SAN DIEGO (KGTV) -- The delta variant is now fueling more than 90 percent of the infections in the United States, but recently another variant has started getting some attention: lambda.
The lambda variant was first detected in Peru late last year. (There is conflicting information from the World Health Organization about whether scientists recorded the first samples in August or December of 2020).
Since then, it has become the dominant variant in Peru and spread to other South American countries. Lambda has now been detected in at least 30 countries, according to Outbreak.info.
As the prevalence of lambda increased in Peru, so did its death rate. Peru now has the highest COVID mortality rate in the world.
The World Health Organization labeled lambda a Variant of Interest in June, one step below a Variant of Concern.
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UC San Diego virologist Dr. Davey Smith said lambda is the offspring of the gamma variant, the version of the virus that is also called P.1 and was first detected in Brazil.
Now it evolved and its got some key mutations in it that probably make it more infectious. Now its out-competed its dad, he said.
Lambda has several notable mutations found in other concerning variants, including a mutation at the 452nd position in its genetic sequence.
This mutation, called L452Q, changes how the virus attaches to cells and appears to make it sticker and more infectious. This mutation is also in the section of the virus targeted by neutralizing antibodies, Dr. Smith said.
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Several variants have a mutation at position 452, including the delta variant. But lambdas change is unique; it swapped in an amino acid called glutamine that hasnt appeared here before.
One study released this month showed this one mutation makes lambda about twice as infectious as the original version of the virus. Another suggests lambda is likely more infectious than both alpha and gamma.
But how does it compare to delta?
Im much more worried about delta than lambda, said UC San Francisco infectious disease expert Dr. Peter Chin-Hong.
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Lamda is still largely confined to South America and accounts for less than 1 percent of sequences worldwide, according to Outbreak.info.
Delta has been detected in far more countries, at least 112, and accounts for more than 90 percent of recent samples.
In my gut sense, if delta and lambda went into a boxing ring, delta would probably win, Dr. Chin-Hong said.
South Americas struggles with lambda may have to do with healthcare inequities, low vaccination rates, and the use of less effective vaccines from China, experts said.
A new study showed the antibodies produced by the Pfizer and Moderna vaccines still neutralize lambda well.
The Johnson & Johnson vaccine showed drops in antibody protection levels against both lambda and delta, but experts said the vaccine will still protect against severe disease.
The study did not evaluate other critical components of the immune system, such as T cells.
The global tally for the coronavirus-borne illness climbed above 194.7 million on Tuesday, while the death toll climbed above 4.16 million, according to data aggregated by Johns Hopkins University. The U.S. leads the world with a total of 34.5 million cases and in deaths with 611,007 as the highly infectious delta variant continues to spread fast, especially in states with low vaccination rates. The federal government will keep existing COVID-19 travel restrictions on international travel in place for now due to concerns about the surging infection rate because of the delta variant, the Associated Press reported. It was the latest sign that the White House is having to recalibrate its thinking around the coronavirus pandemic as the more infectious variant surges across the U.S. and a substantial chunk of the population resists vaccination.India is second by cases at 31.4 million and third by deaths at 421,382, according to its official numbers, which are expected to be undercounted.Brazil is second in deaths at 550,502, but is third in cases at 19.7 million. Mexico has fourth-highest death toll at 238,595 but has recorded just 2.7 million cases, according to its official numbers. In Europe, Russia continues to pull ahead of the U.K. by deaths at 152,836, while the U.K. has 129,460, making Russia the country with the fifth-highest death toll in the world and highest in Europe.
CNN
While people putting their masks back on indoors will help reduce the spread of Covid-19 across the country, getting more Americans vaccinated is still central to ending the pandemic, US Surgeon General Dr. Vivek Murthy said Tuesday.
The bottom line is the masks will help us reduce spread further, but the vaccinations remain the bedrock of ending this pandemic, Murthy told CNNs Wolf Blitzer.
The Centers for Disease Control and Prevention updated its mask guidance Tuesday to recommend fully vaccinated people wear masks indoors in areas with substantial or high transmission of Covid-19 more than half of all US counties.
Whats really important, also, is to say what has not changed, Murthy said. And what has not changed is that vaccines still work. They still save lives. They still prevent hospitalizations at a remarkably high rate.
