When guests arrive at Jeanne Sauvages home in Seattle for Thanksgiving dinner this year, they will have to take a rapid Covid-19 test on her front porch before entering.
My husband and I have asthma and I have an autoimmune disorder, and so we just figured, why take the risk? says Ms. Sauvage, who got her booster shot in early November and is concerned about breakthrough infections.
Significance
Plastic waste causes harm to marine life and has become a major global environmental concern. The recent COVID-19 pandemic has led to an increased demand for single-use plastic, intensifying pressure on this already out-of-control problem. This work shows that more than eight million tons of pandemic-associated plastic waste have been generated globally, with more than 25,000 tons entering the global ocean. Most of the plastic is from medical waste generated by hospitals that dwarfs the contribution from personal protection equipment and online-shopping package material. This poses a long-lasting problem for the ocean environment and is mainly accumulated on beaches and coastal sediments. We call for better medical waste management in pandemic epicenters, especially in developing countries.
The COVID-19 pandemic has led to an increased demand for single-use plastics that intensifies pressure on an already out-of-control global plastic waste problem. While it is suspected to be large, the magnitude and fate of this pandemic-associated mismanaged plastic waste are unknown. Here, we use our MITgcm ocean plastic model to quantify the impact of the pandemic on plastic discharge. We show that 8.4 1.4 million tons of pandemic-associated plastic waste have been generated from 193 countries as of August 23, 2021, with 25.9 3.8 thousand tons released into the global ocean representing 1.5 0.2% of the global total riverine plastic discharge. The model projects that the spatial distribution of the discharge changes rapidly in the global ocean within 3 y, with a significant portion of plastic debris landing on the beach and seabed later and a circumpolar plastic accumulation zone will be formed in the Arctic. We find hospital waste represents the bulk of the global discharge (73%), and most of the global discharge is from Asia (72%), which calls for better management of medical waste in developing countries.
Plastics have an excellent strength to weight ratio, and they are durable and inexpensive, making them the material of choice for most disposable medical tools, equipment, and packaging (1, 2). The COVID-19 pandemic has demonstrated the indispensable role of plastic in the healthcare sector and public health safety (2). As of August 23, 2021, about 212 million people worldwide have been infected with the COVID-19 virus with the most confirmed cases in the Americas (47.6%) and Asia (31.22%) followed by Europe (17.26%) (3). The surging number of inpatients and virus testing substantially increase the amount of plastic medical waste (4). To sustain the enormous demand for personal protective equipment (PPE, including face masks, gloves, and face shields), many single-use plastic (SUP) legislations have been withdrawn or postponed (2). In addition, lockdowns, social distancing, and restrictions on public gathering increase the dependency on online shopping at an unprecedented speed, the packaging material of which often contains plastics (5, 6).
Unfortunately, the treatment of plastic waste is not keeping up with the increased demand for plastic products. Pandemic epicenters in particular struggle to process the waste (7), and not all the used PPEs and packaging materials are handled or recycled (8, 9). This mismanaged plastic waste (MMPW) is then discharged into the environment, and a portion reaches the ocean (10). The released plastics can be transported over long distances in the ocean, encounter marine wildlife, and potentially lead to injury or even death (1114). For example, a recent report estimated that 1.56 million face masks entered the oceans in 2020 (15). Earlier studies have also raised the potential problem of COVID-19 plastic pollution and its impact on marine life (1618). Some cases of entanglement, entrapment, and ingestion of COVID-19 waste by marine organisms, even leading to death, have been reported (19, 20). The plastic debris could also facilitate species invasion and transport of contaminants including the COVID-19 virus (2123). Despite the potential impacts, the total amount of pandemic-associated plastic waste and its environmental and health impacts are largely unknown. Here, we estimate the amount of excess plastic released during the pandemic that enters the global ocean and its long-term fate and potential ecological risk.
As of August 23, 2021, the total excess MMPW generated during the pandemic is calculated as 4.4 to 15.1 million tons (Fig. 1). We use the average of scenarios with different assumptions as our best estimate (Methods), which is about 8.4 1.4 million tons. A dominant fraction (87.4%) of this excess waste is from hospitals, which is estimated based on the number of COVID-19 inpatients (24) and per-patient medical waste generation for each country (25). PPE usage by individuals contributes only 7.6% of the total excess wastes. Interestingly, we find that the surge in online shopping results in an increased demand for packaging material. However, we find that packaging and test kits are minor sources of plastic waste and only account for 4.7% and 0.3%, respectively.
Global generation of mismanaged plastics from different sources (hospital medical waste, test kits, PPE, and online packaging) attributable to the COVID-19 pandemic. High- and low-yield scenarios are considered for each source (Methods).
