This article is the third in a series on COVID-19 and the Districts health care workforce which will discuss the ecosystem of care providers relevant to COVID-19 and primary care outcomes, evaluate patients access to clinicians, and measure health care capacity. Read the other articles in the series:
Since March 2020, over 33 million people have contracted COVID-19 in the United States.[1] Compared to the national average and many other large metropolitan areas, D.C. fared relatively well, with a case rate of 6,996 per 100,000 people, compared to the national average of 10,140 per 100,000 people.[2],[3] While many elements contributed to D.C. s relatively low case rate during COVID, one factor is the existing health infrastructure, including the quantity of healthcare workers.
In previous articles in this series, we have focused specifically on health care workforce and health care demand within the District of Columbia. However, modest distances are frequently traveled by individuals seeking health care. Additionally, health care providers are relatively mobile in terms of employment and may relocate to a different city while staying within the broader region (e.g., in order to retain within-state licensure). Therefore, this article focuses on the ecosystem of health care providers in the metropolitan statistical area (MSA) in addition to looking within city boundaries (see the previous piece in this series on the number of healthcare workers within D.C.), and compares the size and composition of the D.C. regions health care workforce to areas with similar demographics.
The Districts health care workforce has high numbers of clinicians, as there are seven private hospitals in D.C., as well as a Veterans Affairs hospital, childrens hospital, and six specialty hospitals, in addition to more than 50 primary care facilities and urgent care facilities. D.C. also has three medical schools, as well as many other universities offering programs to become nurses, physician assistants, medical assistants, and respiratory therapists. The D.C. clinical environment offers ample opportunity to recent graduates in the healthcare field and also attracts health care workers from other areas because of its density, the quality of healthcare facilities, and competitive salaries. For instance, the average annual nursing salary with a bachelors degree in D.C. is almost $94k, compared to the national average of $79k.[4]
Due to the relative ease of travel and providers ability to move between areas in the metro region, focusing on the District alone will conceal whether people in the metropolitan area have adequate access to health care. In contrast to the Districts high concentration of medical schools and facilities, and population of approximately 700,000 people, the Washington, D.C. metropolitan statistical area (alternatively the Washington MSA) has a population of 6.3 million people and sprawls from Spotsylvania, VA in the southwest to Calvert and Prince Georges counties in the east, and Frederick, MD in the north. Given that providers can move around the region and that people often travel for medical care, we wondered: How does the Washington D.C. metropolitan areas healthcare capacity compare to other similar jurisdictions within the United States?
To see how the D.C. area compares to other MSAs, we chose the following six jurisdictions, which, like the Washington MSA, have medical schools and other health care teaching institutions producing a pipeline of health care clinicians (HCCs), are racially and ethnically diverse, and are hubs for travel and business:
Within the Washington MSA, registered nurses (682 per 100,000 people) far outnumber all other types of healthcare providers. Home health aides (561 per 100,000 people) make up the second largest share of the workforce, while doctors (254 per 100,000 people) are the third most abundant HCC group. The allied health workforce includes medical assistants and home health aides, the latter of whom have provided in-home care during the pandemic even at great personal risk.[5] Physician assistants, respiratory therapists, and occupational therapists have also been vital front-line workers during the pandemic, although there are fewer per capita than other clinicians.
While the Washington MSA has the second-highest rate of physicians and surgeons among the comparative cohorttrailing just New Yorkit trails the bulk of the cohort for its supply of other HCCs. For all other providers besides respiratory and occupational therapists, the Washington MSA is sixth among the seven-member cohort. Its population-adjusted count of respiratory therapists (20 per 100,000 population) is just more than half that of the cohort-wide average (37 per 100,000 population). Accordingly, the Washington MSA trails the cohort-wide average for every HCC type besides physicians and surgeons.
During the COVID-19 pandemic, physicians and surgeons handled a variety of interventions ranging from intensive care unit (ICU) ventilation treatment and blood filtration on the invasive end, to more straightforward practices such as the administration of antiviral drugs. Importantly, they also make critical decisions about which treatments to administer, and especially during the early days of the pandemic, were making decisions about elective surgeries and other procedures.
With a physician workforce of 254 per 100,000 population, the Washington MSA is near the top of its comparative cohort but falls far short of leaders such as Massachusetts, which has the highest per capita physician supply of any state (449.5 per 100,000 population). The Washington regions physician supply is similar to, but less than, the nationwide average in 2018 (277.8 active physicians per 100,000 population).[6]
On a global scale, according to a 2018 Kaiser Family Foundation survey of physicians per-capita worldwide, the U.S. physician density, and the similar Washington MSA physician density, fall short of those of peer countries, such as Austria (520 per 100,000 population), Switzerland (430 per 100,000 population), and France (320 per 100,000 population).[7]
As the U.S. scrambled to mount a workforce response to the COVID-19 pandemic, several jurisdictions relaxed or removed supervision requirements and made it easier for physician assistants (PAs) to cross state borders, which in some cases meant going from more-restrictive to less-restrictive environments.[8] The Washington regions relatively strong per-capita count of physicians and surgeons is offset somewhat by a relatively low count of PAs per-capita (32 per 100,000 population), which is considerably less than the cohort average (47 per 100,000 population) and nearly half that of the neighboring Baltimore MSA (61 per 100,000 population).
