As the Delta variant of COVID-19 spreads across the country, health authorities are concerned about the increase in cases in rural counties where vaccination rates are very low. According to data from the Centers for Disease Control and Prevention (CDC), as of July 15 there were 33,000 new cases of COVID, nearly 70 percent higher than the 7-day average the previous week.
“It’s clear that this is becoming a pandemic of the unvaccinated,” said Dr. José Montero, director of the CDC’s Center for State, Tribal, Local and Territorial Support, during a July 16 briefing hosted by Ethnic Media Services.
“People who are unvaccinated account for a majority of the new infections, hospitalizations and deaths. We’ve seen outbreaks of cases in different parts of the country, especially those that have low vaccination coverage,” he added.
According to the CDC’s Social Vulnerability Index (SVI), which includes factors such as socioeconomic status, race, and ethnicity, rural communities have a higher proportion of residents who lack health insurance, have a chronic illness or disability, and are over 65 years old. That’s why vaccination disparities between urban and rural areas could undermine efforts to reduce COVID-19 mortality at the national level.
Although current figures are more encouraging compared to January when the country was at a high level of transmission at an average of 200,000 per day, since June the cases are rising and the 7-Day average of hospitalizations admissions is now about 2,790 per day.
“It is quite clear that this pandemic is not over,” Montero said. “The good news is that if you are vaccinated (with any of the vaccines authorized by the FDA: Pfizer, Moderna and J&J), you have good protection against severe COVID-19 and hospitalization, and you are protected against co-related variants, including the Delta variant.”
The Delta variant represents more than 57 percent of the samples that CDC sequences nationwide and has increased transmissibility.
About 90 percent of those who have received the Pfizer or Moderna vaccine have taken both doses, which exceeds the completion rates for other vaccines that require more than one shot, such as the hepatitis, the varicella or the shingles vaccine, explained Dr. Lauri Hicks, Chief Medical Officer of the CDC’s Vaccine Task Force.
“Both vaccines provide effective protection after two weeks following the second dose, with each exceeding 90 percent effectiveness against serious illnesses,” Hicks said. “Not completing the series puts those who are partially vaccinated at risk of illness, including the highly contagious Delta variant.”
Preliminary data don’t suggest that booster doses are required. But due to the lack of availability of vaccines in certain counties, especially where ethnic communities live, there are people who have not received even a second dose within the recommended four weeks. Experts warn that it is never too late to get the full protection that the second shot offers.
“One area of focus for the CDC is ensuring access and equity in terms of targeting (with vaccines) those hotspots where we’re seeing a lot of transmission,” added Hicks. She said they are working with primary care physicians, providers in schools, medical associations, community and faith-based organizations, and the National Resource Center for Refugees, Immigrants, and Migrants (NRC-RIM).
“We are working with a number of different trusted advocates and providers who are the patients’ most trusted source of information on vaccines… Peer-to-peer promotion is another approach to try to reduce some of the inequities that we’re seeing,” Hicks said.
The CDC investment to close social disparities in populations with health inequities is $2.25 billion.
Populations at risk
The risk of contracting COVID-19 continues to fall between two populations: those who cannot be vaccinated and the skeptics. In the first group are those under 12 years old for whom the vaccine is still in clinical trials that will define its efficacy, safety and the appropriate dose for that age group, before being approved by the FDA.
“Our children remain vulnerable and transmission (among them) is especially high,” Hicks said. “I think it’s really important to make sure parents are getting vaccinated in order to protect their kids.”
There is also the immunocompromised population that even if vaccinated may not have the same level of protection as someone else and could still be at high risk for severe complications from COVID-19. “Making sure that the individuals they are exposed to are getting vaccines is a really important step,” Hicks added.
With respect to the skeptics or the anti vaxxers, experts believe that the social acceptability of not being vaccinated will decrease with time and as more people get vaccinated, the pressure to do so will increase. As much of the mistrust is based on what Montero called “historical wrongdoings” to populations such as African Americans that have been subjected to unethical clinical trials, the doctors reiterated that COVID-19 vaccines “are under the most intense scrutiny of any vaccines we’ve ever rolled out in any vaccine campaign in history.”
“There is always the potential for side effects or adverse events and we are seeing a few safety issues (with vaccines), but they are really rare compared to the number of cases we are preventing in terms of hospitalizations and deaths from COVID,” Hicks added.
The FDA recently warned of new side effects from the J&J vaccine such as Guillain-Barré syndrome, a neurological disease that can cause muscle weakness. Hicks clarified that as of July 12, more than 12.8 million doses of the J&J vaccine had been administered in the United States and that the CDC had identified roughly 100 preliminary reports of this syndrome. “This is not an insignificant side effect, but most people do fully recover from Guillain-Barré syndrome,” Hicks said. “There really isn’t any medication or any vaccine that doesn’t have the potential for side effects or adverse events, but the benefits of the vaccine still outweigh the risks.”
Finally, Dr. Montero clarified that the CDC has not said that we should stop using masks, and that in some settings such as homeless shelters or correctional facilities, they should be mandatory.
“It may be incumbent upon the local or state authorities based on the epidemiological situation in the region, to recommend or mandate the mask use,” Montero said. “The message is not black and white, but we know that vaccines are good and if we are protected, we can be around most people without any risk, or we can use the mask if we
want to.” He recalled that the CDC provides advice and direction to “all jurisdictions in the country,” but that “states are autonomous” to make these decisions.
Montero recommended an active testing approach especially in places with low vaccination rates, “so we can maybe identify early on those asymptomatic who may be able to transmit (the virus),” he concluded.
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