Table 1 shows the distribution of COVID-19 cases across different continents (Asia, Europe, North America, South America, Oceania, and Africa). About 70% of COVID-19 cases are found in North and South America and Asia (Table 1). We find that MMPW generation does not follow the case distribution, as most MMPW is produced in Asia (46%), followed by Europe (24%), and finally in North and South America (22%) (Table 1 and Fig. 2E). This reflects the lower treatment level of medical waste in many developing countries such as India, Brazil, and China (range between 11.5 and 76% as the low- and high-end estimates) compared with developed countries with large numbers of cases in North America and Europe (e.g., the United States and Spain) (0 to 5%) (Fig. 2A). The MMPW generated from individual PPE is even more skewed toward Asia (Fig. 2C and SI Appendix, Table S1) because of the large mask-wearing population (26). Similarly, the MMPW generated from online-shopping packaging is the highest in Asia (Fig. 2D). For instance, the top three countries in the express-delivery industry of global share are China (58%), United States (14.9%), and Japan (10.3%) followed by the United Kingdom (4%) and Germany (4%) (27).
Percentage of the confirmed COVID-19 cases (as of August 23, 2021), the generated mass of pandemic-associated MMPW ending up in the environment, and the pandemic-associated MMPW that is transported to river mouths for different continents
Accumulated riverine discharge of pandemic-associated mismanaged plastics to the global ocean. Panels are for the discharges caused by (A) hospital medical waste, (B) COVID-19 virus test kits, (C) PPE, (D) online-shopping packaging material, and (E) the total of them. The background color represents the generated MMPW in each watershed, while the sizes of the blue circles are for the discharges at river mouths.
Based on the MMPW production from each country and a hydrological model (28), we calculate a total discharge of 25.9 3.8 (12.3 as microplastics [< 5 mm] and 13.6 as macroplastics [> 5 mm]) thousand tons of pandemic-associated plastics to the global ocean from 369 major rivers and their watersheds (Fig. 2E). We believe that the 369 rivers (account for 91% of the global riverine plastic discharge to the sea) considered here include a vast majority of the global pandemic-associated plastic discharge. The top three rivers for pandemic-associated plastic waste discharge are Shatt al Arab (5.2 thousand tons, in Asia), Indus (4.0 thousand tons, in Asia), and Yangtze River (3.7 thousand tons, in Asia) followed by Ganges Brahmaputra (2.4 thousand tons, in Asia), Danube (1.7 thousand tons, in Europe), and Amur (1.2 thousand tons, in Asia). These findings highlight the hotspot rivers and watersheds that require special attention in plastic waste management.
Overall, the top 10 rivers account for 79% of pandemic plastic discharge, top 20 for 91%, and top 100 for 99%. About 73% of the discharge is from Asian rivers followed by Europe (11%), with minor contributions from other continents (Table 1). This pattern is different from that of the generation of MMPW (Table 1) because of the different ability of rivers to export plastic load to the ocean, which is measured as the yield ratio (defined as the ratio between the plastic discharges at the river mouth and the total MMPW generation in the watershed). The yield ratio is influenced by factors such as the distribution of plastic release along rivers and the physical conditions of rivers (e.g., water runoff and velocity) (28). The top five rivers with the highest yield ratios are the Yangtze River (0.9%), Indus (0.5%), Yellow River (0.5%), Nile (0.4%), and Ganges Brahmaputra (0.4%). These rivers have either high population density near the river mouth, large runoff, fast water velocity, or a combination of them. The combination of high pandemic-associated MMPW generations and yield ratio for Asian rivers results in their high discharge of MMPW to the ocean.
We simulate the transport and fate of the 25,900 3,800 tons of pandemic-associated plastic waste by the Nanjing University MITgcm-Plastic model (NJU-MP) to evaluate its impact on the marine environment. The model considers the primary processes that plastics undergo in seawater: beaching, drifting, settling, biofouling/defouling, abrasion, and fragmentation (29). The model reveals that a large fraction of the river discharged plastics are transferred from the surface ocean to the beach and seabed within 3 y (Fig. 3). At the end of 2021, the mass fraction of plastics in seawater, seabed, and beach are modeled as 13%, 16%, and 71% respectively. About 3.8% of the plastics are in the surface ocean with a global mean concentration of 9.1 kg/km2. Our model also suggests that the discharged pandemic-associated plastics are mainly distributed in ocean regions relatively close to their sources, for example, middle- and low-latitude rivers distributed in East and South Asia, South Africa, and the Caribbean (Fig. 4 and SI Appendix, Fig. S2). The beaching and sedimentation fluxes are mainly distributed near major river mouths (Fig. 4 and SI Appendix, Fig. S2). This suggests that the short-term impact of pandemic-associated plastics is rather confined in the coastal environment.
Projection of the fate of discharged pandemic-associated plastics (including both microplastics and macroplastics) in the global ocean. (A) The mass fractions and average concentrations in the surface ocean. (B) The mass fractions in the seawater, seabed, and beaches.
Modeled spatial distribution of mass concentrations of COVID-19-associated plastics in the surface ocean (AC, JL), on the beaches (DF, MO), and the seabed (GI, PR) in 2021, 2025, and 2100, respectively. The black boxes on the Top panel indicate the five subtropical ocean gyres (North Pacific Gyre, North Atlantic Gyre, South Pacific Gyre, South Atlantic Gyre, and Indian Gyre). Panels AI are for the microplastics, while JR are for the macroplastics.
