HONG KONG For Chan Shun Ki, a cleaner at a construction site in Hong Kong, getting over the coronavirus was the easy part.
Ms. Chan was anxious to return to work after missing more than a week last month while recovering. She had already skipped her rent payment after the pandemic wiped out her previous jobs cleaning hotels and waiting tables. She was borrowing money from relatives to make up for the loss of her $83 daily wage.
But then she received a text message from the government health system, which was battling days-long backlogs. It ordered her to stay home for two more weeks because her coronavirus test had come back positive. She had taken it 12 days earlier.
I feel so much pressure, said Ms. Chan, who is a single mother of a 15-year-old. The government is really incompetent, and it leaves us residents not knowing what to do.
As Hong Kong sinks under its fifth, and worst, coronavirus wave, the brunt is falling upon its most vulnerable: migrants, racial minorities, the working class. While the city has long been one of the most unequal on earth, rarely has the cost of that inequality been as steep as now.
That is, in part, because of the sheer scale of this wave, which in two months has led to more than 250,000 infections and 800 deaths multiple times as many as in the previous four waves combined. Bodies have piled up in hospital hallways because morgues have no more room. Older patients have been left on gurneys outdoors.
But the suffering has also been exacerbated, some say, by government policy. Under direction from the central Chinese authorities, Hong Kong officials have insisted on some of the worlds most stringent social distancing rules, crippling many service industries. Yet, they have failed to contain the virus.
As a result, poor residents in cramped apartments have spread the virus to their families because the government has run out of isolation facilities. Those who recover cannot return to work because the testing jam means they cannot prove they are negative.
Migrant domestic workers, predominantly Southeast Asian women who work as caregivers and cleaners, have been fired after getting sick and forced to sleep on the streets. (Hong Kong law requires the workers to live in their employers homes.) Vegetable prices have soared, but the government has offered limited cash relief.
At times, officials have actively challenged efforts to help the needy. A top official threatened to prosecute members of the public who raised funds for migrant workers fined for violating social distancing rules.
Roger Chung, a professor of public health ethics at the Chinese University of Hong Kong, said the containment measures risked doing as much harm to low-income residents as the virus itself.
I dont think the goal of protecting peoples health from Covid-19 is the only incontestable goal in policymaking, he said. Because these policies can also take a toll on other peoples well-being, especially in destabilizing their income and livelihoods.
Even before the pandemic, Hong Kongs inequality was staggering. It has more billionaires than any city but New York, yet more than 200,000 residents live in carved-up tenement homes where the average living space per person is 48 square feet.
Amid the pandemic, those often dilapidated living quarters are even more perilous. The plumbing is frequently reconfigured to accommodate the multiple households sharing one apartment, and faulty installation can allow the virus to spread between floors. Insufficient ventilation has also fueled transmission.
Social distancing is impossible. Ms. Chan, the single mother, shares a one-room apartment with her son. Days after she fell sick, he did, too.
March 2, 2022, 9:48 a.m. ET
Some residents, desperate to avoid infecting their relatives, have slept on their rooftops or in stairwells. The Society for Community Organization, a nonprofit organization, said that it had received calls for help from nearly 300 people who were isolating at home, without access to food or medical supplies, since the fifth wave began in January.
The lack of isolation facilities has proved equally, if not more, challenging for migrant domestic workers, who make up about 10 percent of the working population, have few legal rights and often suffer discrimination.
Inah, an Indonesian worker who has been in Hong Kong for three years, began coughing on Feb. 21. Her employer ordered her not to return to the house until she had a negative test result, said Inah, who insisted on being identified only by her first name for fear of losing her job.
For hours, she stood in the rain outside her employers home. Finally, around midnight, her employer allowed her in, ordering her to go straight to her room without using the restroom, Inah said. In the morning, she was kicked out again.
Why do you just push me; you never helped me with anything? said Inah, who eventually found a place to stay through the nonprofit HELP for Domestic Workers.
