A year ago this week, a new administration unveiled a “National Strategy for the COVID-19 Response and Pandemic Preparedness.” The strategy had seven goals:

1. Restore trust with the American people.

2. Mount a safe, effective, comprehensive vaccination campaign.

3. Mitigate spread through expanding masking, testing, treatment, data, workforce and clear public health standards.

4. Immediately expand emergency relief and exercise the Defense Production Act.

5. Safely reopen schools, businesses and travel, while protecting workers.

6. Protect those most at risk and advance equity, including across racial, ethnic and rural/urban lines.

7. Restore leadership globally and build better preparedness for future threats.

A year later, if we were to conduct a performance review (remotely, of course), we might check two boxes for each of the above: “Progress made” and “Improvement needed.”

In some ways the results are heartening, in other ways deeply disappointing. We have fully vaccinated more than 200 million Americans, yet the pandemic keeps reinventing itself and causing human wreckage. Communications are well-intentioned but, to put it charitably, inconsistent.

The seven goals are five fewer than the 12 Labors of Hercules, but no less daunting. Fighting the coronavirus is most like Hercules’ labor number two, slaying the nine-headed Hydra, a poisonous serpent lurking in dark swamp waters. Every time Hercules cut off one head, the monster grew two more. You might consider them variants.

Spoiler alert: Hercules, with the help of his nephew Iolaus (who doesn’t get nearly enough ink), ultimately vanquished the beast by severing the one head that was immortal. Would that it were so with the spike-headed Sars-CoV-2.

Focusing for a moment on goal number two—this is, after all, the Vaccine Project Newsletter—let’s take a quick look at how we’re doing a year later and where we’re headed.

First, the numbers:

• 249 million people—80% of the vaccine-eligible population 5 and older—have had at least one COVID-19 shot, including 87% of adults and 95% of seniors.

• 209 million are fully vaccinated (not including boosters). That’s 67% of everyone 5 and older, 74% of adults and 88% of seniors.

• 81 million have had a booster or additional dose, including 42% of fully vaccinated adults. Another 87 million are booster-eligible.

Vaccination rates are notably lower in kids. As of January 12, 27% of children ages 5 to 11 had received one shot, with state rates bouncing from 10% to 59%. Adolescents are faring better, with 64% receiving one shot and 53% fully vaccinated.

The Kaiser Health Network has done a thoughtful piece on why the effort to vaccinate youngsters is stalling. Reasons include parental perceptions that COVID is not a threatening disease for children, worries about possible long-term side effects and difficulty securing vaccination appointments.

Amid all the noise surrounding the latest wave of the pandemic, not the least of which is a heavy sigh of COVID fatigue, it’s easy to lose track of the core message that it’s better to be vaccinated (and boosted) than not. In that context, here’s our Top 10 countdown:

10. Hospitals in Code Blue

• The White House is sending medical military teams to relieve short-staffed hospitals in Michigan, New Jersey, New Mexico, New York, Ohio and Rhode Island as inpatient beds and ICUs fill up. Governors in 49 states have activated more than 14,000 members of the National Guard to assist with COVID response.

• We have passed this way before: A headline in the New York Times Magazine said, “I’m an ER doctor in New York. None of us will ever be the same.” The date: April 14, 2020.

• The difference between then and now: vaccines. While both vaccinated and unvaccinated are occupying hospital beds, ICUs are predominantly the province of the vaxless, the Houston Chronicle reports.

Source: Getty Images.

9. Omicron peaking? Wishful thinking?  

Some headlines claim that the Omicron wave is cresting and will have spent itself within another month. Surgeon General Vivek Murthy and other health officials are urging us to hold that thought and say it’s too soon to let down our defenses.

• Acting Food and Drug Administration Commissioner Dr. Janet Woodcock raised some eyebrows, and blood pressures, when she told a Senate committee, “It’s hard to process what’s actually happening, which is most people are going to get COVID.” She quickly added that the main challenge is to “make sure that hospitals can still function” and that transportation and other essential services continue without disruption.