The model suggests the impact could expand to the open ocean in 3 to 4 y. The mass fraction of plastics in the seawater is predicted to decrease in the future while those in seabed and beach are modeled to gradually increase. At the end of 2022, the fractions of riverine discharged, pandemic-associated MMPW in seawater, seabed, and beach are modeled as 5%, 19%, and 76%, respectively, and the mean surface ocean concentration sharply decreases to 3.1kg/km2. In 2025, five garbage patches in the center of subtropic gyres merge, including the four in North and South Atlantic and Pacific and the one in the Indian Ocean (Fig. 4 and SI Appendix, Fig. S2). Hot spots for sedimentation fluxes are also modeled in the high-latitude North Atlantic and the Arctic Ocean in 2025 (Fig. 4 and SI Appendix, Fig. S2), reflecting the large-scale vertical movement of the seawaters (SI Appendix, Fig. S3).
We find a long-lasting impact of the pandemic-associated waste release in the global ocean. At the end of this century, the model suggests that almost all the pandemic-associated plastics end up in either the seabed (28.8%) or beaches (70.5%), potentially hurting the benthic ecosystems. The global mean pandemic-associated plastic concentrations in the surface ocean are predicted to decrease to 0.3 kg/km2 in 2100, accounting for 0.03% of the total discharged plastic mass. However, two garbage patches are still modeled over the northeast Pacific and the southeast Indian Ocean, exerting persistent risk for ecosystems over there. The fate of microplastics and macroplastics are similar but with a higher fraction of macroplastics ending up in the beaches due to their lower mobility (Fig. 4 and SI Appendix, Fig. S1).
The Arctic Ocean appears to be a dead-end for plastic debris transport due to the northern branch of the thermohaline circulation (30). About 80% of the plastic debris discharged into the Arctic Ocean will sink quickly, and a circumpolar plastic accumulation zone is modeled to form by 2025. In this year, the Arctic seabed accounts for 13% of the global plastic sedimentation flux, but this fraction will increase to 17% in 2100. The Arctic ecosystem is considered to be particularly vulnerable due to the harsh environment and high sensitivity to climate change (31, 32), which makes the potential ecological impact of exposure to the projected accumulated Arctic plastics of special concern.
It is speculated that the pandemic will not be completely controlled in a couple of years, and many of the containing policies will continue to be implemented (33). By the end of 2021, it is conservatively estimated that the number of confirmed cases will reach 280 million (34). The generated pandemic-associated MMPW will reach a total of 11 million tons, resulting in a global riverine discharge of 34,000 tons to the ocean. The MMPW generation and discharge are expected to be more skewed toward Asia due to record-breaking confirmed cases in India (3). Given the linearity between the discharge and ocean plastic mass, the fate and transport of the newly generated plastic discharge can be deduced from our current results.
There are substantial uncertainties associated with our estimate of pandemic-associated MMPW release due to the lack of accurate data (e.g., the number of used masks and online-shopping packages and the fraction of mismanaged waste under the over-capacity conditions). For example, our estimate for the discharge from face mask usage is much lower than that of Chowdhury etal. (35), which assumes that a person uses a single mask daily while we assume a mask lasts for 6 d based on survey data (Methods). We thus consider multiple scenarios to cap the actual situations (Methods). The estimated MMPW as hospital medical waste varies by 53%, while that from packaging and PPE vary by 25% and a factor of 3.5, respectively. The estimated amounts of riverine MMPW discharge to the ocean have also uncertainty as they are based on a coarse resolution (i.e., watershed-wise) hydrological model (28). In addition, factors such as the fragmentation, abrasion, and beaching rate of plastics in NJU-MP also have a substantial influence on the simulation results (29). Despite these uncertainties, the spatial pattern of the pandemic-associated releases and their relative fate in different compartments of the ocean is more robust.
The pandemic-associated plastic discharge to the ocean accounts for 1.5 0.2% of the total riverine plastic discharges (28, 36). A large portion of the discharge is medical waste that also elevates the potential ecological and health risk (37) or even the spreading of the COVID-19 virus (38). This offers lessons that waste management requires structural changes. The revoking or delaying of the bans on SUPs may complicate plastic waste control after the pandemic. Globally public awareness of the environmental impact of PPE and other plastic products needs to be increased. Innovative technologies need to be promoted for better plastic waste collection, classification, treatment, and recycling, as well as the development of more environmentally friendly materials (15, 39). Better management of medical waste in epicenters, especially in developing countries, is necessary.
We develop an inventory for the excess plastic waste generated due to the COVID-19 pandemic. We consider four categories of sources: hospital-generated medical waste, virus testing kits, PPE used by residents, and online-shopping packages.
For hospital-generated medical waste, we estimate the amount by the number of hospitalization patients (nH) and per-patient healthcare waste generation rates (HCWGR). The nH is estimated based on the number of COVID-19 infections (nI) and the global average hospitalization rate (HR) of this disease:nH=nIHR.[1]
The nI and HR data are based on the statistics of the World Health Organization (3). The HCWGR of COVID-19 patients is approximately two times higher than that of general patients (40), which is calculated as a function of life expectancy (LE) and CO2 emissions (CDE) based on Minoglou etal. (25):HCWGR=2(0.014LE+0.31CDE).[2]
This relationship was developed based on the statistical data from 42 countries worldwide and can explain 85% of the variability of the HCWGR data (25). The LE data are from Roser etal. (41), and the CDE data are from Worldometer (42).