Registered nurses (RNs), the largest single HCC group of the providers in this analysis, had a direct impact on COVID-19 diagnosis and treatment during the pandemic. One of the chief tools in health policymakers toolkits was the expansion of the RN workforce, whether through accelerated graduation of nursing students or reintroduction of previously retired nurses. Nurses played pivotal roles across nearly every COVID-19 treatment, including in the most life-threatening ICU situations. Policymakers expanded nurses ability to provide COVID-19 treatment through similar methods used for increasing the available supply of PAs (e.g., making it easier to practice across multiple states).[9]
There are almost 4 million actively licensed RNs in the U.S. Of all actively licensed RNs, 3.3 million are employed in the nursing field, 2.7 million of whom are involved in patient care. The density of RNs and advanced practice RNs (APRNs) per 100,000 population varies across states. In 2018, the South Atlantic region of the U.S., which contains the Washington MSA, had 682 nurses with patient care responsibilities per 100,000 population. The Washington MSA (682 RNs per 100,000 population) falls well short of the cohort average (882 per 100,000 population). In fact, the Washington MSA trails each MSA in the cohort except Atlanta (646 per 100,000 population). Nearby Baltimore (1,135 RNs per 100,000 population) and Philadelphia (1,153 per 100,000 population) have nearly double the population-adjusted supply of nurses relative to the Washington MSA.
This disparity underscores the importance of evaluating larger regions such as MSAs or commute zones rather than just looking at Washington. According to 2018 Bureau of Health Workforce data, the Districts supply of nurses (1,841 per 1,000 population) is considerably larger than the nationwide average (1,206 per 1,000 population). State-level data showing high rates for MD and VA masks the fact that parts of MD and VA have much higher RN counts than the cities just outside of the Washington MSA. Washington, D.C. itself enjoys a high supply of health care training programs and provides ample incentives to retain HCCs, but the events of the last 15 months show the importance of regional health care resilience.
Occupational and respiratory therapists play more specific roles within the continuum of care than many of the other HCCs discussed. Occupational therapists enable patients suffering from physical or mental health issues to perform in everyday activities, like how to communicate following a brain injury or preparation to return to work after an accident. They work in a variety of settings, including hospitals, homes, and rehab facilities. During the pandemic specifically, occupational therapists work with COVID-19 patients whose health was severely impacted by the virus as well as people adapting to a different level of mobility, resource access, and well-being due to pandemic-related changes. Respiratory therapists conduct clinical interventions to improve patients breathing when they suffer from chronic obstructive pulmonary disease, chest trauma, pneumonia, asthma, and other diseases that impact a persons ability to consume oxygen. During the pandemic, they often worked with the most severely sick COVID-19 patients, helping them to breathe.
The Washington MSA falls short of its comparative cohort for population-adjusted supply of both occupational and respiratory therapists, though the range of estimates is similar across all MSAs.
As those infected with COVID-19 are increasingly treated from home (at least relative to the pandemic peak that saw ICUs at capacity), home health providers become ever-more central to adequate healthcare delivery. Coupled with medical assistants, who provide valuable COVID-19 care such as vaccine administration, home health aides and other allied health professionals show how an adequate workforce depends on strength of the care continuum.
Research specifically looking at the adequacy of the Washington regions allied health workforce is scarce. Still, national and state-level studies of health professional shortage areas (HPSAs) show that the Washington MSAs primary care settings where allied health professionals are an integral part of care delivery are vulnerable to an undersupply of providers. Averaging across Washington, D.C., Maryland, and Virginia, less than half of health care need is met; the District itself is in the weakest position of the three with just more than one quarter of its need met according to June 2021 data.[10]
Allied health workforce experts have indicated that Americans will be returning to their health care providers offices, which will undeniably lead to a huge spike in demand for [allied] health care workers who help keep the health care system running.[11] A chief concern cited is the contraction of non-essential health care jobs during the pandemic coupled with the relatively low pay seen in some allied health occupations.[12] This scarcity could be exacerbated by the potential that allied health professionals may depart for higher-paying occupations, both within and outside of the healthcare field, or leave the workforce altogether.
Scarcity will impact a variety of health care settings, as allied care professionals work in a multitude of environments. For example, while respiratory therapists work mostly in hospital settings (82% of RTs according to Bureau of Labor Statistics data), medical assistants are much more varied (just 15% work in hospitals, with 57% working in physicians offices). Data on home health aides is more scarce, but a shortage would make it increasingly difficult for those in need of at-home care to find it.
The Washington metro area falls short of its peers for supply of both allied health professional types. While comparable to neighboring region Baltimore and two southern geographies, Atlanta and Dallas, the Washington MSA trails each Northeastern MSA by at least three-fold. The overall cohort average (1,114 per 100,000 population) has double the home health aides that the Washington MSA reported in 2020 (561 per 100,000 population), and 128% of the Washington regions supply of medical assistants (882 per 100,000 population compared to 682).
Certification, and thus quantification, of allied health professionals varies considerably by state, and even by locale. It is hard to precisely estimate the number of allied health professionals given issues of self-reporting (i.e. individuals employed in other professions choosing to self-report as home health aides, or conversely home health aides identifying with another occupation).[13] However, assuming that all estimates have similar biases in the identification of allied health professionals, the data still yields a significant gap between the D.C. region and neighboring jurisdictions.
The COVID-19 pandemic has shown how important an adequate workforce is to the delivery of high-quality health outcomes. Indeed, ensuring an effective supply of health care clinicians is critical beyond current pandemic conditions as the ongoing effects of the coronavirus and pre-existing health needs (primary care and beyond) remain. The analysis in this article underscores the difference between looking at the roughly 700,000-person District of Columbia and the roughly 6.3 million Washington metropolitan area residents. Washingtons myriad physician, nursing, therapist, and allied health training programs all-but-ensure that the District will have a large pipeline of providers. The broader region, meanwhile, falls short in a number of critical provider types, many of whom have been integral to COVID-19 response. Further analysis could yield the dynamics underlying these descriptive facts and illuminate how to go about shrinking the gap.
