CNN
For anyone who loves freedom and hates mask mandates or remote learning, Dr. Jerome Adams has a blunt message: Get vaccinated.
More mitigation is coming. Whether its masking, or whether its closures or whether its your kids having to return to virtual learning, that is coming, the Trump administration surgeon general told CBS Face the Nation on Sunday.
And its coming because this pandemic is spiraling out of control yet again. And its spiraling out of control because we dont have enough people vaccinated.
As of Sunday, only 49.1% of Americans have been fully vaccinated, according to the US Centers for Disease Control and Prevention.
Thats nowhere near enough vaccinations to stop the spread of the Delta variant, the most contagious strain of novel coronavirus ever identified.
In 48 states, the rate of new Covid-19 cases this past week jumped by at least 10% compared to the previous week, according to data from Johns Hopkins University.
In 34 of those states, the rate of new cases increased by more than 50%.
Hospitals are filling up again with Covid-19 patients except now, patients are younger than before, said doctors in Alabama, Mississippi, Florida and Missouri.
The thing thats making this possible is the fact that we are dealing with the most transmissible version of Covid-19 that weve seen to date, current US Surgeon General Dr. Vivek Murthy said.
So eligible Americans who want to prevent more mask mandates, business closures and a return to remote learning need to do their part and get vaccinated, said Adams, the Trump administration official.
Its going to help every single American enjoy the freedoms that we want to return to, he said.
Vaccine mandates would be the quickest way to raise vaccination rates, Adams told CBS Sunday. But that wont happen without full approval by the US Food and Drug Administration.
If you want to get a bunch of people vaccinated really quickly, get these vaccines licensed, Adams said. And then youll see the military make it mandatory, youll see businesses make it mandatory.
Each vaccine available in the United States has been authorized by the FDA for emergency use, but they have yet to be fully approved.
And the lack of full-fledged approval is contributing to vaccine hesitancy, he said.
Asked Sunday if vaccine mandates should be on the table, White House coronavirus coordinator Jeffrey Zients told CNN municipal governments and businesses should consider any strategy that would make it safe to enter their location, whether thats requiring vaccines or negative Covid-19 tests.
But he wants the FDA to take its time to thoroughly review the applications for approval, so the public knows the agency wasnt bowing to political pressure.
Dr. Doran Fink of the FDAs Center for Biologics Evaluation and Research said last week the agency was working as rapidly as possible to review submissions for approval.
Zients is hopeful some approval will come sometime in August or September. President Biden last week said full approval could come before the end of August.
Pfizer/BioNTech and Moderna have started their applications for full FDA approval, while Johnson & Johnson has said it intends to file for licensure.
The Covid-19 vaccines used in the US dont have any coronavirus in them, but they do require an immune system response to work.
So millions of Americans who are immunocompromised or take drugs that suppress the immune system might not get as much help from a vaccine as others do.
While theres been much speculation as to whether (or when) booster shots might be needed, the CDC and the US Food and Drug Administration said this month that Americans who have been fully vaccinated do not need a booster shot at this time.
But that could change as the data evolves, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
If a booster dose of vaccine is needed, people with suppressed immune systems might be the first to get one, Fauci told CNN on Sunday.
Those with suppressed immune systems can include transplant patients, those undergoing cancer chemotherapy, people with autoimmune diseases and those who are taking immune-suppressing drugs, Fauci said.
Like with many other vaccines, a small fraction of vaccinated people have gotten breakthrough infections.
But more than 97% of those hospitalized with Covid-19 are unvaccinated, CDC Director Dr. Rochelle Walensky said last week.
Within the tiny percentage of US hospitalized Covid-19 patients who were fully vaccinated, a study found 44% of them were immunocompromised people.
The CDC and the FDA are exploring multiple options for how to make a third dose of Covid-19 vaccine possible for immunocompromised people if needed, according to a statement Friday.
Emerging data show there is an enhanced antibody response after an additional dose of mRNA COVID-19 vaccine in some immunocompromised people, the CDC said in a statement to CNN on Friday.
While early data show some potential benefit to administering an additional dose, more evidence is needed to determine safety and effectiveness in immunocompromised people.
Those who are immunocompromised and vaccinated against Covid-19 might still want to keep wearing masks, Murthy said.
In California, San Diego County and Los Angeles County both reported their highest number of cases since February, and hospitalizations in LA County have more than doubled in two weeks. On Sunday, Los Angeles County officials said hospitalizations surpassed 700 for the first time since March.
In Florida, state health data shows that new case positivity nearly doubled in two weeks, from 7.8% the week of July 2 to 15.1%.
A total of 870 hospitalized patients were reported Sunday in Alabama, according to the states public health Covid-19 dashboard. Hospitalizations there have been steadily rising since early July: On July 4 there were just 213 hospitalized patients reported.
And Louisiana now has the highest increase in cases per capita in the US, state officials said Friday.
We know that more than 80% of these are the Delta variant that is whats causing this surge, Gov. John Bel Edwards said.
And whats enabling the surge is a very low percentage of people who have been vaccinated.
In the rare case that a fully vaccinated person later gets infected, that infection will likely result in mild or no symptoms at all, Murthy said.
If you do get a breakthrough infection which itself will be unusual it will be more likely to be mild or asymptomatic, the surgeon general said.
The bottom line? If you get the vaccine and still get a breakthrough infection, you are protected close to 100% from being hospitalized, getting severely sick and dying, said Dr. Saju Mathew, a primary care physician and public health specialist.
What more do you really want from a vaccine?
CNNs Melissa Alonso, John Bonifield, Elizabeth Cohen, Deanna Hackney, Chuck Johnston, Lauren Mascarenhas and Alexandra Meeks contributed to this report.
