Millions of people are missing their second COVID-19 doses, and that has experts worried about herd immunity

Vaccine distribution
  • The CDC said millions of people who got one dose of the COVID-19 vaccine are missing their second.
  • Some fear possible adverse reactions and others are simply unable to get the second dose.
  • Experts worry it will only be more difficult to achieve herd immunity if that 8% increases.
  • See more stories on Insider’s business page.

Over the weekend, data from the Centers for Disease Control and Prevention revealed millions of Americans who’ve had their first vaccine dose against the coronavirus are not receiving their second.

Some are choosing to forgo their second dose, either because they believe they’re sufficiently safe after receiving the first or because they fear possible adverse reactions from the second. Others, meanwhile, are unable to receive their second dose because of circumstances out of their control like limited vaccine supply.

In total, about 8% of people who received their first dose have so far missed their second, the CDC said.

Octavio Venegas told Insider his 89-year-old mother, Gladys, missed her second vaccine appointment because she was hospitalized after having a stroke and needing to treat an ulcer.

Venegas said his mother, an advanced Alzheimer’s patient, received her first Pfizer shot on March 1. She was scheduled to get her second one on March 22. A week after receiving her first dose, she ended up in the hospital with “a duodenal ulcer and she had to have two transfusions,” Venegas said.

Venegas said doctors did not specify whether his mother’s hospitalization was related to her vaccination dose. But her doctors were aware that she had received her first shot and had not suggested to Venegas that the Pfizer vaccine could have led to her hospitalization, he said. She had also been experiencing constipation issues for a while before her stay in the hospital, which suggests to Venegas it wasn’t the vaccine that caused the issues.

Venegas said he experienced difficulty scheduling a second-dose appointment.

His mother stayed in the hospital for three weeks from March 8 to March 26, missing her second vaccine appointment. After she was discharged, she went home to receive hospice care, where she remains “completely bedridden” and uses a urine catheter, Venegas said. Nurses from the hospice provider bathe and care for her.

In the last few weeks, Venegas said he has been trying to get his mother the second dose. He called the pharmacy where she received her first shot to ask about rescheduling her second. He said he also called various vaccination sites and clinics in Florida, where they live.

He asked pharmacies and clinics about the possibility of administering an at-home second dose, since his mother cannot leave her bed and can no longer use a wheelchair to get around.

All the sites he contacted either told him they cannot administer vaccines outside their own facilities or said they cannot schedule individual doses, Venegas said. Providers, therefore, must schedule two doses for individuals receiving an appointment, he said he was told.

The Florida Department of Health did not respond to Insider’s request for comment asking about the process to reschedule second-dose vaccine appointments.

Venegas said he has been stressed about the process, worrying about his elderly mother potentially contracting the virus.

“Most likely I will have to let it go, and just in my mind rely on the fact that only one of the two vaccines provide some level of protection,” he said, which is “better than nothing.”

“[The] hospice sends nurses and also people to bathe my mom in bed, and I wonder if some of these frequent and daily visitors might have had contact with people with COVID,” Venegas added.

Since vaccines began rolling out in December, health officials have recommended people get two doses of either the Pfizer and Moderna vaccine to most efficiently protect against the coronavirus.

Pfizer’s doses are 21 days apart, while Moderna’s are 28. Those timelines, however, are just guidelines. The CDC says people can get the two doses up to six weeks, or 42 days, apart.

“Up to 42 days, there should be no change in efficacy,” said Dr. Elena Cyrus, an infectious disease epidemiologist working at the University of Central Florida.

Moderna vaccine
A nurse prepares a coronavirus vaccine shot developed by the National Institutes of Health and Moderna Inc., July 2020.

Others are opting out of the second dose on purpose

Jo Henrion, 72, says she had a cardiac arrest shortly after receiving the first dose and isn’t sure whether it was brought on by the Moderna vaccine.

She received her first Moderna dose on March 18. Six days later, she had a cardiac arrest and ended up in the hospital for 12 days, she said. Since then doctors and specialists have been running tests and collecting blood from her.

Her second-dose appointment was April 15, but she skipped it fearing it spurred her cardiac arrest.

“I wouldn’t risk another cardiac arrest for hardly anything,” Henrion told Insider. She said she’d “have to really be convinced that it wasn’t the shot” that caused it.

Doctors have not told her the cardiac arrest was caused by the vaccine, but Henrion says they also haven’t ruled it out yet. Specialists, however, have recommended she avoid getting the second dose until they find out what caused the cardiac arrest, Henrion said.

