Delta has effectively flipped a switch and flipped the script on pandemic life in America, though we’re not exactly right back where we started from. A year ago at this time, we had millions of willing arms and, alas, no vaccines. Today, eight months into a vaccination campaign, with half the country vaccinated and half not, we have an ample supply of vaccines in search of willing arms.

Any way you look at it, the aggressive spread of the SARS-CoV-2 Delta variant both here and abroad is a game-changer, a tipping point or whatever catchphrase captures a reality we had hoped was long gone. Delta is not the only culprit, however. Its accomplices include suboptimal vaccination coverage and summertime loosening of social restrictions coast to coast and across the pond.

The moment arrived without great fanfare, but we did reach our goal of getting at least one COVID-19 shot into the arms of 70% of adults. It didn’t happen on the original “due date” of July 4, but a month later. Despite that collective achievement, only 20 of 50 states reached the 70% mark.

Delta, now accounting for more than 80% of new infections, has taken advantage of opportunities to surge over the past few months. The seven-day moving average of new COVID-19 cases was 72,790 last Friday, higher than the average of 68,700 last summer when no vaccine was available. For perspective, the low was 11,000 in June of this year and the high more than 250,000 in January.

Florida recently logged its highest one-day total of the entire pandemic period, with more than 21,000 cases. The sunshine state is also dealing with the shade cast by a new variant first detected in Colombia that doesn’t even have a Greek letter yet.

The demographics of disease are changing in a scenario some have described as “younger, sicker, quicker.” The typical patient hospitalized with COVID-19 in Massachusetts, the Boston Globe reports, is no longer a 70-year-old with multiple health conditions but someone in their 40s or 50s, previously healthy, often a person of color—and unvaccinated.

Emergency rooms in Alaska are seeing and admitting more COVID-19 patients in their 30s, 40s and 50s, notes the Anchorage Daily News. In Montana, the Billings Clinic is caring for 18 COVID-19 patients, with four patients on ventilators, two of them in their 30s, the Billings Gazette reports. The vast majority of hospitalized COVID-19 patients across the country are unvaccinated.

Post-July 4 fireworks

We are now witnessing the ripple effect of several Delta-driven announcements within the past week. One came from the Centers for Disease Control and Prevention, advising that all persons, regardless of vaccination status, wear masks indoors in public places in areas with substantial or high transmission of disease. That description now applies to 80% of counties in the U.S. The policy reverses the “no masks for the vaccinated” pronouncement delivered in mid-May, when Delta represented just 1% of new infections.

CDC Director Dr. Rochelle Walensky said, “I have no interest in continuing mask guidance, and the best way to stop a new variant from spreading is to have less virus out there and the best way to do that is to get people vaccinated and to mask up until they are.”

Influential in the CDC decision was an outbreak on Cape Cod, following “multiple summer events and large public gatherings” from July 3 to 17 where future COVID-19 patients attended “densely packed indoor and outdoor events at venues that included bars, restaurants, guest houses and rental homes.” The “tourism-focused community” was not mentioned in the CDC report, but was identified in other reports as Provincetown. Of 469 COVID-19 cases among Massachusetts residents, 74% were fully vaccinated people. Of those, 87% were male with a median age of 42.

Most of the breakthrough infections in Provincetown (79%) were symptomatic (cough, headache, sore throat, fever, muscle pain). Four patients needed hospital care. Genomic sequencing of specimens from 133 of the 469 cases turned up Delta in 89%. Infection produced similar viral loads in the vaccinated and unvaccinated.

“This finding is concerning and was a pivotal discovery leading to CDC’s updated mask recommendation,” Walensky said. The purpose of the update on masking, she added, is “to ensure the vaccinated public would not unknowingly transmit virus to others, including their unvaccinated or immunocompromised loved ones.” The revised guidelines advise wearing masks not just in public indoor places in COVID hot spots but also in households with people who are vulnerable to the disease because they are older, have underlying medical conditions or a weakened immune system. Or are unvaccinated.

