Virus World

Lyme disease diagnoses have increased dramatically in the U.S. during the past 15 years, rising 357% in rural areas and 65% in urban areas, according to new data released by FAIR Health. 

The trends show that tick-borne illnesses are becoming a more common concern nationally, not just in the areas where Lyme disease has been found historically. “Lyme disease remains a growing public health concern,” Robin Gelburd, president of FAIR Health, said in a statement. FAIR Health is a national, independent nonprofit group that highlights health care information by looking at data from its collection of more than 36 billion private insurance claims records. “FAIR Health will continue to use its repository of claims data to provide actionable and relevant insights to healthcare stakeholders seeking to better understand the ongoing rise of Lyme disease cases,” Gelburd said. The 15-year analysis included private insurance claims from 2007 to 2021, which showed a 357% increase in Lyme disease diagnoses in rural areas and a 65% increase in urban areas. In the past 5 years, from 2016 to 2021, diagnoses rose 60% in rural areas and 19% in urban areas.  The cases peaked in the summer months, when people spend more time outside in grassy areas, wooded areas, parks, and fields where ticks live. In June and July, Lyme disease diagnoses were more common in rural areas, but from November to April, diagnoses occurred more often in urban areas.

This report describes the epidemiologic and clinical characteristics of monkeypox cases reported to CDC by July 22, 2022. 

What is already known about this topic?

A global monkeypox outbreak began in 2022.

What is added by this report?

Among U.S. monkeypox cases with available data, 99% occurred in men, 94% of whom reported recent male-to-male sexual or close intimate contact; racial and ethnic minority groups appear to be disproportionately affected. Clinical presentations differed from typical monkeypox, with fewer persons experiencing prodrome and more experiencing genital rashes.

What are the implications for public health practice?

Public health efforts should prioritize gay, bisexual, and other men who have sex with men, who are currently disproportionately affected, for prevention and testing, address equity, and minimize stigma, while maintaining vigilance for transmission in other populations. Clinicians should test persons with rash consistent with monkeypox, regardless of whether the rash is disseminated or was preceded by prodrome...

Scientists have been keeping an eye on BA.2, one of three genetically distinct varieties of the Omicron variant of the coronavirus.  The highly contagious Omicron subvariant known as BA.2, which led to a surge of coronavirus cases in Europe, is now the dominant version of the virus in new U.S. cases, according to estimates from the Centers for Disease Control and Prevention on Tuesday. Last week, the World Health Organization reiterated that BA.2 was the dominant version of Omicron around the world, and Dr. Rochelle Walensky, the director of the C.D.C., said she anticipated it would soon become dominant in the United States. Scientists have been keeping an eye on BA.2, one of three genetically distinct varieties of the Omicron variant of the coronavirus, which was discovered by South African researchers in November. BA.2 was first identified in the United States in December, and it accounted for about 55 percent of new U.S. cases in the week ending Saturday, according to C.D.C. estimates on Tuesday. The figures are rough estimates subject to revision as more data comes in, as happened in late December, when the agency had to significantly decrease its estimate for the nationwide prevalence of the BA.1 Omicron variant. Before that, the Delta variant had been dominant since July.

The White House on Wednesday unveiled a plan to move the nation to a new stage of the pandemic where Covid-19 "does not disrupt our daily lives," while also preparing the nation for any new variants that may emerge.  The National Covid-19 Preparedness Plan, which will require additional funding from Congress, is focused on spending on treatments for Covid-19, preparing for new variants, keeping schools and businesses open and continuing the effort to vaccinate the nation and the world. "Vaccines, treatments, tests, masks -- these tools are how we continue to protect people and enable us to move forward safely and get back to our more normal routines. Going out to eat at a restaurant, taking that trip that's been long delayed, arranging a play date for your kids, attending a sports game, a movie or a concert again," White House Covid-19 response coordinator Jeff Zients told reporters at a White House briefing. A major new part of the plan includes a new "Test to Treat" initiative that President Joe Biden announced during his State of the Union address Tuesday night. He said Americans would be able to get tested for Covid-19 at a pharmacy and receive free antiviral pills "on the spot" if they test positive. 

