covid resembles the flu and usually a mild one. Society does not grind to a halt over the flu.

In Britain, many people have become comfortable with the current Covid risks. The vaccines make serious illness rare in adults, and the risks to young children are so low that Britain may never recommend that most receive the vaccine. Letting the virus continue to dominate life, on the other hand, has large costs.

“There’s a feeling that finally we can breathe; we can start trying to get back what we’ve lost,” Devi Sridhar, the head of the global public health program at the University of Edinburgh, told The Times.

I know that many Americans feel differently. Our level of Covid anxiety is higher, especially in communities that lean to the left politically. And there is no “correct” response to Covid. Different people respond to risk differently.

But at least one part of the American anxiety does seem to have become disconnected from the facts in recent weeks: the effectiveness of the vaccines. In a new ABC News/Washington Post poll, nearly half of adults judged their “risk of getting sick from the coronavirus” as either moderate or high — even though 75 percent of adults have received at least one shot.

In reality, the risks of getting any version of the virus remain small for the vaccinated, and the risks of getting badly sick remain minuscule.

In Seattle on an average recent day, about one out of every one million vaccinated residents have been admitted to a hospital with Covid symptoms. That risk is so close to zero that the human mind can’t easily process it. My best attempt is to say that the Covid risks for most vaccinated people are of the same order of magnitude as risks that people unthinkingly accept every day, like riding in a vehicle.

The bottom line

Delta really has changed the course of the pandemic. It is far more contagious than earlier versions of the virus and calls for precautions that were not necessary a couple of months ago, like wearing masks in some indoor situations.

But even with Delta, the overall risks for the vaccinated remain extremely small. As Dr. Monica Gandhi, an infectious-disease specialist at the University of California, San Francisco, wrote on Friday, “The messaging over the last month in the U.S. has basically served to terrify the vaccinated and make unvaccinated eligible adults doubt the effectiveness of the vaccines.” Neither of those views is warranted.
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Why I Trust the Data:
https://thenevadaindependent.com/article/why-i-trust-the-data

There is an abundance of data and information—and misinformation—surrounding COVID-19 and the vaccine. For the general public, it might be hard to understand what the data actually mean or even trust the information being presented.

As a physician, I rely upon peer-reviewed journals to make the best-informed decisions about my patients and implement my knowledge and experience as a medical professional accordingly. Created by scientists and physicians, peer reviews are vital tools that present an even deeper exploration into the studies of different disease processes and provide me with the optics of how a group of people are experiencing a disease as a whole.

Through this lens, I’m able to decide whether I want to endorse the use of a medication, or wait until there is another review with more information. For example, I like to see if a blind study was involved and the number of patients who participated, which can affect the overall outcome and accuracy of results.

For the COVID-19 vaccine, I looked to the works of virologist Dr. Kizzy Corbett, who was part of the clinical trials for the vaccine. Seeing how strong, robust, and accurate her work was provided me with my initial layer of trust. I then looked at how the studies were performed, and made certain they included all races, ages and ethnicities, and also that they were blind studies — meaning they included participants who didn’t know whether they were receiving the vaccine or a placebo. (In addition, mRNA vaccines were studied well past the beginning of the pandemic, which many people are completely unaware of. The history of mRNA vaccines and the way the trials were performed helped me trust that the vaccine would be effective.)

I’ve also used data I’ve found in specific studies to make decisions for my pediatric patients. In the beginning of the pandemic, we thought that children were rarely affected by coronavirus. A study I read helped shine light on why we first thought this, and why we are now seeing an uptick in pediatric cases: The study noted that when the pandemic hit, schools and daycares were closed. With so many children being quarantined in their homes, we were unable to collect accurate data in order to find out a child’s level of transmission and symptomatology. Now, based on current data, we know that children ages 4 to 8 and 9 to 13 years old can have a high-level of transmission. We were able to obtain this information because children are now back in school and engaging in other social activities.

When I hear from my patients that they don’t want to be “an experiment” or a “guinea pig,” I like to share with them that I and other health care providers were among the first to take the vaccine. Based on what we saw on a daily basis in the hospitals––and based on the extensive available data––we stood up and said, “Yes, we want to protect ourselves, our patients, and our families because we believe in the vaccine.”

That being said, it is my belief that if you don’t initially trust something, you should try to understand it from all perspectives in order to make the most informed decision for yourself and your loved ones. If you are a skeptic, ask yourself, “Why do I not trust the vaccine?” and see if you can find credible resources that address your concerns. Because at the end of the day, the most important thing we have in life is our good health.
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Sonya · Sep 8, 2021

Nevada COVID-19 updates for 9/8:

Test positivity (note, w/ 7-day lag) is slightly down: 12.30% (+0.05%)
Hospitalizations are fluctuating but down: 1,137 (-44)
Cases are fluctuating but down: 1,026 (-1)

Clark County cases are down: 589 (-34)
Washoe County cases are down: 256 (-17)

https://thenevadaindependent.com/coronavirus-data-nevada

And checking in with the CDC County Data for this past week to see the status of the mask mandate:
https://covid.cdc.gov/covid-data-tracker/#county-view

Clark County is still listed as High.

As you can see, the case rate per 100k population is now down to 182.03. Clark County needs that number down below 50 for two consecutive weeks, before the mask mandate is lifted.

Children Make Up More Than 25% of Weekly COVID Cases, Pediatricians Say:
https://www.cnn.com/2021/09/07/health/us-coronavirus-tuesday/index.html

Children now represent more than a quarter -- or 26.8% -- of weekly Covid-19 cases nationwide, according to data released Tuesday from the American Academy of Pediatrics (AAP).

The update comes as schools across the US have been in session or are getting into full swing. Experts have encouraged adults to get vaccinated to protect young children returning to the classroom.

"If we want to protect the children, particularly those who are not yet eligible for vaccination, you want to surround the children with people who are vaccinated -- teachers, school personnel, everyone else," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said Tuesday.

Some 251,781 child cases of Covid-19 were reported in the past week (August 26-September 2). That number represents more than a quarter of the 939,470 cases total that were reported over that period.

In each of the previous two weeks, children represented about 22% of the weekly reported cases. The definition of a child varies by state but generally includes those up to age 17 or 18.

"After declining in early summer, child cases have increased exponentially, with over 750,000 cases added between August 5 and September 2," the AAP's data said.

Despite the alarming rise in cases, it still appears that severe illness due to Covid-19 is uncommon among children at this time, according to AAP.
"There is an urgent need to collect more data on longer-term impacts of the pandemic on children, including ways the virus may harm the long-term physical health of infected children, as well as its emotional and mental health effects," the academy said.

So far, more than 5 million children total have tested positive for Covid-19 since the start of the pandemic, representing 15.1% of all cases in the United States.

Meanwhile, case numbers are up for a rare complication linked to Covid-19 in children -- multisystem inflammatory syndrome or MIS-C, the CDC said Tuesday. While rare, MIS-C tends to appear a few weeks after a child has been infected with Covid-19. Many MIS-C cases follow a Covid-19 infection that had no symptoms.

The number of cases -- counted through August 22 -- represents a 6% increase from late July, according to the CDC. As of August 22, 41 children have died from MIS-C, a more than 10% increase in deaths from the month before and one of the largest increases this year.
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Sonya · Sep 9, 2021

Nevada COVID-19 updates for 9/9:

Test positivity (note, w/ 7-day lag) is fluctuating but down: 12.19% (-0.11%)
Hospitalizations are fluctuating but down: 1,137 (-22)
Cases are fluctuating but down: 1,023 (-3)

Clark County cases are down: 539 (-16)
Washoe County cases are back up: 274 (+18)

https://thenevadaindependent.com/coronavirus-data-nevada

I'm happy to see Clark County's numbers continue their downward trend. We'll have to see if they continue to go down, because 539 cases per day is still pretty high.

How Delta's Remarkable Ability to Spread Threw New Twists Into the Pandemic:
https://www.statnews.com/2021/09/09/covid19-delta-variant-transmission/

One of the key reasons the Delta variant has ignited new surges of Covid-19 infections across the United States is its remarkable ability to make copies of itself.

That skill has helped make Delta far more transmissible than any other iteration of the coronavirus seen thus far. But its replication prowess could also be at the heart of the other twists Delta has thrown into the pandemic, including the increase in breakthrough infections with the variant and why it potentially causes severe Covid-19 more often.

Delta’s breakneck proliferation isn’t its only trick tied to the increase in infections — and symptomatic infections — in people who’ve been vaccinated. With the mutations the variant picked up as it evolved, it can partially cloak itself from the immune system’s antibodies. That gives the variant a better chance of sneaking past that first line of defense to start an infection compared to earlier forms of the virus. (The vaccines, however, haven’t lost any significant step in protecting against severe outcomes from the coronavirus. They are also still preventing many infections entirely.)

But experts say a crucial factor in Delta’s spread even to vaccinated people is that those infected with the variant seem to be “shedding” comparatively massive amounts of virus, exposing others to much higher levels. An oft-cited statistic is that, with Delta, people have 1,000 times as much virus in their upper airways early on in their infections compared to with the strain that emerged in China in 2019. Some experts quibble with that exact estimate, but the point remains that people who contract Delta have lots more virus in their noses and throats, and are in turn emitting lots more virus. That influx of virus into others’ airways seems to be able to overwhelm the antibodies that aim to guard the cells from infection.

Jeremy Kamil, a virologist at Louisiana State University Health Shreveport, offered an analogy. “It’s like trying to light a wet pile of hay on fire,” he explained. The body’s immune system is keeping the tinder damp, but if you throw more and more sparks on that wet hay, “eventually one of them catches.”

Delta also seems particularly attuned at cracking into cells to start an infection. Once it has a toehold, it starts cranking out copies of itself like the viral version of the brooms in “The Sorcerer’s Apprentice,” which can then go on to infect neighboring cells, quickly driving the viral load up beyond what other variants can do and outpacing the body’s initial response.

“All it takes is to get into a few cells to start a cascade of infection events,” Kamil said.

As the virus gets into more cells, it can bring on symptoms, which is why you’ve likely heard from friends or family about how they’ve felt sick for a few days after getting a breakthrough infection. But soon after the infection onset, the immune system — trained by the vaccine (or an earlier infection) to recognize and fight off the coronavirus — brings in the big guns, with an onslaught of additional antibodies and immune cells that can clear out the virus before it leads to more serious consequences. This is why, even if Delta is causing infections in some people who are vaccinated, in nearly all cases, it is causing only up to moderate disease — the goal the shots were designed to achieve.

There are other factors outside of Delta’s traits that are likely contributing to the increase in breakthrough infections, experts caution. For one, mitigation efforts have largely lapsed and people have restarted their social lives, leaving us more likely to come into contact with the virus.

Beyond that, it was always going to be difficult to completely ward off a pathogen that first infects the upper airway. The strong immune response generated by the vaccines that is so powerfully protecting people from severe Covid-19 is much harder to generate and sustain in the nose and throat.

“It’s a very tall order to ask a shot in your arm to protect the cells in your nose or in your mouth,” said immunologist Michal Tal, who has affiliations at Stanford and MIT.

What’s more, the antibodies generated by the vaccines, which are the body’s front line fighters in trying to block infections, wane months out from getting immunized. This is what happens with antibodies generally, and does not mean that people are more susceptible to getting severe disease. But it does mean that people could be more vulnerable to an infection months out from their last dose.

“The combination of not as much antibody being there, and the virus so quickly getting into cells,” helps explain the increase in breakthrough infections, said longtime coronavirus researcher Stanley Perlman of the University of Iowa.

It’s a different story in people who are unvaccinated and don’t have immune protection. And some research has indicated that, among these people, Delta is more likely to cause disease severe enough to put them in the hospital than earlier forms of the virus — though the evidence is divided.

A study out of the United Kingdom, for example, found people infected with Delta faced twice the risk of hospital admission compared to people infected with the Alpha variant, which was echoed by research out of Denmark. A study out of Norway, however, found no such difference, and a report from the Centers for Disease Control and Prevention last week noted that “it is not clear whether the Delta variant causes more severe illness in adult or pediatric populations.”

Researchers note it’s hard to compare disease severity from one point in the pandemic to another and from one variant to another, given all the variables involved: the demographics of people getting infected, the burden on the health system, improvements in care over time, and more. And many experts argue that the cases overwhelming hospitals in some states are just a reflection of the uncontrolled spread of the virus, not anything particular about this version.

But if Delta does cause severe disease more frequently than other forms of the virus, one possible explanation is how quickly its levels explode, experts said. If there are such high levels of virus in the nose and throat, the thinking goes, then it’s more likely that the virus will be able to infiltrate into the lungs, which is when more serious consequences can occur.

“If you have much more virus in the nose, why wouldn’t you have much more virus in the lungs as well?” Perlman said.
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LVRJ has an article about the Mu Variant:
https://www.reviewjournal.com/news/politics-and-government/nevada/about-40-cases-of-mu-coronavirus-variant-detected-in-nevada-2436563/

I didn't put the headline on here because it's not really representative of the story. It makes it sound like the variant is growing in Nevada, but a few paragraphs in, they stay it hasn't been detected in 30 days in a Reno Lab.

It's still worth a read because there is a lot of good information about the different variants.

There have been roughly 40 cases identified in Nevada of the mu variant of the coronavirus, the latest troubling strain to join the World Health Organization’s watch list, a top state public health official said.

In designating mu a “variant of interest” on Aug. 30, WHO said it possesses a constellation of mutations that could make it resistant to the protection against disease afforded by vaccination or past COVID-19 infection.

Despite the designation, the head of the Nevada State Public Health Laboratory thinks it’s unlikely that mu (pronounced “mew”) will overtake the highly contagious delta mutant as the state’s dominant strain.

“It got seeded here. It wasn’t a flash in the pan,” lab director Mark Pandori said about mu, first spotted in the state in late April and consistently present until early August. However, his lab at University of Nevada, Reno, now hasn’t detected the newer mu variant in more than 30 days.

“That means that it didn’t survive competition with delta. It didn’t survive vaccination. It didn’t survive masking and social distancing.”

Variant with unique mutation

Labs detect variants through sequencing, a form of genetic analysis conducted on test samples from positive cases.

The 40 or so cases of mu, also called B.1.621, were spotted in five Nevada counties: Clark, Washoe, Lander, Elko and Churchill, Pandori said.

Cases of the mu variant first identified in Colombia have been found in 42 countries at at least 47 states in the U.S., according to the website outbreak.info, a project of labs at Scripps Research supported by the National Institute for Allergy and Infectious Diseases, the National Center for Data to Health and the Centers for Disease Control and Prevention.

There have been 1,742 cases of mu identified in the U.S., amounting to 0.05 of sequenced cases. California leads the nation with 243 cases, the most recent spotted on Aug. 16, according to the website.

The WHO said in a bulletin that although the global prevalence of mu is declining, its prevalence in Colombia and Ecuador has consistently increased.

Scientists are focusing attention on the mu variant because of mutations already found in other variants that could make it more contagious as well as resistant to monoclonal antibodies and antiviral therapies, epidemiologist Katelyn Jetelina wrote recently in her coronavirus newsletter.

It also has a mutation that is unique, one that could inhibit the immune system’s B- and T-cell response to the virus, according to Jetelina, an assistant professor at the University of Texas Health Science Center at Houston. “Researchers are quickly studying this change. It could be concerning but it also could be nothing,” she wrote.

Delta descendants ascend

When a new variant is identified, it’s not immediately clear how great a threat it will pose.

“We went from alpha to mu, and only alpha and delta took off,” Pandori said, referencing the letters of the Greek alphabet used to name troubling strains or lineages. The more transmissible alpha variant first identified in the U.K. became the dominant variant in the U.S only to be replaced by the even more contagious delta variant first identified in India.

As the coronavirus continues to evolve as a result of ongoing transmission, he believes a descendent of delta eventually will become the next dominant strain. The delta variant, also called B.1.617.2, accounted for 90 percent of Nevada’s sequenced cases in the past 14 days, according to a Sept. 3 report by the state lab.

“Delta has proven to be extraordinary in its ability to spread,” he said. Through natural selection, strains that evolve from delta may be more deft at spreading.

Delta has so far produced 25 or so descendants. The handful or so identified in Nevada have tripled in the past week, Pandori said, contributing to his theory that a delta descendant eventually will dominate.

“We’ve got a bad situation here, because we’ve got a lot of unvaccinated people that can serve as replication entities for the virus, which drives mutation,” he said. ”Yes, vaccinated people can do the same thing, but they do it slower and for a shorter amount of time.”

With many people unvaccinated, the virus continues to rapidly evolve and the pandemic to linger, Pandori said. Constraints on normal living remain.

“There’s a lot of variants because we’re creating them,” he said “And as long as we continue to create these variants, we’re going to continue to live the lives that we currently live.”
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Please reread (or read) this kicker. This is our problem in the US right now. The solution is to get everyone who can get a vaccine to get them.

“We’ve got a bad situation here, because we’ve got a lot of unvaccinated people that can serve as replication entities for the virus, which drives mutation,” he said. ”Yes, vaccinated people can do the same thing, but they do it slower and for a shorter amount of time.”

With many people unvaccinated, the virus continues to rapidly evolve and the pandemic to linger, Pandori said. Constraints on normal living remain.

“There’s a lot of variants because we’re creating them,” he said “And as long as we continue to create these variants, we’re going to continue to live the lives that we currently live.”

It's shameful that this is a problem and the reality is in the end of this article. As long as people remain unvaccinated and continue to create new variants, we are going to continue to have mask mandates and all the other restrictions, along with needless illness and death. We have surpassed 40 million cases and 650,000 deaths in the US from this virus. At some point, we need to start taking this seriously, and I mean ALL of us. This is not a political issue, it's a public health issue.

And related,

White House Releases Vaccination Mandate Plan:

You can read the plan here - https://www.whitehouse.gov/covidplan/

Basically it requires vaccines or weekly testing for employees in healthcare at facilities that accept Medicare/Medicaid, as well as employers with over 100 employees. Federal Executive Branch employees and contractors that do business with the Federal Government will be required to be vaccinated, with no testing option. It was also moved to double fines for not wearing a mask on airplanes or on federal property. The new OSH Act rule will also require employers give time off for employees to get vaccinated.

Here's an Associated Press article if you don't want to wade through the actual guidance.
https://apnews.com/article/joe-biden-business-health-coronavirus-pandemic-executive-branch-18fb12993f05be13bf760946a6fb89be

In his most forceful pandemic actions and words, President Joe Biden on Thursday ordered sweeping new federal vaccine requirements for as many as 100 million Americans in an all-out effort to increase COVID-19 vaccinations and curb the surging delta variant.

Speaking at the White House, Biden sharply criticized the tens of millions of Americans who are not yet vaccinated, despite months of availability and incentives.

“We’ve been patient. But our patience is wearing thin, and your refusal has cost all of us,” he said, all but biting off his words. The unvaccinated minority “can cause a lot of damage, and they are.”

...
The expansive rules mandate that all employers with more than 100 workers require them to be vaccinated or test for the virus weekly, affecting about 80 million Americans. And the roughly 17 million workers at health facilities that receive federal Medicare or Medicaid also will have to be fully vaccinated.

Biden is also requiring vaccination for employees of the executive branch and contractors who do business with the federal government — with no option to test out. That covers several million more workers.

Biden announced the new requirements in a Thursday afternoon address from the White House as part of a new “action plan” to address the latest rise in coronavirus cases and the stagnating pace of COVID-19 shots.

Just two months ago Biden prematurely declared the nation’s “independence” from the virus. Now, despite more than 208 million Americans having at least one dose of the vaccines, the U.S. is seeing about 300% more new COVID-19 infections a day, about two-and-a-half times more hospitalizations, and nearly twice the number of deaths compared to the same time last year. Some 80 million people remain unvaccinated.

“We are in the tough stretch and it could last for a while,” Biden said.

After months of using promotions to drive the vaccination rate, Biden is taking a much firmer hand, as he blames people who have not yet received shots for the sharp rise in cases killing more than 1,000 people per day and imperiling a fragile economic rebound.

In addition to the vaccination requirements, Biden moved to double federal fines for airline passengers who refuse to wear masks on flights or to maintain face covering requirements on federal property in accordance with Centers for Disease Control and Prevention guidelines.

He announced that the government will work to increase the supply of virus tests, and that the White House has secured concessions from retailers including Walmart, Amazon, and Kroger to sell at-home testing kits at cost beginning this week.

The administration is also sending additional federal support to assist schools in safely operating, including additional funding for testing. And Biden called for large entertainment venues and arenas to require vaccinations or proof of a negative test for entry.

The requirement for large companies to mandate vaccinations or weekly testing for employees will be enacted through a forthcoming rule from the Occupational Safety and Health Administration that carries penalties of $14,000 per violation, an administration official said.

The rule will require that large companies provide paid time off for vaccination.

Meanwhile, the Centers for Medicare & Medicaid Services will extend a vaccination requirement issued earlier this summer — for nursing home staff — to other healthcare settings including hospitals, home-health agencies and dialysis centers.

Separately, the Department of Health and Human Services will require vaccinations in Head Start Programs, as well as schools run by the Department of Defense and Bureau of Indian Education, affecting about 300,000 employees.

Biden’s order for executive branch workers and contractors includes exceptions for workers seeking religious or medical exemptions from vaccination, according to press secretary Jen Psaki. Federal workers who don’t comply will be referred to their agencies’ human resources departments for counseling and discipline, to include potential termination.

An AP-NORC poll conducted in August found 55% of Americans in favor of requiring government workers to be fully vaccinated, compared with 21% opposed. Similar majorities also backed vaccine mandates for health care workers, teachers working at K-12 schools and workers who interact with the public, as at restaurants and stores.

Biden has encouraged COVID-19 vaccine requirements in settings like schools, workplaces and university campuses. On Thursday, the Los Angeles Board of Education voted to require all students 12 and older to be fully vaccinated in the the nation’s second-largest school district.

Walmart, the nation’s largest private employer, said in late July it was requiring that all workers at its headquarters in Bentonville, Arkansas, as well as its managers who travel within the U.S. be vaccinated against COVID-19 by Oct. 4. But the company had stopped short of requiring shots for its frontline workers.

CVS Health said in late August it would require certain employees who interact with patients to be fully vaccinated by the end of October. That includes nurses, care managers and pharmacists.

In the government, several federal agencies have previously announced vaccine requirements for much of their staffs, particularly those in healthcare roles like the Department of Veterans Affairs, and the Pentagon moved last month to require all servicemembers to get vaccinated. Combined, the White House estimates those requirements cover 2.5 million Americans. Thursday’s order is expected to impact nearly 2 million more federal workers and potentially millions of contractors.

Biden’s measures should help, but what’s really needed is a change in mindset for many people, said Dr. Joshua Sharfstein, vice dean at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

“There is an aspect to this now that has to do with our country being so divided,” said Sharfstein. “This has become so politicized that people can’t see the value of a vaccination that can save their lives. Our own divisions are preventing us from ending a pandemic.”

More than 177 million Americans are fully vaccinated against the coronavirus, but confirmed cases have shot up in recent weeks to an average of about 140,000 per day with on average about 1,000 deaths, according to data from the Centers for Disease Control and Prevention.

Most of the spread — and the vast majority of severe illness and death — is occurring among those not yet fully vaccinated. So-called breakthrough infections in vaccinated people occur, but tend to be far less dangerous.

Federal officials are moving ahead with plans to begin administering booster shots of the mRNA vaccines to bolster protection against the more transmissible delta variant. Last month Biden announced plans to make them available beginning on Sept. 20, but only the Pfizer vaccine will likely have received regulatory approval for a third dose by that time.

Officials are aiming to administer the booster shots about eight months after the second dose of the two-dose vaccines.
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And one more...

Vaccination Mandates are an American Tradition:
https://www.nytimes.com/2021/09/09/us/politics/vaccine-mandates-history.html

As disease and death reigned around them, some Americans declared that they would never get vaccinated and raged at government efforts to compel them. Anti-vaccination groups spread propaganda about terrible side effects and corrupt doctors. State officials tried to ban mandates, and people made fake vaccination certificates to evade inoculation rules already in place.

The years were 1898 to 1903, and the disease was smallpox. News articles and health board reports describe crowds of parents marching to schoolhouses to demand that their unvaccinated children be allowed in, said Michael Willrich, a professor of history at Brandeis University, with some even burning their own arms with nitric acid to mimic the characteristic scar left by the smallpox vaccine.

“People went to some pretty extraordinary lengths not to comply,” said Professor Willrich, who wrote “Pox: An American History,” a book about the civil liberties battles prompted by the epidemic.

If it all sounds familiar, well, there is nothing new under the sun: not years that feel like centuries, not the wailing and gnashing of teeth over masks, and not vaccine mandates either.

As the coronavirus overwhelms hospitals across the South and more than 650,000 Americans — an increasing number of them children — lie dead, the same pattern is emerging. On Thursday, President Biden announced that he would move to require most federal workers and contractors to be vaccinated and, more sweepingly, that all employers with 100 or more employees would have to mandate vaccines or weekly testing. Colleges, businesses and local governments have enacted mandates at a steady pace, and conservative anger has built accordingly.

On Monday, Representative Jim Jordan, Republican of Ohio, tweeted that vaccine mandates were “un-American.” In reality, they are a time-honored American tradition.

But to be fair, so is public fury over them.

“We’re really seeing a lot of echoes of the smallpox era,” said Elena Conis, an associate professor and historian of medicine at the University of California, Berkeley. “Mandates elicit resistance. They always have.”

The roots of U.S. vaccine mandates predate both the U.S. and vaccines. The colonies sought to prevent disease outbreaks by quarantining ships from Europe and sometimes, in the case of smallpox, requiring inoculations: a crude and much riskier predecessor to vaccinations in which doctors rubbed live smallpox virus into broken skin to induce a relatively mild infection that would guard against severe infection later. They were a source of enormous fear and anger.

In January 1777, George Washington mandated inoculations for the soldiers under his command in the Continental Army, writing that if smallpox were to break out, “we should have more to dread from it, than from the Sword of the Enemy.” Notably, it was in large part the soldiers’ desires that overcame his resistance to a mandate.

“They were the ones calling for it,” said Andrew Wehrman, an associate professor of history at Central Michigan University who studies the politics of medicine in the colonial and revolutionary eras. “There’s no record that I have seen — and I’ve looked — of any soldier turning it down, protesting it.”

Buoyed by the success of the mandate, Washington wrote to his brother in June 1777 that he was upset by a Virginia law restricting inoculations. “I would rather move for a Law to compell the Masters of Families to inoculate every Child born within a certain limitted time under severe Penalties,” he wrote.

Over the next century, many local governments did exactly that. Professor Wehrman this week tweeted an example of what, in an interview, he said was a “ubiquitous” phenomenon: The health board in Urbana, Ohio, Jordan’s hometown, enacted a requirement in 1867 that in any future epidemic, “the heads of families must see that all the members of their families have been vaccinated.”

But by the end of the 1800s, opposition was louder and more widespread. Some states, particularly in the West, introduced laws prohibiting vaccine mandates. Others narrowly passed mandates after intense debate.

The reasons for resistance were myriad: Some Americans opposed mandates on the grounds of personal liberty; some because they believed lawmakers were in cahoots with vaccine makers; and some because of safety concerns that were, to be fair, more grounded in reality than the modern equivalent. Vaccines then were not regulated the way they are now, and there were documented cases of doses contaminated with tetanus.

The government’s response resembled what, today, are wild conspiracy theories. Contrary to the assertions of some on the far right, the Biden administration has never suggested going door to door to force people to take coronavirus vaccines. But in the 1890s and 1900s, that actually happened: Squads of men would enter people’s homes in the middle of the night, breaking down doors if necessary, to inject people with smallpox vaccines.

Legally speaking, the Supreme Court resolved the issue of mandatory vaccinations in 1905, ruling 7-2 in Jacobson v. Massachusetts that they were constitutional.

The Constitution “does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint,” Justice John Marshall Harlan, known for defending civil liberties, wrote. “Real liberty for all could not exist under the operation of a principle which recognizes the right of each individual person to use his own, whether in respect of his person or his property, regardless of the injury that may be done to others.”

In the court of public opinion, there was no such resolution.

The polio vaccine was less controversial, mainly because it wasn’t initially mandated and because it had been funded by a widely respected nonprofit: the National Foundation for Infantile Paralysis, now called the March of Dimes. This reduced opposition based on mistrust of pharmaceutical companies, and most parents willingly got their children vaccinated. The measles vaccine, too, was not particularly controversial because mandates were not initially enforced.

“Nobody was enforcing vaccination, and so it simply didn’t elicit that mistrust,” Professor Conis said. In the smallpox era, by contrast, “skeptical people said, ‘Well, why are we doing this? It just benefits the companies making the vaccine and the doctors administering the vaccine, and why should we trust any of them?’”

But the fear and anger came roaring back with the introduction of childhood vaccination mandates in the 1970s. By 1980, all 50 states required schoolchildren to be vaccinated against an array of diseases.

None of it is new, but one thing distinguishes today’s anti-vaccination protesters from those of the past. The opposition was always political. It wasn’t always partisan.

“There are plenty of echoes today: There are liberty claims, there are strong sentiments about parental rights, there are concerns about the science, there are concerns about the profit involved,” Professor Willrich said. “But this party divide in terms of who is most likely to be hesitant or refuse a vaccine mandate is really, I think, something of our own 21st-century moment.”
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Sonya · Sep 10, 2021

Nevada COVID-19 updates for 9/10:

Test positivity (note, w/ 7-day lag) is fluctuating but up: 12.19% (+0.05%)
Hospitalizations are fluctuating but down: 1,105 (-10)
Cases are fluctuating but up: 1,044 (+21)

Clark County cases are up slightly: 547 (+8)
Washoe County cases are up: 279 (+5)

https://thenevadaindependent.com/coronavirus-data-nevada

Coronavirus Contextualized, 58th Edition:
https://thenevadaindependent.com/article/coronavirus-contextualized-58th-edition-numbers-remain-high-in-northern-rural-nevada-as-federal-government-announces-vaccine-mandates

Below, we take a look at how the northern and rural portions of the state continue to be hit hard by COVID-19 as the federal government announced new measures on Thursday aimed at curbing the virus’s spread, including a new employee vaccine mandate that is expected to affect as many as 100 million Americans.

Cases

Statewide case numbers remain high, though both Clark and Washoe counties have seen drops in recent days.

As of Thursday, 1,023 new cases were reported on average each day over the previous seven days, down from the highest point of the current wave so far, 1,160, which the state hit Aug. 24. That peak is just below the highest point of last summer’s wave, 1,176 on July 20, 2020, but a little less than half of the fall and winter wave case record, 2,736 on Dec. 10, 2020.

In Clark County, which was hit early and hard by the latest wave of the virus, cases have been fairly steadily decreasing for more than two weeks, hitting 539 on Thursday. The highest point of the current wave, which the state hit on Aug. 1, was 917. That peak is below both the high point of the 2020 summer wave — 1,072 on July 20, 2020 — and the fall and winter wave, when Clark County hit its highest seven-day case average ever of 2,092 on Jan. 12.

Washoe County, where cases were steadily rising for nearly two months, started to see some decreases this week, hitting 274 on Thursday, down from the highest point of the current wave, 295, last Thursday. That number is significantly higher than the peak of last summer’s small wave, 98 on July 30, 2020, and a little less than half of its record high point of 532 on Nov. 27 during the fall and winter wave.

Adjusted for population size, Washoe County’s case rate remains more than double Clark County’s. As of Thursday, Clark County was seeing 24 cases reported per 100,000 residents each day over the previous seven days, compared to 54 in Washoe County. The case rate in the other 15 counties, meanwhile, was 61.

Across the rest of the state, almost every other county continues to see elevated or increasing case numbers as well.

According to the Nevada State Public Health Lab’s weekly lineage report, the Delta variant was responsible for 93.7 percent of sequenced COVID-19 cases over the last five days.

Since the beginning of the pandemic, there have been 400,349 COVID-19 cases confirmed statewide, meaning 1 in 8 Nevadans has tested positive for the virus. More than 8 percent of those cases, 33,765, have been diagnosed in the last month, and nearly 2 percent, or 7,161 cases, have been reported in the last week.

Test positivity

The statewide test positivity rate, which looks at the percentage of tests coming back positive out of the total tested, has been fluctuating in recent days following a couple of weeks of steady decreases.

It is not possible to independently calculate the test positivity rate based on test encounters because the state only publicly reports the number of positive cases, not the number of positive test encounters. However, the state does provide this number, calculated as an average over a 14-day period with a seven-day lag. As of Tuesday, that number was 12.2 percent, down from a recent high of 16.4 percent on Aug. 13 but even with last week’s rate of 12.2 percent.

The test positivity rate remains more than double the World Health Organization’s recommended 5 percent threshold but less than the peak test positivity rate of 21.3 percent the state saw in mid-January.

Since the beginning of the pandemic, more than 1.9 million people — 62 percent of Nevadans — have been tested for COVID-19, and there have been more than 4 million individual testing encounters.

Vaccinations

The pace of vaccine distribution in Nevada is slightly down after several weeks of increases as the state worked to boost its vaccination rate.

As of Wednesday, about 6,100 vaccines were reported administered each day over the last seven days, down from 7,900 last week but still up from a low point of 5,200 on July 13.

Nearly 59 percent of Nevadans have now been either partially or fully vaccinated against COVID-19 — including nearly 49 percent fully vaccinated — and about 28 percent of Nevadans eligible for the vaccine have yet to receive it.

Since vaccinations started in December, more than 1.8 million people have received at least one dose of the COVID-19 vaccine and more than 1.5 million Nevadans have been fully vaccinated.

Among the counties, Carson City continues to have the highest percentage of residents fully vaccinated against COVID-19 at 55.7 percent, followed by Washoe County at 52.7 percent, Douglas County at 48.1 percent and Clark County at 44.2 percent. Tiny Storey County has still vaccinated the least, with only 16.4 percent of its residents partially or fully vaccinated.

Nationally, Nevada ranks 31st among the 50 states for percentage of its population fully vaccinated, at 48.7 percent, behind all of its neighbors except Idaho, at 48th.

Breakthrough cases

There have been 7,634 breakthrough cases — fully vaccinated individuals who have tested positive for COVID-19 — in Clark County as of Sept. 2, meaning that 0.75 percent of fully vaccinated individuals have contracted the virus. In Washoe County, there have been 1,701 breakthrough cases as of Thursday, representing 0.67 percent of fully vaccinated people in the county.

As of Sept. 2, there were 362 breakthrough hospitalizations in Clark County and 112 breakthrough deaths, meaning that 0.04 percent of vaccinated individuals in Clark County have been hospitalized and 0.01 percent have died.

Of the people hospitalized with breakthrough infections, 66 percent had underlying conditions, 74 percent were those 65 years or older and 60 percent were men.

Data from the Southern Nevada Health District released last week show that breakthrough cases represent just a small, but increasing, percentage of the total number of cases identified in Clark County each month. In August, fully vaccinated people represented 17.4 percent of overall cases, compared to 15.7 percent in July and 11.6 percent in June.

Deaths

The number of new COVID-19 deaths reported on average each day dropped this week, though it isn’t uncommon to see a drop in reported cases or deaths following holidays.

As of Thursday, 17 COVID-19 deaths were being reported on average each day over the prior seven days, down from 24 last week and a high point during the current wave of 25 on Aug. 30. Last summer’s surge peaked at an average of 21 daily deaths, while the fall and winter surge peaked at 45 daily deaths.

Over the last seven days, 116 new COVID-19 deaths have been reported across the state — down from 167 last week — including:

70 in Clark County

27 in Washoe County

5 in Lander County

4 in Churchill County

3 each in Lyon and Nye counties

2 in Elko County

1 each in Carson City and Douglas County

Since the beginning of the pandemic, there have been 6,681 deaths from COVID-19. In the last month, 641 deaths from COVID-19 were reported statewide, nearly 10 percent of the deaths reported statewide since the beginning of the pandemic.

Hospitalizations

The number of people hospitalized with COVID-19 statewide has been fluctuating in recent days, though statewide numbers are still down from where they were last month. That’s largely a result of decreasing hospitalizations in Clark County and increases in Washoe County and rural portions of the state.

As of Tuesday, there were 1,115 people hospitalized with confirmed or suspected cases of COVID-19 across the state, down slightly from 1,126 last week and significantly down from this wave’s peak of 1,317 on Aug. 10. The peak of last summer’s wave was 1,165, which the state hit on July 31, 2020, and the peak of the fall and winter wave was 2,025, on Dec. 13, 2020.

“COVID-19 hospitalizations represent upwards of 20-25% of all patients hospitalized in the northern and rural areas with some variation by the facilities,” the Nevada Hospital Association wrote in its weekly report. “The overwhelming majority of these patients are unvaccinated, driving some hospitals to publish pleas within their neighborhoods and communities to get vaccinated.”

The hospital association wrote that continued staffing shortages are affecting patient care, “including ambulances delayed at hospitals, difficulties discharging or placing patients in a skilled nursing facility, and delayed or canceled procedures.”

County by county

Fourteen counties are considered by the state to be at elevated risk for the spread of COVID-19 as of Thursday. That’s all except Pershing, White Pine and Lincoln.