In the next article in this series, using an original dataset created collected from the D.C. Department of Health and other stakeholders, we will zoom in on the healthcare workforce within the District specifically, how it has fluctuated over time, and specifically the composition of the healthcare workforce during the spring of 2020.
Feature photo by Ted Eytan (Source).
[1] https://coronavirus.jhu.edu/region/united-states
[2] ibid.
[3] https://www.census.gov/quickfacts/DC
[4] https://www.ziprecruiter.com/Salaries/BSN-Nurse-Salary-in-Washington,DC
[5] https://khn.org/news/mostly-poor-minority-home-health-aides-lacking-ppe-share-plight-of-vulnerable-covid-patients/
[6] Estimates in the main text are based on data from the Bureau of Labor Statistics (BLS) Occupational Employment Statistics (OES), which is a survey of employers. As such, it undercounts physicians and other HCCs that are in private practice rather than employed for an organization that would be surveyed through BLS OES.
[7] https://www.healthsystemtracker.org/chart-collection/u-s-health-care-resources-compare-countries/#item-nurses-licensed-to-practice-density-per-1000-population-2000-2018
[8] https://www.fsmb.org/siteassets/advocacy/pdf/state-emergency-declarations-licensures-requirementscovid-19.pdf
[9] https://www.ncsbn.org/State_COVID-19_Response.pdf
[10] https://data.hrsa.gov/Default/GenerateHPSAQuarterlyReport
[11] https://www.statnews.com/2021/07/02/the-health-care-workforce-is-understaffed-for-life-after-covid-19/
[12] While occupational therapy assistants and aides made an average of $60,950 in 2020, the average across professions classified as similar to medical assistants by the Bureau of Labor Statistics is just $46,257.
[13] Self-report is less of an issue in data sources like the BLS OES, which is a survey of employers. Still, employers might apply different definitions for various types of allied health professional.
D.C. Policy Center Fellows are independent writers, and we gladly encourage the expression of a variety of perspectives. The views of our Fellows, published here or elsewhere, do not reflect the views of the D.C. Policy Center.
COVID-19 cases going up in Oregon as number of people getting vaccinated drops - OPB
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COVID-19 cases are going up again in Oregon, as the number of people getting vaccinated in the state continues to drop.
Since last Friday, the Oregon Health Authority has reported 15 new deaths in the state and 1,372 new cases.
Of those new cases, 595 were reported on Tuesday alone. It was the highest daily case count reported since May 11.
Positivity rates continue going up in rural Oregon counties. In Wallowa, Sherman and Morrow counties, at least 1 in 5 people tested early this week tested positive for the coronavirus.
Meanwhile, the 7-day average for new COVID cases in Oregon is up by about 27 percent this week compared to a month ago, from 237 cases to 326. And the running average for new vaccine doses is down by about 75 percent from a month ago, from nearly 11,000 to about 2,500.
Health officials put out a statement Tuesday reminding Oregonians that vaccination remains the safest and most effective way to prevent serious illness from COVID-19. That includes protection from the widespread delta variant.
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The highly contagious delta variant is causing a surge in new cases. Here's what you need to know about how to keep yourself and your family safe.
More contagious than other variants, and maybe more likely to cause severe disease, Delta is spreading so fast in the U.S. it could cause another surge this summer or fall, according to new research.
Tags:Health
Confirmed cases of COVID-19 have passed 191.4 million globally, according to Johns Hopkins University. The number of confirmed deaths stands at more than 4.11 million. More than 3.7 billion vaccination doses have been administered globally, according to Our World in Data.
The vast majority of new COVID-19 cases in Spain over the past five weeks have been in unvaccinated people, Health Minister Carolina Darias said on Monday.
Peru has signed a deal to buy 20 million doses of the Sputnik V vaccine, its Health Ministry announced yesterday.
Daily new confirmed COVID-19 cases in Turkey have risen to 8,780 - double a low point reached earlier in July.
New COVID-19 cases in Britain have risen by nearly 41% in the last seven days, with 46,558 new cases reported yesterday.
Zimbabwe has ordered all its workers should receive a COVID-19 vaccine and asked all but 10% of civil servants to work from home, in an effort to curb the spread of the disease.
Australia's two largest states have reported increases in new COVID-19 cases, hitting hopes that restrictions could be eased. New South Wales registered 110 new cases - up from 78 the day before - nearly four weeks into a lockdown of its largest city, Sydney. Victoria reported 22 new cases - up from nine.
South Korea has reported a daily record of 1,784 new COVID-19 cases, breaking a mark set last week.
The Delta variant of COVID-19 is behind more than 80% of new U.S. cases, but authorized vaccines remain more than 90% effective in preventing hospitalizations and deaths, said top U.S. infectious disease expert Anthony Fauci yesterday.
It comes as the U.S. Centers for Disease Control and Prevention announced that life expectancy in the U.S. fell by a year and a half in 2020 to 77.3 years - primarily as a result of deaths caused by the pandemic. It's the biggest one-year decline since World War Two.
As part of work identifying promising technology use cases to combat COVID, The Boston Consulting Group recently used contextual AI to analyze more than 150 million English language media articles from 30 countries published between December 2019 to May 2020.
The result is a compendium of hundreds of technology use cases. It more than triples the number of solutions, providing better visibility into the diverse uses of technology for the COVID-19 response.
To see a full list of 200+ exciting technology use cases during COVID please follow this link.
Indonesia has extended its COVID-19 restrictions to 25 July, with case numbers still high. The country is aiming for a gradual easing of restrictions next week if infections drop, President Joko Widodo said yesterday.
