California will require health care workers to get a Covid-19 booster in order to be fully vaccinated, Gov. Gavin Newsom announced Tuesday.

“Omicron is spreading rapidly and we must do all we can to keep staff at hospitals and medical facilities healthy and safe to protect Californians during a potential winter surge,” Newsom tweeted late Tuesday afternoon.

The announcement came as federal officials revealed Monday that the highly transmissible Omicron variant accounted for 73 percent of all new infections last week. Infections and deaths among unvaccinated people continue to vastly outpace those of vaccinated people.

Meanwhile, San Jose Mayor Sam Liccardo announced Tuesday a plan to mandate the Covid-19 booster for those who work for the city or enter city-owned facilities. San Jose would be the first city in California to require boosters.

“We lack the benefit of time, and we need to move quickly,” Liccardo said in a press briefing Tuesday .

Newsom is planning to reveal more details about the health care worker requirement at a press event Wednesday in Alameda County. Liccardo’s proposal will be heard by the city of San Jose’s rules committee Jan. 5.

Liccardo has directed the city manager to work with employees’ bargaining units to enact the booster requirement in January by redefining fully vaccinated to include the booster shot. San Jose already requires proof of full vaccination to enter all city-owned facilities, so the updated mandate would require people to show proof of a booster shot or third dose of vaccine.

A growing number of state and local officials are requiring boosters. New Mexico Gov. Michelle Lujan Grisham (D) earlier this month amended the state’s vaccine order to require workers covered by the state’s existing mandate to receive a booster shot by Jan. 17, or within four weeks of becoming eligible for it.

University of California officials on Tuesday said eligible staff and students will have to get the booster shot before the beginning of the winter quarter or spring semester in order to be considered fully vaccinated.

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SACRAMENTO, Calif. (AP) — California will require health care workers to get a booster shot of the coronavirus vaccine, Gov. Gavin Newsom announced Tuesday, pledging to make sure hospitals are prepared as a new version of the disease begins to spread throughout the state.

California already requires health care workers to be vaccinated against the coronavirus, a directive that took effect in September and has since led to the firing or suspension of thousands of people. Now it will join New Mexico as at least the second state to require booster shots for health care workers.

Newsom made the announcement on his personal Twitter account. His office declined to give more details, including how many workers would be affected and whether frequent testing would be allowed as an alterative. Newsom has scheduled a news conference in the San Francisco Bay Area on Wednesday.

“California will require healthcare workers to get their booster,” Newsom said. “With Omicron on the rise, we’re taking immediate actions to protect Californians and ensure our hospitals are prepared.”

California has so far fared far better than many other states that are dealing with a coronavirus surge, with areas in the Midwest and Northeast seeing the biggest jump in cases and hospitalizations amid frigid temperatures that have kept people indoors.

The U.S. Centers for Disease Control and Prevention lists California as a place with “high” transmission of the virus, along with nearly everywhere else in the country. But in the last week California averaged 114 new cases per 100,000 people, less than half the national rate.

Meanwhile, coronavirus related hospitalizations have been rising slowly in California, up 15% in the last 11 days to 3,852. That’s less than half as many as during the late summer peak and one-fifth of a year ago, before vaccines were widely available.

But while hospitals overall have fewer patients than last winter, many have fewer workers to treat the patients they do have. The staffing shortage comes as businesses are having trouble finding workers, including hospitals. A recent study by the University of California-San Francisco estimated the state’s nursing shortage could persist until 2026.

“The staffing shortages we are experiencing are worse than ever,” Kiyomi Burchill, group vice president for policy for the California Hospital Association, said in an interview Tuesday before Newsom made his announcement about booster shots.

California is poised for a surge in new infections amid holiday parties and family gatherings forced indoors by a series of winter storms.CORONAVIRUS PANDEMIC

But experts say the nation’s most populous state is likely to avoid the worst scenario — spikes in hospitalizations and deaths — because most Californians have either been vaccinated or already been infected. That gives a higher level or protection against the omicron variant that, while not guaranteeing people won’t get sick, means they are less likely to need to go to the hospital.