In response to CDC’s latest pronouncements, mandates or “strong recommendations” for indoor masking are back in place in many areas across the country, from Disneyland to the San Francisco Bay Area and from the campus of Ohio State University to the museums of the Smithsonian Institution.

Louisiana Governor John Bel Edwards has temporarily reinstated a mask mandate for everyone age 5 and older, noting that the state has the nation’s highest rate of new cases per capita and is experiencing “the worst surge of the COVID-19 pandemic so far in terms of case growth rate, percent positivity and hospitalizations,” Edwards said. “I am pleading with unvaccinated Louisianans to get their shot as soon as they can to protect themselves. We can end this nightmare, but it is going to take all of us working together to do it.”

The CDC, while emphasizing that COVID-19 mitigation policies are developed locally, offers guidance to decision makers that takes into account community transmission rates, vaccination coverage, health system capacity and populations at risk.

Source: Getty Images.

On the road to Mandate Land

·  Another influential recommendation came from a group of more than 55 national organizations of healthcare professionals, supporting mandatory vaccination policies for healthcare workers. Support for organizations that choose to mandate is now coming from the American Healthcare Association/National Center for Assisted Living, representing more than 14,000 nursing homes and other senior care facilities. Danielle Brown and Kimberly Marselas have details in McKnight’s Long-Term Care News.

·  The senior care industry had set a national goal of vaccinating 75% of staff by July 1, but by July 11 the number stood at 58.4%, Marselas notes. A closer look by the CDC reveals a yawning gap between the vaccination rates of physicians and advanced-care providers in long-term care (75%) and the vaccination rates of nurses (57%) and aides (46%). Alicia Lasek has more on this in McKnight’s. Reality check: As of March of this year, long-term care residents and staff represented one third of all COVID-19 deaths in the US.

·  A growing number of healthcare organizations are making the leap from vaccine recommendation to requirement, including St. Louis-based Ascension Health, which employs more than 160,000 people at hospitals and senior care facilities in 19 states and the District of Columbia, Kimberly Bonvissuto reports in McKnight’s Senior Living. Three health systems in Idaho—including St. Luke’s Health, the state’s largest private employer—are implementing vaccination mandates for their employees. Taking the same step, Bonvissuto adds, are LCS, a senior living provider based in Des Moines, and Episcopal Retirement Services, based in Cincinnati.

·  The list will keep growing. Add the California-based Kaiser Permanente system with 216,000 employees and 23,000 physicians; Memorial Hermann Hospital and Baylor College of Medicine, both in Houston; and Norton Healthcare and Baptist Health in Louisville. The “biggest shoe to drop” in the long-term care industry is Genesis HealthCare, largest nursing home chain in the country with 357 facilities, according to McKnight’s James M. Berklan. Genesis employees have until August 23 to get their first dose.

·  Joining the healthcare sector in mandate land are a number of major employers, including Disney and Walmart, along with Google, Facebook, Microsoft, Uber, Lyft, Tyson Foods and the Washington Post, along with Wall Street heavyweights Morgan Stanley and Goldman Sachs. Disney’s mandate applies to salaried and non-union hourly employees in the US as well as all new hires. Walmart’s requirement is for corporate employees but not store workers, though the latter now qualify for a $150 bonus (up from $75) if they roll up their sleeves.

·  New York City will require proof of at least one dose of vaccination for patrons of restaurants, gyms, and indoor entertainment venues. Before that announcement, most Broadway theaters had agreed to require audiences to be fully vaccinated for performances through October. Cast and crew must be vaccinated too, but there will be no meet and greet autograph sessions or backstage tours.

·  Some bars, restaurants and nightclubs in Chicago and Seattle are choosing to serve vaccinated patrons only.