Much of the country remains unvaccinated, despite incentive programs and urging from health experts. Only 49.2% of the US population is fully vaccinated, according to the CDC. More than 34.6 million people in the United States have tested positive for the coronavirus.
Murthy said he doesnt want Americans to think the new mask guidelines mean that progress against Covid-19 is lost.
That is not the case, he said, adding that vaccines have prevented many hospitalizations and deaths.
Dr. Anthony Fauci, the longtime director of the National Institute of Allergy and Infectious Diseases, said the situation could have been different.
If we had the overwhelming proportion of the people vaccinated, we would not be having this conversation, he told PBS.
Fauci addressed the changing guidance from the CDC, which in mid-May said most fully vaccinated people dont have to wear masks indoors or outdoors.
We are dealing with an evasive type of a virus. It evolves, Fauci said. People need to understand. Its a painful realization, but its true. Were dealing with a virus thats a wily character.
The CDCs May guidance was based on the Alpha coronavirus variant being dominant, he and Murthy said. It no longer is, so the CDC isnt flip-flopping, Fauci said; its keeping up with the changing science.
The CDC updated the When Youve Been Fully Vaccinated section of its website on Tuesday.
The guidance change also included the recommendation that everyone in and around K-12 schools wear masks, even if they are fully vaccinated.
CDC Director Rochelle Walensky said Tuesday on a telebriefing that the agency, through investigations of clusters of Covid-19 outbreaks, determined the Delta variant is more likely to infect even fully vaccinated people.
What weve learned in that context is that when we examine the rarer breakthrough infections, and we look at the amount of virus in those people, it is pretty similar to the amount of virus in unvaccinated people, Walensky said.
She said the vast majority of transmission is through unvaccinated people.
Nearly two-thirds of US counties have high or substantial transmission of Covid-19, according to CDC data; 46% of counties have high transmission and 17% have substantial transmission.
The CDC defines high transmission as at least 100 new cases per 100,000 people or a test positivity rate of at least 10% in the past seven days. The threshold for substantial transmission is 50 new cases per 100,000 people or a test positivity rate of 8%.
Schools are filled with unvaccinated people who can spread Covid-19 to other settings, former US Surgeon General Dr. Jerome Adams said.
Schools are a large reservoir of unvaccinated people of superspreaders, if you will who can take the Delta variant home and to other places, Adams told CNNs Anderson Cooper.
Adams said the risk of serious illness or death is low for children but the point is they also spread the virus to other people.
Florida is one state unlikely to require masks in schools. Gov. Ron DeSantis, responding through a spokesperson to the CDC recommendations, said parents know whats best for their children.
Fortunately, the data indicate that Covid is not a serious risk to healthy children, which is why schools in most countries were among the first institutions to reopen, said spokesperson Christina Pushaw. At the end of the day, the governor trusts parents to weigh the risks and benefits and make the best choices for their kids.
DeSantis statement is in contrast to CDC evidence that shows Covid-19 can be a serious risk to children. CDC data indicate more children have died from Covid-19 517 so far than are killed by the flu annually, even in a bad influenza year.
There were reports of more than 38,600 new cases in children for the period between July 15 and 22, according to the American Academy of Pediatrics.
Children have accounted for 1.3% to 3.6% of the hospitalizations, depending on the state, according to the organization, which represents pediatricians.
The US could see nearly four times the current rate of Covid-19 cases in the next four to six weeks as the Delta variant spreads and the population hits a wall on vaccinations, a former director of the Centers for Disease Control and Prevention told CNN.
Were heading into a rough time. Its likely, if our trajectory is similar to that in the United Kingdom, that we could see as many as 200,000 cases a day, Dr. Tom Frieden said Monday, adding the US likely wont see the horrific death tolls of earlier in the pandemic thanks to the number of vulnerable people who are vaccinated. Frieden was CDC director during the Obama administration.
But, he said, You will see a steady increase in deaths, and these are preventable deaths.
Cases have jumped as the Delta variant has spread.
The US averaged more than 57,300 new daily cases over the last week an average thats generally risen since the country hit a 2021 low of 11,351 daily on June 22, according to Johns Hopkins University data.
As of Tuesday, cases have risen by 50% or more in 35 states over the past seven days compared to the week before.
The last time more than 200,000 US cases were reported in a day was in January, according to Johns Hopkins.
The Delta variant is believed to be more transmissible than other strains so much so, Frieden said, that it is essentially finding people who are unvaccinated.
