Daily Covid Briefing
Aug. 1, 2021, 12:09 p.m. ET
Aug. 1, 2021, 12:09 p.m. ET
A survey of data from 10 states shows that more than one million doses have gone to waste since the nation began administering Covid-19 vaccines in December.
Much of the loss has come as demand for inoculations plummeted, with the daily rate of vaccinations now at less than one-fifth of its peak average of 3.4 million shots, reached in mid-April.
More than 110,000 doses have been destroyed in Georgia, officials there said. Of the more than 53,000 doses wasted in New Jersey, nearly 20,000 were discarded in June, up from around 4,000 in April. In Ohio, more than 370,000 doses have been reported as unusable by state providers, while around 50,000 doses in Maryland were not used, officials said.
Reasons for vaccine wastage include breakage, storage and transportation problems, expiration, and shots that were prepared but not used after people did not show up for appointments, officials said. In many states, data shows that wasted or unusable doses are no more than 2 percent of those received from the federal government and successfully administered.
In Georgia, more than 8.5 million doses have been administered; the state’s unused doses total just 1.4 percent of that number, officials said. Idaho has wasted about 2 percent of delivered doses, and New Jersey less than half of 1 percent.
Other states are likely to face some of the same issues as the 10 states whose data was reviewed by The New York Times, suggesting that the number of wasted doses in the country could be far higher. Other states, including North Carolina and South Carolina, did not respond to requests for information. State data does not include all doses that the federal government ships directly to chain pharmacies, so there could be unaccounted-for waste.
The Centers for Disease Control and Prevention tracks wasted doses, but did not respond to a request for that data, which would provide a broader national picture.
The rise in wasted vaccine doses reflects the challenge American health officials face in inoculating residents, even as the more contagious Delta variant of the coronavirus fuels outbreaks among the unvaccinated across the United States. Delta is also one driver of a rise in cases globally, and many countries are begging for vaccine doses.
Full vaccination offers strong protection against severe disease and death, including from the Delta variant, and the C.D.C. says breakthrough infections in vaccinated people are rare. However, recent data suggest that vaccinated people infected with the Delta variant may transmit the virus to others, a finding that contributed to the C.D.C.’s recent decision to advise vaccinated people in Covid hot spots to wear masks again in indoor public areas.
Vaccinations are now ticking upward in some states; more than 850,000 shots were recorded on Friday, raising the daily national average to more than 650,000 from about 500,000 three weeks ago. Still, more than half of the U.S. population is not fully vaccinated, according to a Times database. That includes children under 12, who are not yet eligible.
“Early on, it was kind of a crisis because people wanted it and couldn’t get it, and now it’s a crisis because we’ve got it and people don’t want it,” said Dr. Marcus Plescia, who represents state health agencies as the chief medical officer for the Association of State and Territorial Health Officials.
Many states have asked about redistributing unused vaccines abroad, but once the doses are shipped out to states, federal regulations prohibit recalling them. And some countries, like Canada, have declined states’ offers of surplus vaccines.
“Here we are with loads of vaccine, and there are other countries in the world where people are desperate for vaccination,” Dr. Plescia said.
With vaccinations lagging, some state health officials have directed providers in recent months to open a new vial even if some of it goes unused.
“It’s better to give two doses and waste 12 than to leave 14 doses sitting in the freezer,” said Kristen Dillon, a director of the Oregon Health Authority’s Covid-19 Vaccine Planning Unit. Oregon has reported more than 78,000 doses as nonviable, the “vast majority” of which were unused doses from opened vials, officials said.
In Arkansas, where just 36 percent of residents are fully vaccinated, nearly 55,000 doses had gone to waste by mid-July, up from around 580 in mid-March, as officials prioritized vaccinations over saving doses. “If we have the opportunity to give the vaccine, let’s go ahead and do it,” said Robert Ator, a retired National Guard colonel who runs the state’s vaccination effort.