WASHINGTON (AP) — Dealing the White House a stinging setback, a government advisory panel overwhelmingly rejected a plan Friday to give Pfizer COVID-19 booster shots across the board, and instead endorsed the extra dose only for those who are 65 or older or run a high risk of severe disease.  The twin votes represented a heavy blow to the Biden administration’s sweeping effort, announced a month ago, to shore up nearly all Americans’ protection amid the spread of the highly contagious delta variant. The decision was made by an influential committee of outside experts who advise the Food and Drug Administration.  In a surprising turn, the panel rejected, by a vote of 16-2, boosters for almost everyone. Members cited a lack of safety data on extra doses and also raised doubts about the value of mass boosters, rather than ones targeted to specific groups. Then, in an 18-0 vote, it endorsed the extra shot for select portions of the U.S. population — namely, those most at risk from the virus. That would help salvage part of the White House’s campaign but would still be a huge step back from the far-reaching plan proposed by the administration a month ago to offer booster shots of both the Pfizer and Moderna vaccines to practically everybody eight months after they get their second dose. Friday’s vote was just the first step in the process. The FDA itself is expected to make a decision on boosters in the next few days, but it usually follows the committee’s recommendations. The offering of boosters is also subject to approval by the Centers for Disease Control and Prevention. A CDC advisory panel is expected to take up the question on Wednesday. The CDC has said it is considering boosters for older people, nursing home residents and front-line health care workers, rather than all adults.

Separate FDA and CDC decisions will be needed in order for people who received the Moderna or J&J shots to get boosters.

During several hours of vigorous debate Friday, members of the panel questioned the value of offering boosters to almost everybody 16 and over. “I don’t think a booster dose is going to significantly contribute to controlling the pandemic,” said Dr. Cody Meissner of Tufts University. “And I think it’s important that the main message we transmit is that we’ve got to get everyone two doses.” Dr. Amanda Cohn of the CDC said: “At this moment it is clear that the unvaccinated are driving transmission in the United States.” Scientists inside and outside the government have been divided in recent days over the need for boosters and who should get them, and the World Health Organization has strongly objected to rich nations giving a third round of shots when poor countries don’t have enough vaccine for their first. While research suggests immunity levels in those who have been vaccinated wane over time and boosters can reverse that, the Pfizer vaccine is still highly protective against severe illness and death, even amid the spread of the highly contagious delta variant.  The surprise turn of events could reinforce recent criticism that the Biden administration got out ahead of the science in its push for boosters. President Joe Biden promised early on that his administration would “follow the science,” following disclosures of political meddling in the Trump administration’s coronavirus response.

The FDA panel’s overwhelming initial rejection came despite full-throated arguments about the need for boosters from both Pfizer and health officials from Israel, which began offering boosters to its citizens in July. Sharon Alroy-Preis of Israel’s Ministry of Health said the booster dose improves protection tenfold against infection in people 60 and older. “It’s like a fresh vaccine,” bringing protection back to original levels and helping Israel “dampen severe cases in the fourth wave,” she said. And representatives for Pfizer argued that it is important to shore up immunity before protection against severe disease starts to erode. A company study of 44,000 people showed effectiveness against symptomatic COVID-19 was 96% two months after the second dose, but had dropped to 84% by around six months. Both Pfizer and the Israeli representatives faced pushback from panelists. Several were skeptical about the relevance of Israel’s experience to the U.S. Another concern was whether third doses would exacerbate serious side effects. Meissner said he was worried about extra doses for younger age groups, given the risk of heart inflammation that has been seen in mostly younger men after a second dose. While the condition is very rare, he said, it is not clear if that risk would increase with another dose. Pfizer pointed to Israeli data from nearly 3 million boosters to suggest side effect rates would be similar to that seen after second doses. Dr. Paul Offit, a vaccine expert at Children’s Hospital of Philadelphia, said he was supportive of a third dose for adults over 60 or 65, but “I really have trouble” supporting it for anyone down to age 16. While an extra shot likely will at least temporarily decrease cases with mild or no symptoms, “the question becomes what will be the impact of that on the arc of the pandemic, which may not be all that much,” Offit said. Biden’s top health advisers, including the heads of the FDA and CDC, first announced plans for widespread booster shots in mid-August, targeting the week of Sept. 20 as an all-but-certain start date. But that was before FDA staff scientists had completed their own assessments of the data.

Earlier this week, two top FDA vaccine reviewers joined a group of international scientists in publishing an editorial rejecting the need for boosters in healthy people. The scientists said continuing studies show the shots are working well despite the delta variant. On Friday, U.S. Surgeon General Dr. Vivek Murthy said that in announcing its booster plan, the Biden administration was not trying to pressure regulators to act but was instead trying to be transparent with the public and be prepared in the event that extra shots won approval. “We have always said that this initial plan would be contingent on the FDA and the CDC’s independent evaluation,” Murthy said. The Biden plan has also raised major ethical concerns about impoverished parts of the world still clamoring for vaccine. But the administration has argued that the plan is not an us-or-them choice, noting that the U.S. is supplying large quantities of vaccine to the rest of the globe. The U.S. has already approved Pfizer and Moderna boosters for certain people with weakened immune systems, such as cancer patients and transplant recipients. Some Americans, healthy or not, have managed to get boosters, in some cases simply by showing up and asking for a shot. And some health systems already are offering extra doses to high-risk people.