"If the trend of cases continue to decline, from July 26 the government will initiate gradual easing," he said in a virtual address.
Infections have repeated been around 50,000 per days in the last week, with the number of COVID-19-related deaths above 1,000 for the fifth consecutive day on Tuesday.
Restrictions that were first introduced on 3 July will remain in place on the island of Java and Bali and other cities across the archipelago. They include having workers at non-essential businesses working from home, limited on travel and the closure of shopping malls.
Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, has said the Tokyo Olympic Games should go ahead to demonstrate what is possible with the right plan and measures amid the COVID-19 pandemic.
Speaking to the International Olympic Committee members at their session in the Japanese capital, Tedros said the world needed the Olympics now "as a celebration of hope".
"The Olympics have the power to bring the world together, to inspire, to show what's possible," he said.
Dr Tedros criticised the vaccine discrepancies between countries though, saying the pandemic could be ended if there was a fairer distribution of vaccines.
COVID-19 vaccine doses administered by continent.
Image: Our World in Data
"Instead of being deployed widely, vaccines have been concentrated in the hands and arms of a lucky few," he said.
"The pandemic will end when the world chooses to end it. It is in our hands," he said. "We have all the tools we need. We can prevent this disease, we can test for it and we can treat it."
Written by
Joe Myers, Writer, Formative Content
The views expressed in this article are those of the author alone and not the World Economic Forum.
The COVID-19 vaccines are safe and effective, but misinformation keeps many people from taking the shot. Allen J. Schaben/Los Angeles Times via Getty Images hide caption
The COVID-19 vaccines are safe and effective, but misinformation keeps many people from taking the shot.
Misinformation about COVID-19 vaccines can appear almost anywhere: from an uncle's Facebook post to a well-trusted news commentator. But where does it come from, and why do some myths spread further than others?
With the help of the internet research firm Graphika, NPR analyzed the rise of one persistent set of lies about COVID-19 vaccines: that they can affect female fertility.
Despite a mountain of scientific evidence showing the vaccines are safe and effective, the false information persists.
Graphika's data analysis tools allow the firm to track key points at which a piece of information is shared or amplified. It can illustrate how many of these kinds of lies often go viral.
The events outlined here represent a major amplification event for this false information, but they're by no means the only source of lies about female fertility and the vaccine. Claims about fertility and the coronavirus vaccines go back to at least December, and fertility claims about other vaccines date back even further, in some cases decades.
But the events of earlier this year illustrate how misinformation can spread in a nonlinear manner with many different players adding threads to a web of false content.
Here then is the life cycle of a lie:
After receiving the COVID-19 vaccine this spring, "a lot of women noted heavy menstrual periods," says Alice Lu-Culligan, an MD-Ph.D. candidate at Yale University who studies the immune system and reproductive health.
Lu-Culligan says that immune cells play an important role in menstruation, and so it is in fact possible that the vaccine could temporarily alter that process. "It's very plausible that you could have abnormalities to the typical menstrual cycle," she says.
Other scientists agree it's possible. One team of biological anthropologists is conducting a survey of experiences with menstruation and the vaccines, which has had over 120,000 responses so far, according to Kathryn Clancy, a researcher at the University of Illinois Urbana-Champaign. The researchers learned many thousands of people who menstruate have unusually heavy flows after vaccination, and some older people also experienced breakthrough bleeding.
Unfortunately, definitively establishing a link has proved difficult, in large part because trials for the new vaccines never asked women about their periods. Because there is so much natural variation in women's periods month to month, a controlled clinical trial would be needed to try and establish whether it was happening. "When you don't collect these data during the clinical trial, you really lose an opportunity to study it in a controlled fashion," Lu-Culligan says.
The lost opportunity for scientists became an opening for anti-vaccine activists, says Melanie Smith, former director of analysis for Graphika. "In the more successful misinformation cases that we see, there is always that gap of knowledge," she says.
With no firm data, stories about the disruption to menstrual cycles began popping up in forums and groups. Many were just wondering if it had happened to others and whether they should be worried. But there was one Facebook group in particular that turned out to be important.
"It's called, literally 'COVID-19 Vaccine Side Effects,' " Smith says. There were a lot of posts by ordinary people there, looking for answers, but anti-vaccine activists were also part of the group.
One of the people reading this page was an anti-vaccine campaigner named Naomi Wolf. Formerly best known for her writing about feminism, Wolf has, over the years, drifted into anti-vaccine advocacy. "She is a very highly followed influencer in what we call the pseudo-medical community," Smith says.
Wolf is not a medical doctor, and yet on April 19, she tweeted out a link to the Facebook group along with this message: "Hundreds of women on this page say that they are having bleeding/clotting after vaccination, or that they bleed oddly AROUND vaccinated women. Unconfirmed, needs more investigation, but lots of reports."
Smith points out that Wolf is using an old trick: by saying something "needs more investigation," she's raising doubts, without presenting facts that can be refuted.
An anti-vaccine protester dressed up as President Biden holds a sign outside Houston Methodist Hospital in June. Myths about vaccines and fertility are often incorporated into global conspiracy theories. Mark Felix/AFP via Getty Images hide caption
An anti-vaccine protester dressed up as President Biden holds a sign outside Houston Methodist Hospital in June. Myths about vaccines and fertility are often incorporated into global conspiracy theories.
Wolf's tweet also seamlessly inserted a myth: that somehow vaccinated women could pass side effects on to the unvaccinated.
Lu-Culligan says that's absolutely not the case. She adds that this myth seems to echo another popular falsehood: that somehow women who live together can influence each other's cycles.
Wolf kept tweeting and piling on more misinformation in question form: Can vaccines cause infertility? Miscarriages?