Alba Feliz is a little nervous about getting the vaccine. At 17, she's the first person in her immediate family to seriously consider getting it. "In my house, they never really trust the vaccine," she says. Social media has been her main source of information, and the contradictory messages have been confusing.
She doesn't believe the COVID vaccines will put a chip in you, but she does have some concerns about "side effects and all that."
Another teen, Ryan Howard, 16, says he has become the resident vaccine expert among his friends. "My friends will send it to our group chat and I'll be like 'ehhhh that's kinda, like, wrong.' "
A lot of teens are still deciding about the vaccine. People ages 12 and up have been able to get one since mid-May, but two out of three teens have not gotten their shots.
Yet getting vaccinated could mean freedom for a lot of young folks who've been pretty cooped up. "A lot of us didn't like being at home for a whole year," says Feliz.
NPR asked teens to share their most pressing questions about the vaccines. Here are answers from several ace pediatricians and trusted sources of health information.
Let's start with what's similar. All three COVID-19 vaccines are currently available for free in the U.S., and they're proven to be safe and effective. And all three offer good protection against all known strains of the coronavirus.
What's different is the way they teach your immune system to recognize the coronavirus.
The J&J vaccine uses a harmless virus an adenovirus, not a coronavirus to ferry instructions, in the form of DNA, to your cells. These instructions, train your immune system to recognize proteins that stud the surface of the coronavirus and to create antibodies and immune cells that can fight off the virus if you ever become infected. The Pfizer and Moderna vaccines uses a microscopic bubble of grease to carry instructions to your cells in the form of something called messenger RNA.
Here's another difference: The two mRNA vaccines (Pfizer's and Moderna's) each require two doses, spaced three to four weeks apart. The J&J vaccine is just one shot. In all cases, it takes time for your body to make sufficient antibodies so a person is considered "fully vaccinated" and protected from COVID-19 only after at least two weeks since the final shot.
Right now, only the Pfizer vaccine is authorized for use in people as young as 12 to 17 years old. The FDA is reviewing data from Moderna's studies in younger people right now, and it's likely that Moderna shots will become available to teens soon, too.
The common side effects are basically the same for all three vaccines, and all the evidence from the Pfizer vaccine the one currently available to teens suggests teens experience the same range of side effects as adults do.
Your arm might be a bit sore that day or the next, explains Dr. Yvonne Maldonado, a pediatrician at Stanford Children's Hospital. Beyond that, many people don't really feel bad at all, but worst case, if you do get symptoms, it would be like getting a mild flu.
You might get a low fever within a day or so after getting your shot, says Maldonado. You could also feel some body aches, tiredness, headaches or nausea.
If you feel this way, don't worry. Just rest, drink plenty of fluids and take acetaminophen if you have a headache. You'll feel better soon. Remember, these symptoms are signs that your body is revving up to fight the virus if it comes your way.
In online forums, we've seen other concerns from teens that the vaccines might increase the risk of infertility, for example, or chronic fatigue. But anything that suggests those is misinformation pure and simple.
So let's be clear. The American College of Obstetricians and Gynecologists (the group of top medical doctors who have been keeping an eagle eye out for any worrisome side effects regarding pregnancy, infertility or reproduction) is very firm in dismissing the first concern: "Claims linking COVID-19 vaccines to infertility are unfounded and have no scientific evidence supporting them."
And while long-term fatigue is certainly a part of what's come to be called "long COVID" in adults and young people, that's a side effect of an infection with the coronavirus not a side effect of the vaccine. Getting vaccinated is your best protection against getting COVID-19 and long COVID.
For most people, even those with significant allergies, the risk is very small. If you have hay fever or even a severe allergy to bee stings, peanuts or other foods, no problem. The vaccine is as safe for you as it is for anyone else.
On the other hand, if you've ever had any kind of allergic reaction to an ingredient in one of the vaccines (such as the food additive polysorbate in the J&J vaccine or the common drug additive polyethylene glycol, in the Moderna and Pfizer vaccines), you should get a different COVID-19 vaccine, the CDC advises. And if you've ever had a severe allergic reaction to past vaccinations of any kind, check in with a doctor for advice specific to your situation.
In a very few cases, people have had severe allergic reactions, or anaphylaxis, after getting a COVID-19 vaccine. Luckily, as serious as that is, it's reversible and treatable, generally with a shot of epinephrine. When you go get your vaccine, you'll be asked to sit and wait for 15 to 30 minutes, just in case you have a severe reaction, so you can be treated on the spot.
How rare are these allergic reactions? For every million doses given out, roughly two to five people have an anaphylactic reaction.
OK, yes. It's true that very, very rarely, some people are getting serious side effects. One that's turned up related to the Pfizer and Moderna vaccines is temporary heart inflammation, which appears to be happening in about 13 out of every million shots given to people under 40, and more so in young men.
But here's the thing: This is a short-term issue that gets better with rest and care in a matter of days.
"There's no zero-risk proposition," explains Dr. Brian Feingold, medical director of the heart transplant program at Children's Hospital of Pittsburgh. But, he says, the health risks you face if you don't get vaccinated are much higher. He has been advising his friends, family members and most patients, including those with existing heart problems, to get vaccinated as soon as possible.
A few other very rare side effects have turned up in relation to the J&J vaccine: Serious blood clots have occurred in around three out of every million people who got the vaccine, mostly middle-aged women. And Guillain-Barr syndrome, a neurological disorder that can lead to weakness in the muscles and sometimes paralysis, has occurred in around eight of every million people who get the vaccine, mostly among men over 50 but it's usually temporary.
But before you get too freaked out, remember that the risks associated with getting COVID-19 include long-term heart damage and long-haul COVID, and in the worst case, you can die from the disease.
To stay healthy, it still makes a lot more sense to get vaccinated than not. "If you're statistically going after what's safest, the data right now stacks up [to show] that vaccines are absolutely the safer route," Feingold says.