Widespread human SARS-CoV-2 infections combined with human-wildlife interactions create the potential for reverse zoonosis from humans to wildlife. We targeted white-tailed deer (Odocoileus virginianus) for serosurveillance based on evidence these deer have ACE2 receptors with high affinity for SARS-CoV-2, are permissive to infection, exhibit sustained viral shedding, can transmit to conspecifics, and can be abundant near urban centers. We evaluated 624 pre- and post-pandemic serum samples from wild deer from four U.S. states for SARS-CoV-2 exposure. Antibodies were detected in 152 samples (40%) from 2021 using a surrogate virus neutralization test. A subset of samples was tested using a SARS-CoV-2 virus neutralization test with high concordance between tests. These data suggest white-tailed deer in the populations assessed have been exposed to SARS-CoV-2.

Preprint available in bioRxiv (July 29, 2021):

 https://doi.org/10.1101/2021.07.29.454326 

The Centers for Disease Control and Prevention (CDC) yesterday said that Delta, a highly transmissible COVID-19 variant first identified in India and currently sweeping through the United Kingdom, now makes up at least 10% of all US cases. On May 22, the variant had made up only 2.7% of cases.The CDC also now designated Delta as a variant of concern, which means the agency officially recognizes that the variant may carry a risk of more severe illness and transmissibility. In addition to Delta, the CDC has noted five other variants of concern. The rapid rise of the variant in the United Kingdom—where it now accounts for 90% of cases—has slowed that nation’s reopening efforts by 4 or 5 weeks.

See variant distribution in the U.S.A:

https://covid.cdc.gov/covid-data-tracker/#variant-proportions 

About 5,800 people out of tens of millions who have been vaccinated against coronavirus have become infected anyway, the CDC tells CNN. Some became seriously ill and 74 people died, the CDC said. It said 396 -- 7% -- of those who got infected after they were vaccinated required hospitalization.  This is the CDC's first public accounting of breakthrough cases, and the agency is searching for patterns based on patient age and gender, location, type of vaccine, variants and other factors. "So far, about 5,800 breakthrough cases have been reported to CDC. To date, no unexpected patterns have been identified in case demographics or vaccine characteristics," the CDC told CNN via email.  About 77 million people in the US are fully vaccinated against coronavirus, according to a CNN analysis of CDC data. The CDC's reports on breakthrough cases will lag day-to-day reports of vaccines given, so many, if not most, of those breakthrough cases will have happened weeks ago. Nonetheless, the total represents a very small percentage of those who have been vaccinated. Breakthrough cases are expected. The vaccines are not 100% effective in preventing infections and as tens of millions of people are vaccinated, more and more such cases will be reported.

APA’s Stress in America ™ poll reveals secondary pandemic health crisis; parents, essential workers, communities of color more likely to report mental, physical health consequences. 

WASHINGTON — As growing vaccine demand signals a potential turning point in the global COVID-19 pandemic, the nation’s health crisis is far from over. One year after the World Health Organization declared COVID-19 a global pandemic, many adults report undesired changes to their weight, increased drinking and other negative behavior changes that may be related to an inability to cope with prolonged stress, according to the American Psychological Association’s latest Stress in AmericaTM poll. APA’s survey of U.S. adults, conducted in late February 2021 by The Harris Poll, shows that a majority of adults (61%) experienced undesired weight changes – weight gain or loss – since the pandemic started, with 42% reporting they gained more weight than they intended. Of those, they gained an average of 29 pounds (the median amount gained was 15 pounds) and 10% said they gained more than 50 pounds, the poll found. Such changes come with significant health risks, including higher vulnerability to serious illness from the coronavirus. For the 18% of Americans who said they lost more weight than they wanted to, the average amount of weight lost was 26 pounds (median amount lost was 12 pounds). Adults also reported unwanted changes in sleep and increased alcohol consumption. Two in 3 (67%) said they have been sleeping more or less than desired since the pandemic started. Nearly 1 in 4 adults (23%) reported drinking more alcohol to cope with their stress. “We’ve been concerned throughout this pandemic about the level of prolonged stress, exacerbated by the grief, trauma and isolation that Americans are experiencing. This survey reveals a secondary crisis that is likely to have persistent, serious mental and physical health consequences for years to come,” said Arthur C. Evans Jr, PhD, APA’s chief executive officer. “Health and policy leaders must come together quickly to provide additional behavioral health supports as part of any national recovery plan.”

