Have you been to an “unmaskeraded” event in the month of June? Have you attended a public gathering where, without the benefit of Zoom technology, you can see the noses and mouths and chins of others?

Chances are pretty good that you have, depending on where you live and whether you’ve been vaccinated against COVID-19 and how comfortable you are about returning to some semblance of daily life as we once knew it. Since the beginning of this year, the Ad Council/COVID Collaborative vaccination campaign and other public education efforts have focused on the appeal of returning to the things we love, the daily joys we have missed.

One example: The creative folks at Klick Health have captured that spirit in a send-up of the Beatles’ “Get Back.” Sample lyric: “Get vaxxed/get vaxxed/Get back to where we once belonged.” Read about it and listen in at MM+M.

Regardless of how the sentiment is expressed, the desire to get back—and, of course, the desire to stay healthy—have helped us fully vaccinate more than 154 million Americans age 12 and older, including 57% of the adult population.

Vaccination works. According to the Associated Press, fewer than 1% of COVID-19 deaths in the U.S. in May occurred among the fully vaccinated, an analysis based on data from 45 states. Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, says that virtually every adult death in this country is “entirely preventable.” She adds, “This new virus forced too many of our families to accept death as an outcome for too many of our loved ones, but now this should not be the case.” Somewhat more pointedly, West Virginia Governor Jim Justice said that people who refuse to be vaccinated are “entering the death drawing.

For the first time in nearly a year, New Jersey last Thursday reported a day with no COVID-19 deaths in the state’s hospitals. The vaccine passport we should be talking about is the passport to protection that the vaccine offers.

Virtually everywhere you look, you can see evidence of the world reopening and regaining a measure of its lost buzz —at restaurants, live concerts, graduations, wedding venues. The New Yorker showcased a new feature called Dept. of Returns. “As vaccination rates climb, and the virus loses its grip on us, we are easing back into something like the world we left behind,” the editors declared.

Radio City Music Hall reopened to a fully vaccinated, full-capacity crowd on June 19 for the final night gala of the Tribeca Festival. Springsteen on Broadway, which reopened Saturday night, is the first full-capacity show to light up Broadway since the early days of the pandemic 15 months ago. The Boss said, “I am here tonight to provide proof of life.”

Also on Saturday, the Celebrity Edge departed Fort Lauderdale, making it the first cruise ship to set sail from a U.S. port (other than on a trial run) since March 2020. Although a Florida law forbids businesses to require proof of vaccination, at least 95% of the ship’s passengers and all crew members were vaccinated. “We’re definitely finding that cruisers prefer to be vaccinated and to share this information with us,” said a Celebrity spokesperson. In PRWeek, Diana Bradley explores how another major cruise line, Royal Caribbean, is luring passengers back to sea with detailed explanations of its health and safety protocols.

President Biden is hosting a July 4 celebration for up to 1,000 healthcare workers and military personnel and families on the South Lawn of the White House. Muriel Bowser, Mayor of Washington, D.C., is inviting tourists to return to the nation’s capital as part of a $5 million “Experience D.C.” campaign. However, there will be no July 4 parade on the National Mall, and the concert usually held on the Capitol grounds will be online only.

The White House theme for the holiday weekend is “America’s Back Together.” The first and second families and numerous cabinet leaders will be venturing out across the country to visit parades, festivals, firehouses, ballgames and cookouts to celebrate our progress against the pandemic.

And yet.

All the good news about vaccination must be coadministered with a dose of caution. The Boston Globe, in telling the stories of families that lost loved ones this spring, reminds us that people are still dying of COVID-19 every day.

Danger still lurks in the shadows. Variants of the SARS-CoV-2 virus are cropping up and posing a particular threat to the unvaccinated. A CDC study notes that the distribution of circulating variants changed rapidly from December through May. The Alpha variant, first reported in the U.K., went from 0.2% of U.S. infections in January to 66% in late April.

And now we have the highly transmissible Delta variant, first detected in India, hot on our trail. Delta is largely responsible for a 210% spike in COVID-19 hospitalizations in one Missouri county in June, where virtually all patients hospitalized with the disease were unvaccinated. Delta knocked the North Carolina State baseball team out of the College World Series in Omaha, one victory short of reaching the finals. Delta is also responsible for a recommendation this week in Los Angeles County that everyone, vaccinated or not, mask up once again in public indoor spaces, just two weeks after California’s celebrated re-opening.