Like officials in many other states, Mr. Ator said he stopped ordering additional doses in April as demand dropped, and he has since shifted to repackaging doses in smaller quantities for distribution to drugstores and doctors’ offices. The state’s stockpile has decreased from 550,000 doses in April to about 350,000 in late July, he said.
Despite his efforts, Mr. Ator projected that about 100,000 doses of the state’s stockpile could expire over the next three months.
As cases and hospitalizations rise across the country, Dr. Francis Collins, director of the National Institutes of Health, said on Sunday that businesses asking employees for proof of vaccination or regular testing were taking steps “in the right direction.”
“I think anything we can do to encourage reluctant folks to get vaccinated — because they’ll want to be part of these public events — that’s a good thing,” Dr. Collins said on CNN’s “State of the Union.”
Dr. Collins said he was pleased to see companies such as Disney and Walmart asking their employees to get vaccinated. And he expressed support for President Biden’s decision this week requiring federal workers to get the vaccine or, “if they’re not, to get regular testing, which is inconvenient.”
“All of those steps, I think are in the right direction,” Dr. Collins said.
When asked whether airlines should require proof of vaccination for passengers, Dr. Collins said that the decision was up to the airlines, but that it could motivate people to get vaccinated if they want to be able to travel.
Proposals for business and government agencies to recommend or require employees to get vaccinated have come as coronavirus infections are surging across the country. In the past two weeks, new infections have risen by 148 percent in the United States, and hospitalizations have increased by 73 percent, according to New York Times data.
The surge has been largely attributed to the highly contagious Delta variant, and to low vaccination rates in some states.
In an interview on “Face the Nation” on Sunday, Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, emphasized the importance of getting more Americans vaccinated as the country faces a more contagious variant of the virus, implicating the unvaccinated in the rise in Delta cases.
“We’ve really got to get those people to change their minds, make it easy for them, convince them, do something to get them to be vaccinated, because they are the ones that are propagating this outbreak,” he said.
Dr. Fauci also addressed recommendations this week from the Centers for Disease Control and Prevention for Americans to wear masks, regardless of vaccination status, in areas where transmission rates are high. The recommendation was issued days before the agency released a report, on Friday, suggesting that fully vaccinated people are capable of spreading the virus to others just as readily as unvaccinated people.
“We’re now dealing with a virus that has an extraordinary capability of spreading from person to person,” he said. “So when you superimpose one on the other, you have a very difficult situation, a pool of unvaccinated people and a virus that spreads very efficiently.”
Amid the highly uneven rollout of Covid-19 vaccines, many health officials and community organizations are drawing upon geospatial data to plan their vaccination campaigns and track their progress in fine-grained detail, brandishing brightly colored maps to pinpoint the exact neighborhoods where cases are rising or where testing rates are lagging.
In mid-March, for instance, officials in Milwaukee County released a color-coded map that categorized census tracts according to their vaccination rates and their scores on a national “social vulnerability index,” incorporating more than a dozen social, economic and demographic factors to calculate how susceptible a given community would be in the event of some kind of disaster, like a hurricane or a pandemic.
The map revealed a county divided: Much of the city of Milwaukee was colored dark orange, signaling that the area had high levels of social vulnerability but low vaccination rates, whereas the suburbs, where the population is wealthier and whiter, were shaded a pale yellow, indicating that they had low scores on the vulnerability index but climbing vaccination rates.
County and city officials began pouring resources into deep orange neighborhoods, prioritizing those residents for vaccine appointments, adding more vaccination sites in those areas and creating pop-up sites and events at churches, food pantries, libraries, schools and cultural centers. They also started a community ambassador program — the Crush Covid Crew — to train volunteers from those deep orange census tracts to talk to their neighbors about the vaccines and dispel misinformation about them.
Although vaccination rates in the most vulnerable areas still lag behind, they have more than tripled since mid-March. “The darkest orange communities are now gone,” said Dr. Ben Weston, who oversees the medical aspects of the county’s Covid-19 response. “So we’re making progress.”