The pandemic has taken a particularly heavy toll on parents of children under 18. While slightly more than 3 in 10 adults (31%) reported their mental health has worsened compared with before the pandemic, nearly half of mothers who still have children home for remote learning (47%) reported their mental health has worsened; 30% of fathers who still have children home said the same. Parents were more likely than those without children to have received treatment from a mental health professional (32% vs. 12%) and to have been diagnosed with a mental health disorder since the coronavirus pandemic began (24% vs. 9%). More than half of fathers (55%) reported gaining weight, and nearly half (48%) said they are drinking more alcohol to cope with stress. The majority of essential workers (54%), such as health care workers and people who work in law enforcement , said they have relied on a lot of unhealthy habits to get through the pandemic<. Nearly 3 in 10 (29%) said their mental health has worsened, while 3 in 4 (75%) said they could have used more emotional support than they received since the pandemic began. Essential workers were more than twice as likely as adults who are not essential workers to have received treatment from a mental health professional (34% vs. 12%) and to have been diagnosed with a mental health disorder since the coronavirus pandemic started (25% vs. 9%). 

Further, people of color reported unintended physical changes during the pandemic. Hispanic adults were most likely to report undesired changes to sleep (78% Hispanic vs. 76% Black, 63% white and 61% Asian), physical activity levels (87% Hispanic vs. 84% Black, 81% Asian and 79% white) and weight (71% Hispanic vs. 64% Black, 58% white and 54% Asian) since the pandemic began. Black Americans were most likely to report feelings of concern about the future. More than half said they do not feel comfortable going back to living life like they used to before the pandemic (54% Black vs. 48% Hispanic, 45% Asian and 44% white) and that they feel uneasy about adjusting to in-person interaction once the pandemic ends (57% Black vs. 51% Asian, 50% Hispanic and 47% white). “It’s clear that the pandemic is continuing to have a disproportionate effect on certain groups,” said APA President Jennifer Kelly, PhD. “We must do more to support communities of color, essential workers and parents as they continue to cope with the demands of the pandemic and start to show the physical consequences of prolonged stress.” Overall, Americans are hesitant about the future, regardless of vaccination status. Nearly half of respondents (49%) said they feel uneasy about adjusting to in-person interaction once the pandemic ends. Adults who received a COVID-19 vaccine were just as likely as those who had not received a vaccine to say this (48% vs. 49%, respectively).

Infographics at:

https://www.apa.org/news/press/releases/stress/2021/data-charts-march-weight-change 

As of May 2020, at least 17 U.S. states have shown an increase in daily cases in the last week.

A recent case in a New York suburb has reignited concerns over the disease.  During the slog of yet another Covid wave, and mounting monkeypox anxieties, health officials reported a case of polio in a New York suburb in July— the first detected in the United States in nearly a decade. State health officials said that polio was detected in an unvaccinated person in Rockland County, New York, and that the virus had been found in county wastewater samples in June, as well as in wastewater samples in two different locations in Orange County, New York, in June and July. On Aug. 12, health officials announced that poliovirus had been detected in sewage samples in New York City, indicating that the virus is likely circulating there too. These occurrences, as well as reports that health officials in Britain had detected evidence of poliovirus in sewage samples in London, have reignited polio concerns. However, experts said that people who are vaccinated against polio do not need to change their daily behaviors or panic about the disease. Here’s what you need to know.

Understanding the death toll — who makes up the one million and how the country failed them — is essential as the pandemic continues.

Different choices that were available and plausible could have been made at several crucial turning points.  Zeynep Tufekci's Latest:  Dive deep into the internet, technology, politics and society with Zeynep Tufekci's latest column as soon as it’s published. This article is part of Times Opinion’s reflection on the two-year mark of the Covid pandemic. Read more in a note from Alexandra Sifferlin, Opinion’s health and science editor, in our Opinion Today newsletter.

Most of the 43 COVID-19 cases caused by the Omicron variant identified in the United States so far were in people who were fully vaccinated, and a third of them had received a booster dose, according to a U.S. report published on Friday. The U.S. Centers for Disease Control and Prevention (CDC) said that of the 43 cases attributed to Omicron variant, 34 people had been fully vaccinated. Fourteen of them had also received a booster, although five of those cases occurred less than 14 days after the additional shot before full protection kicks in.  While the numbers are very small, they add to growing concerns that current COVID-19 vaccines may offer less protection against the highly transmissible new variant. The Omicron variant of the coronavirus has been found through testing in about 22 states so far after first being identified in southern Africa and Hong Kong in late November.  Among the Omicron cases, 25 were in people aged 18 to 39 and 14 had traveled internationally. Six people had previously been infected with the coronavirus. Most of them only had mild symptoms such as coughing, congestion, and fatigue, the report said, and one person was hospitalized for two days. Other symptoms reported less frequently including nausea or vomiting, shortness of breath or difficulty breathing, diarrhea and loss of taste or smell.