The virus testing kitsgenerated medical waste is estimated based on the number of conducted tests and the amount of waste generated per test. The former data are from Ritchie etal. (43) while the latter is from Cheon (44) and ShineGene (45). Depending on the specifications of the testing kits, the waste generated per test ranges 21 to 28 g/test.
For the PPE used by residents, we consider only face masks, as other items such as gloves and face shields are less commonly used. We use two ways to estimate the number of used masks: consumption-based and production-based. For the former way, we first assume an ideal condition that each person uses a new mask every 6 d (46), and we assume that the actual mask usage lies 25 to 75% of this situation. The population data are from United Nations (26). For the latter way, we assume that all masks produced are used up. The global production (PW) is estimated based on the mask production in China (PC), which is the largest mask producing country (54 to 72%) in the world (47):PW=PCp,[3]where p is the share of Chinese-produced masks (47). We also consider two scenarios for the mass of waste generated by each mask (for surgical masks or N95 masks).
The online-shopping packaging (np) in this study refers to the excess part that is caused by lifestyle changes during the pandemic compared to the normal situation (no COVID-19 pandemic) (nno-covid):np=nactualnnocovid,[4]where nactual is the actual online package usages from 2020 to the first quarter of 2021 and is estimated based on the financial report of the top six e-commerce companies worldwide (Taobao, Tmall, Amazon, Jingdong, eBay, and Walmart) (4852). The nno-covid is calculated based on the package numbers in 2019 and an average annual growth rate in recent years (53). The mass of generated plastic waste (m) is then estimated based on the average mass of plastics in the packaging material (mp) (54):m=npmp.[5]
The amount of MMPW for each source (i) can be calculated based on the waste generation rate of the above four sources (Rw), the fraction of plastic waste in the total waste (Pp), and the fraction of mismanagement waste in the total waste (Pm):MMPW=i=14RwiPpiPmi.[6]
We consider the former two source categories as medical waste while the latter two as municipal waste. The Pm for each country is specified according to the waste type. The Pm of municipal waste is based on Schmidt etal. (28). There is no solid data for the Pm of medical waste, and we use the data of Caniato etal. (55) as a function of the economic status (56) and the level of treatment and disposal of waste for individual countries. The dataset includes two scenarios, and we consider an additional scenario that is 50% lower than the lower one to account for the uncertainty of this fraction.
We estimate the river discharge of pandemic-associated MMPW to the ocean based on the watershed model developed by Schmidt etal. (28), which calculates the yield ratio of plastic discharge at the river mouth to the total MMPW generated in the entire corresponding watershed. We assume this ratio is the same for pandemic-associated plastic waste and other wastes. We consider a total of 369 major rivers and their watersheds in this study. We split the country-specific, pandemic-associated MMPW data to each watershed based on the amount of regular MMPW (28).
The NJU-MP model has a resolution of 2 latitude 2.5 longitude horizontally with 22 vertical levels and is driven by ocean physics from the Integrated Global Systems Model with 4-h time step (29). The model considers five categories of plastics with different chemical composition, and the density of each category is predetermined: polyethylene (PE, 950 kg/m3), polypropylene (PP, 900 kg/m3), polyvinyl chloride (PVC, 1,410 kg/m3), polyurethane (PU, 550 kg/m3), and others (1,050 kg m3). The plastics densities are modeled to increase when biofouled but decrease when defouled (57). The densities determine their buoyancy as low-density polymers float, whereas high-density polymers sink to the sediment (58, 59). Each category has six size bins: four belong to microplastics: <0.0781 mm, 0.0781 to 0.3125 mm, 0.3125 to 1.25 mm, and 1.25 to 5 mm, and two belong to macroplastics: 5 to 50 mm and >50 mm. There is thus a total of 60 plastic tracers in the model. We assume all the plastic debris as spheres for simplicity. The pandemic-associated MMPW discharge from rivers are released as half 5 to 10 mm and half >50 mm for macroplastics, while the largest size bin (i.e., 1.25 to 5 mm) for microplastics. After their discharge into the ocean, the plastics undergo removal by beach interception (57) and sinking to the deeper ocean and eventually on the seafloor. Biofouling of light plastic types (PE and PP) is modeled following Kooi etal. (60) but adjusted for more realistic scenarios. Three types of plastics with different degrees of biological attachment are considered. In addition, the model considers the removal processes including ultraviolet degradation, fragmentation, and abrasion.
The MMPW generation and river discharge datafor all the countries are provided in the Environmental Biogeochemistry Modeling Group (EBMG), https://www.ebmg.online/plastics (61). All study data are included in the article and/or SI Appendix.
This research was funded by the National Natural Science Foundation of China (Grant Nos. 42177349 and 41875148), the Fundamental Research Funds for the Central Universities (Grant No. 0207-14380168), Frontiers Science Center for Critical Earth Material Cycling, Jiangsu Innovative and Entrepreneurial Talents Plan, and the Collaborative Innovation Center of Climate Change, Jiangsu Province. We are grateful to the High Performance Computing Center of Nanjing University for doing the numerical calculations in this paper on its blade cluster system.
Author contributions: A.T.S. and Y.Z. designed research; Y.P. and P.W. performed research; Y.P. and P.W. analyzed data; and Y.P., A.T.S., and Y.Z. wrote the paper.