Breakthrough cases, in which someone who is fully vaccinated still gets infected with the coronavirus at some point, do happen but the infections have mostly been mild or even symptomless.
Once you're fully vaccinated, your body is prepped to fight the virus. That means if you're exposed to the delta variant or any other form, you are very unlikely to get sick enough to require hospitalization.
The other thing you should know is that in this latest surge of COVID-19 cases across the U.S., 97% of people who got hospitalized were unvaccinated.
"If you are vaccinated you are protected," says CDC director Dr. Rochelle Walensky. "If you remain unvaccinated, you are at risk."
Yes! Vaccine experts now say you can get the COVID-19 vaccine at the same time you get other routine vaccines, like the HPV vaccine or the flu shot.
If you missed a regularly scheduled vaccine like a Tdap or the meningococcal jab during the pandemic, you're not alone. Doctors say that getting several vaccines together this summer is safe and effective and could be a good opportunity to catch up on vaccines before going back to school.
You will probably need a COVID-19 booster shot at some point, say doctors who are tracking the pandemic, but it may not be any time soon.
So far, the best evidence suggests that people who are fully vaccinated even those who got their shots way back in December or even earlier are well-protected from getting very sick or dying from COVID-19.
Still, health officials are particularly watching for any sign of lowered protection in a couple of different groups, especially the elderly and the immunocompromised.
If boosters are needed, they'll likely be recommended for specific groups first based on when you got your vaccine and whether you're at special risk for getting very sick from COVID-19 yourself or accidentally spreading it to vulnerable people (like if you work at a hospital or nursing home).
It's true that the younger and healthier you are, the less likely you are to get very sick or die from an infection with the coronavirus. But some kids and teens have gotten serious cases of COVID-19, which can lead to complications like MIS-C, an inflammatory disorder that can cause a range of serious effects that are sometimes lethal.
Then there are the lingering effects of an infection what's come to be called long COVID. Among adults, the evidence shows that one out of every three or four has lingering problems after getting COVID-19 fatigue or difficulty breathing for weeks or months after the virus is gone. There's less research about this condition in teens, but some do develop it.
"The question," Maldonado says, "is: Are you willing to take that risk of getting infected and having those long-term impacts when we don't have any answers to how to treat them whereas we know we have an answer to how to prevent them?"
And even kids and teens who don't get very sick from the coronavirus can still infect those around them, including friends or family members who are older or in worse health or not able to get vaccinated.
Teens and 20-somethings, Maldonado says, are "the primary age group that could really make a difference in preventing transmission of the disease."
Whatever your age, in an era when so much of life seems beyond our individual control, she says, choosing to get vaccinated against COVID-19 is a way to contribute personally to the health of your community and the world.
Good point. Dr. Benjamin Danielson, a pediatrician at the University of Washington School of Medicine, says he finds the spirit of this comment refreshing. It's an unfortunate reality that people who make more money in the U.S. often have better access to good health care than people who make less.
COVID-19 has hit communities of color particularly hard Black, Latinx, and Native peoples have been more likely to catch COVID-19 and get very sick and die from it.
That tragedy is one way the pandemic has illuminated how poverty and systemic racism are hurting people's health, Maldonado says.
"This is an opportunity to shine a light," she says. "I think this is something that communities of color, and all communities, should take on as a social justice issue."
While there are no easy answers here, Danielson says he's happy to hear young people starting to reject the status quo. He says it reflects "an expectation of things being different, which is a whole different mindset from hope or aspiration." It's the right mindset to spark change, Danielson says, to start demanding equity in the U.S. health care system.
Over the last decade, Dr. Mercola has built a vast operation to push natural health cures, disseminate anti-vaccination content and profit from all of it, said researchers who have studied his network. In 2017, he filed an affidavit claiming his net worth was in excess of $100 million.
And rather than directly stating online that vaccines dont work, Dr. Mercolas posts often ask pointed questions about their safety and discuss studies that other doctors have refuted. Facebook and Twitter have allowed some of his posts to remain up with caution labels, and the companies have struggled to create rules to pull down posts that have nuance.
He has been given new life by social media, which he exploits skillfully and ruthlessly to bring people into his thrall, said Imran Ahmed, director of the Center for Countering Digital Hate, which studies misinformation and hate speech. Its Disinformation Dozen report has been cited in congressional hearings and by the White House.
In an email, Dr. Mercola said it was quite peculiar to me that I am named as the #1 superspreader of misinformation. Some of his Facebook posts were only liked by hundreds of people, he said, so he didnt understand how the relatively small number of shares could possibly cause such calamity to Bidens multibillion dollar vaccination campaign.
The efforts against him are political, Dr. Mercola added, and he accused the White House of illegal censorship by colluding with social media companies.
He did not address whether his coronavirus claims were factual. I am the lead author of a peer reviewed publication regarding vitamin D and the risk of Covid-19 and I have every right to inform the public by sharing my medical research, he said. He did not identify the publication, and The Times was unable to verify his claim.
July 24, 2021, 11:34 a.m. ET
A native of Chicago, Dr. Mercola started a small private practice in 1985 in Schaumburg, Ill. In the 1990s, he began shifting to natural health medicine and opened his main website, Mercola.com, to share his treatments, cures and advice. The site urges people to take control of your health.
As the more contagious Delta variant sows more coronavirus infections among the countrys unvaccinated, it has also started to send more unprotected Americans to the hospital, straining health care centers in portions of the Midwest, the West and the South.
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Covid-19 hospitalizations are trending upward in 45 states, though levels remain well below previous peaks. In parts of the country with relatively low vaccination rates, including Arkansas, Florida, Louisiana, Mississippi, Missouri and Nevada, hospitalizations have increased more rapidly.