HELPs executive director, Manisha Wijesinghe, said that, over five days in February, the group took in nearly 70 workers who had become homeless after testing positive.
Hong Kongs Labor Department said in a statement that firing domestic workers for illness was illegal.
Vaccine protection in adolescents. Five months after immunization, two doses of the Pfizer vaccine appeared to offer virtually no defense against moderate illnesscaused by Omicron among adolescents aged 12 to 17 years, according to new C.D.C. data. Booster shots, however, dramatically increased the protection.
But the authorities themselves have been accused of discrimination. Last month, after the government tightened restrictions on group gatherings, the police announced they had conducted a raid in an area where domestic workers commonly gather and issued 17 tickets. The $640 per person fine is more than the workers minimum monthly wage.
In response, some residents organized an online fund-raiser, collecting $14,000 in three days. Then the labor secretary, Law Chi-kwong, accused them of encouraging illegal activity and said he would consider legal action. The organizers shut down the fund-raiser.
Even residents who have avoided infection are straining under the pandemics economic burden.
The prices of vegetable shot up after one-fifth of the citys vegetable truck drivers were left unable to work because of quarantine rules. (About 90 percent of Hong Kongs produce comes from mainland China.) In late February, the average cost of Chinese lettuce was nearly three times as high as the price a month earlier, according to official statistics. Prices for tomatoes and potatoes have nearly doubled.
Chan Lap To, who owns a vegetable stand on western Hong Kong Island, said most customers were buying less than usual. But he had to hike prices. In addition to running the stall, he also sold vegetables to hotels and restaurants, and that business had plummeted by half because of the unstable supply and weak demand.
He said he had not received any government aid to make up for his losses. This is very unfair for all Hong Kong people, Mr. Chan said. Its all connected.
The government has offered financial support for certain industries, and last week, officials proposed a nearly $22 billion relief package, including roughly $1,300 vouchers for most residents. But some businesses have been excluded from the previous subsidies. And the vouchers are digital, meaning they cannot be used for rent or at ubiquitous stalls like Mr. Chans that accept only cash.
Hong Kong also does not have unemployment insurance. The government pledged last month to give one-time $1,300 payments to people who lost their jobs in the fifth wave. But those who became unemployed earlier were not eligible.
For Ms. Chan, the governments promises may bring temporary relief. But what she really wants is to get back to work. To do that, she would welcome even more draconian measures, such as a citywide lockdown, to get coronavirus cases under control.
Dragging along like this, so I cant work for several months this is no way to do things, she said. Short-term pain is better than long-term pain.
Joy Dong contributed reporting.
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In November, a new coronavirus variant took the world by storm. Omicron has since caused an unprecedented wave of infections, striking about 90 million people in just 10 weeks. Thats more COVID-19 cases than were recorded in all of 2020.
Omicron also left scientists scratching their heads. Its riddled with mutations, which might normally doom a virus. Early experiments showed that omicron wasnt nearly as good as the previous coronavirus variant champ, delta, at melding with a cells membrane crucial for infecting that cell or at replicating in lung cells. Yet here it was, sweeping delta virtually off the map in just weeks in some places (SN: 2/10/22). Omicron even managed to infect people who already had immunity to the virus from vaccines or previous cases of COVID-19. How, researchers wondered, was omicron doing it?
Its a very interesting variant, says virologist Shan-Lu Liu, who codirects the Viruses and Emerging Pathogens Program at The Ohio State University in Columbus. I call it weird.
Researchers in Botswana and South Africa were the first to unveil omicrons genetic makeup. Their analysis revealed more than 60 mutations, including 42 changes alone in omicrons spike protein the knobby structure on the surface of the virus that initiates a cell break-in and can help evade antibody defenses. Some of those mutations have popped up in previous variants, including alpha and delta. But omicron has never-before-seen tweaks and unique combinations of mutations.
Scientists have been scrambling to discover how those changes affect omicrons ability to infect people and cause disease. Researchers around the world are infecting cells in lab dishes with omicron mimics, putting the virus under the microscope, testing the viral variant in lab animals and examining medical and other records all to discover what makes the variant tick. Heres what scientists have found so far.
