Covid-19 News: Vaccines, Mandates and situations

Daily Covid Briefing

Oct. 9, 2021, 7:13 p.m. ET

Oct. 9, 2021, 7:13 p.m. ET

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Credit…James Estrin/The New York Times

at the minimum 34,000 home health workers in New York appear to have missed a deadline to get vaccinated under a new state mandate, according to preliminary state data, rendering them unable to work and deepening a shortage of home health aides.

At the same time, the vaccination rate among home health workers as the deadline arrived on Thursday — 86 percent — surpassed the expectations of some union and industry leaders, and suggested that thousands of workers decided to get their first shot at the last minute to stay employed. Some industry leaders had expected that as few as 70 percent of workers were likely to meet the deadline.

Faced with a similar cutoff the past week, hospital and nursing home staff in New York accepted the shot in greater numbers than home health aides, who typically make just above minimum wage. About 92 percent of hospital and nursing home workers had received at the minimum one shot when their deadline arrived on Sept. 27.

Though home health workers have largely been out of the spotlight during the pandemic, New York State has at the minimum 250,000 of them, with some estimates rising to over 500,000. The deadline applied to employees of the state’s 1,500 licensed home health agencies. Another 30 percent of home health aides statewide were hired directly by patients by a Medicaid program and were not unprotected to the mandate.

New York had never before released data on what percentage of home health aides have been vaccinated, making it impossible to draw comparisons with the new numbers, which were released Friday.

The numbers came from a Department of Health survey of all licensed home care agencies, which asked them to report their vaccination levels on Thursday. Agencies representing some 245,000 workers responded. They reported that on average, 86 percent of their employees had been slightly vaccinated and that 71 percent had been fully vaccinated.

The home health care work force in New York has suffered from sharp shortages that have only been intensified by the pandemic, as has been the case in other states. At the same time, need for home care has risen as people have tried to keep their loved ones out of nursing homes, in part because of the poor conditions in homes that the pandemic exposed.

Though the loss of workers was not as steep as feared, some industry leaders warned that losing already 5 percent or 10 percent of aides in a field already experiencing from a labor shortage could rule to the curtailment or elimination of care for thousands of patients. The losses might also create backlogs of patients at hospitals that typically release patients to home care, the leaders said.

Al Cardillo, president of the Home Care Association of New York State, said the percentages alone did not tell the whole story. already some agencies with high vaccination rates were losing large numbers of employees that would be hard to replace, he said.

“I just received information from a New York City-area agency that today, to comply, had to remove 175 home health aides from service,” Mr. Cardillo wrote in an email. “And this is from an agency with a 94 percent vaccination rate among aides. One hundred seventy-five aides in one agency, on top of the emergency shortage that already exists, is just huge.”

Credit…Guy Faulconbridge/Reuters

Over the summer, many countries across the world opened to international visitors following the successful rollout of vaccination programs. But fragmented rules about which vaccines will be accepted and what documentation is required, in addition as a without of compatibility between vaccine apps, have left many travelers confused and frustrated over where they can visit without extraordinary headaches and restrictions.

More than 2.7 billion people around the world have been fully vaccinated with a range of vaccines that vary in degrees of efficacy, according to Our World in Data, an Oxford University Covid-19 database. Across Asia, the United Arab Emirates and South America, millions have received Sinopharm, Sinovac and other vaccines manufactured in China, but concern over their efficacy has resulted in many countries not recognizing them for the purpose of travel. Millions more who received domestic vaccines like the Sputnik V in Russia and Covaxin in India, which have not received approval from the World Health Organization, are also limited in where they can go.

Britain eased its travel rules this week, expanding the list of vaccination certificates it recognizes from other countries and territories, including Turkey and India, but certificates from many nations in Africa and South America were excluded. In terms of vaccines, the United Kingdom, the 27-member European Union and the 26-country Schengen Area accept the four vaccines approved by the European Medicines Agency — AstraZeneca, Pfizer-BioNTech, Moderna and Johnson & Johnson — but Britain and many E.U. states do not recognize the Sinopharm and Sinovac vaccines, despite their approval by the World Health Organization.

