An unvaccinated elementary school teacher in California shed the mask just long enough to read stories to the children. The teacher, who had attributed nasal congestion and fatigue to allergies, later developed a cough and headache and tested positive for COVID-19. So did 12 of the 24 students in the classroom, all of whom were too young to be vaccinated. The attack rate was 80% in the two rows closest to the teacher and 28% in the three back rows in a classroom with desks spaced six feet apart.

School policy required masks for students and teachers. The teacher was one of two unvaccinated members of a staff of 24. All classrooms had high-efficiency particulate air filters and kept doors and windows open.

Investigation of the outbreak turned up another 14 cases among other students at the school (including three who shared a sleepover) as well as parents and siblings of infected students. Of the 27 total cases, 22 had symptoms, including three fully vaccinated adults. No one required hospital care. Genomic sequencing of 18 available specimens (which did not include the teacher) revealed all had the Delta variant of SARS-CoV-2.

This particular outbreak happened in May, but in publishing the report at the end of August the Centers for Disease Control and Prevention said it “highlights the importance of vaccinating school staff members who are in close indoor contact with children ineligible for vaccination as schools reopen.”

CDC Director Rochelle Walensky said that schools experiencing outbreaks are generally not following guidelines to mask up indoors and to get vaccinated when eligible. She called on educators to take a multifaceted approach that includes testing, social distancing, improving ventilation and advising people to stay home when they are sick.

Similar scenarios are likely to play out as long as children younger than 12 remain ineligible for vaccination and 50% of eligible children and adolescents ages 12-17 remain unvaccinated … as long as conflicts continue to erupt over masks in school … and as long as school staff is less than fully vaccinated and masked.

The Children’s Hospital Association describes the current situation as a “perfect storm” of pediatric health challenges. Over the weekend the presidents, CEOs and executive directors of 68 children’s hospitals issued a joint statement, saying their institutions are pushed to capacity and “the pediatric safety net for all children is being threatened in unprecedented ways.” In full-page ads in the Los Angeles Times and New York Times, they urged all eligible populations to be vaccinated against COVID-19 and said that “everyone should mask responsibly, particularly during school and while attending large gatherings.”

The US Department of Education is launching civil rights investigations in five states that have imposed bans on local mask mandates—Iowa, Oklahoma, South Carolina, Tennessee, and Utah. The investigation “will focus on whether … students with disabilities who are at heightened risk for severe illness from COVID-19 are prevented from safely returning to in-person education, in violation of federal law.”

The American Academy of Pediatrics has asked the Food and Drug Administration to speed the authorization of vaccines now in clinical trials for children under 12.  At the same time, it cautions against off-label use of the Pfizer/BioNTech vaccine in those children; it is licensed for ages 16 and older. Vaccines could be available for the youngest among us by early winter.

White House chief medical adviser Dr. Anthony Fauci says that mandating COVID-19 vaccination for in-person attendance at school is a “good idea,” and it’s one that the Culver City Unified school district in Los Angeles County has already adopted for vaccine-eligible students as well as staff.

The task of vaccinating those currently eligible remains a formidable one. In the last week of August, just 35% of 12- to 15-year-olds were fully vaccinated, the AAP reports, as were 45% of 16- and 17-year-olds. The US has fully vaccinated 63.5% of adults and the 27-country European Union has reached its end-of-summer goal of 70%. 

The challenges

•  John Dick, founder and CEO of the survey firm CivicScience, says that when it comes to COVID-19, people are “locked into their tribes,” displaying a “deep calcification” of beliefs for and against vaccination. Despite the FDA’s approval of the Pfizer/BioNTech vaccine, CivicScience reports that 60% of the unvaccinated intend to remain that way; 10% say they will definitely get the shot, 11% say maybe and 19% are not sure. That’s actually a glimmer of light.

•  Jay Baruch, professor of emergency medicine at Brown University’s Alpert Medical School, believes that reasonable dialogue with the unvaccinated is still possible—in conversations that avoid ideological extremes and the harsh, often accusatory tones of social media messages. Writing in STAT, Baruch suggests that we seek common ground in a “messy middle … where people listen for understanding and not rebuttal,” a place that “honors respectful disagreement and … invites a range of ideas, opinions and experiences.”