The secret of omicrons increased transmissibility has proven elusive. The spike protein is certainly one key to its success, allowing omicron to infect nearly 10 times as many cells as earlier versions of the virus, researchers in China reported December 17 in Signal Transduction and Targeted Therapy.
It is distinct from all other variants, from a structural point of view, says structural biologist Priyamvada Acharya. She and her colleagues at the Duke Human Vaccine Institute in Durham, N.C., used cryo-electron microscopy and other techniques to examine omicrons spike protein.
In past studies, researchers, including Acharya, have pinpointed how certain mutations have given previous variants a leg up. For instance, some mutations in the delta variants spike protein helped that version of the coronavirus more easily grab a human protein called ACE2 or more readily fuse with human cells (SN: 12/16/21). Omicron shares some of those mutations but has many others that drastically change how the variant behaves. Its not just one thing, Acharya says. Its multiple properties of the spike that confer an advantage to omicron.
Like other versions of the coronavirus, each of omicrons knobby spikes consists of three identical pieces that snap together in a single unit. Each of those pieces has a jointed, fingerlike portion called the receptor binding domain that reaches out, much like the prongs of a claw machine, to grasp ACE2 and anchor the virus to the cell it will infect.
Many antibodies that prevent the virus from entering cells target those fingers. But omicron keeps its knuckles bent, hiding the bits that antibodies will attack, Acharya and colleagues reported in a preprint, which has not been peer reviewed yet, posted January 26 at bioRxiv.org.
This closed-fist strategy helps the variant evade the immune system. But the fingers eventually have to extend in order to grasp ACE2. Some mutations essentially spring-load omicrons claw so that it can shoot out at least one finger to snag ACE2. That ensures some of the spike proteins studding the surface of the virus are always pointing the way to infect cells, Acharya and colleagues found.
Delta and alpha variants of the coronavirus were also likely to have multiple extended fingers, but those variants efforts to open up went way too far to the point that they lost control and fell apart, Acharya says. Omicron contains mutations that stabilize the spike protein through hydrogen bonds weak electrostatic connections between a positively charged hydrogen atom in one molecule with a negatively charged atom in another molecule. As a result, omicron doesnt become floppy the way the earlier variants do, the Duke group discovered. Another group also found new hydrogen bonds and other connections that help omicron keep itself together, researchers reported January 20 in Science. I think omicron has struck just the right balance, Acharya says.
Simple attraction may be one key to omicrons success.
In the cellular environment, it can be difficult to find your partner, says computational biologist Hin Hark Gan of New York University. Mutations in omicrons receptor binding domain give that fingerlike portion of the protein a positive electric charge, Gan and NYU colleagues in New York City and Abu Dhabi reported February 14 at bioRxiv.org.
That electric charge complements ACE2s negative charge, creating an electrostatic force that attracts the two proteins like a static-charged balloon to a wall, even over relatively long distances, the researchers propose in their preliminary report. Omicrons electrostatic attraction to ACE2 is three to five times greater than more neutrally charged deltas, the team found. The electrical attraction may make it easier for omicron to locate ACE2 on cells. Once the virus gets close to the human protein, other types of forces, including hydrogen bonds, cement the connection, he says.
Multiple teams around the world have recently proposed another thing that makes omicron special: The variant may not use the same entry route into cells that earlier versions of the virus use.
There are two major ways the coronavirus can enter cells (SN: 8/2/20). Both start with grabbing ACE2. In the direct route, a scissorslike protein called TMPRSS2 snips away part of the spike protein, revealing a portion that allows the virus to fuse with human cells and immediately dump its RNA inside to make new viruses. That is the way all previous versions of the SARS-CoV-2 have entered human cells.
But omicron may take a back door through a compartment inside the cell membrane called an endosome. There, a different scissorslike protein called cathepsin L cleaves the spike protein to allow the virus to dump its payload into the cell.