The United States is nevertheless in a “regulatory course of action” to determine which vaccines it will accept when the country opens to fully vaccinated travelers in November, the Centers for Disease Control and Prevention said in a statement. But vaccines listed for emergency use by the W.H.O. will be recognized, the agency said. Besides the three empowered for use in the United States — those made by Moderna, Pfizer-BioNTech and Johnson & Johnson — they are AstraZeneca, the version of AstraZeneca made in India, and two Chinese vaccines: Sinopharm and Sinovac.

The Sputnik V vaccine, which has been approved in more than 70 countries but not however by the W.H.O., is doubtful to be accepted by the United States as it initially reopens for international travel.

These confusing rules over approved vaccines are not limited to Britain and the United States. Experts warn that the haphazard and preferential approach to travel regulations is creating a two-tier system where people vaccinated with the most effective vaccines — mainly in the west — are able to cross borders freely, while those in developing countries, who have received vaccines with a lower efficacy, are not.

Credit…Bruna Prado/Associated Press

RIO DE JANEIRO — Brazil surpassed the grim landmark of more than 600,000 Covid-19 deaths this week, making its death toll second only to the United States.

The country’s official tally of fatalities reached 600,493 late on Friday, more than a year and a half after the beginning of the pandemic in Brazil, according to a consortium of major media companies that have been collecting data from local governments. The United States has recorded 712,822 deaths, according to a New York Times database.

Brazil’s vaccination campaign appears to have slowed the progress of the coronavirus, experts said. It took only 36 days for the country to go from 300,000 to 400,000 deaths, and 51 days for the disease to claim the next 100,000 victims, a point passed on June 19. The most recent 100,000 Covid-19 victims died over 111 days.

Natália Pasternak, a microbiologist who is the president of the Instituto Questão de Ciência, a Brazilian nongovernmental organization, said the country was on track to control the pandemic if it continued to vaccinate people at the same rate.

“We have to have a responsible optimism in the country with the improvement of vaccination,” Ms. Pasternak said in Portuguese. “This is thanks to a very good national immunization program, built up decades ago, and a population extremely popular to the vaccine.”

Brazil’s president, Jair Bolsonaro, a conservative populist, has drawn heavy criticism for his handling of the pandemic. He repeatedly played down the threat of the virus, railed against quarantine measures, declined to be vaccinated himself and defended the use of ineffective treatments. His government was also slow to obtain access to coronavirus vaccines already as Covid overwhelmed hospitals across the country.

Most Brazilians are willing to get immunized against the virus, surveys show. already though the initial campaign to vaccinate the population was hampered earlier in the year by a shortage of doses, health workers had managed to fully immunize 46 percent of Brazilians by Friday, the data from the media consortium shows.

The United States surpassed 700,000 deaths from Covid-19 earlier this month. Its death toll rose over the summer as the highly contagious Delta variant spread, despite an abundant supply of vaccines. Brazil, India, and Mexico follow in the ranking of total deaths, according to The New York Times database.

Questions have been raised about the quality of the data released by the Brazilian government, because of delays and omissions. But the group of major media companies, the Consórcio de Veículos de Imprensa, has been collecting information from regional governments and releasing it daily since April 2020.

With vaccination gaining ground in Brazil, local governments have loosened restrictions aimed at curbing the virus, and social distancing rules are often overlooked in many places. The pandemic appears to be over in some neighborhoods, like the Saúde area in Rio Janeiro, where there are frequent outdoor concerts.

Some public health experts, however, have said it is too early to relax measures intended to stop the virus from spreading. “Brazil shouldn’t start releasing now, removing the restriction on the use of masks, giving people a false sense of security, because it’s not over,” Ms. Pasternak said.

Credit…Patrick Meinhardt / AFP via Getty Images

The Massachusetts-based company Moderna has been supplying its shots almost exclusively to wealthy nations, keeping poorer countries waiting and earning billions in profit.

According to Airfinity, a data firm that tracks vaccine shipments, Moderna has shipped a greater proportion of its doses to wealthy countries than any other vaccine manufacturer. About one million Moderna doses have gone to countries the World Bank classifies as low income, as compared to 8.4 million doses of the Pfizer shots set aside for those nations.