The authors declare no competing interest.
This article is a PNAS Direct Submission.
This article contains supporting information online at https://www.pnas.org/lookup/suppl/doi:10.1073/pnas.2111530118/-/DCSupplemental.
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Dr. Rebecca Smith, an epidemiologist at the University of Illinois, said she planned to travel by vehicle with her children to see family but would get tested before and after.
People want to get back to normal and we understand that and there are ways to do that safely, she said.
Still, Dr. Smith said she expected the outbreak in Illinois to continue to worsen as the virus rips across Midwestern and Northeastern states that largely avoided the worst of the summer surge. In the last two weeks, reports of new cases have increased by more than 40 percent in Pennsylvania, by more than 80 percent in Massachusetts and by 70 percent in Indiana.
Infection levels are also persistently high across much of the West, including in Arizona and New Mexico, where hospitalizations are rising, and in Alaska and Wyoming, which have started to improve after enduring major outbreaks. But case rates in California are relatively low, as they also are in the South, the region hit hardest over the summer.
Ahead of Thanksgiving 2020, the country was reporting 175,000 new infections a day and was midway through its worst case surge of the pandemic. Vaccines were still weeks away from being authorized, many schools were closed and at-home rapid tests were rare. But even as scientists warned that Covid-19 was unlikely to completely vanish, there was widespread optimism back then that vaccines could make the virus an afterthought in daily life.
It was wicked bad last year during the holidays, said Kirk Burrows, 26, a paramedic in Unity, Maine, who said he planned to stay home for another Thanksgiving. I think its going to be worse this year.
Mr. Burrows, who described long ambulance rides with coronavirus patients being transferred to hospitals hours away, said he thought many people had let their guard down as the pandemic persisted. Maine is routinely reporting more than 700 new cases a day, its most since the pandemic started, and hospitalizations have reached record levels.
Connecticut's COVID-19 positive test rate remains above 3% ahead of the Thanksgiving holiday when many residents will travel or spend time with extended families, the governor said in his first coronavirus briefing in a couple of months.
As of Monday, the state's test positive rate is 3.53%. Of the 58,379 tests administered since Friday, 2,060 came back positive. Twenty-one more residents are hospitalized in the state since Friday.
The governor said the state's seven-day rolling average is 3.3%, the highest since early September. The current infection rate is 21 per 100,000 residents.
The rate as "gone up quite a bit" since the end of the summer, Gov. Ned Lamont said.
The state has seen a recent uptick over the last several weeks of COVID-19 cases in residents aged five to 11, according to Connecticut Department of Public Health Commissioner Dr. Manisha Juthani.
"This virus will find the unvaccinated," Juthani said.
The governor's office releases information on coronavirus cases on a daily basis on weekdays, but it has been a while since he held a news conference specifically about coronavirus response efforts.
On Friday, the states COVID-19 positivity rate was 3.27%. Data from the weekend is usually released on Monday.
Anyone 5 years old and up is now eligible for a COVID-19 vaccine.
The governor said 84% of the state's eligible residents 18 and older are fully vaccinated and 18% have received boosters.
LX, or Local X stands, for the exponential possibilities of storytelling in our communities.
COVID-19 booster shots are now available for anyone 18 and older who received a Johnson & Johnson coronavirus vaccine at least two months ago and anyone who received the Pfizer or Moderna shots at least six months ago.
Learn more here about who is eligible.
Lamont will hold a briefing at 4 p.m. by videoconference.
US opens COVID-19 booster doses to all adults
The U.S. is opening COVID-19 vaccine boosters to all adults and urging them for anyone 50 and older. The decision Friday seeks to simplify what's been a confusing list of who's eligible. Anyone 18 or older can choose a Pfizer or Moderna booster. (Nov. 19)
AP
With COVID-19 cases ticking up again in Oklahoma and across the U.S., experts predict were headed for another surge this winter.
Cases and hospitalizations had fallen dramatically since a COVID-19 wave hit Oklahoma in late summer, taxing health care workers and hospitals. Even after weeks of declining numbers, they never returned to the lows the state saw before the fast-spreading delta variant took hold, and cases are now rising again.
But, in part because Oklahomas most recent COVID-19 wave this summer wassevere, the winter surge were facing isnt forecasted to be as brutal, experts said.
As long as a new variant doesnt take hold, we arent expected to see the hospital overcrowding we saw in August and September of this year, said Dr. Aaron Wendelboe, a University of Oklahoma epidemiologist.Wendelboe has been modeling the spread of COVID-19 in Oklahoma since the early days of the pandemic.
Having said that, what this model doesn't account for is the reality that our health care workers face the shortage of health care workers, the many people leaving the field just the exhaustion that everyone's facing, he said.
COVID-19 Coverage: CDC makes COVID vaccine boosters available for all US adults, recommends for 50 and older
The seven-day average of new COVID-19 cases reported in Oklahoma hovered in the mid-500s in early November, but its since risen back up to 838 as of Fridays latest figures.
Hospitalizations, which had plateaued briefly after weeks of decline, also appear to be ticking up again.
Dr. David Chansolme, medical director of infection prevention with Integris Health, said the increase in cases is worrisome.
