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The U.S. Moving In Different Directions On Covid-19

The U.S. Moving In Different Directions On Covid-19

No fully vaccinated adult should be denied a COVID-19 booster shot, the California Department of Public Health says.

The move comes as health authorities are trying to increase the number of Californians getting the booster shots, fearing that slow early demand could increase the chances of another winter coronavirus wave.

“Do not turn a patient away who is requesting a booster,” Dr. Tómas Aragón, the state health officer and public health director, wrote in a letter. Booster patients must be adults, and at least two months must have passed since receiving a Johnson & Johnson vaccine or six months since getting the second dose of the two-shot Pfizer-BioNTech or Moderna vaccination series.

The U.S. Centers for Disease Control and Prevention has said for weeks that any adult who has received any of the three vaccines should get a booster shot if they live or work in settings that put them at increased risk for exposure to the coronavirus, such as hospitals, schools, grocery stores, factories, farms, jails, the Postal Service and public transit.

But as concerns grow about the potential threat of a fifth wave of COVID-19, health officials in California — at both the state and local levels — are increasingly encouraging all residents to consider getting the booster.

There is increasing evidence that the immunity provided by shots received months ago weakens over time. Without a booster, vaccinated people will be at greater risk for breakthrough infections, which can lead to hospitalizations and death among the most vulnerable.
Officials are suggesting it would be tragic if those eligible did not get a booster ahead of the winter holidays. According to the CDC, only about 34% of fully vaccinated seniors in California 65 and older have received a booster shot; among all fully vaccinated adults in the state, only 14% have received one.

“If you think you will benefit from getting a booster shot, I encourage you to go out and get it,” said Dr. Mark Ghaly, secretary of the California Health and Human Services Agency. “It’s not too late to get it this week. Get that added protection for the Thanksgiving gatherings that you may attend. Certainly, going into the other winter holidays, it is important.”

Authorities are already noticing more coronavirus cases among the first group of vaccine recipients last winter, Ghaly said.

Scientists and doctors say vaccinated seniors or those who have weakened immune systems are at greatest risk of having to be hospitalized from a breakthrough infection. And, while younger, healthier people are more likely to survive a breakthrough infection without severe illness, they can become a source of viral transmission that could sicken elderly family members and friends.

In the state’s letter, Aragón directed vaccine providers to allow patients themselves to determine whether they’re at risk — which would qualify them for the booster, according to the CDC’s criteria.

He offered a host of explanations that would fit the CDC’s eligibility criteria and cover essentially all California adults. People at increased risk may include those “who live in geographic areas that have been heavily impacted by COVID,” those who “reside in high transmission areas,” “who work with the public or live with someone who works with the public,” or “live or work with someone at high risk of severe impact of COVID.”

The bottom line? Vaccine providers should take the position that “nobody will be turned away who wants a booster,” Dr. Marty Fenstersheib, the COVID-19 vaccine officer for Santa Clara County, Northern California’s most populous county, told reporters this week.
“If you look at the CDC guidelines, and you drill down to the various groups, what you end up with is the recognition that pretty much everybody is eligible,” Dr. Sara Cody, the public health director and health officer for Santa Clara County, said.

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The California Department of Public Health went even further, offering more ideas of who could be eligible under CDC criteria. In a statement, the department said: “In general terms that everyone can understand, we urge Californians to get a booster if someone in their home has a medical condition or if they work around other people.”

The list of qualifying medical conditions is expansive — including being overweight, pregnant, a current or former smoker, or having high blood pressure, diabetes, asthma, depression, anxiety or an alcohol- or drug-use disorder.

