The CDC now recommends masks for vaccinated people – but at least 6 major cities had already told residents to mask up again

la mask requirement
Lilian Zhu, 17, works at her laptop inside Charlie’s Coffee House in South Pasadena, California, on July 18, 2021.

The Centers for Disease Control and Prevention recommended on Tuesday that vaccinated people wear masks in public indoor settings – a change from the previous guidelines, which suggested vaccinated people didn’t need masks. The new rules apply to areas of the country with high rates of coronavirus transmission, as well as K-12 schools, the CDC said.

Some vaccinated Americans, though, have already been told to mask up again.

Amid a rise in COVID-19 cases fueled by the Delta variant, at least six cities have issued new mask guidance in the last few weeks. Los Angeles and St. Louis have instated official mask mandates for all residents, while New Orleans, Philadelphia, San Francisco, and Seattle have recommended masks.

Some cities have also reissued mask mandates for specific indoor settings. Clark County, Nevada – which includes Las Vegas – began requiring masks in court facilities last week. Public schools in Atlanta, Chicago, and New York City will require students and staff to wear masks this school year, regardless of their vaccination status. And in Hawaii, the government is waiting until more residents are vaccinated before lifting its indoor mask mandate.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told Fox News that these local mask requirements are “quite understandable” given Delta’s prevalence in the US.

CDC Director Rochelle Walensky said on Tuesday that vaccinated people infected with Delta may be contagious and spread the virus to others. Data on previous variants indicated that vaccinated people were less likely to transmit the virus than unvaccinated people.

At least 6 cities have issued new mask guidance

New Orleans mask
An employee at Turtle Bay, a bar in the French Quarter, wears a mask as he takes the names and contact information of people walking in on May 16, 2020.

The San Francisco Bay Area was among the first places to buck the no-mask trend in July. Several Bay Area counties, including San Francisco County, began recommending masks for all people – vaccinated or not – in indoor spaces like theaters, grocery stores, and retail stores starting July 16. In nearby San Mateo County, masks are now required, even for fully vaccinated people, inside county offices, clinics, and public facilities.

Los Angeles County also reinstated its indoor mask mandate on July 18 following a sharp uptick in cases. Average daily cases more than doubled there in the first two weeks of July, then tripled by the third week.

In New Orleans, health officials issued a “mask advisory” instead of a mandate. The city’s “inadequate vaccination rate” was part of the reason for that rule, they said. New Orleans has the second-highest vaccination rate in Louisiana – around 57% of residents have received at least one dose – but cases have still increased 10-fold there since the start of July.

two students sitting at their desks, wearing masks
Students wearing masks listen to their teacher during third grade summer school in Los Angeles, June 23, 2021.

On Thursday, Philadelphia also “strongly recommended” that all residents wear masks inside public places. James Garrow, a spokesperson for the city’s health department, told The Philadelphia Inquirer that officials were concerned about an uptick in COVID-19 hospitalizations among the city’s unvaccinated children.

King County, Washington, which includes Seattle, followed suit with a similar recommendation on Friday. Health officials now advise that all residents ages 5 and up wear masks in indoor public settings – despite the fact that King County is one of the most vaccinated counties in the US. (Around 72% of residents have received at least one dose.)

“This extra layer of protection will help us all stay safer, including those who are unvaccinated, such as the 300,000 children in King County who aren’t able to get vaccinated yet, and the many thousands of people who have immune systems that are weakened or suppressed,” the county said in a statement.

St. Louis County, Missouri, took a firmer stance on Monday by requiring vaccinated people ages 5 and older wear masks on public transportation and in all indoor public spaces. The mandate doesn’t apply to people eating or drinking in restaurants or bars, though.

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UK coronavirus cases have been dropping dramatically over the last week. Vaccines aren’t the only reason why.

UK economy reopens
The UK economy officially reopened on July 19.

  • The UK’s daily coronavirus cases dropped to 25,000 on Monday after a recent peak of nearly 55,000 on July 17.
  • Experts think a combination of warm weather and fewer public gatherings may have helped.
  • The UK’s promising trajectory may bode well for the US, where cases are surging.
  • See more stories on Insider’s business page.

The UK’s daily coronavirus cases are falling almost quickly as they rose earlier this summer.

During the first two weeks of July, average daily cases there jumped 80%, peaking at nearly 55,000 on July 17. That’s close to the levels recorded during the worst days of the UK’s winter outbreak, when vaccines weren’t yet widely available.

But cases have dropped dramatically in the last week, down to just 25,000 cases on Monday, as shown in the chart below.

UK COVID-19 cases over the last month

UK summer covid cases chart

Experts, though surprised, have a few theories as to what happened. A recent decline in testing could be one factor: The UK administered 9% fewer tests this week than it did three weeks prior, and testing overall has declined since mid-March.

“A lot of the people who are becoming symptomatic are becoming more mildly symptomatic because they’re younger people or they’re people who have been vaccinated,” Scott Gottlieb, former commissioner of the US Food and Drug Administration, told CNBC on Monday. “So those people aren’t presenting for testing.”

But a likelier explanation, according to other experts, is a combination of warm weather – which encourages people to spend less time indoors – and fewer public gatherings.

