No images? Click here Click here to subscribe to the daily brief. September 20, 2021 - Brief Issue 237 The Coronavirus Daily Brief is a daily news and analysis roundup edited by New America’s International Security Program and Arizona State University. Watch Daily Brief Editor Emily Schneider’s conversation with Dr. Leana Wen, former Health Commissioner, City of Baltimore and author of “Lifelines: A Doctor's Journey in Fight for Public Health” filmed as part of New America and ASU’s Future Security Forum here. Please consider making a donation to support our ongoing analysis of the most important news and headlines surrounding Covid-19. Top Headlines Fauci Urges Americans to Wait on Boosters After FDA Advisory Panel Recommends Limiting Booster Availability to Those Over 65 (Health & Science) Delta Variant Detected in Almost All U.S. Cases (Health & Science) Pfizer: Vaccine is Safe for Young Children (Health & Science) U.S. Insurance Companies Return to Asking Patients to Cost-Share for Covid Treatment (Health & Science) Deaths Outpaced Births in Alabama in 2020 (Health & Science) U.N. General Assembly to Address Covid-19; Unvaccinated Brazilian President to Attend in Violation of ‘Honor System’ (Around the World) Bookings for Vaccinations Surge After Italy Makes Covid Pass Mandatory for All Workers (Around the World) Australian Mines Face Worker Shortage (Around the World) Iran Reopens Museums (Around the World) Brazil Reports Over 150,000 Cases in One Day Due to Backlog (Around the World) Biden Seeks to Expand Telehealth (U.S. Government & Politics) As Vaccinations Drive Hope, the Global Economic Recovery is Slowing (U.S. Economy) Still No Hiring Boost for States that Cut Benefits Early (U.S. Economy) School Districts Embrace “Test to Stay” Policies (U.S. Society) Hit Hard by Covid and Amid Other Factors, Conditions at Rikers Island Spin Out of Control (U.S. Society) Horse Owners Face Difficulties Obtaining Ivermectin (U.S. Society) Health & Science There have been 42,088,404 coronavirus cases in the United States, and 673,768 people have died (Johns Hopkins). The United States has administered 385,586,012 vaccine doses, with 63.8% of all Americans having received at least one vaccine dose and 54.6% fully vaccinated. Among adults aged 18 or older 76.5% have received at least one dose, and 65.8% are fully vaccinated (U.S. CDC). Worldwide, there have been 228,606,746 confirmed cases of coronavirus, with 4,693,332 deaths. Fauci Urges Americans to Wait on Boosters After FDA Advisory Panel Recommends Limiting Booster Availability to Those Over 65 Dr. Anthony S. Fauci, the top infectious disease doctor in the U.S., urged vaccinated Americans to wait until they are eligible for an extra shot of Covid-19 vaccine before getting one. Dr. Fauci made remarks on three Sunday morning news shows and also defended President Biden’s decision last month to announce the availability of booster shots before regulators had weighed in. On Friday, an advisory panel to the Food and Drug Administration (FDA) recommended that those who received the Pfizer-BioNTech vaccine get a booster dose if they are over 65 or are at high risk of developing severe Covid-19 (WaPo). The panel’s recommendation did not go as far as Biden’s summer announcement in which he said that all Americans who were fully vaccinated would be eligible for booster shots eight months after their last dose beginning today, September 20 (NYT). Dr. Francis Collins, director of the National Institutes of Health, told Fox News Sunday that he supported the FDA panel recommendation but also believed that the eligibility would be expanded to include more people. Collins said, “It would surprise me if it does not become clear over the next few weeks that the administration of boosters may need to be enlarged. Based upon the data that we’ve already seen both in the U.S. and in Israel, it’s clear that the waning of the effectiveness of those vaccines is a reality and we need to respond to it." The advisory panel’s recommendation is not binding and FDA officials are expected to make a decision about who will get booster shots next week. Peter Marks, the FDA official overseeing coronavirus vaccines, indicated that the final decision could be slightly different and include people who are at higher risk of infections because of their professions. Delta Variant Detected in Almost All U.S. Cases According to the U.S. Centers for Disease Control and Prevention, the extremely transmissible Delta variant of the coronavirus now represents more than 99% of cases tracked in the country (NYT). In mid-June, the Delta variant was responsible for just over a quarter of cases. “It’s not unexpected, because it’s more transmissible, but it is also a strong reminder that we need to have continuous vigilance,” said Dr. Saskia Popescu, an epidemiologist and assistant professor at George Mason University. “We have transmission occurring with very limited exposure, and that means that, for example, times without a mask, when you are out and around others, become much more of a risk,” Dr. Popescu said. The CDC’s Covid Data Tracker put the B.1.617.2 lineage of the Delta variant at 99.4%, with two other lineages at 0.2% and 0.1%. The Mu variant, first detected in Colombia in January, was at 0.1%. The data is based on thousands