• Epidemiologist Ali Mokdad estimates that about half of the U.S. population will be infected with Omicron in the next three months, but that most cases will be asymptomatic.

• No speculation here: Cases and deaths are rising again in nursing homes. Facilities are pushing boosters; 63% of residents have received one, but just 29% of staff.

• Deaths nationwide are increasing as well—to the tune of a seven-day moving average of 1,746 deaths per day as of Monday, more than twice the level seen just after Thanksgiving.

8. Thumbs up, thumbs down on mandates

• The Supreme Court has delivered a split decision, upholding the mandate for healthcare workers while shooting down the vaccinate-or-test requirements for private businesses with 100 or more employees. President Biden is urging employers to implement mandates of their own, which have generally withstood court challenges.

• As James M. Berklan and Kimberly Marselas report in McKnight’s Long-Term Care News, patient-facing employees of Medicare- and Medicaid-funded health facilities will have to be fully vaccinated by February 28 or March 15, depending on the state in which they work. That’s the result of a strange mixed brew of lower and upper court rulings. Berklan cautions that the court skirmishes are not over and a return visit to SCOTUS is entirely possible.

• The assisted living industry comes away from the rulings without facing federal vaccination mandates. However, leaders say they will push for better immunization rates in their facilities, with or without individual company mandates. And the Labor Department says it plans to “vigorously enforce” existing COVID safety standards. Kimberly Bonvissuto and Lois A. Bowers provide details in McKnight’s Senior Living.

• Elsewhere in the world, Italy began the year with a requirement that everyone older than 50 receive the vaccine. A new law in France requires proof of vaccination at restaurants, sports arenas and other public venues for everyone 16 and older. 

Quebec plans to institute a health tax for the unvaccinated and to require proof of vaccination to patronize government-run cannabis and liquor stores. Greece is imposing fines on unvaxxed folks over 60.

7. Still high on the to-do list: Persuade the unvaccinated

• One key group at risk: pregnant women, with vaccination rates in the mid-30s. A population-based study of pregnant women in Scotland, published in Nature Medicine, reports that 77% of SARS-CoV-2 infections, 91% of COVID-19 related hospital admissions and 98% of critical care admissions—not to mention all infant deaths—occurred among the unvaccinated. The takeaway: “Addressing low vaccine uptake rates in pregnant women is imperative to protect the health of women and babies in the ongoing pandemic.”

• Messaging also must not lose focus on the multiple adverse effects of COVID-19 itself. People with diabetes, for example, are at higher risk for severe COVID-19—and getting sick with COVID makes diabetes worse. Now comes a CDC study finding that COVID-19 increases the risk of newly diagnosed diabetes in youngsters under 18.

Low education levels are a major contributor to vaccine hesitancy and low vaccination rates, researchers report in the American Journal of Infection Control. Five of the top 10 reasons for not receiving the COVID-19 vaccine involved a lack of knowledge—about side effects, vaccine benefits, vaccine effectiveness and the risks of remaining unvaccinated. Feeding the knowledge gaps: an Augean stable filled with misinformation (cleaning the stables was Hercules’ Labor number five).

Source: Getty Images.

6. Tools for schools

• Schools, struggling with staffing shortages and Omicron outbreaks, are turning to principals, superintendents and counselors as substitute teachers. Students in several cities are protesting in-person classes and calling for stepped-up protective measures.

• The Biden administration is making 5 million rapid tests and 5 million PCR tests available to schools each month. Federal aid may also include setting up testing units on or close to school grounds in the hardest-hit and highest-risk communities.

5. A return to normal… but what is normal?

Pfizer CEO Albert Bourla predicts that life will start returning to normal as soon as this spring.

• In Campaign US, Mariah Cooper assesses the impact of the pandemic on the events industry. The CES trade show in Las Vegas, Cooper notes, “was supposed to be the industry’s big return to live events.” Alas, the in-person element crumbled in the path of Omicron “with exhibitors, large sponsors and attendees pulling out.”