Hospital staff members and health officials in these areas say the rise has come quickly and unexpectedly, driven by the more aggressive Delta variant, low vaccination coverage and their communities return to the social activities of pre-pandemic life.
At Mercy Hospital in Springfield, Mo., in a county where just over a third of the population is fully vaccinated, staff say that this summers surge in patients came nearly five times as fast as last fall. In just over a month, the hospitals Covid patient count grew to 115 from 26, and it briefly faced a shortage of ventilators.
And now with 155 Covid patients, the hospital has far surpassed its last peak, and expects to see more than 200 patients by early August. To prepare, its readying a third I.C.U. for patients with Covid-19.
I think any community that has low vaccination rates and has not experienced this yet, better get ready, said Erik Frederick, chief administrative officer at Mercy Hospital Springfield. Because what we are seeing with this Delta variant, its not an if, its a when.
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Hospital and state officials across the country report that a vast majority of people hospitalized with Covid-19 are unvaccinated. Nationally, the Centers for Disease Control and Prevention estimates that more than 97 percent of patients who have gone to the hospital with Covid-19 havent been immunized.
And while breakthrough cases and hospitalizations can happen for those who are vaccinated, officials say that these patients tend to be less sick because the vaccines are highly protective against severe illness and death.
Vaccination patterns and the high rates of coverage among the countrys oldest and lower rates among the young also seem to have changed who is coming to the hospital.
We have seen the elderly population like we had before, said Shannon Nachtigal, the chief nursing officer at Baxter Regional Medical Center in Mountain Home, Ark. But with this surge they are definitely more of a younger group, people in their 30s and 40s.
Read more: Some Florida Hospitals Have More Covid Patients Than Ever Before
At Mercy Springfield in Missouri, just over half of patients are under the age of 60.
You walk through the I.C.U.s and you just look and youre like, Wow, those people dont look much older than me, added Mr. Frederick, who is 48. Its a little alarming to see.
National data reveal a similar shift. While the overall number of people newly admitted to the hospital with Covid-19 each day is lower now than it was in January, the share of those admitted under age 60 has grown. In July, about 54 percent of new admissions were people under 60, and in early January it was 36 percent.
Note: Data is through July 21.
The Delta variants ability to spread may also be to blame for the shifting demographics of people going to the hospital with Covid.
If its more transmissible, its more likely to also transmit to healthy individuals as well as people who are less healthy, said Dr. Thomas Tsai, an assistant professor of health policy at Harvard University. You may have an increase in hospitalizations just because you are putting a broader swath of individuals at risk.
But with the vaccine readily available to most Americans, hospital staff say it has been frustrating to watch people of all ages suffer when there is now a weapon to fight back.
It makes me so sad that we are doing this again, because it is so preventable at this point, said Dr. Rachel C. Keech, an inpatient physician serving Mercy Hospitals eastern Missouri region, who helped the Mercy Springfield location in recent weeks.
The first three waves, we didnt have this great tool of vaccines and now we do, she added. Its really heartbreaking.
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A Japanese company has started human trials of the first once-a-day pill for Covid-19 patients, joining Pfizer Inc. and Merck & Co. in the race to find treatments for the disease.
Osaka-based Shionogi & Co., which helped develop the blockbuster cholesterol drug Crestor, said it designed its pill to attack the Covid-19 virus. It said the once-a-day dosing would be more convenient. The company said it is testing the drug and any side effects in trials that began this month and are likely to continue until next year.
Shionogi is months behind Pfizer and Merck, which have started later-stage tests of pills to treat Covid-19. Pfizer has said its twice-daily pill could be ready to hit the market as soon as this year. It is preparing to enroll more than 2,000 patients in a test of the antiviral pill combined with a booster antiviral drug against a placebo.
All three companies aim to fill one of the biggest gaps in fighting the pandemic. Vaccines remain effective at preventing serious illness from known strains of the Covid-19 virus including the contagious Delta strain, studies have shown. But some people dont want to get vaccinated, and cases can occur for those who do get their shots.
Existing treatments, including Gilead Sciences Inc.s infused antiviral drug remdesivir, generally have to be administered in hospitals and work only some of the time. Other drugs that can be given in hospitals include monoclonal antibody drugs such as one made by Regeneron Pharmaceuticals Inc. and the steroid dexamethasone.
"My darling," it says. "How are you? Are you enjoying school? Do you have friends? Your brother is one year old now. I hope you can come and see me in Australia one day. I love you and think of you often -- from 'Nana in Australia.'"
"Nana in Australia" is the pixelated face on my laptop, the voice cutting out on my phone.
She lives on the other side of the world, in a place where Covid-19 doesn't exist, or at least not to the degree that it has ravaged the United Kingdom with a terrifying ferocity.
For much of 2020, Australia's success in controlling the virus was the envy of the world. By March of that year, as Italian hospitals drowned in cases and the UK dithered about restrictions, Australia decisively closed its borders -- and the tactic initially paid off.
A country of 25 million people, it has recorded just over 900 coronavirus-related deaths since the pandemic began. Its total case numbers are around 32,000 -- a figure the UK is exceeding daily. And its economy has bounced back.
But more than a year on, Australians remain shut inside their gilded cage, relying on a series of short, sharp lockdowns to quell an outbreak of the highly-contagious Delta variant.
More than half the population -- including those in state capitals Sydney, Melbourne and Adelaide -- are again living under lockdown measures following dozens of new cases.
"Fortress Australia" is now facing uncomfortable questions about just how far this island sanctuary is willing to go to protect itself from external threats -- including raising the drawbridge to its own citizens.
Australians have been willing to "put up with restrictions which elsewhere in the democratic world would have been entirely politically impossible," said Marc Stears, director of the Sydney Policy Lab at the University of Sydney.
That's because these restrictions speak to "quite a deep cultural sense that danger lurks overseas, and the best thing that Australia can do in these moments is cut itself off from the world," Stears added.