This slam went well beyond disruption to menstrual cycles, raising the stakes dramatically. Lu-Culligan says the evidence overwhelmingly shows that the vaccines do not cause these problems. "At this point there have been many, many millions of women who have gotten the vaccine, and there have been no scientific reports of any infertility," she says.
The Centers for Disease Control and Prevention also says that the available data shows that vaccines are safe for those who are pregnant or nursing.
Days after Wolf started tweeting about vaccines and fertility, other influencers began picking it up, and a few clickbait websites wrote fake news stories.
But it was the real news that gave the lies their biggest boost. About a week after the initial tweets, a Miami private school, the Centner Academy, announced it would no longer allow vaccinated teachers into the classroom. It said there were too many questions about whether the vaccine could spread to unvaccinated mothers and children.
The school's CEO, Leila Centner, is an established anti-vaccine advocate, so her decision wasn't surprising. But the ban made national news anyway.
"To some people it's crazy and to others they question it because they want to know more, so for everyone there's a reason why you click on it," says Tara Kirk Sell, a senior scholar at the Johns Hopkins Center for Health Security. She says this perfectly illustrates how a lie that's grown big enough can use the mainstream media to get a further boost.
"By covering it, which is important for people to know what kind of stuff is going on out there, the other side of that is that the lie spreads faster, and more people see it and more people pick up on it," Sell says.
And that's what happened. The Miami school story led to global coverage. "This is the point at which we start to see Spanish and Portuguese content, specifically," says Smith, formerly of Graphika.
The lies piggybacked along with news of the school. Outlets in other languages began reporting that the vaccine can spread person to person, or cause fertility problems.
Finally, because misinformation about vaccines is not grounded in data, it can mutate to fit any political message or worldview.
Vaccine myths about fertility and reproduction are particularly potent because they affect a large swath of the population, particularly when they incorporate myths about vaccinated women spreading the side effects. "It's kind of a one-size-fits-all theory in some ways, and the potential impact is everyone, rather than one specific community," Smith says.
In the weeks following the initial wave of coverage, others were using these ideas to grab audiences. Conservative commentator Candace Owens brought the link between vaccines and menstruation up on Instagram. In a six-minute video questioning vaccine safety, Owens never directly repeated the lies about fertility but didn't refute them either.
Far-right commentator Alex Jones folded the vaccine lies into his conspiracy theories about Google and Facebook, which he claims are trying to depopulate the Earth. "It's not just that you're going to be sterile, you're not going to be able to have children," Jones said during a recent broadcast. "You're not going to be able to eat beef anymore."
By late June, the lies about fertility had spread everywhere from France to Brazil. But then, Smith says, they started fading away.
"It seems to have kind of fallen by the wayside in terms of the COVID-19 news cycle that happens in these spaces on the internet," she says.
And that's the last lesson about the lies: They don't stick around. They grab the attention, raise questions and doubt, but there's no substance there. So once they've shocked those they're meant to engage, they disappear.
Or more properly, they're replaced by a new, incredible story.
A popular Cape Cod, Massachusetts, summertime destination is reporting a worrisome spread of COVID-19 infections following the Fourth of July.
Officials in Provincetown, Massachusetts, issued a number of renewed mitigation measures on Monday after at least 132 individuals tested positive for COVID-19 in the weeks after the holiday weekend.
Town Manager Alex Morse told ABC News on Monday that the "vast majority" of the COVID-19 cases associated with the town's outbreak are among vaccinated individuals.
Eighty-nine of the reported cases are amongst Bay State residents, 39 of whom reside in Barnstable County, and the remainder of the individuals, who tested positive, reside in other states and jurisdictions, local officials said.
At the height of its tourist season in the summer months, Provincetowns population swells from 3,000 year-round residents, to over 60,000 people, according to state data.
People walk on Commercial Street in Provincetown, Mass., on June 27, 2021.
"We have a lot of visitors in Town, and given the volume, it's inevitable that cases will continue to pop up over the summer," Morse said last week, after the first cases were reported.
Morse reported most individuals are experiencing "mild symptoms." According to medical experts, fully vaccinated individuals are far less likely to become severely ill, and hospitalized, if infected with COVID-19.
Nina Hargus, and her husband, Stan, of Sudbury, Massachusetts, were among the influx of tourists who enjoyed the busy Fourth of July weekend in Provincetown.
It really felt like a pre-COVID Fourth of July in Provincetown, Hargus said. Restaurants and bars were packed. The streets were filled with pedestrians, we saw very few masks, and no social distancing.
Last week, Johnny Chagnon, of Vermont, and several of his friends, were thrilled to return to Provincetown after a difficult year. Although Chagnon had heard about breakthrough Fourth of July infections, he had not been too concerned, he told ABC News, because he was fully vaccinated.
I have a lot of faith in vaccines, said Chagnon, who has also conducted COVID-19 testing throughout the pandemic for the Vermont Department of Health.
Nevertheless, preferring to be cautious, we were avoiding indoor events, because they were very packed, opting instead for outdoor events, but without wearing a mask, he said.
However, on Monday, right after leaving Provincetown, he began to feel sick, coming down with a fever, and experiencing shortness of breath, a sore throat and cold-like symptoms.
Today, my fever is even worse, Chagnon said on Tuesday. Although his symptoms have been manageable, it's definitely not what I expected being fully vaccinated.
People gather on MacMillan Pier in Provincetown, Mass., on June 27, 2021.
With hundreds of people posting images of their Provincetown parties on social media, Chagnon added that the stealthy spread of the virus among visitors almost felt like a train wreck.