The Euro 2020 soccer championship, which ended two weeks ago, may have temporarily driven up UK cases, since the semifinals were held at London’s Wembley Stadium on July 6 and 7, then the finals on July 11. Many schools also closed for summer holidays last week.

Additionally, the recent spike in cases may have prompted more people to self-isolate, either to avoid getting sick or because they had known exposure to someone with COVID-19.

The UK’s promising trajectory may bode well for the US

london UK reopening
Outdoor dining in Soho, London, on April 18, 2021.

There’s no guarantee that the UK’s downward case trend will last, however, especially since most social distancing restrictions lifted on July 19. Since then, venues like restaurants, clubs, and festivals have reopened. Official case numbers generally reflect the spread of infections two weeks prior, due to the virus’ incubation period and the time it takes to get tested, get results, and see those results reported to health authorities.

“Today’s figures do not of course include any impact of last Monday’s end of restrictions,” Paul Hunter, a professor of medicine at the University of East Anglia, told the BBC. “It will not be until about next Friday before the data includes the impact of this change.”

So it’s possible that case totals will tick up again starting next week. Still, vaccines should continue to prevent fully immunized people from becoming severely ill. New research suggests that two doses of Pfizer’s or AstraZeneca’s vaccine are 88% and 67% effective, respectively, at preventing symptomatic COVID-19 from the Delta variant – the UK’s dominant strain.

The UK’s promising trajectory may even bode well for other highly vaccinated counties like the US, where cases are surging.

“If the UK is turning the corner, it’s a pretty good indication that maybe we’re further into this than we think,” Gottlieb told CNBC. “Maybe we’re two or three weeks away from starting to see our own plateau here in the United States.”

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Vaccine regret went mainstream this week. Fear of getting sick could finally be encouraging some Americans to get their shots.

coronavirus hospital texas
Dr. Joseph Varon (right) speaks to a patient in the COVID-19 intensive care unit at the United Memorial Medical Center in Houston, Texas on December 29, 2020.

  • Several hospitalized coronavirus patients expressed regret this week for not getting vaccinated.
  • Their stories may be resonating with other unvaccinated Americans.
  • Vaccination rates are increasing in states with recent COVID-19 surges like Arkansas and Louisiana.
  • See more stories on Insider’s business page.

US health authorities are calling it “a pandemic of the unvaccinated.” In the last two weeks, average COVID-19 hospitalizations have risen more than 50%, with unvaccinated people now representing the vast majority – around 97% – of hospitalized cases, according to the US Centers for Disease Control and Prevention.

For many of these patients, their illness was a wake-up call.

“I’m admitting young, healthy people to the hospital with very serious COVID infections,” Dr. Brytney Cobia, a hospitalist at Grandview Medical Center in Birmingham, Alabama, wrote on Facebook on Sunday. “One of the last things they do before they’re intubated is beg me for the vaccine. I hold their hand and tell them that I’m sorry, but it’s too late.”

Several other hospitalized patients publicly expressed regret this week for not getting vaccinated.

Amanda Spencer, a 37-year-old woman from Ohio, told her local news site WBNS-10TV that she was initially worried about side effects from the shot. She spent 11 days in a medically-induced coma after getting COVID-19 in June.

“After what I went through, I would’ve much rather been sick for a couple of days and have the mild symptoms that maybe the shot causes than to go through what I went through,” Spencer said on Thursday.

Abderrahmane Fadi, a 60-year-old science teacher in the UK, told the BBC that spending nine days in the hospital with COVID-19 was “the punishment I deserve” for not getting vaccinated.

“It’s like a hammer in my head all the time: ‘Why didn’t you have the vaccine? You had all the chances, the opportunities, the appointments, the letters – everything,'” Fadi said.

These stories may be resonating with unvaccinated Americans lately.

Over the last week, the five states with the highest COVID-19 case rates – Arkansas, Florida, Louisiana, Missouri, and Nevada – had higher vaccination rates than the national average, the CDC said. In Louisiana, the number of first doses administered daily has risen 50% in the last two weeks, from roughly 3,600 to 5,400 per day. Arkansas’s daily first doses also rose 85% during that time, from around 2,800 to 5,300 per day.

“Whether it’s seeing loved ones sick or something else, it’s having an impact,” Ashish Jha, dean of the Brown School of Public Health, wrote of COVID-19 surges in states with rising vaccination rates.

Rising cases and hospitalizations could change the minds of vaccine skeptics

covid vaccine
Maryland National Guard Specialist James Truong (right) administers a Moderna vaccine at CASA de Maryland’s Wheaton Welcome Center in Wheaton, Maryland on May 21, 2021.

It’s hard to know exactly why vaccinations have risen in some states and not others. At the national level, average daily vaccinations have actually declined 15% in the last week, even though no state has vaccinated more than 75% of its residents so far, and 16 states haven’t crossed the 50% threshold.

“We can’t really say with any certainty why we’re seeing an uptick in vaccinations,” Mindy Faciane, a public information officer for the Louisiana Department of Health, told Insider. But rising hospitalizations may be having some effect, she added.

“We think some Louisianans are also seeing the rising numbers of cases and hospitalizations among the unvaccinated, seeing the more contagious Delta variant in circulation and how it’s affecting their communities, and understanding that it is really urgent,” Faciane said. “They’re working through whatever questions they may have had about the vaccine and are now extra motivated to protect themselves and their loved ones in a way they hadn’t before.”