Vaccination rates have hit a wall, and that could have serious consequences, said Dr. Paul Offit, director of the Vaccine Education Center at Childrens Hospital of Philadelphia.
Now we are at a point where there is a solid 25 or 30% of the population thats saying they dont want to get vaccinated, that they are okay with allowing this virus to continue to spread, continue to do harm and, worst of all, continue to possibly create variants that are going to be resistant to vaccine-induced immunity, Offit said.
And vaccinated people will likely pay a price for those choices, CNN medical analyst Dr. Leana Wen said. Even though vaccines offer strong protection against the virus, being surrounded by unvaccinated people could lead to infection spillover, and vaccinated people could get sick or pass on the infection to their loved ones, she said.
CNNs Keith Allen, Tina Burnside, Jen Christensen, Kacey Cherry, Kaitlan Collins, John Couwels, Rosa Flores, Virginia Langmaid, Kevin Liptak, Lauren Mascarenhas, Deidre McPhillips, Sarah Moon, Jenn Selva and Kate Sullivan contributed to this report.
As coronavirus cases resurge across the country, many inoculated Americans are losing patience with vaccine holdouts who, they say, are neglecting a civic duty or clinging to conspiracy theories and misinformation even as new patients arrive in emergency rooms and the nation renews mask advisories.
The country seemed to be exiting the pandemic; barely a month ago, a sense of celebration was palpable. Now many of the vaccinated fear for their unvaccinated children and worry that they are at risk themselves for breakthrough infections. Rising case rates are upending plans for school and workplace reopenings, and threatening another wave of infections that may overwhelm hospitals in many communities.
Its like the sun has come up in the morning and everyone is arguing about it, said Jim Taylor, 66, a retired civil servant in Baton Rouge, La., a state in which fewer than half of adults are fully vaccinated.
The virus is here and its killing people, and we have a time-tested way to stop it and we wont do it. Its an outrage.
The rising sentiment is contributing to support for more coercive measures. Scientists, business leaders and government officials are calling for vaccine mandates if not by the federal government, then by local jurisdictions, schools, employers and businesses.
Ive become angrier as time has gone on, said Doug Robertson, 39, a teacher who lives outside Portland, Ore., and has three children too young to be vaccinated, including a toddler with a serious health condition.
Now there is a vaccine and a light at the end of the tunnel, and some people are choosing not to walk toward it, he said. You are making it darker for my family and others like mine by making that choice.
On Monday, Mayor Bill de Blasio of New York City ordered that all municipal workers be vaccinated against Covid-19 by the time schools reopen in mid-September or face weekly testing. Officials in California followed suit hours later with a similar mandate covering all state employees and health care workers.
The Department of Veterans Affairs on Monday required that 115,000 on-site health care workers be vaccinated in the next two months, the first federal agency to order a mandate. Nearly 60 major medical organizations, including the American Medical Association and the American Nurses Association, on Monday called for mandatory vaccination of all health care workers.
Its time to start blaming the unvaccinated folks, not the regular folks, a frustrated Gov. Kay Ivey, Republican of Alabama, told reporters last week. Its the unvaccinated folks that are letting us down.
There is little doubt that the United States has reached an inflection point. According to a database maintained by The New York Times, 57 percent of Americans ages 12 and older are fully vaccinated. Eligible Americans are receiving 537,000 doses per day on average, an 84 percent decrease from the peak of 3.38 million in early April.
As a result of lagging vaccination and lifted restrictions, infections are rising. As of Sunday, the country was seeing 52,000 new cases daily, on average, a 170 percent increase over the previous two weeks. Hospitalization and death rates are increasing, too, although not as quickly.
Communities from San Francisco to Austin, Texas, are recommending that vaccinated people wear masks again in public indoor settings. Citing the spread of the more contagious Delta variant of the virus, the counties of Los Angeles and St. Louis, Mo., have ordered indoor mask mandates.
For many Americans who were vaccinated months ago, the future is beginning to look grim. Frustration is straining relations even within closely knit families.
Josh Perldeiner, 36, a public defender in Connecticut who has a 2-year-old son, was fully vaccinated by mid-May. But a close relative, who visits frequently, has refused to get the shots, although he and other family members have urged her to do so.
She recently tested positive for the virus after traveling to Florida, where hospitals are filling with Covid-19 patients. Now Mr. Perldeiner worries that his son, too young for a vaccine, may have been exposed.