• Businesses are now viewing virtual events as a permanent strategy, Cooper adds.  A survey of event professionals by marketing technology company Splash notes that 79% expect to host hybrid events this year, with 46% hosting more such events than in 2021.

• The cruise industry is aggressively pushing back against CDC restrictions and “hoping to kill the Petri dish metaphor once and for all,” Chris Daniels writes in PRWeek. The CDC recently recommended that people avoid cruises, including river cruises, regardless of vaccination status. The industry says its protocols make sailing on the seas safer than, say, cruising the aisles of your local supermarket.

4. We need a bigger boat and a better mask

• According to polling firm Civic Science, 16% of adults have been wearing N95, KN95 or other respirator masks in January 2022, up from 6% in March 2021. However, those who report wearing a mask “rarely” or “never” has doubled, from 8% in 2021 to 17% in 2022.

• The Public Health Communications Collaborative has put together a “shareable graphic” on “What Mask Should I Wear?

• The CDC updated its mask guidance last week. It suggested that individuals who can’t get their hands on a high-quality mask might try a disposable mask underneath a cloth mask.

• Coming soon to community health centers and pharmacies: 400 million free N95 masks.

Source: Getty Images.

3. Two types of COVID fatigue

The people who say they are done with COVID are not the same people who are exhausted from dealing with it every day on the frontlines. Nor are they the individuals at greatest risk.

• A valuable perspective comes from Jon Gluck, diagnosed with multiple myeloma 20 years ago at age 37. In an opinion piece in the Washington Post, he cautions that “COVID fatigue is setting in and established safety protocols are going by the wayside” even as Omicron surges. “As more and more people decide to just live with the virus, or even try to deliberately contract it to ‘get it over with,’ the immunocompromised and other vulnerable populations are being forgotten.”

OzSAGE, a group of Australian experts in health, science and public policy, warns that “the ‘let it rip’ strategy and defeatist narrative that ‘we are all going to get it’ ignores the stark lived reality of the vulnerable of our society,” not just the immunocompromised but the 50% of the population with underlying health conditions.

2. Vaccines are the sharpest tool in the shed, but not the only one

Gaining control over the pandemic—what some imaginatively refer to as “defanging” the virus—will take a village. Vaccines, yes, but also effective treatments along with comprehensive testing, masking and spacing. That’s why they call it a strategy.

• In MPR, Diana Ernst offers a helpful side-by-side comparison of the two pills recently authorized for treating COVID-19, Merck’s molnupiravir and Pfizer’s Paxlovid.

• Free rapid test kits (four per household) are now available at two government-connected websites.

• Cenzino, an Italian restaurant in Oakland, NJ, offered a cocktail called The Vaccinator, a Manhattan-like drink with oak-barrel-soaked bourbon, vermouth and a cherry. It comes with a box of two rapid COVID-19 test kits. The cocktail is $20 and the test kit is free. Restaurant owners ordered test kits for employees and ended up with more than they needed.

1. One is the loneliest number.

When it comes to achieving national strategy goal number one—restore trust with the American people— it’s not a stretch to say that the nation has not come together. We’ve gone from the days of I Like Ike (or, for the truly politically nerdy, I’m Madly for Adlai) to Let’s Go Brandon.

In the study of vaccine hesitancy cited above, the three most common reasons among the “highly” hesitant were lack of trust in COVID-19 vaccines (55%), concern about side effects (48%) and lack of trust in government (46%). Build Back Better is not just for bridges and highways.

As for the top-ranked tennis player in the world, it was game, set and match against Novak Djokovic. Unvaccinated and ultimately denied an exemption, the Serbian superstar came back up from down under without defending his title in the Australian Open, a tournament he has won nine times.

Parting shot

 “We must accept finite disappointment, but never lose infinite hope” -Martin Luther King, Jr.

…and some songs

One, Three Dog Night

New Rules, Dua Lipa

Abraham, Martin and John, Dion

Why (The King of Love is Dead), Nina Simone

One Vision, Queen

It’s been another busy if not frantic week – but we’ll be back next week for more. Thank you for reading and please stay well.