Indeed, data collected by The Economist and polling site YouGov indicates that the escalating severity of the pandemic can successfully change the minds of vaccine skeptics. In Taiwan, for instance, people reported that they were more likely to get a COVID-19 vaccine following a spike in cases in May, which forced the country back into a partial lockdown.

“Anecdotally, we are hearing from pharmacists and healthcare providers administering shots that more Arkansans are seeing the urgency in the need to get vaccinated as cases increase in the state,” Arkansas’s state health director, Dr. José Romero, told Insider.

Romero said earlier this month that his department’s vaccination strategy includes highlighting stories of unvaccinated people who became severely ill from COVID-19 – like a couple whose baby was delivered while the mother was still on a ventilator.

“Those people are becoming ambassadors and getting these public service messages out,” Romero said, adding, “This couple in particular exemplifies the view that many, many people have in the state – that is, ‘This is nothing, it’s an insignificant viral infection’ – and really shows the consequences of that type of belief.”

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A 22% surge in US coronavirus deaths is hitting unvaccinated people hardest. Experts worry about the long-term effects for vaccinated people, too.

us 500,000 covid-19 deaths
El Paso County Medical Examiner’s Office staff roll bodies in bags labeled “COVID” from refrigerated trailers into the morgue office on November 23.

  • The US’s daily coronavirus deaths surged 22% in the past week – mostly among unvaccinated Americans.
  • Disease experts worry about breakthrough cases in older people or those who are immunocompromised.
  • Increased transmission could also allow the virus to mutate into a more dangerous strain.
  • See more stories on Insider’s business page.

The US is far removed from the deadliest point in its coronavirus outbreak: The country reported more than 3,000 daily coronavirus deaths in January, compared with less than 275 daily deaths, on average, in the past week.

But average daily deaths surged 22% in the past seven days, following a record low of 30 deaths on July 11. In the past two weeks, average daily deaths rose 33%.

The vast majority these deaths are among unvaccinated Americans: Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, told NBC earlier this month that unvaccinated people represented more than 99% of recent coronavirus deaths. The Centers for Disease Control and Prevention also reported Friday that more than 97% of people entering hospitals with symptomatic COVID-19 hadn’t received shots.

The US is now dealing with a “pandemic of the unvaccinated,” CDC Director Rochelle Walensky said at a press briefing.

“We are seeing outbreaks of cases in parts of the country that have low vaccination coverage because unvaccinated people are at risk, and communities that are fully vaccinated are generally faring well,” Walensky said.

But disease experts worry that allowing the virus to spread among unvaccinated people could give it more opportunities to mutate. That could pose a long-term risk for vaccinated people, too. Already, the Delta variant – now the dominant strain in the US – appears to be more transmissible than any other version of the virus detected so far.

“The worst-case scenario is if Delta mutates into something completely different, a completely different animal, and then our current vaccines are even less effective or ineffective,” Vivek Cherian, an internal-medicine physician in Baltimore, told Insider last month.

Experts also worry that increased transmission could result in more severe breakthrough infections – cases of COVID-19 diagnosed at least two weeks after someone is fully vaccinated – among older people or those who are immunocompromised, since vaccines may already be less effective among these groups.

People over 65 represent about 75% of breakthrough cases that result in hospitalization or death, according to the CDC.

The UK offers insight into what to expect in the US

london UK reopening
Outdoor dining in Soho, London, on April 18.

Disease experts worry that the US could soon follow in the footsteps of the UK, where average deaths have more than doubled in the past two weeks, from 17 to 40 a day. The UK’s average hospitalizations have also increased about 60% during that time, from about 380 to 615 a day.

That’s despite the fact that nearly 70% of UK residents have received at least one vaccine dose.

In the US, about 44% of the population remains unvaccinated. (That includes about 48 million children under age 12, for whom vaccines haven’t been authorized yet.)

The country is now administering as many daily vaccine doses as it was in late December, when vaccines were available only to healthcare workers and residents of long-term-care facilities. Just 384,000 daily doses were given out on average over the past week.

Some Americans, particularly in rural counties, may still struggle to access shots, while others can’t afford to take time off work to get vaccinated. But, for the most part, widespread vaccine hesitancy has slowed down vaccination rates.

About 18% of adults surveyed in a recent YouGov poll said they didn’t plan to get vaccinated, while 11% said they were unsure. These rates were significantly higher among Republicans and people in the Midwest and South.

Most vaccine-hesitant people in the survey said they were worried about side effects from coronavirus shots – though studies have shown that vaccine side effects are generally mild and fleeting. The vast majority of them also said they believed that the threat of the virus was exaggerated for political reasons.

Lifting mask and social-distancing mandates could delay herd immunity

US reopening concert phone picture Instagram
A couple at Madison Square Garden in New York City on June 20.

Despite lagging vaccination rates, most US states have lifted mask and social-distancing mandates. In states such as Delaware, Florida, Missouri, and South Carolina, masks are recommended but not required for unvaccinated people.

Some disease experts said removing these restrictions too soon could send the wrong message about the state of the pandemic.