•  A survey of 2,100 long-term care workers by Cleveland-based Onshift highlights the challenges posed by the federal government’s plan to withhold funds from facilities that don’t fully vaccinate their staff. Of the employees surveyed, 38% had not been vaccinated against COVID-19, Danielle Brown reports in McKnight’s Long-Term Care News. Among the unvaccinated, only 8% said they planned to get the shot; more than half (53%) said they will seek job opportunities where vaccination is not mandated and 39% were not sure about their future employment status.

•  MM+M’s Lecia Bushak speaks to LTC industry experts about their options. Richard Mollot, executive director of the Long-Term Care Community Coalition, believes that as more employers adopt vaccination mandates, “It’ll be harder for someone to say, ‘I’m going to work at Walmart or Target’ if Walmart and Target are also going to have these requirements.” (Note: Walmart has mandated vaccines for office-based employees and Target has offered workers cash incentives for vaccination but neither has adopted a company-wide mandate.)

•  Genesis, the nation’s largest nursing home operator (200 facilities, 40,000 employees) reached 100% compliance with the first milestone in its staff vaccination mandate—getting the first shot by August 23, Brown reports. The company granted a “small number” of medical and religious exemptions but did not say how many noncompliant employees were terminated.

•  Bonaventure Senior Living, based in Oregon, has disavowed a video posted on TikTok by one of its recruiters, inviting unvaccinated individuals who were “unjustly fired” from their previous jobs to apply for open positions as nurses, med techs and caregivers. Bonaventure operates 26 communities in Oregon, Washington and Colorado. In McKnight’s Senior Living, Kimberly Bonvissuto describes the company’s efforts at damage control.

•  Down the road at Gateway Living, an assisted living facility in Springfield, Oregon, Bonvissuto reports, an unvaccinated worker triggered a COVID-19 outbreak that has infected at least 64 people and led to the deaths of five residents.

•  In ads recruiting RNs and LPNs for jobs at four veterans’ homes and other state-run health facilities, Nebraska officials offered “many great benefits,” including “no mandated COVID-19 vaccination” along with hiring bonuses of up to $5,000. The Nebraska Nurses Association is among those voicing strong objections to this tactic, saying it “demeans the dedication and diligence of the nursing workforce.”

•  Meanwhile, eight health systems in the Omaha and Lincoln areas issued a joint statement announcing they will mandate COVID-19 vaccination for all employees.

•  A national religious organization is suing the state of Maine and several senior living organizations over a vaccination mandate for healthcare workers that allows medical but not religious exemptions, Bonvissuto reports. McKnight’s Kathleen Steele Galvin notes that five health advocacy organizations are asking for an extension of the October 1 vaccination deadline, saying that providers have lost 20% to 30% of their workforce during the pandemic and are “running on empty.”

•  Experts disagree on the need for vaccine mandates among healthcare workers, Jonathan Goodman notes in Cancer Therapy Advisor. Some acknowledge that HCPs have a “duty of care” to be vaccinated but say that the emphasis should be on educating the vaccine-hesitant, with mandates available as a last resort.

Source: Getty Images.

Getting the word out

•  Delta Airlines CEO Ed Bastian, in a memo to employees, announced that as of November 1 unvaccinated workers enrolled in the company’s healthcare plan will be subject to a $200 monthly surcharge. Bastian noted that each COVID-19 hospitalization costs the company $50,000 and that in recent weeks “since the rise of the B.1.617.2 variant, all Delta employees who have been hospitalized with COVID were not fully vaccinated.”

•  Mobile health provider VIP StarNetwork hosted a six-hour block party at Bethany Baptist Church in Brooklyn to promote COVID-19 vaccination among communities of color and to reach people without ready access to the Internet and social media. As Sabrina Sanchez reports in PRWeek, the event featured a combination of good food and helpful information on vaccines, featuring Q&A sessions with medical professionals. Neighborhood vaccination vans were on hand to give shots. Partners in the effort included NYPD Community Affairs and the National Action Network.

•  Pfizer/BioNTech may throw away the traditional marketing playbook for Comirnaty, its newly licensed COVID-19 vaccine, Marc Iskowitz reports in MM+M. One industry leader who thinks that’s a good idea is PJ Pereira, creative chairman of Pereira O’Dell, which has spearheaded the Ad Council’s “It’s Up to You” vaccination campaign. Pereira says, “I don’t believe they [Pfizer] are going to go with a ‘Take mine, it’s been approved,’ approach. It’s still a humanitarian play.” Pereira emphasizes that the tone toward the unvaccinated must be respectful. “There’s no way out of this through judgment.”

