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

Summary
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.

Background
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.

New Pocket Guides from MidAtlantic AETC Available

The MidAtlantic Aids Education and Training Center (AETC) has created several new pocket guides on the following topics:

  • Rapid Initiation of HIV Treatment
  • HIV and Medication Assisted Treatment Centers (MAT)
  • Differential Diagnosis of HIV and SARS-COV-2
  • Best Practices & Tips for Clinicians Providing Care for Patients with HIV via Telehealth
  • Integrating Geriatric Principles into an HIV Clinic
  • Workplace Burnout Guide for Health Professionals
  • Addressing Social Determinants of Health and Persons with HIV

The pocket guides were created by Dr. Linda Frank and the regional partners of the MidAtlantic AETC and are available for download here or with all of their pocket guides and clinical tools by clicking here.

Status of Cancer Annual Report to the Nation Released

The Annual Report to the Nation on the Status of Cancer was recently released and contains some good and bad news. The good news – mortality rates for lung cancer in the United States rapidly declined from 2001 to 2018. Among the bad news- age-standardized oral and pharyngeal cancer incidence rates increased during that period and pharyngeal mortality rates also increased for men but dropped slightly for women. The incidence of most smoking-related cancers (lung, larynx, bladder) has been declining in the U.S. largely due to the declining prevalence of smoking.

Read more.

Telehealth Essential for Millions to Continue Access to Health Care Once Pandemic is Over

A new report and infographic from the National Association of Community Health Centers (NACHC) present recently collected survey data on community health center experiences with audio-only telehealth during the pandemic. The report examines the lifeline telehealth provided for health centers and patients during the pandemic and stresses that unless lawmakers ensure the emergency flexibilities granted during the public health crisis continue, millions of patients could lose access to care. See the infographic for a summary of the impact of termination of emergency flexibilities.

Out of Reach 2021: The High Cost of Housing Report

The National Low Income Housing Coalition (NLIHC) recently released Out of Reach 2021: The High Cost of Housing. This report highlights the mismatch between the wages people earn and the price of decent rental housing in every state, metropolitan area, and county in the U.S. This robust report and data are extremely valuable in making the case for rental assistance, affordable housing, and livable wages among other important policy priorities. The report also includes housing cost and wage data specific for Pennsylvania and our counties. Explore the full report that includes an interactive website with an easy-to-use search function for data by metropolitan-area ZIP codes.

New Pennsylvania Law Increases Access to Medicaid Workers with Disabilities

On July 1, Pennsylvania Governor Tom Wolf signed into law Act 69 of 2021 formally Senate Bill 156. This Act increases earning eligibility under the Medicaid Assistance for Workers with Disabilities (MAWD) program. Dollars earned over the cap will move contributions into a new category instead of eliminating eligibility and covers workers from 250% of the federal poverty level to 600% or about $75,000.  Workers will pay 7.5% of their income to the MAWD program to cover their healthcare, which is a 2.5% increase from the current 5%. This means, when a worker earns $75,000 annually, they will pay 100% of the average cost of the MAWD program.

Young Invincibles Releases State of Enrollment Report

The current enrollment landscape is and has been quite tumultuous. With many trying to return to a regular routine, taking a step back and looking at what we learned about enrollment assistance during the height of the COVID-19 pandemic is key. With millions losing job-based health insurance, assisters stepped up to the plate, creating new and initiative ways to conduct enrollment, outreach virtually, harnessing the power of social media, and continued to enroll despite lack of internet or Wi-Fi access or the ability to meet in-person with those who needed assistance the most. Young Invincibles, founded by a group of students in 2009, is a network of advocates committed to educating young adults on all aspects of life from finances to the importance of health insurance coverage to making smart economic choices to build a better future. This new report discusses the current enrollment landscape, COVID-19 enrollment, and highlights some federal policy recommendations.

Read the full State of Enrollment Report.