I don't think we'll see some of the huge increases that we saw before, but anything could happen, he said. If we've not learned anything yet, it's that COVID zigs when we think it's going to zag more often than not, and it could certainly happen again.
Even with a milder surge projected than the ones Oklahoma has already been through, it would still take a toll on health care workers, Chansolme said.
It certainly would be difficult. There's more and more stories coming out now about people leaving the health care workforcebecause they just can't take it anymore. he said. Personally, I really don't want to do another surge. It takes something out of you every time.
Read more: 7 questions answered about COVID vaccines for kids 5-11, including where to get them in OKC
In Oklahoma County, vaccination rates are high enough that health officials hope it can blunt the effect of a winter increase on hospitalizations and death rates, said Phil Maytubby, chief operating officer of the Oklahoma City-County Health Department.
Weve done a good job here of getting people vaccinated, he said. Oklahoma County has 70% of its residents over 12 fully vaccinated. Butwe know that its not going to be absolute were still going to get cases, and were still going to have people end up in the hospital.
While Oklahoma County is on much of the same trajectory for the increase in COVID-19 cases across the country, the more people who get vaccinated, the better the county will fare, Maytubby said.
In Wendelboes initial modeling for Oklahomas COVID-19 transmission heading into the winter, we werent expected to see an increase until December.
But with higher levels of transmission going into the winter, his updated models show that we start to plateau, but actually, as we go into, say, January and February, we don't surge as much either, Wendelboe said.
Those projections hinge on no new variant showing up
Oklahoma has reported over 11,700 COVID-19 deaths, according to provisional data from the Centers for Disease Control and Preventions National Center for Health Statistics.
Deaths climbed dramatically after the delta variant began to spread in Oklahoma.More than 3,300 Oklahomans have died of the virus since June, and experts have said many of those deaths could have been prevented by vaccinations.
By March, the total is projected to eclipse 13,500, according to the latest forecast from the Institute for Health Metrics and Evaluation (IHME)at the University of Washington.
But if 95% of people in the state wore a mask, the model projects about 1,000 fewer deaths.
From the experts: Oklahomans with mood disorders like depression are at high risk for COVID-19, CDC says
The rest of the U.S. is also projected to see a winter surge, but Oklahoma may fare better than states that had a less severe delta variant surge in the summer, said Ali Mokdad, a professor of health metrics sciences at IHME.
Because the delta variant sickened so many in the state, a sizable part of the population has recent infection-acquired immunity to the delta variant, Mokdad said.
For those who received a vaccination early on, they may besusceptible to infection because of waning immunity from the vaccine, he said.
Thats why a booster dose is critical. The CDC and FDA on Friday approved booster doses for all adults, and experts have said it's important for people to get them as soon as possible.
My advice for everybody in Oklahoma: go get your third dose, because right now we know a third dose is needed for full protection and it will save lives, Mokdad said.
For public health professionals, vaccinations have allowed for some more normalcy in their holiday plans this year.
Compared to a muted holiday season last year without family get-togethers, Dr. Dale Bratzler, the University of Oklahomas chief COVID officer, said he now feels comfortable gathering with a small group of family, since everyone is vaccinated.
We know were a vaccinated group of people (and) that the risk of spreading COVID-19 is very, very low in that setting, he said, adding that he is fully vaccinated and has also received a booster dose.
See more: Oklahoma AG sues Biden administration over health care worker vaccine mandate
Maytubby, with the Oklahoma City-County Health Department, said his family went without holiday gatherings last year too. This year, we want people to all be vaccinated that are coming, he said.
Well wear masks unless were eating, and Im hoping that the weathers good enough where we can be outside a lot, Maytubby said. Normal precautions like hand-washing and sanitizing will also be part of holiday plans, he said.
Vaccine news: As COVID-19 shots begin for younger kids, it's a dose of relief for Oklahoma families
Mokdad, with IHME at the University of Washington, said hes going into this holiday season more frustrated than last year, since we have a safe, effective COVID-19 vaccine that couldve saved thousands of lives in the U.S. if more people had taken it. But he wants people to know there is a light at the end of the tunnel.
If we do our homework, we can go back to our normal lives, but we shouldn't do it prematurely, he said.
New Jersey on Monday reported another 1,330 COVID-19 cases and seven confirmed deaths as nearly every county in the state is once again reporting high community transmission heading into Thanksgiving.
The states seven-day average for new positive tests increased to 1,669, up 20% from a week ago and 39% from a month ago. Thats the highest seven-day average since Oct. 1.
The statewide transmission rate increased to 1.23, up from 1.21 on Sunday and 1.2 on Saturday. Any transmission rate above 1 indicates that each infected person is passing the virus to at least one other person.
Gov. Phil Murphy noted this is a national trend as more people spend time inside because of colder weather. He said 42 or 50 American states have a transmission rate above 1.
This thing takes turns that humble you, Murphy said during his latest coronavirus briefing in Trenton.
State officials said theyre concerned about cases continuing to rise as people gather for Thanksgiving on Thursday and other holidays over the next two months. State Health Commissioner Judith Persichilli encouraged all residents to take precautions, get vaccinated, get a booster, stay home if youre feeling ill, mask up in crowded indoor areas or when you are around high-risk individuals.
