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Vaccination to Prevent COVID-19 Outbreaks with Current and Emergent Variants — United States, 2021

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network Health Advisory to notify public health practitioners and clinicians about the urgent need to increase COVID-19 vaccination coverage (i.e., the percentage of the population fully vaccinated) across the United States to prevent surges in new infections that could increase COVID-19 related morbidity and mortality, overwhelm healthcare capacity, and widen existing COVID-19-related health disparities. Increasing vaccination coverage is especially urgent in areas where current coverage is low. Unvaccinated persons account for the majority of new COVID-19 infections, hospitalizations, and deaths. Currently circulating SARS-CoV-2 variants of concern, especially the highly infectious Delta variant (B.1.617.2), are accelerating spread of infection. Unvaccinated and partially vaccinated people need to practice all recommended prevention measures until fully vaccinated. In areas with substantial and high transmission, CDC recommends that fully vaccinated individuals wear a mask in public indoor settings to help prevent the spread of Delta and protect others.

COVID-19 case rates are rising again after a period of decline: COVID-19 cases have increased over 300% nationally from June 19 to July 23, 2021, along with parallel increases in hospitalizations and deaths driven by the highly transmissible B.1.617.2 (Delta) variant. While significant progress has been made to make COVID-19 vaccine widely available, disparities in vaccination coverage persist across population groups and geographic areas. As of July 23, 2021, 1,856 (63.0%) of the 2,945 counties with available vaccination data have particularly low vaccination coverage, defined here as <40% of the population being fully vaccinated. As of July 23, 2021, among the counties with vaccine coverage <40%, 36.0% (N = 668) have COVID-19 incidence rates in the high burden level (≥100 cases/100,000 over the last seven days) (see figure below, and further data at COVID Tracker).

Overall, the majority (81.4%) of counties with high COVID-19 incidence rates are found in communities with low vaccination coverage. As COVID-19 case counts continue to rise nationally, areas with lower vaccination coverage are at especially high risk for a surge in cases.

Most cases of COVID-19 and hospitalizations are in unvaccinated individuals:  While COVID-19 vaccines authorized in the United States remain effective against SARS-CoV-2 infection and severe disease, some infections among vaccinated persons (i.e., breakthrough infections) are anticipated and have been reported. However, the majority of COVID-19 cases and hospitalizations are occurring among individuals who are not fully vaccinated.  From January through May 2021, of the more than 32,000 laboratory-confirmed COVID-19-associated hospitalizations in adults ≥18 years of age for whom vaccination status is known, <3% of hospitalizations occurred in fully vaccinated persons.

The COVID-19 Delta variant is widely prevalent and more infectious than prior strains: The COVID-19 Delta variant currently accounts for more than 80% of all COVID-19 cases in the United States. This variant is significantly more infectious than prior SARS-CoV-2 variants and has led to a rapid rise in COVID-19 cases in other countries, including the United Kingdom and Israel. Emerging evidence suggests that fully vaccinated people who do become infected with the Delta variant are at risk for transmitting it to others.

COVID-19 vaccination is our most effective strategy to prevent infection and severe disease: Vaccination is a priority national strategy to interrupt SARS-CoV-2 transmission, protect personal and public health, and preserve healthcare system capacity. COVID-19 vaccines are safe and recommended for all persons aged 12 years of age and older, even for those with prior SARS-CoV-2 infection.  Immunologic data support the role of Food and Drug Administration (FDA)-authorized COVID-19 vaccines in offering protection against the known currently circulating variants. By limiting viral spread, vaccination also minimizes opportunities for the introduction of more infectious variants through random mutation. Mutations could produce future variants that are more virulent and capable of evading diagnostic and therapeutic tools or overcoming vaccine-induced immunity.

COVID-19 vaccination coverage at skilled nursing facilities (SNF) helps prevent infection: Nursing home residents have been severely impacted by COVID-19 and are disproportionately represented in overall burden of COVID-19-related morbidity and mortality in the United States. While there has been significant progress in vaccinating SNF residents, vaccination coverage of staff at many facilities remains low. Preliminary data from CDC’s National Healthcare Safety Network (NHSN) indicate residents of SNFs in which vaccination coverage of staff is 75% or lower experience higher crude rates of preventable COVID infection.