It goes beyond just putting us at risk, he said. People with privilege are refusing the vaccine, and its affecting our economy and perpetuating the cycle. As infections rise, he added, I feel like were at that same precipice as just a year ago, where people dont care if more people die.
Hospitals have become a particular flash point. Vaccination remains voluntary in most settings, and it is not required for caregivers at most hospitals and nursing homes. Many large hospital chains are just beginning to require that employees be vaccinated.
July 27, 2021, 9:15 p.m. ET
Even though she is fully vaccinated, Aimee McLean, a nurse case manager at University of Utah Hospital in Salt Lake City, worries about contracting the virus from a patient and inadvertently passing it to her father, who has a serious chronic lung disease. Less than half of Utahs population is fully vaccinated.
The longer that were not getting toward that number, the more it feels like theres a decent percentage of the population that honestly doesnt care about us as health care workers, Ms. McLean, 46, said.
She suggested health insurers link coverage of hospital bills to immunization. If you choose not to be part of the solution, then you should be accountable for the consequences, she said.
Many schools and universities are set to resume in-person classes as early as next month. As the number of infections increases, these settings, too, have seen tension rise between the vaccinated and unvaccinated.
Recommendations from the Centers for Disease Control and Prevention on K-12 school reopening are tied to rates of community virus transmission. In communities where vaccination lags, those rates are rising, and vaccinated parents must worry anew about outbreaks at schools. The vaccines are not yet authorized for children under 12.
The American Academy of Pediatrics has advised that children wear masks in class when schools reopen. On Friday, school districts from Chicago to Washington began putting mandates into effect.
Universities, on the other hand, often can require vaccinations of students and staff members. But many have not, frustrating the vaccinated.
If were respecting the rights and liberties of the unvaccinated, whats happening to the rights and liberties of the vaccinated? said Elif Akcali, 49, who teaches engineering at the University of Florida, in Gainesville. The university is not requiring students to be vaccinated, and with rates climbing in Florida, she is worried about exposure to the virus.
Some are even wondering how much sympathy they should have for fellow citizens who are not acting in their own best interest. I feel like if you chose not to get vaccinated, and now you get sick, its kind of your bad, said Lia Hockett, 21, the manager of Thunderbolt Spiritual Books in Santa Monica, Calif.
Understand the State of Vaccine Mandates in the U.S.
As the virus begins to spread again, some vaccinated people believe the federal government should start using sticks rather than carrots, like lottery tickets.
Carol Meyer, 65, of Ulster County, N.Y., suggested withholding stimulus payments or tax credits from vaccine refusers. I feel we have a social contract in this country with our neighbors, and people who can get vaccinated and choose not to get vaccinated are breaking it, Ms. Meyer said.
Bill Alstrom, 74, a retired innkeeper in Acton, Mass., said he would not support measures that would directly affect individual families and children, but asked whether federal government funding should be withheld from states that dont meet vaccination targets.
Maybe the federal government should require employees and contractors to be vaccinated, he mused. Why shouldnt federal funding be withheld from states that dont meet vaccination targets?
Though often seen as a conservative phenomenon, vaccine hesitancy and refusal occur across the political and cultural spectrum in the United States, and for a variety of reasons. No single argument can address all of these concerns, and changing minds is often a slow, individualized process.
Pastor Shon Neyland, who regularly implores members of his church in Portland, Ore., to get the Covid-19 vaccines, estimated that only about half of the members of the Highland Christian Center church have gotten shots. There have been tensions within the congregation over vaccination.
Its disappointing, because Ive tried to help them to see that their lives are in jeopardy and this is a serious threat to humanity, he said.
Shareese Harris, 26, who works in the office of Grace Cathedral International in Uniondale, N.Y., has not been vaccinated and is taking my time with it. She worries that there may be long-term side effects from the vaccines and that they were rushed to market.
I shouldnt be judged or forced to make a decision, Ms. Harris said. Society will just have to wait for us.
Rising resentment among the vaccinated may well lead to public support for more coercive requirements, including mandates, but experts warn that punitive measures and social ostracism can backfire, shutting down dialogue and outreach efforts.
Elected officials in several Los Angeles County communities, for example, are already refusing to enforce the countys new mask mandate.