“It’s a highly transmissible respiratory virus and people are going to get it. And they are going to get it every winter,” said Dr. Monica Gandhi, a professor of infectious diseases at the University of California, San Francisco. “We have to go toward measuring our true success with a disease, which is how we’re doing with hospitalizations.”

More than 70% of the state’s nearly 40 million residents have been fully vaccinated while 42% have gotten a booster shot. As of Monday omicron is now the dominant variant of the coronavirus in the United States.

Much about the omicron variant remains unknown, including whether it causes more or less severe illness. Scientists say omicron spreads more easily than other coronavirus strains, including delta. Early studies suggest the vaccinated will need a third shot for the best chance at preventing infection but even without the extra dose, vaccination still should offer strong protection against severe illness and death.

Computer models used by state officials to forecast the virus say hospitalizations will stay steady through the holidays and dip slightly in mid-January.

“I’m on the fence a little bit about how horrible is this,” said Dr. Brad Pollock, associate dean for public health sciences at the University of California, Davis School of Medicine. “We’re going to have more people infected because of the more transmissible variant. It may be a little less virulent, which means it causes less symptoms.”

In San Diego, researchers recently discovered the highest levels of coronavirus since February in a wastewater treatment plant that serves about 2.3 million people.

“Every time we’ve seen that kind of increase in the wastewater, a couple of weeks later we see an increase in cases,” said Rob Knight, a professor at the University of California-San Diego School of Medicine.

Last week, Newsom, who imposed the fist statewide shutdown order in March 2020, warned that cases would likely rise and re-imposed a rule requiring everyone to wear masks at public indoor gatherings. Los Angeles, the nation’s second-largest city, once again canceled its in-person New Year’s Eve celebration.

Mayor Eric Garcetti said Tuesday that he didn’t anticipate another lockdown because “I think we’re so much better protected than we were.” However he said he believes restrictions such as masking indoors will continue into February and perhaps even March, depending on vaccination, hospitalization and infection rates.

While 70% of Californians have been fully vaccinated, that still leaves 30% — or roughly 12 million people — who haven’t been. The California Department of Public Health says people who are not vaccinated are seven times more likely to get infected, nearly 13 times more likely to be hospitalized and nearly 16 times more likely to die from the coronavirus.

Places in California with lower vaccination rates, including Riverside and San Bernardino counties, have seen jumps in hospitalizations recently.

“The problem is there are counties in California, particularly in central California and eastern California, where they have had neither high vaccination coverage or a lot of prior infections,” said Dr. Jeffrey Klausner, a professor of infectious diseases at the University of Southern California’s Keck School of Medicine. “We can expect in those communities that there may be an increase in hospitalizations for people at high risk for severe consequences.”

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WASHINGTON (AP) — Federal regulators are expected to authorize the mixing and matching of COVID-19 booster doses this week in an effort to provide flexibility as the campaign for extra shots expands.

The upcoming announcement by the Food and Drug Administration is likely to come along with authorization for boosters of the Moderna and Johnson & Johnson shots and follows the OK for a third dose for the Pfizer vaccine for many Americans last month. The move was previewed Tuesday by a U.S. health official familiar with the matter who was not authorized to speak publicly ahead of the announcement.

The FDA was expected to say that using the same brand for a booster was still preferable, especially for the mRNA vaccines from Pfizer and Moderna that have proved most effective against the coronavirus. The agency was still finalizing guidance for the single-shot J&J vaccine.

Preliminary results from a government study of different booster combinations found an extra dose of any type revs up levels of virus-fighting antibodies regardless of the brand people first received. But recipients of the single-dose J&J vaccination had the most dramatic response — a 76-fold and 35-fold jump in antibody levels, respectively, shortly after either a Moderna or Pfizer booster, compared to a four-fold rise after a second J&J shot.

One confusing decision is what Moderna dose to recommend in combination with other brands. Moderna has applied for its booster to be half the original dose, saying that’s plenty for people who already received two full-strength shots. But the mix-and-match study used full-strength extra doses, and there’s no way to know if a half-dose Moderna booster would trigger as strong a reaction in J&J recipients.

