Delta spurs vaccine mandates, while some schools buck anti-mask orders

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Amber Dance | Courtesy Photo

THE CORONAVIRUS FILES

Amber Dance | Columnist

Missing kindergarten could mean long-term repercussions

More than one million children didn’t show up for school — virtual or in-person — last year, according to a new analysis from researchers at Stanford University and The New York Times. Elementary students were most likely to go unaccounted for, with kindergarten enrollment dropping by 9.3%. The biggest declines were in neighborhoods just above or below the poverty line. “Just as the pandemic lay bare vast disparities in health care and income, it also hardened inequities in education, setting back some of the most vulnerable students before they spent even one day in a classroom,” write reporters Dana Goldstein and Alicia Parlapiano.

While kindergarten is optional in 32 states, it plays an important role in setting students up for long-term success, both socially and academically, before the workload increases in higher grades. Low-income students are already more likely to drop out before graduation. “We have to be deeply concerned,” said professor Thomas S. Dee of the Stanford Graduate School of Education.

U.S. states outstrip some countries in COVID case rates

The delta variant continues to pummel the U.S., creating sky-high case rates in several Southern states. Louisiana is averaging more than 100 cases per 100,000 people daily, the highest per capita rate in the nation, while Florida has the highest number of cases at more than 20,000 a day. “The COVID-19 surges in states like Florida, Louisiana and Mississippi are so severe they rank among the very worst outbreaks in the world,” writes Robert Hart at Forbes. “And many states have outbreaks worse than the countries on the CDC’s ‘Do Not Travel’ list.” Rural areas, where vaccine uptake is low and health care is scarce, are especially vulnerable amid the delta wave, reports Erin Banco at Politico. “Delta can spread in a rural community just like it can in an urban community,” said Kim Proffitt, public health nurse and county manager for Uinta County, Wyoming. “Especially if, in those rural communities, people are not being very cautious.”

Military announces vaccine mandate

For the U.S. military, being all that you can be will soon require a coronavirus shot, the Pentagon said last week. The mandate, which will likely apply to civilian employees and private contractors too, is expected to take effect in mid-September, or earlier if the FDA fully approves the Pfizer vaccine before then. About 65% of active-duty military have been fully inoculated against COVID-19, and 28 service members have died of the disease since the pandemic began, reports Dan Lamothe at The Washington Post. Those who refuse vaccination going forward could be subject to penalties ranging from a written reprimand to dishonorable discharge, reports Jonathan Custodio at Politico.

The Pentagon’s plans are part of an ongoing wave of vaccine mandates, supported by NIH director Dr. Francis Collins, who told ABC’s “This Week,” “We ought to use every public health tool that we can when people are dying.” A majority of American voters agree, according to a Morning Consult/Politico poll, with Republicans the outliers. And Dr. Anthony Fauci told USA Today to expect a “flood” of vaccine mandates once the Pfizer vaccine gets the full FDA nod, a move expected within weeks.

Many institutions aren’t waiting. The latest organizations to require vaccination (or a negative test) include the state of California for school employees; Amtrak for its employees; and the city of New Orleans for anyone who wishes to enter public spaces including casinos, restaurants and the Superdome. While some employees are pushing back against the requirements, the mandates are lawful, ethical, and likely to be quite effective, writes Lawrence O. Gostin, an expert in global health law at Georgetown University, in Scientific American. “Requiring people to get a vaccine is part of the fabric of American history going back to the Revolutionary War,” Gostin notes.

Breakthrough cases incite new vaccine worries

With delta surging, there are fresh questions about how effective vaccines are in warding off infection. A scientific preprint — not yet vetted by other scientists — suggests Pfizer’s vaccine efficacy is waning, according to authors from the Mayo Clinic in Rochester, Minnesota and nference, a biomedical computing company in Cambridge, Massachusetts. The team compared the efficacy rates for the Moderna and Pfizer vaccines between January and July, when the alpha strain dominated, and during July, after delta took over. Moderna’s efficacy against breakthrough infections dropped from 86% to 76% over that time, but Pfizer’s went from 76% to 42%. Breakthrough cases in people vaccinated with either shot had similar rates of complications and hospitalizations. There are some caveats to the study, notes Molly Walker at MedPage Today: It did not cover the entire U.S., and does not definitively conclude that delta defanged the immunity created by the Pfizer shot. Dr. Eric Topol, a cardiologist at Scripps Clinic who closely tracks and tweets COVID-19 research, spurred online debate when he estimated that Pfizer and Moderna vaccines are 50% to 60% effective against symptomatic infections, tweeting “There needs to be truth-telling about the reduced protection of mRNA vaccines vs symptomatic Delta infections.” Dr. Ashish Jha, dean of the Brown University School of Public Health, responded that his own “best estimate” for mRNA vaccines was between 75 and 85%.

Growing fears of breakthrough infections have renewed discussions on booster shots. Some people have already gotten a third shot — more than 1 million, according to CDC estimates. And some of those who initially got the one-shot Johnson & Johnson vaccine are also seeking boosters. The practice has not yet been authorized or recommended for the general population, since the vaccines still provide excellent protection against severe illness and death. But the FDA just granted emergency authorization to a booster for immunocompromised individuals, such as organ transplant recipients and people with HIV. Those who fall into that category can receive a third dose of the Moderna or Pfizer vaccine, 28 days or more after their second shot. (There’s no change to recommendations for people who got the J&J vaccine.) Moderna has also developed a reformulated booster shot that works against delta and other variants; the company’s CEO said it could be available by fall.

The CDC last week updated its guidelines for pregnant women to a “strong recommendation” to get vaccinated. Only about one-quarter of this group has received one dose of vaccine, and more of them are requiring hospitalization, reports NPR’s Ashley Lopez for “All Things Considered.” A recent study found that coronavirus infection increased, by 60%, the risk of very preterm birth (before 32 weeks; 40 weeks is full-term). People who’ve had the coronavirus already can also gain protection from vaccination, though evidence is building that one shot is sufficient for that population.

Schools counter politicians to require masking

While pediatric cases surge as children under 12 remain ineligible for vaccination, some schools are bucking governor’s orders against setting mask mandates — and they’re starting to get some support from judges and the White House. Florida Gov. Ron DeSantis signed an executive order preventing school districts from requiring masking, and then told the state Board of Education it could withhold salaries from school board members and superintendents who don’t follow the order. At least four districts are defying the governor’s office by moving ahead with mask mandates, and the White House is considering reimbursing officials with unspent stimulus funds. “We want what DeSantis wants: to keep schools open,” wrote Alachua County Public Schools superintendent Carlee Simon in The Washington Post. “I value life too much to take chances with the lives of others, even under threat of retaliation.” Parents of students with disabilities who are vulnerable to the virus are suing the governor.

In Texas, too, school districts are defying Gov. Greg Abbott’s prohibition against mask mandates, but the courts appear to be on the side of local officials. Judges in Dallas and San Antonio issued temporary orders blocking the state’s mandate against mask mandates. The CDC recommends that all students wear masks at school.

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