Anything that reduces the opportunity for honest dialogue and an opportunity for persuasion is not a good thing, said Stephen Thomas, a professor of health policy and management at University of Maryland School of Public Health. We are already in isolated, siloed information systems, where people are in their own echo chambers.
Gentle persuasion and persistent prodding convinced Dorrett Denton, a 62-year-old home health aide in Queens, to be vaccinated in February. Her employer urged Ms. Denton repeatedly to be immunized, but in the end it was her doctor who persuaded her.
She says to me: Youve been coming to me from 1999. How many times did I do surgery on you, and your life was in my hands? You trust me with your life, dont you? Ms. Denton recalled.
I said, Yes, doctor. She said, Well, trust me on this one.
Giulia Heyward contributed reporting from Miami, Sophie Kasakove from New York and Livia Albeck-Ripka from Los Angeles.
CNN
Covid-19 infections in fully vaccinated people have come under increasing scrutiny as the virus once again surges across the country due to the more contagious Delta variant.
But those so-called breakthrough infections remain rare and may not even include any symptoms. Those who do have symptoms typically get a milder case, research shows.
Emily Baker Hurley and her family, including two young children, were among those rare cases. Baker Hurley told CNN affiliate KCRA that she regrets not continuing to wear a mask after getting her vaccine. The kids have been really, really sick. One hundred and three (degree) fevers, diarrhea and vomiting, Baker Hurley said. Its been especially scary with a baby.
A breakthrough infection is defined as someone who tested positive for the coronavirus that causes Covid-19 at least 14 days being fully vaccinated with either one dose of Johnson & Johnson or two doses of Pfizer and Moderna, according to the US Centers for Disease Control and Prevention.
The agency says that, as with any vaccine, breakthrough cases are expected to happen with the coronavirus vaccine.
More than 163 million people in the United States have been fully vaccinated, or 49.1% of the population, according to the CDC. Over 97% of people getting hospitalized with Covid-19 are unvaccinated, Dr. Rochelle Walensky, director of the CDC said recently.
The Covid-19 vaccines we have in the US do work very well. But no vaccine works 100% of the time, CNN Medical Analyst Dr. Leana Wen said.
If you have multiple encounters every day with unvaccinated people, and there is a high level of community transmission in your area, your chances of having a breakthrough infection after vaccination will increase.
Wen said wearing a mask reduces that risk.
Baker Hurleys youngest daughter is only 9 months old. Both she and her 5-year-old sibling are too young to be vaccinated.
Despite her childrens illness, Baker Hurley believes getting vaccinated helped her and her husband, who has an underlying health condition, from becoming even sicker.
Obviously my husband was not as sick as he would have been since we had the vaccine, she said.
This is a disease that has taken the lives of over 600,000 Americans and millions of people around the world, Wen said. If you get the vaccine, you know that you are very unlikely to become severely ill to the point of needing to be hospitalized or to succumb to the disease.
An anchor at CNN affiliate WSB-TV in Atlanta had a very similar experience.
Fred Blankenship posted his story on his Facebook page. He hadnt been on air for a while, so he took to social media to explain the absence to his followers.
While on vacation in California members of my immediate family came down with Covid. We took all the precautions, got the vaccinations and it still happened, he said.
Blankenship explained that even though he was vaccinated, his symptoms were not as mild as he hoped, but getting his shot helped him from getting the worst of it.
My doctor told me the fact that I got the vaccination and stayed in relatively good shape kept me out of the hospital. Its been a big reminder that health is the true wealth, he said.
Adam Rothman, a history professor at Georgetown, told CNN that he and his wife are both breakthrough cases and their 10-year-old daughter also contracted the virus.
Vaccines do generally seem to be effective and be instrumental, but I think that people need to understand they may not be 100% effective, he said.
But I would say If more people were vaccinated, its less likely that our daughter would have gotten the disease and being vaccinated, we hope, has kept me and my wife out of the hospital.
Dr. Wen agreed with Rothmans belief that if more people had the vaccine, less people would get sick overall.
Your chance of becoming infected from a vaccinated person, if youre also vaccinated, is virtually zero, Wen said. This is also why we have to see vaccination as not just an individual choice. Even if youre vaccinated yourself, it matters if others around you are vaccinated, too.
A CDC study conducted in June shows fully vaccinated people are more than 90% protected against infection. Even partially vaccinated people are 81% less likely to become infected than people who havent had been inoculated, according to the ongoing research.