The challenge now is how to rejoin it.
'Couldn't quite believe our luck'
As a kid growing up in Australia, I always believed my home was the "Lucky Country" -- a beautiful, peaceful nation with cool marsupials and the best Olympic swimmers.
It was only later I realized that "Lucky Country" was an ironic phrase, penned by author Donald Horne in the 1960s: "Australia is a lucky country run mainly by second rate people who share its luck."
Australia's good fortune held steady at the start of the pandemic, when the country closed its borders "just in time," said Stears. What's more, it "had that remarkable stroke of luck that there wasn't very much community transmission," he said.
For much of last year, life in Australia went on relatively unchanged: A friend in Cairns continued cheering on his local basketball team at packed games. A cousin on the Gold Coast talked of crowds at music concerts.
Aside from Melbourne, which underwent one of the strictest lockdowns in the world, "the rest of the country couldn't quite believe its luck," said Stears. "There was a real sense of: 'Oh gosh, we've dodged a bullet here.'"
Closing the borders was a crucial part of the "Lucky Country's" zero-Covid strategy, but experts say the policy has also roused a fearful and isolationist instinct.
"There is a strong protectionist streak in the national psyche," said Tim Soutphommasane, professor of sociology and political theory at the University of Sydney and Australia's former race discrimination commissioner.
"In the past, this had its most potent expression in the form of the White Australia immigration policy," said Soutphommasane, referring to historical racial policies that barred non-European immigrants.
"Obviously that's no longer in place," he said. "But the sentiment remains there under the surface. There remains a strong reflex of closing down our borders to any perceived threat."
It brings to mind the anti-asylum seeker rhetoric that emerged under former Prime Minister John Howard in the 1990s and 2000s. His famous quote: "We will decide who comes to this country and the circumstances in which they come" has been a key issue in almost every federal election since.
And with another election due next year, current Prime Minister Scott Morrison won't be flinging open the doors anytime soon, said Latika Bourke, London-based journalist with Australian newspapers The Sydney Morning Herald and The Age.
"This is a country that puts cities of millions into lockdowns over one, or two, or three cases," she said. Morrison is "not going to want to risk a major outbreak, or general circulation of this virus in the country, even if everyone's had their vaccine, probably before the election."
They have seen how quickly the virus can spread, even in countries with advanced health systems. Health officials give daily press conferences updating local numbers, however small. Local clusters are invariably linked back to leaks from hotel quarantine where returning travelers must spent 14 days in isolation.
Cutting the number of returning travelers is seen as an easy way to relieve pressure on the system, as contact tracers gather information on exposure sites and state leaders impose local restrictions and lockdowns.
But the latest series of lockdowns are testing Australians' patience, with protests against the new restrictions on Saturday drawing thousands across the nation's major cities.
And frustration is growing over the country's woeful vaccine rollout. The government initially planned to fully vaccinate all adults by the end of October. On Thursday, an increasingly under pressure Morrison said he was "sorry" Australia hadn't been able to meet its targets.
Locked in
On a dreary winter evening, Melbourne's fifth lockdown grinds on for Genevieve Neve, a 38-year-old actor, originally from San Diego, who moved to Australia as a teenager with her family.
"Australia was a penal colony, and it kind of feels like that now," she said. "We feel like prisoners in this country."
The lockdowns have been tough financially on Neve, her tattooist husband and their 2-year-old daughter; she says they have received little government assistance while unable to work.
Emotionally, too, the situation has taken a toll: Neve couldn't attend her aunt's funeral in the United States.
Over the past year she's watched the tables turn in her homeland. "This time last year I felt a lot better living in Australia than I did America, because it seemed quite chaotic over there," she said. But under the Biden administration's vaccine rollout, she feels there's "more of a sense of hope in the States."
Neve is "dying to get vaccinated," she said, but: "I'm too young."
Jabs are being offered to people over 40 and other eligible groups including health care and elder-care workers, those with disabilities, and Aboriginal and Torres Strait Islander people over the age of 16.
A generational divide is now emerging in Australia, with lockdowns and closed borders disproportionately affecting younger people, according to Soutphommasane.
Many young lives had been put "on hold," he said. Young people had been denied the "opportunities and freedoms previous generations have enjoyed, if not taken for granted."
The government's lack of urgency in procuring vaccines -- Morrison said Australia could enjoy a "front row seat" to watch immunization rollouts in other countries -- has meant the country has so far had a limited supply to draw on.
It had planned to vaccinate most Australians with AstraZeneca doses produced within the country. But fears over blood clots changed the official health advice, meaning most Australians are now waiting for Pfizer vaccines that are yet to be delivered.
People under 40 haven't been formally offered the first dose of Pfizer, due to low supplies, so the government has invited them to take the surplus stock of AstraZeneca vaccine, but only after consulting their doctor.
The mixed messaging over AstraZeneca has undermined public confidence in the vaccine, with many people content to "wait for Pfizer," said Soutphommasane.
"Unfortunately, many Australians believe there are only two real choices: Either bunker down in 'Fortress Australia' for as long as necessary, or allow the virus to let rip in the community," he said.
But Soutphommasane believes there is a third way: "Vaccinate as quickly as possible, and have a staged, controlled and safe reopening of Australia."
Locked out
Outside the country, patience is also wearing thin. There are around 37,300 Australians registered overseas who want to return home, according to the Department of Foreign Affairs and Trade (DFAT).
Since the start of the pandemic, DFAT has helped more than 50,400 Australians get home -- including more than 22,400 on 150 government facilitated flights, it told CNN.
But many remain unable to obtain travel exemptions or to stump up the thousands of dollars in airfare and hotel quarantine costs. At one point, those returning from India even faced the prospect of five years in jail or $50,000 fines, if they breached a temporary ban on flights from the country during the peak of India's second Covid wave.
