Let's focus on reaching the unvaccinated at home and abroad as we await more data on Omicron

by Amesh Adalja, MD December 2, 2021

In the wake of the discovery of the Omicron variant of COVID-19, the CDC modified its guidance on booster vaccines. [MedPage Today]

The agency now says that all adults should get a booster vaccine dose if at least 6 months have passed since their initial mRNA vaccine series (or 2 months for Johnson & Johnson recipients). For some time, there have been differing opinions over the benefit of universal boosting, especially for healthy younger individuals. Now it is important to consider whether Omicron changes the calculus.

A booster dose has clearly been demonstrated to be beneficial for certain populations. However, the net benefit of rushing to boost the average healthy person is less clear, especially in the context of the potential need for an Omicron-specific vaccine in the near-term and considering the global fight against COVID-19, which depends on first and second doses.

Studies have established, unsurprisingly, that a booster dose increases antibody levels and is, at least temporarily, likely to stave off a breakthrough infection. But with a destined-to-be endemic coronavirus, a breakthrough infection (symptomatic or asymptomatic), especially with our current vaccines, is likely for most people. For those at heightened risk for severe COVID-19, preventing a breakthrough infection from becoming severe is very important. Anyone over 65 or who has underlying conditions should be boosted as soon as possible. But for most people who are not at high-risk for severe COVID-19, any breakthrough infection will be unlikely to cause severe illness, hospitalization, or death. Therefore, for the young, healthy population, the value of boosting with the vaccine currently available to transiently prevent what would likely be non-severe illness is, to me, of marginal value. The likelihood of non-severe COVID-19 in young, healthy people is almost certain to be as true for Omicron as it has been for Delta, and we will learn more in the coming days and weeks.

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Since 1988, World AIDS Day has been an annual call to end the HIV/AIDS pandemic as we remember the many who lost their lives to the disease. Considerable progress has been made since the first World AIDS Day; however, far too many people continue to acquire HIV and die from its related illnesses. In 2020, an estimated 680,000 people globally died from HIV-related causes, and roughly 1.5 million people became newly infected with HIV, according to the World Health Organization (WHO). (NIH 12.1.2021]

Remarkable scientific progress achieved over the past four decades has led to highly effective HIV treatment and prevention strategies. Unfortunately, these life-saving tools are not reaching all the people who most need them. The theme for World AIDS Day 2021 is Ending the HIV Epidemic: Equitable Access, Everyone’s Voice. Equity must be a goal for every researcher, public health official, healthcare worker, and advocate working to address HIV/AIDS. Here in the United States, HIV remains a major healthcare challenge that disproportionately affects marginalized groups, such as members of the Black/African-American and Latinx communities, women, people who use drugs, men who have sex with men, and transgender women. A part of U.S. government efforts to end the epidemic in the United States, NIH research plays a key role in the HIV National Strategic Plan: A Roadmap to End the Epidemic(link is external), and its goal of reducing new HIV cases by at least  90% in 2030.

Download the HIV National Strategic Plan here. 

Download the One-Page Highlighted Brief here. 

For the full announcement, visit this page. 

The National HIV/AIDS Strategy and the Ending the HIV Epidemic in the U.S. Initiative

The Strategy and the Ending the HIV Epidemic in the U.S. (EHE) initiative are closely aligned and complementary. They have the common goal of reducing new HIV transmissions in the United States by 75% by 2025 and by 90% by 2030. The Strategy is the broader, overarching national plan that extends across many federal departments and encompasses the entire nation. The EHE initiative will be a leading component of the work by the Department of Health and Human Services – in collaboration with state, tribal, territorial, and local partners – to implement the Strategy.

More details here> 

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During the COVID-19 pandemic, people have been exposed to an abundance of information from a large number of sources. Amid all this information, many people have also been exposed to health misinformation: information that is false, inaccurate, or misleading according to the best available evidence at the time. Misinformation has caused confusion and led people to decline COVID-19 vaccines, reject public health measures such as masking and physical distancing, and use unproven treatments. [HHS Office of the Surgeon General]  The U.S. Surgeon General's Community Toolkit for Addressing Health Misinformation, developed in collaboration with the HHS Office of Evaluation Sciences (OES), provides specific guidance and resources for health care providers, educators, librarians, faith leaders, and trusted community members to understand, identify, and stop the spread of health misinformation in their communities. Check out the 22-page toolkit.  Download the toolkit here>  Learn more here>  ###

Community Resilience Estimates for Equity matter. They have been updated by the US Census Bureau. 