The World Health Organization is telling folks, including the fully vaccinated, to mask up and socially distance in the path of Delta. The variant is spreading in at least 85 countries, leading to re-imposition of lockdowns and restrictions from Australia and Bangladesh to South Africa, Israel and Germany.

Vaccination will help protect against these variants, but the rollout is glaringly uneven from state to state. Considering the goal of getting at least one shot into the arms of 70% of American adults by July 4 (we have made it to 66.2%), 20 states have already reached the 70% level, led by Vermont, Massachusetts and Hawaii at more than 80%. On the other hand, a handful of states are at 50% or less (Alabama, Wyoming, Louisiana, Mississippi) and a dozen more are in the 50s.

In addition, more than 10% of people who have received their first shot have not gone back for the second dose and thus do not have a full measure of protection. Only 8% of fully vaccinated people in the U.S. have gone one-and-done with the single-dose J&J vaccine.

These cautions come at a time when the pace of COVID-19 vaccination has slipped into a lower gear. Daily shots that peaked at more than 3 million in April are now hovering around 800,000, according to Our World in Data.

Source: Getty Images.

Keep on pushing

·  The White House is continuing to campaign, election-year style, as the vaccination effort moves from a macro to a micro level, from megasites at stadiums to barbershops, churches and grocery stores in a neighborhood near you. The emphasis is on some 55 million people in the so-called “moveable middle.”

·  In an op-ed for the New York Times, Saad Omer, director of the Yale Institute for Global Health, writes that it’s time for doctors and nurses to become the voices of vaccine persuasion: “The most effective vaccine message is one that comes from a trusted source and not only leads the listeners to get vaccinated but also motivates them to encourage others around them to do so as well. This is what we need, as people become complacent with the benefits of others getting vaccinated.” The Yale School of Medicine is one of numerous organizations that have developed guidelines for healthcare professionals on how to conduct these conversations.

·  The CDC and WhatsApp are collaborating on a Spanish language chat for Latinos to help combat misinformation and support COVID-19 vaccination. As of mid-June, just 36% of Latinos had received one dose of vaccine, versus 45% of whites, according to the Kaiser family Foundation. Videos and other messages on social media may be able to make inroads where other techniques and messengers have not.

·  Among the notable gaps in vaccination that persist, the long-term care industry is searching for ways to push the staff vaccination rate to a goal of 75%, Kimberly Bonvissuto reports in McKnight’s Senior Living. The staff vaccination rate across the aging services field is estimated at 57%; it’s slightly higher at 64% among members of LeadingAge, an association of more than 5,000 nonprofit senior services providers.

·  As Bonvissuto notes, some leaders suggest that now is the time to push harder against vaccine hesitancy among healthcare staff, given the growing body of evidence that COVID-19 vaccines are safe and effective.

·  An additional push will come from vaccine mandates as more and more hospitals and health systems make the leap. The four largest healthcare systems in Massachusetts, employing 135,000 people, have decided to mandate COVID-19 vaccination. At least 85% of employees at two of them, Mass General Brigham and Beth Israel Lahey Health, have already had their shots.

·  Incentives large and small have not gone away. In Chicago, anyone 12 and older who gets an in-home vaccination also receives a $50 GrubHub gift card. The Illinois “All In for the Win” lottery will shell out $10 million in cash and $3 million in scholarships to the vaccinated, with drawings beginning July 8.

The challenges

·  The FDA is adding a warning to the fact sheets for the Pfizer/BioNTech and Moderna COVID-19 vaccines, stating that heart inflammation (myocarditis/pericarditis) is a rare risk of vaccination. Onset of symptoms (chest pain, shortness of breath, fast or fluttering or pounding heartbeat) occurs a few days after vaccination, especially after dose two.

·  The CDC’s Advisory Committee on Immunization Practices says that the benefits of vaccination clearly outweigh the risks. Here is the risk/benefit presentation from the ACIP session.

·  A statement co-signed by the leaders of 17 national health organizations, including the American Academy of Pediatrics and American Academy of Family Physicians, emphasizes that heart inflammation “is an extremely rare side effect, and only an exceedingly small number of people will experience it after vaccination… Most cases are mild, and individuals recover often on their own or with minimal treatment. In addition, we know that myocarditis and pericarditis are much more common if you get COVID-19, and the risks to the heart from COVID-19 infection can be more severe.”