Counties are considered at risk for elevated spread of COVID-19 if they meet two of the following three metrics:

The average number of tests per day per 100,000, calculated over a 14-day period. If this number is less than 100, a county could be considered at risk.

The case rate per 100,000, calculated by taking the number of cases diagnosed and reported over a 30-day period. If this number is greater than 200, a county could be considered at risk.

The case rate per 100,000 and the test positivity rate, calculated over a 14-day period with a seven-day lag. If the case rate is greater than 50 and the test positivity rate is greater than 8.0 percent, a county could be considered at risk.

The state continues to align its mask mandate with federal guidance, however, meaning it is using the CDC’s community transmission tracker to determine which counties are at substantial or high risk for the spread of COVID-19 and therefore required to abide by indoor mask mandates for vaccinated and unvaccinated individuals alike.

Under the CDC’s metrics, counties are considered at risk for “high” transmission if they have more than 100 cases per 100,000 residents in the last seven days, “substantial” if they have between 50 and 100, “moderate” if they have between 10 and 50 and “low” if they have fewer than 10.

As of Wednesday, all Nevada counties were considered at “high” or “substantial” risk of transmission. As of Friday, all counties will be required to follow universal indoor masking precautions for both vaccinated and unvaccinated individuals.

Counties can have mask mandates put in place if they have two weeks of “substantial” or “high” transmission; those mask mandates will automatically be removed after two weeks of “low” transmission.
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Doctors Explain the Persistent Loss of Taste and Smell some COVID Patients are Experiencing:
https://www.kolotv.com/2021/08/27/long-lasting-loss-smell/

Last January Jill Pellicciarini rang in the new year with a COVID infection. She says she woke up hitting a wall of fatigue. And it didn’t take long for the other symptoms to follow.

“Woke up one morning and in addition to not being able to smell or taste anything, was like a sense of a smell. It was very metallic, chemical metallic,” she says of the experience. “Somewhere between walking into a pool and that assault of chlorine. But, it didn’t smell like chlorine. It smelled like metal,” she says.

She says her loss of smell came and went. She worried she would never fully regain it. But those waves of no sense of smell came further and further apart as she fully recovered from COVID and received her vaccine.

But some patients aren’t as lucky as Jill.

Ear, nose and throat specialists are seeing patients, infected more than six months ago with the virus, who still have not regained their sense of smell.

“The people that have more persistent olfactory dysfunction are probably the younger people having less systemic illness, and less hospitalization and ventilation,” says Dr. Josh Meier with Nevada ENT.

Doctors don’t know why those who lose their sense of smell are less likely to be hospitalized. However, that sense of smell does not return quickly in some patients and no one can predict when that patient will be able to smell and for that matter taste food again.

To add to the problem, Dr. Meier says he is seeing a subset of patients who do regain those senses. But there’s a problem.

“Their smell has decreased after COVID,” says Dr. Meier. “It is still decreased, but now when they smell things, they smell bad. They don’t smell like they used to. But, it is never like it’s a good smell. It’s always like everything smells like garbage or burning trash,” says Dr. Meier.

Eating a great hamburger is the least of it. Loss of smell means patients can’t tell if food has gone bad, the smell of smoke--indicating a fire, or detect other pungent odors that help navigate our world.

There are no medicines to treat the problem, and no time frame in which patients can expect a faster recovery.

Dr. Meier says the only way to avoid the problem is to get the vaccine.
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Please take care of yourself this weekend if you're feeling some trauma fatigue around COVID and the 9/11 Annniversary.

COVID-19 Trauma Complicates the 9/11 'Anniversary Effect':
https://www.statnews.com/2021/09/10/covid-19-complicates-9-11-anniversary-effect/

Trauma caused by violence or tragic events can have a huge impact on individuals’ lives. And though their responses to trauma may fade away, it can reemerge or be heightened by anniversaries. That the 20th anniversary of the horrific attacks on the United States on September 11, 2001, is taking place amid the ongoing collective tragedy of the Covid-19 pandemic is bound to make this year’s remembrances of 9/11 extra difficult for some Americans.

When two hijacked commercial airliners plowed into the World Trade Center’s Twin Towers, a third crashed into the Pentagon, and a fourth plunged into a field near Shanksville, Pennsylvania — diverted by the plane’s passengers from its intended target — life in the U.S. came to a halt. The events of that day traumatized tens of thousands of people and forced many to rethink America’s place in the world.

Covid-19 is doing something similar, albeit spread out over months.

Though these two generation-defining occurrences are, on the surface, quite different and have different timelines, their aftermaths share some similarities.

There are several normal and common responses to a traumatic event. These include hypervigilance (feeling on edge), avoiding triggers related to the trauma, trying to maintain control of people or situations around you, not knowing who or what to trust, and difficulty knowing who you can safely share your thoughts and emotions with.

It’s important to understand that these responses are different from those caused by grief or bereavement. They are the result of experiencing vicarious trauma (things no one should have see); of traumatic stress (doing things no one should ever have to do); of moral distress (having to make decisions that are less than optimal); and more.

And though these responses lessen for some people with distance from the traumatic event, they can reemerge as part of what’s called the anniversary effect.

The 9/11 anniversary effect comes at a particularly difficult time. Results from the national Household Pulse Survey, conducted by the National Center for Health Statistics in partnership with the Census Bureau, show that 32% of Americans reported symptoms of depression or anxiety in August 2021. That’s two to three times higher than in pre-pandemic years.

What many people do around the time of an anniversary is measure what’s happened in their lives since the trauma. But that’s hard to do in the midst of a pandemic. We’re in phase four of the pandemic, and don’t know what phase five will be. We don’t know what other variants will emerge, and if they might be even worse than Delta. And the country is in the midst of a disastrous polarization that is making things worse.

People who have experienced trauma generally follow one of three paths: a gradual return to pre-trauma life, a life shaped by post-traumatic stress, and one changed by post-traumatic growth. Helping people achieve the latter is something I have tried do over the course of a 30-year career studying trauma and working with traumatized individuals.

Following a traumatic event, there’s a strong pull to focus on the negative. Humans are hard wired to see the negative as part of our fight or flight survival mechanism. While the negative screams at you, the positive only whispers. It is very hard to not be pulled down by the inertia of the negative.

Yet some people harness their feelings and channel them in ways that change the trajectories of their lives. I recall a student of mine who had lost a child to sudden infant death syndrome. Inspired by a social worker who helped her come to grips with this tragedy, she threw herself into learning about crisis intervention and went on to help other mothers who had lost young children. It changed her entire life.

The concept of healing from trauma by trying to move beyond one’s circumstance in order to help others isn’t new. A mainstay of Alcoholics Anonymous since the mid-1930s is that one person helps another and in so doing helps himself or herself.

Recovery is also aided by a sense of shared experience, something that my colleagues and I have been seeing with our efforts on behalf of health care workers, many of whom are traumatized — sometimes daily — by the pandemic. Our Stress Trauma and Resilience (STAR) program has trained close to 900 people to do peer support for their colleagues in the form of brief emotional support teams. This support is a framework of some psychological first aid, a bit of cognitive reframing, and motivational interviewing stitched together. Over the past 10 years, this program has helped create a common framework and language for addressing the impact of traumatic stress, vicarious trauma, and moral distress. It literally gives people permission to check in with peers who are distressed and a framework for processing this distress.

Today what we are working toward is giving people a common language to talk about working in a time of coronavirus, a time when so many health care workers have felt that the organizations they work for don’t care about them or have their backs — and many rightfully so. In addition, because health care professionals are trained to think critically, many say to themselves, “It’s all my fault” or “I should have made a different decision.”

But when you have peers trained to say “I know how you are feeling” and “Wait a minute, you weren’t caring for that patient alone but are part of a team,” it turns what can be traumatic memories into common understanding. It is empowering for the people who offer help and healing for the people who need to hear it.

In our Stress, Trauma, and Resilience Trauma Recovery Center, we hold group orientations for victims of crime. These sessions help individuals who have felt isolated by their experience know from the get-go they aren’t alone. This is especially important for individuals dealing with intimate partner abuse, which is an isolating and shaming situation to begin with.

Working against recovery or healing is what I call community betrayal. We saw it after 9/11 from the deniers and the conspiracy theorists. We’re seeing much the same thing during this pandemic. A colleague of mine who is an emergency physician described it to me like this: For three months, as she cared for people with Covid-19, many of whom died, she stayed in a hotel rather than go home and bring the virus to her children. She recalls how difficult it was for her to go outside the hospital during that time and see people not wearing masks or hear people on the news or on social media deny that Covid was real. The death of a colleague who contracted Covid and died three days later made this community betrayal even more enormous.

After 9/11, Americans generally pulled together. We need that today, though sadly it appears we are headed in the opposite direction. Another thing that could help people cope with Covid-19 is getting out and interacting with others, and ideally helping others. But therein lies a challenge with Covid-19: People are being advised to lock down for periods and avoid everyone not in their “bubble.” What they do instead is watch TV or be on social media, which can be harmful.

Just as many people were traumatized by watching the Twin Towers burn and collapse over and over again on television, the health care catastrophe wrought by Covid-19 and the deaths from it are causing secondary trauma that’s almost impossible to escape. Descriptions, often with vivid video, of the wildfires in the West and the hurricane damage in the South only compound the problem.

For people concerned about their mental health, I offer a simple suggestion: Turn off the television and eschew social media. Take care of your children or parents or elderly neighbors or friends. Get out of your head and into the life of someone who needs you.
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If you need help, please reach out. You can call the Suicide Hotline at 800-273-8255, or go to their website - https://suicidepreventionlifeline.org/

This isn't exactly COVID related, but it is extremely exciting news for mRNA technology. 19 of 20 mice in this study treated with "the four-component mixture had complete tumor regression."

BioNTech Reports Promising Data on mRNA Cocktail in Mouse Models of Colon Cancer and Melanoma
https://www.fiercebiotech.com/research/biontech-reports-promising-data-mrna-cocktail-mouse-models-colon-cancer-and-melanoma

Now that two mRNA COVID-19 vaccines have been embraced as tools to end the pandemic, their developers are looking for ways to apply the technology to other diseases. They include Pfizer’s COVID vaccine partner, BioNTech, which now has fresh data on one of the mRNA therapies it is developing for cancer.

A BioNTech-led team designed a cocktail of mRNAs that instruct cells to produce four cancer-fighting molecules. The treatment suppressed tumors in mouse models of colon cancer and melanoma, and it worked even better when combined with checkpoint inhibition, they reported in the journal Science Translational Medicine.

The mRNAs in the experimental treatment code for the cytokines interleukin-12 (IL-12), interferon-alpha, granulocyte-macrophage colony-stimulating factor and IL-15 sushi. These cytokines are known to assist the immune system in fighting cancer. But their short half-life makes them difficult to administer to patients as treatments, because they can be toxic.

Preclinical studies have shown that administering cytokines directly to tumors with gene therapy could be a viable approach, but that can also trigger unwanted side effects, the scientists explained in their study.

“In contrast, mRNA is an ideal therapeutic to ensure transient and local translation of cytokines, which can be delivered with or without specialized formulation and be further tuned for translation and activity on innate immune receptors,” they wrote in the paper.

The researchers injected the mRNA mixture into colon and melanoma tumors in 20 mice. The treatment halted tumor growth, and caused a complete regression of the cancer in 17 of the animals, they reported.

They then combined the mRNA cocktail with anti-CTLA-4 or anti-PD-1 checkpoint inhibitors. That strengthened the anti-tumor effects, as well as the tumor regression.

BioNTech’s co-authors on the study included researchers from Sanofi, which has partnered with the mRNA pioneer to develop the therapy. The two companies have launched a phase 1 basket trial of the drug, dubbed SAR441000, in patients with solid tumors. They are testing it both as a monotherapy and in combination with Libtayo, a PD-1 inhibitor launched by Sanofi and Regeneron last year.

SAR441000 joins a long list of mRNA-based oncology projects at BioNTech. The company is also in phase 2 trials of BNT122, a Roche-partnered melanoma treatment. And it has a dozen other cancer drugs in development addressing prostate cancer, triple-negative breast cancer and several other solid tumor types.
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You can find the study here - https://www.science.org/doi/10.1126/scitranslmed.abc7804

And the Human Trial can be found here - https://clinicaltrials.gov/ct2/show/NCT03871348

I want to end this week by talking about a piece of hate mail I got last night.

The whole email was mostly a rant about the new vaccine mandate plan and something about tyranny and freedom and what an awful bitch I am for posting about it. I would like to address a few of the issues brought up, partially because this isn't the first email I've received like this, but also because I think this is an important issue.

Vaccine mandates are not new. We have had them for centuries in this country, in fact a Supreme Court case on their constitutionality was decided in 1905 (Jacobson v. Massachusetts).

In 2019, my state (and as far as I know. all the other states) required vaccines for children to enroll in school - MMR, Polio, Chickenpox, TDap and Hepatitis B. To serve in the military, you are mandated to get 17 different vaccinations. George Washington mandated vaccines for troops when smallpox was spreading. It's not authoritarianism or a violation of the constitution. It's public health.

In addition, if you really don't want to get the vaccine, nobody is forcing you. There are options. If your employer requires them, you can find another job that doesn't. And under the guidelines provided by the White House yesterday, you have the option to provide a weekly negative COVID test. So much unnecessary pearl clutching is going on.

The person who sent the email asked: "Why do you care if I get the vaccine or not?"

I don't want anyone to get sick with this virus and I really don't want anyone to die, especially when we have highly effective and safe vaccines available for free.

I understand the argument that you should be able to make decisions about your health for yourself. But your decision not to take the vaccine doesn't stop with you. Your decision affects all of us.

Not getting vaccinated keeps you at risk of getting and spreading the virus. When the virus spreads, it mutates, creating more transmissible and more dangerous versions of the virus that gets spread to others, creating more mutations and more illness.

When we have spikes like the one we are seeing right now, hospitals are full of unvaccinated people with COVID. This means that there isn't availability of staff and resources for things like cancer surgery, car accidents, heart attacks, etc.

When we have spikes like the one we are having now, things get shut down, or capacity limits are put in place. Mask mandates crop up in places like casinos because unvaccinated people didn't follow the CDC guidance to wear masks in public places. Schools are forced to close when outbreaks occur and that's not good for children, education or parents.

And high levels of transmission put people like myself, with immune system issues, at a much higher risk. Cancer patients, organ transplant patients, people with lowered immune systems due to medications, etc. are all at risk because of the unvaccinated. I did everything that was asked of me. I did the right thing, but I'm back to curbside pickup at the grocery store and staying home as much as I can because you can't be bothered to do what is best for public health.

Pandemics sicken and kill a lot of people. According to the NYT, 657,770 have died so far in the United States, 1,579 yesterday alone. As we look back at 9/11, when the world mourned the loss of 3.000 people, it's kind of ironic that nobody seems to care that we're losing that many people every two days in this country. Over 550 deaths from COVID in Florida and Texas yesterday alone.

Our country is only 54% fully vaccinated, despite the wide availability of a free vaccine. Nobody under 12 is eligible, leaving all children at risk. But even among eligible people, only 63% are fully vaccinated.

Public health doesn't exist in a vacuum. Your decision makes things harder for all of us. Get your vaccine and we can end this stupid pandemic and get back to living our lives and bickering about stupid things like resort fees and 6:5 blackjack. The longer we remain at these terrible rates of vaccination, the longer this pandemic continues, and the more likely we are to create a variant that evades the vaccine and puts us all back to square one.

Some people saw a political advantage to make this a culture war issue, sending people to fish tank cleaner and animal dewormer instead of the proven and effective vaccines. Stop it. We could be like Denmark right now if we weren't so stupid in this country. Denmark has reached 80% vaccination rates and have dropped their COVID restrictions and are returning to normal again. We could too if that 30% or so of the country would just get vaccinated.

https://apnews.com/article/europe-health-coronavirus-pandemic-epidemics-denmark-58f504553ea4c54bb5ae129e74989625

After 548 days with restrictions to limit the spread of COVID-19, Denmark’s high vaccination rate has enabled the Scandinavian country to become one of the first European Union nations to lift all domestic restrictions.

The return to normality has been gradual, but as of Friday, the digital pass — a proof of having been vaccinated — is no longer required when entering night clubs, making it the last virus safeguard to fall.

More than 80% of people above the age of 12 have had the two shots.

“I wouldn’t say it is too early. We have opened the door but we have also said that we can close it if needed,” Soeren Riis Paludan, a professor of virology with the Aarhus University in Denmark’s second largest city, told The Associated Press.

As of midnight, the Danish government no longer considers COVID-19 “a socially critical disease.” Health Minister Magnus Heunicke said Aug. 27 that “the epidemic is under control” but warned: “we are not out of the epidemic” and the government will act as needed if necessary.

Jens Lundgren, a professor of viral diseases at the Copenhagen University Hospital said the government would be “quite willing” to reintroduce restrictions if infections spike again. He pointed at night clubs being the last thing to open because “it is the activity associated with the highest risk of transmission.”

“The world is in the middle of a pandemic and none of us can claim that we are beyond the pandemic,” said Lundgren who described Denmark as being “an isolated island” where the vaccine rollout has worked.

“Nobody should have the illusion that we are over this.”

The tipping point in Denmark to start easing restrictions came when a majority in the age group of 50+ had the two shots, Riis Paludan said.

Since Aug. 14, a face mask on public transportation is no longer mandatory. On Sept. 1, night clubs reopened, limits on public gatherings were removed and it was no longer mandatory to show the pass when one wanted to be seated inside restaurants, or go to soccer games, fitness centers or hairdresser.

However, the face mask or shield are still mandatory at airports and people are advised to wear one when at the doctor’s, test centers or hospitals. Distancing is still recommended and strict entry restrictions still apply for non Danes at the borders. The outbreak is still considered “an ordinary dangerous illness.”

“The ghost of corona sits in the back of our head,” said Frank Oestergaard, a patron in a downtown Copenhagen restaurant.

After more than a year, several European countries are starting to see the light at the end of the tunnel, but with caveats. Some have lifted restrictions but will introduce a vaccination passport. Others expect to do so soon. And in some places, there are few restrictions and they are not respected.

On July 19, the British government lifted remaining legal restrictions for England, though it still plans to introduce a vaccination passport for entry into nightclubs and other crowded venues at the end of September.

In Denmark’s neighbor Sweden, which has stood out among European nations for its comparatively hands-off response to the pandemic, the government said earlier this month that most restrictions, including the ceiling for private and public gatherings and the advice to work from home, will be removed as of Sept. 29.

The Scandinavian country has not gone into lockdowns or closed businesses, relying instead on citizens’ sense of civic duty to control infection. According to official figures, 70% of people over the age of 15 have gotten both shots and nearly 82 % have received the first shot.

And despite a surge, most of the Balkan countries practically have no restrictions, and those which are in place are not respected.

In late May, the Danish government presented the passport app featuring a QR code and a green bar if the person has been vaccinated twice or recently tested negative. A paper version also was available. People either had to scan the code or flash it before entering an airport, a harbor, a train station, a hairdresser or an eatery.

While in many European countries there were pockets of resistance such passes, people used it all the time in Denmark because people trust authorities, Riis Paludan said.

Armed with their pass, people were able to get a haircut, have a drink with friends or attend a cultural event. “It was getting one’s freedom back instead of having to sit at home in isolation,” laughed Oestergaard.

“I think it’s very good, so hopefully we can get back to a normal day in the restaurant business without checking people and just no restrictions whatsoever. That’s nice,” said cafe owner Ralph Marker.
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Oh, and also, don't send me hate mail. I haven't done anything to deserve your abuse.

Have a good weekend everyone! Enjoy the last of summer weather if you still have it.

Sonya · Sep 13, 2021

Nevada COVID-19 updates for 9/13:

Test positivity (note, w/ 7-day lag) is fluctuating but up: 11.28% (+0.01%)
Hospitalizations are fluctuating but up: 1,120 (+15)
Cases are fluctuating but up: 1,225 (+181)

Clark County cases are up: 583 (+36)
Washoe County cases are up: 279 (+100)

*(+XX) reflects change since Friday

A caveat with these numbers: Whenever there is a holiday (Labor Day, in this case) it messes up the seven-day averages for a bit, so that may be playing into the case number increase a bit here. Tomorrow will give us a better sense of where things are at.

There are also other reasons the numbers are weird around holidays, including lab delays, people just not voluntarily seeking testing because they're off doing things, etc. etc. So always best to look at numbers around a holiday with a bit of caution.

https://thenevadaindependent.com/coronavirus-data-nevada

Vaccine Mandates Crash Into America's 'Don't Tell Me What To Do' State:
https://www.politico.com/news/magazine/2021/09/13/covid-crushed-las-vegas-revive-510204

The back doors of the union hall are propped open, letting the desert sunshine in to reflect off metal shelves lining the cinder block walls. On them are jars of peanut butter and piles of canned goods, unfolded cardboard boxes and other remnants of the food bank the local entertainment union set up here to help its 1,700 members after the coronavirus shutdowns last year threw them out of work almost overnight.

Standing on the back steps, facing out toward the Las Vegas Strip on a 100-plus-degree August Friday, Phil Jaynes reflected on the progress his union had made in the months since. As coronavirus case counts fell and high-rise hotels, theaters and convention spaces began hiring again this past spring, the food bank grew quieter. In early July, Jaynes, as president of the International Alliance of Theatrical Stage Employees Local 720, reopened the union’s doors for the first time in 16 months.

Then everything started to move in the wrong direction again.

Within days of Las Vegas’ official reopening in early June, Covid case numbers had begun trending up, and within weeks some events around the city were getting canceled. Once Las Vegas reached the highest infection rate in the country among major metropolitan areas, and once 13 cast and crew members at a local hotel tested positive for the virus, Jaynes shut the union hall doors again — 11 days after reopening them.

He sat down to send a message to his members, though what came out turned into more of a desperate plea. “This did not have to happen,” Jaynes wrote. “We are on the brink of a massive flood of work that might be cut to a trickle because people are not getting vaccinated.” Jaynes gets emotional reading the letter even now, weeks after sending it, pulling off his thick-rimmed glasses before a tear slips down the union logo emblazoned on his black face mask. “It’s just this post-traumatic … ” he trails off. “It feels like March of 2020.”

After its halting reopening and a summer of Delta, Las Vegas has become a case study in just how difficult it will be to fully reopen America’s services sector — and especially its entertainment, tourism and hospitality industries, the ones fueled by in-person activity — as long as the pandemic remains an active threat. Services account for more than two-thirds of U.S. economic activity, and growth in that sector will be crucial to a robust recovery across the country. But without broader uptake of the vaccine, cities everywhere risk entering into the brutal boom-and-bust cycle Las Vegas is currently enduring: a celebratory reopening followed by near-immediate illness and death. Pull back, mask up, reset, reopen, repeat.

It's exactly the scenario President Joe Biden is seeking to put a stop to by mandating vaccines for federal workers and requiring, via a rule set to be written in the coming weeks, that private businesses with more than 100 employees either mandate vaccinations or submit workers to weekly testing.

“A lot of people thought once we got the vaccine, everything was going to be fine. The pandemic was going to be over, and we’d be back to normal,” says Rep. Dina Titus (D-Nev.), who has represented Vegas for nine years. “Well, we’re not back to normal.”

It wasn’t supposed to have to come to this. One in 3 Las Vegas workers was out of a job at the peak of the pandemic shutdowns last year, and unemployment in Nevada overall stood at nearly 30 percent — the highest level on record for any state since the government began tracking the data in the 1970s. The 2021 reopening was going to be the start of something new. The vaccine was here, and, with any luck, the four-mile Strip that supports half the state’s economy would soon be flooded with visitors. Surely Las Vegas, a city in the business of bringing people together, would recognize the economic need to knock out the coronavirus and get back to normal as soon as possible.

But with just over one-third of Vegas’ Clark County fully vaccinated by the June 1 reopening, when the people started to flood back, so did the virus — and at a rapid pace. Case counts skyrocketed, with the county’s seven-day average of new daily cases jumping 86 percent in a week. By early July, the case rate had risen nearly 200 percent, and the White House designated Las Vegas a “sustained hot spot” as the hospitals filled. Honolulu, Chicago, Los Angeles and other places warned their citizens not to travel to Las Vegas, a city more economically dependent on its visitors than perhaps anywhere else in the United States.

When Democratic Gov. Steve Sisolak, following CDC recommendations, brought back mask mandates to the Strip, it began losing business from both sides of the spectrum: those who stayed away for fear of catching the virus, and those who canceled plans because they didn’t want to have to abide by public health rules while they were here. Even despite a surge in visitors — the city welcomed more than 3.3 million tourists in July, and gaming revenue hit a record high — it all happened fast enough that the labor market hardly had a chance to recover. Unemployment here remained close to 10 percent in July — nearly double the national average and the highest of any major metropolitan area in the country. As of Sept. 10, the entire state of Nevada was back under an indoor mask mandate.

Biden’s new vaccine intervention for private businesses marks a dramatic step, one legal experts say is within his authority but that still sparked near-immediate pushback, including multiple threats of lawsuits from GOP governors and the Republican National Committee. Even under a best-case scenario for Biden, it will likely be weeks before the rule is written and several weeks more before companies will be required to comply, and it remains unclear how easily the measure will be enforced.

Just how effective a federal vaccine mandate will be in a place like Clark County is particularly uncertain. It’s a blue enclave in a deep purple state and an area where just over half the eligible population is fully vaccinated, compared with 62 percent nationally. There is a strong libertarian streak in Nevada, which one paramedic working to distribute vaccines described to me as a “don’t tell me what to do” state. Las Vegas Mayor Carolyn Goodman, an Independent who oversees the city but not the Strip, has consistently downplayed the severity of the pandemic and pushed back against coronavirus restrictions since early last year.

And even while there had been increasing recognition among business owners and many elected officials here that some sort of mandate — whether for workers or for anyone wanting to eat or gamble indoors — is likely the best and perhaps the only path forward, there’s concern even among supporters that a presidential decree forcing private companies to act could spark a backlash from Nevada’s right wing and politicize the vaccine even further. The Las Vegas Chamber of Commerce, for example, had already been encouraging vaccines and adopted the shot-or-test policy for its own employees, but opposes the mandate itself. Jaynes, too, worries the new measures could provide ammunition for those who are already anti-vaccine and who will “preach about this as the slippery slope” toward total government control.

Biden’s move in some ways provides cover to local officials and employers in Nevada who had supported a stricter vaccine mandate but felt helpless to impose one. But a certain degree of local control remains over when and how to implement the new rules, and whether to push back. And for smaller businesses that are not covered under the mandate, and that have spent 18 months struggling to stay open, there are still the risks of voluntarily cutting off customers or discouraging an already scarce labor pool if they choose to implement their own vaccine requirements.

Looming over the debate is the race for governor — a fight between Sisolak, the first Democrat to lead the state since 1999, and a growing cast of Republicans vying to unseat him next year. While Sisolak has begged his constituents to get their shots, because “no one wants to mandate,” GOP candidates have slammed him for his “iron-fisted government overreach,” and warned, falsely, that vaccines are “garbage” that will “kill millions.” Goodman, the Las Vegas mayor, has criticized the governor for ruling like “a dictator.” Sisolak says he will work to “ensure a successful rollout” of Biden’s new measures, while the Nevada GOP has suggested implementing them would run against Democrats’ “pro-choice” ideals.

In Nevada’s other statewide race next year, for the Senate, Adam Laxalt, who previously served as attorney general of the state and later was Donald Trump’s Nevada campaign co-chair, is running to unseat Democratic Sen. Catherine Cortez Masto after spending much of the past year working to overturn the 2020 election results in Nevada and declaring that “draconian shutdowns based on political science have not worked.”

Nevada presents a microcosm, in other words, of the vaccine debate playing out nationwide — albeit with higher stakes, given just how dependent the state’s economy is on Las Vegas’ tourism business. And because of that, because of the way so much of the city lives and dies on the Strip’s ability to welcome visitors from around the country and the world, the case for the vaccine here has become as much about money as it is about public health. If the latter argument hasn’t worked so far, the thinking goes, maybe the former will — a hypothesis that is being tested here in real-time.

Jaynes is trying it with his members, many of whom, he says, “have felt emboldened by the last president to just believe what they want to believe” about vaccines. “I tell them, ‘Remember that time when we were all sitting around doing absolutely nothing, and we were just waiting for that vaccine to come out? It came out! And now we’re going back to work,’” Jaynes says. “I’m just telling them, ‘I don’t care what you feel about it. I’m just letting you know that if you don’t get vaccinated, you’re not going to work.’"

“That’s it.”

-----

It’s still too early to measure the full impact of the Delta variant on the economic recovery nationwide, but there has been a tangible dampening effect. Major forecasters, from Goldman Sachs to Wells Fargo, slashed their outlooks for growth as the spike in cases hit the services sector and stoked concerns over a drop in spending and further job losses. The economy added less than one-quarter as many jobs in August as it did in June and July, driven by the net zero jobs created in the hard-hit leisure and hospitality sectors.

Perhaps most dramatically, consumer confidence also plunged in August, University of Michigan’s Consumer Sentiment Index found, showing the “least favorable economic prospects” in more than a decade. That was partly due to “an emotional response from dashed hopes that the pandemic would soon end and lives could return to normal,” as the survey’s chief economist, Richard Curtin, put it.

Las Vegas shows what that economic impact looks like. Coronavirus case counts here have been trending about four weeks ahead of the rest of the country, and as they have risen — and the mask mandate was reinstated — some business owners said they saw a direct hit to their bottom lines. While leisure travel has bounced back to some degree, Las Vegas’ dominant convention industry has yet to recover — and will not until international travel returns — which has left weekdays, in particular, far quieter than usual.

“Vegas is sort of the center of letting everything else go, and just focusing on the fun,” says David Noll, who runs two businesses in the city — the CEG Dealer School, which trains casino dealers, and Casino Quest, which teaches gambling techniques and tricks for $20 an hour. “As long as people have money to spend and, you know, proclivities towards drinking and gambling and everything else that goes with it, they’re going to come.”

Even so, Noll has seen the effects of the Delta variant take hold, especially at Casino Quest, which often hosts groups of tourists learning games such as blackjack and poker for the first time, as well as regulars who want to improve. Through the summer, when the masks were off, revenues at the store were soaring roughly 25 percent month over month. Then there was the bachelor party that canceled its trip because the guys didn’t want to wear masks. And the group of medical professionals who canceled because they were concerned about the optics of holding an indoor event at a gaming store. In August, Casino Quest revenues dropped 11 percent below normal — the first month of losses since the store first reopened in the peak of the pandemic last summer, Noll says.

Part of the concern is what’s going to happen to the economy once the unprecedented level of stimulus money the government doled out last year runs out, after the federal jobless benefits expire and the excess savings dry up. Before the unemployment aid ended on Labor Day, federal dollars pouring into the state accounted for roughly 6 percent of all wages, according to Bob Potts, deputy director of the Nevada Governor’s Office of Economic Development.

The end of that program is a double whammy for workers who lose those benefits but are still unable to find work. Despite months of improvement in the state’s labor market before the Delta variant took hold, more than 40 percent of the 60,000 members of Culinary Workers Union Local 226, the powerful union representing casino workers on and off the Strip, have yet to return to work, says Geoconda Argüello-Kline, the group’s secretary-treasurer. Potts estimates that as many as 50,000 jobs in the leisure and hospitality sector, particularly in the accommodations realm, might never return.

Policymakers and businesses in Nevada have to strike a near-impossible balance between boosting the economy without inflating it, and between welcoming people from around the world to have fun, while implementing restrictions to keep them safe.

“Customers don’t want to come if they feel like they’re going in a hospital to gamble,” Titus, the congresswoman, says. “So, it can’t be too strict. But if they don’t feel safe, then they’re not going to come, either.”

A few blocks up the Strip at Resorts World, a new $4.3 billion mega-property that opened in June, it was quiet throughout the casino on a recent Tuesday during happy hour. An employee at the formerly 24-hour convenience store across the street said she had been hopeful the new resort would bring a flood of business and allow the store to restore its hours, but that has yet to happen. And Josh Marrujo, a bartender at the Dawg House Saloon & Sports Book inside the resort, said it had been noticeably less busy since the return of the mask mandate — a step more damaging, he suggested, because of its inconvenience than for the increase in health risks that it symbolizes.

“Hey, it’s Sin City. You come here to have a good time,” Marrujo said. “You don’t come here to worry about — well, anything, really.”

-----

The orange bulbs of the road sign blinked urgently, flashing a message to the cars speeding by: “COVID VACCINES. AT CITY HALL. LEFT ON MAIN STREET.”

Inside, at the second-floor vaccine clinic, the setup was sanitized and sparse. Two rows of chairs were spaced 6 feet apart. A handful of volunteers from the fire department and medical students from the University of Nevada-Las Vegas chattered in hushed voices. Bags of Lays and Doritos lay scattered on a table covered with a “Get Vaxxed Vegas” blanket. The City Hall clinic had the vague feel of being all dressed up with nowhere to go: In the first three and a half hours it had been open that morning, just 10 people showed up looking for a vaccine.

The clinic is part of a major push across southern Nevada to make the shots as accessible as possible. Mi Familia Vota, an organization that has previously focused on increasing voter registration and participation in Latino and immigrant communities, began shifting its Nevada operations in June to focus on getting out the vaccine; by late August it had doled out 2,300 shots in partnership with the city of Las Vegas and other organizations. And elected officials are focused on accessibility issues as well. In a single day in late summer, Michael Naft — a commissioner on the seven-seat Board of County Commissioners, which has jurisdiction over the Strip — oversaw vaccine clinics in his district at a mosque, a fire station and a strip club. “So, there’s something for everybody,” Naft says.

Still, even after months of effort, Clark County’s vaccination rate has lagged the national average, and only about 53 percent of residents ages 12 and older were fully vaccinated by the end of August, according to the CDC tracker. That puts the county behind most others that house major cities, where vaccination rates tend to be higher than in more rural areas, and on par with places in the Deep South, including Alabama’s Jefferson County, home to Birmingham.

The holdouts are wearing on officials in a community that has been devastated by the coronavirus — 1 in 7 people has been infected at this point — but that has encountered enduring resistance from people who say they don’t trust the science. “We’ve been at this for seven months now,” says Dustin Signor, a community paramedic with the city of Las Vegas. “And it’s just — it’s really frustrating.”

As the Biden administration works to push its vaccine mandate through the system and into effect, the latest approach to try to increase vaccine uptake here has centered on the economic implications — the idea that getting a shot is the surest way for city residents to keep their jobs and avoid another shutdown. It has worked to some degree, among people who had not been persuaded that a vaccine would protect them from the coronavirus, as well as those who have resisted the $5 million in cash prizes and college tuition credits that Sisolak began rolling out in June. And it’s been particularly impactful among the Latino community, where the main concerns have been whether the casinos were going to reduce capacity again or construction workers were going to lose their hours, says Cecia Alvarado, the Nevada state director for Mi Familia Vota.

“That’s honestly what terrifies them even more than Covid: having to go through it again, losing their jobs and income. That’s more concerning to them than, you know, telling them that you have to wear masks, you have to get vaccinated,” she says.

This argument also preys on people’s fears of a return to the bleak days of March 2020, when casinos had to build makeshift locks to find a way to close doors that had never been shut before. (“An emotional moment,” Naft, a Las Vegas native, calls it.) The vaccine, then, is offered as a way out. “That’s been the message,” Titus says. “You want the jobs back, you want the conventions back, you want the fun times back, then we have to make recovering the priority and getting those shots in arms.”

The rising concern is that Clark County might be close to hitting its vaccine ceiling, even as it remains some 330,000 shots away from getting 70 percent of the eligible population vaccinated, a level the Biden administration had set as a nationwide goal. The murmuring among many of those tasked with doling out vaccines has been that requiring the shot, either at the public- or private-sector level, might be the only way to get closer to that number. And that’s where Biden’s mandate could play a crucial role.

“We can’t wait for people to come to us,” Titus said after touring the City Hall clinic.

Some major employers and venues in Las Vegas had already moved to impose vaccine requirements even ahead of Biden’s mandate. Sisolak declared in late August that any large venues seating 4,000 or more people could opt out of his mask mandate if they required proof of vaccination. Later that same day, the Las Vegas Raiders announced they would ask for vaccination status at the city’s brand-new Allegiant Stadium — and anyone who hadn’t received a vaccine could only be let in if they got a shot on site, and then wore a mask. MGM Resorts International, one of the state’s largest employers, also has started requiring vaccinations for all new hires and will soon require them for salaried workers, as well.

Nationally, the percentage of employers currently mandating vaccines or planning to more than doubled between January and August, from less than 10 percent to more than 20 percent, according to a recent survey from employment law firm Littler. And while the number of job postings requiring vaccination soared in August — rising 242 percent over the month — the overall fraction of hiring ads listing a mandate remained tiny: less than 1 percent of all job ads on the hiring website Indeed, according to an analysis by the company.

Small businesses here, who would be left untouched under Biden’s new plan, say requiring vaccinations is an impossible decision for them to make, amid what has already been an impossible year. They’re feeling the squeeze on cash flow, particularly in restaurants where profit margins are already notoriously thin; choosing to impose restrictions that could limit their customer base feels unpalatable. Small businesses in Las Vegas and across the country already are having trouble competing with bigger firms and meeting demands for higher wages or more flexibility for staff.