In Clackamas County in Oregon, G.I.S. data has become the backbone of efforts to vaccinate people who are homebound. Mass vaccination sites “were just not accessible to homebound seniors and homebound people with mental, developmental or physical disabilities,” said Kim La Croix, a public health program manager for the county.
When residents call or email the county to request an at-home vaccination, staff members log their location, which pops up on a digital map. Then, when assigning specific appointment slots, they review the map, which displays the number and type of vaccines that have been requested across the county. The goal is to reduce nurses’ travel time, maximize the number of shots they give in a day and to minimize waste, by ensuring that the number of doses a nurse gives in a shift matches the number of doses in a vial.
“One of the common questions I used to get was, ‘Where is it bad?” said Dr. Harsha Rajashekharaiah, the senior project coordinator for the county’s Covid-19 response. “Where is the Covid transmission bad? Where is the testing bad? Where should we improve? Where should we invest our resources?”
Dr. Rajashekharaiah began using digital mapping tools — commonly known as geographic information system, or G.I.S., software — to explore how vaccination rates varied across the county and how they correlated with a variety of demographic factors.
Several patterns soon emerged on the color-coded maps. In March, for instance, magenta splotches on the western side of the county made it clear that vaccination rates were low in neighborhoods with a high share of residents who did not speak English well. After he presented the map to his colleagues, they quickly added Spanish and Haitian Creole language assistance to their county vaccine hotline.
Over the next few months, as vaccination rates rose in these neighborhoods, portions of the map turned to yellow or even green. “I cannot sit here and conclude that our G.I.S. system is the reason that this has happened,” Dr. Rajashekharaiah said. But, he added, “G.I.S. has been a very, very powerful tool for us to communicate these barriers.”
At least 233 staff members at two major San Francisco hospitals, most of them fully vaccinated, tested positive for the coronavirus this month, and most, according to a hospital official, involved the highly contagious Delta variant.
Some of the cases were asymptomatic, most involved mild to moderate symptoms and only two required hospitalization, officials said. The infections were determined to be Delta-related because most samples in San Francisco were tested for the variant, which is now dominant in the city.
About 75 to 80 percent of the more than 50 staff members infected at Zuckerberg San Francisco General Hospital were fully vaccinated, Dr. Lukejohn Day, the hospital’s chief medical officer, said in an interview on Saturday. The University of California, San Francisco Medical Center said in a statement issued on Friday that 153 of its 183 infected staff members had been fully vaccinated.
The statement from the U.C.S.F. Medical Center said that two of the infected staff members required hospitalization. None of the infected staff members at San Francisco General have been hospitalized and most had mild to moderate symptoms, Dr. Day said. The asymptomatic cases were discovered through contact tracing.
Without vaccinations, Dr. Day said, the hospitalization rate would be much worse.
“We’re concerned right now that we’re on the rise of a surge here in San Francisco and the Bay Area,” Dr. Day said. “But what we’re seeing is very much what the data from the vaccines showed us: You can still get Covid, potentially. But if you do get it, it’s not severe at all.”
On July 11, San Francisco ordered that workers in high-risk workplaces, including hospitals, be vaccinated by Sept. 15. The U.C.S.F. statement said that the hospital was “doubling down on our efforts to protect our staff. This includes requiring all employees and trainees to comply with the new UC-systemwide Covid-19 vaccination mandate, with limited exceptions for medical or religious exemptions.”
Staff members at both hospitals have continued to wear personal protective equipment, Dr. Day said. But the number of staff infections reported in July is about as many as during the peak of the winter surge.
“We’re nervous that we could potentially exceed it,” Dr. Day said.
Vaccinations are rising in U.S. states where lagging demand left entire regions vulnerable to a Delta-driven surge of coronavirus cases. The shift offers a sign of hope, even as the country’s known cases since the start of the pandemic surpassed 35 million on Saturday.
For the third consecutive week, states with the highest number of coronavirus cases also had the highest vaccination rates, Karine Jean-Pierre, the deputy White House press secretary, said on Friday.