The CDC said that while many of the first reported Omicron cases appear to be mild, a lag exists between infection and more severe outcomes. Symptoms would also be expected to be milder in vaccinated persons and those with previous SARS-CoV-2 infection. The first known U.S. Omicron case was identified on Dec 1 in a fully vaccinated person who had traveled to South Africa. The CDC said that the earliest date of symptom onset was Nov. 15 in a person with a history of international travel. The Delta variant still accounts for more than 99% of all U.S. cases. But reports from South Africa show that the Omicron variant is very transmissible. Even if most cases are mild, a highly transmissible variant could result in enough infections to overwhelm health systems, the CDC cautioned. Laboratory studies released this week suggest that the Omicron variant will blunt the protective power of two doses of Pfizer (PFE.N) and BioNTech's COVID-19 vaccine, although a third dose may restore that protection.

While COVID-19 vaccines are highly effective at preventing severe disease, hospitalization, and death from COVID-19 and also reduce the likelihood of mild or asymptomatic infection, a small share of fully vaccinated individuals do become infected, and some become hospitalized or have died. These rare occurrences are known as “breakthrough cases” which are to be expected, and historically known to occur with other vaccines as none is 100% effective.  The Centers for Disease Control and Prevention (CDC) currently monitors hospitalizations and deaths, from any cause, among fully vaccinated individuals with COVID-19, but not breakthrough infections, which it stopped monitoring as of May 1. CDC presents this data in aggregate at the national level but not by state, and there is no single, public repository for data by state or data on breakthrough infections, since the CDC stopped monitoring them. We therefore reviewed the websites and other official state sources for all 50 states and D.C. to see which are providing data on COVID-19 breakthrough cases, hospitalizations and deaths, how regularly, and what those data may tell us. We only used data from official state sources (we did not include data available only in news media reports, for example). Where a state did not provide comparable data on overall COVID-19 cases, hospitalizations, or deaths reported over the period in which it captured breakthrough events, we obtained data on cases and deaths from the Johns Hopkins University COVID-19 Dashboard and on hospitalizations from the U.S. Department of Health & Human Services for the appropriate period (see methods for more detail).

Importantly, not all hospitalizations and deaths of those fully vaccinated and diagnosed with COVID-19 are due to COVID-19 or have a known cause at the time of reporting. The CDC reports that as of July 19, of 5,601 hospitalized breakthrough cases, 27% were asymptomatic or not related to COVID-19 and of 1,141 fatal cases, 26% were asymptomatic or not related to COVID-19. States differ in whether they provide this detail. DC, for example, reports that as of July 11, 50% of hospitalized breakthrough cases were due to COVID-19, 19% were not, and 31% were of unknown reason. However, few states made these distinctions. Where they did, we only included breakthrough hospitalizations and deaths due to COVID-19. In other cases, some of these breakthrough events may be due to causes other than COVID-19. Overall, we find that:

• Half of states (25) report some data on COVID-19 breakthrough events (see Table 1). Twenty-four provide data on breakthrough cases, 19 on hospitalizations and on deaths.
• Fifteen of these states regularly update these data, often on a weekly basis. The rest use a different frequency, have one-time reports, have stopped updating, or have an unclear reporting frequency.
• The data reported from these states indicate that breakthrough cases, hospitalizations, and deaths are extremely rare events among those who are fully vaccinated against COVID-19 (see Figure 1). The rate of breakthrough cases reported among those fully vaccinated is well below 1% in all reporting states, ranging from 0.01% in Connecticut to 0.29% in Alaska.
•  
  • The hospitalization rate among fully vaccinated people with COVID-19 ranged from effectively zero (0.00%) in California, Delaware, D.C., Indiana, New Jersey, New Mexico, Vermont, and Virginia to 0.06% in Arkansas. (Note: Hospitalization may or may not have been due to COVID-19.)
  • The rates of death among fully vaccinated people with COVID-19 were even lower, effectively zero (0.00%) in all but two reporting states, Arkansas and Michigan where they were 0.01%. (Note: Deaths may or may not have been due to COVID-19.)