Allowing mixing and matching could make the task of getting a booster simpler for Americans and allow people who may have had adverse reactions to the initial dose to try a different shot.

Last week, the U.S. said it would recognize combinations of vaccines administered overseas for the purposes of entering the country. The practice was common in Canada and some European countries in the early months of the vaccination campaign..

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By Amber Dance

Black COVID-19 patients at disadvantage during COVID triageAs hospitals overflow with delta patients, parts of the U.S. are at or close to the point when doctors have to choose who gets treatment based on who is more likely to survive. But at least one common method used to score a person’s chances of survival seems to undervalue Black lives, according to two new studies. A popular, 25-year-old scoring system based on measures from several organ systems gave higher ratings — indicating lower chances of survival — to Black COVID-19 patients than other races admitted at Yale New Haven Health System Hospitals in Connecticut. Nonetheless, the actual survival rate of Black patients was no different from others. At the time of the study, the health system was not using the scores to decide who got care, such as use of limited ventilators. But if they did, “We could end up disproportionally steering resources away from Black patients,” cautioned Benjamin Tolchin, director of Yale New Haven Health’s Center for Clinical Ethics, in a press release. Some states rely primarily on this organ-system score in their rationing protocols, while others combine it with other information. In Idaho, physicians have recently been forced to use the organ-system scores to make rationing decisions as hospitals filled up, according to the Yale release. One solution the Yale study authors suggest is to modify the triage scores to give marginalized patients a bit of an edge, potentially making up for some of the socioeconomic disparities. They also caution that their findings might not apply to health care systems in communities different from New Haven. CDC director greenlights boosters for high-risk workers In a surprise move made in the wee hours of Friday morning, CDC director Dr. Rochelle Walensky overruled the recommendation of the agency’s vaccine advisory committee, which had declined to approve Pfizer booster shots for people who are at high risk of exposure at work. The decision was just one more twist in the complex and ongoing debate over who should get a booster and when. On Wednesday, the FDA officially granted emergency authorization to Pfizer’s vaccine for a third dose, six or more months after the last one, in people older than 65, adults at high risk for severe breakthrough infections, and people who are at high risk for exposure due to their occupation (such as health care workers and teachers) or living situations (for example, those in homeless shelters). This matched the recommendations of the FDA’s own advisory committee. The task then fell to the CDC to decide more precisely who would be eligible for the shots. The CDC’s advisory board, made up of external experts, cast a complex series of votes on Thursday: Yes to boosters for those over 65 and residents in long-term care facilities, as well as adults with underlying medical conditions. No on boosters for those who risk exposure at home or work. The latter decision garnered immediate derision from some quarters. Epidemiologist Elizabeth Pathak of the Women’s Institute for Independent Social Enquiry tweeted that the denial of boosters to health care workers was a “TRAVESTY” with “no logic to this decision.” Johns Hopkins epidemiologist Keri Althoff asked, “How do we ensure hospitals/clinics and schools are staffed if we do not allow healthcare workers and teachers access to #COVID19 boosters?” STAT reporter Helen Branswell speculated that if the committee had had the option of limiting boosters just to health care workers, they might have supported the extra shots. That logic anticipated Walensky’s subsequent move to authorize shots for people exposed at work but not where they live. While the committee was not asked to address boosters for people who got Moderna or Johnson & Johnson vaccines originally, some members expressed support for a mix-and-match approach, as Benjamin Mueller and Apoorva Mandavilli reported for The New York Times. Further discussion on boosters for those brands should come soon (see J&J item below), so there will be more wrinkles to this story. As Dr. Wilbur Chen, a CDC committee member from the University of Maryland, put it during the discussions, “The implementation part of this is going to be fraught with such complexity that the people with the best health literacy will get boosters.”