of sequences provided every week through the CDC’s national genomic surveillance efforts. The U.S. has averaged about 153,000 new Covid cases and 1,940 deaths each day over the past week, with some states where cases are surging having to ration medical care. Hospitals in Alaska, Idaho, and Montana have had to make decisions about which patients would receive vital treatment (WaPo). Pfizer: Vaccine is Safe for Young Children On Monday, Pfizer and its partner BioNTech announced that based on their Phase 2/3 study, they believe their vaccine is safe for children aged five to eleven (WSJ, CNN). The study provides the first data to be released on any vaccine’s efficacy among this age group. However, the study has not yet been peer reviewed or published. CNN writes, “The trial included 2,268 participants ages 5 to 11 and used a two-dose regimen of the vaccine administered 21 days apart. This trials used a 10-microgram dose -- smaller than the 30-microgram dose that has been used for those 12 and older.” Pfizer reported a “strong immune response in this cohort of children one month after the second dose,” adding, “Further, the COVID-19 vaccine was well tolerated, with side effects generally comparable to those observed in participants 16 to 25 years of age.” The company plans to share the data with the FDA and seek emergency approval for the vaccine’s use among children as soon as possible. U.S. Insurance Companies Return to Asking Patients to Cost-Share for Covid Treatment Last year, U.S. health insurance companies stated that they would cover 100 percent of the cost of Covid treatment, but now the Washington Post reports that many companies are returning to asking patients to share the cost by paying deductibles (WaPo). The Post reports, “most insurers have reinstated co-pays and deductibles for covid patients, in many cases even before vaccines became widely available. The companies imposed the costs as industry profits remained strong or grew in 2020, with insurers paying out less to cover elective procedures that hospitals suspended during the crisis.” As insurance companies return to making patients pay for Covid treatment, a Kaiser Family Foundation survey shows the burden falls unevenly across the United States. The Post writes, “If you’re fortunate enough to live in Vermont or New Mexico, for instance, state mandates require insurance companies to cover 100 percent of treatment. But most Americans with covid are now exposed to the uncertainty, confusion and expense of business-as-usual medical billing and insurance practices — joining those with cancer, diabetes and other serious, costly illnesses.” The Post interviewed some of the patients impacted by the insurance changes. Deaths Outpaced Births in Alabama in 2020 On Friday, Alabama Health Officer Dr. Scott Harris stated during a press conference that more people died in the state in 2020 than were born (CNN). Harris stated, “This past year, 2020, is going to be the first year that we know of in the history of our state where we actually had more deaths than births,” adding, “Our state literally shrunk.” The health department’s preliminary data showed that 64,714 people died in 2020 while 57,641 were born. In contrast, in 2019, there were 54,109 deaths and 58,615 births. Covid-19 played a key role in the grim statistic, with Alabama reporting 7,182 Covid deaths in 2020. CNN notes that “Of Alabama's 67 counties, 65 have a ‘high’ level of coronavirus transmission, and two are at the ‘substantial’ tier,” according to the state’s data. Bonus Read: “Former FDA commissioner: ‘We remain almost equally vulnerable to threat from the next pandemic,’” (WaPo). Around the World Bonus Read: “Slow but steady has seen the EU win out in the vaccine race,” (Guardian). U.N. General Assembly to Address Covid-19; Unvaccinated Brazilian President to Attend in Violation of ‘Honor System’ World leaders will gather in New York this week for the United Nations General Assembly, with the coronavirus pandemic taking center stage in the discussions. President Biden will speak to the General Assembly for the first time as president on Tuesday and his in-person address is expected to focus on the pandemic and climate change, while also mentioning human rights issues regarding China and the new Taliban regime in Afghanistan (WSJ). “Authoritarians have used the pandemic as a pretext to violate human rights and tighten their grips,” Ms. Thomas-Greenfield, the U.S. Ambassador to the United Nations, told reporters Friday in New York, adding, “Democracy, human rights and the international rules-based order are under attack.” The U.N. is requiring participants to be vaccinated but will rely on the “honor system,” according to a U.N. spokeswoman. Diplomats arriving in the U.S. will need to submit a negative test and have been asked to limit the number of delegates attending. Brazilian President Jair Bolsonaro, who had the coronavirus but has very publicly refused to get vaccinated, is scheduled to speak on Tuesday in front of other world leaders (WaPo). “Everyone who has contracted this virus are vaccinated, even in a way that’s more effective than the vaccine itself. So don’t argue it,” Bolsonaro has said. Europe Bookings for Vaccinations Surge After Italy Makes Covid Pass Mandatory for All Workers There was a 