Compassion for their plight is all in the "eye of the beholder," said Bourke.
"From the average, onshore Australian's view, compassion is not letting tens of thousands of your citizens die. Compassion is not letting your borders remain open to allow that virus to spread," she said.
Meanwhile, for Australians outside the country, "compassion is not needing to lock out your own citizens in order to achieve health outcomes," said Bourke.
Angela O'Connell, a 39-year-old teacher from Australia, moved to Singapore six years ago along with her Australian husband and two children. Their work contracts end later this year, and the family is now expecting to pay up to 12,000 Australian dollars ($8,800) for airfares and quarantine fees to return home.
"Never in my mind would I ever think that there would be a possibility that your own country would shut the borders on you," she said, the sound of traffic on Singapore's Orchard Road roaring in the background.
"When I think of past disasters, it's always been: 'Get our people home.' This one seems to be very different."
Before the pandemic, being an expat was always viewed as a "very positive thing," said O'Connell. "I think we're bringing back great skills from where we've come from, and a different world view."
But with Covid-19, she said the mood had changed. "Suddenly it was like, 'oh no, they shouldn't have gone over there.'"
Georgina Scholes, a 39-year-old Australian living in Denmark with her Danish husband and two children, always thought she would return home at some point, "because I want my kids to grow up a little bit Australian." Those plans have now been put on hold indefinitely; her Australian family is yet to meet her five-month-old son.
Scholes initially supported Australia's coronavirus elimination strategy. But she now casts doubt over whether such a policy is achievable anywhere in the world -- particularly in Europe, she said, where "it's not as possible to just lock the borders and keep people out."
Speaking to fellow Australians locked both in and out of the country, the question that comes up time and time again is: How long can this go on for?
Meanwhile, back home, "Nana in Australia" waits for her second jab, waits for a 4-year-old's postcard and waits to cuddle a 1-year-old grandson she's never met.
Introduction
India has been struck hard by the second wave of the COVID-19 pandemicdaily cases and deaths peaked at more than 400,000 cases and 4,000 deaths, respectively, almost four to five times higher than the peak number of cases and deaths in the first wave.1 The second wave was largely attributed to complacency by the Indian government.2 As important as this may have been, it is crucial to examine the role of the media during the pandemic. In particular, what were the discussion topics on the eve of the second wave, and was COVID-19 a fading topic of discussion when the tragedy struck? In this paper, we answer this question and discuss how inadequate media coverage may have slowed Indias COVID-19 response.
News media is an important institution in a democracy. It is instrumental in conveying information to people and drawing the governments attention to issues of concern, and provides a platform for advocacy and criticism of policies of the government in power.3 In the context of a pandemic, the medias role becomes even more significant: It can be a vital source to identify early outbreaks, and it can inform the public about non-pharmaceutical interventions (NPIs) like maintaining physical distance, hand hygiene, wearing a mask, etc. to contain the spread of the disease and limit its impact.4 Although NPIs and government-imposed travel restrictions can be burdensomerequiring significant alterations in human behavior, which is difficult to maintain over extended periods5the media can ensure compliance with these important measures by educating the public on their effectiveness at fighting diseases and preventing additional outbreaks.
Furthermore, research on epidemics has shown a cyclical behavioral response with respect to the disease; that is, more disease leads to more demand for self-protection, in turn leading to less disease; however, this results in less self-protection, which then leads to more disease.6 Unfortunately, this implies that until a sufficiently large number of people are vaccinated or protected from the disease, an epidemic is likely to come in waves. Therefore, it becomes imperative for the media and the government to repeatedly, perhaps in a novel manner, convey messages to the public regarding NPIs to the public to lessen the impact of the disease, primarily when the prevalence of the disease is in a downward trend.
This paper uses data from Twitter for 20 English-language media outlets across print, digital, and broadcasting and uses structural topic modeling (STM)7 to identify discussion topics and the evolution of these topics during the pandemic from March 2020 to April 2021. Our primary objective was to understand whether, on the eve of the second wave in India, topics related to COVID-19in contrast to other topics of discussion, such as politics, protests, and entertainmentwere a fading topic of discussion.
In the Indian context, this is the first paper to our knowledge that relies on Twitter data to look at the role of media during the pandemic using STM methods,8 a machine-assisted text reading tool. Our article complements the literature that has explored how mass media in post-independence India forced the Indian government to respond to threats of famine; as a result of this public pressure, Indiadespite its high level of povertyhas not had a large-scale famine post-independence.9 Moreover, research has also shown that state governments with a higher circulation of newspapers were more responsive to a decline in food production or damage caused to the crops by flooding.10 These papers highlight how media can draw government attention to issues of grave concern, especially for lower-income and historically disadvantaged groups and areas.
Our data consists of tweets posted by 20 English-language media outlets11 from March 1, 2020 through April 30, 2021. Twint, an advanced Twitter scraping tool written in Python, was used to scrape all the tweets posted by the media outlets for the given dates. A total of 1,253,531 tweets were downloaded, of which the media outlet TIMES NOW, with more than 10 million followers, accounted for 156,523 (12.5%) of the tweets (see table 1). The data include the date and time of the tweet, the name of the media outlet, the actual content of the tweet, and the number of the retweets, likes, and replies for each tweet.
To identify tweets for this study, the data were analyzed to identify if COVID or coronavirus was mentioned in the tweet. If it was mentioned, then the tweet was labeled as a COVID-19 tweet. We then ran a logistic regression of the following form:
To get the proportion of tweets labeled as a COVID-19 tweet each month, we compute the average predicted probabilities for each month, using the margins command in STATA MP 16.1.