Omicron doesnt use the TMPRSS2 pathway efficiently and relies more on cathepsin L to get into cells, two groups of researchers independently reported February 1 in Nature. As a result, omicron doesnt fuse as well with cell membranes as delta does, those teams and other preliminary reports suggest.
That could seem like a handicap. But for omicron, it may be a good thing, Liu of Ohio State says. While the virus needs to fuse with cell membranes to get inside and replicate, too much fusibility may lead cells to merge with each other and die, he says. That would leave the virus with nowhere to copy itself.
Omicron may have struck the perfect balance between being fusible enough to enter cells, but not enough to kill its host, he says. This characteristic may also make omicron less likely to cause severe disease.
Once in the endosome, though, the viruses come up against a gang of protein guards called IFTIMs that block entry. But both delta and omicron have that problem licked: They breeze past those backdoor guards, researchers in the United Kingdom reported January 3 at bioRxiv.org.
Still, some researchers are not convinced that omicron uses the endosome back door into cells. In mimics of human airways grown in lab dishes, omicron used the direct route, but may be using a different and still unknown set of scissors than TMPRSS2, Bart Haagmans, a virologist at Erasmus Medical Center in Rotterdam, the Netherlands, and colleagues reported January 20 at bioRxiv.org.
Haagmans team infected various types of cells with omicron, delta or earlier versions of the coronavirus. In the first couple of days of infection, omicron infected more cells than delta did, and replicated faster, giving omicron a competitive edge.
Omicron was able to infect cells that dont have an endosome back door but do have TMPRSS2. It infects these cells much less efficiently than earlier versions of virus do. In another experiment, a chemical that blocks cutting by TMPRSS2 and other similar scissors proteins stopped omicron from breaking into cells, suggesting that some sort of spike cutter is still needed. Together, those results indicate that omicron uses TMPRSS2 inefficiently and might use different scissors all together, the researchers conclude. Those unknown scissors arent on lung cells, as omicron has a hard time breaking into those cells in lab dishes, the team found. That work is still preliminary, Haagmans stresses, and it is difficult to predict from studies of cells grown in lab dishes how the virus will behave in humans.
Acharyas group sees another possibility: Omicron may not need scissors to trim it before it can enter cells. Some of omicrons mutations may expose the fusion peptide portion of the spike responsible for melding the virus with cells. Its possible that omicron could fuse directly with cells without being snipped, she speculates.
Omicron may use multiple routes for cell entry, depending on which type of cell it is infecting and what host proteins are available, Liu says. Its mixed. Its not one or the other, he says. Using different scissors or entry routes would allow omicron to break into potentially more types of cells than other versions of the virus could crack.
But the entry point may not matter as much as other of omicrons characteristics, Liu says. My take is that the major reason that this [version of the] virus spreads so fast is because it evades antibody protection.
As omicron took over globally, it quickly became obvious that the variant could slip past antibodies and patrolling immune cells. Unvaccinated people remained the most likely to get infected, with 3,230.1 of every 100,000 unvaccinated people developing a case of COVID-19 at the height of the omicron peak on January 8, according to the U.S. Centers for Disease Control and Prevention.
But a startling 1,467.31 of every 100,000 fully vaccinated people also got breakthrough infections at that time. And fully vaccinated people who got a booster dose were still being infected at a rate of 1,053.6 for every 100,000 people on January 8. That far exceeds even slippery deltas peak rate of 699.12 of every 100,000 unvaccinated and 140.8 of every 100,000 fully vaccinated people on August 28.
A study of the Moderna vaccines effectiveness conducted at Kaiser Permanente Southern California in December found that two doses of the mRNA vaccine were about 80 percent effective at protecting against delta infection from 14 to 90 days after inoculation. That effectiveness slipped to 68.9 percent for people three to six months out from their second shot. A booster shot raised the effectiveness against delta infection back to nearly 94 percent, though it dipped to 86 percent after two months. Both two and three doses of the vaccine gave better than 99 percent protection against hospitalization from delta, researchers reported February 21 in Nature Medicine.