That’s the main concern for Kristen Corral, who runs a fast-casual vegan taco restaurant in downtown Las Vegas called Tacotarian. Corral and her husband have worked with elected officials throughout the pandemic to keep their doors open, including pushing Sisolak to allow restaurant workers to gain priority access to the vaccine once it became available. But Corral says a mandate has never felt like her fight to take on.

“Those decisions have to come from government,” she says. “It’s difficult as a business owner to individually say, ‘OK, all of our staff has to be vaccinated’ — but then we also have a staffing shortage. So, what if all of our staff is like, ‘Well, we don’t want to get a vaccine. We’re going to leave’? And then we’re like, ‘Oh, crap.’”

Corral says she was approached over the summer by local officials who were trying to get business owners to come out in favor of a vaccine mandate, a move she says appeared aimed at giving politicians cover if they do take that step — “like, ‘Oh, well, all the businesses told us that we should do it.’” But she didn’t bite. Now she says while Biden’s mandate doesn’t change any of her own plans, she saw it coming because “as a country, we’re running out of options.”

“I don’t envy them having to make these hard decisions,” she says. “But that’s their job, you know? They gotta do it.”

Some local business owners I spoke with criticized elected officials in the state for not doing more sooner, blaming them for appearing to be so worried about the near-certain backlash and threats to their re-election prospects that they were hesitating on a step that would help both public health and the economy. Politicians dispute that characterization — no one orders an unprecedented shutdown of the Las Vegas Strip, they say, in an attempt to build popularity — and argue that too many directives from them would only drive people further away from masks and shots.

“There are better salespeople than me for this vaccine,” says Naft, the county commissioner. “It’s got to be peers. It’s got to be medical professionals. And it’s got to be people who people relate to in a more direct way.”

There’s the added difficulty that not all local officials agree on how critical the vaccine is to the city’s recovery. In her spacious office with a panoramic view of the city, Goodman, the Vegas mayor, has a small sign sitting on her desk: “Without facts and data, you’re just another person with an opinion.” But, despite study after study finding that the vaccines are effective, she says she’s waiting for more facts and data on the necessity of mask and vaccine mandates — more evidence that would, as she puts it, “prove without equivocation this is what we should be doing.”

“I don’t think, at this point, we are 100 percent assured in this, that we have answers,” she told me. Asked whether she would support any sort of vaccine mandate, Goodman replied that she “really can’t answer that. I just, we don’t have enough information.”

Goodman gained notoriety early last year for calling the shutdowns “total insanity” and for telling CNN anchor Anderson Cooper that she wanted to offer Las Vegas as a “control group” by allowing it to reopen. She doesn’t answer directly now when asked whether it became clear over the past 18 months that some restrictions were necessary to get the economy back — “As soon as we knew there was a virus, you had to do wise things,” she replied — and her office offered no comment on Biden’s move to mandate the shots. While she has been encouraging vaccines because that’s what the CDC tells her to do, she equates telling someone to get a shot to telling them to get a haircut.

“I have no right,” she says.

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Deep within the Mandalay Bay Resort and Casino at the south end of the Strip, past rows and rows of neon slot machines and around the corner from the massive sportsbook, four floor-to-ceiling posters of Michael Jackson coat the wall outside the theater where the Cirque du Soleil show celebrating Jackson’s life and career is about to reopen its doors in late August for the first time in 18 months.

The energy is electric. A trio of women in town for a girls’ trip waits in line wearing matching cheetah-print masks. A young couple from Colorado have pushed their flight home back a day so they could be here. A bride and groom from California show up fresh from their wedding, the woman still wearing her white dress and carrying her bouquet. One salesperson manning the Jackson memorabilia store claps her hands as she walks up to another, who has been selling programs. “This is so excitiiiing!” she squeals.

After months of shutdowns, record-breaking unemployment and an unfathomable amount of illness and death, here are signs of Las Vegas returning to its old self: A theater packed tight. Photographers snapping pictures of attendees on their way in. A man inexplicably dressed in a Jackson outfit livestreaming opening night, keeping an eye out for celebrities and broadcasting the event for all who can’t be there.

“It feels good to be back to normal — somewhat,” says Aaron Wegener, a tourist in town from California, holding onto his son’s hand as they wait to get their tickets scanned.

The show is not sold out, and neither are those coming up over the next few days. Attendees are still wearing masks and being encouraged to sanitize their hands as they enter. Even still, the reopening marks an attempt at a return to normalcy — and a return to work for hundreds of cast and crew members, not just the dancers at center-stage but also the small army of trainers, makeup artists, costume designers and lighting technicians who power the production. From the airport to the Strip, the city is coated in Cirque billboards broadcasting that “INTERMISSION IS OVER.”

The energy is electric. A trio of women in town for a girls’ trip waits in line wearing matching cheetah-print masks. A young couple from Colorado have pushed their flight home back a day so they could be here. A bride and groom from California show up fresh from their wedding, the woman still wearing her white dress and carrying her bouquet. One salesperson manning the Jackson memorabilia store claps her hands as she walks up to another, who has been selling programs. “This is so excitiiiing!” she squeals.

After months of shutdowns, record-breaking unemployment and an unfathomable amount of illness and death, here are signs of Las Vegas returning to its old self: A theater packed tight. Photographers snapping pictures of attendees on their way in. A man inexplicably dressed in a Jackson outfit livestreaming opening night, keeping an eye out for celebrities and broadcasting the event for all who can’t be there.

“It feels good to be back to normal — somewhat,” says Aaron Wegener, a tourist in town from California, holding onto his son’s hand as they wait to get their tickets scanned.

The show is not sold out, and neither are those coming up over the next few days. Attendees are still wearing masks and being encouraged to sanitize their hands as they enter. Even still, the reopening marks an attempt at a return to normalcy — and a return to work for hundreds of cast and crew members, not just the dancers at center-stage but also the small army of trainers, makeup artists, costume designers and lighting technicians who power the production. From the airport to the Strip, the city is coated in Cirque billboards broadcasting that “INTERMISSION IS OVER.”

There are signs of improvement on the horizon for Las Vegas. The Clark County School Board voted to approve a vaccine mandate for employees on Sept. 1. Some large conventions are starting to require proof of vaccination for entry. The county’s case count has been slightly but steadily decreasing in recent weeks, though the state overall is staying level. All of which signals the end of this surge might not be too far off.

But the question is what comes after that. The drop in cases could lead to a loosening of restrictions, which may well invite yet another surge. The next variant could require another round of masking and distancing, with all the resistance that comes with it. The decision to move forward with a booster shot could require another uphill battle to get the vaccine to those who can’t access it and to persuade those who won’t take it.

How to reopen safely, keep businesses running and revive the services sector without sparking another virus surge is a challenge the entire world is facing at once. But for Las Vegas the difficulty feels particularly acute — because the economy depends not just on in-person activities but also on international visitors; because of the persistently high unemployment rate; because of how nearly half the eligible population is turning away from what for now appears to be the clearest path back toward normalcy.

“When we have 40 million people coming here in a year, we’re dependent on people all over the country — and hopefully soon all over the world — doing the right thing,” Naft, the commissioner, says. “So, it’s bigger than getting our own folks taken care of. But obviously, that’s where we’ve got to start.”

In the meantime, the city is still trying to break out of its boom-and-bust cycle, to find a way to lift coronavirus restrictions without having to brace for their reimposition several weeks later.

“I just want this to be over,” says Corral, the Tacotarian co-founder. “And aside from everybody getting vaccinated, I don’t know …” she pauses. “Now I don’t even know if that is the end of it.”
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And on a related note, Megan Messerly had a piece this weekend about small businesses wondering about mandates:

To Mandate or Not to Mandate:
https://thenevadaindependent.com/article/exempt-from-new-federal-employee-vaccine-mandate-small-businesses-grapple-with-whether-to-follow-suit

All Cassie Rice wants to do is coach.

The Henderson gym owner wishes she didn’t have to require her staff and kids to wear hot, stuffy masks during practice. She doesn’t want to be thinking about her employees’ vaccination status. She’s a gymnastics coach, not a doctor, epidemiologist or virologist.

But she also doesn’t want to see any of her youngest gymnasts, not yet eligible for the shot, fall ill with COVID-19. She doesn’t want another employee out on quarantine. She doesn’t want to see her gymnastics team lose its third dad in a year and a half to the virus.

For the last several weeks, Rice has been gently nudging her employees to get vaccinated. She has sent emails sharing vaccine research and data. She has told her staff she prefers they get the shot. She isn’t hiring anyone new that is unvaccinated.

The nudging has only gone so far, though. Rice estimates there are about 15 unvaccinated holdouts among 90 employees between her family’s Henderson and Summerlin gyms.

When one told Rice she believed there was still too much “mystery” around the vaccine, Rice tried to persuade her with an analogy.

“I just said, ‘I think when you’re thinking about being an expert, I’m an expert in the field of gymnastics, so people can ask me questions about that. But we are not experts in epidemiology or science in any way. We have to defer to people who study this for a living,’” Rice said. “‘A parent can’t come in and tell me the better way to teach this gymnastics move. They don’t know. That’s how it should be with this.’”

Rice has drafted a letter, one she’s leaning toward sending. In it, she has outlined a new company policy: that employees get the shot or be tested weekly for the virus.

Her coaches, some of whom have been with her for the last 15 to 20 years, are like family, Rice said. But she is also a firm believer in the vaccine.

“We’re trying really hard to do it slowly and really think through it and make a good decision that takes into consideration the staff we really love,” Rice said. “We’re not wanting to kick a member of our family out, but I believe in this being a safety issue. So, then do you follow that principle, or do you follow the principle of supporting your family?”

It is a question some small business owners supportive of the vaccine in Nevada and across the nation have been asking themselves in recent weeks as the Delta variant continues to spread and the vaccination campaign inches forward.

The considerations are complex: Some, like Rice, fear losing longtime employees. Some worry about whether a vaccine mandate will stymie their ability to hire new employees in an already-competitive labor market. Others are grappling with whether they feel comfortable requiring their employees to get the shot, even though they support vaccination.

They are thinking through the consequences of not requiring their employees to get vaccinated, too. Companies have reduced hours or scaled back operations as a result of employees testing positive or quarantining. They worry about the worst-case scenario — that the situation gets so bad again that they’re forced to close their doors like they did in March 2020.

For some, it’s more than all of that: They don’t want to see employees they care about as humans — not just workers — fall ill, or worse. It’s more than just business sense; it’s also about protecting them.

“We had one of our staff member’s husbands go in the hospital for a while, and they were really worried about him,” Rice said. “It just creates so much stress.”

While a wave of large corporations announced employee vaccine mandates over the summer, some had hoped full approval of the Pfizer vaccine last month would promptly set off an even larger wave of mandates, including among small businesses.

There is no tally of how many Nevada businesses have implemented employee vaccine mandates to date, but interviews with business owners, human resources representatives and chamber leaders over the last two weeks suggest they’re currently more an exception than the rule.

That will soon be changing, though.

President Joe Biden announced on Thursday that all businesses with 100 or more employees will be required to mandate vaccination or weekly testing for their workers, a policy expected to affect as many as 100 million Americans, though it has already faced political pushback and threats of litigation. The smallest businesses, including Rice’s, aren’t subject to the new mandate, though the new federal rule may encourage some to voluntarily follow suit.

The new mandate aside, businesses large and small will still be faced with the question of whether to go further and require all employees to get the shot, eliminating any testing option. Public health experts say vaccination-only policies are the gold standard for virus mitigation, as vaccines remain the most effective method of preventing the spread of COVID-19.

Several private and public sector entities have already adopted or are in the process of adopting such policies, including the federal government, which announced a vaccination-only policy for all federal workers and contractors on Thursday. In Nevada, MGM Resorts, the Clark County School District, the Department of Corrections, the Department of Health and Human Services and the Nevada System of Higher Education all have implemented or are in the process of implementing similar policies for some or all of their workers.

If scientists, public health officials, family doctors, public information campaigns and the lure of cash prizes can’t convince people to get vaccinated, the thinking goes, maybe a mandate from their employer will.

In the vaccination campaign, mandates may just be the final frontier.

‘The right thing’

Tisha Overman, who runs a small engineering firm in Las Vegas with her husband, was surprised by the reaction she got last month when she told her employees they had to get vaccinated: None.

She knew there were a couple holdouts among TERPconsulting’s staff of 30, but she had also been open about the fact that a vaccine mandate might be coming, dependent on the COVID-19 vaccine receiving full approval from the Food and Drug Administration. As soon as that approval came, she sent a message to her team letting them know that vaccines were required and asked staff to forward her a copy of their vaccine cards within a week. She told them she was available if they had any questions.

There were no questions.

“I was fully expecting to have a dialogue. I was fully expecting to have to educate myself on exemptions and what’s appropriate for exemptions, but it didn’t come up at all,” Overman said. “The small number of people who had not been previously vaccinated got vaccinated immediately after the announcement.”

The vaccine mandate, Overman said, has been a “definite positive” for their business, both because they believe in the importance of vaccination to keep themselves and their employees safe and because a number of their clients are requiring staff to be fully vaccinated in order to visit job sites. (TERPconsulting’s clients span a number of different industries, including health care, education and hospitality.)

“Both things can be true at the same time,” Overman said. “You can try to do the right thing and believe the right thing is the financially viable thing.”

The pandemic hasn’t been an easy ride for business owners. Though Overman said they were “incredibly lucky” to be in a construction-adjacent business that was allowed to operate during the spring 2020 shutdown, she highlighted the interconnectedness of business in Southern Nevada, where the hospitality industry reigns.

“As business owners, and just as members of the community, we have a responsibility to do everything in our power to not go through another shutdown, and that means following the rules and trying to keep the economy going,” Overman said. “We have an altruistic community feeling about it, but we also have a very realistic business feeling.”

As small businesses in recent weeks started to think through what implementing vaccine mandates might look like, some turned to their local chambers of commerce for help. Prior to the federal government's announcement, chambers hadn’t been pushing business owners either way. Instead, they were informing them that vaccine mandates are allowed under state and federal law and helping them navigate the mechanics of how to enforce them, sometimes using their own vaccine mandates as a model.

The term “vaccine mandate” is used broadly, though there are actually a number of ways to approach a mandate: Vaccination for all employees, vaccination plus weekly testing for unvaccinated individuals and vaccination for new hires only.

Under the new federal rule, all businesses with 100 or more employees will be required to have a vaccine plus weekly testing policy in place, at the minimum, though businesses could choose to go further by requiring vaccination either for all employees or for new hires, with no testing opt-out. Small businesses, which aren’t subject to the new rule, will continue to face the same dilemmas over whether to implement vaccine mandates.

While some have argued against vaccine mandates as overly burdensome, Ann Silver, CEO of the Reno + Sparks Chamber of Commerce, framed them as another requirement employers might enact as a condition of employment, similar to a background check or drug screening.

“Every individual business owner may have a political view, religious view, social view, moral view about vaccines, and I’m not inquiring about that. I’m just letting them know they can require it if they wish to,” Silver said. “The more I can spread that word, the more the chance that businesses pick up that opportunity.”

Silver, in an interview last month, said she didn’t know how many of the chamber’s 2,300 members had put in place or were considering employee vaccine mandates, though she said she was pleased that the chamber’s entire leadership class — which represents a couple dozen businesses in the region — said they had gotten the shot.

“That’s a good indicator. They’re all coming from different businesses and industries,” Silver said. “Whether it was required or they did it on their own, I was thrilled to see that 100 percent compliance.”

While some had hoped the recent full approval of the Pfizer vaccine would spark a wave of employee mandates, it didn’t play out that way in practice. Chamber leaders, in recent interviews, said they hadn’t seen an uptick in inquiries from member businesses about employee vaccine mandates as a result of the Pfizer approval.

Federal officials are now trading hope for a mandate.

“We’ve been patient,” Biden said on Thursday, speaking directly to the unvaccinated. “But our patience is wearing thin, and your refusal has cost all of us.”

Prior to Biden’s announcement, Mary Beth Sewald, CEO of the Las Vegas Chamber, said what seemed to have an impact on small business interest in vaccine mandates were the decisions large employers, including those in the casino industry, made. While many of Las Vegas’s biggest resorts have long had vaccination and testing programs, MGM Resorts was the first major gaming company to establish a full vaccine mandate with no testing opt out. (That policy is, for now, limited to salaried employees and new hires.)

“[The resorts] are definitely leading the way, and they’ve kind of pulled the Band-Aid off creating these policies to keep people safe,” Sewald said. “The big picture, really, is we want to reduce the number and trend of COVID cases, and the best way for us to do that is to create a safe environment through vaccinations, negative COVID tests, mask wearing and continuing the social distancing.”

But it’s been a slow process. In an interview before the White House’s announcement, Sewald said that while some businesses have already implemented vaccine mandates, others are still ramping them up and putting plans in place.

“It’s really about finding the right balance for their employees and for their customers as well,” Sewald said. “Having a policy that requires proof of vaccination or weekly COVID tests for their employees, it really does make a lot of sense in keeping the workplace safe.”

‘Incredible cost’

Vaccine mandates are easier said than done, even for business owners who strongly support vaccination, something that helps explain why employee vaccine mandates weren’t more common before the Biden administration moved in that direction this week.

Take Tom Young, brewmaster and owner at Great Basin Brewing, who is getting ready to host the brewery’s fourth on-site vaccination event, called “Shot and a Beer,” on Thursday. Young is hoping this one will be a particular draw, with vaccines administered inside the brewery itself, next to tanks of beer.

“We’re working hard to make this planet a better place one pint at a time,” Young said. “That sounds kind of silly and stupid and far-fetched, but it's something where you have to walk the walk.”

As dedicated as the brewery has been to supporting Northern Nevada’s vaccination effort, Young said there are still a handful of holdouts on his staff — about 10 people out of 120.

Young, in an interview last week, said the brewery had discussed establishing an employee vaccine mandate, though he would rather staff get the shot of their own volition. (All staff get rewarded with a free six pack of beer as soon as they’ve gotten their second shot.)

But from a strict business standpoint, the benefits of an employee vaccine mandate are clear, Young said. He has personally experienced the crunch of having several staff members out sick with COVID, and he also feels a responsibility generally to protect the members of the public who come into the brewery.

He also remembers what the shutdown last spring was like, when he had to lay off 55 of 115 employees. He says it’s one of the hardest things he’s had to do.

There’s also the real, human cost. Young said he recently learned a 65-year-old musician who had played at the brewery passed away from COVID being on a ventilator in the intensive care unit.

Last week, Young said he was mulling a modest vaccine mandate that would require all new staff to be vaccinated. But the Thursday announcement appears to have made the decision for him, though he is waiting to see the full details of the new rule and how it might take into consideration full- and part-time employees.

“The data is clear. Scientific endeavors overwhelmingly point to the value of getting more and more folks vaccinated. It is our best weapon so far to curb the spread,” Young said in an email following the White House’s announcement. “We will staff up for our Thursday Shot and a Beer event, inviting all procrastinators and those whose excuses have been exhausted and get started with the Pfizer first or second shot or the one and done Janssen vaccine. It is the right thing to do.”

For many businesses, the already-difficult labor market, which has caused staffing shortages, adds an extra layer of complexity to the decision, particularly when it comes to considering vaccine-only mandates. In an interview last week, Mary Beth Hartleb, CEO of human resources firm Prism Global Management Group, said that’s why she hasn’t been recommending employee vaccine mandates to her clients.

“I think you really need to take into consideration our extremely, extremely difficult labor market right now. I’ve never seen it like this in 30 years doing this type of work,” Hartleb said. “When you look at that, are you really going to hold somebody to a vaccine when there’s other things you can do to keep people safe, etc., and lose all that institutional knowledge, have to replace these positions, train people? I mean, that’s an incredible cost to a business.”

Fears about losing workers to vaccine mandates may be overstated, though, and changing with time. Though polling on vaccine mandates varies depending on how the question is asked, a recent Axios-Ipsos poll found that 43 percent of unvaccinated Americans would get the shot if their boss required it, up from 33 percent a month ago. Nationally, only about 14 percent of Americans say they definitely won’t get the COVID-19 vaccine, while another 10 percent are still in the “wait and see” phase and 3 percent say they’ll get it if required, according to the Kaiser Family Foundation’s vaccine monitor survey.

(On the other hand, a Gallup poll in August found that 38 percent of U.S. employees would either oppose or strongly oppose their employer requiring all employees to get the shot, and a Washington Post-ABC News poll showed that 72 percent of unvaccinated people whose employers don’t currently have mandates said they would quit if they couldn’t get a medical or religious exemption to the requirement.)

At least in some instances, job seekers may see employee vaccine mandates as a benefit. Such was the case for Amber Seifert, who left her job with an HVAC company to work for the Boys and Girls Club of Truckee Meadows in August.

Seifert estimates she was one of just about a quarter of employees at her old job who had gotten the shot, as vaccinated employees were allowed to go without a mask if they submitted a copy of their vaccine card to the company. It created an uncomfortable situation, she said, where everyone knew who was vaccinated and who wasn’t.

“Previously, it was kind of like, ‘Oh, you’re vaccinated. So that’s what you think about this and that’s how you believe about this,’ making it political,” Seifer said. “It’s definitely relieving to be working somewhere where the vaccine is required because it’s not polarizing. There’s not going to be a stigma on you because you’re vaccinated. Everybody just is.”

Seifert takes the issue particularly seriously because she contracted COVID-19 last fall. While her primary symptoms were body aches, fever, fatigue and loss of the sense of taste and smell, the virus caused optic nerve damage that required her to get an MRI, a spinal tap and drop 20 pounds in three months or face having a shunt inserted into her brain.

“Everything is okay now, but it’s just been a lot to deal with,” Seifert said.

Scott Muelrath, CEO of the Henderson Chamber of Commerce, believes some people who have been putting off getting the shot while unemployed may voluntarily decide to get vaccinated upon returning to the labor force.

“You could see people coming back into the job market and that could be a reason why they choose to get vaccinated and they haven’t thus far,” Muelrath said. “That maybe could result in an uptick in vaccinations.”

After Thursday’s announcement, many business owners will no longer have a choice in establishing some level of a vaccine mandate. Muelrath, in an email, described the decision as “not unexpected.”

“This adds the further directive and clarity that will spur people to action as to being vaccinated, whether they like it or not,” Muelrath said. “And one step closer to making it required for all, no doubt – no matter what the business size.”

The Vegas Chamber, in a statement on Friday, said that while many Las Vegas companies, including the chamber, have implemented vaccination-testing policies, it was concerned about the new vaccine mandate happening by presidential executive order without debate outside of the legislative or regulatory process.

“While many companies are voluntarily taking proactive measures to fight the spread of COVID, mandating them to do so through Executive Order sets a worrisome precedent and creates a slippery slope for future potential mandates on employers and employees,” the chamber said.

Meanwhile, owners of the smallest businesses, unaffected either way by the federal mandate, will have to base their decisions on the complex calculation of whether it would be better to weather the toll that a COVID outbreak would have on their workforce or mandate the vaccine and risk losing a portion of their employees. Which scenario would have the greater impact on their ability to keep their doors open?

“What’s the point of all this money given out to help businesses get back on their feet if a customer is walking in and possibly in a contagious state … you’re then saying, ‘Okay, now I have no choice but to quarantine them and basically shut down,’” Silver, head of the Reno + Sparks Chamber, said. “I think the mask and vaccine capability should be strengthened by a communal decision that we want to continue commerce in our daily lives.”

‘Shifting the assumption’

For those involved with the state’s COVID-19 vaccination effort, there’s a glimmer of hope that employee vaccine mandates will move the needle on the overall vaccination effort.

“The business community, they are a critical part of this effort,” Heidi Parker, executive director of Immunize Nevada, Nevada’s only statewide immunization-focused nonprofit, said.

Dr. Andy Pasternak, a family medicine doctor in Reno, said employee vaccine mandates — or even just talk about potential vaccine mandates — are one more thing that will encourage people to think about getting the vaccine. And for those who are, he encourages them to talk with their doctor before doing so.

“I have had a few people that are like, ‘Okay, my employer is mandating this now, which vaccine do you think would be right for me?’” Pasternak said. “There are some differences, so I like to talk to them about which one might be the best for you.”

Amid all the hand-wringing over vaccine mandates, Ellie Graeden, founder and CEO of Talus Analytics and an adjunct faculty member at Georgetown University’s Center for Global Health Science and Security who has been consulting with the state on its COVID-19 response, noted they actually aren’t as foreign as people might imagine.

Vaccination, Graeden noted, is the default for kids, who are required to get certain shots to attend school. There isn’t a mechanism in place to broadly require adults to get vaccines, she said, because they have already gotten them as kids.

“The only reason that we haven’t had the conversation about mandates for adults is because we already dealt with our mandates when we were kids,” Graeden said. “This is the first new disease where we’re actually needing to talk about how you get that first wave of vaccines into the adult population.”

Making vaccinations mandatory, Graeden said, may actually reduce some of the stigma around getting the shot and what vaccination might mean about someone’s personal political leanings or beliefs.

“I think that’s a real value with these mandates. You’re shifting the assumption from being, ‘Oh, this is your choice, you’re doing it because you believe in it,’ to ‘I have to,’” Graeden. “That actually does shift the discussion as well and I think actually depoliticizes it in a lot of ways.”

Employee vaccine mandates may also just be the start. While vaccination mandates for the general public are still uncommon in Nevada — unlike in San Francisco and New York, where vaccination is required for indoor bars, restaurants and gyms — they do exist.

The Las Vegas Raiders are requiring proof of vaccination to attend all home games at Allegiant Stadium, while organizers of the Life is Beautiful festival have required guests to have proof of vaccination or a negative COVID-19 test for entry.

Conventions, meanwhile, are adopting their own policies: Attendees of the HIMSS21 Global Health Conference & Exhibition last month were required to be fully vaccinated in order to attend, while two future conventions – the National Association of Broadcasters and the Consumer Electronics Show – announced in August their own attendee vaccination policies.

At the same time, a Gallup survey released this week found that 61 percent of Americans favor vaccination requirements for air travel, 53 percent for dining out and 56 percent in office or work settings.

“I do believe commerce is the answer here … It often takes some brave person that says, ‘This is what I’m going to do, and the rest of you be darned,’ and others will follow,” Silver, the head of the Reno + Sparks Chamber, said. “It takes a real leader to be brave and have strong shoulders to say, ‘This is what’s necessary, and I’m going to do it.’”

This, public health experts say, is why the private sector’s involvement is key to the vaccination effort. It means that mandates aren’t really mandates at all.

Don’t want to work for this company? No problem. Don’t want to attend this concert? No problem. Don’t want to attend a Raiders game? No problem.

The choice is yours.
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Kernels of Truth Mixed with Misinformation Keep Some Away From Vaccinations:
https://www.reviewjournal.com/local/local-nevada/kernels-of-truth-mixed-with-bad-information-keep-many-from-vaccines-2438446/

Misinformation — especially authoritative-sounding articles posted online and circulated on social media — plays a significant role in keeping many Nevadans from getting vaccinated against COVID-19, according to public health experts.

In interviews with the Review-Journal about a dozen unvaccinated residents cited a variety of factors for their decisions not to get the COVID-19 vaccine. Almost all fell into one of these six categories:

■ The vaccines hasn’t undergone enough testing and may have side effects that are not yet known.

■ The shot or shots don’t work because people who are inoculated still get COVID-19.

■ They are unnecessary for otherwise healthy people.

■ All types of vaccines are potentially harmful and should be avoided.

■ Vaccine mandates by the government and employers violate workers rights to make decisions about their health.

■ The vaccination effort is part of a government plot.

While there are some kernels of truth in some of those assertions, they are all contradicted in large degree by the available evidence, experts say.

Here’s a look at the facts for each of these arguments:

Lack of testing

While all three available COVID-19 vaccines — Pfizer, Moderna and Johnson & Johnson — were initially authorized by the federal government for emergency use in the U.S. under an accelerated approval process after 11 months of development and testing, the Centers for Disease Control and Prevention says that all evidence so far indicates that all are “safe and effective.”

“These vaccines have undergone and will continue to undergo the most intensive safety monitoring in U.S. history,” the agency says on its website.

The Pfizer vaccine was recently granted full approval by the Food and Drug Administration, and both Moderna and J&J are in the process of being certified.

The vaccines were developed so quickly because scientists already had experience with similar coronaviruses like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).

Also, two of the vaccines — Pfizer and Moderna — used a new gene-based technology known as messenger RNA (mRNA) that came of age at just the right time after being studied for decades. The vaccines can be developed and manufactured more quickly than traditional vaccines, which have to be grown in a lab. With the mRNA vaccine, the body itself grows the protein to stimulate the immune system response.

Some people who are vaccinated experience minor side effects, including swelling and pain at the injection site, headaches and fever, but many have no adverse effects whatsoever.

Serious side effects are rare but can include anaphylaxis, or a severe allergic reaction. That can occur after any vaccination, and providers have medicines on hand to immediately treat such a reaction, the CDC says.

Thrombosis, a combination of blood clots and low platelets — also has been identified as a rare but potentially serious side effect of the J&J vaccine, which requires only a single shot. The risk is slightly higher for women between 18 and 49 years old, occurring at a rate of about seven per 1 million vaccinations, according to the CDC.

In contrast, unvaccinated people run a much higher risk of becoming seriously ill or dying if they contract COVID-19, experts say. Over 90 percent of Nevada’s hospitalized COVID-19 patients were not vaccinated when they became ill, according to state officials.

The vaccines don’t work

This argument is usually raised regarding so-called breakthrough cases of COVID-19 that occur in fully vaccinated people.

Experts and government officials have stressed that those types of cases are to be expected, as “no vaccine is 100 percent effective,” as the CDC notes.

“Some fully vaccinated people will get sick, and some will even be hospitalized or die from COVID-19,” the CDC says. “However, there is evidence that vaccination may make illness less severe for those who are vaccinated and still get sick.”

Vaccination also continues to reduce the chances of contracting the disease or becoming seriously ill from mutant forms of the new coronavirus like the more-contagious delta variant, the CDC says.

I’m healthy, so I don’t need the vaccine

While many unvaccinated people believe they either have “natural immunity” or are otherwise healthy, evidence conclusively shows that COVID-19 can effect even young people with no underlying health conditions. In fact, as vaccination rates slowly rise across the U.S., younger healthy Americans are accounting for higher percentages of cases.

Data also indicates that people who already have had COVID-19 benefit from the vaccine, as the natural immunity may fade or be less effective against variants than its lab-produced alternative.

Another reason to get vaccinated is that more and more people are vaccinated, community transmission will go down. That reduces the creation of coronavirus variants that could be more contagious or deadly.

“Every person that gets vaccinated brings us one step closer to ending the pandemic,” experts at Johns Hopkins University in Baltimore advise on the school’s website.

All types of vaccines should be avoided

This has been a prevalent myth for years, with childhood vaccines being blamed for several chronic illnesses or disorders, including autism spectrum disorder (ASD).

Though certain vaccines do slightly increase risks for certain ailments, the CDC notes that “there is solid medical and scientific evidence that the benefits of vaccines far outweigh the risks.”

As for the autism connection, “studies have shown that there is no link between receiving vaccines and developing ASD,” the CDC says.

Vaccine mandates are government overreach

There are still questions about the legality of vaccine mandates put in place by some government agencies and by private employers.

One particular point of contention is whether vaccines authorized only for emergency use by the U.S. Food and Drug Administration can be mandated, according to the nonprofit FactCheck.org.

That said, “There is no federal law that says vaccines cannot be required for employees or students,” it noted.

David Orentlicher, director of UNLV’s health law program, said Congress can impose certain limited mandates in places that get federal funding, but the U.S. Constitution doesn’t give federal lawmakers control over broad public health measures like vaccine mandates.

States, on the other hand, can impose vaccine mandates, something that the Supreme Court settled with Jacobson v. Massachusetts in 1905, he said. But he said broad mandates requiring all state residents to get vaccinated are unlikely for political reasons.

The shots are part of a government plot

There is no credible evidence of a government conspiracy related to the discovery, spread or vaccine against COVID-19. Nor do the COVID-19 vaccine doses contain microchips to allow the government to track you or include ingredients that make a person magnetic, according to the CDC’s website.
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US Could Authorize Pfizer COVID Vaccine for 5-11 Year Olds in October:
https://www.reuters.com/business/healthcare-pharmaceuticals/exclusive-us-decision-pfizer-covid-19-shot-kids-age-5-11-could-come-october-2021-09-10/

Top U.S. health officials believe that Pfizer Inc's COVID-19 vaccine could be authorized for children aged 5-11 years old by the end of October, two sources familiar with the situation said on Friday.

The timeline is based on the expectation that Pfizer, which developed the shot with Germany's BioNTech will have enough data from clinical trials to seek emergency use authorization (EUA) for that age group from the U.S. Food and Drug Administration (FDA) towards the end of this month, the sources said.

They anticipate the FDA could make a decision on whether the shot is safe and effective in younger children within three weeks of the EUA submission.

The decision on whether to authorize a vaccine for younger children is eagerly anticipated by millions of Americans, particularly parents whose children started school in recent weeks amid a wave of infections driven by the Delta variant.

Top U.S. infectious disease expert Dr. Anthony Fauci outlined the timetable during an online town hall meeting attended by thousands of staff at the National Institutes of Health (NIH) on Friday, according to one of the sources. A second source familiar with the situation said that the FDA anticipated a similar timeline for Pfizer.

If Pfizer submits its EUA by the end of September, and the data support its use, "by the time we get to October, the first couple of weeks of October... the Pfizer product will likely be ready," Fauci said, according to the source.

Fauci said that Moderna Inc will likely take about three weeks longer than Pfizer to collect and analyze its data on children age 5-11, according to the source. He estimated that a decision on the Moderna shot could come around November, according to the source. The second source said Fauci's timeline for Moderna appeared "optimistic."

Officials at Pfizer, Moderna and NIH did not immediately comment.

Pfizer has previously said that it would have data on children age 5-11 ready in September and planned to submit for an EUA shortly after. Previously, federal health regulators, including Fauci, have suggested that an FDA decision might come in November or later. Moderna on Thursday told investors it expected data from its children's study by the end of the year.

Earlier on Friday, the FDA said it would work to approve the COVID-19 vaccines for children quickly once the companies submitted their data. It said it would consider applications based on a faster path to authorize the shot for emergency use.

Such emergency authorization requires companies to submit two months of safety data on trial participants, versus six months required for full licensure.

Pfizer partner BioNTech told Der Spiegel that it also expects to request authorization globally for the COVID-19 vaccine in children as young as five over the next few weeks and that preparations for a launch were on track.
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The US Surpassed 41 Million Cases this weekend:

Increasing another million in 6 days this time.

The stories about rationing of healthcare in low vaccination areas of the country continue.

Idaho Patients in Hospital Halls Amid COVID Rationed Care:
https://apnews.com/article/business-health-public-health-coronavirus-pandemic-idaho-7bdb1aa76f4f98e1c31df3fd9ac338b0

Amid the Idaho coronavirus surge that prompted officials to authorize hospitals to ration health care, Army soldiers sent to one hospital have traded their fatigues for personal protective equipment to help treat a flood of infected patients.

The conference center at Kootenai Health hospital in the city Coeur d’Alene has been converted into a field hospital of sorts — with some of its classrooms filled with hospital beds where patients receive oxygen or get monoclonal antibody treatment, hospital officials said.

At the nearby main hospital building in the city of about 50,000, some emergency room patients receive care in a converted lobby and others get it in hallways. Urgent surgeries have been put on hold and some patients in critical condition are facing long waits for intensive care beds.

The hospital is licensed for 200 regular medical beds — not including the ones designed for children, women giving birth and people experiencing a mental health crisis — and on Wednesday had 218 “med surge” patients, said Jeremy Evans, the hospital’s COVID-19 incident commander.

Meanwhile, about 500 of its roughly 3,600 clinical and staff positions are empty, he said, forcing managers to ask administrative staffers and others to take on additional work like cleaning hospital rooms.

The overwhelmed hospital is at the epicenter of a coronavirus crisis for the northern part of the state — and where state officials this week authorized “crisis standards of care” status.

That allowed Kootenai Health, where an entire floor has been turned into a makeshift COVID-19 unit, and other hospitals in the region to ration health care during the surge.

Public health officials are warning the health care rationing could soon spread statewide, forcing already traumatized doctors and nurses to make gut-wrenching decisions about who will get life-saving care.

Newly confirmed coronavirus infection cases in Idaho are surging and the state is now averaging more than 950 new cases every day, according Johns Hopkins University — an increase of more than 41% over the past two weeks.

Idaho is also last among U.S. states with only about 45% of residents having received at least one dose of COVID-19 vaccine, according to the Centers for Disease Control. Just under 40% of residents are fully vaccinated, making Idaho 48th the nation compared to other states and Washington, D.C.

“For the rest of the state, we remain dangerously close to crisis standards of care,” Idaho Department of Health and Welfare Director Dave Jeppesen warned Tuesday, when there were just nine available intensive care unit beds in the entire state.

The crush of patients has forced Kootenai Health into “doing things that were not normal — way outside of normal — at times,” said hospital chief of staff Dr. Robert Scoggins.