The study tested more than 3,900 essential workers, and since December only 16 of the 204 people who became infected had been vaccinated.
NEW YORK (AP) New York City will require all of its municipal workers including teachers and police officers to get coronavirus vaccines by mid-September or face weekly COVID-19 testing, Mayor Bill de Blasio announced Monday.
The rule is expected to affect about 340,000 city employees, making the city one of the largest employers in the U.S. to take such action.
While it isnt a vaccine mandate no workers will be forced to take a shot officials hope the inconvenience and discomfort of weekly tests will persuade many to overcome a reluctance to get inoculated.
This is about our recovery. This is about what we need to do to bring back New York City, de Blasio said. This is about keeping people safe.
But some of the unions representing city workers balked at the announcement, saying the city couldnt impose the requirement without negotiations.
New York City is a union town, and that cannot be ignored, said Henry Garrido, executive director of District Council 37 of AFSCME. DC 37 represents about 100,000 New York City employees across several departments.
Hours after de Blasios announcement, officials in California announced that state employees and all health care workers will be required to show proof of COVID-19 vaccination or get tested weekly.
New York Gov. Andrew Cuomo declined to answer a question about whether he will require state employees to be vaccinated. Speaking at a news conference at Yankee Stadium, Cuomo urged localities to consider vaccinating public-facing government workers.
The Sept. 13 deadline in New York City coincides with the start of public school, when the Democratic mayor has said he expects all pupils to be in classrooms full time. City health care workers and employees in congregate setting such as group homes will face earlier deadlines.
The move comes as the city battles a rise in COVID-19 cases fueled by the highly contagious delta variant. Since the end of June, the daily average of new cases has increased by more than 300%.
Last week, the city had announced it was mandating vaccinations or weekly testing for workers in the citys hospital system.
De Blasio expanded the requirement Monday and urged private employers to adopt similar rules.
My message to the private sector is: Go as far as you can go right now, the mayor said. I would strongly urge a vaccination mandate whenever possible, or as close to it as possible.
City workers unions offered mixed responses to the new mandate.
Vaccination and testing have helped keep schools among the safest places in the city, the United Federation of Teachers said in a statement. This approach puts the emphasis on vaccination but still allows for personal choice and provides additional safeguards through regular testing.
But the union that represents the citys 4,300 EMS workers blasted the city for not consulting them.
The city and the mayor cannot simply disregard the civil liberties of the workforce, said FDNY EMS Local 2507 President Oren Barzilay.
He said some EMS workers like some other people around the country are concerned about taking a vaccine that got fast-track, emergency use authorization but not yet a full approval from federal regulators.
The three vaccines authorized in the U.S. still underwent the normal massive testing required of any vaccine. The U.S. Food and Drug Administrations acting commissioner, Dr. Janet Woodcock, told a Senate committee this week that the agency did not cut any corners on safety.
City workers who choose testing will be responsible for getting it done. Tests are available to city workers and the general public at city-run sites, private walk-in clinics and many other locales for free to the person being tested; insurers or public money covers the cost.
Asked about union objections, de Blasio said the city has a right to require that its workforce gets vaccinated or tested.
When it comes to the health and safety of our workers in the midst of a global pandemic, we have the right, as employers, to take urgent action to protect peoples health, to protect their lives, he said.
The number of vaccine doses being given out daily in the city has dropped to less than 18,000, down from a peak of more than 100,000 in early April. About 65% of adults in the city are fully vaccinated.
Meanwhile, caseloads have been rising for weeks, and health officials say the variant makes up about seven in 10 new cases.
De Blasio has said that he does not plan to reimpose a broad indoor mask mandate, as Los Angeles County has done. Masks are required in some settings such as public transportation.
De Blasio said unvaccinated city employees will be required to wear masks indoors at all times.
Asked how the city would handle unvaccinated employees who dont want to wear masks in the workplace, city labor relations commissioner Renee Campion said, If employees refuse to comply, they just cant be at work. And in fact, they will not be paid.
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Associated Press writer Marina Villeneuve contributed to this report.
TEHRAN, Iran (AP) Iran recorded over 34,900 new coronavirus infections on Tuesday, setting the nations single-day record for cases as vaccinations lag, public complacency deepens and the countrys outbreak spirals further out of control.