CDC recommends urgent action by all: CDC recommends continued efforts to accelerate primary vaccination efforts, especially in areas with lower vaccination coverage. Individuals who are not fully vaccinated need to maintain all recommended prevention measures. People who are immunocompromised should be counseled about the potential for reduced immune responses to COVID-19 vaccines and to follow current prevention measures to protect themselves against COVID-19 until advised otherwise by their healthcare provider.  CDC recommends ensuring tailored, culturally responsive, and linguistically appropriate communication of vaccination benefits (see vaccine equity resources below).

Recommendations for Public Health Jurisdictions

  • Continue and increase efforts to reach and partner with communities to encourage and offer vaccination. Co-lead the conversation by participating in community education and outreach events.
  • Leverage resources to promote vaccine equity.
  • Encourage clinicians to offer and recommend COVID-19 vaccination to their patients and community members.
  • Work with community partners to make vaccination easily accessible for unvaccinated populations.
  • Implement additional prevention strategies when transmission is high and vaccination coverage is low (MMWR).
  • Continue to monitor community transmission levels, variant, and vaccination coverage levels, and focus vaccine efforts on populations with low coverage.
  • Communicate vaccination coverage, variant, and transmission levels to key partners, including the key information on risk associated with the B.1.617.2 (Delta) variant.

Recommendations for Clinicians

  • If you are a clinical provider and are not fully vaccinated, get vaccinated as soon as possible to protect yourself, your family, and your patients.
  • Increase patient outreach efforts to encourage, recommend, and offer COVID-19 vaccination.
  • Remind patients that vaccination is recommended for all persons aged 12 years of age and older, even for those with prior SARS-CoV-2 infection. Follow trusted sources carefully for any new recommendations and changes in vaccine guidance.
  • Support efforts to ensure people receiving a first dose of a COVID-19 mRNA vaccine (i.e., Pfizer-BioNTech or Moderna) return for their second dose to complete the series.
  • Communicate with unvaccinated staff, patients, and other individuals to increase confidence in vaccination. CDC has many resources for providers to help increase vaccine confidence .
  • Recommend that fully vaccinated patients who are immunocompromised continue to practice all recommended prevention measures for unvaccinated persons.

Recommendations for Healthcare Facilities and Systems, Nursing Homes, and Businesses

  • Recommend and offer COVID-19 vaccine to your staff and employees and establish policies to encourage uptake such as time off to receive the vaccine.
  • Consider offering COVID-19 vaccine at your workplace (Workplace COVID-19 Vaccine Toolkit).
  • Evaluate whether your facility can implement vaccine requirements or vaccine incentives.

For More Information

COVID Data Tracker

USDA Extends COVID-19 Relief for Single-Family Housing Borrowers

United States Department of Agriculture (USDA) Deputy Under Secretary for Rural Development Justin Maxson announced that the Department is extending the COVID-19 Special Relief Measure for USDA’s Single-Family Housing Guaranteed Loan borrowers.

The USDA COVID-19 Special Relief Measure provides new alternatives for borrowers to help them achieve up to a 20 percent reduction in their monthly principal and interest payments. New options include an interest rate reduction, term extension and a mortgage recovery advance, which can help cover past due mortgage payments and related costs.

Borrowers will first be assessed for an interest rate reduction, and if additional relief is still needed, the borrowers will be considered for a combination rate reduction and term extension. In cases where a combination of rate reduction and term extension is not enough to achieve a 20 percent payment reduction, a third option combining the rate reduction and term extension with a mortgage recovery advance may be used to reach the target payment.

In addition, the Department of Treasury’s Homeowner Assistance Fund (HAF), a critical component of President Biden’s American Rescue Plan, provides $9.961 billion to states, Washington, D.C., territories and Tribes for relief to homeowners impacted by the COVID-19 economic crisis. These funds can be used for assistance with mortgage payments, homeowner’s insurance, utility payments and other specified purposes. Homeowners can access these funds in addition to the payment reduction options discussed above.

For more information, see the White House Fact Sheet: Biden Administration Announces Additional Actions to Prevent Foreclosures.

If you’d like to subscribe to USDA Rural Development updates, visit our GovDelivery subscriber page.

How Do We Integrate COVID-19 Vaccination into Primary Care?