“Almost every day at this point we are having cardiac arrest from patients when their oxygen levels dip too low and we can’t supply them with enough oxygen,” he said.

Kootenai Health recently installed a larger oxygen tank in an effort to treat all the patients. If the hospital’s caseload grows, Scoggins said, the hospital’s oxygen delivery infrastructure — the actual pipes that run through the walls — may not be able to handle the demand.

While many of northern Idaho’s smaller, rural hospitals have not been forced to ration health care, they frequently have no place to send their critically ill patients who would normally be transferred to Kootenai Health.

Hospitals in neighboring Washington state would normally help with the overflow, but they are also full of patients, Jeppesen said.

Peter Mundt, the spokesman for Gritman Medical Center in the Idaho city of Moscow said the institution is struggling to find hospital destinations to transfer patients with serious heart problems and other conditions unrelated to COVID-19.

“Our ability to accommodate non-COVID patients are very strained at this point,” Mundt said. “Even though we’re all different hospitals, we normally work together as collaborative colleagues and peers. We need it to work as a giant system and that system is just under severe strain right now.”

In the city of Lewiston, St. Joseph Regional Medical Center is also operating “at the very edge of our capacity,” spokeswoman Sam Skinner said.

“Our current situation is worse than it’s ever been,” Skinner said. “As we continue to see the COVID-19 surge in our community, the impact on one hospital can quickly have this rippling effect. Our low community vaccination rates are putting an incredible burden on our community.”

The Idaho Department of Health and Welfare moved northern and north-central Idaho into the crisis designation Monday evening, giving hospitals a legal and ethical template to use while rationing care.

The designation will remain in effect until there are enough resources — including staffing, hospital beds and equipment or a drop in the number of patients — to provide normal levels of treatment to all patients.

Under the guidelines, patients are given priority scores based on a number of factors that impact their likelihood of surviving a health crisis.

Those deemed in most in need of care and most likely to benefit from it are put on priority lists for scarce resources like ICU beds.

Others in dire need but with lower chances of surviving will be given “comfort care” to help keep them pain-free whether they succumb to their illnesses or recover.

Other patients with serious but not life-threatening medical problems will face delays in receiving care until resources are available.

Jeppesen stressed Tuesday that vaccines are the best way to reduce the demand on hospitals. Data from the U.S. Centers for Disease Control and Prevention shows that full vaccination with any of the currently available coronavirus vaccines dramatically reduces the risk of requiring hospitalization for a coronavirus infection.

State health officials have also asked people should not go to emergency rooms for asymptomatic coronavirus tests or other matters that can be handled in doctor’s offices, but said no one should hold off emergency room visits for potentially serious conditions. They warned people people to be prepared to wait for care.

Idaho’s hospitals have struggled to fill empty nursing, housekeeping and other health care positions, in part because some staffers have left because they are burned out by the strain of the pandemic and because others have been quarantined because they were exposed to COVID-19.

Late last month, Little called in 220 medical workers available through federal programs and mobilized 150 Idaho National Guard soldiers to help hospitals cope with the surge.
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And people who didn't take the virus seriously continue to die from the virus.

California Couple Dies of COVID, Leaving Five Kids, Including a Newborn, Behind:
https://www.yahoo.com/news/california-couple-dies-covid-leaving-105447801.html

Davy Macias, 37, was intubated and dying of complications from covid-19 when doctors helped her give birth to her daughter. She would never see her baby.

Her husband, Daniel Macias, 39, would only get a brief glimpse of their child because he, too, was hospitalized after contracting the virus. According to Davy's sister-in-law, Terri Serey, Daniel waited to name the baby girl because he believed he and his wife would walk out of the hospital alive to introduce the newborn to their four other children, the eldest age 7 and the youngest, 2.

But about a week after the baby was born, Davy died. Two weeks later, so did Daniel.

Daniel "was well enough to send me a picture of the baby," Serey told The Washington Post. But "that was the last text I received from him."

Davy and Daniel Macias, of Yucaipa, Calif., are among the 658,000 Americans to have died from covid-19 as the delta variant causes a resurgence of cases and health officials race to immunize a population divided on whether to take the shot. Davy Macias did not get vaccinated because she was pregnant, Serey said. It is unclear if Daniel was vaccinated.

The Centers for Disease Control and Prevention has urged those who are pregnant to take the vaccine, as studies have found that the coronavirus vaccine does not heighten the risk of miscarriages. Rather, research shows that those who are pregnant face a higher risk of severe covid-19 symptoms, preterm births and "other adverse pregnancy outcomes" if they contract the virus, the CDC says.

The deaths of Davy and Daniel Macias echo the story of Lydia and Lawrence Rodriguez, a Texas couple who last month died weeks apart from each other, leaving behind four children. Neither parent was vaccinated; before she died, Lydia Rodriguez asked her family to make sure her children received the vaccine.

The Macias children, who are being cared for by Daniel's parents, have not quite grasped what has happened to their mother and father, Serey said. After Daniel died on Sept. 9, a counselor explained to the two eldest children, 7 and 5, that both of their parents were gone, Serey said. While the oldest child - Daniel and Davy's only son - understood the situation, his younger sister is "still looking for mommy," Serey said. All of the children, Serey has heard from the grandparents, "spend a lot of time at night looking for mom and dad."

In June, Davy and Daniel celebrated 11 years of marriage. Davy was a registered nurse at the labor and delivery ward at Kaiser Permanente Fontana Medical Center, and Daniel was a teacher at Jehue Middle School in San Bernardino County. When asked what the couple enjoyed doing together, Serey had one answer: Their hobby was their kids.

Because Davy often worked nights, she would spend time with her kids during the day, Serey said. Davy's TikTok account is almost entirely dedicated to chronicling life with her children. One video from last year shows her with her four kids, all of them dressed in shark costumes, dancing to Coolio's "Gangsta's Paradise."

In early August, the entire family came down with covid-19, Serey said. While the children recovered relatively quickly, the symptoms only worsened for Davy, who went to the hospital for treatment. Less than a week later, Daniel followed.

Davy was already intubated and had stopped directly communicating with her family by the time her newest daughter was born via Caesarean section on Aug. 18, Serey said. About three days after the baby was born, Daniel was intubated. The husband and wife were only a few rooms apart at the hospital. "He had no idea that she passed away," Serey said.

As news circulated about the couple's deaths, Serey said strangers have reached out to her and her husband - Davy's brother, Vong - to ask whether they should take the vaccine.

"They ask me questions about side effects," Serey said. "It's interesting, because people want somebody to give them the answer."

Her answer? "I don't know anybody that's died from the vaccine, but I do know people who have died from covid."

Serey said she does not know whether Davy had regrets about not taking the coronavirus vaccine, but she did get the impression that Davy didn't believe she'd get seriously ill.

"I don't believe that she really thought it was going to get that bad."
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Sonya · Sep 13, 2021

Oopsie.. forgot one.

Westgate and Resorts World Announced Employee Vaccine Mandates:
https://www.8newsnow.com/news/local-news/westgate-resorts-world-announce-employee-vaccine-mandates/

A pair of Las Vegas resorts announced new vaccine mandates for employees Friday. The orders cover the Westgate and Resorts World.

Westgate CEO David Seigel told staff in a memo that he survived a difficult battle against COVID-19 in July. He said he believes if he hadn’t been vaccinated he would not be alive today.

Seigel went on to tell his employees that starting Oct. 15, 2021, proof of vaccination will be required for all team members.

Resorts World announced similar, though less-inclusive rules Friday. It says starting Monday, it will require COVID vaccines as a condition of employment for all new hires, both hourly and salary.
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Sonya · Sep 14, 2021

Nevada COVID-19 updates for 9/14:

Test positivity (note, w/ 7-day lag) is fluctuating but up: 11.49% (+0.25%)
Hospitalizations are fluctuating but down: 1,095 (-25)
Cases are fluctuating but down: 1,203 (-22)

Clark County cases are up: 587 (+4)
Washoe County cases are up: 300 (+29)

https://thenevadaindependent.com/coronavirus-data-nevada

County By County Mask Mandate Data:
https://covid.cdc.gov/covid-data-tracker/#county-view|Nevada|32003|Risk|community_transmission_level

Clark County remains at the High Level. All counties in Nevada are at High or Substantial Risk and all will have a mask mandate.

Clark County's case numbers per 100k population continues to decline. But it is still way above the limit of 50 cases per 100k to lift the mask mandate.

Their Crisis is Our Problem: Washington Grapples with Idaho's Problem:
https://www.nytimes.com/2021/09/13/us/coronavirus-hospitals-washington-idaho.html

Surgeries to remove brain tumors have been postponed. Patients are backed up in the emergency room. Nurses are working brutal shifts. But at Providence Sacred Heart Medical Center in Spokane, Wash., the calls keep coming: Can Idaho send another patient across the border?

Washington State is reeling under its own surge of coronavirus cases. But in neighboring Idaho, 20 miles down Interstate 90 from Spokane, unchecked virus transmission has already pushed hospitals beyond their breaking point.

“As they’ve seen increasing Covid volumes, we’ve seen increasing calls for help from all over northern Idaho,” Dr. Daniel Getz, chief medical officer for Providence Sacred Heart, said in an interview. As he spoke, a medical helicopter descended with a new delivery.

At a time when Washington State hospitals are delaying procedures and struggling with their own high caseloads, some leaders in the state see Idaho’s outsourcing of Covid patients as a troubling example of how the failure to aggressively confront the virus in one state can deepen a crisis in another.

On the Washington side of the border, residents must wear masks when gathering indoors, students who are exposed to Covid face quarantine requirements, and many workers are under vaccination orders. On the Idaho side, none of those precautions are in place.

“It’s ridiculous,” said Cassie Sauer, the president of the Washington State Hospital Association. “If you have your health care system melting down, the idea that you would not immediately issue a mask mandate is just bizarre. They need to be doing everything they can possibly do.”

Last week, Idaho took the extraordinary step of moving its hospitals in the northern part of the state to crisis standards of care — the threshold at which facilities facing overwhelming caseloads are authorized to ration their resources, perhaps withholding or delaying optimal care for some patients.

Idaho now has more than 600 patients hospitalized with Covid-19, about 20 percent higher than a previous peak in December. Only 40 percent of the state’s residents are fully vaccinated, one of the lowest rates in the nation, compared with 61 percent in Washington State, one of the highest.

The strain on health care facilities is particularly evident in northern Idaho, where the vaccination rate is even lower; the area just hosted the North Idaho State Fair, and in a region where there is deep wariness of government, no mask orders or other strategies were adopted to halt the spread of the virus. At Kootenai Health in Coeur d’Alene, a conference room has been converted to house excess patients.

Washington State has faced its own challenges and record hospitalizations, especially in areas on the eastern side of the state where vaccination rates are lower. This week, that state, too, began talking openly about the possibility that crisis standards of care could become necessary.

But Washington is in better shape than Idaho, where hospitalizations as a share of the population are 45 percent higher.

“We certainly need our friends in Idaho government to do more to preserve their citizens’ health, because we know that their crisis is becoming our problem,” Washington’s Democratic governor, Jay Inslee, said last week. “I’m asking the people of Idaho to adopt some of the safety measures — like masking requirements — like we have in Washington so we can help both of our states reduce this horrible pandemic.”

In Idaho, Gov. Brad Little’s office said he was not available for an interview, but he has indicated in recent weeks that he has no plans to restore virus restrictions, even if hospitals entered dangerous territory, saying that he wanted residents “to choose to do the right thing and get vaccinated.” He issued a statement on Friday saying he was exploring legal action to halt new mandates from President Biden that will push millions of people to get vaccinated.

“President Biden is out of touch, and his mandates only add to the divisiveness within our country,” Mr. Little said.

The governor has urged personal responsibility, and in northern Idaho, where schools are not requiring masks or doing contact tracing, health care leaders have grown exasperated at statements from members of the community suggesting that they do not believe the situation is as dire as doctors and hospital administrators portray it.

“That’s extremely disappointing,” Dr. Robert Scoggins, medical director of the intensive care unit at Kootenai Health, said at a news conference on Wednesday. “In north Idaho, we don’t have a lot of mitigation going on. In taking care of these patients in the I.C.U. that are very sick, they regret that they didn’t take this very seriously.”

Last week, a U.S. Army medical team deployed to support health care workers at the hospital.

Dr. Getz and other doctors in Spokane have not resisted taking patients from Idaho. Providence Sacred Heart has long seen the neighboring state as part of its larger community, and when there is space, the facility has opened its doors. But the transfers have helped push the hospital toward its own capacity limits.

Last week, 29 of the facility’s inpatients were from Idaho. The number of patients sent over to the emergency room from Kootenai Health alone was up 34 percent in August, officials said. MultiCare Health System, which also has a hospital in Spokane, has also seen a substantial rise in calls for support from Idaho — although, like Providence, capacity issues have forced them to decline some of the requests.

It is not uncommon for hospitals to divert patients during busy periods or transfer them to facilities where there might be specialists better suited to their needs. But the current virus spike in the region — and across much of the country — has left hospitals scrambling for options. In Spokane, Providence has fielded calls from hospitals as far away as Texas and Missouri, which also have large outbreaks.

Hospitals are generally obligated under federal law to accept transfer requests when there is space to care for them. For cases in closer proximity, officials said, patients may drive themselves across state lines to hospitals where they believe they can get more immediate care, and hospitals must care for those who show up at their door. For patients without insurance, the hospitals may end up providing the care for free.

With the influx of patients, both from within the community and from across state lines, Providence Sacred Heart has seen patients stuck in the emergency room for hours longer than normal, awaiting an open bed. Those who do have a bed may not get a place in the I.C.U., as they normally would. The hospital has begun canceling elective procedures and is proceeding only with those that are urgent, Dr. Getz said. Procedures to excise brain tumors and treat orthopedic injuries are among those that have been postponed, he said.

“We are delaying care for people who are in misery,” Dr. Getz said. “It’s agonizing for those patients. This has real impacts on these people who are waiting.”

Care rationing under crisis standards of care would go even further. In Idaho, that has meant nurses have higher patient loads and are authorized not to check vital signs as often as usual. If the situation were to deteriorate, with insufficient supplies or staff to manage caseloads, health officials said, care rationing could mean having to decide which patients get priority for oxygen or ventilators.

States across the country have discussed triage plans that could be used when admissions reached a crisis level, but few have actually activated them. Arizona and New Mexico activated their crisis plans earlier in the pandemic, but Idaho appears to be the only state with those standards currently in effect.

Medical staff members have struggled to keep up in both states. Some are quitting, unable to endure more of a pandemic that has already consumed them for 18 months. Some are demoralized by what they see as the public’s failure to take the virus seriously. Nurses are regularly working 16-hour shifts.

Mary Jo Moore, a director of critical care at Providence Sacred Heart, said health care workers frequently deal with anger from people who are asked to wear masks or told they cannot have visitors. Some patients come in refusing to believe they are infected with the virus, and some push for unapproved forms of treatment.

“There’s a lot of verbal abuse that the staff are taking right now,” Ms. Moore said, as she walked through Covid units, where nurses were caring for patients who had been placed on their stomachs in an attempt to help them breathe.

“And I have staff like this that are as pleasant as can be,” she said. “And they are coming back to work every day and providing care for these patients.”
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Sonya · Sep 15, 2021

Nevada COVID-19 updates for 9/15:

Test positivity (note, w/ 7-day lag) is fluctuating but down: 11.47% (-0.03%)
Hospitalizations are fluctuating but down: 1,090 (-5)
Cases are fluctuating but down: 1,146 (-57)

Clark County cases are down: 583 (-4)
Washoe County cases are up: 304 (+4)

https://thenevadaindependent.com/coronavirus-data-nevada

The Nevada Health Association Put Out This Announcement:

Here are two stories about the booster shots, specifically Pfizer.

New Pfizer Data Makes Case for Booster Shots:
https://www.yahoo.com/gma/pfizer-data-makes-case-booster-141500020.html

The Food and Drug Administration on Wednesday released new data from Pfizer's submitted application to approve booster doses of its Covid-19 vaccine. In it, Pfizer demonstrates what it sees as proof that third shot will be both safe and necessary for most Americans to take, arguing that immunity wanes over time -- regardless of any new variant of concern.

It comes two days ahead of a critical juncture in the COVID-19 vaccine booster approval process: Friday, the Food and Drug Administration's independent advisory committee (VRBPAC) is set to convene to review and discuss the latest data on potential booster doses of the Pfizer vaccine. The committee will be asked to vote on whether a booster dose is safe enough for widespread use -- and whether it's necessary and effective at improving protection levels.

In mid-August, the FDA authorized boosters of Moderna and Pfizer for the roughly 7 million immunocompromised Americans who didn't get an optimal immune response to their initial vaccine doses.

Pfizer/BioNTech, which partnered to develop the nation's first fully approved vaccine, has said it has early data suggesting a booster dose anywhere from six to 12 months after the second dose will help maintain a high level of protection; Pfizer asked the FDA to approve booster doses of its vaccine in late August by submitting an application and data. On Wednesday morning, the FDA made that data public.

While the independent members of the VRBPAC's votes are not binding, the agency takes its recommendations under serious advisement in deciding whether to grant vaccines new authorization or approval. If and when a recommendation does come to green light booster shots, several additional steps must follow before it's time for more Americans to role up their sleeves a third time.

First, the FDA would need to formally amend its current vaccine approval for Pfizer; then the Centers for Disease Control and Prevention's advisory committee (ACIP) will weigh to whom, and when, expanded booster shots should begin. Then, the CDC director must formally sign off on whether to recommend the vaccine to the public, including who it will be recommended for and at what time period. It's expected to be authorized for anyone eight months after their second dose. Authorization for Moderna and Johnson & Johnson may not be far behind.

The new data -- and proximate committee vote -- also come days before the Sept. 20 date set by the White House as the target to begin deploying booster shots for a wider pool of Americans.

The question of whether America's immunity is waning has become an urgent question in recent months with the rise of the delta variant and large pockets of the country still unvaccinated.

FDA acting Commissioner Janet Woodcock and CDC Director Rochelle Walensky -- both White House appointees -- endorsed President Joe Biden's Sept. 20 plan.

However, it has been getting some pushback, with health experts criticizing the Sept. 20 boosters-for-all timeline as premature and prior to any ruling from their advisory groups.

Two top FDA officials who are leaving the agency later this year publicly waded into the booster debate on Monday, splitting from the agency and arguing in a scientific journal that it was too soon to give booster shots to the general public since the vaccines still offer strong protection against serious disease.

One of them is scheduled to attend Friday's VRBPAC discussion.

"The message that boosting might soon be needed, if not justified by robust data and analysis, could adversely affect confidence in vaccines and undermine messaging about the value of primary vaccination," the officials wrote, backed by other worldwide organizations.

For their part, the Biden administration has emphasized that science will lead and federal regulators will have the final say -- and that their call to push out booster shots is motivated by wanting to "stay ahead" of the virus.

"You don't want to find yourself behind playing catch up," Dr. Anthony Fauci said when announcing the plan. "Better stay ahead of it than chasing after it."
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FDA Sounds Skeptical Note on Pfizer Booster Ahead of Vote:
https://www.politico.com/news/2021/09/15/fda-sounds-skeptical-note-on-pfizer-booster-shot-ahead-of-key-vote-511909

The Food and Drug Administration refrained from endorsing a Covid-19 booster shot from Pfizer and BioNTech in an analysis posted Wednesday ahead of a crucial advisory committee meeting.

The agency appeared skeptical about the companies' assertion that an apparent drop in immune protection conferred by their Covid-19 vaccine is likely due to the passage of time, rather than the emergence of the hyper-contagious Delta variant.

Documents released ahead of the FDA vaccine advisory committee meeting Friday, which will focus on Pfizer's booster application, show the companies made their conclusion based on study data and real-world evidence. The latter includes Israel's experience observing waning immunity within its population. The country has fully vaccinated the majority of its population — largely with the Pfizer shot — and began administering boosters in July to people over 60. It has since expanded eligibility to people over 30.

But FDA said observational studies don't unanimously support the suggestion that the shot's efficacy declines over time, while data overall show that all three vaccines authorized or licensed in the U.S. — from Pfizer-BioNTech, Moderna and Johnson & Johnson — still protect against severe disease and death.

"There are many potentially relevant studies, but FDA has not independently reviewed or verified the underlying data or their conclusions," the agency said, adding that some of those studies — including data from Israel — would be discussed Friday.

The Israeli data, some of which is set to be published Wednesday, has shaped the Biden administration's effort to begin offering boosters to most adults next week. In its absence, federal scientists and other public health experts have questioned the move toward boosters when available data shows that the vaccines still offer high protection against severe disease, hospitalization and death in most age groups.

"Known and unknown biases" can affect the reliability of observational studies, FDA cautioned.

"Furthermore, US-based studies of post-authorization effectiveness of [the Pfizer-BioNTech vaccine] may most accurately represent vaccine effectiveness in the US population," the agency said.

Still, FDA acknowledged that the companies met the pre-defined success criteria in their booster study.

The third vaccine dose was "well-tolerated" among study participants, Pfizer said, with no serious adverse events or deaths reported. Mild to moderate injection site pain, fatigue, chills and muscle soreness were commonly reported side effects.

Pfizer's booster shot application would apply to individuals 16 and older. If members of FDA's vaccine advisory committee vote to recommend boosters, FDA and the CDC's own outside advisory panel could act within days to permit use of the Pfizer booster. FDA is not bound by its advisory committees' recommendations but often follows them.

The Biden administration's goal of rolling out boosters by Sept. 20 has stirred controversy within FDA. Two of the agency's top vaccine scientists, Marion Gruber and Philip Krause, recently decided to retire this fall — in part over frustration with the planned booster launch.

Gruber, director of FDA's Office of Vaccines Research and Review, will give a presentation Friday at the FDA advisory committee meeting.

More on side effects: About 5 percent of study subjects — predominantly female — experienced swollen lymph nodes within four days of the shot, Pfizer said. All but one case of the condition, a known side effect of the vaccine, were considered mild.

"As Dose 3 is a booster, it is not surprising that stimulation of a lymph node reaction by vaccination would be present in the setting of a significant increase in neutralizing antibodies observed after Dose 3," Pfizer said.

No participants experienced myocarditis or pericarditis, two heart inflammatory conditions that have been linked to the vaccine, especially among males 30 and younger.

Pfizer is also recommending that its booster dose be given six months after a patient's second of two initial doses, rather than the eight months that top Biden administration health officials have suggested. The final decision on timing will rest with federal regulators at the FDA and CDC.
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We will know more after the FDA Meeting on Friday.

COVID-19 Has Killed 1 in 500 Americans:
https://www.popsci.com/health/one-in-500-americans-dead-from-covid/

It’s 19 months into the pandemic, and the United States has reached another morbid milestone: 1 in 500 American residents has died from COVID-19 since the country’s first reported infection.

As of Tuesday evening, the US had recorded more than 663,000 COVID deaths according to data from the John Hopkins Coronavirus Resource Center. The 2020 census count of 331.4 million residents puts the country’s death toll right at 0.2 percent of the total population, or 1 in 500.

People aged 85 and older make up just 2 percent of the US population, but account for more than 30 percent of deaths.

The Washington Post reports that the numbers reveal stark racial inequalities when assessing deaths among people aged 40 to 64: COVID-19 has killed just 1 in 1,300 white people, but has taken down 1 in 480 Black people, 1 in 390 Hispanic people, and 1 in 240 Native American people—making the death rate for Native Americans in that age group five times higher than the rate for the white population.

In people aged 18 to 39, the racial disparity is even starker, with coronavirus claiming Black and Hispanic lives at rates more than three times higher than in white people, and Native American lives at a rate more than nine times higher.

“So often when we think about the majority of the country who have lost people to COVID-19, we think about the elders that have been lost, not necessarily younger people,” Abigail Echo-Hawk, executive vice president at the Seattle Indian Health Board and director of the Urban Indian Health Institute, told The Post. “Unfortunately, this is not my reality nor that of the Native community.”

The latest data from the US Centers for Disease Control & Prevention says that 63.2 percent of everyone eligible for vaccination (people aged 12 and up) have gotten all of their shots. While state and federal governments are considering vaccine mandates, the issue is already causing division. New York tried to pass a vaccine mandate for medical workers, but the movement was blocked by a federal judge after a group of health workers sued, saying the mandate would violate their religious rights, AP News reported. A hearing is scheduled for September 28.

The US Food and Drug Administration is also set to meet at the end of the week to discuss whether Americans will need booster shots—though the deliberation looks like it will be tricky.

“This will be much messier than in December,” Vanderbilt University infectious disease specialist William Schaffner told CNN. President Joe Biden has already publicly announced his administration’s intention to move forward with boosters, but FDA staffers recently penned an opinion piece in The Lancet saying that the data doesn’t support a need for boosters right now.

Most Americans are also unaware of just how limited vaccine availability is around the world. A report by Pew Research shows that 42 percent of Americans think that at least half of all adults in developing countries have access to COVID-19 vaccines, while 32 percent say they aren’t sure.

The US Food and Drug Administration is also set to meet at the end of the week to discuss whether Americans will need booster shots—though the deliberation looks like it will be tricky.

“This will be much messier than in December,” Vanderbilt University infectious disease specialist William Schaffner told CNN. President Joe Biden has already publicly announced his administration’s intention to move forward with boosters, but FDA staffers recently penned an opinion piece in The Lancet saying that the data doesn’t support a need for boosters right now.

Most Americans are also unaware of just how limited vaccine availability is around the world. A report by Pew Research shows that 42 percent of Americans think that at least half of all adults in developing countries have access to COVID-19 vaccines, while 32 percent say they aren’t sure.
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A week or two ago there was a tiny article in a Photo journal about how a few vendors, including major ones, had cancelled their participation at NAB. Today we got this article:

National Association of Broadcasters (NAB) Cancels 2021 Convention:
https://www.reviewjournal.com/business/conventions/nab-cancels-2021-las-vegas-convention-2440839/

The National Association of Broadcasters show announced it is cancelling its Las Vegas convention this year.

The annual convention was set to take place Oct. 9-13. NAB’s 2020 show also was canceled due to the coronavirus. The show released a statement announcing the cancellation.

“For more than a year, we have worked tirelessly to bring our industry together safely in Las Vegas at NAB Show,” the statement said. “Unfortunately, the pandemic and surge of the Delta variant has presented unexpected and insurmountable challenges for our global community. As we have always kept the best interest and safety of the industry as our priority, it has become apparent in the face of these challenges that we can no longer effectively host NAB, or our co-located events, the Radio Show and Sales and Management Television Exchange, in person.”
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This is a big financial loss for Las Vegas. Hopefully they can get COVID under control so there won't be more cancellations.

Sonya · Sep 16, 2021

Nevada COVID-19 updates for 9/16:

Test positivity (note, w/ 7-day lag) is fluctuating but down: 11.40% (-0.07%)
Hospitalizations are fluctuating but down: 1,073 (-17)
Cases are fluctuating but up: 1,198 (+52)

Clark County cases are up: 632 (+49)
Washoe County cases are down: 292 (-12)

https://thenevadaindependent.com/coronavirus-data-nevada

Have COVID-19 Misinformation Reached Crisis Levels in Clark County?
https://www.reviewjournal.com/news/politics-and-government/clark-county/have-covid-19-falsehoods-reached-crisis-level-in-clark-county-2441467/

Clark County lawmakers will consider formally taking on a potential crisis that has emerged from the COVID-19 pandemic: misinformation.

The county commission is expected to vote Tuesday on whether to declare COVID-19 misinformation a public health crisis that has fueled public mistrust and prolonged the pandemic by undermining efforts to combat the spread of the disease, according to a proposed resolution.

“We’ve certainly seen across the country, but certainly right here in Nevada, what misinformation about the vaccines and the masks has resulted in,” said Commissioner Justin Jones, who is recommending the county adopt the resolution.

If it decides that dubious claims about COVID-19 have reached a crisis level, the county will become one of few governments in the nation thus far to do so, following San Diego County, which was first to label misinformation a public health crisis late last month.

The possibility that the county will formally wage a campaign against the spread of misinformation comes amid efforts already underway: The county has livestreamed conversations with health officials, for instance, and deployed messaging on social media.

But while more than 1.1 million people are fully vaccinated countywide, the figure only represents 56 percent of the eligible population aged 12 years and older, according to the Southern Nevada Health District.

“I don’t think that there’s any doubt that it is misinformation” that has dissuaded more people from getting vaccinated, Jones said.

Falsehoods and conspiracy theories

Public meetings have recently turned into tense forums for people to air criticisms of vaccines, face masks and public health decrees. Grievances have generally challenged public policy and scientific opinion while sometimes devolving into conspiracy theories.

When commissioners called an emergency meeting on July 20 to consider measures to reverse a rising COVID-19 positivity rate, more than three dozen people showed up to address the board. Many feared another devastating shutdown, although lawmakers ultimately required all workers in the county to wear face masks.

Critics disputed the efficacy and safety of masks and vaccines, alleged the pandemic was a hoax, vouched for unproven treatments and accused officials of skewing COVID-19 data.

Jones said that county officials have also been accused of being pawns for Bill Gates and he has heard other “plainly ridiculous” conspiracy theories such as that microchips were being injected into the vaccinated.

One woman during that July meeting claimed the pandemic was a “biologic cyber war investigated by a large group of eugenicists involved in massive depopulation agenda.”

Bad information a threat

On July 15, U.S. Surgeon General Dr. Vivek Murthy warned Americans that health misinformation threatened the nation’s response to the pandemic. Two-thirds of unvaccinated adults by late May had heard at least one COVID-19 vaccine myth, and were either convinced it was true or unsure, according to Murthy’s advisory, citing findings by the nonprofit Kaiser Family Foundation.

He called upon technology and social media companies to do more to prevent health misinformation from spreading online.

With the resolution, Jones said that county efforts will continue to focus on people who are hesitant but can also be persuaded to get vaccinated, recognizing that there is a segment of the population that will not be responsive to any amount of messaging.

“I think it’s always difficult to cut through the noise,” Jones said.
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You can find the proposed resolution here - https://clark.legistar.com/View.ashx?M=F&ID=9811967&GUID=87D8B173-3775-406C-86F1-9A62EBCF7432

The Nevada Department of Agriculture Wants You To Not Take Animal Dewormer to Treat a Virus:

Just use common sense and logic with these "cures". Why would any kind of medication for parasites do anything for a viral infection? SPOILER: It won't.

Rapid Tests Should Play a Larger Role in the COVID-19 Plan:
https://www.statnews.com/2021/09/16/beyond-vaccinopia-larger-role-rapid-tests-fighting-covid/

This has been a personal beef of mine for the last 18 months. I have no idea why testing isn't easier and more readily available.

America is suffering from a serious case of vaccinopia: an inability to look beyond shots in arms when considering how to manage the pandemic. This was made clear by President Biden’s new Covid-19 plan, which emphasizes vaccine mandates while providing insufficient support for rapid tests, which we believe to be the most promising — and most underused — tool in the armamentarium against the coronavirus.

We are strong proponents of the Covid-19 vaccines, which have proven to be impressively effective and safe. In an ideal world, every eligible American would have been vaccinated by now. But we do not live in an ideal world. Covid-19 vaccination has become so politicized that a broad, societal consensus on its merits seems all but impossible. As many as one in five eligible Americans may continue to decline vaccination.

Vaccine mandates could change that, but their immediate impact will be blunted by the inevitable legal challenges and the months-long process of delivering millions of vaccinations and waiting for sufficient immunity to develop. In addition, 48 million children under 12 are not yet eligible for vaccination.

Beginning in January 2020, just weeks after a novel coronavirus had begun to wreak havoc in Wuhan, China, public health experts in the U.S. were advocating for the development of rapid tests. Within a few months, effective ones began appearing on the market. Germany and other countries approved a large number of rapid tests and widely deployed them. In the U.S., bureaucratic and political obstacles delayed their arrival. With a new administration in Washington in January 2021, it seemed that rapid tests would at last get the attention and support they deserved. But the Biden team ultimately continued with the vaccine-centric strategy pursued by its predecessor.

Rapid tests could help us get the pandemic under control in the near term. And over the long run, they could become an essential tactic for reducing the spread of SARS-CoV-2 to low levels, so Covid-19 becomes more a nuisance than remaining a national emergency.

In the early months of the pandemic, before the emergence of rapid tests, the main way to detect the presence of SARS-CoV-2 was via laboratory-based testing, which requires expensive equipment and trained technicians. Such testing is exquisitely sensitive, because it uses the polymerase chain reaction (PCR) to detect and amplify tiny amounts of genetic material from the coronavirus. But the results from PCR tests are often not available for several days — too late to prevent infected individuals from spreading the virus.

Rapid antigen tests, which provide results in about 15 minutes, look for viral proteins instead. This makes the process much faster. And unlike the deeply probing nasal swab typically used in PCR tests, a much less invasive swipe of a swab in the front of the nose is sufficient. (Antigen tests should not be confused with antibody tests, which require a few drops of blood, often from a finger stick, and look for signs of previous infection.)

If SARS-CoV-2 could be said to have a superpower — a unique feature that contributes greatly to its unchecked spread — that might be its ability to make infected people who are symptom free highly contagious. For days before the onset of symptoms, infected individuals can pass the virus to others, sometimes dozens of people at a time, as has been seen in the many superspreading events that have been documented over the last 18 months.

PCR tests are poorly suited for identifying and containing presymptomatic spread of the virus, which has been estimated to account for about half of all new infections. And because PCR tests are so sensitive, they often yield positive results after infected individuals are no longer contagious.

In contrast, rapid tests are ideally suited for spotting infectious individuals. Considering the growing number of breakthrough infections during the Delta wave, widespread use of rapid tests could be a powerful tactic for breaking viral transmission chains and quelling outbreaks.

In many countries, rapid tests are provided free of charge. In some parts of Europe, they can be purchased in retail stores for less than one dollar each. In parts of Asia, they are widely available in vending machines for a nominal price. Ideally, they should be provided free to all households to encourage their use on a frequent basis.

Rapid tests can be used in different settings for different purposes. At home, rapid tests could help parents keep sick children out of classrooms, allowing schools to stay open. In offices, rapid tests could give employers the confidence to reopen workplaces and their employees the confidence to return to them. And with testing required for entry, the travel and hospitality industries could use rapid tests to assure customers that airports and hotels are safe.

To be sure, there are challenging logistics regarding rapid tests. In an airport, for example, screening hundreds of passengers per hour would not be easy. But as we learned about security after 9/11, if there is sufficient demand, innovative organizations and start-ups will supply solutions.

Biden’s new Covid-19 plan does acknowledge a role for rapid tests. But it proposes to purchase only 280 million of them at a cost of around $7 each — about six times more than what they cost in European retail stores. This is far too few for far too much.

Instead, the U.S. should plan for a several-month surge of rapid testing, aiming to test a substantial proportion of the population at least twice a week. That would require around one billion tests a month. And the goal should be to get the price per test much closer to one dollar.

A key obstacle to achieving these goals is the onerous — and we believe inappropriate — criteria the FDA has set for authorizing rapid tests. Because the agency requires that rapid tests return results that are comparable to PCR tests, only a handful are now available for home use. In our opinion, the FDA is mistaken in classifying rapid tests as medical diagnostic devices. Instead, they should be deemed to be public health screening tools and evaluated solely on their ability to identify and isolate infectious individuals on a timely basis.

The European Union has recognized more than 135 rapid tests that provide accurate results. We urge President Biden to consider issuing an executive order that would break the FDA logjam and immediately make available in the U.S. suitable rapid tests developed here and around the world.

We know that rapid tests are not a panacea. In parallel with new testing efforts, the U.S. must press on with the difficult project of vaccinating a greater proportion of the population. But focusing primarily on vaccines and overlooking a valuable tactic like rapid testing is a dangerous kind of myopia that the country should avoid.
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James Hamblin is a physician and public health lecturer at Yale and has written this wonderful and thoughtful piece. Although it's on his Facebook blog thingie, I have to share it here.

The Two Ways COVID Ends:
https://body.bulletin.com/5212449512104445/?fbclid=IwAR3FHoi5skltfHI0tcJu7qSMDMhb6U9g3jAyZOcZrQdbIskQuz-NPLDJj10

I think we're at an inflection point in the pandemic, ostensibly spurred by the new vaccine mandates, paired with exhaustion and frustration and anger, and much preventable suffering.

Some 1,600 Americans are dying every day of a disease that—in most cases—could have been avoided with a free shot. People are declining not simply donuts but cash payments to get this shot, putting themselves and everyone around them (and everyone around those people, and on and on) at continued risk.

And this isn't just typical human behavior; the U.S. is failing uniquely. Despite a huge global head start—outbidding poorer countries and hoarding hundreds of millions of doses—American vaccination levels have now fallen to the middle of the pack, behind Cambodia, Uruguay, Mongolia (where, incidentally, our old friends beavers are testing positive for SARS-CoV-2), and most other wealthy countries in the world. Only 54 percent of Americans are fully vaccinated.

Without a clear vision of an end goal, it's tempting to give in to apathy and resentment, even rage or despair. I know at times I have. In recent weeks, readers have been asking even more wearily than usual about when this ends.

Does the pandemic just go on forever? If 80 million Americans aren't going to get vaccinated, what are we even doing here?