The Community Resilience Estimates (CRE) provide an easily understood metric for how at-risk every neighborhood in the United States is to the impacts of disasters, including COVID-19. 

Here are Cook County's numbers. 

For more details and to learn more, visit this page: 

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The Biden administration is investing $1.5 billion from the COVID-19 aid package to address healthcare workforce shortages in underserved communities, the White House announced Nov. 22. 

The funding will go to the National Health Service Corps, Nurse Corps, and Substance Use Disorder Treatment and Recovery programs, which address workforce shortages by providing scholarship and loan repayment funding for healthcare students if they agree to work in high-risk and underserved communities. 

The funding, provided through the American Rescue Plan, will support more than 22,700 providers, including physicians, nurses and dentists. 

The Biden administration also plans to award $330 million in funding for the Teaching Health Center Graduate Medical Education program. This additional funding will further support the expansion of the primary care physician and dental workforce in underserved communities through community-based residency programs.  

Read more here> 

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Between Nov. 11 and Nov. 18, 141,905 COVID-19 cases were reported among children in the U.S., marking a 32 percent increase since the week ending Nov. 4., according to a Nov. 22 update from the American Academy of Pediatrics. [Becker's Health Review 11.23.2021]

Children accounted for about a quarter of weekly COVID-19 cases in the U.S. for the week ending Nov. 18 and about 17 percent of total accumulated cases since the start of the pandemic. 

Overall, the data indicates severe illness due to COVID-19 is uncommon among children, with 0.1 percent to 1.9 percent of child cases resulting in hospitalization throughout the pandemic, according to the American Academy of Pediatrics update, which includes hospitalization data from 24 states and New York City. The latest update also found less than 1 percent of all child COVID-19 cases resulted in death, based on mortality data from 45 states and New York City. 

"However, there is an urgent need to collect more data on longer-term impacts of the pandemic on children, including ways the virus may harm the long-term physical health of infected children, as well as its emotional and mental health effects," the update said. 

While the risk of severe COVID-19 illness among children remains low, health officials urge vaccination among those eligible to prevent potential long-term symptoms, hospitalization and multisystem inflammatory syndrome in children, a rare but serious condition linked to COVID-19. As of Nov. 1, more than 5,000 kids in the U.S. had developed MIS-C since 2020. 

The CDC recommends everyone ages 5 and older get vaccinated against COVID-19. The Pfizer-BioNTech shot is currently the only one authorized for use in children aged 5 to 17. 

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U.S. COVID-19 deaths in 2021 have now surpassed those from 2020, according to data compiled by Johns Hopkins University. (The Hill)

As of Monday at 8 a.m. EST, the unofficial U.S. COVID toll is 47,731,237 cases and 771,118 deaths, increases of 656,538 cases and 8,026 deaths versus a week ago. [MedPage Today 11.22.2021]

NIAID Director Anthony Fauci, MD, said vaccinated family members can certainly enjoy a maskless Thanksgiving together. (CNN)

Fauci also detailed how he was inundated with calls about beagle experiments after a "misleading image" went viral. (Washington Post)

Disney World announced that it has "paused" its COVID vaccine mandate, in light of the new anti-mandate Florida law. (Fox Business)

A new analysis projects that at least 12 states will have over 70% of their population fully vaccinated by the end of the year, while nationwide the U.S. vaccination rate among eligible Americans could reach 65%. (Verywell Health)

The Marine Corps is expected to come in last for military vaccine compliance. (Washington Post)

Michigan is asking that everyone ages 2 and up wear face masks indoors, as the state now leads the nation in new cases. (WXYZ)

Experts note COVID outbreaks are certainly now resembling those of a seasonal virus. (The Atlantic)

Older individuals and people with underlying conditions are most susceptible to breakthrough COVID infections requiring hospitalization, a Wall Street Journal analysis shows.

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Pregnant women with COVID-19 face increased chances for stillbirths compared with uninfected women, and that risk spiked to four times higher after the delta variant emerged, new government data show. [US News 11.19.2021]

The federal Centers for Disease Control and Prevention released a report Friday that examined 1.2 million deliveries in 736 hospitals nationwide from March 2020 through September 2021.

Stillbirths were rare overall, totaling 8,154 among all deliveries. But the researchers found that for women with COVID-19, about 1 in 80 deliveries resulted in stillbirth. Among the uninfected, it was 1 in 155.