The second part of our analysis involves text mining of the tweets to discover topics associated with the tweet and how these topics evolve for different media outlets. We used STM to analyze the texts of tweets for each media outlet are analyzed using machine-assisted reading of text corpora.12
The STM model builds on the probabilistic topic models such as the Latent Dirichlet Allocation,13 Correlated Topic Models,14 and extensions of these models.15 However, the critical innovation in STM is to relate the topic models with information associated with the document or the tweet. In our paper, this information relates to the media outlet and the month they posted the tweet. In other words, STM, while discovering the latent topics in the tweet, also uses the information associated with the tweet, such as the media outlet that posted the tweet and the date when the tweet was posted.
Moreover, our structural model also allows the evolution of the topic to vary with each of the media outlets. Our purpose for this is to differentiate the topics of discussion across different media outlets. In particular, in our STM models, topic prevalence takes the following structural form:
In this, i is the topic of discussion, and the effect of the month on topic prevalence is estimated with a spline. The media outlet is interacted with the spline of the month to allow for topic prevalence to vary for the media outlet. Since STM can be computationally challenging, we select 10% of the population of tweets. The tweets were selected based on stratified random sampling without replacement. In particular, for each month, we randomly selected 10% of every media outlets tweets. A total of 125,606 tweets were part of the STM analysis (see table 1). Before the STM analysis, we prepared the data by removing infrequent words; in our analysis, if a word appears only in one tweet, it is dropped from the vocabulary. Based on this, a total of 107 (<0.1%) tweets were dropped. Our final data for the STM analysis was 125,499 tweets with a vocabulary of 29,999 words. The default initialization that we used was spectral, primarily because of its stability.
Next, we took the sample of 125,499 tweets and labeled each tweet with the dominant topic of discussion based on the STM analysis. We then made five categories based on the topic of discussion related to (1) coronavirus, case, vaccine, (2) China, border, import, (3) farmer, protest, law, Delhi, (4) elections, poll, assembly, and (5) others. We created a count of engagement for each tweet, which is the sum of retweets, likes, and replies. We then regress this count over the months while controlling for the media outlet, using negative binomial regression. In particular, we run the following regression:
Here, nbreg is negative binomial regression and subscript i is the index for the tweet.
Our model selection for the number of topics was based on a data-driven approach. We performed several automated diagnostic tests, such as computation of held-out likelihood and residual analysis and compared the models with the varying topic along each of these criteria. In addition, we also report results associated with semantic-coherence for each of the models.16 There is always a possibility in STMs to produce topics that would be judged nonsensical by human domain experts. To minimize this, we selected the model that had fewer outlier topics based on semantic-coherence and also had higher exclusivity of the topics. Exclusivity of topic refers to words that have high overall frequency but at the same time are exclusive to the topic. Based on our diagnostic tests, we selected a model with 40 topics.
We should note that possible limitations of our analysis are that these data are limited to English media outlets and their messages on Twitter. The stories covered on Twitter could be very different from stories covered in print or discussed on news broadcasts, so they are not representative of the overall media discussion. In addition, the audience of the English-language media outlets on social media platforms could be different, for example, from the audience on other vernacular media outlets. It could be possible that other vernacular media outlets have a higher coverage of COVID-19 compared to the English-language media outlets.
Based on the logistic regression, we found that the average proportion of daily tweets that mention covid or coronavirus was lowest in February 2021. It fell from a high of 52.9% (95% confidence interval [CI]; 52.6% to 53.3%) in April 2020 to 9.2% (95% CI; 9.0% to 9.4%) in February 2021. This pattern was observed across all the media outlets (see figure 1).
Our next set of results relates to the STM analysis. The objective was to exploit the machine-assisted reading of the tweets across all the media outlets to discover the topics of discussion and how each of these topics evolved. Based on model diagnostics (see appendix 1 for a discussion on this), a 40-topic model was estimated with spectral initialization using STM. For our paper, we focus on general topics that relate to (a) COVID-19, coronavirus, vaccine, (b) elections and politics, (c) farmers protests and agitations, and (d) foreign affairs that include border issues with China.
Next, we plotted topic prevalence as a smooth function of time, which in our setting is the month (the topic prevalence model was related to the spline of the month), holding the media outlet at the sample median (see figure 2). Our results indicate that topics related to COVID-19 were the dominant topics of discussion from March 2020 until mid-May 2020; from then until the middle of June 2020, the conversation shifted to foreign affairs and border-related issues with China. Beginning in mid-September 2020, the topic of discussion turned to elections and farmers protests. State assembly elections in Bihar17 dominated the debate from mid-September until December 2020, when farmers protests began to dominate the discussion, even though there was an influx of debate related to COVID-19 vaccination.
From early February 2021, state elections (in West Bengal, Tamil Nadu, and Puducherry)18 dominated the conversation (see figure 2). Next, we conducted a similar analysis that allowed for topic prevalence to differ across media outlets (see figure 3). Topic prevalence varied across media outlets; for example, for public news agencies such as DD News and PIB India, the dominant topic of discussion in the initial months was related to COVID-19 and coronavirus. However, over time, this declined and shifted to the issues related to finance and projects. For private media outlets in broadcasting, such as IndiaToday, NDTV, TIMES NOW, the dominant topic in the early months of the pandemic was related to COVID-19 and coronavirus; however, in subsequent months, border-related issues with China, elections, and farmers protests gained prominence. A similar pattern was observed for print media outlets such as The Hindu, The Indian Express, and The Times of India. However, a common feature across all media outlets was that, on the eve of the second wave (the period between mid-February 2021 and mid-March 2021), topics related to COVID-19 and coronavirus had insignificant coverage relative to other topics; the news instead was focused on topics like farmers protests, India-China border issues, state assembly elections, and cricket.