Contrast those figures with omicron. Two doses of Modernas vaccine were 44 percent effective at preventing omicron infection from 14 to 90 days after getting the shot, quickly dipping to 23.5 effectiveness in the three- to six-month period after getting jabbed. A booster shot brought the effectiveness against omicron infection up to 71.6 percent for about two months, after which it declined to 47.4 percent. Against hospitalization from omicron, two doses were 84.5 percent effective. A booster dose brought effectiveness against hospitalization back above 99 percent.
How did omicron manage to get past the highly effective vaccine? The variant swapped out or is missing some of the spots on the spike protein where antibodies latch on to other variants, multiple studies show. And new data that hasnt yet been vetted by peer-review may suggest other reasons omicron is so sneaky.
First, the variants spike protein has that closed-fist stance that protects its ACE2-grabbing bits from antibodies. It has also changed shape slightly to tuck away other spots where antibodies can bind, helping the protein escape from the immune system, Acharya and colleagues found. For instance, one popular hitching post for antibodies is called the N-terminal domain, but there are so many mutations that, omicron has completely destroyed the N-terminal domain for antibodies. Nothing binds there, she says.
Another evasion tactic: Omicron is especially good at spreading from cell to cell where the immune system cant catch it as easily as when it is outside of cells, Liu and colleagues reported December 20 at bioRxiv.org. Despite not being good at fusing cells together, the variant is nearly 5 times better at cell-to-cell spread than an early version of the virus.
Plus, the same electric charge that helps omicrons receptor binding domain to hold ACE2 may repel antibodies, the New York University researchers found. The team tested a handful of monoclonal antibodies taken from people who had recovered from COVID-19 early in the pandemic. Just like the omicron spike protein, those antibodies all carried positive electrical charges, which may act like a force field keeping antibodies away from the spike protein.
A strategically placed sugar molecule stuck to the receptor binding domain may also obscure the spike protein from immune system attack, researchers at the University of WisconsinMadison reported February 10 at bioRxiv.org.
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About the only good news about omicron is that it is less likely than the delta variant to cause severe disease. It is definitely less virulent than delta, says William Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health in Boston.
But there are challenges to pinpointing just how dangerous omicron may be, Hanage and Harvard colleague Roby Bhattacharyya discussed February 2 in the New England Journal of Medicine. Hospitals full of COVID-19 patients infected with omicron attest that the variant still has teeth and can cause severe illness or kill people. While vaccines and immunity from prior or breakthrough infections may blunt omicrons edge, its increased infectiousness and slipperiness may offset its reduced nastiness.
Even so, you would definitely rather have 750,000 daily cases of omicron than delta, because delta would be much worse, Hanage says. For instance, the risk of dying from omicron is about 60 percent lower than the risk of death from a delta infection, the United Kingdoms Health Security Agency reported February 11.
One reason for omicrons relative mildness may be that it doesnt replicate as well in lung cells as it does in the airways that feed the lungs, researchers in Hong Kong reported February 1 in Nature. That finding, initially reported in December, has also been confirmed with preliminary work from Haagmans and others (SN: 12/21/21).
Another omicron Achilles heel may be that it triggers interferon responses, the frontline of the immune systems antiviral defenses, a study published January 21 in Cell Research found.
Gan of New York University speculates that omicrons positive charge may cause the viral variant to get trapped in negatively charged mucus more easily than previous variants were.
Still, omicron can be dangerous in a number of ways, including landing vulnerable people in the hospital and sickening large numbers of hospital staff at the same time, Hanage says. It is definitely milder, but thats not a reason to chill.
Add to that the fact that a sibling version of omicron called BA.2, which has some different mutations from the original omicron, has now burst on the scene (SN: 2/24/22). BA.2 seems to be slightly more infectious than the original version. Though cases of omicron are falling overall, BA.2s proportion of those cases is growing, and some experts warn that it could prolong the omicron outbreak or lead to another wave of infections.
DENVER (KDVR) Colorado is moving into the endemic phase of COVID-19, the governor announced last week.