Kids ages 5–11 may get first shots by HalloweenPfizer announced last Monday that its vaccine safely and effectively induced coronavirus antibodies in children as young as 5. The finding sets the stage for potential emergency use authorization from the FDA by the end of October, some experts have predicted. But there are still several steps that must happen first, as explained by Jacqueline Howard at CNN. Safety considerations — heart muscle inflammation is associated with vaccination in rare cases — will surely be a topic of discussion. In the Pfizer trial, which was too small to reliably indicate the rate of heart inflammation, side effects included fever, aches, and sore arms. But many parents may be reluctant to have their kids immunized, write Sarah Mervosh and Dana Goldstein at The New York Times. Only about half of adolescents had started a vaccine course by mid-August. Some parents worry about the small size of the trials and lack of long-term data, especially since most children do not suffer severe COVID symptoms. However, rising case rates and hospitalizations of otherwise healthy children have led pediatricians and lawmakers to consider the matter urgent. Cases among children have increased exponentially during the delta wave, with more than 925,000 children testing positive in the last four weeks, according to the American Academy of Pediatrics. “Until we look at the data, I can’t comment on this, other than to say: We need a vaccine for children,” Paul Offitt, a vaccine expert at Children’s Hospital of Philadelphia and member of the FDA’s vaccine advisory committee, told The Washington Post. Pfizer has said it expects results for children under 5 later this fall, which might set up further authorizations by the new year. Two shots better than one for J&J While Pfizer took the lion’s share of media attention last week, Johnson & Johnson also offered major news: a second shot, two months following the first, boosted efficacy against moderate to severe disease from 72% to 94% in its U.S. studies. That would put the vaccine on par with two-dose regiments of the RNA vaccines from Moderna and Pfizer. When the delay between shots was six months instead of two, the booster resulted in twice as many antibodies. While the company’s data has not yet been reviewed, it has been submitted to the FDA, where it adds another wrinkle to the nation’s complex, multistage booster rollout, writes Lauren Morello at Politico. While only about 14.6 million Americans received J&J’s vaccine so far, “the data could also help increase use of the vaccine in the U.S. and globally,” writes Matthew Herper at STAT. The original one-and-done dosing was once seen as an advantage, particularly for people in hard-to-reach areas, but the vaccine still has a bit of an edge over the mRNA options for ease of storage and transport, because it requires less extreme cold temperatures.

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This decision follows the Food and Drug Administration’s authorization and Centers for Disease Control and Prevention recommendation for a booster dose of Pfizer-BioNTech vaccine to:

• People 65 years and older and residents in long-term care settings should receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series.  
• People aged 50–64 years with underlying medical conditions should receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series.
• People aged 18–49 years with underlying medical conditions may receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series, based on their individual benefits and risk.
• People aged 18-64 years who are at increased risk for COVID-19 exposure and transmission because of occupational or institutional setting may receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series, based on their individual benefits and risks.

“These booster doses are an important step forward in the fight against COVID-19,” said VA Secretary Denis McDonough. “With the authorization of the Pfizer-BioNTech booster for eligible individuals, VA can provide Veterans an opportunity to maximize their protection, continuing our work to keep people safe and save lives during the COVID-19 pandemic.”

The safety and care of Veterans is VA’s top priority, as well as ensuring the health and welfare of its workforce. VAs doors are open for walk-ins today during hours when vaccine clinics are operational, with full opening on Monday where Pfizer-BioNTech booster vaccines are available. Vaccines will be offered to Veterans receiving care at VA and employees, prioritizing those persons who are 65 and older, residents of long-term care facilities, and people 50-64 years with underlying conditions. As supply and capacity permits, VA will offer booster doses to all other Veterans, spouses, caregivers and CHAMPVA recipients under the authority of the SAVE LIVES Act (SLA), which was signed into law in March 2021. The law expanded VA’s authority to offer vaccine to include Veterans not traditionally eligible for VHA care, and others including spouses and caregivers of Veterans.

Veterans who receive care in VA and are due for booster shots will be contacted and advised of the recommended booster shots, which may be offered by appointment or on a walk-in basis. Veterans who received a Pfizer-BioNTech COVID-19 vaccine outside of VA, and persons who received a Pfizer-BioNTech vaccine in VA for whom we don’t have records of their high-risk condition, will need to contact their local VA facility for information about how they can receive their booster shot.

CDC advises that people can get both the COVID-19 vaccine and flu vaccine at the same time. Veterans receiving care at VA who wish to get a booster shot can get both shots together during the same visit.