In addition, middle income countries have had difficulty getting a keep up of the Moderna vaccine, with most of those that have reached deals to receive it reporting they have not obtained any doses, and at the minimum three countries reporting they are paying more for the doses than the United States and the European Union.

Moderna executives have said that they are doing all they can to make as many doses as possible as quickly as possible but that their production capacity remains limited.

Moderna developed its breakthrough vaccine — its only commercial product — with the financial and scientific sustain of the U.S. government. The company’s market value has nearly tripled this year to more than $120 billion. Two of its founders, in addition as an early investor, this month made Forbes magazine’s list of the 400 richest people in the United States.

The disparity in the dispensing of its doses has earned the company some criticism. “They are behaving as if they have absolutely no responsibility beyond maximizing the return on investment,” said Dr. Tom Frieden, a former head of the Centers for Disease Control and Prevention.

Credit…Thalia Juarez for The New York Times

Dozens of people gathered at the information of Life International Church in the South Bronx in New York City on a recent Saturday for its weekly food bank, but the pastor was also interested in discussing a different subject.

He said he wanted everyone there — mostly Black residents, including seniors and mothers with small children — to know that Covid vaccines were easy to find. More important, the pastor, the Rev. John S. Udo-Okon, wanted them to know that the vaccines would not harm them.

More than 80 percent of adults in New York City have received at the minimum one measure of a Covid vaccine, but there are meaningful racial disparities in the vaccination rate.

Only 55 percent of Black adults have received at the minimum one vaccine measure, compared with 92 percent of Asian Americans, 75 percent of Hispanic adults and 62 percent of white residents, according to data published by the city government. Community leaders attribute that low vaccination rate among Black New Yorkers to a combination of factors, chiefly a history of racism in the medical system and a later distrust of authorities.

To address the gap, health officials and some Black churches have sought to use the strength of the pulpit to vouch for the safety of vaccines and to push back against misinformation. They have also hosted vaccination events in church halls or from mobile vans parked outside of churches after Sunday sets.

“These cultural institutions are a safe space to have discussions — you go to your faith leader and they’ll answer questions,” said Dr. Torian Easterling, the first deputy commissioner and chief equity officer at the New York City Department of Health and Mental Hygiene.

Credit…Jae C. Hong/Associated Press

Vaccine hesitancy among police officers in the United States has been one of the themes of pandemic news this year, but in some places, firefighters are joining the resistance.

This week, hundreds of firefighters in Los Angeles filed a notice of intent to sue the city over its vaccine mandate, saying an Oct. 20 deadline to get vaccinated is “extreme and outrageous.”

The notice, filed on Thursday, said each of the 871 firefighters would seek $2.5 million each if the lawsuit is filed — for a projected total of over $2.1 billion. A lawyer representing the group said that the city would have 45 days to estimate the notice and that he expected to file the suit closest after that period.

Firefighters in Spokane, Wash., joined state workers in a lawsuit over statewide vaccine mandates, according to KXLY-TV. In Orange County, Fla., a group of firefighters upset by a vaccine mandate sued the county, WFTV reported.

The International Association of Fire Fighters’ statement on vaccines offers no sustain for rejecting vaccine mandates. Instead, it notes the extreme importance of vaccination for “fire fighters and medical emergency personnel who work in confined and uncontrolled environments while treating or transporting patients or interacting with the public.” The statement lists the few options obtainable for exemptions, and lists some of the financial penalties and job losses that resisting mandates could incur.

Kevin McBride, the lawyer representing the Los Angeles firefighters, said in an interview that his clients did not trust the obtainable vaccines and could be fired for resisting the city’s vaccine mandate.

All three vaccines used in the United States are highly effective at preventing serious illness, hospitalization and death from Covid-19, and serious side effects, like a strong allergic reaction, are extremely scarce.

Mr. McBride said the Los Angeles authorities had rejected his offer of a “middle ground” in which weekly testing would replace getting the shot. The mandate passed by the Los Angeles City Council in August did not include an option for regular testing.

As of Thursday, about 64 percent of members of the Los Angeles Fire Department were fully vaccinated, according to a spokeswoman, Cheryl Getuiza, and about 1,200 members had not had a single shot. Since the pandemic began, two members have died, and 1,070 have been infected, she said.