·  Mandate momentum is growing among government workers. First, we had a vaccination mandate from the VA system for its 115,000 healthcare workers, then a policy declaration by President Biden that all federal civilian workers who are not vaccinated must submit to weekly testing and other mitigation measures. Similar actions are taking place at the city, county and state levels. In Denver, a vaccination mandate issued Monday by Mayor Michael B. Hancock applies not only to 10,000 municipal workers but also to people working in congregate settings, including nursing homes, homeless shelters, corrections facilities, hospitals, schools and colleges.

·  Healthcare workers in public and private facilities in New Jersey will have a choice between COVID-19 vaccination (by September 7) and once or twice a week testing, per an order by Governor Phil Murphy.

·  A US Court of Appeals has upheld Indiana University’s vaccination mandate. “People who do not want to be vaccinated may go elsewhere,” wrote Judge Frank Easterbrook. For the students challenging the requirement, “elsewhere” will now be the U.S. Supreme Court. Six hundred other colleges that have announced mandates will be watching closely.

Managing the messaging

·  The Cape Cod study and other investigations demonstrate that the vaccinated, while well protected against severe COVID-19 outcomes, can still get infected and transmit the virus to others. Processing this news requires keeping in mind the bigger picture: As the overall level of vaccination coverage increases, “Vaccinated persons are likely to represent a larger proportion of COVID-19 cases,” the CDC noted. Also a key part of the bigger picture: 99.99% of vaccinated individuals in the U.S. have not had a breakthrough case resulting in hospitalization or death.

·  At the same time, Delta is now known to be highly transmissible and virulent, thus warranting an extra measure of caution, especially for people at highest risk for severe disease. In Axios, Caitlin Owen describes the balancing act that communicators must pull off: “Reassuring the majority of vaccinated Americans they don’t need to freak out could backfire if it causes those who are at risk to let down their guard.”

·  To lend a helping hand, the Public Health Communications Collaborative has updated its messaging guidance in response to the CDC’s latest mask recommendations. Among the points to emphasize: While fully vaccinated people can experience breakthrough infection and transmit the virus to others, “These cases represent a very small amount of transmission occurring around the country.” Vaccination remains the best way to prevent illness, curb transmission and end the pandemic.

·  Someone out there is listening. Vaccination rates are up in nearly all states, notably Southern states that had lagged, including Louisiana, Mississippi, Alabama and Arkansas. The Axios-Ipsos Coronavirus Index reports that hard opposition to vaccination is down to its lowest level, at 15%, and that firm parental opposition to children’s vaccination is 25%, down from 29% in mid-July.

Source: Getty Images.

The communications effort

·  In MM+M, Larry Dobrow connects with Drs. Italo Brown and Jamie Rutland, young Black physicians who host YouTube’s “Barbershop Medicine.” With recent guest Dr. Anthony Fauci, they explored vaccine hesitancy in Black and Brown communities. The hosts hope their show generates increased interest in medicine for young African Americans, stimulates health-and-wellness conversations at the dinner table and increases health-literacy levels throughout the community.

·  To boost vaccinations among young people, the White House has enlisted an “eclectic army” of more than 50 influencers with huge followings on Twitch, YouTube and TikTok, The New York Times reports. In addition, state and local governments are turning to local influencers and paying them up to $1,000 a month to promote COVID-19 vaccines.

·  In the U.K., Grey London has developed a campaign that sends a message to pub goers on their beer mats (a.k.a. coasters): “Get the vaccine when you can. Keep the fun flowing.” Campaign reports that the beer mats are designed to help independent pubs “that have lacked financial support during the pandemic and see the vaccination program as their key to their business survival.”

·  Researchers in the U.K., writing in the journal Virulence, warn that easing pandemic restrictions, as the country did two weeks ago, can open the door to new and dangerous variants, Nick Bostock reports in GP. “The laissez-faire approach that many governments are now taking towards COVID-19 management risks substantially increasing mortality and morbidity in the wider population,” the researchers wrote.