In Mississippi, where 44 percent of adults have been fully vaccinated, the seven-day average of people receiving a first dose was 5,203 on July 27, more than triple the average from July 1, according to data from the Centers for Disease Control and Prevention.
The same pattern is in play for other less vaccinated states where infections are surging. From July 1 to July 28, Louisiana almost quadrupled its seven-day average of administered first doses. And in Missouri, where the Delta variant spurred an outbreak in early July, the number of first doses administered daily almost doubled over a month.
Still, compared with the rest of the country, these states’ vaccination rates remain low. And their rates of hospitalizations and deaths are higher compared with states with more vaccinations.
More than 850,000 shots were recorded on Friday, raising the daily national average to more than 650,000 from about 500,000 three weeks ago. But the overall rate is less than a fifth of the U.S. peak average of 3.4 million shots, reached in mid-April.
The C.D.C. said on Friday that about 190.5 million people had received at least one dose of a Covid vaccine, and about 164.2 million people were fully vaccinated, some by Johnson & Johnson’s single-dose vaccine but many more by the two-dose series made by Pfizer-BioNTech and by Moderna.
That still leaves more than half the country not fully vaccinated, including about 48 million children under 12, who are not eligible. Only full vaccination affords high protection from severe disease if someone is infected with the Delta variant.
The national outlook is quickly worsening. Louisiana, which was averaging fewer than 400 cases a day at the start of July, is now averaging more than 4,100 cases a day, the most ever. The county that includes Jacksonville, Fla., is averaging almost 1,200 cases a day.
As a whole, daily case reports in the United States have risen 150 percent over the past two weeks, pushing the known pandemic total past 35 million.
Dr. Bertha Hidalgo, an associate professor of epidemiology at the University of Alabama at Birmingham, said the higher vaccination numbers in recent days are a clear improvement, even later than hoped.
“It’s not as optimal as we would like, but anything that trends in the positive direction with respect to vaccination is fantastic,” Dr. Hidalgo said. “It’s absolutely not too late because Delta is, unfortunately, likely not the only variant that we may see unless we continue to increase vaccination rates.”
The highly contagious Delta variant is now responsible for almost all new Covid-19 cases in the United States, and cases are rising rapidly. On Tuesday, for the first time since February, the country logged more than 100,000 confirmed cases.
Many places in the United States with some of the country’s lowest vaccination rates are seeing more new cases than at any point in the outbreak. For example, the areas encompassing Branson, Mo., and Harrison, Ark., have set records this month, and Louisiana now has daily case rates more than 10 times higher than in June.
And in low-vaccinated areas, deaths are also on the rise.
A new internal report from the Centers for Disease Control and Prevention cited evidence that vaccinated people experiencing breakthrough infections of the Delta variant, which remain infrequent, may be as capable of spreading the virus as infected unvaccinated people.
Vaccines remain effective against the Delta variant, particularly against hospitalization and death. About 97 percent of those recently hospitalized by the virus were unvaccinated, the C.D.C. said.
The spread of the super-contagious Delta variant of the coronavirus has prompted new restrictions around the world and spurred stark new warnings from public health officials.
“It is one of the most infectious respiratory viruses we know of and that I have seen in my 20-year career,” Dr. Rochelle P. Walensky, director of the Centers for Disease Control and Prevention, said last week.
The variant is as transmissible as chickenpox — meaning far more than the common cold virus, SARS, smallpox and seasonal flu. And even though the vaccines still provide strong protection against severe illness and death, fully vaccinated people can still be infected by and transmit Delta to others, according to an internal C.D.C. document obtained by The New York Times.
Fatality rate
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Delta variant
More transmissible than Ebola or smallpox, and as contagious as chickenpox.
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Delta variant
More transmissible than Ebola or smallpox, and as contagious as chickenpox.
Original version of corona-
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Average number of people infected by each sick person
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As infectious as chickenpox.
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Here are answers to some common questions about the Delta variant.
