Vax mandate rules finalized as many children get their first shots

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THE CORONAVIRUS FILES

By Amber Dance

Well-vaccinated tribes face renewed surge 

Despite a vaccination rate well above the national average, the Navaho Nation and other tribes are experiencing a new wave of COVID-19 cases, report Alyssa Lukpat and Adeel Hassan at The New York Times. The Navajo Department of Health recently reported 80 new cases, but no recent deaths. The Indian Health Service has also noted more cases in the Billings and Great Plains areas.

Tribal communities, despite their best efforts, have been affected by lower rates of vaccination or lack of masking in surrounding areas. Many tribal members are at risk of exposure in the border towns or urban areas they work in, and others have brought the virus back after visiting neighboring areas. “We do have multigenerational families living under one roof, and when someone brings COVID home, it spreads quickly in the house,” Navajo Nation President Jonathan Nez told The Times.

Dr. Mary Owen, president of the Association of American Indian Physicians and member of the Tlingit tribe, has encouraged those not yet vaccinated — including newly eligible children — to get their shots. Advocates have also blamed cases among American Indian and Alaska Native populations to a “data genocide,” reports Jenna Kunze at Native News Online. Sixteen states don’t report COVID statistics on Indigenous peoples separately, but just classify them as part of a catchall “other” category.

Pfizer offers another pill to reduce COVID severity

Pfizer announced on Friday that its experimental COVID-19 treatment slashed hospitalization rates by 89% in unvaccinated people at risk for severe disease. The antiviral, pill known as PF-07321332 or ‘332 for short, also seemed to prevent death in the 389 people who took it. None of those people died, while there were 7 deaths among 385 study participants who received a placebo medication. Studies are ongoing in low-risk and vaccinated patients, as well as to test if the medication can prevent infection in people who are probably going to be exposed to the coronavirus.

“With an oral antiviral, patients have more time and greater access to a treatment that will keep them out of the hospital,” Nahid Bhadelia, director of the Center for Emerging Infectious Diseases Policy at Boston University, told STAT’s Matthew Herper. “But the promise of oral antivirals will only be recognized if they’re available at your local pharmacy, and you can afford it, and you can get the test that tells you that you’re positive for COVID, so you can actually take advantage of this drug.” While Pfizer’s chief scientific officer Mikael Dolsten expressed a desire to make the drug accessible worldwide, some experts who spoke with Herper expressed doubt that would happen.

Pfizer’s medication works on a viral protein, unlike Merck’s drug molnupiravir that interferes with viral genes. The early results from ‘332 also suggest higher efficacy than molnupiravir’s 50% reduction in hospitalization rates. Merck’s drug got its first authorization, for use in the U.K., last week; an FDA committee is scheduled to review molnupiravir on Nov. 30.

Mandate deadlines loom as some workers resist

The Biden administration released new rules and guidelines on vaccines at work last week, extending mandates to approximately two-thirds of people employed in America, reports Shannon Firth at MedPage Today. An official rule from the Occupational Safety and Health Administration requires companies with 100 or more employees to ensure employees are vaccinated by a Jan. 4 deadline, or that they test negative once a week. Employers are not required to pay for that testing, “in a move that appears designed to push workers to choose vaccinations over testing,” notes Andrea Hsu at NPR. All workers at any clinics that receive Medicare or Medicaid funding must also be vaccinated by Jan. 4, with no testing option.

The administration also pushed back the deadline for federal employees and contractors to be vaccinated to Jan. 4, but new White House guidance gives the job of enforcement to individual contractors, note Spencer Kimball and Leslie Josephs at CNBC.

Republican leaders have argued against the federal mandates, stating the regulations would damage the “already-too-tight labor market.” The Biden administration tried to head off such criticism by pointing out that with more than 745,000 Americans dead — and 5 million deaths worldwide — workers are facing a “grave danger” that OSHA must mitigate. On Saturday, a federal appeals court in Louisiana issued a temporary stay on the rule pertaining to large employers, citing “grave statutory and constitutional issues.” The government has until 5 p.m. Monday to respond.

Some workers, too, are pushing back against mandates, walking off the job or choosing unpaid leave over the vaccine. Among workers as a whole, Gallup reports that 56% support a mandate but 37% are opposed.

The U.S. military and Department of Veterans Affairs mandated vaccination a couple of months ago, and officials told The New York Times’ Jennifer Steinhauer it’s granted “few” requests for exemptions. Nearly all active-duty service members have had at least one dose. The Air Force, which had the earliest deadline of Nov. 1, has discharged a few dozen service members, mainly trainees, over vaccine refusal, reports Paul D. Shinkman at US News & World Report. But the Biden administration, wary of losing too many service members, contractors and civilian staffers, will initiate an “education process” for vaccine resisters rather than discharging them immediately, writes John M. Donnelly at Roll Call.

Shots reach the smallest arms yet

With both the FDA’s and CDC’s official blessing as of last week, children aged 5 through 11 can now receive the Pfizer COVID-19 vaccine. President Joe Biden called this “a turning point in our battle against COVID-19.” More than 6 million children of all ages have tested positive for COVID-19, and more than 650 have died. Notably, children have been a big driver in case rates in the U.K. In the U.S., a computer simulation from the COVID-19 Scenario Modeling Hub predicts a small drop in case rates, hospitalizations and deaths if children are vaccinated, but the effect of child vaccinations could be much greater if a new variant arises.

About one in three parents say they won’t get their children vaccinated. But the vaccines for young children will likely boost vaccination rates among minority groups, particularly Hispanics, writes Mary Biekert at Bloomberg. An August poll suggested Hispanic parents were less likely than white families to say they definitely wouldn’t get older kids vaccinated — but getting time off work to take their children for vaccination was a concern.

The new eligibility of elementary-age children raises the possibility of new vaccine mandates, writes Marisa Fernandez at Axios. Only a handful of school districts have mandated vaccination for teens 12 and up, who were already eligible for vaccination. Bree Dusseault, principal at the Center on Reinventing Public Education, told Fernandez that mandates for the younger group would be challenging to impose, given parental hesitation, low risk of severe disease in kids, and the fact that many parents were against mask mandates. “Districts may feel that asking students to vaccinate crosses a line they’re not willing to cross,” Dusseault said. “It puts them at risk of potentially losing some of the students they serve.”

CDC says vaccines beat natural immunity

Do the tens of millions of Americans who’ve had COVID need to be vaccinated? Republican lawmakers such as Rep. Diana Harshbarger of Tennessee have suggested not, but a new CDC report says yes, write Lena H. Sun and Joel Achenbach at The Washington Post. The CDC, after reviewing nearly 100 studies, concluded that natural immunity can be quite good, but it varies between individuals, and there’s no reliable test to determine if a COVID-19 survivor is well-protected or not. Vaccines, on the other hand, produce much more consistent protection from future infection. However, The Post notes that some nations and experts consider a bout of COVID to be equivalent to a single shot. “If you’ve had it, get at least one dose of the vaccine,” recommended Dr. David Rubin, director of the PolicyLab at Children’s Hospital of Philadelphia.

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