“The concern is if you’re on the fence, and then you go outside and you see, ‘Hey, things are back to normal,’ that may decrease the chance of you wanting to even get vaccinated,” Cherian said.

For now, experts are hopeful that the US can still vaccinate at least 70 to 85% of its population – a threshold that may allow the country to reach herd immunity. But a new variant that evades protection from vaccines or prior infection could push that goal even further from view, so public-health officials remain determined to vaccinate more Americans as quickly as possible.

“If you get to that situation, then you essentially get us back to a level” that we were in before March 2020, Cherian said, adding: “That’s just not a place that you want to be.”

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The Delta variant is hitting red states hardest as the US’s vaccine divide widens

anti vaccine trump rally
A protester holds an anti-vaccine sign as supporters of President Donald Trump rally in Woodland Hills, California, on May 16, 2020.

  • The Delta variant is sickening people most in unvaccinated, heavily Republican “red” states.
  • Arkansas, Mississippi, Missouri, and Wyoming have seen upticks in cases and hospitalizations.
  • But the variant has had little effect in blue states like Maine, New Hampshire, and Vermont.
  • See more stories on Insider’s business page.

The US’s daily coronavirus cases have soared 60% in the last two weeks as the Delta variant strengthens its hold on the country. Delta now accounts for more than half of US cases, making it the dominant strain nationwide.

But the variant isn’t hitting all states equally. Delta cases have risen primarily in states with low vaccination rates, which for the most part are heavily Republican – “red” states like Arkansas, Mississippi, Missouri, and Wyoming. Overall, these states have seen higher upticks in daily cases and hospitalizations than “blue” states that voted Democratic in the 2020 election.

In Missouri, for instance, daily cases have risen around 75% in the last two weeks, from around 800 to 1,400 cases per day. Hospitalizations have also risen 34% during that time, from around 830 to 1,100 per day. Delta has made up nearly 70% of all coronavirus cases there over the last two months, according to data compiled by Scripps Research’s Outbreak.info tracker. Less than half of Missouri residents (around 46%) have received at least one vaccine dose so far – well below the US average of 56%.

But Vermont, where nearly 75% of residents have received at least one dose, has reported just five daily cases and five daily hospitalizations in the last two weeks. Delta made up less than 1% of coronavirus cases there in the last two months.

Other blue states, like Maine, New Hampshire, and Pennsylvania, have also reported some of the lowest case numbers and highest vaccination rates in the country. In each of these states, Delta has represented less than 10% of overall cases in the last two months, according to Outbreak.info.

“We’ve got to get away from the divisiveness,” Anthony Fauci, director of the National Institute of Allergy and Infectious Disease, told ABC on Sunday – a reference to the way the US’s vaccine divide falls along political lines.

Viruses, Fauci added, “don’t know the difference between a Democrat, a Republican, or an Independent.”

Republicans are less likely than Democrats to trust vaccines

vermont covid-19 vaccine
A National Guard soldier gives a COVID-19 vaccine at a pop-up vaccination stand at the Vermont Creamery in Websterville, Vermont, on June 29, 2021.

Data collected by the New York Times shows that just 34% of people are fully vaccinated in an average US county that voted for Donald Trump, whereas 45% of people are fully vaccinated in an average county that voted for Joe Biden.

There are several reasons why vaccination rates are stalling in red states. For one, Republicans are more likely to believe that vaccines aren’t safe or that the shots aren’t necessary to protect their health, according to a June survey from the Kaiser Family Foundation.

Additionally, Republican states also tend to be more rural, so access to shots may still prevent some people in those areas from getting immunized.

In Arkansas, for instance, around 42% of counties are rural. Research from Boston Children’s Hospital suggests that several Arkansas counties qualify as “vaccine deserts,” with the nearest COVID-19 vaccination site more than a 15-minute drive away. Just 43% of Arkansas residents have received at least one vaccine dose.

But the state’s health director, Dr. José Romero, blames the low vaccination rate on widespread vaccine hesitancy – not lack of access. The Kaiser Family Foundation survey found that rural residents are also significantly more vaccine hesitant than urban or suburban residents.

“We’ve done everything we can,” Romero told Insider. “We’ve made the vaccine available. We’ve gone the extra mile to make it pretty much on demand if you want it.”

arkansas vaccine campaign
Arkansas Gov. Asa Hutchinson watches an ad featuring former NBA star Sidney Moncrief that encourages people to get the COVID-19 vaccine, at the state capitol in Little Rock on May 20, 2021.

Delta has made up nearly 40% of Arkansas’ cases over the last two months – among the highest shares in the country. Romero said he has tried to remind residents that the variant poses “a much greater threat” than the original coronavirus strain.

An analysis from Public Health England found that Delta was associated with a 60% increased risk of household transmission relative to the Alpha variant discovered in the UK, though more recent estimates suggest the difference is closer to 40%. The Alpha variant is already about 50% more transmissible than the original strain, according to the Centers for Disease Control and Prevention.

Researchers in Scotland also found that getting infected with the Delta variant doubled the risk of hospital admission relative to Alpha. (Previous studies have suggested that the Alpha variant may be 30% to 70% deadlier than the original strain.)

