Nursing Home Staff Required to be Vaccinated

On Wednesday, President Biden announced that his administration will require nursing homes that receive federal Medicare or Medicaid funding to have staff vaccinated against COVID-19. According to federal data, there is a large population of nursing home staff who are still not vaccinated, endangering residents who are high-risk for COVID-19. The new mandate is expected to take effect as soon as next month. This comes as the administration tries to find ways to encourage vaccines for those still holding out. President Biden has recently required millions of federal workers to share their vaccination status or else comply with new rules on mandatory masking, weekly testing, social distancing, and more. These requirements are even stricter for those working in frontline health positions. With COVID-19 rates on the rise, vaccinations are a key ingredient to protecting those who are most vulnerable. 

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Being Previously Infected with COVID-19 Does Not Provide the Same Protection as Vaccination

Recently, the leader of the Michigan Senate GOP, Mike Shirkey, made statements that he was opposed to a vaccine mandate in place for a conference on Mackinac Island. Shirkey’s reasoning was that because he was infected with COVID-19 last year, his natural immunity will be lifelong and more effective than immunity developed after receiving a vaccine. 

This claim is false. There is currently no definitive understanding of how long natural immunity (immunity developed after infection, without having received a vaccine) lasts. Some studies have suggested that people recovered from COVID-19 can produce antibodies that last a very long time, possibly their whole lives, but that does not mean that the levels of antibodies they have are high enough to provide immunity. Research on immunity after infection and vaccination is still ongoing to better understand how to keep people as safe as possible now and in the future.

Based on the research so far, experts have consistently recommended vaccination for individuals who have previously had a COVID-19 infection. Studies have shown that vaccination gives the immune system of people who were previously infected with COVID-19 an important boost to protect them from reinfection. According to the CDC, among previously infected individuals, those who are not vaccinated are more than two times more likely to get reinfected compared to those who are fully vaccinated. This is attributed in part to the fact that vaccination helps people’s immune systems create a stronger, broader immune response to COVID-19 — for example, producing antibodies that can potentially protect you from additional variants. Natural immunity may only protect a person from the variant they were initially infected with, potentially leaving many people who were infected with COVID-19 early in the pandemic vulnerable to the Delta variant. 

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COVID-19 Vaccine Booster Update

In a recent announcement, White House officials stated that COVID-19 vaccine booster shots are planned to be available for all U.S. adults that received two doses of either the Pfizer or Moderna vaccines 8 months after their second dose, starting September 20, 2021. Currently, only those who are immunocompromised are approved to get a third dose of either the Pfizer or Moderna vaccine. For those who have received the single dose of the Johnson and Johnson vaccine, data and updates to policies and recommendations are still pending.

This change comes following three CDC Morbidity and Mortality Weekly Reports (MMWR), cited by CDC Director Dr. Rochelle Walensky, which largely showed that while vaccines were still highly effective at preventing severe disease and hospitalization, there was decreased immunity over time and increased potential for getting COVID-19.

While many experts think that this is a proactive step in curbing the pandemic, many have stated that this move is potentially more harmful and can prolong the pandemic. The WHO criticized the U.S. for this move, pointing to the fact that there are still huge disparities in vaccine availability for less wealthy countries. Many experts have agreed with this and some have stated that this move will lead to further disparities and potential for more variants to arise in other parts of the world. White House officials responded saying that the U.S. could provide booster shots while also continuing to donate vaccine doses to the rest of the world.

At the current rate, booster vaccines are inevitable to manage the pandemic, but by nature, this is a concern for the world and thus, equitable access to the vaccine is crucial domestically and globally. If you have any questions or concerns about the vaccine or know anybody who does, please feel free to have them reach out to us or to their primary health care provider. In addition, we recommend that folks continue to practice proper hand hygiene and wear masks when indoors in public so that we can protect ourselves and each other.

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U.S. Transportation Mask Mandate Extended

A recent Reuters report stated that a TSA spokesperson confirmed the extension of the current CDC mask mandate for travelers on public conveyances. These include airplanes, ferries, trains, subways, and buses, as well as airports and train stations. The mask mandate, which has been extended multiple times and was set to expire on September 13, 2021, has now been extended to January 18, 2022, largely due to the current Delta variant concerns. 