So I thought it might be helpful to step back and look at where we are, and where it's still possible to go. To look at the two potential pandemic paths ahead of us. I'm picturing it like two roads are diverging, if you will, and we could still choose either.

One is straightforward. We have a map and all necessary resources. The other is meandering and recursive. It's like the one we've been on. The birds are clearly screeching at you to turn back, and there are trolls, and we keep stopping to engage with their bizarre riddles, and they keep turning more of us to stone. Some of us get so tired or hopeless that we start to think the riddles are medical advice. The trolls allude to horse paste, and people eat it. You know the road.

The complicated thing is that, given the nature of infectious disease, whichever road we choose, everyone's on it together.

The textbook ways that infectious disease outbreaks play out fall into three categories: (1) eradication, (2) elimination, or (3) control.

These were described in 1997, when the World Health Organization convened a panel of experts in Atlanta to prioritize—among the myriad preventable contagions—where the most good could be done. These are broad categories (and, like most categories, they're actually describing parts of a spectrum). But the terminology remains in use, and throughout the pandemic it's been helpful to me to think of things in terms of these three basic conceptual roads.

I. Eradication

This would mean absolutely zero COVID cases anywhere. We've only ever eradicated one virus, smallpox. For centuries, it caused a horrific, sometimes disfiguring disease. Now it’s totally gone. The campaign to beat the virus involved widespread mandatory inoculation (including a mandate from the notorious tyrant George Washington. He wrote: "Necessity not only authorizes but seems to require the measure, for should the disorder infect the Army . . . we should have more to dread from it, than from the Sword of the Enemy.") In other words, freedom isn't free.

Eradication of SARS-CoV-2 isn't currently on the menu, for a lot of reasons, including the basic nature of the virus and disease it causes, and the handful of changes that have happened in the world since 1777 (e.g. even amid this pandemic, people are recreationally darting all over the globe in "flying horseless carriages" and seeding variants faster than they can be identified), and the rather precipitous decline of the global-health coalition that united to fully eradicate smallpox in the mid twentieth century.

So, this leaves us with the other two fates: elimination and control.

II. Elimination

This term belongs in quotes. (Not "scare" quotes, but "this word isn't being used in a way that accords with any standard definition" quotes.) In this case, "elimination" actually means something more like ... make it so there's not too much around here. More like vanquish.

"Elimination" is where the U.S. stands with regard to diseases like polio and measles. They still exist, and viral spread persists in under-vaccinated areas of the world. But the diseases have been effectively eliminated from the long list of daily concerns for most humans. Accordingly, interventions to contain outbreaks can be limited and targeted. People don't need to plan their lives around these viruses—even though, as with COVID, our vaccines are less-than-100-percent perfect. Thanks to widespread uptake, in places where 90-plus percent of people are vaccinated, there's so little measles around that it can be considered "eliminated." People don't have to waste time and energy debating things like how to open schools or whether elective surgeries need to be canceled to make room for all the measles cases.

Some experts think elimination is still theoretically on the table for COVID-19, Fauci said last week. At least, as a worthy goal. The possibility also depends on things like how the virus evolves, and how durable immunity proves to be over the years. But on our current course, we're leaning pretty hard into option three.

III. Control

Control means, essentially, a forever war. The disease persists indefinitely, and though it's rarely at the front of our minds, we're endlessly devoting resources to keep the rates of disease and death "at an acceptable level."

Obviously that's an extremely subjective term, acceptable. No one wants to put it into words. But common examples are things like malaria, which infects hundreds of millions of people, or influenza, which kills hundreds of thousands of people every year, especially among vulnerable populations. Some people are vigilant about doing their part to prevent unnecessary spread—things like hand washing, and getting a flu shot. Vaccines are only required in a few circumstances, and only about half the population chooses to get one. The imperfection of the vaccines is regularly on display (since the virus circulates so widely and mutates so readily that we can't even predict its course well enough to make durable, reliable vaccines), and this imperfection adds to people's reluctance to get vaccinated, and the cycle continues.

Even if it seems we're inevitably headed toward option III with COVID-19, there is still a big difference between a world where the virus occasionally flares up—and people are asked to wear masks and make sure their vaccines are current, and they simply do, and the outbreak is quickly squelched—and a world where each instance is an interminable nightmare of arguments and political grandstanding and deworming agents.

As of now, the goal seem to be to push toward the former path. And we all have some role to play in that. Much depends on how we navigate the escalating culture war. We can either allow ourselves to get sucked into it indefinitely—repeating the same mistakes that have plagued the U.S. throughout this pandemic—or find a way to break the cycle.

There was a time when it was reasonable to hope that vaccine mandates would be unnecessary. It was fine to be That Guy on the Zoom happy hour who said, "I'm all for vaccination, but I don't think it should be required." That's effectively what the Biden administration had been saying until last week. The president waited months to impose these mandates, which many experts thought were warranted earlier.

In an ideal world, mandates aren't needed. No one wants to have to deal with enforcing mandates, or carrying around documentation to do basic things, or missing your train because your phone died and the app was on it. Mandates cost money to enforce, require effort, et cetera. It would've been simpler if people had just gotten vaccinated. But they didn't. We're dealing now in reality, not hypotheticals. The time to argue that vaccination will work without mandates has passed.

And it doesn't need to be complicated. Everyone wants freedom. Living indefinitely in a world where COVID-19 is consistently flaring up, and you wonder if you have it every time you start to feel sick, and school districts are seasonally debating how many pediatric deaths constitute "an acceptable level" is not freedom. There is a long historical precedent for mandates, which are demonstrably legal, widely supported, and can be extremely effective. Even though mandates involve short-term costs and annoyances, they serve to prevent far greater long-term costs (financially and physically).

At the same time, the effectiveness of mandates still depends largely on how they're received, implemented, and enforced. One of the clearest lessons of the pandemic has been that its arc has as much to do with public opinion as with science. Another is that no single intervention is a magic wand. Even mandates. If you think of rules around issues like drunk driving or teenage smoking, regulations will change some behavior, but solving the problem also involves changing hearts and minds. Mandates work best when people understand that they're in their interest, but fail if they seem pointlessly punitive or antagonistic, such that defiance itself becomes appealing.

That sense of antagonism is exactly what the breathless minority is constantly attempting to stoke. By turning basic public-health measures into escalating culture wars, they stretch the road ahead further. The question of just how far it stretches depends on how we react.

On Thursday, the ambient mix of exhaustion and anger and indignation came through in President Biden's pandemic address. “We’ve been patient," he admonished, "but our patience is wearing thin." Biden explained to unvaccinated Americans that vaccination "is not about freedom or personal choice. It's about protecting yourself and those around you.”

If unvaccinated people haven't already been persuaded by that reasoning, it's unclear why they would when it's said a thousandth time, more sternly. The intended audience of lines like that was pretty clearly not unvaccinated people, but the majority of Americans who are vaccinated and whose patience with Biden is wearing thin. His approval ratings have fallen as COVID cases haven't, and the tough-on-crime, law-and-order rhetoric tends to serve politicians well during crises. People want bold, decisive, authoritative leadership.

It also carries risk when the people you actually need to reach are the ones protesting because they want the opposite.

This is where the long-term goals matter, and can be undermined by short-term incentives. If we were driving toward eradication of this virus, it might be strategic to take the George Washington approach. Essentially: Listen, I don't care if you hate me now, it's for your own good, you'll thank me later. But since SARS-CoV-2 will be around indefinitely, and will require efforts to keep in control—e.g. a likely need for booster shots, and things like masking and distancing during future surges—success also depends on actual understanding and buy-in over a long term.

And this is the real, highest-stakes challenge: not allowing COVID to become a chronic wedge issue. Throughout the pandemic, a vocal minority of attention-seeking opportunists have managed to divide us around even the most simply necessary measures. News media are given to amplifying these voices, and buying into a both-sides controversy. Now, each time an expert or leader admonishes unvaccinated people, it serves as yet more fodder for the voices on the other shoulder of unvaccinated Americans (the one telling them to ignore the global scientific consensus and "do your own research").

We saw it clearly last week. Like a spinal reflex, just as Biden announced the new mandates, pundits and opportunists reached under their desks and pressed the Socialism alarm, rallying red-blooded Americans to rise up against this attack on freedom and liberty as yet another example of the condescending elites telling you what to do. A firebrand Senate candidate from Ohio is campaigning on the notion that vaccine requirements are “tyranny.” The term has since been used by governors and sheriffs and many others.

Blustery as that may sound, this is yet another instance of the fundamental false dichotomy that has set the U.S. back so many times. People are told to believe they have to choose between taking a basic collective action to address a problem that almost everyone agrees is indeed a problem *or* having freedom. When you put it like that, it sounds like a valid debate. Many choose the latter. And then, after taking sides, some slide further, objecting even to purely voluntary measures to address the problem, or denying that the problem is even a problem. (See: climate change, gun violence, health-care costs, etc.) Others will continue to say that these are indeed serious problems, but they just don't think we should have rules or policies or mandates to address the problems. Even as the problems persist and persist and persist.

And that's how we end up doing little or nothing about solvable problems that almost everyone previously wanted to solve.

The pandemic continues to remind us that beating it isn't fundamentally about masks or expensive hospitals or vaccines themselves. You can have all these, sometimes in obscene abundance, as the U.S. does, and still fail without social cohesion. Every society has profiteers and contrarians and opportunists who spread disinformation. The U.S. is not alone in that. But we've proven especially vulnerable. Every time someone tries to seed a wedge issue, for attention or personal gain, it's like a school cafeteria yelling "fight! fight! fight!" We know fighting is bad, but we run to watch, and progress halts.

That's why it feels like this is such a precarious moment.

The calls to fight are loud. After 18 months, some people who've been thoughtful, considerate, and conscientious are throwing up their hands and deciding to engage. It may feel justified, even cathartic to see unvaccinated people chastised, mocked, or deprived of health care. The question isn't whether that's right; it's whether it's helpful, or just perpetuating the nightmare. If our objective is to end the pandemic and save lives, the challenge is not to lose sight of the longer-term goal.

Social cohesion doesn't mean everyone needs to get along, or that everyone's opinion on how viruses spread is equally valid. It doesn't mean "both sides are equally to blame." It doesn't mean smiling and nodding when someone who works in a nursing home says that vaccines are 5G, and then swallows a cough as they wheel your mother away. As of last month, about a third of people who work in nursing homes were still unvaccinated. Social cohesion doesn't mean that statistic doesn't sadden or enrage you, and make you feel the urgency of doing something about it.

Social cohesion just means that the something you do is undertaken in the spirit of solving the problem, or at least improving the situation. Which requires remembering that we're all in the same boat. That can be extremely challenging. Most of us have been rowing that boat for more than a year now. Others aren't rowing. A handful are deliberately rowing backwards, trying to get others to do the same. It might feel appropriate to chide or mock or fight them. But ultimately, you need them to row. And keep rowing.

Until this week, I didn't see a problem with the phrase "a pandemic of the unvaccinated." It's an objectively accurate way of framing things: The vast majority of serious COVID cases are among unvaccinated people. Vaccinated people are still at risk of breakthrough cases, yes, but those would be vanishingly uncommon if everyone simply got vaccinated. Now I've started hearing it in a new light. The phrase not only describes who's suffering, but also names them as the cause. In the middle of a crisis, the question isn't whether that sentiment is accurate or just; but whether it's useful. The fact that only half of U.S. adults are vaccinated is not everyone's fault. But it's everyone's problem. It's still everyone's pandemic.
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Sonya · Sep 17, 2021

Nevada COVID-19 updates for 9/17:

Test positivity (note, w/ 7-day lag) is fluctuating but down: 11.31% (-0.10%)
Hospitalizations are fluctuating but down: 1,037 (-36)
Cases are fluctuating but down: 1,172 (-26)

Clark County cases are down: 615 (-17)
Washoe County cases are down: 280 (-12)

https://thenevadaindependent.com/coronavirus-data-nevada

Coronavirus Contextualized, 59th Edition:
https://thenevadaindependent.com/article/coronavirus-contextualized-59th-edition-cases-remain-high-as-northern-nevada-hospitals-face-crush-of-covid-19-patients

Case numbers are fluctuating, but remain high.
Nevada ranks 30th among the 50 states for percentage of its population fully vaccinated at just under 50%.
140 new deaths this week, up from 116 last week. One in 452 Nevadans has died from COVID-19.

Below, we take a look at how hospitals in the northern and rural portions of the state continue to be hit hard by COVID-19 as medical staffing challenges facing the nation challenge the state.

Cases

Statewide case numbers continue to fluctuate, though they remain high.

As of Thursday, 1,198 new cases were reported on average each day over the previous seven days, just slightly less than the seven-day average of 1,226 it saw on Monday, the new high point of the current COVID-19 wave. That peak has now exceeded the highest point of last summer’s wave, 1,176, which the state hit on July 20, 2020, but is still a little less than half of the fall and winter wave case record, 2,736 on Dec. 10, 2020.

In Clark County, which was hit early and hard by the latest wave of the virus, cases had been steadily decreasing for a couple of weeks but started to increase again this week, hitting a seven-day average of 632 on Thursday, up from a recent low point of 539 a week ago. The high point of the current wave, which the state hit on Aug. 1, was 917. That peak is below both the high point of the 2020 summer wave — 1,072 on July 20, 2020 — and the fall and winter wave, when Clark County hit its highest seven-day case average ever of 2,092 on Jan. 12.

Washoe County, which was hit later by the current wave of the virus, has experienced some fluctuations in case numbers recently, though numbers remain high, setting a new high point of the current wave, 304, on Wednesday before dropping slightly to 292 on Thursday. (That high point excludes an outlier on Monday created by reporting delays because of the Labor Day weekend.) The numbers continue to be significantly higher than the peak of last summer’s small wave, 98 on July 30, 2020, but less than half of the county’s record high point of 532 on Nov. 27 during the fall and winter wave.

Adjusted for population size, Washoe County’s case rate remains more than double Clark County’s. As of Thursday, Clark County was seeing 28 cases reported per 100,000 residents each day over the previous seven days, compared to 62 in Washoe County. The case rate in the other 15 counties, meanwhile, was even higher at 80.

According to the Nevada State Public Health Lab’s weekly lineage report, the Delta variant was responsible for 97.2 percent of sequenced COVID-19 cases over the last 14 days.

Since the beginning of the pandemic, there have been 408,733 COVID-19 cases confirmed statewide, meaning 1 in 8 Nevadans has tested positive for the virus. More than 8 percent of those cases, 35,084, have been diagnosed in the last month, and more than 2 percent, or 8,384 cases, have been reported in the last week.

Test positivity

The statewide test positivity rate, which looks at the percentage of tests coming back positive out of the total tested, continues to fluctuate following a couple weeks of steady decreases.

It is not possible to independently calculate the test positivity rate based on test encounters because the state only publicly reports the number of positive cases, not the number of positive test encounters. However, the state does provide this number, calculated as an average over a 14-day period with a seven-day lag. As of Tuesday, that number was 11.4 percent, down from a recent high of 16.4 percent on Aug. 13 but even with last week’s rate.

The test positivity rate remains more than double the World Health Organization’s recommended 5 percent threshold but less than the peak test positivity rate of 21.3 percent the state saw in mid-January.

Since the beginning of the pandemic, more than 1.9 million people — 63 percent of Nevadans — have been tested for COVID-19, and there have been more than 4.2 million individual testing encounters.

Vaccinations

The pace of vaccine distribution in Nevada continues to fluctuate, though it remains slightly below where it was a couple of weeks ago.

As of Wednesday, about 6,800 vaccines were reported administered each day over the last seven days, up from 6,100 last week but down from 7,900 the week before that.

Some of the shots this week were administered outside of Allegiant Stadium before the Las Vegas Raiders’ home opener on Monday. Vaccination was required as a condition of attendance, with fully vaccinated fans allowed to remove their masks and partially vaccinated fans required to keep them on.

Candice McDaniel, deputy director of programs for the Department of Health and Human Services, said on a press call on Thursday that nearly 300 COVID-19 vaccines were administered on site on Monday. The Raiders reported that roughly 6,000 fans initiated the vaccination process because of their requirement, which was put in place following an announcement from Gov. Steve Sisolak last month.

“This is an incredible example of how Nevada is leading the way to help make large events safer,” McDaniel said.

Nearly 60 percent of Nevadans have now been either partially or fully vaccinated against COVID-19 — including more than 49 percent fully vaccinated — and about 27 percent of Nevadans eligible for the vaccine have yet to receive it.

Since vaccinations started in December, more than 1.8 million people have received at least one dose of the COVID-19 vaccine and more than 1.5 million Nevadans have been fully vaccinated.

Among the counties, Carson City continues to have the highest percentage of residents fully vaccinated against COVID-19 at 56.5 percent, followed by Washoe County at 53.4 percent, Douglas County at 48.8 percent and Clark County at 45 percent. Tiny Storey County has still vaccinated the least, with only 16.9 percent of its residents partially or fully vaccinated.

Nationally, Nevada ranks 30th among the 50 states for percentage of its population fully vaccinated, at 49.5 percent, behind all of its neighbors except Utah and Idaho, at 33rd and 48th, respectively.

Breakthrough cases

There have been 7,634 breakthrough cases — fully vaccinated individuals who have tested positive for COVID-19 — in Clark County as of Sept. 2, meaning that 0.74 percent of fully vaccinated individuals have contracted the virus. (As of early Thursday evening, the health district had not yet posted a new report, citing technical difficulties.)

In Washoe County, there have been 2,374 breakthrough cases as of Thursday, representing 0.93 percent of fully vaccinated people in the county.

As of Sept. 2, there were 362 breakthrough hospitalizations in Clark County and 112 breakthrough deaths, meaning that 0.03 percent of vaccinated individuals in Clark County have been hospitalized and 0.01 percent have died. Of the people hospitalized with breakthrough infections, 66 percent had underlying conditions, 74 percent were 65 years or older and 60 percent were men.

Deaths

The number of new COVID-19 deaths reported on average each day continues to fluctuate, though it remains high.

As of Thursday, 20 COVID-19 deaths were being reported on average each day over the prior seven days, up from 17 last week but less than the high point of the current wave, 25, which the state hit on Aug. 30. Last summer’s surge peaked at an average of 21 daily deaths, while the fall and winter surge peaked at 45 daily deaths.

Over the last seven days, 140 new COVID-19 deaths have been reported across the state — up from 116 last week — including:

104 in Clark County

22 in Washoe County

5 in Elko County

2 each in Carson City and Mineral County

1 each in Douglas, Humboldt, Lincoln, Nye and White Pine

Since the beginning of the pandemic, there have been 6,821 deaths from COVID-19. In the last month, 631 deaths from COVID-19 were reported statewide, more than 9 percent of the deaths reported statewide since the beginning of the pandemic.

One in 452 Nevadans has died from COVID-19.

Hospitalizations

The number of people hospitalized with COVID-19 statewide has been generally decreasing, though that trend belies the sharp increase in hospitalizations Washoe County and rural parts of the state have been seeing and the staffing challenges being experienced statewide.

As of Tuesday, there were 1,073 people hospitalized with confirmed or suspected cases of COVID-19 across the state, down slightly from 1,115 last week and significantly down from this wave’s peak of 1,317 on Aug. 10. The peak of last summer’s wave was 1,165, which the state hit on July 31, 2020, and the peak of the fall and winter wave was 2,025, on Dec. 13, 2020.

The Nevada Hospital Association, in a rare press release this week, urged Nevadans to help hospitals and health care workers by getting vaccinated, wearing masks and avoiding hospital emergency rooms except in cases of true emergencies.

“Our state is experiencing above average hospitalizations, especially in northern Nevada and our rural communities,” the hospital association said. “COVID-19 has once again taken hold of Nevada, and we also continue to see patients this time of year for other illnesses.”

The hospital association, in its weekly report, also highlighted the increasing seriousness of staffing challenges in hospitals across the northern, southern and rural portions of the state.

“Hospitals are short-staffed in many departments, not unlike the rest of the economy, with the nursing shortage becoming a country-wide concern,” the hospital association wrote.

The situation has gotten so bad that multiple Northern Nevada hospitals, including St. Mary’s Regional Medical Center and Northern Nevada Medical Center, sent emails this week looking for medical volunteers, including nurses, respiratory therapists and medical assistants, because of the surge in COVID-19 cases. Neither hospital returned a request for comment from The Nevada Independent on Thursday.

Renown, in a statement on Thursday, said the hospital has no plans to request medical volunteers from the community at this time.

“Renown understands how precious and limited our community medical volunteer pool is in Nevada,” the hospital said. “We have trained hundreds of our own nurse extenders, should additional staff be needed.”

Renown also reiterated pleas from the hospital association to preserve emergency care services for those who need them.

“COVID-19 cases are still high and ED, ICU and hospital bed capacity across Renown and the region continues to be near capacity,” the hospital said.

County by county

Fifteen counties are considered by the state to be at elevated risk for the spread of COVID-19 as of Thursday. That’s all except Pershing and White Pine.

Counties are considered at risk for elevated spread of COVID-19 if they meet two of the following three metrics:

The average number of tests per day per 100,000, calculated over a 14-day period. If this number is less than 100, a county could be considered at risk.

The case rate per 100,000, calculated by taking the number of cases diagnosed and reported over a 30-day period. If this number is greater than 200, a county could be considered at risk.

The case rate per 100,000 and the test positivity rate, calculated over a 14-day period with a seven-day lag. If the case rate is greater than 50 and the test positivity rate is greater than 8.0 percent, a county could be considered at risk.

The state continues to align its mask mandate with federal guidance, however, meaning it is using the CDC’s community transmission tracker to determine which counties are at substantial or high risk for the spread of COVID-19 and therefore required to abide by indoor mask mandates for vaccinated and unvaccinated individuals alike.

Under the CDC’s metrics, counties are considered at risk for “high” transmission if they have more than 100 cases per 100,000 residents in the last seven days, “substantial” if they have between 50 and 100, “moderate” if they have between 10 and 50 and “low” if they have fewer than 10.

As of Tuesday, all Nevada counties were considered at “high” or “substantial” risk of transmission. That means that counties remain subject to universal indoor masking precautions for both vaccinated and unvaccinated individuals.

Counties can have mask mandates put in place if they have two weeks of “substantial” or “high” transmission; those mask mandates will automatically be removed after two weeks of “low” transmission.
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FDA Advisory Panel Met Today To Vote on Booster Shots for Americans:
https://www.statnews.com/2021/09/17/fda-advisory-panel-recommends-against-booster-doses-of-covid-19-vaccine-for-most-americans/

They do not recommend boosters for all people over 16 years old. They did unanimously recommend them for those over age 65 or at high-risk due to comorbidities. Not included in this article, but in coverage elsewhere, they also suggested that people who have high exposure in their jobs get a booster. I assume this will be healthcare workers, but not sure if grocery store or restaurant workers will be included. This article indicates that those guidelines will probably come from the CDC's Advisory Committee on Immunization Practices.

An advisory panel to the Food and Drug Administration on Friday recommended against a booster dose of a Covid-19 vaccine for most Americans at this time — a major rebuke to the Biden administration — but voted unanimously to recommend one to Americans who are 65 or older.

The FDA is not required to follow the recommendation of its advisory committees but generally does. If the recommendation is adopted by the FDA and Centers for Disease Control and Prevention, it would put the U.S. policy on a par with countries like the United Kingdom.

After seven hours of deliberation, members of the Vaccines and Related Biological Products Advisory Committee voted 16 to 2 against a proposal to administer a third dose of the vaccine developed by Pfizer and BioNTech to individuals 16 years and older. The vote to recommend a booster to people 65 years and older — as well as people who are at risk of severe Covid — was 18 to 0.

It was not immediately clear who would qualify as high risk; fleshing that out will likely fall to the CDC’s advisory committee, the Advisory Committee on Immunization Practices.

The panelists acknowledged that data show that the protection conferred to the vaccinated is waning over time, but argued the overwhelming number of vaccinated people have sufficient protection at this time to cope with any infection without requiring hospitalization or risking death.

The vaccine “may eventually be indicated for the general population, I just don’t think we’re there yet,” said Ofer Levy, the director of the Precision Vaccines Program at Boston Children’s Hospital.

Peter Marks, who is in charge of the FDA biologics center that decides on vaccine approvals, voted to recommend a booster dose.

“It’s no secret here that there is still debate over the need for an additional Covid-19 vaccine at this phase of the pandemic,” he said. “But the emerging evidence such as that from our Israeli colleagues is very helpful. We also know that breakthrough infections, including some that are severe, are occurring in the United States.”

The vote puts the FDA in a difficult position. In August, President Biden, the agency’s commissioner, Janet Woodcock, and other top health officials in the administration took the unusual step of saying booster doses would be authorized to most Americans before the FDA and CDC had weighed in on the data.

In recent weeks, it became increasingly clear that many outside experts to did not support that decision. The World Health Organization has also been highly critical of the idea of boosting in affluent countries while most people in developing countries haven’t yet received a dose of vaccine.

A separate meeting has been scheduled of ACIP for next week. While the FDA issues decisions on whether to approve vaccines, ACIP advises the CDC on whether it should recommend use of vaccines the FDA has approved.

Most experts believe booster doses may eventually be needed. The question is when.

“I think having a late boost is going to make this a much better vaccine,” Barney Graham, who designed the structure for the vaccines made by Moderna and a number of other producers while he was deputy director of the Vaccine Research Center at the National Institutes of Health, told STAT in a recent interview.
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Here is a little more info from a different article:
https://www.statnews.com/2021/09/17/tracking-the-fda-advisory-panel-meeting-on-covid-19-booster-shots/

So what happens now?

Today’s FDA panel was full of tension and drama, as the panelists rejected the broad FDA approval requested by Pfizer and instead, after a real-time deliberation with FDA representatives, voted unanimously that the FDA should recommend a booster shot for people over 65, for people with conditions that put them at high risk of complications from Covid-19, and for people whose jobs put them at high risk for complications from SARS-CoV-2.

So what now? Here are a few issues to watch in the weeks ahead:

The ball now gets passed to ACIP. That’s the Advisory Committee on Immunization Practices, a separate committee that advises the Centers for Disease Control & Prevention, which is meeting next week. That committee, the FDA’s Peter Marks said, will likely “fine tune” the recommendations made today.

What about people who received other shots? This vote only covers people who initially received the Pfizer vaccine. What about those who received the vaccines from Johnson & Johnson or Moderna? Those decisions still lie ahead.

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Speaking of vaccines, you all are going to get your Flu Shot right? It's time. Typically it is recommended that you get the flu vaccine in September or October. Certainly by the end of October. I usually get one for my birthday.

CDC Study On Vaccine Efficacy:
https://www.cnn.com/2021/09/17/health/moderna-vaccine-most-effective-cdc-study/index.html

Moderna was the "winner" at 93%, but Pfizer at 88% and Johnson & Johnson at 71% are also highly effective.

A head-to-head study of all three authorized coronavirus vaccines in the United States finds the Moderna vaccine is slightly more effective than Pfizer's in real-life use in keeping people out of the hospital, and Johnson & Johnson's Janssen vaccine comes in third, but still provides 71% protection.

Pfizer's vaccine provided 88% protection against hospitalization, and Moderna's was 93% effective.

The US Centers for Disease Control and Prevention led a nationwide study of vaccination involving more than 3,600 adults hospitalized for Covid-19 between March and August.

"Among U.S. adults without immunocompromising conditions, vaccine effectiveness against COVID-19 hospitalization during March 11- August 15, 2021, was higher for the Moderna vaccine (93%) than the Pfizer-BioNTech vaccine (88%) and the Janssen vaccine (71%)," the team wrote in the CDC's weekly report on death and disease, the MMWR.

"Although these real-world data suggest some variation in levels of protection by vaccine, all FDA-approved or authorized COVID-19 vaccines provide substantial protection against COVID-19 hospitalization."

They found that the biggest difference between the vaccine made by Moderna and Pfizer/BioNtech's vaccine was driven by a decline that started about four months after people were fully vaccinated with Pfizer's vaccine.

"Differences in vaccine effectiveness between the Moderna and Pfizer-BioNTech vaccine might be due to higher mRNA content in the Moderna vaccine, differences in timing between doses (3 weeks for Pfizer-BioNTech versus 4 weeks for Moderna), or possible differences between groups that received each vaccine that were not accounted for in the analysis," the team wrote.

"Vaccine effectiveness for the Pfizer-BioNTech vaccine was 91% at 14 -120 days after receipt of the second vaccine dose but declined significantly to 77% at more than 120 days," the team wrote.

Pfizer's and Moderna's vaccines both use genetic material called messenger RNA to deliver immunity, but they use differing doses and slightly different formulations. The Janssen vaccine uses an inactivated common cold virus called adenovirus -- a viral vector -- to carry genetic instructions into the body.
"A single dose of the Janssen viral vector vaccine had comparatively lower anti-SARS-CoV-2 antibody response and vaccine effectiveness against COVID-19 hospitalizations," the team said. "Understanding differences in vaccine effectiveness by vaccine product can guide individual choices and policy recommendations regarding vaccine boosters. All FDA-approved or authorized COVID-19 vaccines provide substantial protection against COVID-19 hospitalization."

CDC worked with researchers across the country to study 3,689 patients at 21 hospitals in 18 states for the study. They also looked at antibodies in the blood of 100 healthy volunteers after they had been vaccinated with one of the three available vaccines.

"These real-world data suggest that the two-dose Moderna and Pfizer-BioNTech mRNA vaccine regimens provide more protection than does the one-dose Janssen viral vector vaccine regimen. Although the Janssen vaccine had lower observed vaccine effectiveness, one dose of Janssen vaccine still reduced risk for COVID-19-associated hospitalization by 71%," they wrote.

The study had limitations. "This analysis did not consider children, immunocompromised adults, or vaccine effectiveness against COVID-19 that did not result in hospitalization," the team wrote. Plus, the volunteers were only followed for 29 weeks -- just over six months.
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Vaccine Mandates are working to increase vaccination rates:

Here are some places that implemented a vaccine mandate and the resulting changes:

United Airlines went from 59% to 90% vaccinated in 6 weeks

Department of Defense went from 76% to 89% in 3 weeks

Louisiana State University went from 63% to 81% with a month left to get vaccinated under their mandate

Fox News, Rutgers University and Kaiser Permanente are all at 90% or above.

Vaccine mandates work.

Sonya · Sep 20, 2021

Nevada COVID-19 updates for 9/20:

Test positivity (note, w/ 7-day lag) is fluctuating but down: 11.25% (-0.06%)
Hospitalizations are down: 1,004 (-33)
Cases are fluctuating but down: 1,065 (-107)

Clark County cases are down: 522 (-93)
Washoe County cases are slightly down: 279 (-1)

*(+XX) reflects change since Friday

https://thenevadaindependent.com/coronavirus-data-nevada

And HUGE Congratulations to Megan Messerly who won the Nevada Press Association award, First Place for Health News Story.

Pfizer Reports Robust Response and No Serious Safety Issues for Vaccine for 5-11 Year Old Children:
https://www.statnews.com/2021/09/20/pfizer-covid-19-vaccine-children/

Pfizer and its partner BioNTech said Monday that they would file for authorization of their Covid-19 vaccine for use in children after clinical trial results showed encouraging antibody levels in volunteers and side effects similar to those in teens and young adults.

The pediatric study, in children ages 5 to 11, is the first to disclose results in young children.

It used a lower dose of the vaccine than the one currently being administered, because earlier studies showed that the adult dose could cause more side effects. Adults receive two 30 microgram doses of the vaccine three weeks apart. In school-aged children, this was lowered to 10 micrograms.

Antibody responses and common side effects were compared between 2,268 children and a separate group of volunteers ages 16 to 25 who received the adult dose. The children were also compared to a placebo group of similar age to determine safety. One volunteer received the placebo for every two who received the vaccine.

The antibody response in children was roughly comparable to the response in participants ages 16 to 25. The companies said that side effects were also “generally comparable” between the two groups.

William Gruber, a senior vice president of vaccine clinical research and development at Pfizer, said the company hopes to submit the data to the Food and Drug Administration by the end of the month. He said specific side effects such as fevers and chills were similar to those in the 16- to 25-year-old group.

Pfizer and BioNTech provided only an average antibody level. That could mean that some kids would have lower levels — and less protection. However, Gruber said antibody levels were high throughout the group.

Outside experts viewed the data as positive, but limited.

“It’s not a lot to go on, but what we do have to go on looks great,” said Kathleen Neuzil, director of the Center for Vaccine Development and Global Health at the University of Maryland School of Medicine. “A lower dose of this vaccine in children appears as good as the higher dose in older children and adults.”

Pfizer’s press release did not include any data on the extent to which the vaccine reduced the chances that children would become sick. Gruber said that there were not enough cases of illness to tell. But outside experts said it was reasonable to assume that similar levels of antibodies would mean similar protection from disease.

John Moore, a professor of microbiology and immunology at Weill Cornell Medical College, emphasized that the FDA will be able to analyze both safety and efficacy data from the vaccine. “The bigger dimension is what they’re going to have available for safety assessments because of course that’s going to matter,” Moore said.

One worry could be cases of myocarditis, an inflammation of the heart, that have been seen, albeit rarely, in adults. These have occurred only once in every tens or hundreds of thousands of vaccine administrations. But no clinical trial is going to be big enough to give an accurate study of such a rare risk.

“It appears that children in the five to 11 year old age group are the least likely to have severe outcomes of Covid,” said Neuzil, citing recent data from the Centers for Disease Control and Prevention. “So not that it’s not important and not that it’s not a disease worth preventing, but if your severe outcomes are lower, then you’re going to have a higher bar for the vaccine performance. You’re going to want to be very careful about safety issues.”

But that has to be balanced against the risk of Covid-19, experts said. Recent data show more infected children are being hospitalized, and more are ending up in intensive care units. It is no longer just children who have other ailments that are becoming sick, they said.

Neuzel said that she believed that risks could best be dealt with by making sure that parents understand them, and are making an informed choice for their children.

“If this misperception that children do not get affected persists, some people could think it’s not necessary to vaccinate children or this smaller risk of side effects could be enough to not vaccinate children,” said Flor M. Munoz, an associate professor of pediatrics at Baylor College of Medicine and an investigator in the trial. “We have a different pandemic now than the pandemic we had in 2020.”

That means a decision has to be made on more limited data than regulators might like.

“We’re stuck between an urgent need for a vaccine and the uncertainty that comes about with making decisions on modest studies,” said Andrew T. Pavia, the chief of the division of pediatric infectious disease at the University of Utah. Assuming that the safety and efficacy data hold up when closely examined, Pavia said he thinks the best option is to go ahead and to continue to track rare side effects among people who choose to receive the vaccine.

Gruber, the Pfizer executive, emphasized that public health authorities will have to be the ones to judge whether Pfizer’s data are enough to authorize its lower dose vaccine for children.

But Gruber argued that it is important to think of the benefits of the vaccine beyond just preventing severe illness.

“Until we actually get control of the pandemic and children are felt to be protected, there are still going to be significant restrictions in terms of masking, after-school activities, all the things that allow children to be children,” said Gruber. “You know, I’m a pediatrician. I see the vaccine as liberating. To allow people to get back to their normal lives, that particular aspect can’t be lost in all of this.”

Pavia said that, if the vaccine is authorized by the FDA, it will probably be received in the same fashion it has been among adults.

“There’s going to be a subset of people who are going to be lined up on the morning that it’s available, including doctors and their kids and nurses and their kids,” said Pavia. “I think there will be a group of people who are just going to be really against it because they’re convinced that children are not at risk. And a large number of people [will be] in the middle: ‘We need to understand what we know and what we don’t know.’ Every academic pediatrician in the country with kids 5 to 11 is probably already in line.”

Data readouts in children 2 to 5 and 6 months to 2 are expected as early as the fourth quarter of this year, the companies said.
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Now we wait for a FDA Emergency Use Authorization for this age group.

Winter is Coming Again, What to Expect From COVID Season:
https://www.statnews.com/2021/09/20/winter-is-coming-again-what-to-expect-from-covid-19-as-the-season-looms/

Winter is coming, again.

A year ago, experts warned that the United States faced a grim winter if Americans didn’t mask up and social distance to slow transmission of the SARS-CoV-2 virus before “indoor weather” — aka winter — settled in for its long stay. We all know how well that warning was heeded. In January, cases topped 300,000 a day; Covid ended the lives of about 95,000 Americans before the month was out.

Now indoor weather again looms in many parts of this country, and daily case counts are rising well into the six figures. The highly transmissible Delta variant is driving spread, even among fully vaccinated people. Children are back in classrooms that can function as germ incubators. As you walk around in public you see noses poking out of masks, masks under chins, faces that are mask free.

So what should we expect as we head into our second Covid autumn and winter?

“The bottom line is, I think, uncertainty,” said Jeffrey Duchin, health officer for the Seattle and King County public health department, who has been mired in the Covid response since the earliest days of the U.S. outbreak.

“We’re experiencing a new virus, a newly emerged pathogen, and we’re trying to fight it with new tools that we don’t have a lot of experience with,” he said. “And we’re dealing with unpredictable human behavior … which is a very important factor as well, and environmental factors that may influence the severity of Covid outbreaks and how well it transmits.”