20-40% increase in bookings for the first dose of the coronavirus vaccine in Italy this week after the government made the Covid Pass mandatory for all workplaces (Reuters). Prime Minister Mario Draghi’s national unity government introduced the pass in August as a uniform way of proving proof of vaccination, a recent negative Covid-19 test, or recent recovery from the virus (Guardian). Initially, it was to be used for indoor dining, museums and sports events, but this week the government extended the pass to all workplaces beginning October 15. Employees who refuse to comply will be considered absent without pay. On Saturday, reservations for the first dose of the vaccine were up 35% compared to the same time a week earlier. Bonus Read: “When Covid-19 Stole Their Smell, These Experts Lost Much More,” (NYT). Australia Australian Mines Face Worker Shortage Western Australia is the world’s main source of iron ore and is a significant source of gold, but mines there are facing a shortage of truck drivers and other workers so severe that mining companies are turning to Silicon-Valley style perks and benefits to attract workers. Some companies are pressing retired soldiers and furloughed airline pilots into service on mine sites, while others are offering gourmet meals and installing swimming pools for workers to cool off after 12-hour shifts in the sun (WSJ). Traditionally, skilled workers and staff are shuttled between mining sites, but border closures due to the pandemic have complicated that practice. Many companies are having difficulties obtaining exemptions for workers or are finding quarantine obligations too challenging. But Western Australia’s situation is unique because it is one of the last remaining places in the world to have no local infections of Covid-19. The state’s premier, Mark McGowan, has said that the border could remain shut to the rest of Australia until April because of outbreaks elsewhere. Middle East Iran Reopens Museums On Sunday, Iran reopened museums in Tehran and other cities after a year-long closure due to the pandemic. The director of Iran's museums, Mohammad-Reza Kargar said, “We are absolutely delighted, and we think the people are too because they were fed up with staying home, and visiting museums improves their mood (AFP). Iran has 746 museums, including 170 in the capital; over 21 million visitors took advantage of the country’s cultural heritage in the year before the coronavirus forced the museums to close. Americas Brazil Reports Over 150,000 Cases in One Day Due to Backlog Brazil reported 935 Covid-19 deaths on Saturday and 150,106 positive cases, according to the nation’s Health Ministry. The unusually large number of cases in a single day was the result of an adjustment in how cases are tabulated, according to officials (Reuters). The state health ministry "emphasizes that these are not cases that occurred in the last 24 hours, but rather cases that were not displayed before due to changes in the federal (case counting) system," it said. "Of these cases, 62% occurred in 2021." Bonus Read: “Fighting a Pandemic, While Launching Africa’s Health Revolution,” (NYT). U.S. Government & Politics Biden Seeks to Expand Telehealth The New York Times reports on the Biden administration’s effort to expand telehealth access, particularly amid the pandemic (NYT). The Times writes, “The roughly 15 percent of the population living in rural America includes some of the oldest and sickest patients in the country — a disparity that has grown more stark during the coronavirus pandemic. The Biden administration is investing more in telemedicine, whose use has grown sharply during the pandemic, as a way to improve their access to care.” The administration’s steps include the Department of Health and Human Services announcing that it was distributing $20 million to support such services. The Times, writes, “While the amount is relatively modest, it is part of a broader push to address the long-neglected health care infrastructure.” The Times adds that, ‘The spending includes about $4 million to help bring primary, acute and behavioral health care directly to patients via telehealth in 11 states, including Arkansas, Arizona and Maine” as well as another $4.3 million to “help specialists at academic medical centers provide training and support to primary care providers in rural and other underserved areas via ‘tele-mentoring,’ so that they can treat patients in their communities with complex conditions, such as long Covid or substance use disorders.” Diana Espinosa, acting administrator of the agency in the department tasked with distributing the funds, stated, “Telehealth expands access to care and is a vital tool for improving health equity,” adding, “This funding will help drive the innovation necessary to build clinical networks, educational opportunities and trusted resources to further advance telehealth.” The Biden administration has also included funding for telehealth in previous efforts surrounding the pandemic as well. California Governor Gavin Newsom Announces Two of His Children Have Tested Positive On Friday, California Governor Gavin Newsom, who recently fought back a recall effort motivated largely by Republican opposition to his pandemic policies, announced that two of his four children have tested