Why are people worried about the Delta variant?
Delta, formally known as B. 1.617.2, is believed to be the most transmissible variant yet. It is believed to be roughly twice as contagious as the original virus. An internal C.D.C. document, a copy of which was obtained by The New York Times, said that Delta was as transmissible as chickenpox.
People who are infected by Delta may carry 1,000 times more virus, and for a longer period of time, than those infected by the original virus. Other evidence suggests that the variant may be able to partially evade the antibodies made by the immune system after a coronavirus infection or vaccination.
Where is it spreading?
Delta has been reported in 182 countries, and is now the most common variant in many of them. Over the past month, infections have nearly doubled in most regions of the world, the W.H.O. said at a news briefing on Friday.
Delta was first identified in the United States in March. It spread quickly. In early April, Delta represented just 0.1 percent of cases in the United States. The C.D.C. now estimates that the number has hit 82.2 percent.
If I’m vaccinated, do I need to worry about getting sick?
There is not yet good data on how all of the vaccines hold up against Delta, but two doses of several widely used shots, including those made by Pfizer-BioNTech, Moderna and AstraZeneca, appear to retain most of their effectiveness against the Delta variant, research suggests.
Delta may cause more frequent infections in people who have been fully vaccinated than other variants. However, these infections tend to be mild or asymptomatic. The vaccines prevent more than 90 percent of severe disease, the C.D.C. document notes.
If I’m vaccinated, can I transmit Delta?
The C.D.C. believes it’s possible. Although vaccinated people are less likely to become infected by Delta than those who are unvaccinated, those who do contract the virus may carry just as much of the virus in their noses and throats as unvaccinated people, Dr. Walensky said this week.
“Delta variant vaccine breakthrough cases may be as transmissible as unvaccinated cases,” the internal C.D.C. document said.
Will Delta return us to last year’s pandemic peak?
After a long and steady decline, cases are on the rise again in the United States, most likely fueled by Delta. More than 78,000 new infections are being reported each day, up from about 11,000 a day a little over a month ago.
But case numbers remain far below last winter’s peak, and experts do not expect them to rise that high again. However, Delta is driving outbreaks in areas where vaccination rates are low.
What can I do?
Get vaccinated. Inoculation is likely to slow the spread of variants and reduce the odds that more dangerous variants emerge. Face masks can provide additional protection.
PARIS — Pascale Collino, 64, is far more afraid of the Covid-19 vaccines than of the disease itself. So when the French government decided to implement a new health pass policy barring those without proof of vaccination or a recent negative test from many indoor venues, she took to the streets in protest.
“We have to be on the front lines of this fight,” Ms. Collino said on Saturday near the French health ministry in Paris, where a large crowd had converged, banging pots and cowbells.
For the third week in a row, thousands took to the streets around France to protest the government’s health pass law, which was passed by Parliament recently but still needs a final greenlight from a top constitutional council, expected next week, before it can be fully enforced.
The protests come as the authorities try to stem a new wave of infections that is starting to put pressure on France’s hospitals, where 85 percent of Covid-19 patients are unvaccinated, according to a government report published this week.
More than 200,000 people marched in Paris, where 3,000 police officers were deployed, and in other cities, including Marseille, Rennes and Strasbourg, according to the French interior ministry. The growing size of the protests from week to week and their motley mix of demonstrators have become an increasing source of concern for the government.
The demonstrators are united in their distrust of the news media and of President Emmanuel Macron’s government, but that is where the similarities end. They include far-right and far-left activists, Yellow Vest members and vaccine conspiracy theorists, as well as vaccinated people who argue that the health pass is oppressive and unfair. They also encompass families angry over new rules dictating that unvaccinated middle and high school students, but not vaccinated ones, will be sent home if a coronavirus infection is detected in their class.
One march that started in northern Paris ended with violence on the Place de la Bastille, where some protesters set trash cans on fire and threw projectiles at riot police officers, who responded with tear gas and water cannons.