•  Pfizer is working with Ogilvy Health on a global ad campaign, Iskowitz notes, and has not tipped its hand other than to say it will be taking a “thoughtful approach” to marketing with the goal of “increasing confidence in vaccination.”

•  Healthcare has fueled PR’s recovery over the past 12 months, Steve Barrett observes in PRWeek. “Pretty much every story or narrative these days is communicated through a public health lens in some form or fashion,” he says, as the pandemic has had wide-ranging effects on travel, employment and leisure activities as well as healthcare itself and health equity. PR Week will be ramping up its coverage after Labor Day, launching Healthcare Focus and a Healthcare Daily email newsletter, with a Health Influencer 30 list to follow in November.

•  The CDC is reminding the public—not for the first time—that the antiparasitic drug ivermectin is not approved for treatment or prevention of COVID-19. Retail pharmacy prescriptions for ivermectin have soared from a prepandemic baseline of 3,600 per week to more than 88,000 in mid-August. Meanwhile, calls to poison control centers related to ivermectin—including the use of veterinary formulations for horses, sheep and cattle—are up fivefold from the pre-pandemic baseline.

•  The FDA took a folksy approach to public education on ivermectin in a tweet: “You are not a horse. You are not a cow. Seriously, y’all. Stop it.” Even so, some doctors continue to prescribe ivermectin (human formulation) for COVID-19, Becker’s Hospital Review reports.

•  The Oregon chapter of the American College of Emergency Physicians, noting that ERs are “overflowing with patients whose suffering could have been avoided,” issued an urgent plea to residents to get vaccinated, wear masks and practice social distancing.

The vaccine dashboard

•  Moderna has completed the application for formal approval of its COVID-19 vaccine in people 18 and older, Brian Park reports in MPR. It is the first Biologics License Application for Moderna in its 10-year history.

•  Meanwhile, Pfizer/BioNTech has filed a supplemental BLA for a booster (third) dose of Comirnaty in individuals 16 and older.

•  J&J has shared data supporting a booster dose of its single-shot COVID-19 vaccine, saying it “generated a rapid and robust increase in spike-binding antibodies nine-fold higher than 28 days after the primary single-dose vaccination.”

•  At its Monday meeting, the CDC’s Advisory Committee on Immunization Practices reviewed a framework for COVID-19 boosters, focusing on high-risk groups and the time interval since primary immunization. No recommendations are likely until the FDA authorizes a booster for the general population. The ACIP work group emphasized that the “top priority” should remain vaccinating the unvaccinated.

Source: Getty Images.

The rest

•  The pandemic could claim another 100,000 lives in the US by December 1, predicts an economic model at the University of Washington’s Institute for Health Metrics and Evaluation. That toll could be cut in half if everyone wore a mask in public.

•  The US Open tennis championships, which began last week in New York City, require proof of at least one COVID-19 vaccination for all attendees 12 and older. Organizers are asking fans to “refrain from approaching players or gathering in groups, courtside or elsewhere, for autographs.”

•  An ER physician in Tallahassee lost his job when the hospital found out that he offered to write letters exempting schoolchildren from mask mandates for a $50 fee.

•  As if the news out of Afghanistan weren’t sobering enough, it is one of just two countries in the world (the other is Pakistan) that have continued to report cases of wild poliovirus since 2016.

Parting shot

You don’t hear the word “post-pandemic” as much as you did at the beginning of this summer. Hawaii Governor David Ige is asking tourists to stay away as the pandemic surges again on island shores. A new public service campaign is reaching out to Native Hawaiians, the AP reports, “many of whom harbor a deep distrust of the government dating back to the US-supported overthrow of the monarchy in 1893.”

… and some songs

Summer’s Almost Gone, The Doors

Summer’s End, John Prine

Cruel Summer, Bananarama

Summer Madness, Kool and the Gang

See You in September, The Happenings

Super. Human. Tokyo 2020 Paralympic Games Trailer

Many thanks for being here with us. A happy and peaceful Labor Day to all. Stay safe, stay well and we’ll see you back here next week.