I know there's responsibility on my end, because Im kind of there, partying like it's 2019, so I'm a little mad at myself, Chagnon said. However, he added, everyone who has tested positive around me was fully vaccinated, so we thought we were doing the right thing, we were doing everything that the town management said, and then this still happens.
In light of the outbreak, officials in Provincetown have issued a new mask advisory, in which masks are now advised indoors where social distancing cannot be achieved. All unvaccinated individuals, including children under the age of 12, are required to wear masks both outdoors in crowded areas where social distancing cannot be achieved and in public indoor spaces.
Local officials are also now "strongly advising" venues with high density, where social distancing is not achievable, to enforce vaccine verification prior to admittance.
The Boston Public Health Commission also announced that it too would issue guidance for recent Provincetown visitors, after officials identified at least 35 positive COVID-19 cases tied to the Cape cluster among Boston residents.
The citys residents, who have traveled to Provincetown since the first of the month, are now being urged to get tested, regardless of vaccination status or symptoms, self-isolate, and avoid groups or gatherings for at least five days and until residents have received a negative COVID-19 test. All residents are now being asked to take additional precautions to help identify COVID-19 infections, and to prevent additional spread.
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Gov. Jay Inslee today terminated two proclamations and gave advance notice of the termination of one additional proclamation related to the COVID-19 pandemic.
Proclamation 20-45
This proclamation suspended/waived deadlines and service of process requirements relating to protection orders. With the passage ofHB 1320, which goes into effect on July 25, this proclamation is no longer needed to provide relief to the judicial branch.
This order will be rescinded as of 11:59 pm, July 24, 2021.
Read the full proclamationhere.
Proclamation 20-67
This proclamation prohibited agricultural employers from operating unless they implemented a Food Production Paid Leave program for their workers, and it was intended to cover only the August 2020 through November 2020 time period. This order is no longer necessary, and its termination is effective immediately.
Read the full proclamationhere.
Proclamation 20-79
This proclamationwaived/suspended the requirement of deductions from unemployment benefits for lump sum payments. With the passage ofSB 5061, which went into effect February 8, 2021, this order is no longer necessary, and its termination is effective immediately.
Read the full proclamationhere.
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When Kishana Taylor welcomes her twins into the world this December, shell be pretty confident that they wont be carrying the virus that causes rubella, an infection that can be disastrous in infants. Thanks to a vaccine she received as a child, Taylor, a virologist at Carnegie Mellon University, is still immune to the pathogen decades later.
She was able to confirm that in June through a simple test that searched her blood for antibodies that recognize the rubella virus, and then added them up. If her antibody counts were above a certain level, called a correlate of protection, she and her babies would be considered well shielded from disease. You are considered immune with a titer of 9.9 to rubella, she tweeted last month, referring to her antibody levels. My titer? 116. I love my immune system sometimes.
The term correlate of protection doesnt exactly roll off the tongue, but its one of the sexiest concepts in the field of vaccinology. Correlates are biological benchmarksmeasurements of a single immune molecule or cellthat can show that a vaccine is achieving its desired effect. With a correlate in hand, researchers can confirm how well a shot is working and identify the rare individuals in whom it doesnt take; they can suss out the need for boosters and fast-track the development of new vaccines. At their most powerful, correlates of protection boil down the complexities of an immune response to a single valueone that can confidently affirm that a person wont get infected or seriously sick. Its kind of a magic number, Ali Ellebedy, an immunologist at Washington University in St. Louis, told me. Its the big holy grail, Emory Universitys Sri Edupuganti says. Its what we dream about, Cornells Sallie Permar told me last month.
In recent weeks, the correlate community has been buzzing louder than ever. Scientists are on the cusp of confidently defining some correlates of protection against symptomatic disease for the COVID-19 vaccines. If confirmed, these correlates could revolutionize the way we tackle SARS-CoV-2 immunization: Vaccine makers testing a new inoculation may no longer need to follow tens of thousands of people for many months to test their products protection. Instead, they could inject just a few hundred people, snag some drops of blood, and see if the elusive correlate is met. Thats how we tee up new flu vaccines every year without the rigmarole of gargantuan clinical trials.
Read: The only way well know when we need booster shots
But for all their apparent simplicity, correlates of protection are devilishly hard to come by. Try as researchers might, capturing the oomph of vaccine-induced immunity in one numberor severalisnt always possible. Even as scientists chase them, correlates are a reminder of just how inscrutable our own bodies can be.
Even our best vaccines start out as educated guesses. Researchers study people who have recovered from a particular infection, and then try to cook up an inoculation that will prompt protection thats similar to or better than natural immunity. What ends up entering people is simplea harmless pantomime of the pathogen. But it leads to a tortuously complex response that marshals the immune systems many defensive players, including antibodies, B cells, T cells, and more.
Finding a correlate means cleaving a single variable out of this mess to act as an envoy for the rest of the immune system. Thats a heavy lift for a single cell or molecule, especially when people react in such different ways to the same pathogen. And not all immune responses can be easily measured. Some of the vaccines weve been using for decades still dont have a concrete correlate, including the shots for mumps, rotavirus, and tuberculosis.
That probably wont be the case for the COVID-19 vaccines. Since the pandemics early days, experts have had their eye on neutralizing antibodies, sometimes nicknamed neuts, which can glom on to the outside of viruses and block them from entering cells. Neuts that recognize the coronavirus teem in the bodies of people and laboratory animals that have successfully fought off coronavirus infections. The molecules disease-fighting powers have made them the workhorses of antibody-based treatments, such as convalescent plasma and monoclonals. Levels of these neuts also soar after vaccination, and seem especially high in people who dont come down with COVID-19 after getting all their shots. By now its clear that neut numbers do correspond pretty well with protectionthe more neuts someone has, the more likely it is that theyre safe from disease. As far as Im concerned, the data are clear, Stanley Plotkin, a vaccine expert at the University of Pennsylvania, told me. Neutralizing antibodies are it.