Currently, only the Pfizer-BioNTech vaccine has been authorized as a booster shot. FDA and CDC continue to review data to determine whether and when a booster might be recommended for recipients of the Moderna and Johnson & Johnson (J&J)/Janssen) COVID-19 vaccine(s). VA will plan to offer boosters of these vaccines if authorized and recommended.

VA is also continuing to reach out to Veterans who have not yet been vaccinated. Even without a booster, COVID-19 vaccination offers excellent protection and makes it 10 times less likely to be hospitalized or die from COVID-19.  Monitoring Incidence of COVID-19 Cases, Hospitalizations, and Deaths, by Vaccination Status — 13 U.S. Jurisdictions, April 4–July 17, 2021 | MMWR (cdc.gov).

Veterans who would like additional information can visit the VA COVID-19 vaccines webpage, visit their local facility’s website or contact their care team. Visit VA’s Questions webpage for questions and answers regarding COVID-19 vaccine.

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U.S. health officials may soon recommend COVID-19 booster shots for fully vaccinated Americans. A look at what we know about boosters and how they could help fight the coronavirus:

WHY MIGHT WE NEED BOOSTERS?

It’s common for protection from vaccines to decrease over time. A tetanus booster, for example, is recommended every 10 years.

Researchers and health officials have been monitoring the real-world performance of the COVID-19 vaccines to see how long protection lasts among vaccinated people. The vaccines authorized in the U.S. continue to offer very strong protection against severe disease and death.

But laboratory blood tests have suggested that antibodies — one of the immune system’s layers of protection — can wane over time. That doesn’t mean protection disappears, but it could mean protection is not as strong or that it could take longer for the body to fight back against an infection.

The delta variant has complicated the question of when to give boosters because it is so much more contagious and much of the data gathered about vaccine performance is from before the delta variant was widely circulating. Delta is taking off at the same time that vaccine immunity might also be waning for the first people vaccinated.

Israel is offering a booster to people over 50 who were vaccinated more than five months ago. France and Germany plan to offer boosters to some people in the fall. The European Medicines Agency said it too is reviewing data to see if booster shots are needed.

WHEN WOULD THEY BE GIVEN?

It depends on when you got your initial shots. One possibility is that health officials will recommend people get a booster roughly eight months after getting their second shot of the Pfizer or Moderna vaccine.

Officials are continuing to collect information about the one-shot Johnson & Johnson vaccine, which was authorized for use in the U.S. in late February, to determine when to recommend boosters.

WHO WOULD GET THEM?

The first people vaccinated in the United States would likely be first in line for boosters too. That means health care workers, nursing home residents and other older Americans, who were the first to be vaccinated once the shots were authorized last December.

BOOSTER? THIRD SHOT? WHAT’S THE DIFFERENCE?

Transplant recipients and other people with weakened immune systems may not have gotten enough protection from vaccines to begin with. They can now receive a third dose at least 28 days after their second shot as part of their initial series of shots needed for them to be fully vaccinated. For those with normal immune systems, boosters are given much later after full vaccination — not to establish protection, but to rev it up again.

WHAT QUESTIONS REMAIN?

Still unknown is whether people should get the same type of shot they got when first vaccinated. And the nation’s top health advisers will be looking for evidence about the safety of boosters and how well they protect against infection and severe disease.

Global access to vaccines is also important to stem the pandemic and prevent the emergence of new variants. Booster shots could crimp already tight global vaccine supplies.

WHAT ABOUT THE UNVACCINATED?

Dr. Melanie Swift, who has been leading the vaccination program at Mayo Clinic in Rochester, Minnesota, says getting more shots into people who haven’t yet been vaccinated at all is “our best tool, not only to prevent hospitalization and mortality from the delta variant, but to stop transmission.” Every infection, she says, “gives the virus more chances to mutate into who knows what the next variant could be.”

“People who took the vaccine the first time are likely to line up and get their booster,” Swift says. “But it’s not going to achieve our goals overall if all their unvaccinated neighbors are not vaccinated.”

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