“There’s a lot of moving parts,” said Duchin, who is also an infectious diseases professor at the University of Washington. Among them: the questions of when Covid vaccines will be approved for use in children and what percentage of parents will agree to vaccinate their kids.

While the crystal ball may be cloudy, who can resist taking a peek? Let’s talk about some things we might face in the months ahead.

Whither the Delta wave?

The high, high crests of Delta transmission are subsiding in some parts of the country, as they have in countries where Delta took off before it did in the U.S.

Cécile Viboud, an infectious diseases epidemiologist at the National Institutes of Health’s Fogarty International Center, said nine modeling efforts her group is monitoring suggest that by the end of November, the Delta wave will have waned and new cases will be down “at quite a low level.” How low? Down to where the country was in late June and early July, before Delta took off. At that point the country was reporting somewhere between 7,500 to 15,000 new cases most days.

Sounds heavenly, doesn’t it? So does what Viboud said next. “We’re probably going to stay there, because there is quite a bit of immunity in the population,” she told STAT.

That heartening prediction comes with a big but. “That assumes that no new variant comes in. Because if you get a new variant that either has a higher transmissibility or immune escape potential, then we will see a resurgence.”

Late November coincides with Thanksgiving, America’s favorite week for cross-country travel. Last year, Thanksgiving and Christmas turbo-charged Covid spread. Can transmission levels remain low if large family gatherings occur across the nation this year?

Viboud said all the models factor in events like Thanksgiving. The expectation of low transmission by around that time is predicated on the amount of immunity there will be by then in the country, antibodies generated by vaccination — 63.9% of eligible Americans are fully vaccinated — or acquired the hard way, through Covid infection.

Trevor Bedford, a computational biologist at the Fred Hutchinson Cancer Research Center in Seattle, thinks the massive summer wave the country has been experiencing will have taken some of the loft out of the balloon when it comes to fall and winter spread. By crashing over the country in the summer, Delta pulled forward in time some infections that otherwise would have occurred later, he said.

“It is likely that we’ll see some wave,” Bedford said. “I would like to think it’s very unlikely to be as big as it was last year.”

The World Health Organization’s top coronavirus expert is less hopeful in her prognostication. Maria Van Kerkhove thinks people are making the mistake of trying to interpret SARS-2’s behavior and predict its path by looking through the prism of influenza. SARS-2 may one day behave much more like that seasonal scourge, which causes a wave of illness in winter months in temperate climes — but it’s not there now, she said.

“I feel that a lot of people want it so badly to behave like flu. So that we can get into this pattern of ‘OK, in the summer everybody can relax. And then we just need to gear up for the fall. We need to get the vaccines underway. Get people vaccinated and just ride it out through that peak, that winter peak,’” Van Kerkhove said. “But I don’t see that in the data that we have.”

She believes human behavior — whether that’s wearing masks, social distancing, or getting vaccinated — has much more to do with declines of Covid transmission still than built-up immunity. The Delta variant hasn’t run through all the unprotected people, she insisted.

“Delta still has a lot more energy in it,” Van Kerkhove said. “I think we should expect more ups and downs. I think we should expect more peaks and troughs. I think the peaks could become less [lofty]. Potentially. But I think those peaks will be very sharp in specific populations like unvaccinated, unprotected populations. That should be expected.”

Deaths should subside. Some.

As people’s immune systems have acquired experience grappling with SARS-2 — again, via vaccine or infection — deaths as a percentage of overall cases have declined. That trend will hopefully continue.

It’s not clear how long immunity lasts following infection. It can be pretty transient with human coronaviruses, but so far there haven’t been huge numbers of people reporting their second or third case of Covid. We’re going to learn how long infection-induced protection lasts as time goes on — as well as how long protection lasts after vaccination. When immunity levels in communities start to subside, that could trigger a new resurgence of cases, Viboud said, but she added the expectation is that with further waves of cases, hospitalization and deaths will not resemble the earlier waves of Covid.

Bedford agreed. “You could also imagine a large Covid wave this fall-winter, but with much lower morbidity and mortality than it was last year,” he said, noting “that it seems almost certain” that the infection fatality rate — the percentage of infected people who die from the disease — will remain lower than it was earlier in the pandemic.

Alpha, Beta, Gamma, Delta — what’s next?

Early in the pandemic, coronavirus experts confidently opined that this family of viruses mutates far more slowly than, say, influenza, and major changes weren’t likely to undermine efforts to control SARS-2. But no one alive had watched a new coronavirus cycle its way through hundreds of millions of people before. (The global estimate has now passed a quarter of a billion cases.) Our baseline assumptions didn’t figure on Delta.

Whatever comes next will almost certainly be some new twist of this now-dominant variant, Bedford said. That’s because Delta has so effectively swept the globe it has crowded out almost all the other lineages of viruses; about 88% of recent viruses that have been sequenced belong to the Delta family. “Basically everything that is circulating is Delta, so then the only avenue for evolution becomes mutations on top of Delta,” he said.

As effective as the Delta variant is, Bedford assumes it could acquire more tricks. “It seems unlikely that Delta is the ceiling, but there is going to be some ceiling,” he said.

Barney Graham, who led the vaccine design work that laid the foundation for many of the current Covid vaccines, is hopeful, though, that in Delta the virus has hit a sweet spot that will eventually undermine it.

“I’m hoping the virus has gotten itself to a point where it’s basically trapped now,” said Graham, who was deputy director of the NIH’s Vaccine Research Center until his retirement at the end of August. “That it can’t get any better at transmission, and any adaptation it makes in the immune response is going to make it less transmissible.”

If the virus effectively stands still, the increase in the rollout of vaccines worldwide that is projected to take place over the next half year or so could start to hem the virus in.

“I’m hoping now that we’re going to level out on the nature and the amount of change that’s going to be happening, especially if we can get people immunized and as the number of new infections diminishes, the less the chance that new mutations will occur,” Graham said.

Fingers crossed, everyone.

There are other complications ahead

One of the amazing things about the control measures countries used to slow Covid transmission is the effect they had on the swarm of other viruses that cause colds and flu-like illnesses every fall and winter. Rhinoviruses, the most common cause of the common cold, continued to spread. But respiratory syncytial virus (RSV), human coronaviruses, adenoviruses, and mother of all influenza-like illnesses, influenza itself, all but disappeared.

With kids back in school, mask-wearing more sporadic, and people abandoning Covid controls because they’re frankly just sick of them, these bugs are coming back. They may hit us especially hard when they do, because our immune systems are out of shape from the 20-month hiatus.

Last fall Hong Kong, which has had much more success controlling Covid than the U.S. has, resumed in-person teaching for children. Schools were quickly hit with large outbreaks of rhinoviruses. These ubiquitous viruses are generally just pests, but some of the infected children became so sick they needed to be admitted to hospitals.

We could see similar outbreaks here. And when kids, parents, and teachers start to get sick, there will be a lot of scrambling to figure out what’s the cause.

Before Covid, people rarely got tested if they came down with a respiratory infection, unless they got really sick. But now, much more is at stake. Is this a cold or the early stages of Covid? There are ramifications, depending on the answer to that question.

“How do you distinguish between Covid and flu or Covid and RSV in a child? You can’t — without a diagnostic,” said Van Kerkhove, whose youngest son had a series of three severe respiratory illnesses in the spring. He was so sick she and her husband took him to the hospital, but Switzerland doesn’t test children for Covid and they still don’t know what made him so ill.

“Kids will get sick, and I think that these other viruses that are circulating will complicate these matters,” she said.

Duchin worries we’re not ready for what’s coming when influenza-like illnesses and Covid collide. “It’s going to put a lot of stress on the health care system to help people figure out whether they have Covid-19 or not and what they need to do next,” he said. Cheap and easy-to-access Covid rapid tests could fill this gap, but tests are still too expensive and haven’t yet been adopted widely enough, he and others argue. “It’s a huge gap, I think, in our national preparedness still,” Duchin said.

A Covid season + a flu season = a whole lot of bad news

Influenza activity hasn’t yet rebounded globally from the coma induced by Covid control measures. But flu will be back. Whether that happens this season isn’t in the realm of knowable things.

Respiratory viruses each have their own patterns and there may be interactions among them — spread of one, for instance, may delay spread of another. What happens to that ballet when a new prima ballerina takes center stage? No one knows.

“I wonder what the role of the co-circulation of other pathogens will be in the dynamics of Covid transmission and/or the manifestations of Covid-19 illness,” Duchin said. “Will influenza facilitate the spread of Covid? Will RSV or parainfluenza viruses or adenoviruses … facilitate Covid or will they possibly crowd it out?”

“These are things somebody smarter than me needs to figure out,” he said.

Viboud doesn’t have answers either, but sees an enormous opportunity ahead. “It’s going to be a really interesting season to watch. We’ll learn a lot.’’

Nicole Lurie fears that what we’re about to learn is that flu plus Covid is going to make winters miserable and deadly.

Lurie, who was the assistant secretary for preparedness and response in the Department of Health and Human Services during the Obama administration, notes that in pre-Covid times, between 20,000 and 60,000 Americans died each winter from influenza. Covid’s toll could be higher than that still, because people have largely given up on changing their lifestyles to avoid becoming infected, and a substantial portion of people remain unvaccinated.

“I feel like we have to be giving this some thought and preparing the public for some kind of a steady state that minimizes morbidity and mortality and has a set of actions that you can take to mitigate the bad consequences,” said Lurie, who is now the U.S. director for the Coalition for Epidemic Preparedness Innovations.

Bedford shares her concerns.

“My expectation would be that it will become a seasonal respiratory disease, but it will be the worst of our seasonal respiratory diseases,” he said. “I’m imagining something that circulates at three times the level of flu and has a similar [infection fatality rate] to flu. So maybe causing three times flu’s deaths every year.”

But Ben Cowling of Hong Kong University voiced some optimism. People may be fed up with Covid restrictions, but they have learned that respiratory illnesses don’t have to be inevitable features of winter. In the face of surges of virus, they may choose to protect themselves, he said. “Certainly Covid has changed the perception of respiratory infections. People are much more concerned about them than they used to be.”
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Sonya · Sep 21, 2021

Nevada COVID-19 updates for 9/21:

Test positivity (note, w/ 7-day lag) is fluctuating but slightly up: 11.29% (+0.07%)
Hospitalizations are slightly up: 1,007 (+3)
Cases are fluctuating but down: 1,048 (-17)

Clark County cases are slightly up: 530 (+8)
Washoe County cases are down: 260 (-19)

https://thenevadaindependent.com/coronavirus-data-nevada

Clark County remains at High Risk.
https://covid.cdc.gov/covid-data-tracker/#county-view|Nevada|32003|Risk|community_transmission_level

All counties in Nevada are currently at High Risk, per the CDC and all will maintain their indoor mask mandates.

Last week, Clark County was at 168.88 cases per 100k population. This week they are at 161.20, which is somewhat down, but not close to being under 50, which is required for the end of mask mandates indoors.

Johnson & Johnson Says Additional Dose Boosts COVID Vaccine Efficacy:
https://www.statnews.com/2021/09/21/johnson-johnson-says-additional-dose-boosts-covid-vaccine-efficacy/

Johnson & Johnson said Tuesday that a large, global study showed its Covid-19 vaccine is more effective when given as a two-dose regimen, and that other data indicate the efficacy of the vaccine does not wane.

The two-dose regimen prevented 75% of moderate to severe Covid cases in all countries where it was tested — and 94% of such cases in the United States, where fewer troublesome variants of the SARS-CoV-2 virus circulated at the time the trial was underway. Importantly, the two-dose regimen was 100% effective against severe disease.

It appears J&J may use the data to argue in favor of making a booster broadly available to people who received the one-dose vaccine six months ago or more. A press release from the company did not say so explicitly, but stated J&J had submitted the data to the Food and Drug Administration and plans to submit them to other regulators and the World Health Organization.

The data could also help increase use of the vaccine in the U.S. and globally. Currently, in the U.S., it is the least-often administered of the Covid vaccines authorized or approved by the Food and Drug Administration. According to the Centers for Disease Control and Prevention, 14.6 million Americans have been inoculated with the Johnson & Johnson vaccine, compared to 67.7 million with the Moderna vaccine and 99.3 million with the Pfizer-BioNTech vaccine.

In its press release, J&J argued that available data, in aggregate, show both that the effectiveness of its single-shot vaccine does not wane and that adding a booster dose will make the vaccine more effective.

“It is critical to prioritize protecting as many people as possible against hospitalization and death given the continued spread of COVID-19 and rapidly emerging variants. A single-shot COVID-19 vaccine that is easy to use, distribute and administer that provides strong and long-lasting protection is crucial to vaccinating the global population,” Paul Stoffels, J&J’s chief scientific officer, said in a statement. “At the same time, we now have generated evidence that a booster shot further increases protection against COVID-19 and is expected to extend the duration of protection significantly.”

Like much of the vaccine data during the pandemic, summary data of the J&J two-dose study were made public in a press release, not a scientific publication. Companies feel obligated to release summary data of clinical trials immediately as a result of regulations meant to prevent insider trading, but this often means data are made public without details scientists would want to vet them.

When J&J began trials of its vaccine, developed with researcher Dan Barouch of Harvard Medical School, it said that it believed a single-dose vaccine would provide advantages in a pandemic. When results were released in January, the vaccine’s efficacy against moderate to severe disease was 66%. Although researchers cheered that benefit, it was lower than the 94% efficacy shown by both the Pfizer-BioNTech and Moderna vaccines.

The J&J vaccine rollout was bedeviled by other issues. There were supply problems. And then regulators paused the use of the vaccine for 10 days to get a clearer idea of a rare side effect, thrombosis with thrombocytopenia syndrome, that causes both bleeding and the formation of dangerous blood clots at the same time. The vaccine returned to use in April.

At the same time as it was organizing its first study, ENSEMBLE 1, Johnson & Johnson also planned a second 30,000-patient study, ENSEMBLE 2, in which volunteers would receive two doses 56 days apart. Part of the reason for the long interval is that there was some data indicating that J&J’s vaccine platform, which uses a modified virus called adenovirus, does not work as well when doses are given too close together.

In this study, there were 14 cases of moderate-to-severe Covid in the vaccine arm compared to 52 in the placebo arm (that works out to 75% efficacy) and zero cases of severe or critical Covid in the vaccine arm compared to eight in the placebo arm. In the U.S., there was one case of moderate-to-severe Covid in the vaccine arm and 14 in the placebo arm.

J&J also released further results from the ENSEMBLE 1 study of the one-dose vaccine. There were 433 cases of moderate-to-severe Covid in the vaccine arm, compared to 883 in the placebo arm — an efficacy of 53%. The efficacy against hospitalizations remained high, at 76%. (There were 16 cases in the vaccine arm and 64 in the placebo arm.)

Giving two doses instead of one increased antibody levels four- to six-fold. But the increase in antibody levels was much higher when the doses were spaced much further, and a booster was given at six months, J&J said. At six months, antibody levels increased nine-fold after one week and were 12-fold higher four weeks after the booster.

J&J also included a link to a paper, which has not been peer-reviewed, using claims from an insurance company to analyze the efficacy of the one-dose vaccine in practice in 390,000 people who received the J&J vaccine compared to 1.52 million who were matched based on age, sex, time, ZIP code, and risk factors that might predict Covid outcomes. These data showed a vaccine effectiveness of 79% for Covid-19 diagnoses and 81% for Covid-related hospitalizations. J&J argues that this shows that the efficacy of the vaccine was stable.

The data appear to set the stage for a discussion over whether the J&J vaccine should be thought of as a two-dose regimen, with the doses given six months apart. In order for that to happen, regulators will convene open meetings and much more detailed data will need to be made public.
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Plans to Ease International Travel Restrictions Welcome News in Las Vegas:
https://www.reviewjournal.com/local/local-nevada/plans-to-ease-international-travel-rules-welcome-news-in-las-vegas-2444563/

The U.S. on Monday announced plans to ease international airline travel restrictions to allow vaccinated foreign nationals to once again travel to the country starting this fall.

Las Vegas had more than 2 million international visitors in 2019, the year before pandemic restrictions took effect.

The new policy, slated to go into effect in early November, will require travelers to show proof that they are fully vaccinated before boarding a U.S.-bound plane as well as proof of a negative COVID-19 test taken within three days of the flight, White House COVID-19 coordinator Jeff Zients said.

Testing requirements also will tighten for unvaccinated Americans, who will now be required to be tested within a day of their trip to the U.S. and again after returning.

For Southern Nevada, the changes signal the return of one of the key cogs that has been missing amid the recovery of the region’s tourism-reliant economy.

‘Welcome news’

The news was met with cheers by tourism and travel officials.

"Today marks an important turning point in the recovery of international visitation essential to Las Vegas’ tourism industry. This milestone is also significant and welcome news for many of our major tradeshows and conventions that draw exhibitors and attendees from around the world,” Las Vegas Visitors and Convention Authority CEO Steve Hill said in a statement.

Virginia Valentine, president of the Nevada Resort Association, called the move an “essential step for Las Vegas’ recovery to continue moving forward.”

“Las Vegas attracted nearly six million international visitors in 2019, which supported tens of thousands of jobs and generated billions of dollars for our local economy. The lack of this key business has had a substantial economic impact on our community over the past 18 months,” Valentine said in a statement.

Roger Dow, CEO and president of the U.S. Travel Association, said getting the international travelers back is “huge,” in large part because they tend to stay longer and spend more than their domestic counterparts.

“When you look at CES and all the monster conventions that come here (to Las Vegas), if they can’t have the international buyer here, we lose,” said Dow, who’s in town for the travel association’s annual conference.

When those international flights will return remains up in the air. Some of the logistics are still not clear, including which vaccines will be acceptable under the U.S.’s system and whether those unapproved in the U.S., such as AstraZeneca, would be acceptable. Zients said that decision would be up to the Centers for Disease Control and Prevention, which will also require airlines to collect contact information from all U.S- bound travelers to facilitate tracing efforts.

The U.S. has been one of the slowest countries to lift international travel restrictions, frustrating allies in the United Kingdom and European Union as well as tourism and travel officials.

The EU and U.K. had previously moved to allow vaccinated U.S. travelers in without quarantines, in an effort to boost business and tourism. But the EU recommended last month that some travel restrictions be reimposed on U.S. travelers to the bloc because of the rampant spread of the delta variant of the coronavirus in America.

In May, Rosemary Vassiliadis, McCarran International Airport’s director of aviation, testified before a Senate subcommittee and pushed for the federal government to find ways to restore international travel to the U.S., saying that the country’s “blanket approach is unnecessarily crippling our economic productivity.”

At McCarran, domestic air travel has started to look more like it did pre-pandemic. International travel, however, has continued to lag.

International traveler volume for for first seven months of 2021 is down nearly 90 percent compared with the same period in 2019, with international carriers accounting or just 246,054 passengers at McCarran during that time, compared nearly 2.2 million in 2019.

“For Las Vegas, so much of our travel is dependent on people coming in for tourism reasons,” Chris Jones, chief marketing office for McCarran International Airport, said.

“In terms of domestic air, we are back to where we were,” Jones added. “International (travel) has been a huge missing component.”

Jones said the return of those international flights will vary by market and by airline. Some airlines plan their international schedules in six-month segments, which could mean that some carriers may not bring those flights back until sometime in the spring, he added.

Jones said that officials from McCarran and the LVCVA will be in Milan for a conference next month to meet with air carriers.
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Vaccine Mandates Work

Few Health Workers Actually Quit over Vaccine Mandate:
https://mainebeacon.com/few-health-workers-actually-quitting-over-vaccine-mandate-despite-ongoing-protests/

Only 65 out of 33,000 healthcare workers (0.19%) in Maine have quit their jobs over a statewide vaccine mandate announced for healthcare workers last month.

Employment data shows that very few Maine health care workers have quit their jobs over the recent statewide COVID vaccine mandate, despite a number of lawsuits and ongoing protests organized by anti-vaccine activists, suggesting that opponents of the mandate represent a vocal minority in Maine.

Statewide anti-vaccine mandate protests have been happening since Gov. Janet Mills announced a COVID vaccine mandate for health care workers on August 12, which will be enforced starting October 29. Health care providers already require their workers to be vaccinated against measles, Hepatitis B and other infectious diseases. Mills’ mandate adds the COVID vaccine to that list.

During a September 1 news conference, Northern Light, the second-largest health care provider in Maine, said that “only 20 staff, out of more than 10,000, left their jobs over Mills’ healthcare worker vaccine mandate.”

The Northern Light representative added that “many more staff workers have had to leave their jobs after catching COVID and unvaccinated workers are more susceptible to that outcome.” Eighty-eight percent of Northern Light’s staff is currently vaccinated.

Maine Health, the largest in-state health care provider, shared similar employment information. So far only 0.19% of their workforce has quit in protest.

“Over recent weeks, we have had 45 people out of our care team of 23,000 resign and cite the vaccination requirement as among the reasons for their doing so,” said John Porter, Maine Health’s Associate Vice President of System Communications and Public Affairs.

On Monday, the Maine Centers for Disease Control and Prevention reported that a record 214 individuals were currently hospitalized with COVID in Maine, the highest number since the pandemic began.
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Ed Yong, so worth a read.

Six Rules that Will Define Our Second Pandemic Winter:
https://www.theatlantic.com/health/archive/2021/09/six-ways-think-about-pandemic-now/620129/

For nearly two years now, Americans have lived with SARS-CoV-2. We know it better than we once did. We know that it can set off both acute and chronic illness, that it spreads best indoors, that masks help block it, that our vaccines are powerful against it. We know that we can live with it—that we’re going to have to live with it—but that it can and will exact a heavy toll.

Still, this virus has the capacity to surprise us, especially if we’re not paying attention. It is changing all the time, a tweak to the genetic code here and there; sometimes, those tweaks add up to new danger. In a matter of weeks, the Delta variant upended the relative peace of America’s early summer and ushered in a new set of calculations about risk, masking, and testing. The pandemic’s endgame shifted.

Do vaccines work as well as they need to? Who is now most vulnerable? What new variants might emerge? Our lost summer has layered on new anxieties to pandemic life. But these questions do have some clear answers, which have come up time and again in our reporting and will continue to guide us through the coming months. Even after this latest surge crests and subsides, the new pandemic reality will linger, through fall and winter and into the spring, as vaccination rates rise and the virus continues to change. Here are six principles that are helping us make sense of the pandemic now:

The role of vaccines has changed (again)

The COVID-19 vaccines were originally meant to prevent severe infections. They do so very well. But for a few brief months, we thought they could do even better. Unexpectedly spectacular clinical-trial results from Pfizer and Moderna raised hopes that these vaccines could protect against almost all symptomatic infections and might even be as good as the vaccines against polio and measles, which eliminated transmission of those diseases in the United States.

But, from the very beginning, vaccine experts warned that respiratory diseases are especially tricky to immunize against. The coronavirus first takes hold in the nose, and injections in the arm are just not very good at stimulating immunity in the nose. (They are still good, however, at raising immunity deep in the lungs to protect against severe disease.) Flu shots, for example, tend to be only 10 to 60 percent effective at keeping people out of the doctor’s office. If COVID-19 vaccines end up somewhere similar, they would prevent hospitalizations and death, but the coronavirus would still circulate. Given Delta’s ability to slightly evade vaccines, combined with its extreme transmissibility, this is again looking like the most likely scenario. So we need to adjust our expectations, again.

Vaccines work more like dimmer switches than on/off buttons, and as their protection fades out, there are three thresholds that we care about: protection against infection, against symptoms, and against severe disease. Protection against infection is always the first to erode—either because of new variants or because of waning immune responses over time. Protection against symptoms goes next, but protection against severe disease is the most durable. (One unknown is how much vaccines prevent long COVID, although a recent study found that full vaccination can decrease the risk of long-lasting symptoms.)

We’ve seen this pattern play out: Breakthrough infections are happening with Delta, but they tend to be mild or even asymptomatic. And especially when case numbers get very high—as they are in many parts of the U.S. now—additional layers of protection, including improved ventilation and masks, are necessary to protect people, such as young children, who are still unvaccinated. Vaccinating as many people as possible as quickly as possible is still the most powerful way to control the virus. We can already see how well the vaccines are working.

The proportion of vaccinated people matters, but who they are and how they cluster also matters

Delta caused a new wave of cases in even the most vaccinated countries in the world, but the wave of hospitalizations that followed there have generally been much more modest. In the U.K., for example, where 66 percent of people are fully vaccinated, cases reached 80 percent of their winter peak this summer. But hospitalizations rose less than 25 percent. As U.K. health officials have declared, vaccines are “breaking the link” between infections and hospitalizations. Again, this means the vaccines are working.

The United States seems to paint a different picture. Overwhelmed hospitals are turning patients away. They’re running out of oxygen. They’re once again cramming beds into conferences rooms and cafeterias. It feels like déjà vu—even though 54 percent of Americans are also fully vaccinated.

The difference between the U.K. and the U.S. isn’t just that fewer Americans are vaccinated. It’s that fewer of the most vulnerable Americans are vaccinated, and they tend to cluster together.

Risk of death and hospitalizations from COVID-19 rises sharply with age, and in the U.K. nearly everyone over 65 is vaccinated. A New York Times analysis found very few areas in the U.K. where more than 2 percent of residents are 65 and not fully vaccinated. In contrast, that number is above 10 percent in many counties in the American South and Mountain West. Even small differences in these rates can determine the level of crisis: A community where 10 percent of residents are unvaccinated seniors has essentially five times as many people who might need an ICU bed than a community where that number is only 2 percent.

Vaccine coverage also varies dramatically from county to county in the U.S. The more unvaccinated people are concentrated, the more easily the virus can find its next victim. Imagine three out of four people in every household are vaccinated; the unvaccinated person is unlikely to spread the virus very much at home, says Graham Medley, an infectious-disease modeler at the London School of Hygiene & Tropical Medicine. Now imagine three out of every four households are completely vaccinated; the virus will spread through the unvaccinated households. The overall vaccination rate is the same, but the results are very different. This unevenness also means that …

The people at greatest risk from the virus will keep changing

Since the pandemic’s early days, vaccines have shifted the risk the virus poses to us, at a community level. Older people and health-care workers were among the first in line for the shots—a practical move to protect the people whose underlying conditions or jobs ranked them among the most vulnerable. But younger members of the community had to contend with a slower schedule, and vaccine makers are still figuring out the correct dosages for the youngest among us. That’s all shifted the virus’s burden down to uninoculated children. At the same time, the virus has been evolving into speedier and speedier forms; by the time Delta slammed the world this spring, many of its most viable hosts were at risk not because of their age or circumstances, but in spite of it.

Kids still seem relatively resilient against SARS-CoV-2 compared with adults, as they always have been. But compared with the variants that came before it, Delta is a faster spreader, and therefore a larger threat to everyone who is unvaccinated—which means children are now at greater risk than they were before.

Relative risk will keep shifting, even if the virus somehow stops mutating and becomes a static threat. (It won’t.) Our immune systems’ memories of the coronavirus, for instance, could wane—possibly over the course of years, if immunization against similar viruses is a guide. People who are currently fully vaccinated may eventually need boosters. Infants who have never encountered the coronavirus will be born into the population, while people with immunity die. Even the vaccinated won’t all look the same: Some, including people who are moderately or severely immunocompromised, might never respond to the shots as well as others. The assumptions we first had about whom the virus might hit hardest will keep changing, as will the population of people who fall ill at all.

As vaccination increases, a higher proportion of cases will appear in vaccinated people—and that’s what should happen

In July, after a COVID-19 outbreak in Provincetown, Massachusetts, a Washington Post headline noted that three-quarters of the people infected were vaccinated. Throughout the summer, many stories have reported similar figures, always with the same alarming undercurrent: If vaccines are working, how could vaccinated people make up such a large proportion of an outbreak?

The answer is simple: They can if they make up a large proportion of a population. Even though vaccinated people have much lower odds of getting sick than unvaccinated people, they’ll make up a sizable fraction of infections, hospitalizations, and deaths if there are more of them around.

Let’s work through some numbers. Assume, first, that vaccines are 60 percent effective at preventing symptomatic infections. (There’s a lot of conflicting information about this, but the exact number doesn’t affect this exercise much.) Vaccinated people are still less likely to get infected, but as their proportion of the community rises, so does the percentage of infections occurring among them. If 20 percent of people are fully vaccinated, they’ll account for 9 percent of infections; meanwhile, the 80 percent of the population that’s unvaccinated will account for 91 percent. Now flip that. If only 20 percent of people are unvaccinated, there will be fewer infections overall. But vaccinated people, who are now in the majority, will account for most of those infections—62 percent.

That is why this particular statistic—the proportion of vaccinated people in a given outbreak—is so deeply misleading. “The better the vaccine uptake, the scarier this number will seem,” wrote Lucy D’Agostino McGowan, a statistician at Wake Forest University. By extension, the safer communities become, the more it will seem like the sky is falling—if we continue focusing on the wrong statistics.

“If you’re trying to decide on getting vaccinated, you don’t want to look at the percentage of sick people who were vaccinated,” McGowan wrote. “You want to look at the percentage of people who were vaccinated and got sick.”

Note percentage. In July, an NBC News article stated that “At Least 125,000 Fully Vaccinated Americans Have Tested Positive” for the coronavirus. In isolation, that’s an alarming number. But it represented just 0.08 percent of the 165 million people who were fully vaccinated at the time. More recently, Duke University reported that 349 students had tested positive in a single week—a figure that represents just 2.5 percent of the more than 14,000 students who were tested. The denominator matters.

The denominators in these calculations also change, dragging the numerators higher along with them. As surges grow, so too will the number of infected people, which means the number of breakthrough infections will also grow. Even if the percentage of breakthroughs stays steady, though, vaccines will feel less effective if the pandemic is allowed to rage out of control, because …

Rare events are common at scale

Throughout the past year and a half, commentators have downplayed a variety of pandemic-related risks because they were “rare”—deaths, long COVID (which isn’t actually rare), infections and multisystem inflammatory syndrome in children, and more. But infectious diseases spread, and if they do so widely enough, events that are relatively rare can rack up large numbers: A one-in-a-thousand event will still occur 40,000 times when 40 million people are infected. Such events can’t be written off, especially when they involve decades of lost health or life.

As outbreaks spread, more types of rare events become noticeable as well. A wider pandemic is also a weirder pandemic. Many aspects of COVID-19’s mystique—the range of symptoms and affected organs, the possibility of persistent illness, reinfections—are common to other viral illnesses, but go unnoticed because most illnesses don’t sweep the world in a short span of time. Similarly, as this current post-vaccine surge continues, breakthrough infections will feel more common, newspapers will have more stories to run about them, and more people will know someone who had one.

Our reaction to such events must account for both the denominator and the numerator—both how relatively common they are and how much they cost each affected individual. And that assessment will change as the pandemic waxes and wanes, and as the virus itself continues to mutate.

There is no single “worst” version of the coronavirus

As in every game, who the most formidable opponent is depends on who else is playing, and the nature of the field. Right now Delta, a super-transmissible variant that hops into human airways, copies itself, and blazes back out, is especially well poised to rip through the world’s mostly unvaccinated, mostly immune-naive population—which is exactly what it’s doing. Laxness around masking, distancing, and other infection-prevention measures, in the United States especially, has given Delta plenty of opportunities to hop from human to human, further fueling its rise. The variant, for now, has about as good a home-field advantage as it can get.

But the ideal strategy, from the perspective of the virus, might look drastically different for a population with a lot more immunity. Strong, speedy immune responses will keep the virus from getting by on swiftness alone. In these environments, a stealthy version of the virus that can slip by antibodies unnoticed might be the one that wins out. The virus’s goal will still be to spread, just through different means: Mutations that make the virus less visible will help it stick around in airways longer, and potentially transmit to more people in the process. As the world gradually acquires immunity, variants like Delta might eventually be succeeded by these wilier morphs. But these transitions will likely happen at different rates in different countries, depending on who gets access to vaccines. The definition of most threatening will splinter along borders. (There is, by the way, little incentive for the virus to get deadlier along the way. Viruses want to spread, not kill. Still, some pathogens can get symptomatically nastier as a by-product of transmissibility, or if those symptoms facilitate their spread.)

All variants, though, will have some common weakness: They can be stopped through the combined measures of vaccines, masks, distancing, and other measures that cut the conduits they need to travel. When viruses spread faster, they can be tougher to control. But they can’t persist without us, and our behavior matters too.
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I thought this part was important to highlight. It answers those questions I was discussing recently about the reports about huge numbers of breakthrough cases. I was looking for a quick way to sum it up, but I like theirs - Denominators matter.

In July, after a COVID-19 outbreak in Provincetown, Massachusetts, a Washington Post headline noted that three-quarters of the people infected were vaccinated. Throughout the summer, many stories have reported similar figures, always with the same alarming undercurrent: If vaccines are working, how could vaccinated people make up such a large proportion of an outbreak?

The answer is simple: They can if they make up a large proportion of a population. Even though vaccinated people have much lower odds of getting sick than unvaccinated people, they’ll make up a sizable fraction of infections, hospitalizations, and deaths if there are more of them around.

Let’s work through some numbers. Assume, first, that vaccines are 60 percent effective at preventing symptomatic infections. (There’s a lot of conflicting information about this, but the exact number doesn’t affect this exercise much.) Vaccinated people are still less likely to get infected, but as their proportion of the community rises, so does the percentage of infections occurring among them. If 20 percent of people are fully vaccinated, they’ll account for 9 percent of infections; meanwhile, the 80 percent of the population that’s unvaccinated will account for 91 percent. Now flip that. If only 20 percent of people are unvaccinated, there will be fewer infections overall. But vaccinated people, who are now in the majority, will account for most of those infections—62 percent.

That is why this particular statistic—the proportion of vaccinated people in a given outbreak—is so deeply misleading. “The better the vaccine uptake, the scarier this number will seem,” wrote Lucy D’Agostino McGowan, a statistician at Wake Forest University. By extension, the safer communities become, the more it will seem like the sky is falling—if we continue focusing on the wrong statistics.

“If you’re trying to decide on getting vaccinated, you don’t want to look at the percentage of sick people who were vaccinated,” McGowan wrote. “You want to look at the percentage of people who were vaccinated and got sick.”

Note percentage. In July, an NBC News article stated that “At Least 125,000 Fully Vaccinated Americans Have Tested Positive” for the coronavirus. In isolation, that’s an alarming number. But it represented just 0.08 percent of the 165 million people who were fully vaccinated at the time. More recently, Duke University reported that 349 students had tested positive in a single week—a figure that represents just 2.5 percent of the more than 14,000 students who were tested. The denominator matters.

The denominators in these calculations also change, dragging the numerators higher along with them. As surges grow, so too will the number of infected people, which means the number of breakthrough infections will also grow.

Sonya · Sep 22, 2021

Nevada COVID-19 updates for 9/22:

Test positivity (note, w/ 7-day lag) is fluctuating but down: 11.12% (-0.15%)
Hospitalizations are down: 986 (-21)
Cases are down: 1,016 (-32)

Clark County cases are down: 511 (-19)
Washoe County cases are down: 249 (-11)

And this finally happened...

Nevada has reached 50% of the population fully vaccinated.

https://thenevadaindependent.com/coronavirus-data-nevada

That's it for me today. Short on time.

Sonya · Sep 23, 2021

Nevada COVID-19 updates for 9/23:

Test positivity (note, w/ 7-day lag) is down: 11.09% (-0.03%)
Hospitalizations are down: 961 (-25)
Cases are down: 956 (-60)

Clark County cases are down: 479 (-32)
Washoe County cases are down: 235 (-14)

https://thenevadaindependent.com/coronavirus-data-nevada

The downward trend continues. *knocks on wood* *rubs rabbit foot*

FDA Authorizes Pfizer Booster for Older and At-Risk Groups:
https://www.nytimes.com/2021/09/22/us/politics/pfizer-boosters-fda-authorize.html

After weeks of internal strife at the Food and Drug Administration, the agency on Wednesday authorized people over 65 who had received Pfizer-BioNTech’s coronavirus vaccine to get a booster shot at least six months after their second injection.

The F.D.A. also authorized booster shots for adult Pfizer-BioNTech recipients who are at high risk of becoming severely ill with Covid-19 or are at risk of serious complications from the disease due to frequent exposure to the coronavirus at their jobs.

The authorization sets up what is likely to be a staggered campaign to deliver the shots, starting with the most vulnerable Americans. It opens the way for possibly tens of millions of vaccinated people to receive boosters at pharmacies, health clinics, doctors’ offices and elsewhere.

Dr. Janet Woodcock, the acting F.D.A. commissioner, said that the authorization would allow for booster doses “in certain populations such as health care workers, teachers and day care staff, grocery workers and those in homeless shelters or prisons, among others.” Her statement suggested that agency leaders took a permissive view of the subgroups it deemed eligible for an extra injection.

Roughly 22 million Americans are at least six months past their second dose of the Pfizer-BioNTech vaccine, according to the Centers for Disease Control and Prevention. About half of them are 65 and older.

Millions of Americans who received the Moderna and Johnson & Johnson vaccines are still waiting to learn whether they, too, can get boosters. The F.D.A. is expected to take up the question of boosters for them in short order.