As the nation’s COVID-19 vaccination campaign enters a new, more challenging phase, primary care providers will be key to reaching many of the millions of Americans who have not yet gotten their shots. In a new feature, the Commonwealth Fund offer lessons gleaned from interviews with primary care providers on how to integrate COVID-19 vaccination into their day-to-day work. Practices have faced many challenges, but many have also devised creative ways to assess and meet vaccine demand and respond to patients’ questions and concerns. A recent poll found that 53 percent of unvaccinated people prefer to be vaccinated in their personal doctor’s office. Learn how we can make that an easier option for more Americans.

Learn more.

Most Unvaccinated People Have Low Incomes

More than half of unvaccinated Americans live in households that make less than $50,000 annually. Almost two-thirds of unvaccinated people who make less than $50,000 still say they either “definitely” or “probably” will get the vaccine. Making it easier for the working poor to get the COVID-19 shot could help boost vaccination rates. Vaccination has been politicized, but juggling work schedules and child care could be bigger factors than politics, as could worry about experiencing side effects and having to take unpaid time off.

A New Tool: Vaccine Hesitancy by Zip Code & County

The COVID-19 Collaborative and the Institute for Health Metrics and Evaluation (IHME) at the University of Washington School of Medicine released a new tool that shows data on people’s openness to receiving a COVID-19 vaccine by zip code and county for the entire United States. With more than 30,000 zip codes, compared to only 3,000 counties, this tool offers a ten-fold increase in the localization of data on vaccine intention and will be a significant contribution to vaccine uptake efforts. Current existing visualization maps show only up to the county level. Some vaccine intention rates in counties mask the low level of intention within zip codes in those counties, so it is critical to have this level of data.

Click here to see the map.

Resources Available to Support Workforce Resilience and Mental Health Needs

More than half of public health workers reported adverse mental health conditions during the COVID-19 pandemic, according to a recent CDC Morbidity and Mortality Weekly Report. To help build workforce resilience, health centers may be interested in resources available on the COVID-19 Workforce Resilience/Sustainability Resources topic page. Additionally, check out this self-paced course developed by the Department of Health and Human Services and the National Association of County and City Health Officials to introduce the concept of Psychological First Aid as a leadership tool to build resilience.

Study Quantifies Impact of Vaccination on Death and Hospitalization

As the more contagious Delta variant of COVID-19 surges in parts of the United States, a new study from Yale University and the Commonwealth Fund finds that the U.S. vaccination campaign has significantly curbed the virus’s death toll, saving as many as 279,000 lives and averting up to 1.25 million hospitalizations. The study examined the impact of the U.S. COVID-19 vaccination program on the pandemic’s trajectory through July 1, 2021, considering the emergence of more transmissible variants in recent months. The findings demonstrate that the speed of the U.S. vaccination rollout prevented numerous additional COVID-19 fatalities and hospitalizations. Researchers warn, however, that the Delta variant’s spread among unvaccinated populations could produce a surge in new cases and reverse the downward trend of infections and deaths across the country.

Read more.

Provider Relief Fund Portal Now Open

The Department of Health and Human Services (HHS) opened the portal on July 1 for providers to report how Provider Relief Fund (PRF) funding was utilized.  Providers who received one or more PRF payments exceeding $10,000, in the aggregate, during a Payment Received Period must come in and report. The deadline for PRF reporting is September 30, 2021.

Review the updated Reporting Requirements Notice (June 11) and register in the PRF Reporting Portal (if not yet completed).

For additional assistance, reference the following resources:

All of these resources and more may be found on the HHS Reporting and Auditing webpage. Real-time assistance is available by calling the Provider Support Line at (866) 569-3522; for TTY dial 711. Hours of operation are 8 a.m. to 10 p.m. CT, Monday through Friday.



HHS Provides $398 Million to Small Rural Hospitals for COVID-19 Testing and Mitigation

HHS announced that, thanks to the American Rescue Plan, through the Health Resources and Services Administration (HRSA), it provided $398 million in funding through the Small Rural Hospital Improvement Program (SHIP) to 1,540 small rural hospitals for COVID-19 testing and mitigation. State Offices of Rural Health, which work with small rural hospitals to implement quality and operational improvement efforts, will receive the funding announced today to distribute to eligible small rural hospitals in their state. Hospitals will use the funds to maintain or increase COVID-19 testing, expand access to testing for rural residents, and tailor mitigation efforts to reflect the needs of local communities.