COVID-19 National Update: Mandates and Booster Shots

This week the number of children hospitalized with COVID-19 set a record with 1,900 pediatric cases in hospitals across the United States on Sunday night. The Delta variant’s rapid spread is to blame, primarily among unvaccinated populations which include children under age 12.

Of all hospitalizations, children comprise just 2.4% of admissions, Reuters reports. From Sally Goza, former president of the American Academy of Pediatrics:

This is not last year’s COVID. This one is worse and our children are the ones that are going to be affected by it the most.

The Delta variant is characterized by its increase in transmissibility, but not necessarily in symptomatic severity.

Vaccine Mandates

On Wednesday, August 18, the Biden administration announced it will require all nursing home staff to be vaccinated against COVID-19 and will withhold Medicare and Medicaid reimbursements and funding from noncompliant facilities, the Hill reports. Vaccination rates among nursing home staff have slowed, only 60% of staff in long-term care facilities and nursing homes are either partially or fully vaccinated.

This follows the announcement from the U.S. Department of Health and Human Services (HHS) last week, requiring all 25,000 HHS health care workforce employees to be vaccinated against COVID-19. This includes staff at the Indian Health Service and National Institutes of Health. U.S. Surgeon General Dr. Vivek Murthy will also require members of the U.S. Public Health Service Commissioned Corps to be vaccinated in preparation for deployment as emergency responders.

The Biden administration also maintained focus on vaccine preparedness in a statement from the White House on August 13. In “Fact Sheet: Biden Administration Takes Steps to Address COVID-19 in Rural America and Build Rural Health Back Better”, HHS pledged $8.5 billion in American Rescue Plan Funding in the coming weeks to assist rural and low-income healthcare providers.

It also included a promise of $500 million from the U.S. Department of Agriculture for the Emergency Rural Health Care Grant Program. This will provide at least $350 million to rural hospitals to increase access to vaccines and medical supplies.

In the nonprofit sector, CareFirst Blue Cross Blue Shield will require employees and board directors to get vaccinated for COVID-19, according to Becker’s.

Booster Shots

Earlier this month, the World Health Organization called for a moratorium on discussion of third booster shots to protect already vaccinated populations in wealthy nations from the Delta variant. The WHO argued that the priority for vaccinated, wealthy nations should be to bolster supplies to COVAX, the international vaccine distribution program for poorer nations that cannot afford to purchase vaccine outright from manufacturers, according to the Guardian.

The United States did not heed this suggestion and on August 12, the Food and Drug Administration approved a third shot of either the Pfizer or Moderna vaccines for immunocompromised individuals in a press release. From Acting FDA Commissioner Janet Woodcock, M.D.:

Today’s action allows doctors to boost immunity in certain immunocompromised individuals who need extra protection from COVID-19. As we’ve previously stated, other individuals who are fully vaccinated are adequately protected and do not need an additional dose of COVID-19 vaccine at this time. The FDA is actively engaged in a science-based, rigorous process with our federal partners to consider whether an additional dose may be needed in the future.

The Medicare program also announced that it would cover COVID-19 boosters for immunocompromised Americans. Qualifying conditions for debilitated immune system include smoking habits, Type 1 diabetes, and medical treatments like chemotherapy and transplants, Healthpayer Intelligence reports.

On Monday, the American Medical Association announced that the CPT code set for third doses of the COVID-19 vaccine was ready. The CPT Editorial Panel expedited approval of the new administrative code for Moderna, following a similar announcement for the third dose of Pfizer on July 30.

Hospitals also quickly mobilized to incorporate the distribution of the additional dose to immunocompromised people. The Mount Sinai Health System in New York and Maywood in Illinois were already getting prepared as of Monday, according to Modern Healthcare.

Then, the Biden administration decided that most Americans should receive the coronavirus booster, announcing the decision late Monday evening. According to the New York Times, this does not include a recommendation for a second dose for recipients of the Johnson & Johnson Janssen vaccine, as information is still being gathered regarding such a recommendation.

Executive director of WHO Health Emergencies Programme, Dr. Michael Ryan, quickly spoke out against the move by the U.S. President. Via Yahoo!News:

We’re planning to hand out extra life jackets to people who already have life jackets, while we’re leaving other people to drown without a single life jacket.

White House COVID response coordinator Jeff Zients said that the U.S. is capable of both:

To end this pandemic, we have to protect the American people and we have to continue to do more and more to vaccinate the world. Both are critical.