The F.D.A.’s decision will be followed as soon as Thursday by a recommendation from the C.D.C., which issues guidance on vaccine policy for clinicians and public health officials throughout the United States. An advisory committee of the C.D.C. is now in the midst of a two-day meeting on the issue. But even if the C.D.C. takes a different stance, health care providers are now authorized to offer third shots to Pfizer-BioNTech recipients who meet the F.D.A.’s eligibility criteria.

The ruling followed weeks of internal disagreement at the F.D.A., where some vaccine regulators openly challenged the idea of offering booster shots to the general population. Public health experts and state officials have criticized what they said were confusing public messages from the Biden administration about who should be eligible for a booster shot and when.

Regulators have significantly slowed the booster rollout that top federal health officials drafted and President Biden announced in mid-August. At the time, Mr. Biden said that pending regulatory approval, he wanted to offer third shots to every American adult who had been fully vaccinated with the Pfizer-BioNTech or Moderna vaccine at least eight months earlier, starting this week.

Wednesday’s authorization made the United States the most recent wealthy nation to offer people booster doses, joining a list that includes Germany, France, Israel and Britain. Some public health experts say those doses should instead be directed to countries that have vaccinated far fewer of their residents.

At a virtual Covid-19 summit on Wednesday, Mr. Biden pledged an additional 500 million doses of Pfizer-BioNTech’s vaccine to countries that need them.

“We believe boosters have an important role to play in addressing the continued threat of this disease, alongside efforts to increase global access and uptake among the unvaccinated,” said Albert Bourla, the chairman and chief executive of Pfizer.

In an interview, Dr. Peter Marks, the F.D.A.’s top vaccine regulator, described the need to offer boosters to Pfizer-BioNTech recipients aged 65 or older as a “no-brainer.”

But the agency’s decision to specify other population subgroups as eligible could set off a more spirited debate.

It is unclear, for example, whether the C.D.C. will decide to recommend booster shots for people considered at high risk because they are health care workers, teachers or grocery store clerks, or because they live in homeless shelters or prisons, as the F.D.A. clearly favors.

Asked why Dr. Woodcock said in her statement that those groups should be considered eligible for extra shots, Dr. Marks said it was important to identify examples of people who are at special risk because of their jobs or the institutions in which they live.

“If she hadn’t put that there, what would your first question have been?” he said. “‘Who are you talking about?’”

At a meeting last Friday, members of the agency’s advisory committee of experts said that health care workers should be eligible for boosters because of their work.

The F.D.A.’s decision to include those who are at high risk of severe Covid-19 captures another significant swath of the population. An estimated 60 percent of Americans suffer from obesity or other chronic medical conditions that heighten their risk of suffering from severe Covid-19, but not all of them might be included.

Pfizer had asked the F.D.A. to approve a third shot for all recipients of its vaccine who were 16 and older, six months or more after their second injection. Regulators scrambled to collect and review safety and efficacy data fast enough to meet the administration’s goal of offering shots this week.

At a dramatic meeting last week, members of the F.D.A.’s outside advisory committee said the available data was too limited to justify additional injections for so many people and voted 16 to 2 against approving Pfizer’s request. Some of the committee’s experts were concerned that Pfizer’s clinical trial results on boosters included only about 300 volunteers, a point that was brought up repeatedly by the C.D.C.’s experts.

But the advisory committee voted unanimously for the narrower option reflected in the regulatory decision.

As a practical matter, since the F.D.A. fully approved the Pfizer-BioNTech vaccine as a two-dose regimen last month, physicians have had broad latitude to prescribe a third dose to people they deemed in need of one. Many Americans have already sought extra shots on their own, typically by finding a cooperative pharmacist or pretending to be unvaccinated.

“There’s anxiety about this public expectation that everyone should go get a booster,” said Dr. Marcus Plescia, the chief medical officer for the Association of State and Territorial Health Officials, which represents state health agencies. “If we pull back on that, then states are going to get left holding the bag.”

Dr. Jesse L. Goodman, a former chief scientist at the F.D.A., said that because of some uncertainty around the benefits of boosters, regulators were right to grant only an emergency clearance for the shots while continuing to study their safety and performance.

“A stepwise approach is very judicious,” he said.

Some state health officials greeted the F.D.A.’s move enthusiastically. Dr. Clay Marsh, West Virginia’s Covid-19 czar, said that his state’s success vaccinating older residents early meant that they were overdue for extra protection.

He also said that strained hospitals in the state could not afford to lose more staff, and that booster doses could protect frontline workers from milder infections that would require them to stay at home.

“Anxious would be an understatement,” he said of those waiting for extra shots. “We’ve asked them to be patient with us. We’ve gotten texts and emails from people saying they’re living like hermits again with Delta variant, asking when is it going to be safe.”

The decision is the latest in a series of important ones that the F.D.A. is expected to make in the next few weeks. Ahead lie complex decisions on whether to authorize booster shots for recipients of the Johnson & Johnson and Moderna vaccines, whether to authorize the use of Moderna’s vaccine for children ages 12 to 17, and whether to authorize Pfizer-BioNTech’s vaccine for children between the ages of 5 and 11.

Top federal health officials have said they needed to publicly announce plans for a booster campaign so that states could prepare for a rollout. But some state officials said it was a challenge to sort out conflicting messages from federal officials.

For instance, the president said people should be eligible for a booster eight months after their second shot, but the F.D.A. set the interval at six months. Patrick Allen, the director of the Oregon Health Authority, said that the switch has thrown off the state’s planning and caused officials there to “scramble” to prepare for many more residents who now could be eligible.

“We thought at an eight month window we were going to be OK with supply and demand, with our core infrastructure being clinics and pharmacies. But if we have 350,000 people eligible at the beginning, we’re going to have some challenges,” he said, referencing estimates the state has made. At least one county is now preparing to reopen a fairgrounds site for booster doses, he said.
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Nothing is finalized yet though. We're going to have to wait a bit longer for the plan and full approval by the CDC. Hopefully soon. Maybe today.
¯\_(ツ)_/¯

Here's another article on the same topic...

Advisory Committee Recommends Wide Swath of Americans Be Offered COVID Boosters:
https://www.statnews.com/2021/09/23/covid19-vaccine-boosters-cdc-acip/

A vaccine advisory panel voted Thursday to recommend that a wide swath of Americans should be offered Covid-19 vaccine booster shots, given at least six months after their second vaccination.

The Advisory Committee on Immunization Practices, or ACIP, recommended by a 15 to 0 vote that adults 65 and older should be offered booster jabs and by a vote of 13-2 that a booster dose should be offered to individuals 50-64 with underlying health conditions.

In a separate vote, the panel left the door open to 18- to 49-year-olds with underlying medical conditions obtaining a booster shot, based on an assessment of “benefit and risk,” a phrase traditionally meant to suggest a conversation between individuals and their health care providers.

The committee voted against recommending a booster to anyone 18-64 who is in an occupational or institutional setting where burden of Covid-19 infection and risk of transmission is high. A vote in favor would have cleared the way for all health care workers to get an additional dose of vaccine.

Rochelle Walensky, director of the Centers for Disease Control and Prevention, must sign off on the recommendation. She is expected to do so on Thursday, opening the door for the booster shot program to begin soon, potentially in the week that the Biden administration had set as its target.

Based on the ACIP’s recommendation, many adults will soon be able to get a Covid vaccine booster, though only people who received the Pfizer and BioNTech vaccine as their primary series are eligible to receive a booster. Nearly 100 million people in the United States have received two doses of the Pfizer vaccine.

Late Wednesday, the Food and Drug Administration issued an emergency use authorization for the Pfizer booster shot for people 65 years of age and older and a wide array of people who are at higher risk of severe Covid because of health conditions or because they have “frequent and unavoidable exposure” to the SARS-CoV-2 virus in institutional or occupational settings.

A number of ACIP members questioned whether the committee could recommend that people who received the Moderna or Johnson & Johnson vaccine should be allowed to seek a Pfizer booster. But the FDA said it had no data on which to conclude getting a third shot of another vaccine would be as effective as a third shot of one’s original vaccine.

Peter Marks, director of FDA’s vaccines division, told the committee FDA understands the frustration about not being able to give boosters at this point to people who did not get the Pfizer vaccine. The agency is working with manufacturers and will try to fill this gap as quickly as possible, he said.

While most members of the committee supported the use of boosters, several raised concerns that this step won’t fix the country’s Covid problem. Keipp Talbot, a vaccine researcher from Vanderbilt University, said hospitals are full of people with Covid-19 who aren’t vaccinated and boosting fully vaccinated people won’t change that.

“I feel like we’re putting lipstick on hogs,” she said. “This is not going to solve the pandemic.”

Thursday’s ACIP vote punctuates a rocky five-week period in which the Biden administration found itself at odds with many in the scientific community — and those who value drug and vaccine approvals playing out according to regulatory pathways.

Rather than asking the FDA and the CDC to advise it on whether it was time to make booster shots available to Americans, the administration announced a booster shot campaign would begin the week of Sept. 20. The announcement was made before any booster shots had been authorized for use — and before two of the three manufacturers had even filed an application to the FDA for approval of a booster.

Whether most fully vaccinated people need a booster shot at this point remains a point of heated debate. While data from Israel — one of the first countries to rapidly vaccinate a large portion of its population — suggests the Pfizer vaccine’s ability to protect against serious disease subsides within months, many questions remain about the interpretation of those data. And as Israel only used the Pfizer vaccine, the country’s experience tells the world nothing about other vaccines in use.

The FDA’s vaccine advisory committee, the Vaccines and Related Biological Products Advisory Committee, or VRBPAC for short, voted at a meeting last Friday not to recommend boosters for everyone 16 years of age and older who had received the Pfizer vaccine. Instead, it recommended a smaller group of individuals be offered boosters — people 65 and older and people at high risk of severe disease.

Pfizer had applied for approval of a booster that would be offered to anyone aged 16 and older, to be given six months after the second dose of vaccine.

In crafting the emergency use authorization for the Pfizer booster, the FDA used the vagueness of the VRBPAC vote to greatly increase the number of people eligible for a booster shot.

In addition to adults 65 and older, anyone 18 years of age or older who is at high risk of severe Covid because of a health condition or because their work puts them at high risk of being exposed to the SARS-CoV-2 virus can get a booster. That means people who are pregnant, have diabetes, are obese, or have a range of medical conditions like high blood pressure are eligible. Likewise health workers, teachers, day care workers, people who work in grocery stores, or who live or work in homeless shelters and prisons can receive a booster.

As interpreted by the CDC, it would also include people who live with people who are immunocompromised. Studies have shown that immunocompromised people often are not protected by two doses; in August, FDA extended the authorizations for the Pfizer and Moderna vaccines to allow severely immunocompromised people to get a booster dose. But even with a third dose, some have limited vaccine-induced protection.

There is a fair amount of overlap among these groups. Regardless, these groups could total as more than 100 million Americans — though only the portion of them who received the Pfizer vaccine will be eligible for a booster at this time.

One group that did not make the cut was 16 and 17 year olds. Pfizer’s application included no data to support the safety of giving 16 and 17 year olds a booster and members of VRBPAC objected strongly to their inclusion without safety data. In the end, the FDA did not include them.
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So, it sounds like anyone over 65 will be eligible. People over 50 with high-risk factors will be eligible. It does not sound like people in jobs that put them at a high exposure risk (healthcare workers, retail, grocery workers, etc) will be eligible, based on this particular recommendation, but we'll have to wait for the final plan to be released.

No, Vaccinated People Are Not ‘Just as Likely’ to Spread the Coronavirus as Unvaccinated People
https://www.theatlantic.com/ideas/archive/2021/09/the-vaccinated-arent-just-as-likely-to-spread-covid/620161/

For many fully vaccinated Americans, the Delta surge spoiled what should’ve been a glorious summer. Those who had cast their masks aside months ago were asked to dust them off. Many are still taking no chances. Some have even returned to all the same precautions they took before getting their shots, including avoiding the company of other fully vaccinated people.

Among this last group, a common refrain I’ve heard to justify their renewed vigilance is that “vaccinated people are just as likely to spread the coronavirus.”

This misunderstanding, born out of confusing statements from public-health authorities and misleading media headlines, is a shame. It is resulting in unnecessary fear among vaccinated people, all the while undermining the public’s understanding of the importance—and effectiveness—of getting vaccinated.

So let me make one thing clear: Vaccinated people are not as likely to spread the coronavirus as the unvaccinated. Even in the United States, where more than half of the population is fully vaccinated, the unvaccinated are responsible for the overwhelming majority of transmission.

I understand why people are confused. In April, after months of public-health experts cautiously promoting the merits of vaccination, CDC Director Rochelle Walensky cited new real-world data of the shots’ effectiveness to jubilantly proclaim that “vaccinated people do not carry the virus.” The CDC later walked back her comment, but headlines such as “It’s Official: Vaccinated People Don’t Transmit COVID-19” had already given many the impression that in addition to their remarkable protection against infection with the coronavirus, the shots also prevented them from passing the illness on to others.

Scientists and researchers objected, warning that there weren’t enough data to support such a proclamation. Their concerns were prescient. As Delta first took hold early this summer and then quickly spread, our collective relief turned into dejection.

An outbreak in Provincetown, Massachusetts—in which 74 percent of the 469 cases were in the fully vaccinated—forced the CDC to update its mask guidance and issue a sad and sobering warning: Vaccinated people infected with the SARS-CoV-2 Delta variant can be just as contagious as unvaccinated people.

In the aftermath of the Provincetown announcement, many who had gotten their shots were confused about what the news meant for them, especially when headlines seemed to imply that vaccinated individuals are as likely to contract and transmit COVID-19 as the unvaccinated. But this framing missed the single most important factor in spreading the coronavirus: To spread the coronavirus, you have to have the coronavirus. And vaccinated people are far less likely to have the coronavirus—period. If this was mentioned at all, it was treated as an afterthought.

Despite concern about waning immunity, vaccines provide the best protection against infection. And if someone isn’t infected, they can’t spread the coronavirus. It’s truly that simple. Additionally, for those instances of a vaccinated person getting a breakthrough case, yes, they can be as infectious as an unvaccinated person. But they are likely contagious for a shorter period of time when compared with the unvaccinated, and they may harbor less infectious virus overall.

That’s why getting more people their shots is crucial for controlling the spread of the coronavirus: Every vaccinated person helps limit the virus’s ability to hide, replicate, and propagate.

Among the unvaccinated, the virus travels unhindered on a highway with multiple off-ramps and refueling stations. In the vaccinated, it gets lost in a maze of dead-end streets and cul-de-sacs. Every so often, it pieces together an escape route, but in most scenarios, it finds itself cut off, and its journey ends. It can go no further.

This is borne out by recent data from New York City that show that more than 96 percent of cases are among the unvaccinated. Only 0.33 percent of fully vaccinated New Yorkers have been diagnosed with COVID-19.

To highlight what this means in the real world, imagine two weddings with 100 guests, one where everyone is unvaccinated and another where all the guests are vaccinated.

In the unvaccinated wedding group, the likelihood that at least one of the guests has COVID-19 is high. Similarly, everyone present is more susceptible, and the virus will likely infect many others, given the increased transmissibility of the Delta variant.

At the wedding with exclusively vaccinated attendees, however, the likelihood that anyone present has COVID-19 is minuscule. Even if someone present is infected, the likelihood that the other guests will contract the virus is similarly low, given the protection afforded by their shots.

This is exactly why vaccine mandates are so important—and why going to events that exclude unvaccinated people is much, much safer than those that are open to all. Everyone knows that the vaccines help protect each individual who gets their shots. But when more people get vaccinated, this helps keep everyone else (including children and others ineligible for vaccination) safe as well.

It’s worth acknowledging that even though the vaccines are our best protection—and still do what we need them to do very well—they’re not perfect. Vaccinated individuals can experience breakthrough infections, and when they do, they can potentially infect others. Some may also develop long COVID, although thankfully the shots dramatically lower this risk too. These reasons are exactly why, in many circumstances, mitigation measures such as masking and mandates still make sense to help limit the spread, even for the vaccinated.

As an emergency-medicine physician, I’ve seen firsthand the vaccines’ dramatic role in reducing severe outcomes from a virus that flooded my emergency room early in the pandemic. And as a member of one of the first groups vaccinated in the rollout, I was kept safe by the shots while I cared for patients, and they prevented me from bringing the virus home to my family.

But ultimately, a COVID-19 diagnosis in someone close to me is what highlighted why the assertion that the vaccinated are as likely to spread the coronavirus as the unvaccinated is so wrong.

Recently my cousin contacted me when her daughter tested positive for COVID-19. Her daughter fell ill just weeks before her 12th birthday, when she would’ve been eligible for a vaccine. My fully vaccinated cousin spent nearly every moment at her side—always indoors and usually unmasked—yet never fell ill herself.

“The vaccine seems to be working. It’s magic!” she texted me. Before getting her shots, she would have almost certainly been infected, and likely passed it on to others. But the vaccine broke the chain of transmission. My cousin never spread her daughter’s COVID-19 to anyone because she never caught it.
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Clark County Declares COVID Misinformation a Public Health Crisis:
https://www.8newsnow.com/news/health/coronavirus-health/clark-county-declares-covid-misinformation-a-public-health-crisis/

Clark County has declared misinformation about COVID-19 a “public health crisis.”

A tweet from Clark County Commissioner Justin Jones states that misleading information about COVID-19 “has only made matters worse.”

“It’s important for our governing board to declare health misinformation as a public health crisis and commit to doing all we can to combat the falsehoods that continue to jeopardize the lives of our citizens.”

Jones said Clark County is among only a few counties in the nation to take such a step.

“Clark County should commit to combating health misinformation and curb the spread of falsehoods htat threaten the health and safety of our residents,” according to the resolution’s last paragraph.

The resolution includes passages affirming the effectiveness of COVID-19 vaccines and decries statements that have led many to refuse to get vaccinated.

“Misinformation has caused confusion and nationally has led to eligible people declining COVID-19 vaccines, rejecting public health measures such as masking and physical distancing, and using unproven treatments.”
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You can view the resolution here: https://clark.legistar.com/View.ashx?M=F&ID=9811967&GUID=87D8B173-3775-406C-86F1-9A62EBCF7432

Please note that there's no violation of First Amendment rights here. There's no punishment or infringement of the ability to spread misinformation. It just declares that there is a problem with misinformation, highlighting some of the false claims, and says they should do what is necessary to combat that misinformation as it is a threat to the health and safety of county residents.

Sonya · Sep 24, 2021

Nevada COVID-19 updates for 9/24:

Test positivity (note, w/ 7-day lag) is down: 10.95% (-0.16%)
Hospitalizations are down: 922 (-39)
Cases are down: 913 (-43)

Clark County cases are down: 463 (-16)
Washoe County cases are barely up: 236 (+1)

https://thenevadaindependent.com/coronavirus-data-nevada

Coronavirus Contextualized, 60th Edition:
https://thenevadaindependent.com/article/coronavirus-contextualized-60th-edition-case-numbers-start-to-improve-in-much-of-the-state

Below, we take a look at this week’s slightly improved case numbers as Nevada hit the milestone of having 50 percent of its residents fully vaccinated this week.

Cases

Statewide case numbers trended downward this week after several weeks of fluctuations.

As of Thursday, 956 new cases were reported on average each day over the previous seven days, down from 1,198 last week and down further from the highest point of the current wave, 1,226, which the state hit on Sept. 13. That peak is higher than the highest point of last summer’s wave, 1,176, which the state hit in mid-July 2020, but a little less than half of the fall and winter wave record, 2,736 on Dec. 10, 2020.

In Clark County, which was hit early and hard by the latest wave of the virus, cases have been generally trending down since early August with some slight fluctuations. The seven-day average hit 479 on Thursday, down 632 from last week and down significantly from 917 on Aug. 1, the highest point of the current wave. That peak is below both the high point of the 2020 summer wave — 1,072 on July 20, 2020 — and the fall and winter wave, when Clark County hit its highest seven-day case average ever of 2,092 on Jan. 12.

Cases also appear to finally be trending down in Washoe County, which was hit later by the current wave of the virus. After hitting a high point of 304 on Sept. 15, cases have been steadily decreasing, hitting 235 on Thursday. The level of cases Washoe County is seeing remains much higher than the peak of last summer’s small wave, 98 on July 30, 2020, but about half the county’s record high point of 532 on Nov. 27 during the fall and winter wave.

Still, Washoe County’s case rate remains more than double Clark County’s, adjusted for population size. As of Thursday, Clark County was seeing 21 cases reported per 100,000 residents each day over the previous seven days, compared to 50 in Washoe County. The case rate in the other 15 counties continues to be even higher, 71, though that number has also started to drop in recent days.

According to the Nevada State Public Health Lab’s weekly lineage report, the Delta variant was responsible for 96.5 percent of sequenced COVID-19 cases over the last 14 days. (Not all COVID-19 samples are selected for genetic sequencing, though sequenced cases are used to extrapolate a variant’s prevalence in the overall population.)

Since the beginning of the pandemic, there have been 415,424 COVID-19 cases confirmed statewide, meaning 1 in 7 Nevadans has tested positive for the virus. More than 8 percent of those cases, 33,658, have been diagnosed in the last month, and a little less than 2 percent, or 6,691 cases, have been reported in the last week.

Test positivity

The statewide test positivity rate, which looks at the percentage of tests coming back positive out of the total tested, saw some slight decreases this week following recent fluctuations.

It is not possible to independently calculate the test positivity rate based on test encounters because the state only publicly reports the number of positive cases, not the number of positive test encounters. However, the state does provide this number, calculated as an average over a 14-day period with a seven-day lag. As of Tuesday, that number was 11.1 percent, down slightly from 11.4 percent last week and significantly down from the highest point of the current wave, 16.4 percent on Aug. 13 but even with last week’s rate.

The test positivity rate is still more than double the World Health Organization’s recommended 5 percent threshold but less than the peak test positivity rate of 21.3 percent the state saw in mid-January.

Since the beginning of the pandemic, nearly 2 million people — 64 percent of Nevadans — have been tested for COVID-19, and there have been more than 4.3 million individual testing encounters.

Vaccinations

The pace of vaccine distribution in Nevada continues to generally slow.

As of Wednesday, about 6,200 vaccines were reported administered each day over the last seven days, down from 6,800 last week.

More than 60 percent of Nevadans have now been either partially or fully vaccinated against COVID-19 — with more than 50 percent now fully vaccinated — and about 27 percent of Nevadans eligible for the vaccine have yet to receive it.

Since vaccinations started in December, more than 1.8 million people have received at least one dose of the COVID-19 vaccine and more than 1.5 million Nevadans have been fully vaccinated.

Among the counties, Carson City continues to have the highest percentage of residents fully vaccinated against COVID-19 at 57.3 percent, followed by Washoe County at 54.2 percent, Douglas County at 49.3 percent and Clark County at 45.7 percent. Tiny Storey County has still vaccinated the least, with only 17.3 percent of its residents partially or fully vaccinated.

Nationally, Nevada ranks 31st among the 50 states for percentage of its population fully vaccinated, behind all of its neighbors except Utah and Idaho, at 32nd and 48th, respectively.

Breakthrough cases

There have been 9,080 breakthrough cases — fully vaccinated individuals who have tested positive for COVID-19 — in Clark County as of Sept. 16, meaning that 0.86 percent of fully vaccinated individuals have contracted the virus.

In Washoe County, there have been 2,845 breakthrough cases as of Thursday, representing 1.1 percent of fully vaccinated people in the county.

As of Sept. 16, there were 425 breakthrough hospitalizations in Clark County and 137 breakthrough deaths, meaning that 0.04 percent of vaccinated individuals in Clark County have been hospitalized and 0.01 percent have died. Of the people hospitalized with breakthrough infections, 63 percent had underlying conditions, 73 percent were those 65 years or older and 61 percent were men.

Southern Nevada Health District data show that breakthrough cases still represent a small share of total cases identified in Clark County each month. Fully vaccinated people have made up 19.2 percent of overall cases in September so far, compared to 80.8 percent for unvaccinated people.

Deaths

The number of new COVID-19 deaths reported on average each day continues to fluctuate, though it remains high.

As of Thursday, 23 COVID-19 deaths were being reported on average each day over the prior seven days, up from 20 last week but slightly less than the high point of the current wave, 25, which the state hit on Aug. 30. Last summer’s surge peaked at an average of 21 daily deaths, while the fall and winter surge peaked at 45 daily deaths.

Over the last seven days, 162 new COVID-19 deaths have been reported across the state — up from 140 last week — including:

116 in Clark County

22 in Washoe County

6 in Elko County

5 in Carson City

4 in Lyon County

3 in Douglas County

2 each in Nye and Pershing counties

1 each in Churchill and Mineral counties

Since the beginning of the pandemic, there have been 6,983 deaths in Nevada from COVID-19. In the last month, 678 deaths from COVID-19 were reported statewide, nearly 10 percent of the deaths reported statewide since the beginning of the pandemic.

One in 441 Nevadans has died from COVID-19.

Hospitalizations

The number of people hospitalized with COVID-19 statewide continues to generally decrease though staffing challenges continue to plague the state.

As of Tuesday, there were 961 people hospitalized with confirmed or suspected cases of COVID-19 across the state, down from 1,073 last week and significantly down from this wave’s peak of 1,317 on Aug. 10. The peak of last summer’s wave was 1,165, which the state hit on July 31, 2020, and the peak of the fall and winter wave was 2,025, on Dec. 13, 2020.

The last time the state was below 1,000 hospitalizations statewide was July 21.

That decreasing trend is largely a result of steady decreases in hospitalization numbers in Clark County. Hospitalization numbers in Washoe County have seen some fluctuations in recent days, while those in rural Nevada continue to climb.

The Nevada Hospital Association, in its weekly report, highlighted the serious staffing issues happening statewide. The hospital association said the number of staffed beds contracted from 1,782 on Aug. 8 to 1,320 on Sept. 21. Over the same time period, the number of staffed intensive care beds in Washoe County has fallen from 233 to 166.

Rural hospitals are also experiencing staffing shortfalls as larger facilities, and travel staffing agencies poach nurses,” the hospital association wrote. “Similar issues are also being felt in the south.”

The hospital association also moved ICU occupancy rates in Northern Nevada from “watch” to “warning” status this week.

“This has occurred as multiple hospitals report occupied staffed beds in these categories above the 90% threshold,” the association wrote. “Some northern hospitals have open requests for additional staffing and equipment, which emergency managers have difficulty fulfilling.”

County by county

All counties except White Pine are considered by the state to be at elevated risk for the spread of COVID-19 as of Thursday.

Counties are considered at risk for elevated spread of COVID-19 if they meet two of the following three metrics:

The average number of tests per day per 100,000, calculated over a 14-day period. If this number is less than 100, a county could be considered at risk.

The case rate per 100,000, calculated by taking the number of cases diagnosed and reported over a 30-day period. If this number is greater than 200, a county could be considered at risk.

The case rate per 100,000 and the test positivity rate, calculated over a 14-day period with a seven-day lag. If the case rate is greater than 50 and the test positivity rate is greater than 8.0 percent, a county could be considered at risk.

The state continues to align its mask mandate with federal guidance, however, meaning it is using the CDC’s community transmission tracker to determine which counties are at substantial or high risk for the spread of COVID-19 and therefore required to abide by indoor mask mandates for vaccinated and unvaccinated individuals alike.

Under the CDC’s metrics, counties are considered at risk for “high” transmission if they have more than 100 cases per 100,000 residents in the last seven days, “substantial” if they have between 50 and 100, “moderate” if they have between 10 and 50 and “low” if they have fewer than 10.

As of Tuesday, all Nevada counties were considered at “high” risk of transmission. That means that counties remain subject to universal indoor masking precautions for both vaccinated and unvaccinated individuals.

Counties can have mask mandates put in place if they have two weeks of “substantial” or “high” transmission; those mask mandates will automatically be removed after two weeks of “low” transmission.
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Flight Attendants Beg for Help to Deal with "Air Rage"
https://www.usatoday.com/story/travel/airline-news/2021/09/23/flight-attendants-curb-unruly-passengers-air-rage-incidents/5820224001/

American Airlines flight attendant Teddy Andrews was working a flight in mid-January when a co-worker came to the back galley on the verge of tears because a passenger wouldn't put his mask on.

Andrews went to talk to the passenger about the mask requirement and was quickly met with a racist rant.

"He looked at me – and I will not repeat the epithet he used – he said, 'N-word, I don’t have to listen to a damn thing you say, this is a free country,' " Andrews recalled during a congressional hearing on air rage Thursday. "I was completely taken aback. I didn’t know what to say. But he continued, 'You heard me, N-word boy.' "

Andrews told the aviation subcommittee of the U.S. House Committee on Transportation and Infrastructure he has lost count of how many times he has been insulted or threatened on a flight since he returned to work a year ago after nearly dying of COVID-19following a work trip in March 2020. He said flight attendants are well trained for medical emergencies, evacuations and security threats but their most "imminent danger" is air rage.

Andrews and Sara Nelson, international president of the Association of Flight Attendants-CWA, called on the government, airlines and airports to do more to reduce the number of unruly passenger incidents. Proposals included:

a ban on to-go alcohol at the airport,

airlines sharing their internal no-fly lists with other airlines so banned passengers don't disrupt another flight,

and federal criminal prosecution of the most egregious cases.

The new measures would be in addition to a host of efforts already well underway. The FAA has proposed fines totaling more than $1 million under its zero-tolerance policy and put out FAA put out a public service announcement with chilling audio of passengers behaving badly. President Joe Biden issued a plea earlier this month to "show some respect" to airline workers and doubled the TSA fines for not wearing a mask on planes and at airports. And American and Southwest decided not to resume in-flight alcohol sales.

Most passenger-crew incidents are mask-related

"One more air rage event, one more flight attendant who is threatened or assaulted is one too many," Andrews said.

So far this year, airline crews have reported 4,385 incidents of unruly passenger behavior to the FAA, with nearly three out of four of them mask-related. The FAA has initiated 788 investigations tied to the incidents, four times the number of investigations in 2020. The agency has proposed fines in 162 cases to date.

The AFA calls the numbers "staggering" and Nelson said if they continue at this rate there will be more incidents in 2021 than all previous years combined. In testimony submitted for the hearing, she called it a "scourge of abusive passengers."

"We cannot accept this as the new normal," Nelson said.

The Federal Aviation Administration had some positive news on the unruly passenger front Thursday, noting that the rate of reported incidents has fallen about 50% from earlier in the year. The agency said a large part of the decline has happened since it launched a public service campaign warning travelers about the consequences of bad behavior in late August.

The rate of reported incidents is now six times per 10,000 flights, according to the FAA. That's still more than twice as high as the end of 2020 and is remains "too high," the agency said in a news release.

The FAA is planning meetings with airlines, airports and other industry players to share ideas on additional ways to curb the incidents.

"This behavior is from a small percentage of the traveling public," Rep. Rick Larsen, D-Wash., chair of the aviation subcommittee, said at the hearing. "But, it is disgusting, it is unacceptable and it is a danger to fellow passengers, crew and the entire U.S. aviation system. Congress, the federal government and the aviation industry must work together to protect airline crews, airport staff and the traveling public from passenger outbursts."

Flight attendant proposals to end air rage incidents

Flights attendants have plenty of ideas on ways to reduce the number of unruly passenger incidents and haven't been shy about sharing them.

Among the key proposals raised at Thursday's hearing:

Chair of the House Committee on Transportation Peter De Fazio said some airports have been touting sales of alcohol to go during the pandemic.

"That is literally encouraging people to break the law: Get a great big to-go cup with four shots in it and take it on the airplane," he said. "So that needs to end."

De Fazio said he was having a beer at an unnamed airport recently when another passenger ordered three shots of vodka in a to-go cup, noting it is hard for airline gate agents to know what's in there.

"How are you going to tell?" he said. "Is it coffee, a soda? What is it?"

Nelson said ending to-go alcohol sales at the airport is the "low hanging fruit" of additional efforts needed to reduce bad behavior.

Christopher Bidwell, senior vice president of safety for Airports Council International in North America, pushed back on suggestions that airport alcohol restrictions are needed. He said FAA figures say 6% of unruly passenger incidents involve alcohol and there is no way to know where the drunk passengers originally got intoxicated.

Bidwell said alcohol to-go sales started before the pandemic and are only offered at a relatively small number of airports. He added that at some airports there is an effort underway between concessionaires and airlines to mark to-go cups containing alcohol to better help gate agents trying to police the policy. He did not name the airports.

"There are many cases that DOJ could take up and we need DOJ to take more more aggressive action," Nelson said.

The prospect of jail time and publicity about prosecutions, which has repeatedly been recommended, would send a strong message to other passengers, she said.

The DOJ has only taken up one case so far, filing criminal assault charges against a Southwest Airlines passenger in early September. The flight attendants union said the employee lost teeth in the May incident, which went "viral" on social media. Southwest decided against resuming inflight alcohol sales after the incident.

Incoming Southwest Airlines CEO Bob Jordan, who is due to replace Gary Kelly in February, brought up the case when asked about unruly passenger incidents at a travel industry conference in New York Thursday.

"We've had a flight attendant that was punched," he said at the Skift Global Forum. "Nobody deserves to come to work and have that happen to them so we're not going to tolerate that."

He called that an extreme case, though, and said the majority of the airline's flight attendants have not encountered fighting and other headline-making incidents.

Airlines have established internal no-fly lists to deal with the spike in unruly passenger incidents. Delta Air Lines has 1,600 passengers on its internal no-fly list, 600 of them added this year. United Airlines' list is up to 700.

In a memo to flight attendants ahead of the House hearing this week, Delta's senior vice president of inflight service, Kristen Manion Taylor, said the airline has asked other airlines to share their lists to further protect employees.

"A list of banned customers doesn't work as well if that customer can fly with another airline," the memo said.

Nelson recounted an incident where an unruly passenger was banned from one airline, got off the flight and caught a flight on another carrier and "continued to be a problem on the next flight."
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Please don't be one of these people. Do what is required of you and don't make trouble for employees trying to make your trip to Vegas safe.

The Idaho Capital Sun has an interesting piece on COVID Misinformation. Worth a read by everyone so you're aware of how this misinformation works. Nobody is immune from it. It's easy to fall into the confirmation bias trap.

Idaho Needs Media Literacy to Combat COVID Misinformation:
https://idahocapitalsun.com/2021/09/24/idaho-needs-media-literacy-to-combat-covid-19-misinformation/

With Idaho recently announcing crisis standards of care in hospitals across the state, we are seeing first-hand the effects of myths, misunderstandings, and misinformation about COVID-19. In today’s media environment, Idahoans are bombarded from every direction with contradictory claims about COVID-19, and it can be challenging to disentangle the truths from the falsehoods.

Much like inoculation against a harmful virus, media literacy — the ability to analyze and evaluate media messages — can help us stay afloat in this sea of misinformation. But to be media literate, we all need knowledge about how our media system often prioritizes engagement over accuracy and how it takes advantage of our basic human tendencies to stick with our own kind and to avoid effortful thinking.

For most people, working through conflicting information is just not much fun and does not make it to the top of our to-do lists. Making careful judgments requires the painful tradeoff of slowing down and investing mental effort. Unfortunately, our brains evolved to take the easy route, to listen to our intuition and rely on cognitive shortcuts that are usually “good enough” to guide our decisions.

But those shortcuts also leave us all susceptible to common errors in our thinking. Our confirmation bias means we’re more likely to believe new information is true when it fits with our preexisting beliefs.

Studies also show that merely being exposed to false news stories makes those stories feel more believable and true. This is particularly problematic since scientists have shown that misinformation often spreads faster and wider on social media than accurate information. As Jonathan Swift once wrote: “falsehood flies, and the truth comes limping after it.”

The online attention economy knows all of this. Algorithms working behind the scenes when you visit sites like Facebook and Google prioritize content that will keep your eyeballs on the screen and increase the profitability of these giant corporations. It’s easy to ignore the well documented harmful effects of social media and to forget that these are not benign public utilities.

Your information ecosystem is not neutral.

The algorithms that select which content to display on your screen take on a life of their own when they start gathering data about you and using it to tailor your online experience. In some ways, these algorithms know us better than we know ourselves.

This makes it easier than ever for bad actors to manipulate us through eye-catching propaganda that satisfies our deep desire to be part of a group and rewards our hunger for validation. You can mess with the algorithms and avoid being misinformed by simply cutting back on your liking and sharing, or go out of your way to follow a range of reliable sources, especially ones you might not agree with.

Traditional news outlets are certainly imperfect, but print and digital newspapers and noncommercial public media outlets are still your best bet for reliable information. Organizations like these pay trained journalists to gather information and verify facts, not to advance a political agenda.

Instead, their aim is to get to the closest possible version of the truth and to help us understand what’s happening across our society. They follow industry-standard codes of ethics and hold themselves accountable when they make a mistake, unlike purveyors of misinformation who cherry-pick information to serve their narrow ideological interests.

Anecdotes about rare breakthrough cases and uncommon vaccine side effects can understandably raise questions, but it’s more important to look at the overall evidence. Informed citizens know that vaccines and masks are the best ways to protect against the virus and to help put an end to the pandemic — even if you’ve already tested positive. “Doing your own research” is fine, but it’s no substitute for the meticulous work of experts who are doing their best to learn everything they can about COVID-19 and are updating us when their knowledge grows and as situations change.