California’s official recommendations for people who should get the vaccine, last updated Oct. 22, is already slightly more permissive than what the CDC suggests. The state recommends the following people receive booster shots:

Adults who received a Johnson & Johnson shot at least two months ago; and,
Adults who received their second Pfizer-BioNTech or Moderna shot at least six months ago who have an underlying medical condition, live in a long-term care setting, work or live in a setting at high-risk of exposure to the coronavirus, or are at increased risk to COVID-19 due to social inequity.
A federal court judge’s decision to strike down Texas Gov. Greg Abbott’s ban on school mask rules for violating the Americans with Disabilities Act could reverberate around the country and make new children eligible for the requirements. Expect Texas to appeal.

The larger current trend in the US may be away from required masking.
Atlanta’s mayor declared the city a “green zone” and said dropping Covid-19 cases allowed her to follow the science and lift the city’s mask rule.
Florida school districts Miami-Dade and Broward — which both stood up to Republican Gov. Ron DeSantis and risked losing state funding to implement mask rules to protect students this fall — are going mask-optional.
Pennsylvania’s Democratic Gov. Tom Wolf said Tuesday that he would lift a statewide mask rule for students in January. On Wednesday, a state court hurried things along, striking down the rule and lifting it immediately, although Wolf’s administration can appeal.
On the one hand, we’ve seen this movie before. Covid-19 cases and deaths are falling, but the same was true last spring before the Delta variant tore through the country. Is it time to dial back the restrictions or does letting up now risk a resurgence in the winter?
On the other hand, we’re in a new place entirely. Kids ages 5-11 can get vaccinated. Adults and older kids have had access to the vaccines for months.
We know so much more now about when and where masks are needed: in crowded indoor spaces. But we also don’t know when a new variant could flare.
“We’re on a downward trend. We want to keep going on a downward trend,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told Bloomberg TV on Tuesday. “We’re not going to have to be wearing masks forever. But for now, particularly as the CDC recommends, in indoor congregate settings, where you don’t really have a good handle on who is vaccinated and who is not, under those circumstances the CDC still recommends, appropriately, that we wear masks.”
That’s why Broadway has extended its mask requirement and the federal government has extended the requirement for mask use on public transportation through January 18. When I go to an indoor concert this week in Washington, for the first time in nearly two years, I’ll have to flash a picture of my vaccination card and mask up.
Those requirements vary from city to city and venue to venue, but larger concert promoters and big-name bands have required proof of vaccination for indoor and outdoor shows. It’s a different story for sports arenas.
Support for mask requirements is shrinking. Two-thirds of Americans were strongly or somewhat supportive of governments requiring masks to be worn in all public places in an Axios/Ipsos poll conducted at the end of August, with 45% strongly in support. Only about one-third were strongly supportive in the same poll in early November, and a combined 60% were strongly or somewhat supportive.
In September, when the White House announced its long-awaited plan to welcome vaccinated European travelers, the United States was consumed by a Covid-19 surge that far outpaced Europe’s.

At that point the US rate of new cases per capita dwarfed Europe’s by nearly three to one. While European governments were plotting their roadmaps towards normality, America was battling a rise in infections and warning of pressure on hospitals.
But by Monday, when the new rules came into effect and thousands of tourists jetted across the Atlantic to American cities, the two regions had experienced a dramatic reversal in fortunes.
Europe is now the epicenter of the Covid-19 pandemic once again; it overtook the US case count at the end of October and is now careering towards a difficult winter.
Infections are rising in most of the countries that make up the Schengen area, the 26-country bloc where entry rules to the US have been relaxed. Travelers from the United Kingdom and Ireland were also included in the American policy shift.
“We are at another critical point of pandemic resurgence,” WHO regional director Hans Kluge said last week, warning that the pace of transmission across the region was of “grave concern.”
“According to one reliable projection, if we stay on this trajectory, we could see another half a million COVID-19 deaths in Europe and Central Asia by the first of February next year,” Kluge warned, adding that 43 of the 53 countries on his patch could also see high or extreme stress on hospital beds.
Europe’s current wave has not resulted in as high a death rate as the US’ summer spike. But it serves as a reminder of the cyclical nature of the pandemic, experts said.

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