The previous record of 31,814 infections had been set only a day earlier, providing a sense of how quickly Irans latest surge, fueled by the contagious delta variant, is mounting. Health authorities recorded 357 COVID-19 fatalities on Tuesday, bringing the total death toll to 89,479 the highest in the Middle East.
The alarming spread of the variant prompted new anti-virus restrictions last week. The government ordered the closure of state offices, public places and non-essential businesses in the capital of Tehran. But as with previous government measures, the lockdown looked very little like a lockdown at all. Tehrans malls and markets were busy as usual and workers crowded offices and metro stations.
Iranian authorities have avoided imposing heavy-handed rules on a population that can little afford to bear them. The country, which has suffered the worst virus outbreak in the region, is reeling from a series of crises: tough U.S. sanctions, global isolation, a heat wave, the worst blackouts in recent memory and ongoing protests over water shortages in the southwest.
Now, health officials warn that hospitals in the capital are overwhelmed with breathless COVID patients too numerous to handle. Fewer than 3% of Iranians have been fully vaccinated in the sanctions-hit country. Many front-line medical workers have been vaccinated with Irans locally produced shots or the Chinese state-backed Sinopharm vaccine that may be less effective than other inoculations.
Irans government announced that its homemade vaccine provides 85% protection from the coronavirus, without disclosing data or details. Iran also imports Russias Sputnik V vaccine, as well as the Oxford-AstraZeneca shot through the United Nations-backed COVAX program.
In Libya, meanwhile, authorities imposed a nightly curfew in parts of the country, including the capital of Tripoli, amid a spike in coronavirus cases and concerns about the highly infectious delta variant.
The 12-hour curfew takes effect starting Tuesday, the government said. All businesses, cafes, restaurants, and parks are required to close during the curfew.
The number of new cases in Libya has risen more than six times since July 1, according to daily figures from Libyas National Center for Disease Control. On Tuesday, the center reported 3,348 confirmed new cases and 24 deaths.
Libya has recorded more than 240,300 cases so far in the pandemic, including 3,422 deaths. The actual figures are believed to be much higher, given the scarcity of testing and the depletion of the countrys health care system after almost a decade of civil war.
Companies are encouraging their workers to get vaccinated as Covid-19 cases climb again. Yet relatively few workplaces are making shots required.
On Monday, the U.S. Department of Veterans Affairs became the first federal agency to require employee vaccinations, and California became the first state to do so for its public workers. In New York City, Mayor Bill de Blasio said that all municipal employees will be required to be vaccinated by Sept. 13, or get tested weekly, and urged the citys private employers to push similar measures.
President Biden said Tuesday that a vaccine mandate for all federal employees was under consideration.
Some companies, including Morgan Stanley, Goldman Sachs and Wells Fargo, have mandated that all workers must get vaccinated or divulge their vaccination status before returning to the office. United Airlines requires Covid-19 vaccines for new employees.
Overall, though, Covid-19 vaccine mandates at work remain rare, partly because doing so can be a legal minefield for companies, employment attorneys say. In some cases, mandates have resulted in employee lawsuits and termination of workers. And in a tight labor market, employers also risk losing workers who balk at such requirements.
It has been quite a week for vaccine mandates in the United States. The Department of Justices Office of Legal Counsel (the presidents lawyer) expressed its opinion that it is legal to mandate vaccination with vaccines distributed under emergency use authorization. The Department of Veterans Affairs became the first federal agency to mandate Covid-19 vaccination for its frontline health care workers. New York City and the state of California declared vaccination or regular Covid-19 testing obligatory for their workforces.
Vaccination is the key weapon in our nations battle against Covid-19. Either we quickly get closer to full immunity as a nation or we are doomed to another fall and winter of school shutdowns, business closures, fewer recreational opportunities, and more masking and social distancing, with all the likely deaths that new strains of SARS-CoV-2, the virus that causes Covid-19, entail.
Despite this grim reality, vaccine uptake is inadequate. Leaders have tried begging, pleading, and cajoling, but full vaccination in many states and counties hovers around 30%. Some states and cities have tried incentives such as free meals, drinks, lottery tickets, hunting licenses, vacations, cookies, and even marijuana, but to little avail.
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We believe that the solution to this public health crisis is to institute vaccine mandates, set by government or by private businesses and institutions. A vaccine mandate refers to imposing a consequence for vaccine refusal. The consequence can be a fine or denial of access to a service, job, or venues like hotels, cruise ships, and sports events.