Find your way to reliable information by asking a few basic media literacy questions: Who created this information and why? Who is the target audience for this and am I part of it? Is the information designed to provoke a certain reaction? Is it working? What information is missing, and what questions are unanswered? Does this help support the information needs of the community or does it seek to promote a self-serving partisan agenda?

Above all, simply slow down. Avoid making quick judgments based on emotional reactions. If something feels true, it could be, but check it out to be sure.

Reminding social media users to stop and think about the accuracy of a news item makes them less likely to share misinformation online. Be consistently skeptical, not just with information you don’t like. Don’t repeat or amplify misinformation by sharing it. Instead, share evidence-based information from reliable sources.

You can also encourage others to practice the same good information hygiene practices. If friends and family are struggling, listen with empathy to their concerns and ask open-ended questions to help them see if they are being misled.

We all need to remember that misinformation can cost lives and perpetuate major social disruptions, but working together, we can fight misinformation and help bring this pandemic to an end.
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Who Will Get a Booster Shot:
https://www.nevadacurrent.com/2021/09/24/who-will-get-a-booster-shot-a-qa-about-what-the-feds-are-saying/

Booster shots soon will begin rolling out to some Americans who received the two-shot vaccine made by Pfizer—after a contentious and confusing federal approval process that isn’t over yet.

Determining who exactly should be rolling up their sleeves for an additional dose was tricky. The Biden administration had leapfrogged federal regulatory panels in announcing plans for a more sweeping booster campaign that it hoped would have begun last Monday.

Instead, only those who received the Pfizer shots will be eligible for boosters, and boosters will be limited to those 65 and older or individuals with underlying medical conditions, a Centers for Disease Control and Prevention panel recommended Thursday.

The initial eligible groups will also include health care workers, teachers and others at higher risk of exposure to the virus at their workplace — a category that the CDC panel declined to recommend, but the top CDC official added them back in the agency’s official guidance late Thursday night.

The federal booster effort ran into challenges in the month since President Joe Biden made his announcement, including the time it takes to gather data on booster shots.

Pfizer was the first to submit its data to federal regulators, and is the only one of the three vaccines so far to be formally considered for booster use.

Given a lack of data on the safety of mixing vaccines from different manufacturers, Americans who received the Moderna and Johnson & Johnson shots must wait to have their own boosters approved.

As federal health officials have scrambled to assess data on booster shots, the U.S. has been facing a fourth wave of cases, with an average of 130,000 infections and more than 2,000 deaths per day.

The overwhelming majority of current COVID-19 cases, hospitalizations and deaths are among people who have not received a vaccine against the disease. Some members of the CDC advisory panel expressed uncertainty over the potential for boosters to tamp down the spike in infections.

“We may move the needle a little bit” by recommending booster doses, “but that’s not really the answer to this pandemic,” said Dr. Helen Keipp Talbot, associate professor of medicine at Vanderbilt University, emphasizing the need to vaccinate those who still haven’t received their initial shots.

Here are some questions and answers about boosters:

Who can get a vaccine booster?

Pfizer booster shots will initially be recommended to those 65 and older, or in long-term care facilities, as well as those between 50 and 64 who have underlying medical conditions.

The CDC panel also voted to allow those between 18 and 49 years old with underlying medical conditions to obtain booster shots, based on an individual assessment of their risk from COVID-19.

The panel rejected a broader recommendation of a booster for anyone 18-64 who is in an occupational or institutional setting where risk of COVID-19 transmission is high, such as health care workers. Several experts on the panel expressed concerns about the category being too broad and including some who may not receive much benefit from a booster shot.

But Dr. Rochelle Walensky, head of the CDC, included it in her guidance, as did the Food and Drug Administration when that agency granted its signoff on Wednesday.

Roughly 26 million Americans are at least six months past their second Pfizer dose, and about half of those individuals are 65 or older, according to the CDC.

What if I’m not in one of the approved categories?

You should wait to seek out a booster shot.

Data presented during the FDA and CDC hearings shows that while the vaccines’ effectiveness has waned when it comes to being vulnerable to infections, breakthrough infections still tend to be mild and the shots’ protection against severe illness and hospitalization remains strong.

“If you’re not in a group for whom boosters are universally recommended, it’s really because we think you’re well-protected,” said Dr. Matthew Daley, a senior investigator with Kaiser Permanente Colorado’s Institute for Health Research.

What if I received a shot made by Moderna or Johnson & Johnson?

For now, you’ll have to wait.

Moderna has submitted its federal application for a booster shot, and Johnson & Johnson said this week that it has provided data to the FDA on its booster study.

A number of health experts at Thursday’s CDC advisory panel meeting expressed frustration about the lack of safety data on whether the shots can be mixed across manufacturers. FDA officials said they are working with those drug companies and the National Institutes of Health to gather the information needed for a science-backed ruling.

What if I want to get one anyway?

The recommendations do not include any requirements that health care providers confirm that those seeking a booster vaccine are in the eligible categories (which also include people who are immunocompromised, who were approved last month for boosters).

But the federal regulations on using those boosters under emergency approval mean that providers are supposed to strictly follow requirements on how the vaccines can be used.

When and where can I get a booster dose?

For the eligible groups, booster shots are recommended at least six months after receiving the second dose of Pfizer’s vaccine.

Most individuals can head to their local pharmacy: More than 70% of COVID-19 vaccines currently are being administered through pharmacies, according to the CDC.

Will this change what it means to be fully vaccinated?

Not yet. Regulators said Thursday that the definition of being “fully vaccinated” — which is used by workplaces, entertainment venues and a range of other public and private settings — will still be the two doses of the Pfizer or Moderna vaccine (and one of the single-dose J&J shot).

Will the booster recommendation be expanded to more Americans?

These won’t be the last COVID-19 vaccination recommendations from federal health officials.

Throughout Thursday’s meeting, CDC doctors emphasized that the recommendations are on an interim basis, and will be re-evaluated and updated.
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That's it for me this week. Have a wonderful weekend and enjoy the fall colors if they are happening in your area.

Sonya · Sep 27, 2021

Nevada COVID-19 updates for 9/27:

Test positivity (note, w/ 7-day lag) is down: 10.61% (-0.34%)
Hospitalizations are down: 899 (-23)
Cases are down: 880 (-33)

Clark County cases are down: 442 (-21)
Washoe County cases are down: 216 (-20)
(+XX) reflects change since Friday

https://thenevadaindependent.com/coronavirus-data-nevada

These numbers are continuing in the right direction. I am looking forward to seeing the CDC County numbers tomorrow to see how they are doing against the mask mandate criteria.

COVID Booster Shot Campaign Launches in Nevada:
https://www.reviewjournal.com/news/politics-and-government/clark-county/covid-19-booster-shot-campaign-launches-2446894/

The rollout of COVID-19 booster shots began Friday in Southern Nevada, with some pharmacies offering an extra dose of the Pfizer-BioNTech vaccine even as questions remained about who exactly can or should get one.

CVS pharmacies began to give the boosters of the Pfizer vaccine on Friday at locations across the country, including 79 in Nevada, representative Steph Berhane said in an email. Walgreens said in a statement it would begin to schedule booster shots on Saturday.

Meanwhile, the Southern Nevada Health District said it was ramping up to offer boosters at its dozen COVID-19 vaccination clinics in Clark County, likely starting late next week.

Federal regulators this week authorized the booster shots only for some of those who received the the Pfizer vaccine, and indicated they should be administered at least six months after the second shot. They are expected to soon take up the question of booster shots for recipients of either the Moderna or the Johnson & Johnson vaccine.

District officials could not provide an immediate estimate of how many people in Clark County might be eligible for a booster, but said they did not expect supply to be an issue. The district’s vaccination clinics, for example, have been operating at 20 percent capacity.

“We have room for more people to come for this additional dose,” Sarah Lugo, community health nurse supervisor, said during a news briefing on Friday. “In addition, we also have the ability … to be able to scale up quickly, if it’s needed.”

The Centers for Disease Control and Prevention’s advisory panel on Thursday recommended a booster shot of the Pfizer vaccine for those 65 and older and those 50 to 64 with underlying health issues that put them at higher risk. The panel stopped short of recommending a shot for those 18 to 49 with underlying health conditions but said they should have the option of getting a booster shot if they wish.

The CDC’s list of risky underlying health conditions is long and includes cancer, chronic lung or kidney disease, diabetes, obesity and pregnancy.

Boosters for young, healthy

Boosters also are available to young and healthy people in certain living and occupational settings.

In an unusual move, CDC Director Rochelle Walensky on Thursday night rejected the guidance of the agency’s advisory panel by also offering the shots to workers in health care or other occupations that put them at higher risk for exposure, as well as to people who live in institutional settings, such as prisons or homeless shelters.

It has been highly controversial whether young, healthy people need a booster at this point, with much of the data suggesting that this population remains protected from serious illness by the two doses they’ve already received.

However, Walensky said that extending eligibility to those in certain occupations aligns with the Food and Drug Administration’s booster authorization. Earlier this week, acting FDA Commissioner Janet Woodcock said that boosters could be given to those in occupations such as health care workers, teachers, day care staff and grocery workers.

District officials said they were awaiting more specifics from the state on which occupations are considered eligible. It remains unclear, for example, whether young, healthy casino workers, many of whom have high exposure to members of the public, are eligible for a booster.

When asked about eligibility, Shannon Litz, a representative of the Nevada Department of Health and Human Services, said the state was finalizing a technical bulletin with guidance for medical providers.

District officials also said it also remains unclear whether individuals will need to document their eligibility to receive a booster, beyond that their second shot was at least six months ago. This seems unlikely, however. The practice since COVID-19 vaccination began in the state has been that people “self-attest” that they are eligible for a shot.

Honor system expected

JoAnn Rupiper, chief administrative nurse for the district, noted that people already have been able to get a third dose of vaccine by simply self-attesting to a severely or moderately weakened immune system.

Earlier this year, people were required only to self-attest to an underlying medical condition to be prioritized for vaccine.

Berhane with CVS said that its clinics would require customers to self-attest to their eligibility for a booster, which she described as in line with CDC guidance. Walgreens said in a news release it would ask customers to verify their eligibility.

District officials said that individuals should talk to their doctor if they have questions about whether they ought to receive a booster shot.

In other developments, the Western States Scientific Safety Review Workgroup, of which Nevada is a member, endorsed the recommendations of federal regulators for booster shots.

“Every vaccination moves us one step closer to recovery and our state team and vaccinating providers stand ready to implement the latest guidance,” Gov. Steve Sisolak said in a statement.
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On Friday, Southern Nevada Health District issued this statement:

Today, they released this one, as they are starting to offer boosters tomorrow in Clark County:

This doesn't answer the question of Should I Get a Booster Shot? Ultimately what will get us out of this pandemic is everyone getting the first round of vaccines. Please do your part. However, there are certain segments of the population at higher risk of the Delta and other variants.

If you look at that CDC verbiage in the bullet list in the statement above, you'll see that the second two groups "MAY" get the vacccine, but whether or not it's medically necessary is undecided.

James Hamblin has a good post about this.

Should You Boost?
https://body.bulletin.com/392587805573682

A hypothetical debate is suddenly concrete. Pharmacies across the U.S. are now offering booster shots of the Pfizer-BioNTech vaccine. You could go get one right now.

And on the more important question of should you, the long-awaited official guidelines are ... not really guidelines at all. They amount to, "you may." Messages to the public about exactly who should get a booster have been contradictory and confounding. It's clear that certain high-risk groups benefit from a third shot, but experts at CDC and FDA also agreed nearly unanimously that not everyone should get one. And so, for most Americans the official guidance effectively amounts to: It's up to you.

For the majority of people who find themselves in a vast gray area between high risk and low—somewhere on the health spectrum between a centenarian with a lung transplant and an Olympic decathlete who eats only fiber and protein—the vagueness of recommendations means it will fall to individuals to decide.

So ... I’ll try to help add some context here as you do.

Ideally this decision would be made in collaboration with a thoughtful physician who’s readily accessible and knows your medical history, social circumstances, health priorities, et cetera. But since most of us don’t have one of those and are instead just wondering if it’s worth popping into a CVS or a van or tent and asking for a shot based on what we read online, I’m not going to leave it at: “talk to your doctor.” (As always, if possible, definitely do that.) (Also, make sure that any van you get into is indeed giving out vaccines prior to entry.)

Also, for purposes of this letter I’ll only be addressing Pfizer boosts for Pfizer-vaccinated people. (Next week I’ll get into Moderna, J&J, and mixing. Though similar challenges will apply; questions raised by Pfizer boosters aren’t unique.)

Finally, any discussion of boosters should start with two flashing neon caveats:

1. There’s really no way to justify countries giving third doses widely while many people have yet to get their first. It's almost like debating the usefulness of a second life jacket while people are drowning without one.

2. Boosters wouldn’t even be under consideration for widespread use if more people had gotten vaccinated. But because they didn't, and the virus continues to spread widely, that alters everyone's risk-benefit calculus.

Okay, having acknowledged the limitations of reason and morality, on to reality.

If you're grappling with this decision, or even just beginning to consider it, understanding how the booster authorization and guidelines came to be is essential. I’ll recap and keep it as brief as possible since I realize 98 percent of human eyes have a “glaze” reflex that kicks in upon mention of CDC or FDA committee meetings ...

Just nine short days ago, an FDA expert committee roundly rejected an application by Pfizer-BioNTech for emergency authorization of booster shots for all adults. The data simply weren't there to prove that boosters were safe and effective enough to roll out widely.

But the group did agree to authorize boosters for certain high-risk cases. On Wednesday, the FDA officially gave emergency-use authorization for booster shots to help specific high-risk populations remain protected against COVID-19. That effectively made the boosters legal to prescribe, very broadly.

The more relevant, more practical guidelines on who should get boosted are up to CDC. Those came in the middle of the night on Friday morning, in a statement from director Rochelle Walensky.

This was much anticipated, because doctors and scientists have been heatedly disagreeing for weeks about just who needs boosters. The uncertainty was on public display last Friday as the FDA debated (and ultimately granted) the authorization, and continued Thursday as CDC's panel of experts decided to recommend boosters only for people over 65, and younger people with certain medical conditions that put them at high risk for severe cases of COVID-19.

But as CDC director, Walensky has the final call and ultimately she "overruled" her agency's expert panel and opened boosters up to a much broader group. Some doctors applauded. Others were respectfully aghast. I'll get into why, but, first, here are the recommendations.

They boil down to four groups. The first two “should” receive a booster shot “at least 6 months after” initial vaccination:

People 65 and older, and residents in long-term care settings

50–64 with underlying medical conditions

The advice to the 65-and-older group is widely agreed upon, as are boosters for people with significantly compromised immune systems.

Where things start to get murky—at a practical level—is in defining “underlying medical conditions.” CDC’s list is expansive. It includes things like being overweight, having high blood pressure, being a current or former smoker, alcohol overuse, any type of cancer, asthma … basically, if you’re over 50 and have none of those, you’re in a small minority of people. (Or you actually do have one of those things and don't know it yet.)

The spirit of the recommendation seems more clearly directed at people with late-stage emphysema than at 52-year-old marathoners with slightly high blood pressure. But without more data, it's impossible to know precisely where to draw boundaries. So ultimately the reality of the recommendations is: almost anyone qualifies.

But that's not all. The still more vexing recommendations were for those of us under 50:

18–49 with underlying medical conditions (same expansive list) may receive a booster shot

18-64 who are at increased risk for COVID-19 exposure and transmission because of occupational or institutional setting may receive a booster

Like so many people, I fixated on that “may.” CDC guidelines typically offer direction and advice, not permission. FDA is in charge of authorizing what medicines may be prescribed; CDC guides us in deciding what should. As Walensky herself said in an accompanying statement on Friday: “At CDC, we are tasked with analyzing complex, often imperfect data to make concrete recommendations that optimize health.”

That task is daunting. Everyone wants to stay ahead of another wave. Everyone also wants to make sure that medications are safe and effective before recommending them. And striking the balance between these priorities is the real, fundamental divide.

If a bad new variant emerges this fall—or even if it doesn’t, and immunity just wanes precipitously—and it turns out that boosted people are faring far better than un-boosted people, then it will seem like a serious failure not to recommend boosters urgently to more people. On the other hand, if protection remains strong based on initial vaccination, and if cases decline, and a some people who got boosters experience unforeseen untoward side effects, the recommendation will seem premature and ill-advised.

Accordingly, these guidelines are not “concrete recommendations.” They’re essentially an admission that we don’t know enough yet to make concrete recommendations. We don't have enough evidence. We get more every day, but, for now, for most vaccinated people, it wouldn't clearly help or hurt to get a booster. If and when clear signs of benefit or harm arise, the guidelines should become more concrete and meaningful.

For now, we are left to inhabit the ambiguity. If it’s tough to define “underlying medical conditions,” it’s even tougher to define “increased risk because of occupational or institutional setting.” Almost anyone could reasonably qualify.

And if a person seeks out a booster because they perceive their risk to be high, it’s tough to imagine a doctor quibbling that their job isn’t that risky. The volunteer in the vaccine van is even less likely to.

I don’t mean any of this as criticism; only to help show the actual sources of uncertainty and disagreement, which should inform your decision. Because the conflict is basically this: None of the convened experts suggested that everyone categorically needs a booster after 6 months. In fact the FDA committee voted almost unanimously against authorizing boosters for all adults. And yet, at the end of the process, the boosters are authorized for pretty much everyone, and the advice to us is that we “may” qualify to be boosted.

So, what does that mean, and why can't we just have a yes or no.

Frustrating as all this uncertainty may be, I take heart in seeing all of this debated publicly, and hope the process instills some trust among people who believe that the medical establishment is a monolithic entity trying to push an agenda or put shots in arms at any cost. Now more than ever, it's so clearly not.

Instead what we're witnessing is an ongoing attempt to be extremely careful about precisely how and when to recommend vaccine boosters. So careful, in fact, that no one wants to make a definitive call, and so most of us don’t even really have clear guidance yet.

Which is appropriate. And that also means that those of us who “may” get a booster are unlikely to go wrong in deciding. For now, we’re likely still very well protected, but also very likely to tolerate a booster shot without issue. The argument among experts isn’t over whether we definitely should or definitely should not; it’s over what to do in the absence of adequate data. And this isn’t a new dilemma, but one we confront often and have precedent in thinking through.

The default posture in medicine is usually to avoid doing something until you feel confident that it’s safe and effective (i.e. “first do no harm”). But sometimes people argue the inverse: in the face of a known risk, we should go ahead and take plausible measures in hopes that they’ll help until they prove not to be safe and effective.

This was the fringe argument for taking hydroxychloroquine, you may recall. Though the argument that it was plausible as a treatment for COVID-19 was razor thin, and the world subsequently ended up wasting tons of time and money researching the drug, which indeed was not helpful. But the “why not?” line of thinking does have merit in certain instances where risk is extremely high or even imminent, such as trying experimental chemotherapies in the terminal stages of metastatic cancer.

I'm not equating vaccines and horse paste. But some of the decision-making process is analogous. For most vaccinated people, as of now, going without a third dose does not constitute imminent risk. Post-vaccination infection “breakthrough” can occur, but illness tends to be shorter and milder than in unvaccinated people. And, for most people, we don’t know yet whether boosters would change that. But, unlike taking hydroxychloroquine or ivermectin, we have plausible reason to expect these boosters will help some people.

Ultimately, if you’re in the “may” category, the best advice I can give is not to stress over this decision. And as a community, our focus still belongs on helping unvaccinated people get their first doses.

Murky as the booster discussion may be, the risk-benefit calculus of getting vaccinated against COVID-19—while thousands of people die every day—is about as clear as anything medical science has ever had to offer. It’s like a version of the famous “trolley dilemma” (“Would you kill a person if it saved the lives of five others?”) designed for a preschool philosophy curricula: If you’re standing on the tracks and a trolley is coming, should you move off the tracks?

(Yes.)

The decision over whether to get a booster may one day come with similar moral clarity. For now, for most of us, there's just not enough evidence to clearly frame the pros and cons. And there are social and political dynamics at play in this recommendation, which I won’t get into further for now. Instead I’ll close by continuing to torture this trolly dilemma metaphor to incorporate them.

A trolley is coming, and vaccinated people are no longer standing on the tracks, only nearby. But there has been a spate of trolly de-railings, and the conductor sometimes spits out the window. Also, it’s very foggy. And it’s possible for trolleys to mutate into variants that are wider than the trolleys we’re used to. Advising everyone to take a few steps back from the tracks might seem like the safe route. But if someone takes the advice and falls into a pot hole, new issues arise, in terms of distrust and “do no harm.” Some people will take offense at being “told” what to do and call it “tyranny,” and make a spectacle of actually going closer to the tracks to prove that they are high-testosterone patriots. There will be a “take back the tracks” rally where … anyway you get it.

Point being: it’s not hard to see why CDC might say something like “people standing close to the tracks may take a few steps backward.”
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TL;DR - The short story is that there are 4 categories of people here:

People 65 and older, and residents in long-term care settings

50–64 with underlying medical conditions

This group "should" get the Pfizer vaccine booster. They are the groups that data shows are at higher risk than others and could use the extra antibodies. It is widely agreed upon that these groups should be getting a booster.

18–49 with underlying medical conditions (same expansive list) may receive a booster shot

18-64 who are at increased risk for COVID-19 exposure and transmission because of occupational or institutional setting may receive a booster

This group "may" get the Pfizer vaccine booster. There is some evidence that they may benefit from a booster, but there is not enough data to say it's necessary.

James Hamblin says:

Ultimately, if you’re in the “may” category, the best advice I can give is not to stress over this decision. And as a community, our focus still belongs on helping unvaccinated people get their first doses.

If you feel like you are in that second set of groups and you would feel better getting a booster, go ahead. But if you're on the fence or not inclined to do it, it's totally fine to wait a while or see what the next set of recommendations are that come out when we have more data.

In today's No Duh news...

Schools With Mask Mandates See Fewer Outbreaks:
https://www.nytimes.com/2021/09/24/health/schools-mask-mandate-outbreaks-cdc.html

School mask mandates have generated controversy in many parts of the country. Now, two studies, published on Friday by the Centers for Disease Control and Prevention, provide additional evidence that masks protect children from the coronavirus, even when community rates are high and the contagious Delta variant is circulating.

One study, conducted in Arizona, where children returned to school in July, found that schools that did not require staff and students to wear masks were 3.5 times as likely to have a virus outbreak as schools that required universal masking.

A second study looked at infections among all children in 520 different counties across the United States, and found that once the public school year started, pediatric cases increased at a far higher rate in counties where schools did not require masks.

The first study analyzed data on about 1,000 public schools in Maricopa and Pima counties, which include the metropolitan areas of Phoenix and Tucson, and account for most of the state’s population.

Only 21 percent of the schools implemented a universal mask mandate upon opening, and nearly half had no mask requirement at all. Another roughly 30 percent enacted a mask requirement about 15 days after school started.

Between July 15 and Aug. 31, there were 191 school-associated virus outbreaks that occurred about a week after school started. The majority of them — 113 outbreaks, or nearly 60 percent of the total — occurred in schools with no mask requirement.

Only 16 outbreaks, or 8 percent of the total, took place in schools that implemented mask requirements regardless of vaccination status from the start. There were 62 outbreaks, or about one-third of the total amount, in schools that implemented a mask requirement after the school year had already started.

The study defined an outbreak as two or more positive confirmed cases of infection among staff or students within a 14-day period.

“The school year starts very early in Arizona, in mid-July, so we had the advantage of being able to get an early look at data for the new school year a bit sooner than was possible for the rest of the country, which was important, because of the transmission of the Delta variant,” said J. Mac McCullough, associate professor at Arizona State University and a co-author of the study.

The C.D.C. recommends a layered approach to preventing coronavirus outbreaks in schools — masking, distancing, staying home when sick and vaccination for those eligible. “This study really shines a lens on the masking part of that,” Dr. McCullough said.

The second study looked at the association between school mask policies in a given county and communitywide infections among children, finding that counties with no school mask requirement experienced a larger uptick in pediatric case rates after the start of school than counties with school mask requirements.

Between the week before school started and the second week of school, the number of pediatric infections increased by 35 cases per 100,000 in counties without mask requirements, while the number increased by 16 cases per 100,000 population in counties with school mask requirements.
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How America Fell to 36th - We are falling behind on vaccines:
https://www.theatlantic.com/ideas/archive/2021/09/how-america-lost-its-lead-vaccination/620201/

In April, when I received my second Moderna shot, America was on a roll. Adjusted for population, the United States had distributed more COVID-19 vaccines per capita than any country but Israel, Chile, the United Kingdom, and a smattering of small nations and islands. With a surge of doses, we could have been No. 1 in the world.

Five months later, the U.S. is no longer in the top five in national vaccine rates. We’re not in the top 10, or the top 20, or top 30. By one count, we’re 36th—countries as varied as Malta, Canada, Mongolia, and Ecuador have all surpassed us. If the European Union or the G7 were countries, they would be ahead of us too. With about 66 percent of Americans over 18 fully vaccinated, some might be impressed that it's possible to get two-thirds of the country to agree on anything. But America still seems to suffer from an internationally unique reluctance.

How did this happen? The U.S. was arguably more responsible than any other country for the invention, manufacturing, and distribution of the mRNA vaccines. How did the pace-setting effort to vaccinate Americans peter out and leave us behind most of the developed world?

I’ve tried to solve the mystery of the vaccine slowdown before, but I don’t think many of the old popular explanations hold up. This spring, it was briefly fashionable to blame the FDA’s mixed messaging around the side effects of the Johnson & Johnson vaccine. But European countries, including the U.K., dealt with similar vaccine pauses with AstraZeneca, and they’re now miles ahead of us in vaccination rates. So that can’t explain everything.

Some have argued that U.S. public-health officials downplayed the effectiveness of the vaccines, which hurt vaccine uptake. I agree that messaging from the CDC and other institutions has been overly neurotic and often confusing. But many leaders throughout Europe emphasized the vaccines’ side effects on their way to achieving higher total vaccination numbers. So trepidatious sci-comms might not be a major factor either.

Instead, the data point to three key reasons the United States is 36th and falling: It is unusually uninsured, unusually contrarian, and unusually polarized. These are three familiar—even defining—attributes of American life.

A sizable proportion of unvaccinated Americans aren’t unpersuaded and skeptical but rather uninsured and scared. Polling from the Kaiser Family Foundation indicates that no group is more likely to reject the vaccines than young Americans without insurance. Members of this group are disproportionately young and low-income and lack easy access to a doctor if something goes wrong. Many of them don’t know that the vaccine is free. Meanwhile, the fear of side effects is one of the most common reasons people give for avoiding the vaccines. This fear, compounded by a feeling of estrangement from the health system, is clearly keeping many Americans from getting vaccinated

But something else is going on, according to Michael Bang Petersen, a Danish researcher who led the Hope Project, a large international survey of global attitudes about COVID-19. He told me that Americans aren’t radically different from Europeans on how much we trust public authorities or how readily we accept public-health restrictions to fight the pandemic.

What makes the U.S. exceptional, he said, is our unusually low support for vaccines in general. The U.S. had significant levels of vaccine hesitancy before the pandemic, and Petersen’s research found low acceptance of the vaccines in 2020, before their authorization. While support for the vaccines exceeded 70 percent in countries like Denmark and the U.K. last year, only about half of Americans consistently expressed interest in being inoculated.

America’s historical contrarianism about vaccines has many potential sources. Uninsured people who can’t afford to see doctors may be conditioned to trust in their body and hope for the best. A history of medical racism has coincided with lower trust for novel treatments among Black Americans. But not all American vaccine skeptics suffer from discrimination or a lack of resources. Perhaps a country whose laws and culture celebrate independence of thought might naturally yield a bimodal distribution of contrarians: lots of paradigm-breaking entrepreneurs and scientists on one side, and lots of conspiratorial cranks on the other.

That leads to the second part of Petersen’s explanation: America’s vaccine attitudes are unusually politicized. “The level of polarization between Democratic and Republican elites seems unique to me,” Petersen said, “and it’s a leading factor in why American vaccination rates are relatively low.”

The U.S. is distinctly unlucky in having a polarized two-party system, in which one party’s elites take up vaccine resistance as a prominent cause. While GOP governors and even former President Donald Trump have admitted to being vaccinated and occasionally recommended the shots, the party’s most significant media organs, including Fox News, have consistently questioned the benefits of the vaccines, amplified the side effects, celebrated evidence-free skepticism, and blasted attempts to promote vaccinations. Today, Florida Republicans aren’t just claiming that the vaccines are faulty. They’re reportedly looking to rescind measles- and mumps-vaccine requirements. Negative polarization has fully overtaken the right wing of the Republican Party, whose ethos is now something like “Whatever liberals say, I’m against” and whose members stand ready to embrace the most absurd conclusions of that logic.

I asked Petersen how Democratic leaders such as President Joe Biden or public-health officials such as Anthony Fauci could help solve this problem. His answer was not comforting. “Many conservative Americans have simply lost trust in and tuned out public-health communicators, and that’s very hard to solve, because when a population loses trust in the messengers, the content of the message doesn’t matter,” he said.

Petersen’s interpretation has subtle, and potentially depressing, lessons for liberal pandemic commentators, including me. I would love to think that my analysis of the pandemic can convert the unvaccinated, just as many journalists imagine themselves to be frontline soldiers in an information war. For months, journalists and the epidemiologists they follow on Twitter have been energetically discussing the best way to represent the benefits and risks of vaccines. But these debates were held among people who were almost entirely vaccinated and whose friends and families were almost entirely vaccinated. Meanwhile, the truly hesitant were elsewhere—watching Fox News, exchanging side-effect rumors on Facebook, or marinating in conspiracy theories in other pockets of the internet. Mainstream outlets can always improve their coverage, but they cannot change the mind of people who ignore them. If traditional media criticizing public-health messages in other traditional media isn’t quite preaching to the choir, it’s at least screeching among the choir.

“Trust is a resource that you draw upon in a crisis,” Petersen told me. “It’s much harder to build trust as the crisis is ongoing.” The same could be said for institutions, policy, and culture. In a pandemic, you go to war with the country you’ve got, and you learn what kind of country you’ve got only after you go to war. Underinsured, paranoid, and polarized, the U.S. rolled into 2021 with a uniquely impenetrable bedrock of vaccine skepticism.

Americans didn’t fall behind the developed world in vaccines so much as we started with major disadvantages that became more and more apparent as time passed. Today’s vaccination numbers are a lagging indicator of America’s many preexisting conditions.
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Sonya · Sep 28, 2021

Nevada COVID-19 updates for 9/28:

Test positivity (note, w/ 7-day lag) is down: 10.48% (-0.13%)
Hospitalizations are down: 897 (-2)
Cases are down: 833 (-47)

Clark County cases are down: 434 (-8)
Washoe County cases are down: 214 (-2)

https://thenevadaindependent.com/coronavirus-data-nevada

September 28, 2021 CDC Update:
https://covid.cdc.gov/covid-data-tracker/#county-view|Nevada|32003|Risk|community_transmission_level

Clark County Remains at High Risk:

Last Week Clark County was at 161.20 cases per 100k population, this week it is at 142.85, which is down, but not close to being under 50, which is required for the end of mask mandates indoors.

Making progress, but the mask mandate remains in effect.

Side Effects from Third Pfizer Shot, Same to Second Dose:
https://www.statnews.com/2021/09/28/side-effect-rates-from-a-third-covid-19-vaccine-dose-similar-to-those-after-second-shot-early-data-indicate/

People who’ve received a third dose of a Covid-19 vaccine are reporting rates of side effects similar to those after the second dose, according to data released Tuesday by the Centers for Disease Control and Prevention.

The new report, published in the Morbidity and Mortality Weekly Report, relies on submissions from thousands of people who received third shots of the mRNA vaccines from Pfizer-BioNTech and Moderna after such doses were authorized for people with compromised immune systems. People submitted their reactions to v-safe, the CDC’s smartphone-based surveillance network.

Among more than 12,500 people who completed surveys after each shot, 79.4% of people reported local reactions (including itching, pain, or redness at the injection site), while 74.1% reported systemic reactions (mostly fatigue, muscle aches, and headaches), typically the day after the shot. That compared to 77.6% and 76.5% of the people who reported local or systemic reactions, respectively, after their second shot.

Overall, among more than 22,000 v-safe registrants who’ve received third doses, “no unexpected patterns of adverse reactions were observed,” the report says. As of Sept. 19, some 2.2 million people in the United States had received additional doses of the Covid-19 vaccines.

The report focuses on the more common, less worrisome side effects of the mRNA vaccines, and doesn’t mention the very rare, but more serious events like anaphylaxis. Some vaccine side effects occur so infrequently that even studies of thousands of people don’t detect them; it’s only after the shots are administered into millions of arms that a connection becomes clear.

But the new data provide at least an early hint that in terms of immediate reactions, it doesn’t seem as if third shots cause more of a kick than the second shots did. Gathering such data is important as the government authorizes boosters for wider populations. Last week, the CDC recommended boosters for people 65 and older, adults with certain underlying health issues, and those who work places or living sites place them at higher risk of coronavirus exposure. So far, those recommendations only apply for people who received the Pfizer vaccine as their initial series, but boosters for the Moderna and Johnson & Johnson shots are expected to eventually be authorized.

“These initial findings indicate no unexpected patterns of adverse reactions after an additional dose of Covid-19 vaccines; most of these adverse reactions were mild or moderate,” the authors wrote in the new report.

The authors note that enrollment in v-safe is voluntary and is “likely not representative of the vaccinated U.S. population,” with the majority of participants identifying as white.

Overall, the Covid-19 vaccines have proven to be remarkably safe as well as effective, and generally, experts don’t anticipate a significant increase in the likelihood of most side effects with booster shots. But there is some concern in particular with third doses of the mRNA vaccines and myocarditis and pericarditis, two types of heart inflammation that have appeared at the highest rates among boys and young men soon after the second shot. The worry is that a third shot could carry an even higher risk — though for now, that’s just a concern — for that population, which in general remains very well protected by two doses of the vaccine. It’s led to a debate about whether third shots will be justified at some point for young men and boys broadly.
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Early data suggests the 3rd Pfizer dose has similar side effects to the second.

If you're curious about whether or not you are eligible for getting a booster now, my state's Health Department posted this today:

65 years and older?
50-64 and at high risk of severe illness from COVID-19?
Live in a long-term care facility?

If you answered yes to any of the above, AND you got your second dose of the Pfizer vaccine in January, February, or March, you are now eligible for a booster shot.

And to end today, a bit of optimistic news.

Don't Bet Against Vegas:
https://www.bloomberg.com/news/articles/2021-09-28/yes-the-pandemic-was-brutal-but-don-t-bet-against-las-vegas

Taxes on Las Vegas’s 150,000 hotel rooms, which are the economic engine of the city, down 61%. Number of events held at its convention center: down 87%. The amount of revenue spun off by events held at the convention center: down more than 90%.

The endless nature of the pandemic combined with the lag in financial reporting by states and municipalities means that only now are we getting a complete picture of the destruction wrought by Covid-19 on bond issuers, and the results aren’t pretty. That doesn’t mean that Vegas is permanently broken, though.

The Las Vegas Convention and Visitors Authority is selling $23.6 million in revenue bonds this week to refund a deal it sold in 2019, and the preliminary official statement to the issue provides audited data from fiscal 2020, which ended on June 30 of that year, as well as estimated data from fiscal 2021.

July marked the seventh month in a row the nation’s gambling capital gained in visitors. Only after that did the convention business revive, and even then, only fitfully. As it says in the documents, on Sept. 15, the National Association of Broadcasters canceled an event planned for this October.

The pandemic has been brutal for the meetings business. Room taxes dropped from $286.4 million in fiscal 2019 to $111.2 million in 2021. The number of events held at the convention center dropped from 93 in fiscal 2019 to 12 in 2021, and the amount of revenue those events brought in fell to $5.2 million from $54.5 million.

But the pandemic is now entering past tense. Overall visitor volume in Vegas has been rising steeply this year and is nearing 2019 levels. Moody’s Investors Service rated the new bonds Aa3 with a stable outlook, saying the grade “reflects the authority’s entrenched position as the nation’s market leader for large-scale conventions and the area’s substantial tourism amenities throughout the Las Vegas area that will drive a strong return of hotel tax revenue post-pandemic within the next two years.”

Translation: Don’t bet against Las Vegas.
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Sonya · Sep 29, 2021

Nevada COVID-19 updates for 9/29:

Test positivity (note, w/ 7-day lag) is down: 10.37% (-0.1%)
Hospitalizations are down: 889 (-8)
Cases are down: 830 (-3)

Clark County cases are slightly up (amid what appears to be a downward trend): 450 (+16)
Washoe County cases are down: 202 (-12)

https://thenevadaindependent.com/coronavirus-data-nevada

Sonya · Sep 30, 2021

Nevada COVID-19 updates for 9/30:

Test positivity (note, w/ 7-day lag) is down: 10.26% (-0.11%)
Hospitalizations are up amid a downward trend: 922 (+33)
Cases are slightly up amid a downward trend: 830 (+12)

Clark County cases are slightly up again: 468 (+18)
Washoe County cases are down: 188 (-14)

https://thenevadaindependent.com/coronavirus-data-nevada

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