Vaccines, of course, significantly lower that risk, but it’s important to complete the full course. New research suggests that partially vaccinated people are more vulnerable to symptomatic Delta infections than they might be to other strains. A study published last week in the journal Nature found that a single dose of Pfizer’s vaccine was either weakly or not at all effective against the variant.

“It’s very clear that this is a nasty variant,” Fauci told ABC. “It has a much greater capability of transmitting from person to person.”

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Arkansas is the US’s new Delta epicenter. Its health director says ‘we’ve done everything we can’ to convince people to get vaccinated.

arkansas vaccine campaign
Arkansas Gov. Asa Hutchinson watches an ad featuring former NBA star Sidney Moncrief that encourages people to get the COVID-19 vaccine, at the state capitol in Little Rock, May 20, 2021.

  • Arkansas is seeing its highest spike in coronavirus cases in nearly five months.
  • The spread of the Delta variant has made it a new epicenter of the US outbreak.
  • But Arkansas health officials are still struggling to convince people to get vaccinated.
  • See more stories on Insider’s business page.

Few states have had a harder time vaccinating people than Arkansas.

Less than 43% of the state’s population has received at least one vaccine dose, and just 34% of residents are fully vaccinated – among the lowest vaccination rates in the US. That made the state a sitting duck for the Delta variant, which is significantly more transmissible than the original virus or other variants. As Delta spreads rapidly among unvaccinated people in the US, Arkansas and its neighbor, Missouri, have become the epicenter of the US outbreak.

The maps below, from the Centers for Disease Control and Prevention, show how Arkansas’ latest surge correlates with its low vaccination rate. Counties with at least 100 cases per 100,000 people (in blue) also have vaccination rates below 40% (in purple).

A map on the left shows counties where COVID-19 cases rates are above 100 cases per 100.000, a map on the right shows counties where vaccination rates are below 40%. Texas as greyed out on the map on the right as county-level vaccinatin data is not available.
Maps of the us show counties where case rate is over 100 per 100.000, and counties where vaccination rate is below 40%, as of July 2, 2021

Arkansas reported more than 1,200 new coronavirus cases on Friday – its highest tally in nearly five months. The state’s daily coronavirus cases more than doubled over the last two weeks, from around 290 to 600 cases per day, on average. Data compiled by Scripps Research’s Outbreak.info tracker suggests that Delta may account for more than 80% of Arkansas’ new coronavirus infections. That’s among the highest shares of Delta infections in the country.

Hospitalizations have risen in the state as a result: Arkansas’ average is up 42% in the last two weeks, from around 270 to 380 hospitalizations per day.

The state’s health director, Dr. José Romero, blames the low vaccination rate on widespread vaccine hesitancy in rural areas.

arkansas health director
Arkansas Health Director José Romero.

Romero told Insider that the state’s health department arranged for essential workers to get access to shots at their places of work, but demand for the service was low. Even teachers have been reluctant to get their shots, he said: At most, 45% of teachers and staff at Arkansas schools have been vaccinated.

Now, the health department is planning to return to schools and workplaces to offer the shots a second time. Officials are also hosting town halls to address residents’ concerns about vaccine safety, since misinformation on social media has led people to think, falsely, that coronavirus vaccines might increase the risk of infertility.

Since May, Arkansas’ government has also been offering incentives for those who get vaccinated: $20 gift certificates for the Arkansas Game and Fish Commission or $20 lottery tickets.

But if those efforts don’t pan out, there’s no backup plan.

“We’ve done everything we can,” Romero said. “We’ve made the vaccine available. We’ve gone the extra mile to make it pretty much on demand if you want it. We’ve made testing available all around the state through various means. I don’t think there’s anything else that we can do at this point.”

Many rural residents don’t see a need to get vaccinated

dugan's pub arkansas
Anna Barnard, left, wears a mask as she talks to Greg and Judy Robinson at Dugan’s Pub in Little Rock, Arkansas on May 11, 2020.

Access to shots may still be a problem in Arkansas, despite the state’s efforts. Rural communities are historically hard to reach through vaccination campaigns, and around 42% of Arkansas counties are rural. Research from Boston Children’s Hospital suggests that several Arkansas counties qualify as “vaccine deserts,” with the nearest COVID-19 vaccination site more than a 15-minute drive away.

But Romero doesn’t think that’s the issue.

“We really do have vaccine in every county in the state,” he said. “This is the home of Walmart, and Walmart is a federal partner. I say this tongue-in-cheek: You can’t swing a cat without hitting Walmart. They’re everywhere and they’re distributing the vaccine.”

Romero said he is more concerned about how difficult it has been to convince rural residents that the coronavirus is dangerous, even with the spread of Delta.

“There is a significant population within the state that still doesn’t believe this to be a major health threat,” he said. “They consider themselves not at risk because they’re healthy.”

arkansas football game covid-19
A sign at the Donald W. Reynolds Razorback Stadium in Fayetteville, Arkansas, where the Georgia Bulldogs played the Arkansas Razorbacks on September 26, 2020.

Even within his own health department, Romero added, there are still employees “that are not believers in the vaccine.”

Arkansas has one of the highest rates of vaccine hesitancy in the country. As of June, the Department of Health and Human Services estimated that 25% of the state’s population might be hesitant or unsure about getting a COVID-19 vaccine. Only three other states – Mississippi, Montana, and Wyoming – had higher hesitancy rates.