positive for Covid (NYT). Governor Newsom added that the family is “following all Covid protocols.” Erin Mellon, a spokesperson for the governor’s office stated, “The governor, the first partner and their two other children have since tested negative.” The Times notes that the children “are all under 12, the threshold age for inoculation. In a victory speech Tuesday night, the governor mentioned that his oldest daughter was about to turn 12 this weekend.” Newsom himself received the Johnson & Johnson vaccine in April. Bonus Read: “A Pediatrician Joined the School Board During Covid-19. Her Face Mask Recommendations Could Cost Her the Job,” (WSJ). U.S. Economy As Vaccinations Drive Hope, the Global Economic Recovery is Slowing The Wall Street Journal reports that even as countries hope that expanding vaccinations will help drive an economic recovery, there are signs that global economic growth is slowing (WSJ). The Journal writes, “In Europe, growth has surged as rates have climbed this year. But in the U.S., economic activity slowed notably through the summer as the Delta variant of the virus spread, despite rising inoculation rates.” Meanwhile, in July, the United Kingdom’s economy grew by only .1 percent. The U.K. has a higher vaccination rate than the United States does. The Journal notes that “While it is risky to draw firm conclusions from one month’s data, the slowdown suggests that high vaccination rates alone may not be sufficient to drive a rapid recovery.” The Journal also points to August surveys of purchasing managers that suggest decelerating growth. Still No Hiring Boost for States that Cut Benefits Early On Friday, the Bureau of Labor Statistics released new data on employment that according to Reuters shows that states that cut pandemic-related unemployment benefits early in the hopes of encouraging people to return to work have not seen a boost in hiring (Reuters). Reuters writes that on average these states, mostly led by Republicans, “added jobs in August at less than half the pace of states that retained the benefits.” Reuters also notes that, “Overall employment in the leisure and hospitality fell about 0.5% in the 26 states that ended benefits, and rose 1% elsewhere.” Bonus Read: “Inflation Is All Over the Place,” (WSJ). U.S. Society School Districts Embrace “Test to Stay” Policies The New York Times reports that many school districts across the United States are adopting “test to stay” protocols that will allow students who are identified as having had close contact with infected persons to attend school if they test negative and have no symptoms (NYT). Marietta, Georgia schools, which opened on August 3, adopted such a policy after 51 students tested positive and more than 1,000 were identified as close contacts by August 20th. Those so labeled had to quarantine for seven to ten days. The Superintendent for Marietta schools stated, “That’s a lot of school, especially for children that are recovering from 18 months in a pandemic where they missed a lot of school or had to transition to virtual.” The Times writes, “An increasing number of school districts are turning to testing to keep more children in the classroom and avoid disrupting the work lives of their parents.” However, the CDC writes that it “does not have enough evidence at this time to support this approach,” although the CDC does allow vaccinated close contacts to attend school if masked. The CDC told the Times, “At this time, we do not recommend or endorse a test-to-stay program.” It added, “However, we are working with multiple jurisdictions who have chosen to use these approaches to gather more information.” One study in the Lancet provides some evidence to suggest the approach is safe. The Times summarizes its findings, writing, “The randomized controlled trial included more than 150 schools in Britain, and found that case rates were not significantly higher at schools that allowed close contacts of infected students or staff members to remain in class with daily testing than at those that required at-home quarantines. Roughly 2 percent of school-based close contacts ultimately tested positive for the virus, researchers found, which means that schools were keeping 49 uninfected students out of class every time one student tested positive.” The lead author on the paper, Dr. Bernadette Young, told the Times, “When you put that in the broader context of what we’re doing in society, it’s putting a pretty strong penalty on young people, I think.” Meanwhile, the U.K. decided to lift the quarantine requirement for close contacts this summer. The CDC defines a close contact as “Someone who was within 6 feet of an infected person (laboratory-confirmed or a clinically compatible illness) for a cumulative total of 15 minutes or more over a 24-hour period.” Hit Hard by Covid and Amid Other Factors, Conditions at Rikers Island Spin Out of Control The Wall Street Journal reports that conditions at Rikers Island, one of the largest jail complexes in the nation, have spiraled “out of control” (WSJ). The Journal writes, “Entire units of inmates are left unguarded. Suicide attempts among prisoners are rising. Nearly a third of correctional officers are out sick or can’t work with prisoners,” adding that “Lawyers and lawmakers say the safety of inmates and officers