For the next part of the analysis, we study the response that a particular topic elicits from the audience in the form of count of retweets, likes, and replies. In particular, in our sample of 125,499 tweets used for the STM analysis, we label each tweet with the dominant topic of discussion. We then made five categories based on the topic of discussion related to (1) COVID-19, coronavirus, case, and vaccine, (2) China, border, import, (3) farmer, protest, law, Delhi, (4) elections, poll, assembly, and (5) others. Our results indicate that COVID-19 related topics had the least engagement in terms of the number of retweets, likes, and replies compared to other issuesand this trend is consistent across the entire timeline of the study. Issues related to China, elections, and farmers protests had significantly higher counts of retweets, likes, and replies (see figure 4). This is an important finding, as it shows that, compared to other topics, there is a relative lack of engagement on (or interest in) topics related to COVID-19 among Twitter users.
Government complacency was identified as a critical factor for the surge of COVID-19 cases in India during the second wave.19 However, little attention has been paid to the activities of the media on the eve of the second COVID-19 surge, where peak daily cases and deaths were four to five times larger than the peak in the first wave.20 In this paper, using structural topic models based on machine-assisted text reading of tweets, we identify topics of discussion that were making waves in the time of the pandemic in Indian media, and particularly the period immediately before the second surge in COVID-19 cases and deaths. Our results show that discussions related to COVID-19 were at the lowest ebb on the eve of the second wave of the pandemic. Media attention was diverted from COVID-19 to topics related to farmers protests, elections, and entertainment (such as cricket matches in the Indian Premier League). This was true across all media outletsprint, broadcasting, and digital, both private and publicwith varying agendas.
Media is an important institution in a democracy. It conveys information to the public and draws the governments attention to issues that concern the public. It acts as a bridge between the people and the government. During a global pandemic that has devasted lives and livelihoods, the medias role becomes crucial. News institutions are essential to bringing the governments attention to early outbreaks while also nudging, using novel messaging, the tired public to adopt and sustain potentially burdensome NPIs, such as maintaining physical distance and hand hygiene, wearing a mask, etc. to contain the spread of the disease and limit its impact.21 Unfortunately, on the eve of the second COVID-19 surge, discussion related to COVID-19 was at its lowest point across all the media outlets. Moreover, COVID-19 related discussions attracted the least attention on Twitter compared to other topics, such as farmers protests, elections, court cases, and police activity.
Our paper has important implications for the future role of media in the Indian context. As we move forward, it is evident that new variants of the virus with varying transmissibility will emerge. There is also limited evidence on the efficacy of existing vaccines on newer variants.22 Therefore, NPIs will continue to play an important role in containing the deadly impact of the virus.23 Given its vast networks of reporters, the media could play a more proactive role in identifying early outbreaks. Secondly, along with the government, the media would need to innovate its messaging regarding the NPIs to the broader public because NPIs are costly to sustain. Thirdly, research on epidemics has shown a cyclical behavioral response with respect to the disease; that is, more disease leads to more demand for self-protection, in turn leading to less disease; however, this results in less self-protection, and this behavior change then leads to more disease.24
In light of this, it becomes imperative for both media institutions and governments to reinforce the messaging regarding the pandemic when the prevalence of the disease is at its lowestwhich is just the opposite of what we observed in this analysis. Even though media is free to cover any topic in a democracy, we argue that it has to play an essential role during a pandemic to limit the diseases impact on people. This did not happen on the eve of the second wave, and the lack of relevant information likely intensified the disastrous impact of the wave.
Our model selection for the number of topics was based on a data-driven approach. We performed several automated diagnostic tests, such as computation of held-out likelihood and residual analysis and compared the models with the varying topics along each of these criteria. In addition, we also report results associated with semantic-coherence for each of the models.25 There is always a possibility of statistical topic models to produce topics that would be judged nonsensical by human domain experts. To minimize this probability, we selected the model with fewer topics that were outliers based on the semantic-coherence and at the same time had higher exclusivity of the topics. Exclusivity of topic refers to words that have high overall frequency but at the same time are exclusive to the topic. Based on our diagnostic tests, we selected a model with 40 topics.
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The slackening of vaccinations is leading to a large resurgence of COVID-19 infections in Florida. New data provided by University of South Florida epidemiologist Edwin Michael and colleague Ken Newcomb shows that theres been a 70 percent drop in the rate of people getting vaccinated in Hillsborough County since April. There are currently 2,000 people receiving the vaccine each day. Unless that figure doubles, Michael says control of the resurgence of the pandemicduring the fall will not be achieved.
The upsurge in cases and hospitalizations are due to fewer vaccinations, relaxation of social distancing measures, greater population mobility, plus the spread of more contagious variants, which are also slightly better in evading immunity and likely cause more symptomatic disease compared to the original variant, Michael said. These predictions warn that until vaccination rates are ramped up to achieve herd immunity over this fall, people will still need to follow social distancing measures, such as wearing face coverings at the very least, to protect themselves and to reduce infection spread.
Michaels SEIRcast COVID-19 Forecast and Planning Portal shows that the slowing of vaccination since April combined with a steady reduction in the practice of social mitigation measures and the spread of the highly contagious alpha and delta variants will lead to a new spike in cases by mid-September, with 2,800 cases reported in Hillsborough County each day. The size of this spike will be three times greater than that observed during the second wave which occurred last winter.
He expects this to be the final wave of the pandemic in which will primarily occur within the unvaccinated population. However, this will prompt a new surge in hospitalizations, potentially exceeding hospital bed capacity.
While there have been some infections reported by vaccinated individuals, their cases have been relatively mild, with very few requiring hospitalization. Nearly 48 percent of the population in Florida has been fully vaccinated. Michael says we will not reach herd immunity until that figure increases to 85 percent. This is higher than previous projections due to the prevalence of dominant variants. He says the next two months are crucial in trying to put an end the pandemic.
There are many opportunities to receive the COVID-19 vaccine, including on USFs campuses. For more information, please visit the USF Returning to Campus website.