Arkansas has also struggled to get people to return for their second shots. Romero said 15% of people who had received their first dose of either Pfizer’s or Moderna’s vaccine hadn’t gone back for their second as of two weeks ago. Romero said he thinks it’s because many residents were deterred by the side effects of their first dose.

That’s particularly concerning given that new research suggests partially vaccinated people are more vulnerable to symptoms from Delta. A study published Thursday in the journal Nature found that just a single dose of Pfizer’s vaccine was either weakly or not at all effective against the variant.

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The original coronavirus strain has almost disappeared in the US. One chart shows how variants took over.

covid delta variant
A mobile COVID-19 vaccination center in Bolton, England, on June 9, 2021.

  • Coronavirus variants have largely replaced the original strain, rendering it essentially obsolete.
  • The Alpha variant took over as the US’s dominant strain in April. Delta could replace it soon.
  • Scientists aren’t sure whether more contagious variants will evolve from the dominant ones.
  • See more stories on Insider’s business page.

Viruses will do what it takes to survive – even if it means killing off an older, weaker self and replacing it with a more transmissible strain.

For the first several months of the pandemic, however, the coronavirus had no need to become more dangerous: The virus was doing a good job of spreading, with each new infected person passing it to an average of two to three others. At the time, scientists hoped that the original strain of the virus, known as the “wild type,” was already contagious enough that it wouldn’t evolve further.

But as the pandemic swelled and more people got infected, the coronavirus had more opportunities to replicate, and therefore mutate, incurring small, random changes in its genetic sequence. Most mutations are harmless, but every so often a distinct set yields new properties – a variant.

Scientists now estimate that variants have almost completely replaced the original strain in the US, rendering it essentially obsolete.

“Pretty much all the virus that’s circulating right now has one of these variants that make it differ from the original strain that first took off across the world,” Tyler Starr, a postdoctoral research fellow at the Fred Hutchinson Cancer Research Center, told Insider.

The chart below shows how a few variants have dominated the US since February. More than 200 less prevalent strains, including the original version of the virus, are listed as “other.”

The Alpha variant, first identified in the UK in September, became prevalent in the US from February to April, going from 27% to 70% of all circulating strains. It’s about 50% more transmissible than the original strain, according to the Centers for Disease Control and Prevention. Meanwhile, the share of other coronavirus strains (including the original) fell from 20% to 4%.

By May, Alpha had a strong competitor: Delta. An analysis from Public Health England found that the Delta variant was associated with a 60% increased risk of household transmission compared to Alpha, though more recent estimates suggest that difference is closer to 40%.

From May to June, Delta grew from less than 3% of all circulating strains in the US to more than 20%. It’s poised to become the US’s dominant strain within weeks.

“Basically everywhere, once Delta gets there, it does overtake something like the Alpha variant,” Starr said. “That is evidence that, to some degree, it is more transmissible.”

Could an even more contagious variant replace Delta?

variant lab
Researchers sequence coronavirus samples at the University Hospital of Badajoz in Spain on April 15, 2021.

So far, Starr said, coronavirus variants – even Delta – aren’t fundamentally different from the wild type.

“These mutations might be slightly modifying things like transmissibility,” he said, but “that trait was there in the original virus and it’s just being altered slightly.”

In fact, some scientists wonder if the virus is nearing “peak fitness,” the point after which it no longer mutates to become more infectious.

Delta is by far the “fittest” variant to date, according to the World Health Organization. In addition to being more transmissible than other strains, it may also be deadlier: Researchers in Scotland found that getting infected with Delta doubled the risk of hospital admission relative to Alpha. (Previous studies have suggested that the Alpha variant may be 30 to 70% deadlier than the original strain.) Vaccines, of course, significantly lower that risk for both variants.

“Delta is absolutely going up the fitness peak – whether it’s at the top, I think that’s very hard to say until we just don’t see any further change,” Andrew Read, who studies the evolution of infectious diseases at Pennsylvania State University, recently told Insider.

“If Delta takes over the world and nothing changes,” he added, “then we’ll know in a while – a year or two – that it is the most fit.”

But Starr thinks the virus probably won’t ever stop mutating.

“As people continue to get immunity, the virus will continue to evolve to be able to transmit and infect people,” he said. “But at the same time, we’ll have that low-level immune reaction that makes it a much less severe thing over time.”

It’s still possible that an entirely new lineage might replace Delta as the dominant variant, or that two variants – Delta and Alpha, for instance – could combine mutations to produce an even more infectious strain. In the worst-case scenario, the virus could evolve into a “variant of high consequence” – one that’s far more distinct than the variants currently circulating and highly resistant to vaccines. That hasn’t been observed yet.

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A map shows how many people had undiagnosed COVID-19 in the first 6 months of the pandemic, across 7 regions of the US

Biking covid new york
A bike lane in New York City.

  • During the first six months of the pandemic, 16.8 million coronavirus cases went undiagnosed in the US.
  • That’s according to a report that compares the prevalence of coronavirus antibodies in various regions.
  • The Mid-Atlantic saw the most undiagnosed cases – nearly 9 out of every 100 people – by July 2020.
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On paper, the US’s summer and winter coronavirus surges look far more devastating than the first one in the spring of 2020.