• Almost all (more than 9 in 10) COVID-19 cases, hospitalizations, and deaths have occurred among people who are unvaccinated or not yet fully vaccinated, in those states reporting breakthrough data (see Figure 2). 
  • The reported share of COVID-19 cases among those not fully vaccinated ranged from 94.1% in Arizona to 99.85% Connecticut.
  • The share of hospitalizations among those with COVID-19 who are not fully vaccinated ranged from in 95.02% in Alaska to 99.93% in New Jersey. (Note: Hospitalization may or may not have been due to COVID-19.)
  • The share of deaths among people with COVID-19 who are not fully vaccinated ranged from to 96.91% in Montana to 99.91% in New Jersey. (Note: Deaths may or may not have been due to COVID-19.)

Note that as more people get vaccinated, the share of cases, hospitalizations, and deaths accounted for by unvaccinated people will tend to fall, since there will be fewer unvaccinated people in the population. That will be true even if infection, hospitalization, and death from COVID-19 is still very rare among vaccinated people.

Implications

While information on breakthrough events is still limited and incomplete, this analysis of available state-level data indicates that COVID-19 breakthrough cases, and especially hospitalizations and deaths, among those who are fully vaccinated are rare occurrences in the United States. Moreover, this data indicate the vast majority of reported COVID-19 cases, hospitalizations, and deaths in U.S. are among those who are unvaccinated or not fully vaccinated. These findings echo the abundance of data demonstrating the effectiveness of currently authorized COVID-19 vaccines. Moving forward, particularly as the more transmissible Delta variant is now the dominant strain of COVID-19 circulating in the U.S., more robust state-level data will help to monitor ongoing vaccine effectiveness and inform discussions about booster vaccinations.

Published by Kaiser Family Foundation (July  30, 2021)

Nearly all COVID-19 deaths in the U.S. now are in people who weren’t vaccinated, a staggering demonstration of how effective the shots have been and an indication that deaths per day — now down to under 300 — could be practically zero if everyone eligible got the vaccine.  An Associated Press analysis of available government data from May shows that “breakthrough” infections in fully vaccinated people accounted for fewer than 1,200 of more than 853,000 COVID-19 hospitalizations. That’s about 0.1%. And only about 150 of the more than 18,000 COVID-19 deaths in May were in fully vaccinated people. That translates to about 0.8%, or five deaths per day on average. The AP analyzed figures provided by the Centers for Disease Control and Prevention. The CDC itself has not estimated what percentage of hospitalizations and deaths are in fully vaccinated people, citing limitations in the data.  Among them: Only about 45 states report breakthrough infections, and some are more aggressive than others in looking for such cases. So the data probably understates such infections, CDC officials said. Still, the overall trend that emerges from the data echoes what many health care authorities are seeing around the country and what top experts are saying. Earlier this month, Andy Slavitt, a former adviser to the Biden administration on COVID-19, suggested that 98% to 99% of the Americans dying of the coronavirus are unvaccinated. And CDC Director Dr. Rochelle Walensky said on Tuesday that the vaccine is so effective that “nearly every death, especially among adults, due to COVID-19, is, at this point, entirely preventable.” She called such deaths “particularly tragic.” Deaths in the U.S. have plummeted from a peak of more than 3,400 day on average in mid-January, one month into the vaccination drive. 

About 63% of all vaccine-eligible Americans — those 12 and older — have received at least one dose, and 53% are fully vaccinated, according to the CDC. While vaccine remains scarce in much of the world, the U.S. supply is so abundant and demand has slumped so dramatically that shots sit unused. Ross Bagne, a 68-year-old small-business owner in Cheyenne, Wyoming, was eligible for the vaccine in early February but didn’t get it. He died June 4, infected and unvaccinated, after spending more than three weeks in the hospital, his lungs filling with fluid. He was unable to swallow because of a stroke. “He never went out, so he didn’t think he would catch it,” said his grieving sister, Karen McKnight. She wondered: “Why take the risk of not getting vaccinated?” The preventable deaths will continue, experts predict, with unvaccinated pockets of the nation experiencing outbreaks in the fall and winter. Ali Mokdad, a professor of health metrics sciences at the University of Washington in Seattle, said modeling suggests the nation will hit 1,000 deaths per day again next year.  In Arkansas, which has one of the lowest vaccination rates in the nation, with only about 33% of the population fully protected, cases, hospitalizations and deaths are rising. “It is sad to see someone go to the hospital or die when it can be prevented,” Gov. Asa Hutchinson tweeted as he urged people to get their shots. In Seattle’s King County, the public health department found only three deaths during a recent 60-day period in people who were fully vaccinated. The rest, some 95% of 62 deaths, had had no vaccine or just one shot.