Please, please, please enjoy this holiday, but enjoy it safely and responsibly at every level, Murphy said of Thanksgiving. If youre with people that you have a degree of confidence in you know them, you know their vaccine status have at it. Raise hell.
Meanwhile, New Jersey publicly reported for the first time there have been at least 22,842 positive coronavirus tests among students and school staff in grades K-12 across the state since the start of this academic year, along with numbers showing nearly 85% of school staff are fully vaccinated.
MORE: N.J.s 1st full report on school staff, student COVID cases shows 22K positive tests this year
There were 816 patients hospitalized with confirmed (768) or suspected coronavirus cases across New Jersey as of Sunday night.
Of those, 168 patients were in intensive care, with 78 of them on ventilators. At least 74 patients were discharged statewide in the 24 hours leading up to Sunday night.
The statewide positivity rate for Wednesday, the most recent day available, was 4.51%.
All but one of New Jerseys 21 counties are listed as having high rates of coronavirus transmission, with just Hudson County listed as substantial transmission, according to the the U.S. Centers for Disease Control and Prevention. The agency is recommending that all people in the high and substantial transmission counties wear masks for indoor public settings regardless of vaccination status.
Officials said they expect the new surge to peak sometime in January, the same as last year. But Persichilli stressed that the big difference this year is the state has many more people vaccinated.
We just started vaccinating (last year) on Dec. 15, she said. We saw a peak mid-January of almost 3,000 hospitalizations., No, if we did nothing, that may happen again. But because of our high vaccination rate, were hoping severe disease, hospitalizations moderate. But it could still reach 2,000 or more hospitalizations.
Murphy again encouraged everyone in the state 18 and older in New Jersey who has received their second dose of the Pfizer and Moderna vaccines six months ago to get a booster shot. Thats after the CDC announced Friday that it opened booster shot eligibility to all adults.
Anyone 18 and older who received the Johnson & Johnson vaccine was already eligible for a booster two months after their single shot.
As we know from the ongoing research, the vaccines do begin to lose some effectiveness in some people over time, Murphy said. Breakthroughs continue to be relatively rare, but they do happen. So, to protect against a possible breakthrough infection, all of us up here strongly encourage you to go out and get that boost of protection as soon as possible.
As of Monday, New Jersey has reported a total of 50,762 cases among fully vaccinated people, leading to 1,061 hospitalizations and 300 deaths, though those represent a small percentage total cases.
From Nov. 1 to 7, the state reported 9,429 positive tests. Of those, 1,707 were from fully vaccinated people and those cases led to two hospitalizations (out of 525 total) and no deaths (out of 115 total).
More than 6.23 million people who live, work or study in New Jersey a state of about 9.2 million residents have now been fully vaccinated. More than 7.88 million people in the state have received at least one dose, and more than 1 million people have received third doses or boosters.
At least 87,500 children between the ages of 5 and 11 in New Jersey have received vaccine doses since federal authorities approved the Pfizer shots for that age group two weeks ago, according to the state.
Christina Tan, the state epidemiologist, said officials are also concerned about possible new variants in the virus.
The delta variant, which is more contagious than previous variants, represents nearly 100% of all cases circulating in New Jersey right now.
New Jersey, an early epicenter of the pandemic, has now reported 28,274 total COVID-19 deaths 25,442 confirmed and 2,832 considered probable in the more than 20 months since the start of the outbreak. The probable deaths, which are revised weekly, increased Monday by 13 fatalities.
The state has the third-most coronavirus deaths per capita in the U.S., behind Mississippi and Alabama.
New Jersey has reported 1,071,383 total confirmed cases out of more than 16 million PCR tests conducted since it announced its first case March 4, 2020. The state has also reported more than 162,128 positive antigen or rapid tests, which are considered probable cases.
Murphy insisted the state is not waiting for there to be no cases to move on from the pandemic.
This is never going to zero, he said. This is with us. And were not gonna manage it as though we have to see it go to zero to do X or Y. But I do think we owe it to folks to give them a sense of the trends.
CORONAVIRUS RESOURCES: Live map tracker | Newsletter | Homepage
There have been a total 179 in-school outbreaks across New Jersey among students and staff this academic year, leading to 1,026 cases, according to the latest number released last week. Those numbers are cumulative and do not reflect active infections. Just Burlington and Warren counties have not reported any in-school outbreaks this year.
In-school outbreaks, which are reported weekly by the state, are defined as three or more cases that are determined through contact tracing to have been transmitted among staff or students while at school. They do not include total cases among staff and students.
At least 8,671 of the states COVID-19 deaths have been among residents and staff members at nursing homes and other long-term care facilities, according to state data. There are active outbreaks at 115 facilities, resulting in 624 current cases among residents and 530 among staffers.
As of Monday, there have been more than 257.7 million COVID-19 cases reported across the world, according to Johns Hopkins University, with more than 5.15 million people having died due to the virus. The U.S. has reported the most cases (more than 47.7 million) and deaths (more than 771,100) of any nation.
There have been more than 7.4 billion vaccine doses administered globally.