Among those with COVID-19, stillbirths were more common in people with chronic high blood pressure and other complications, including those in intensive care or on breathing machines.

“These findings underscore the importance of COVID-19 prevention strategies, including vaccination before or during pregnancy,’’ CDC researcher Carla DeSisto and co-authors said.

There’s no information on how many had received COVID-19 shots, although the authors noted that the U.S. vaccination rate among pregnant people after delta emerged this past summer was 30%.

More details here>

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With about 1 in 5 healthcare workers leaving medicine since the pandemic began, The Atlantic explored numerous reasons why providers are leaving healthcare, coming up with at least seven key reasons. [Becker's Hospital  Review 11.18.2021]

The U.S. healthcare sector has lost nearly half a million workers since February 2020, according to estimates from the Bureau of Labor Statistics. Eighteen percent of healthcare staff have quit since the pandemic began, while 12 percent have been laid off, according to survey research company Morning Consult. Of the remaining workers, 31 percent have thought about leaving their employer, according to Morning Consult.  

"Physicians are some of the most resilient people out there," Sheetal Rao, MD, a primary care physician who left her job last October, told The Atlantic. "When this group of people starts leaving en masse, something is very wrong."

Excluding those who have left the field because of layoffs or conditions linked to long COVID, below are seven reasons healthcare workers are exiting the field, per The Atlantic: 

1. Many healthcare workers believed vaccines would ease the traumas endured in initial surges. However, plateauing vaccination rates, lifted mask mandates and the delta variant undid such hopes. The unrealized promise of "some sort of normalcy has made the feelings of exhaustion and frustration worse," Amanda Bettencourt, PhD, president-elect of the American Association of Critical-Care Nurses and assistant professor at Philadelphia-based University of Pennsylvania School of Nursing, told The Atlantic. 

2. COVID-19 patients may be more difficult to deal with now. Currently, most are unvaccinated, and while some didn't have a choice in the matter, those who did are often belligerent. Some resist basic medical procedures, while others have assaulted nurses and yelled for treatments the FDA hasn't authorized for COVID-19 treatment. Americans initially applauded its healthcare heroes; now, "we're at war with a virus and its hosts are at war with us," Cassandra Werry, RN, an intensive care nurse in Idaho, told The Atlantic. 

3. These experiences inflict deep psychological scars. "We want to be rooting for our patients," Artec Durham, RN, told The Atlantic. "But anyone I know who's working in COVID has zero compassion remaining, especially for people who chose not to get the vaccine." That's why Mr. Durham became a travel nurse, which is time-limited and more lucrative. He still provides care but is emotionally detached, unsettled by his own numbness. For a healthcare provider, being shaken by a patient's death comes with the territory, but becoming unmoved is almost worse, The Atlantic reported.

4. Many said they left medicine because of how their institutions acted amid the pandemic. Several workers told The Atlantic that hospitals cut salaries, benefits and raises; forced staff to work more shifts; denied paid time off or reduced hours; failed to provide sufficient personal protective equipment; and downplayed the severity of their experiences. "I've been a nurse 45 years and I've never seen this level of disaffection between clinicians and their employers," said Gerard Brogan, RN, director of the California Nurses Association and director of nursing practice at National Nurses United. Dubbed "the Great Resignation," the same is true for nearly every industry, with record numbers of Americans leaving their jobs this April, July and August.

5. Between 35 and 54 percent of U.S. nurses and physicians already felt burned out before the pandemic, according to the National Academies of Sciences, Engineering and Medicine. Now, amid the pandemic, many have been pushed to simply resign. 

6. Hospitals are also flooded by non-COVID patients who delayed care amid the pandemic and require more intensive care. "It doesn't feel great between surges," Esther Choo, MD, emergency physician at Portland-based Oregon Health and Science University, told The Atlantic. "Something always replaces COVID."

7. Healthcare workers want to help patients, and their inability to adequately do so is taking its toll. Providers aren't exiting the field because they can't handle their jobs — they're quitting because they can't handle being unable to do their jobs. 

Full article here>

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Nearly one in five patients with cirrhosis were prescribed opioids during outpatient visits, more often than not by a primary care physician (PCP), according to a national analysis of over 10 million ambulatory visits.

From 2006 to 2016, 17% of all outpatient visits for patients with cirrhosis resulted in an opioid prescription, usually a refill, reported Anna Lee, MD, of the University of California Los Angeles, during a presentation at the virtual American Association for the Study of Liver Diseases (AASLD) meeting. 

Download PDF of article here.

Full article here

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