Vaccination has historically been mandated for legal immigration into the U.S., for the military, and for school children and college students and health care workers. So what is holding up mandates for Covid-19 vaccination?
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The biggest obstacle is that the three main vaccines used in the U.S. are not yet fully licensed and there is legal uncertainty surrounding whether a vaccine distributed under emergency use authorization can be mandated.
Many employers, agencies, and schools have been hesitant to impose mandates because they are concerned that courts will find it illegal to mandate a vaccine that is distributed under emergency use authorization, rather than under full Food and Drug Administration authorization.
The opinion from the Department of Justice should give them confidence, but does not really solve the dilemma. Although this opinion is well-reasoned and persuasive, it carries little legal authority outside the federal government, and would likely get limited deference in court. But the opinion includes a way to remove legal hurdles: The FDA can amend the emergency use authorization documents for the Covid-19 vaccines to make it clear that mandates are permitted.
The current law allowing the secretary of Health and Human Services to give emergency use authorization for drugs and vaccines was enacted into law in 2004. Under its provisions, the HHS secretary can, under some circumstances, allow use of an unapproved product on an emergency basis. The secretary has delegated that power to the FDA, and the FDA has given emergency use authorization for the three Covid-19 vaccines.
This is a new situation: It is the first time a vaccine is being given to the entire population. What creates the uncertainty is that the law requires the HHS secretary to make sure vaccine recipients know of the option to accept or refuse administration of the product, of the consequences, if any, of refusing administration of the product Some read this language as prohibiting mandates: If someone can legally refuse the product, a mandate is not possible. Others argue an argument accepted recently by a Texas court that the provision speaks only to the HHS secretary, not to states, employers, universities and others who may mandate.
So the legal situation is murky. And full licensure of the vaccines is still months away, leaving many entities that could impose mandates hemming and hawing while new strains of SARS-CoV-2 spread rapidly.
But no one needs to wait for licensure. The solution for mandates is obvious: Either the HHS secretary or the FDA commissioner can and should edit the emergency use authorizations to say that refusing the vaccine may lead to one or more of the following consequences: loss of employment, limits on access to education, or limits on access to businesses and private enterprises.
The FDA has more than enough safety and efficacy evidence to support such a modification, and should act promptly to change the emergency use authorizations. If the FDA wont do it, HHS Secretary Xavier Becerra should do it.
The nation should not tolerate more deaths, hospitalizations, shutdowns, and economic and personal ruin. The key solution to promptly getting mandates requires our health bureaucracy to act, and act now, to rewrite the emergency use authorizations.
Arthur L. Caplan is professor of bioethics and the founding head of New York University School of Medicines Division of Medical Ethics. Dorit R. Reiss is a professor of law at UC Hastings College of Law.
On Thursday, Kay Ivey, the unimpeachably conservative governor of a deep red state, treated her Alabama constituents to some straight talk. I want folks to get vaccinated. Thats the cure, she said. The data proves that it works. And it doesnt cost you anything. It saves lives.
Asked what it would take to get more of her states population vaccinated, Gov. Ivey grew visibly frustrated. I dont know, she said. But its time to start blaming the unvaccinated folks, not the regular folks.
In her state, it isnt so easy to determine who the regular folks are. On the day she spoke, 59.8% of adult Americans had been fully vaccinated, compared with only 42.6% in Alabama. The reason is not a vaccine shortage, or huge obstacles to getting vaccinated. Some Alabamians are not bothering to get the shot, others say they are waiting, and the rest are refusing outright.
Around the country, vaccinations have been ensnared in the partisan polarization that suffuses just about everything these days. Joe Biden carried the 20 states with the highest vaccination rates; Donald Trump prevailed in 19 of the 20 with the lowest rates. (The 10 states in the middle, which include five swing states, were split almost evenly.) The same pattern prevails at the county level. And this red-blue gap is growing.
Nearly 90% of Democrats say they have already gotten vaccinated or intend to do so soon, compared with 54% of Republicans, a number that has not budged since April. Some 23% of Republicans insist that they wont get vaccinated under any circumstances, and another 8% say that they will not get vaccinated unless they are required to do so. And despite the hopes of policy analysts, only 8% of those who are refusing would change their minds if the Food and Drug Administrations current emergency-use authorization shifted to full and final approval, as it is likely to do this fall.