Around France, three police officers were injured and 19 people were arrested, the interior minister said.
In southern Paris, Ms. Collino, maskless and carrying a French flag, said she was angry that health workers were forced to get vaccinated by this fall, and that access to bars, restaurants, movie theaters, museums, gyms and other indoor venues would be restricted.
Around her, families waved French flags and protesters shouted “freedom” and “resistance” while carrying makeshift cardboard signs with slogans like “Don’t give in to blackmail” and “No to segregation.”
When the protesters passed a statue of Louis Pasteur, the renowned 19th-century French scientist credited with discovering the principles of vaccination, few seemed to take notice. One elderly man, who was walking past the demonstrators, did. “Pasteur must be turning over in his grave,” he grumbled.
The march there was organized by Florian Philippot, a former member of the far-right National Rally party who has become a figurehead of the anti-health pass movement. Two video journalists for Agence France-Presse left the march after protesters insulted them, spat on them and prevented them from filming, the agency reported.
“We no longer have the freedom to seek the treatment that we want,” said Ms. Collino, a retired I.T. specialist who lives in the nearby town of Sèvres. She did not trust officials to tell the truth about vaccines and said that she had taken it upon herself to seek out information about the pandemic online.
Her attitude, however, has isolated her from some friends and family who favor the health pass policy, as do a majority of French people, according to recent polls. Millions have rushed to get their Covid shots since the pass was announced. But Ms. Collino said she would rather die than get vaccinated.
“I don’t understand why they are in favor while I’m against,” she said.
As coronavirus cases rise across the United States, the fight against the pandemic is focused on an estimated 93 million people who are eligible for shots but have chosen not to get them. These are the Americans who are most vulnerable to serious illness from the highly contagious Delta variant and most likely to carry the virus, spreading it further.
It turns out, though, that this is not a single set of Americans, but in many ways two.
In one group are those who say they are adamant in their refusal of the coronavirus vaccines; they include a mix of people but tend to be disproportionately white, rural, evangelical Christian and politically conservative, surveys show.
In the other are those who say they are open to getting a shot but have been putting it off or want to wait and see before making a decision; they are a broad range of people, but tend to be a more diverse and urban group, including many younger people, Black and Latino Americans, and Democrats.
The problem is the same surveys show that the group firmly opposed to the vaccines outnumbers those willing to be swayed. And unless the nation finds a way to persuade the unwavering, escaping the virus’s grip will be a long way off, because they make up as much as 20 percent of the adult population.
Part of the challenge is that the unvaccinated live in communities dotted throughout the United States, in both lightly and densely populated counties. Though some states like Missouri and Arkansas have significantly lagged behind the nation in vaccination rates, unvaccinated Americans are, to varying degrees, everywhere: In Cook County, Ill., which includes Chicago, 51 percent of residents are fully vaccinated. Los Angeles County is barely higher, at 53 percent. In Wake County, N.C., part of the liberal, high-tech Research Triangle area, the vaccination rate is 55 percent.
The rate of vaccinations across the country has slowed significantly since April, but there are signs in recent days of a new rise in shots being distributed, with upticks in vaccinations particularly in states like Arkansas, Louisiana and Missouri, where cases have grown. As of Friday, about 652,000 doses, on average, were being given each day, according to data from the Centers for Disease Control and Prevention; that was up from recent weeks, when the country hovered just above 500,000 shots a day. Nationwide, about 97 percent of people hospitalized with Covid-19 are unvaccinated, federal data shows.
Dr. Laolu Fayanju, a family medicine doctor in Ohio, has encountered patients on both ends of the spectrum: those who are insistent in their refusal to be vaccinated, and others who agree to a shot after he painstakingly lays out the facts.
Never did he expect that so many Americans would still be resisting a shot this many months into the vaccination effort.
“I vacillate between anguish and anger,” Dr. Fayanju said. “We live in an era of unprecedented scientific breakthroughs and expertise. But we’re also stymied by the forces of misinformation that undermine the true knowledge that is out there.”