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Adam Beam| The Associated Press
FDA authorizes boosters for all US adults
The U.S. booster campaign is getting a lot simpler now that regulators have opened extra vaccine shots to all adults. The Food and Drug Administrations Dr. Peter Marks says the new approach will streamline booster decisions as COVID-19 cases begin rising again across the country (Nov. 19)
AP
SACRAMENTO California now has one of the lowest coronavirus infection rates in the country, with 1.9% of people testing positive for the disease in the last week as the nations most populous state has so far avoided the uptick feared heading into the end-of-year holidays.
Coronavirus hospitalizations in the state have fallen about 14% in the last month a trend state data models forecast will continue for the next month but Gov. Gavin Newsom on Monday continued to sound the alarm about the potential for another winter spike that could overwhelm hospitals in some areas.
Unvaccinated relatives?Families navigate plans as Thanksgiving nears
Visiting a coronavirus vaccination clinic in San Francisco, Newsom urged people to wear masks and get COVID shots ahead of the long Thanksgiving holiday weekend. He pointed to at least 27 states that have seen at least a 10% increase in cases in the past week.
Ask the governor of Michigan (or) Colorado how they are doing, Newsom said. States are struggling because people are taking down their guard or claiming mission accomplished. ... I dont want to see that happen here in California.
>> See how your community has fared with recent coronavirus cases
Newsom has struck a more cautious tone compared to the spring when he lifted nearly all of Californias pandemic restrictions and told people who were vaccinated they could stop wearing masks and socially distancing in some places. But a summer surge prompted some of the states largest local governments to bring back mask mandates and other restrictions, creating a dizzying patchwork of policies across the state.
Last winter brought the deadliest surge of the pandemic to California and while a repeat isnt expected because so many people are vaccinated the state still could see a lesser surge as people gather indoors for the holidays. That possibility prompted Santa Cruz County to reinstate its mask requirement on Sunday, just a few days after neighboring Monterey County lifted its mandate.
Your questions answered: COVID-19 booster shots and breakthrough infections
Unfortunately, a potential winter surge appears to be a significant threat to the health and safety of our community, said Santa Cruz County Health Officer Dr. Gail Newel said in a statement.
Santa Cruz County, located along the coast south of San Francisco, has a per capita infection rate only slightly above the state average. Of Californias 58 counties, the ones with the highest rates are nearly all rural and have lower vaccination rates.
Fresno County, an agricultural powerhouse of nearly 1 million people located in the Central Valley, is the most populated county among those in the top 10 for infections per 100,000 people. Los Angeles County, with its more than 10 million residents making up about a quarter of the states population, has an infection rate that falls in the bottom third.
>> Track coronavirus cases across the United States
Los Angeles became the nations epicenter for the outbreak last winter when California saw its worst surge. Things got so bad that the National Guard had to bring in refrigerated trucks to store bodies at overwhelmed hospitals.
But all of that happened before a coronavirus vaccine was available. Now, more than 75% of people 5 and older in California have gotten at least one dose. For adults 18 and older, more than 91% have received at least one dose. Nearly 5 million people have gotten a booster shot.
Newsom continued to urge parents to get their children vaccinated. While speaking to reporters at the vaccine clinic he was interrupted by a child crying after receiving a shot. He joked that scene wouldnt lead a public service announcement but it is a very human moment. He then turned to applaud the child.
California plans to require all students in public and private schools to receive the coronavirus vaccine as a requirement for attending in-person classes. But that mandate wont take effect until the federal government gives final approval to the vaccine for children 5 and older.
In the meantime, California requires all public school staff and students to wear masks while indoors. Newsom said state officials might lift that rule once more children are vaccinated.
The virus will dictate those terms, he said.
BRUSSELS, Nov 21 (Reuters) - Police and protesters clashed in the streets of Brussels on Sunday in demonstrations over government-imposed COVID-19 restrictions, with police firing water cannon and tear gas at demonstrators throwing rocks and smoke bombs, witnesses said.
About 35,000 people took part in demonstrations, police said, which began peacefully before violence broke out.
Protesters wearing black hoods threw stones at police as they advanced with water cannon at the main junction in front of the European Union Commission headquarters, Reuters journalists said.
Register
Facing up to the police lines, the protesters held hands and chanted "freedom". One protester was carrying a placard reading "when tyranny becomes law, rebellion becomes duty".
People protest against coronavirus disease (COVID-19) measures as police forces stand guard, near the European Commission in Brussels, Belgium November 21, 2021. REUTERS/Johanna Geron
Read More
Protesters also threw smoke bombs and fireworks, the newspaper Le Soir reported. The situation calmed down later, police said.
Belgium tightened its coronavirus restrictions on Wednesday, mandating wider use of masks and enforcing work from home, as cases rose in the country's fourth COVID-19 wave. read more
There have been 1,581,500 infections and 26,568 coronavirus-related deaths reported in the country of 11.7 million people since the pandemic began. Infections are increasing again, with 13,826 new cases reported on average each day.
Violence has also broken out in anti-restriction protests in Belgium's neighbour the Netherlands in recent days. On Friday, police in Rotterdam opened fire on a crowd.
Register
Reporting by Christian Levaux, Johnny Cotton and Sabine Siebold, Editing By Angus MacSwan
Our Standards: The Thomson Reuters Trust Principles.
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