Los Angeles is also experiencing vaccine hesitancy among its law-enforcement agents. The firefighters’ notice of intent to sue was filed on the same day that the Los Angeles County sheriff, Alex Villanueva, said he would not enforce the vaccine mandate at his department, which employs some 18,000 people.

Credit…Taylor Glascock for The New York Times

While not as virulent as the coronavirus, the flu has a staggering global impact: three million to five million situations of harsh illness every year, and up to 650,000 deaths. Every few decades, a new flu strain spills over from animals and leads to a pandemic.

Flu vaccines have been around for eight decades, but they keep average. A flu shot is good for only one flu season, and its effectiveness typically reaches somewhere between 40 and 60 percent. In some years it’s as low as 10 percent.

But a new generation of highly effective flu vaccines may appear in the next few years, based on the same mRNA technology that has protected hundreds of millions of people against Covid-19.

While traditional influenza vaccines are grown for months in chicken eggs, mRNA vaccines are manufactured comparatively quickly from scratch. In theory, their faster production may make them better equaled to each season’s flu strains. And when they’re injected into people, they may provoke a stronger immune response than traditional flu vaccines do.

Two companies — Moderna, the Massachusetts biotech company that produced one of the empowered mRNA vaccines for Covid-19, and Sanofi, a French vaccine maker — began trials for mRNA flu vaccines this summer. Pfizer and BioNTech, the companies that produced the other mRNA Covid-19 vaccine, started their own flu trial last month. And Seqirus, a vaccine producer based in England, is planning to test another mRNA vaccine for the flu early next year.

No one can say for sure how well any of these four seasonal flu vaccines will turn out, but many experts are optimistic. And further down the line, mRNA technology may be tailored to make vaccines that work for years against a wide range of influenza strains.

“I am beyond excited for the future of flu vaccination,” said Jenna Bartley, an immunologist at the University of Connecticut.

Credit…Mike McCleary/The Bismarck Tribune, via Associated Press

While the Delta variant-pushed surge is receding in much of the United States, it rages on in less-vaccinated states like North Dakota, to the point where the state’s governor and health professionals have asked people to avoid risky activities that could add to the burden on hospitals.

The plea to maximize capacity for the grind of Covid patient came last week from Gov. Doug Burgum and doctors and administrators from some of North Dakota’s largest hospitals. They asked the public to excursion defensively, skip dangerous activities that could rule to injuries, regularly visit dominant care physicians and make sure all their vaccinations were up to date.

About this data

Source: U.S. Department of Health and Human sets. The seven-day average is the average of a day and the past six days of data. Currently hospitalized is the most recent number of patients with Covid-19 reported by hospitals in the state for the four days prior. Dips and spikes could be due to inconsistent reporting by hospitals. Hospitalization numbers early in the pandemic are undercounts due to incomplete reporting by hospitals to the federal government.

“The pressure on hospitals and clinics in both our urban and rural areas is reaching basic levels, and we all need to do our part to avoid hospitalization and prevent further strain on these facilities and their staff as we work by this incredibly challenging time,” said Mr. Burgum, a Republican.

The problem has been compounded by health care worker shortages and a wave of patients who can no longer delay care for other conditions, said Dr. Joshua C. Ranum, the vice president of the North Dakota Medical Association.

North Dakota’s caseload — 81 situations per 100,000 residents — trails only those of Alaska and Montana, according to a New York Times database, a 25 percent increase over the past two weeks. And Covid-related hospitalizations are up more than a fifth in the past two weeks.

Nationally, the United States is averaging below 100,000 new daily situations for the first time since Aug. 4. The average of 97,933 situations is down 20 percent from two weeks ago. New daily deaths are down 14 percent, to an average of 1,770.

Covid caseloads keep high in North Dakota and Western states like Wyoming, Montana and Idaho, where vaccination rates are comparatively low. Some areas have had to ration care and send patients to distant hospitals for treatment.

Just 45 percent of North Dakota’s population is fully inoculated, according to federal data, compared with 56 percent nationally.