The state continues to see a decline in COVID-19rates. Only six counties saw an increase in positivity in the last week.
As of Monday, the states seven-day positivity rate was 4.01%, which is down from 5.81% seven days ago. Positivity rate measures the amount of COVID positive tests to the total amount of tests taken.
Over the last week, 55 counties saw a decrease in COVID-19 positivity, six counties saw a rise, and three counties administered fewer than 10 tests.
According to theColorado Department of Public Health and Environment, incidence rates also dropped over the last week.
Heres a look atpositivity rates for every county over the last seven days:
According toJohns Hopkins Bloomberg School of Public Health, the percent positive is exactly what it sounds like: the percentage of all coronavirus tests performed that are actually positive, or: (positive tests)/(total tests) x 100%. The percent positive (sometimes called the percent positive rate or positivity rate) helps public health officials answer questions suchas:
The percent positive will be high if the number ofpositive testsis too high, or if the number oftotal testsis too low. A higher percent positive suggests higher transmission and that there are likely more people with coronavirus in the community who havent been tested yet, Johns Hopkins shared.
Manatt, Phelps & Phillips LLP
02 March 2022
Manatt, Phelps & Phillips LLP
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With new COVID-19 infections and hospitalizations falling topre-surge levels, on February 25, 2022, Governor Gavin Newsom actedto lift almost all of the remaining provisions of his COVID-19executive orders (EOs).
The Governor's Executive Order N-04-22 provides for thetermination of about 95% of the remaining EO provisions by June 30,2022. The policies will be lifted in three tranches, withroughly a third terminated immediately, another third terminated onMarch 31 and the remaining third terminated on June 30. TheGovernor is delaying the termination of some provisions "toensure that impacted individuals and entities have time to preparefor the changes."
The few provisions left in place by Governor Newsom are in linewith the key elements of his SMARTER Plan for managing COVID-19 as along-term public health issue. These provisions fall into fivegeneral categories:
Governor Newsom explained:
As we move the state's recoveryforward, we'll continue to focus on scaling back provisionswhile maintaining essential testing, vaccination and health caresystem supports that ensure California has the needed tools andflexibility to strategically adapt our response for what liesahead.
The Governor's announcement coincides with continued easingof mask requirements in the remaining parts of California that haveenforced them. This includes Los Angeles County, whichrelaxed its indoor masking requirement onFebruary 25, 2022.
The content of this article is intended to provide a generalguide to the subject matter. Specialist advice should be soughtabout your specific circumstances.
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URBANA As school districts around the state drop mask requirements, the Urbana school board voted Tuesday to keep its requirement, at least through spring break.
If we see a big increase in positivity due to spring-break travel, it will be way harder to say, Hey, weve taken our masks off, lets put them back on, Superintendent Jennifer Ivory-Tatum told the board. Once we take the toothpaste out of the tube, we cannot put it back.
Wed like to have that time to watch the positivity rates, to give our community a little more time, she added. We are really just on the downswing of omicron, and we just feel like its too soon and that we need a little more time to watch what is happening and how this is playing out in our community. After spring break, wed like to re-evaluate, assess our position and look at the big picture.
Ivory-Tatum said shes been in close contact with the Champaign-Urbana Public Health District, specifically about the new omicron BA.2 variant and its prevalence, and has gotten positive feedback about the districts plan to move forward.
In addition, the district will still require students and staff members who test positive to stay home for five days, and they will still be required to wear a mask for five days after that.
Ivory-Tatum said Awais Vaid, deputy administrator at the health district, indicated to her that what were doing is smart and that were giving our community a couple more weeks to see what this variant is going to do.
She said the district hasnt had an issue with requiring asymptomatic students and staff to stay home because of the districts rigorous testing procedures. That testing availability wont change.
A few weeks ago, Ivory-Tatum said, the district was having a hard time procuring all of the testing materials it needed. Now that many districts have stepped away from their mitigation procedures, she said the district is able to get all the tests it needs. It also participates in a program in which it uses the University of Illinois SHIELD saliva test.