“Those are all somebody’s parents, grandparents, siblings and friends,” said Dr. Mark Del Beccaro, who helps lead a vaccination outreach program in King County. “It’s still a lot of deaths, and they’re preventable deaths.” In the St. Louis area, more than 90% of patients hospitalized with COVID-19 have not been vaccinated, said Dr. Alex Garza, a hospital administrator who directs a metropolitan-area task force on the outbreak. “The majority of them express some regret for not being vaccinated,” Garza said. “That’s a pretty common refrain that we’re hearing from patients with COVID.” The stories of unvaccinated people dying may convince some people they should get the shots, but young adults — the group least likely to be vaccinated — may be motivated more by a desire to protect their loved ones, said David Michaels, an epidemiologist at George Washington University’s school of public health in the nation’s capital. Others need paid time off to get the shots and deal with any side effects, Michaels said. The Occupational Safety and Health Administration this month began requiring health care employers, including hospitals and nursing homes, to provide such time off. But Michaels, who headed OSHA under President Barack Obama, said the agency should have gone further and applied the rule to meat and poultry plants and other food operations as well as other places with workers at risk. Bagne, who lived alone, ran a business helping people incorporate their companies in Wyoming for the tax advantages. He was winding down the business, planning to retire, when he got sick, emailing his sister in April about an illness that had left him dizzy and disoriented. “Whatever it was. That bug took a LOT out of me,” he wrote. As his health deteriorated, a neighbor finally persuaded him to go to the hospital. “Why was the messaging in his state so unclear that he didn’t understand the importance of the vaccine? He was a very bright guy,” his sister said. “I wish he’d gotten the vaccine, and I’m sad he didn’t understand how it could prevent him from getting COVID.”

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

More than 600,000 people in the U.S. have now lost their lives to COVID-19, a staggering toll that comes even as new infections and deaths steadily decline and much of the country attempts to return to pre-pandemic normal life.  The rate of severe illness and death has fallen dramatically as more and more people get vaccinated, but hundreds of people are still dying daily, offering a striking contrast with the joyous scenes of reopening. Worldwide, more than 176 million people have been diagnosed with the coronavirus, according to a Johns Hopkins University tracker, and more than 3.8 million have died from it.  The U.S. in late February became the first country to surpass a half-million coronavirus deaths. That it has taken more than three months to reach 600,000 deaths is a testament to the slowing pandemic — it took just a month for the U.S. to jump from 300,000 to 400,000 COVID-19 deaths. But it is also a sign that the virus is still circulating, and new variants pose an even greater threat to the remaining people who are unvaccinated. Nationally, 64.5 percent of people in America above age 18 have received at least one dose of vaccine, according to the Centers for Disease Control and Prevention (CDC).

President Biden has set a goal of vaccinating 70 percent of U.S. adults with at least one dose of a COVID-19 vaccine by July 4. While 13 states have reached that threshold, others are lagging behind, especially in the southeast, and the nation appears increasingly unlikely to meet Biden's benchmark. The vaccination rate in the U.S. fell by nearly half in the past few months. At its peak in mid-April, an average of nearly 3.4 million vaccines were being administered daily, according to CDC data, but by May about 1.8 million were being administered, a drop of 46 percent. The daily rate of vaccinations dropped below 1 million doses for the first time earlier this month. Experts say the effort has already reached the low-hanging fruit of people eager to get vaccinated, and the new phase needs to be much more individually focused. Racial and ethnic disparities persist, with access to a vaccine being reported as the most common impediment. However, there is also a significant political disparity, as white Republicans say they have no intention of ever getting vaccinated.  Officials have acknowledged that multiple states across the country have recently stopped asking for the full allotment of vaccines from the federal government. The federal government last week had to extend the shelf life of the Johnson & Johnson vaccine by six weeks, after multiple state officials warned their doses in storage would expire before the end of this month. Despite the drop in vaccine demand, the nationwide vaccination effort appears to be paying off, with the daily infection rate continuing to drop. In May, the number of new reported COVID-19 cases fell below 10,000 for the first time since March 2020. More than 33 million coronavirus cases have been reported in the U.S. so far.