has never been more imperiled in the 90-year history of Rikers, long known for its reputation for violence.” After a tour of the facility, New York City Public Advocate Jumaane Williams stated, “The humanitarian crisis I saw is, simply, stunning” and on Friday, New York Governor Kathy Hochul ordered 191 prisoners released and signed a bill ending reincarceration for parole violations. Hochul pointed to current conditions as part of the reason for her actions, stating, “No one—no inmate, no correction officer, no family member who visits—should have to witness the reality of Rikers as it exists today.” One of the many factors behind the current conditions is the impact of the pandemic. The Journal notes, “The jail complex was hit hard by Covid-19. At the start of the pandemic, Rikers infection levels were among the highest of any known workplace in the U.S.” It reports that 2,500 of New York’s 8,400 uniformed correctional officers are out sick or on medically modified duty. Moreover, the pandemic delayed trials leading to longer stays for those awaiting trial at Rikers. Ross MacDonald, the chief medical officer for Correctional Health Services, referred to a “collapse in basic jail operations” and wrote “I do not believe the city is capable of safely managing the custody of those it is charged with incarcerating” in a letter he sent to New York City’s city hall, calling for action. Bonus Read: “Covid Infections at a California Jail Quadruple in Less Than a Week,” (NYT). Horse Owners Face Difficulties Obtaining Ivermectin The Washington Post reports that horse owners are facing difficulties obtaining Ivermectin for their horses as people seek the deworming agent for unapproved and unproven use on humans to prevent Covid (WaPo). A syringe of the paste for use on horses weighing up to 1,250 pounds is out of sale on QC Supply’s website, a Nebraska-based livestock supplier, according to the Post. The Post also notes, “On the website for Fleet Farm, a livestock supply chain in the Midwest, Horse Health Equine Ivermectin Paste sells for $6.99 but is not available for online orders” and like QC Supply’s site, has a warning that it is not for human use. Cliff Williamson, director of health and regulatory affairs at the American Horse Council, told the Post, “There was an immediate frustration expressed by retailers who felt it was necessary to re-shelve ivermectin labeled products behind counters or locked in cases,” and frustration is visible in horse-related web forums. Meanwhile, Las Vegas based V&V Tack and Feed boasts a sign saying that people purchasing Ivermectin must show a picture of them and their horse and a Florida based shop told the local Fox station that they are hiding their supply “until legitimate customers come in.” Ivermectin has seen growing attention and demand for its unapproved use as prominent figures like Fox’s Laura Ingraham have promoted it and podcaster Joe Rogan announced that he had used ivermectin after testing positive for Covid. Meanwhile, the FDA has signaled its lack of patience with the demand for the drug, tweeting snarkily, “You are not a horse. You are not a cow. Seriously, y’all. Stop it.” National Zoo Lions and Tigers Test Positive for Covid On Friday, the Smithsonian released a statement that some of the tigers and lions at the National Zoo in Washington D.C. have tested positive for Covid (NYT). The statement reads in part, “Six African lions, a Sumatran tiger and two Amur tigers have tested presumptive positive for the virus that causes COVID-19. Last weekend, animal keepers observed decreased appetites, coughing, sneezing and lethargy in several lions and tigers. Fecal samples for all great cats were collected and tested presumptive positive. Final results are expected in the next few days.” It is not the first time that Zoo animals have tested positive. The Times notes a few other examples: “Gorillas at the Zoo Atlanta as well as the San Diego Zoo have previously tested positive for the coronavirus. In Atlanta, as many as 18 of the 20 gorillas at the zoo had tested positive during a recent outbreak while the San Diego infections in January were believed to be the first detected in gorillas in the United States.” The National Zoo has not determined how the lions and tigers were infected. The Smithsonian notes that the U.S. Department of Agriculture has approved a vaccine for Zoo animals, adding, “first round of vaccine disbursement will be administered to select animals identified as a susceptible species at both the Zoo and Conservation Biology Institute in Virginia when it becomes available in the coming months.” Analysis & Arguments Rachel M. Pearson, a professor of bioethics and pediatric hospitalist, writes on what she says (and doesn’t say) to persuade parents to vaccinate their children (WaPo). Peter Nicholas writes on why Biden has emphasized vaccine mandates (Atlantic). Sarah Hosseini explores the phenomenon of parents lying to get their children vaccinated (Atlantic). Readers can send in tips, critiques, questions, and suggestions to coronavirusbrief@newamerica.org. The Brief is edited by David Sterman and Emily Schneider with Senior Editor Peter Bergen. Read previous briefs here and stream and subscribe to our weekly podcast here. 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