But a new report published in the journal Science Translational Medicine offers the most robust look yet at how widespread the virus actually was during that initial wave. The results show that for every diagnosed case of COVID-19 in the US, nearly five others went undiagnosed during the first six months of the pandemic.

That amounts to roughly 16.8 million undiagnosed cases by mid-July 2020 – in addition to the 3 million cases officially reported during that time.

Kaitlyn Sadtler, an investigator at the National Institutes of Health who worked on the study, told Insider that her team spent several months making sure the figure was right.

“It was shocking to an extent of, ‘Wow, that’s a lot of people,’ but at the same time, we knew that there was this big black box out there – the unknown,” she said.

The estimates are based on a collection of blood samples, which the researchers gathered from around 9,000 people across the US from April 1 to August 4, 2020. None of the individuals sampled had ever been diagnosed with COVID-19, but nearly 5% of the samples came back positive for coronavirus antibodies. The researchers determined that these people had gotten undiagnosed infections.

Some regions were hit harder than others, they found. The Mid-Atlantic saw the highest prevalence of COVID-19 cases: Nearly 9 out of every 100 people in the region had an undiagnosed infection, according to the report.

The map below shows how that compares to other regions across the country.

regional covid prevalence

Nearly 7% of people in the Northeast had an undiagnosed infection, compared with less than 2% in the West and Midwest, 3% in the South and Central US, and 4.5% in the Southwest.

Undiagnosed cases were most commonly found among Black Americans: Around 14% of the samples from the group came back positive for coronavirus antibodies. Meanwhile, around 2% of samples from white and Asian American people came back positive – the lowest of any racial group.

Undiagnosed infections were also more common among people ages 18 to 44 than among older age groups – 6% of those samples tested positive for antibodies.

If more young people got COVID-19 early in the pandemic than we thought, it could mean the US is closer to herd immunity than experts were estimating. (Vaccination rates are still relatively low among young Americans – just 38% of people ages 18 to 29 have gotten at least one dose compared to 80% of those ages 65 and older.)

However, Sadtler said people should assume they’re still vulnerable to infection until they’ve gotten a vaccine.

“It definitely doesn’t mean that younger folks should rely on thinking they might have had an infection,” Sadtler said. “Everybody should go out and get vaccinated.”

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The Delta variant is fueling school outbreaks in Israel, leading the country’s cases to tick up

israel kid vaccine
A boy receives the Pfizer COVID-19 vaccine in the Israeli city of Holon, near Tel Aviv, on June 21.

  • The Delta variant seems to be causing an uptick in Israel’s COVID-19 cases, particularly in schools.
  • Vaccinated Israelis may need to quarantine if they’ve been exposed to the variant, officials said.
  • Experts are more worried about kids spreading the variant than getting severely ill themselves.
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On Monday, Israel recorded its highest daily coronavirus tally in two months: 125 new cases, up from around 15 cases at the start of the month.

The Delta variant seems to be to blame: Emerging research suggests that Delta is more transmissible and possibly deadlier than any other coronavirus strain so far. So less than a month after Israel lifted its remaining coronavirus restrictions, the country announced that vaccinated people can be told to quarantine if they’ve been exposed to that variant.

Delta represents around 40% of Israel’s coronavirus cases over the last four weeks, according to the Global Initiative on Sharing Avian Influenza Data. Israel’s health ministry reported that 70% of the 125 new infections recorded on Monday were caused by the Delta variant. Roughly one-third of those new infections were among vaccinated individuals, the ministry said, and half were among children.

Indeed, many of these new cases have been traced to school outbreaks. But disease experts are more worried about kids spreading the variant than getting severely ill themselves.

That’s because severe COVID-19 cases are still extremely rare among children: In the US, kids account for just 1.4% to 3.3% of all COVID-19 hospitalizations and less than 0.23% of all COVID-19 deaths.

So even if you doubled children’s risk of being hospitalized from a Delta infection, it would still be “minuscule,” according to Eyal Leshem, an infectious-disease specialist at Sheba Medical Center, Israel’s largest hospital.

However, children can spread the virus to unvaccinated adults, or perhaps to people who might see a less robust immune response to vaccines – like the elderly or immunocompromised.

Israel is trying to preempt another outbreak

israel vaccine masks
People sit along the promenade in Jaffa, Israel on April 18.

Israel’s schools fully opened in May, masks are no longer required indoors or outdoors, and mass gatherings have been taking place across the country. But the country just started vaccinating kids ages 12 to 15 earlier this month, so only 2% to 4% of that age group has been immunized so far. In televised remarks on Tuesday, Prime Minister Naftali Bennett urged Israelis to “vaccinate your children.”

Israel’s new restrictions go beyond quarantines: Health minister Nitzan Horowitz told the Israeli Parliament on Wednesday that any residents who travel to a high-risk country – Argentina, Brazil, South Africa, India, Mexico, or Russia – could be fined “thousands of shekels.” (One-thousand shekels is around $308.) Masks will also be required at airports, border crossings, and medical facilities.