Vaccine advisers to the federal government tell CNN they don't foresee AstraZeneca's Covid-19 vaccine being used in the United States, and even if it were offered, they personally wouldn't take it, given the other available options.  At one point, hopes had been high for AstraZeneca's vaccine, with the US pledging to invest up to $1.2 billion in the vaccine. But questions arose about the accuracy of AstraZeneca's data, and even more significantly, on Wednesday, European drug regulators said there was a possible link between the AstraZeneca vaccine and rare blood clots. Some countries -- more than 70 have authorized the shot -- have now limited its use. Dr. Anthony Fauci told CNN Wednesday that even if the US Food and Drug Administration granted emergency use authorization to AstraZeneca's vaccine, there's no need for it right now in the United States.  "We already have contracted for enough vaccines, from Moderna and from Pfizer and from [Johnson &Johnson]," he said. "There is no plan to immediately start utilizing the AstraZeneca [vaccine] even if it gets approved through the EUA, which it very well might." Fauci said it wasn't because of the AstraZeneca vaccine itself, but rather that it's not necessary in the US right now.

"It's not any indictment against the product. We just have a lot of vaccines," he said.  But experts advising the government on vaccine policy say that doesn't paint the whole picture. The three advisers spoke to CNN on the condition of anonymity because of the sensitivities surrounding AstraZeneca's possible application to the FDA. One adviser told CNN that federal health officials have privately expressed concern that offering AstraZeneca could increase vaccine hesitancy in the US, which is already a problem among some groups.  "I think they're crossing their fingers that AstraZeneca won't apply for emergency use authorization," the adviser said. "This vaccine has a checkered past. There's baggage. Why go down that road if we don't have to?" Pfizer, Moderna, and Johnson & Johnson's vaccines have excellent safety records, with tens of millions of shots without any reported serious side effects. "Everyone would raise questions -- 'You're not giving me that new blood clotting vaccine, are you?'" another adviser said, referring to AstraZeneca's vaccine. "Why muddy the waters with a vaccine that comes with a somewhat checkered reputation?"

Covid-19 update: The U.S. has now reached 200,000 coronavirus deaths, just four months after the death toll hit 100,000. In the predawn hours of March 30, Dr. Deborah Birx stepped in front of the camera on the White House lawn and made an alarming prediction about the coronavirus, which had, by then, killed fewer than 3,000 people in the United States. "If we do things together, well, almost perfectly, we can get in the range of 100,000 to 200,000 fatalities," Birx, coordinator of the White House coronavirus task force, told Savannah Guthrie of NBC News' "Today" show. "We don't even want to see that," she added, before Guthrie cut her off. "I know, but you kind of take my breath away with that," Guthrie said. "Because what I hear you saying is that's sort of the best-case scenario." "The best-case scenario," Birx replied, "would be 100 percent of Americans doing precisely what is required." On Saturday, Birx's prediction came true, as the number of lives lost to Covid-19 in the U.S. topped 200,000. Experts like Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention, said it didn't have to be this way. "Tens of thousands of people would not have died if the U.S. response had been more effective," said Frieden, now president of Resolve to Save Lives, a global public health initiative.

Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said Birx's prediction in late March was "very sobering." That was the time, he said, to develop and implement a plan to stop or at least slow the spread of the virus. That didn't happen then, and it hasn't happened since. "Where is our national plan?" Osterholm asked. "How are we this far along and we don't have one?" "We have a long way to go," he added. Indeed, the country still faces many challenges in overcoming the pandemic, including agreeing on even the most basic facts. Americans are still fighting over whether to wear masks, whether the virus is serious and to what extent it's safe to reopen certain businesses and to resume certain activities. In short, 100 percent of Americans — government officials included — still aren't doing precisely what is required.

Now, many experts are making another ominous prediction: A surge in the number of new infections in the fall and winter, combined with growing fatigue over social distancing and other public health measures, could result in more than 415,000 deaths in the U.S. by January, according to the Institute for Health Metrics and Evaluation, or IHME, at the University of Washington. The prediction comes even as doctors are growing more adept at treating patients and clinical trials are finding that treatments like remdesivir and dexamethasone can help. And as the pandemic has spread, it has moved into younger, healthier populations, who are less likely to die from Covid-19. The IHME's projections are by no means set in stone. Changes in human behavior, such as increased adherence to wearing masks, can bring the number down considerably, said the director of the IHME, Dr. Christopher Murray, a professor of health metrics sciences at the University of Washington. But the experiences of other countries have shown that, as the pandemic wears on, public complacency is a real concern. "We're seeing it in a very big way in parts of Europe, for example, where lack of vigilance is leading already to a big uptick," Murray said. The IHME model is one of several that the CDC uses to track the evolution of the pandemic, but it has faced its share of skepticism. The model often includes high degrees of uncertainty, and it was criticized early on for underestimating the number of deaths nationwide. In April, for example, the IHME model projected that the death toll in the U.S. through August could be 60,415, although the prediction included a wide range to account for uncertainties early in the pandemic...

One of the nation's top health experts recommends continuing avoiding large crowds and social interactions as the best defense against the pandemic.