·  The FDA has granted emergency use authorization to tocilizumab (Actemra/Genentech) for treatment of adults and children (12 and older) hospitalized with COVID-19. Brian Park shares trial results in MPR. The IV drug is indicated for patients who are receiving systemic corticosteroids and require supplemental oxygen, mechanical ventilation or extracorporeal membrane oxygenation. Actemra, first approved in the US in 2010, is an IL-6 receptor agonist used in treating various types of arthritis, including rheumatoid arthritis.

·  In England, the typical GP with a patient population of 9,000 is likely to have 400 patients with long COVID, with symptoms persisting for at least 12 weeks, Nick Bostock reports in GP.

·  In Psychiatry Advisor, Jessica Nye speaks with experts who offer perspectives on the respiratory, cardiovascular and neurologic consequences of long COVID. The aftereffects of the pandemic, one said, “will go on for many years to come.”

Source: Getty Images.

The vaccine dashboard

·  ACIP’s COVID-19 working group says there is not enough data as yet to recommend COVID-19 booster shots for all. The short list for boosters would likely include long-term care residents and staff as well as frontline healthcare workers, Alicia Lasek notes in McKnight’s Long-Term Care News. The World Health Organization foresees annual boosters for the most vulnerable, including the elderly, and possible boosters every two years for the general population.

·  Recent reports from France and the U.S. in The New England Journal of Medicine and Annals of Internal Medicine, respectively, show promising results for a third dose of COVID-19 vaccine in solid organ transplant recipients, who have challenges mounting an immune response to the vaccine. The COVID-19 vaccine response of kidney transplant patients may depend on which immunosuppressive regimen they are taking, Natasha Persaud notes in Renal & Urology News.

·  The National Institutes of Health has launched a study of COVID-19 vaccination during pregnancy and the first two months postpartum. The study, known as MOMI-VAX, will measure the development and durability of antibody responses to COVID-19 vaccine and determine if vaccine-induced antibodies transfer from mother to child across the placenta or through breast milk. The study will enroll up to 750 pregnant and 250 postpartum individuals.

·  In Russia, where just 11% of the population is fully vaccinated, 18 regions are mandating vaccination for employees in government offices, retail, health care, education, restaurants and other service industries.

The rest

·  Televangelist Jim Bakker and his church will pay about $156,000 in restitution for making claims that Silver Solution (colloidal silver) was a cure for COVID-19. The Missouri Attorney General brought the charges.

·  A COVID outbreak at the U.S. Embassy in Kabul, Afghanistan resulted in 159 cases, 95% of them among unvaccinated or partially vaccinated individuals.

·  An outbreak at a summer camp in central Illinois in mid-June has led to 85 cases of COVID-19 among teens and adult staff, the Chicago Tribune reports. The Illinois health department says the camp did not require masks indoors and did not check vaccination status.

·  Vapors from alcohol-based hand sanitizers can cause headache, nausea or dizziness, the FDA warns, if used in enclosed spaces or areas with poor ventilation. Brian Park has details in MPR.

Parting shot

Is the vaccination campaign a victim of its own success? The Associated Press notes that, “Paradoxically, officials believe the strong response to the early vaccination campaign has served to reduce motivation to get a shot for some. One of the most potent motivators was the high rate of COVID-19 cases and deaths. Now that those figures have dropped to levels not seen since the onset of the pandemic, officials say it’s harder to convince Americans of the urgency to get a shot—particularly for younger populations that already knew they were at low risk of serious complications from the virus.”

Pollster Frank Luntz told the AP that vaccine hesitation among younger Americans and Trump voters “has been too hard to overcome. They think they are making a statement by refusing to be vaccinated. For Trump voters, it’s a political statement. For younger adults, it’s about telling the world that they are immune.”

…and some red, white and blue songs for the 4th of July

Saturday in the Park, Chicago (2017 version)

America, Neil Diamond

America the Beautiful, Ray Charles (Game 2 of the 2001 World Series)

Living in America, James Brown

Star-Spangled Banner, Whitney Houston (Super Bowl XXV)

Star-Spangled Banner, Lady Gaga (Presidential inauguration, 2021)

The Stars and Stripes Forever, John Philip Sousa, U.S. Marine Band

Have a happy and safe 4th! See you back here on the 7th.