“What I guess they’re doing is trying to first provide more conservative or restrictive recommendations, see the [epidemiological] curve, see what impact this has, and then loosen the restrictions rather than be more liberal about restrictions and then face 10,000 cases a day,” Leshem said.

In one to two months, Leshem added, public-health experts could have a better idea of Delta’s effects.

“We’re all still observing Israel as a case study of what’s going to happen in a country where 90% of the population at risk is already vaccinated,” he said, referring to the number of adults who have gotten their shots.

“If we see Israel reaching several hundreds of cases a day, even thousands of cases, but we don’t see a substantial increase in the number of severe cases and hospitalizations, then the public-health angle would be to restrict normal life as little as possible,” he added.

Some infections among vaccinated people, experts say, can’t be avoided.

“Surely there will be cases of breakthrough infections among vaccinated people and further transmission,” Dr. Hagai Levine, an epidemiologist at the Hebrew University-Hadassah Medical Center School of Public Health, told Insider. “We need to find the right balance, as quarantine to vaccinated people is a burden.”

Delta’s triple threat

israel travel restrictions
Israelis and vaccinated tourists get tested for COVID-19 upon arrival to Israel’s Ben Gurion airport near Tel Aviv on May 23.

An analysis from Public Health England found that Delta is associated with a 60% increased risk of household coronavirus transmission compared to Alpha, the variant discovered in the UK. Alpha is already around 50% more transmissible than the original strain, according to the Centers for Disease Control and Prevention.

Researchers in Scotland also found that getting infected with Delta doubles the risk of hospital admission relative to Alpha. (Previous studies have suggested that Alpha may be 30% to 70% deadlier than the original strain.)

What’s more, emerging research suggests that a single vaccine dose doesn’t hold up as well against Delta as it does against other coronavirus strains: Recent Public Health England analyses found that two doses of Pfizer’s vaccine were 88% effective at preventing symptomatic COVID-19 from Delta, while a single shot was just 33% effective. That’s compared to 95% efficacy against the original strain, with 52% after one shot.

Young people increasingly represent the majority of new coronavirus cases not just in Israel, but around the world.

The Scotland researchers found that Delta cases were more prevalent among younger age groups. And a study still awaiting peer review found that coronavirus infections in the UK are five times more prevalent among children ages 5 to 12 and young adults between 18 and 24 than among those above 65. Most young people who recently got infected were unvaccinated, according to the study.

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Biden says the Delta variant – set to become the US’s dominant strain – is ‘particularly dangerous for young people’

biden face mask
Democratic presidential nominee Joe Biden holds up a face mask at The Queen theater on October 28, 2020 in Wilmington, Delaware.

President Joe Biden warned Friday that Delta, a coronavirus variant first discovered in India, poses an increased threat to unvaccinated Americans.

“It is a variant that is more easily transmissible, potentially deadlier, and particularly dangerous for young people,” Biden said at a White House news conference.

His remarks came just hours after Rochelle Walensky, director of the Centers for Disease Control and Prevention, told “Good Morning America” that Delta would likely become the dominant strain in the US in the coming months. (Some experts have even suggested that might even happen within weeks.)

Delta represents just 10% of US COVID-19 cases so far, but it already makes up around 90% of cases in the UK, according to a study from Imperial College London that’s still awaiting peer review. The researchers also found that COVID-19 cases in the UK are doubling every 11 days, most likely as a result of the fast-spreading variant.

Research from Public Health England suggests that Delta is associated with a 60% increased risk of household coronavirus transmission compared to Alpha – the variant discovered in the UK. Alpha is already around 50% more transmissible than the original coronavirus strain, according to the CDC.

Young people may be particularly susceptible to a Delta infection for two reasons: They’re more likely to be socially active and less likely to be vaccinated than older adults.

In the US, fewer adults under 50 have gotten vaccinated than adults ages 50 and older. The Imperial College London researchers also found that coronavirus infections in the UK are two-and-a-half times more prevalent among people ages 5 to 49 than among those ages 50 and older. Most young people who recently got infected were unvaccinated, according to the study.

Experts increasingly worry that young people will be less protected against severe disease caused by a Delta infection: Researchers in Scotland found that getting infected with Delta doubles the risk of hospital admission relative to Alpha.

Emerging research also suggests that a single vaccine dose doesn’t hold up as well against Delta compared to other coronavirus strains. Recent Public Health England analyses found that two doses of Pfizer’s vaccine were 88% effective at preventing symptomatic COVID-19 from Delta cases, while a single shot was just 33% effective by the same standard.

“Please, please if you have one shot, get the second shot as soon as you can,” Biden said on Friday.

So far, less than 45% of Americans are fully vaccinated, while 53% have received at least one dose. US vaccination rates have also fallen dramatically in the last two months, from a weekly average of nearly 3.4 million doses per day in mid-April to fewer than 780,000 doses per day on Thursday.

The more vaccination rates continue to drop, the more opportunities there are for Delta to spread – and therefore keep replicating and mutating.

“The worst-case scenario is if Delta mutates into something completely different, a completely different animal, and then our current vaccines are even less effective or ineffective,” Vivek Cherian, an internal medicine physician in Baltimore, recently told Insider.

Still, Biden said the US likely wouldn’t return to lockdowns because so many people have been vaccinated already.

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