Establishing that this trend exists, though, isnt the same as zeroing in on a cutoff for protection, above which most vaccinated people would likely be guarded from illness. We know lower neutralizing titers predict more infection, Taia Wang, an immunologist at Stanford, told me. What were looking for now is a little more precision. To suss out a more specific set of numbers, researchers need to repeatedly sample the blood of shot recipients, some of whom have to get sick so researchers can get a sense of what falls below the threshold theyre looking for. The more breakthroughs you have, the easier it is to determine, Katy Stephenson, a physician and vaccine expert at Beth Israel Deaconess Medical Center, in Boston, told me. A great irony of vaccinology is that its easier to define the success of a vaccine thats prone to regularly failone of the only downsides of our extraordinary shots.
Another hurdle that correlate chasers need to clear is a lack of consistency across vaccine trials, which were conducted at different times in different populations using different inoculation recipes, different criteria for defining COVID-19 severity, and different brands of antibody tests. Aggregating and analyzing all the evidence to produce one unifying correlate requires some serious statistical gymnastics.
Read: COVID-19 vaccine makers are looking beyond the spike protein
By now, though, enough people have been vaccinated, and enough blood samples drawn, that preliminary numbers are starting to emerge. One group of researchers in the United Kingdom has proposed a correlate of protection against COVID-19 for AstraZenecas vaccine; two others, one in Australia and another in the United States, have taken a stab at pinpointing measurements that will hold true across several different shots, including the three available to Americans. (Representatives from Moderna, Pfizer, and Johnson & Johnson told me that they didnt yet have their own correlates to report, but were continuing to investigate.)
But the case isnt closed. We have some strong leads, but I would not say we have a correlate yet, Holly Janes, a biostatistician at the Fred Hutchinson Cancer Research Center, in Seattle, told me.
While neuts have certainly hogged the spotlight so far, they could still be unseated by another molecule or cell. And even if neuts are the real deal, having one correlate doesnt preclude defining another that captures an additional element of the immune system. Flu vaccines, for instance, seem to come with a bunch of measurable metrics of success, some of which are still being confirmed in research labs. Other, non-neutralizing antibodies exist, and their levels also seem to ratchet up in lockstep with COVID-19 vaccine efficacy.
Many researchers are hoping for more data on T cells, immune cells that support the production of antibodies or annihilate virus-infected cells on their own. Compared with antibodies, T cells are fragile, reclusive, and a pain to measure, Smita Iyer, an immunologist at UC Davis, told me. But they seem fundamental to the success of well-established vaccines, including those for chicken pox and tuberculosis. Against the coronavirus, T cells are known to pick up the protective slack when neuts and other antibodies fail. Theres not only one immune response that protects you, which is good, Florian Krammer, a vaccine expert and virologist at the Icahn School of Medicine at Mount Sinai, told me. If one fails, another can take over. That redundancy is great for us, but frustrating for researchers looking for a simple portrait of protection.
Things could get even thornier. As is the case with any vaccine, the success of a COVID-19 shot hinges on a multitude of factorsincluding the strength of the immune system its bolstering, the mutability of the virus its counteracting, and the exact ingredients in the shot itself. Kids, whose immune systems are still finding their footing, might need correlates of their own; so might older adults and immunocompromised people, whose immune systems are less easily marshaled by vaccines. The numbers we settle on could also vary among vaccine brands because different shots rile up different subsets of immune cells.
Then theres the biggest wild card of all: the coronavirus itself. Its continuing to splinter into new variants, some of which have already revealed themselves to be quite capable of dodging certain antibody-based defenses. A neut level that keeps us safe from Alpha wont necessarily thwart Beta or Delta to the same extent. (Theres at least good news on T cells, which are much harder to stump with mutationsanother reason these cells are looking so attractive to some scientists.) Were starting to get numbers now, but there are going to be asterisks because of the variants, Lisa Gralinski, a virologist at the University of North Carolina at Chapel Hill, told me. Because correlates take so long to determine, whatever number we come up with today is really talking about the past, Stephenson, of Beth Israel, said. SARS-CoV-2 will always mutate far faster than humans can conjure new correlates. We may well end up with an entire menagerie of correlates against COVID-19, each tailored to its own combination of population, variant, and vaccine. (And thats all just in the realm of blocking COVID-19 disease; stopping asymptomatic infection would require its own set of correlates as well.)
Read: Delta is driving a wedge through Missouri
But the mere possibility of hitting protection pay dirt is reason enough to keep plugging away. Having a strong correlate of protection against COVID-19 would allow researchers around the world to more quickly bring new vaccines to market in countries where they are sorely needed. A correlate would also give scientists the chance to monitor the natural wane of immune responses and deploy boosters that could rapidly buoy those defenses, if need be. It could act as a guidepost for new shots that fight specific variants before they outsmart the jabs we already have.
The need for correlates is so urgent, the FDA has already gambled that antibodies are the answer: In recent guidance, the agency noted that it would consider green-lighting updated, variant-specific versions of vaccines if theyre able to prompt the production of adequate levels of neuts. Its a hastier move than some researchers would like. But with variants such as Delta surging amid a largely unvaccinated global population, the shortcut offered by these correlates has never been more appealing. The big hope, researchers told me, is that COVID-19 vaccines will be able to follow in the footsteps of flu shots, which are reformulated seasonally to keep pace with the strains du jour. Vaccine makers can debut new vaccines by simply checking inoculated peoples blood for the telltale markers of protection, rather than waiting to see how these individuals fare against the virus itself.