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Racial Disparities Persist in Treatment of Heart Condition

A recent study led by the University of Pittsburgh found racial disparities in the way a common but potentially dangerous heart condition, atrial fibrillation, is treated. 

Atrial fibrillation is a medical condition where the heart beats irregularly. As a result, patients can experience dangerous blood clots which may result in stroke, heart attack, and/or other serious complications. Blood thinners and proper, individualized management of the condition are an important part of treatment soon after diagnosis. Access to consistent insurance and medical care is important, and it has been hypothesized that barriers to access have historically been responsible for racial disparities in atrial fibrillation. With this in mind, researchers at the University of Pittsburgh looked at the treatment of atrial fibrillation in more than 11,000 patients at the Department of Veterans Affairs, a major national health center where insurance, costs, access to medications, and treatments are meant to be consistent among all veterans. Nonetheless, the study showed that racial disparities were still present, finding that Asian (52.2%) and Black (60.3%) patients were the least likely to be prescribed blood thinners compared to White (62.7%) patients, a statistically significant difference. 

Furthermore, it was found that of the patients who did get treatment with blood thinners, Hispanic (58.3%), American Indian/Alaska Native (59.8%), and Black (60.9%) patients were the least likely, compared to White (66%) patients, to be prescribed newer blood thinners which are now considered to be the standard of care and require less complicated management. These findings are also statistically significant.

More research is needed to understand and address these disparities, but the authors of the study suggest that less trust in the medical system due to a history of mistreatment of BIPOC, in addition to racism and biases in medical providers, are contributing factors to these disparities. Additionally, previous studies have found that BIPOC patients are less likely to have the same level of access to specialists as White patients, and access to specialists can be especially important in the treatment of atrial fibrillation. Outside of the exam room, there are also issues of racial inequity when it comes to access to transportation, time off work, and other variables that impact a patient’s ability to make and attend appointments. Elimination of racism and bias among medical providers, in addition to equity in all aspects of life, are essential for ending the racial disparities in healthcare that BIPOC experience every day. 

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New Report Documents Targeting of BLM Protesters by U.S. Federal Government

The Movement for Black Lives and CLEAR (Creating Law Enforcement Accountability & Responsibility Clinic) released a report detailing the U.S. federal government's efforts to target and silence the Black Lives Matter movement. CLEAR, which is a part of the CUNY School of Law in New York City, looked at 326 criminal cases that federal prosecutors initiated related to BLM protests between May 31 and October 25, 2020, in the wake of the murder of George Floyd. Among the findings:

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COVID-19 Vaccine Hesitancy Among Different Populations

Researchers at Carnegie Mellon University and the University of Pittsburgh surveyed over 5 million adults in the United States about COVID-19 vaccine intent from January to May 2021. Overall, researchers found that vaccine hesitancy decreased by one-third between January and May. Those who were tentative about taking the vaccine were generally concerned with the safety of it and potential side effects, while those with stronger vaccine hesitancy tended to distrust the government. Individuals from counties with higher Trump support in the presidential election showed higher hesitancy and their hesitancy did not decrease over the study period. This is concerning, as rates of the virus are increasing across the country and their hesitancy is based on mistrust of the vaccine or government. That is not a quick or easy challenge to overcome to persuade individuals to take the vaccine. There were decreases in vaccine hesitancy in education level and race. The largest decrease in hesitancy by education level was those with high school education or less, while those with PhDs were the most hesitant and saw little fluctuation during the study period. The researchers are unsure as to why PhD holders were the most hesitant, so further investigation needs to be done to understand. Vaccine hesitancy decreased across all racial groups, but Black individuals and Pacific Islanders saw the largest decreases. Those groups join Hispanic individuals and Asian individuals at having lower vaccine hesitancy than white individuals. These decreases are encouraging, as vaccinations are important to slowing the spread of the virus. With this information, more targeted campaigns and efforts can be directed to those groups with the most vaccine hesitancy. 

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This Week's QM Round-Up Contributors (in alphabetical order):