by Michael D. Cohen MD

The United States continues to re-open as daily new cases, hospitalizations and deaths continue to decline. However, the national numbers obscure the fact that these reduced outcomes are uneven across the states. In states and counties where less than 50% of the people have volunteered to be vaccinated, the pandemic continues. In some of those areas, case rates are as high as they were at the peak last winter. Local surges among the unvaccinated will continue for some time to come.

All of South America, Namibia in Africa and Mongolia in Asia are having their worst surges at this time. In the UK they are having increased numbers of cases due to the Delta variant. (Variants will be identified by Greek letters from now on. Delta was first identified in India). They have delayed their re-opening for one month as of this writing. The World Health Organization is warning of increased cases in Europe this fall as countries reopen and the Delta variant spreads.

Although we feel safer now in the U.S., we are in danger so long as the pandemic is uncontrolled elsewhere in the world. Variants arise due to random mutations. The more the virus reproduces in newly infected people, the more random mutations will occur. With millions of mutations occurring daily for months or years, it may only be a matter of time before a more infectious and more deadly variant emerges. Worse still, such a variant may not be controlled by the immunity we have received from our vaccines.

To prevent this, the U.S. and other developed countries must produce many billions of vaccine doses to help the rest of the world get vaccinated. A massive mobilization of resources is needed to scale up vaccine production to billions of doses and improve worldwide capacity to get the vaccine out to people everywhere. Leaders of the G7 nations are expected to pledge one billion vaccine doses to poor and middle-income countries as part of a campaign to“vaccinate the world”by the end of 2022. This is a first step but may turn out to be too little and too late. What is needed is a world-wide mobilization of resources, such as occurs during wartime.

Take the Vaccine When it is Offered

You should take the vaccine because it works. Evidence of the effectiveness of the current vaccines continues to accumulate:

A recent study showed that vaccination has substantially reduced the numbers of cases in U.S. nursing homes. However, not all nursing home residents have chosen to be vaccinated and outbreaks are continuing to occur due to the disease brought in by unvaccinated staff.

In a town in Brazil they were able to vaccinate almost all of the adults with a vaccine produced by a Chinese company. This resulted in a 95% reduction in deaths.

A study in the UK showed that current vaccines are effective against the Delta variant currently causing 90% of the cases there.

You should take the vaccine even if you already had COVID.Current public health recommendations are for people who had the infection to get vaccinated. This is because the vaccines create more effective and durable immunity than you get from natural disease.

You should take the vaccine because they were thoroughly tested and are safer than COVID disease. Although vaccine development was done rapidly to respond to the pandemic, all of the normal safety and effectiveness procedures were followed. Vaccines authorized for emergency use were found to be safe and effective. Also, there is ongoing safety monitoring to find out about any rare conditions that may occur as millions of people worldwide receive vaccination.

You should take the vaccine even if you have concerns about immediate side effects. The vaccine will not make you sick. There may be pain and swelling at the injection site. There may be some fatigue and body aches for 24 hours. Those are natural responses of the immune system to any new challenge. It is no worse than the routine influenza vaccine we get every year.

You should take the vaccines even though they have not yet been fully approved by the FDA. The vaccines are authorized for emergency use at this time. Moderna has applied for full FDA approval and others will soon follow. The risks from COVID infection and disease are serious for people of all ages. Protection from those risks is more important than the unusual and unlikely side effects or complications associated with the vaccines. On balance, it is more important to be protected from COVID.

You should take the vaccine to help stop the spread and protect others. We cannot get control of this pandemic without mass participation in the needed interventions like masks, keeping apart, ventilating indoor spaces, and vaccination.

Prevention

There are reports that some U.S. 
nursing homes are experiencingclusters of COVID-19. Many of these clusters have been caused by unvaccinated staff who become infected in the community and bring the disease into the nursing home. Similarly, unvaccinated correctional facility staff will continue to bring it into facilities from the community.

Some U.S. businesses have cancelled mask mandates for customers entering their facilities. This has become a problem for their staff who were protected from exposure by the customer mask mandate.Similarly, cancellation of mask mandates for correctional facility staff will expose prisoners to their illnesses. A recent survey found that people who stated they never wore a mask were twice as likely to become infected than those who reported they wore masks all the time.

In June, the Centers for Disease Control (CDC) updated their guidance on COVID in correctional facilities with a statement regarding declines in community transmission as follows: “Facilities may consider modifying their COVID-19 prevention measures if facility vaccination coverage is high, transmission rates are low, population vulnerability is low, and the facility layout and procedures allow for physical distancing.”

They listed these factors to consider when deciding whether or not a particular site should reduce or eliminate procedures that help prevent COVID transmission:

1. Vaccination coverage: Have people living and working in the facility had access to and uptake of COVID-19 vaccination?

Staff vaccination coverage is particularly important given their frequent contact with the outside community. This creates the opportunity for introduction of COVID into the facility. Maintain preventive measures longer where fewer staff and residents are fully vaccinated.

2. Transmission Levels: What is the current level of COVID-19 transmission within the facility?

Facility prevention procedures should not be reduced when any transmission is occurring within the facility.

What is the level of COVID-19 transmission in the surrounding community? Where significant transmission is ongoing in the local community, facility preventive procedures should not be reduced.

3. Facility demographic and health-related characteristics: What proportion of the facility’s residents are both not fully vaccinated and at increased risk for severe COVID-19 illness? 

Correctional facilities with high numbers of people who are not fully vaccinated and at increased risk for severe illness should maintain preventive procedures.

4. Facility physical characteristics and movement patterns: How easily does COVID spread within the facility?

Maintain prevention measures longer in facilities where the layout, ventilation, or movement patterns prevent physical distancing or frequent air exchange in closed indoor spaces.

In the same update, CDC also listed preventive measures to always keep in place:

Maintain COVID-19 testing strategies: If a facility chooses to modify prevention measures, maintain a robust testing program (including both diagnostic and screening testing) to provide necessary information for ongoing assessment of risk and outbreaks.

Prevent COVID-19 introduction: 
Continue to ensure that symptomatic staff do not return to work and that testing and medical isolation procedures remain in place for residents who show symptoms of COVID-19.

Track COVID-19 cases in the community: Monitor community infections to be prepared for an outbreak. Continue to effectively communicate to staff and residents about what to expect if an outbreak occurs.

Continue to have a plan for isolation and quarantine: Maintain the ability to respond quickly to an increase in the number of cases.

Offer COVID-19 vaccination and routine immunizations: Encourage COVID-19 vaccination for those who have not yet received it, as well as routine immunizations such as flu vaccine as needed.

Maintain baseline infection control: Maintain optimized ventilation, handwashing, and cleaning and disinfection for prevention of infectious diseases, including COVID-19.

Conclusion

With widespread vaccination of residents and staff, outbreaks in correctional facilities will be reduced or eliminated, at least for the present. But in localities where fewer people are taking the vaccine, surges in infections will occur, and will spill over into local correctional facilities. Protect yourself by taking the vaccine when it is offered. Continue to use other preventive measures rigorously if you have not been vaccinated and when numerous staff and residents have refused to take the vaccine. 

Subscribe today

Already a subscriber? Login