Only one board member, Brenda Carter, pushed for a need to move toward removing the mask requirement after spring break.
If we are going to be revisiting this conversation in three weeks, thats going to need to have a very specific road map for that to happen, board member Lara Orr said. Otherwise, we know the parameters we have the tests, we have masks, lets get to the end of school.
For board member Brian Ogolsky, the decision was clear after seeing results of a survey of teachers that showed that a majority prefer masks and hearing from the boards student ambassadors Tuesday, who said a majority of his classmates would prefer to keep the requirement in place.
For me, what it boils down to is, How do we minimize disruption in schools, Ogolsky said. When I listen to 57 percent of the teachers saying theyd prefer to see out the rest of the year with masks on, that is an extremely compelling piece of data saying that this is going to minimize disruption to the schools. When I listen to our ambassadors saying that they talk to other students and more are wanting masks than arent.
To me, we want our schools open and not be disrupted, and we need teachers in those buildings. I appreciate, though, that were willing to have these conversations.
Patient deaths: 952,423
Total vaccine doses distributed: 690,435,045
Patients whove received the second dose: 215,677,777
% of population fully vaccinated: 65%
% of infections tied to the Omicron Variant: 100%
Everyone 12and older isnow eligible to receive a COVID-19 booster shot, regardless of underlying medical conditions, giventhe following criteria:
Pfizer is the only FDA-authorized vaccine for people younger than 18, so it is the vaccine used as a booster for those age 12through17.
For more information, see this FAQ. To find a booster dose, find a vaccination site or call the Community Vaccination Line at 1-888-445-4111.
All adults in Pennsylvania are eligible to schedule a COVID-19 vaccine booster. Kids and adolescents ages 12-17 are eligible for a Pfizer booster.
Boosters for the Pfizer and Moderna vaccines are available if its been at least five months since your initial series of two doses.
Individuals who received the Johnson & Johnson (Janssen) vaccine are eligible to get a booster if its been at least two months since your initial dose.
Regardless of which brand of vaccine was received for a primary vaccination, individuals can take any brand for a booster dose.
Find a provider near you to schedule a booster.
Should I be wearing a face mask?
Should I get a COVID-19 vaccine booster?
These are just two of the many questions and concerns physicians and other health care providers frequently encounter when discussing face masks and COVID-19 vaccines with patients. The following guidance is intended to provide some suggested practices for physicians when engaging patients in these discussions.
DO encourage patients in areas with high COVID-19 Community Levels to mask up.
According to current Centers for Disease Control and Prevention (CDC) guidelines, all individuals 2 years and older, regardless of vaccination status, living in areas with high COVID-19 Community Levels should be masking in public. The CDC also recommends in areas with medium COVID-19 Community Levels, individuals at high risk for severe illness and immunocompromised should speak with their physician about taking additional precautions in public, such as mask wearing.
The CDCs COVID-19 Community Level recommendations do not apply in health care settings. Health care setting should continue to monitor community transmission rates and follow CDCs infection prevention and control recommendations for health care settings. Currently, most areas across the country and nearly all of Michigan are presently considered to have substantial or high transmission of COVID-19.
DO encourage patients to get vaccinated.
Based on CDC and FDA guidelines, patients should be encouraged to receive the COVID-19 vaccine to help build protection from the virus. Physicians should counsel patients, who are not candidates for the vaccination due to medical conditions, on risk mitigation strategies, such as wearing face masks indoors, social distancing and hand washing.
DO encourage eligible patients to receive COVID-19 boosters.
When recommending booster doses for patients, reassure patients that the vaccines are effective, but research has shown a slight decrease in protection over time. Remind patients that booster shots are normal for vaccines, such as the annual flu shot or Tdap booster every 10 years. COVID-19 boosters offer elevated protections and have worked well against most variants. Pursuant to the latest CDC guidance from February 2, 2022, the following individuals are currently eligible for a booster dose of the COVID-19 vaccine:
For further recommendations regarding to COVID-19 vaccine eligibility, special clinical considerations, and alerts, visit the
Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States webpage.