Mr. Burgum has asked North Dakotans to get vaccinated, but he has resisted mandating vaccines and threatened legal action after President Biden announced vaccination requirements last month that Mr. Biden said would affect 100 million workers.

About this data

Source: State and local health agencies. Daily situations are the number of new situations reported each day. The seven-day average is the average of a day and the past six days of data.

In North Dakota, Dr. Ranum said most hospitals were being forced to get by with the staff members they had, sometimes training them to work in different parts of the hospital to fill gaps. Reinforcements from in other places are scarce because need for traveling nurses and other health workers is so high, he said.

Dr. Michael LeBeau, president of Sanford Health Bismarck, North Dakota’s second-largest hospital, said the facility’s staff was depleted and depleted as it reckoned with overdue care amid the surge.

“We spent the better part of a year where we had a hard time keeping up with standard health maintenance, yearly physicals, the stuff that prevents hospitalization,” Dr. LeBeau said.

In Case You Missed It

Credit…Jae C. Hong/Associated Press

Across the United States, many families with young children have been anxiously awaiting a vaccine for those under 12 years old.

This week, they moved one step closer, as Pfizer and BioNTech asked federal regulators to authorize emergency use of their shot, which has been proven to be safe and highly effective for young children, for those aged 5 to 11.

If approved, the vaccine could help protect some 28 million more people in the United States. Federal regulators received another major request this week from Johnson & Johnson as the company sought authorization for a booster shot for adults. It was the last of the three Covid vaccine manufacturers whose shots are empowered for U.S. use to make such a request.

Pfizer’s announcement came on Thursday, the same day that President Biden made an popularity to private employers to adopt vaccine mandates, underscoring the administration’s efforts to reach the tens of millions of Americans who keep unvaccinated. In his speech, Mr. Biden said that mandates were the only way to defeat the virus.

Here’s what else happened this week:

  • A study published in the journal JAMA Internal Medicine found that a second measure of the Pfizer-BioNTech and Moderna vaccines can nearly triple the chances of a scarce heart condition in young men, though the risk remained extremely low. Experts have consequently far said that the benefits of the vaccines far outweigh the risk of getting the condition, called myocarditis.

  • After months of decline, the number of nursing home deaths rose severely from July to August as the Delta variant spread across the country, a study by the Kaiser Family Foundation found.

  • The Covax vaccine program backed by the United Nations will fail to meet its target for delivering doses to Latin America and the Caribbean this year, in part because wealthy countries that pay more for the shots are buying up most of the supply, according to the World Health Organization.

  • The United States will use $1 billion to quadruple the availability of at-home rapid coronavirus tests by the end of the year, White House officials said. Two hundred million rapid tests are soon expected to be obtainable to Americans each month.

Credit…Shannon Stapleton/Reuters

Just a day after President Biden visited Chicago to plead for vaccine mandates, saying they were the only way to defeat the coronavirus, Mayor Lori Lightfoot on Friday said public workers could opt out of the city’s mandate until the end of the year by getting regularly tested.

The mayor announced the mandate for Chicago workers in August. But the proposal was met with immediate pushback from employees and labor groups, including the Fraternal Order of Police and the Chicago Federation of Labor.

Now, workers who are not fully vaccinated by Oct. 15, including those who have sought medical or religious exemptions, must get tested twice a week, separated by three to four days, at their own time and expense, the mayor’s office said.

Employees who fail to report their vaccination position by the Oct. 15 deadline will be placed on unpaid leave.

The test-out option will keep in place until Dec. 31, after which employees must be fully vaccinated unless they have received a medical or religious exemption. It was unclear what the consequences will be for those who refuse to comply.

Cities and states around the country have introduced vaccine mandates for their workers, and some have been met with legal challenges.

After being delayed by the courts, a vaccine mandate for educators and staff in New York City public schools was cleared to proceed after a ruling by a federal appeals panel last week. Though it faced opposition, the mandate pushed tens of thousands of Department of Education employees to get their shots.

Municipal workers in Seattle and in Los Angeles are required to be fully inoculated against the virus by next week, though unlike Chicago’s policy, there is no test-out option. Both mandates allow for religious or medical accommodations.

Chicago had been negotiating with labor unions since the August announcement.

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