Spinning the idea of correlates into a personal guarantee of immunity is tempting, especially with antibody tests so readily available. But correlates are just thatcorrelates, patterns gleaned from large groups of people. Levels of certain immune fighters could track with protection against disease without being directly responsible for our vaccines success on a person-by-person basis. Were talking about measurements that apply better to populations than to individual people, Plotkin said.
Some correlates can be tested in individuals, such as in the case of the rubella-antibody test that Taylor took in June, after discovering she was pregnant. But these tests dont offer absolute certainty. Every trend will have exceptionssome people whose SARS-CoV-2 antibody levels are bonkers-high may still end up getting sick; others with low titers will stay safe. Antibody stocks, after all, naturally dwindle over time, but the body retains the ability to replenish them. Thresholds arent hard lines between unprotected and protected; everyone always carries some relative risk, especially amid a pandemic this devastating. There are no sharp edges in biology, Iyer told me. Correlates, while useful, cant actually encompass everything our immune systems are capable of. Without the right amount of nuance, they risk making black-and-white out of a situation that operates entirely in shades of gray.
The highly contagious Delta variant of Covid-19 doesnt pose an immediate risk to the strength of the U.S. economic recovery, with analysts expecting a robust expansion to continue in the second half of the year.
Many economists are maintaining forecasts for solid economic growth due to expectations of steady hiring and continued spending, driven by accumulated savings and Americans desire to travel and socialize more than a year into the pandemic.
They see limited disruptions to the economy as local health officials try to avoid restrictions and boost vaccinations in response to the recent case surge. Economists are more concerned about firming inflation than the Delta variant as they assess the economic outlook.
The variant is a significant downside risk for the economy, but that risk is more than offset by what are still very strong fundamentals, said Oren Klachkin, lead U.S. economist at Oxford Economics. Consumers have a lot of cash and seem eager to spend on activities they couldnt do for 18 months. And, for now, it seems like the vaccines should be able to keep the spike in cases fairly low.
Oxford, a forecasting firm, hasnt changed its projection for U.S. gross domestic producta broad measure of the economys output of goods and services. It expects GDP to rise at nearly a 9% annualized pace in the third quarter. Such historically strong growth would be in line with the stimulus-fueled expansion in the first half of the year.
A new normalcy is on the rise for universities as they prepare for the start of a new school year.
The University of Illinois System recently announced that all faculty and staff are required to be fully vaccinated for COVID-19 by the beginning of the fall semester of 2021.
Weve been intensively preparing for this all along, all the way back to the beginning, said Timothy Killeen, president of the UI System. We do feel now that vaccination is key to getting out of the pandemic as a whole community and to make our campus as safe as possible. Were going beyond encouraging ... getting that extra percent is going to be very important, particularly with the variants emerging.
According to Killeen, student enrollment for the UI System is robust. But not all colleges are seeing these trends.
Since 2013 to 2019, there was a 34% drop in Black student enrollment at our Illinois colleges which we view as a crisis, said Zaldwaynaka Scott, president of Chicago State University. The crisis is now on top of a pandemic which created another significant crisis in the Black community as we continue to see the pandemic has wreaked havoc on our Black and brown communities.
To combat these dips in enrollment and economic barriers posed by the pandemic, colleges and universities across the state are increasing financial aid opportunities and emergency grants for students.
We have emergency funds for students who may struggle with living expenses and additional scholarship opportunities to encourage students to come back, said Aarti Dhupelia, vice president of undergraduate education at National Louis University. And to ensure that financial or other personal barriers that really are the root of equity gaps in higher education that we knock those down so students can continue on in their studies uninterrupted.
According to Dhupelia, about 70% of National Louis University students are low-income and first in their family to go to college.
The UI system is also increasing financial aid support for students as the pandemic continues.
We know from our own surveys that the financial considerations are very paramount in family decision making, Killeen said. Our total amount of financial aid per year given to students based on their needs is above $240 million, and thats more than federal and state financial aid as well.
Mariama Mwilambwe, a junior at the University of Illinois at Urbana-Champaign and elected Student Trustee, believes that in addition to financial and academic support, universities should be stepping up to help emotionally as well.
Students need to feel like theyre supported by the university, Mwilambwe said. They need to feel like there are culturally appropriate counselors available. They need to feel like there is an abundance of appointments for them. They need to feel like not just academically and financially theyre supported, but also mentally and emotionally and that they feel their concerns are being heard.
The US has been limiting non-essential travel along both borders since the start of the pandemic and extending those restrictions on a monthly basis. The restrictions don't apply to cross-border trade, US citizens and lawful permanent residents, as well as people traveling for medical purposes or to attend school, among others.
But over recent weeks, the administration has come under fire for continuing to keep restrictions in place, more than a year into the pandemic, and after Canada announced it was reopening to vaccinated Americans.
In notices to be posted in the Federal Register, Homeland Security Secretary Alejandro Mayorkas notes that there have been "positive developments in recent weeks," citing the millions of vaccines doses administered in the United States and the US Centers for Disease Control and Prevention moving Canada and Mexico to Covid-19 Level 4 (Very High) to Level 3 (High) "in recognition of conditions that, while still requiring significant safeguards, are improving."
Still, DHS found that the outbreak and continued transmission and spread of Covid-19 both in the US and globally posed a risk.
A DHS spokesperson cited concerns over the dangerous Delta variant and said the agency is in "constant contact with Canadian and Mexican counterparts to identify the conditions under which restrictions may be eased safely and sustainably."
The restrictions go into effect Thursday and remain in effect until August 21, "unless amended or rescinded prior to that time."