DO use effective communication that is tailored to the patient.
Physicians are a trusted source of information for patients and you should share accurate, clear, and easy-to-find information that addresses common questions. In encouraging patients to getvaccinated against COVID-19 it is important to listen to patients concerns. Professional answers to patient questions and concerns matter and can help them make an informed decision about receiving the vaccine.
Physicians should consider using words which will better resonate with each patient. For example, when discussing the benefits of COVID-19 vaccination, explain the safety of the vaccine and the benefits to the patient and his or her family. Physicians should also be transparent with patients, such as discussing potential side effects of the COVID-19 vaccine or the effectiveness of cloth vs other types of face masks in preventing the transmission of COVID-19 indoors or in crowded places.
Physicians should avoid using judgmental language against individuals with face mask or vaccine concerns, which could negatively impact the patients trust and the overall physician-patient relationship. In addition, sharing facts about face masks and the COVID-19 vaccine, as opposed to personal opinions, may be more effective.
DO continue to implement COVID-19 policies and other infection prevention measures recommended by the CDC and MDHHS.
The CDC continues to recommend that medical practices and facilities use additional infection prevention and control practices during the COVID-19 pandemic, including, but not limited to, telehealth visits where medically appropriate, screening patients and visitors entering the facility for signs and symptoms of COVID-19, and implementing source control measures, such as face masks.
If a patient or visitor objects to or refuses to comply with the practices COVID-19 policies, such as refusing to wear a face mask, physicians should ensure its policies include a protocol for explaining the CDCs guidelines for health professionals, which may be different from mandates or guidelines for individuals, and that a patient must comply with the policies while inside the facility. If necessary and appropriate, the patients appointment may be rescheduled to a telehealth visit, or the patient may be referred to another physician for treatment.
DONT routinely terminate patients who refuse to receive the COVID-19 vaccine.
It has been reported in the media that some physicians are refusing to treat unvaccinated patients. In other instances, some physicians have declined to treat children based on the parents vaccination status, although the American Pediatric Association advises against refusing to treat pediatric patients based on parental vaccination status or position. Generally, a physician is legally free to determine whom to treat and to end the physician/patient relationship with appropriate advance notice. Until consensus develops on any potential ethical, licensing or liability risk exposures that physicians could face by routinely declining to treat individuals who are unvaccinated or due to the vaccination status of others, physicians should consider making treatment decisions based on the facts and circumstances of each situation.
DO implement a process for handling patient claims of medical exemptions from the practices COVID-19 policies applicable to patients.
Medical practices are generally considered places of public accommodation and must comply with the federal Americans with Disabilities Act as well as Michigans Persons with Disabilities Civil Rights Act, when enforcing the practices own COVID-19 policies. Physicians need to have a process to address requests by patients and visitors for exemptions from the practices face mask mandate or similar policies based on medical grounds and to assess whether or not reasonable accommodations are possible. Physicians should not assume that an unmasked patient or visitor cannot medically tolerate a face mask or comply with other COVID-19 policies, but physicians are permitted to accept the patient or visitors verbal representation to that effect. Best practices advise to not request medical documentation from the patient or visitor to determine whether the patient or visitor has a disability warranting a reasonable accommodation.
DONT provide face mask or vaccine exemption letters or documentation to patients which are not medically necessary.
Several media sources have reported on several physicians who have been disciplined by various state medical boards for issuing medical exemptions to patients without an objective medical basis for the exemption. Some physicians individually oppose policies which mandate face masks or COVID-19 vaccinations. Other physicians may empathize with patients who may be negatively impacted by their refusal to comply with mandatory COVID-19 policies, such as a patient who may face termination from employment unless the patient receives the COVID-19 vaccine. Regardless, physicians should not attempt to help patients circumvent COVID-19 policies applicable to patients by drafting letters or other documentation regarding the patients medical condition that is false or misleading.