·  A bill sponsored by Senator Amy Klobuchar of Minnesota would remove liability protection for social media channels that spread health-related misinformation. Lecia Bushak offers background and details in MM+M. The legislation calls on the Department of Health and Human Services to set guidelines on what constitutes misinformation.

·  In southwest Michigan, two local health departments are teaming up with the United Way to train vaccine champions to educate the community on the importance of COVID-19 vaccination. Their efforts will include door-to-door outreach, conversations on social media, driving people to vaccination appointments and hosting vaccination clinics.

·  Not everything clicks. A traveling van offered COVID-19 vaccinations for two days from 4 to 7 p.m. at the St. Charles County Fair in Wentzville, outside of St. Louis. No one showed up.

Back to work?

For many employers, Delta is delaying the return to work.

·  United Minds and its parent company, Weber Shandwick, are collaborating on a playbook for return-to-the-office communications strategies. PRWeek’s Betsy Kim, in a conversation with United Minds CEO Kate Bullinger, covers vaccination mandates, employee burnout and the importance of preserving flexibility and autonomy in a hybrid culture that is equitable for all.

·  The U.K. is dealing with a “pingdemic” of folks receiving notices from a National Health Service app that they must isolate at home after coming in contact with a person who tested positive for coronavirus. In People Management, Caitlin Powell writes that businesses are worried the test-and-trace program will leave them short-staffed. In the first week of July, the app sent more than 500,000 “stay at home” alerts in England and Wales.

·  The pingdemic has hit the ad industry, Maisie McCabe reports in Campaign, turning photo shoots into an often-frantic search for available talent. “Whereas once you only had to make one phone call to find a replacement, now it takes 30,” said Steve Davies, chief executive of the Advertising Producers Association.

Source: Getty Images.

The vaccine dashboard

·  COVID-19 deaths in Africa have increased 80% over the past four weeks. The World Health Organization describes the disparate impact of the pandemic in poorer countries with lower vaccination rates (and limited access to vaccines) as a “global failure.”

·  The Biovac Institute of South Africa has struck a deal with Pfizer/BioNTech to produce and distribute COVID-19 vaccine at a rate of 100 million doses a year.

·  The FDA is stepping up the pace in reviewing Pfizer/BioNTech’s application for full licensure of its COVID-19 vaccine, STAT reports. The process could be completed by Labor Day, the New York Times says.

·  West Virginia will measure antibody levels in nursing home residents to assess whether immunity levels are waning and booster shots are needed, Caroline Szachnowski reports in McKnight’s Long-Term Care News.

·  Booster COVID-19 shots are already in the works for older and more vulnerable segments of the population in Israel and Germany. Some in the U.S. are chasing boosters prematurely. The WHO wants boosters to be put on hold at least through September, as millions are still waiting for their first shot.

Parting shot

As of early this week, 294 people associated with the Olympics had tested positive for SARS-CoV-2. Officials regard that as a success, considering that 42,000 people from outside Japan converged on Tokyo for the Games. At least six Team USA athletes could not compete because of COVID protocols.

The resurgence of disease reminds us that there is no easy end to a pandemic. Appropriately, the Olympic Games end with a marathon and not a sprint.

…and some Olympic songs

Rise, Katy Perry (Rio De Janeiro, 2016)

Survival, Muse (London, 2012)

You and Me, Liu Huan and Sara Brightman (Beijing, 2008)

Oceania, Bjork (Athens, 2004)

The Power of the Dream, Celine Dion (Atlanta, 1996)

Barcelona, Freddie Mercury and Montserrat Caballe (Barcelona, 1992)

One Moment in Time, Whitney Houston (Seoul, 1988)

Bugler’s Dream and Olympic Theme, John Williams

There’s lots going on, folks, so many thanks for listening. Stay tuned and we’ll be back next Wednesday with more for you in the Vaccine Project Newsletter. Be well, stay safe. Tame those twisties.