A home nurse tending to Henrion told her to contact Moderna to report the “adverse reaction” and ask about the cardiac arrest. Henrion then got on the phone with a Moderna representative, who promised to “report it to her higher-ups and that they then will report it to the CDC,” she said.

Henrion doesn’t believe her cardiac arrest was brought on by any pre-existing health conditions.

“I’m a very active 72-year-old,” she told Insider. “So for me to be down is difficult. I don’t do well laying in the bed and being not productive.”

“I’ve been a realtor for 33 years,” she added. “I get a lot of exercise in my work and I’ve been renovating a house for the last 12 months and a garden.”

Moderna did not respond to Insider’s request for comment.

By choice or circumstance, epidemiology experts say vaccine hesitancy reduces the chance of reaching herd immunity

Cyrus of the University of Central Florida stressed the importance of receiving both doses of either vaccine to reach the highest immunity level possible.

“Any individual that is not fully vaccinated or those who have not received both doses for the two-dose regimen potentially do not have the full protection the vaccine offers, increasing their risk of transmission and potentially also contributing to community spread,” Cyrus told Insider.

One study found the first dose is quite effective on its own. Both the Pfizer and Moderna vaccines are likely to be 80% effective after just one dose.

The first dose of either vaccine “trains the immune system” to recognize the virus. The second dose “boosts antibody levels to afford even better protection,” Dr. Francis Collins, director of the National Institutes of Health, wrote in February.

But despite the relatively high efficacy rate of just a single COVID vaccine, herd immunity is still potentially threatened by the 8% of individuals who have so far not received a second dose.

“If the 8% increases over time, the chances of achieving herd immunity reduces and makes the population more vulnerable to existing strains of the virus and other emerging variants or mutations,” Cyrus said.

Achieving herd immunity is becoming more and more important as the US moves toward reopening, operating in pre-pandemic ways, and relaxing mask and social distancing guidelines.

Others believe 8% is a relatively small number of people. Ashish Jha, a physician at the Brown University School of Public Health, stressed in a Tuesday teleconference that 92% of vaccinated people have received both doses.

Jha said it’s fine if people miss their second doses because they can reschedule them.

“People miss appointments because life happens,” he said. “And the messaging that needs to go out right now to people is: ‘Don’t worry about it. Go get your second shot.'”

“People should keep their second appointment, but if you miss it, you can go back and get your second shot at any point,” Jha added. “Everybody absolutely needs to get their second shot.”

Individuals might miss their second dose appointment for varying reasons.

The appointment time, for example, might not work for them three or four weeks after the initial dose. A lot of people don’t even know what their schedule is going to be like four weeks from today.

“I don’t think it’s people hesitating or not wanting to get it. It’s hard to get this stuff, two shots in a row,” Jha said. “And so we’ve got to be patient, and we’ve got to give people more opportunities to come back and complete their second shot.”

Both Jha and Cyrus suggested the people likeliest to miss their second dose vaccines are vulnerable or marginalized groups. Individuals from these groups might have less control over their schedules and live in areas with more access barriers and socio-cultural issues.

That’s why there should be more opportunities for individuals to reschedule their missed doses, experts say. As the US gets closer to achieving herd immunity, there will be less demand for vaccines, Cyrus said.

“There will be less emergency sites and vaccine administration will move from federal sites to more primary care and access to care in the US is not equitable for all communities,” she added.

Structural sociocultural issues like racism and poverty mean navigating health systems can be difficult for people of color and other marginalized groups.

“This will require more synergy between clinicians, researchers, public health practitioners, and government entities,” Cyrus said.

Insider’s Hilary Brueck contributed to this report.

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The US and UK lead the world’s coronavirus vaccinations – but they may struggle to reach herd immunity if they reopen too soon

london drinks
People in England flock back to pubs and restaurants as lockdown restrictions were eased on April 12, 2021.

  • The US and UK are relaxing restrictions as their vaccinations continue to ramp up.
  • But scientists worry the countries are developing a false sense of security.
  • More contagious variants and vaccine skepticism could still pose a barrier to herd immunity.
  • See more stories on Insider’s business page.

Countries that have vaccinated more than a third of their populations are now taking huge leaps toward normal life.

The UK plans to remove all social distancing restrictions by June 21 now that nearly half its population has received shots. On April 30, the nation will experiment with its first nightclub opening in more than a year: A Liverpool warehouse is set to host 3,000 club-goers who test negative for the virus.

US vaccinations trail closely behind – around 40% of the country has received at least one vaccine dose so far. For the most part, businesses are already open in all 50 states, and 13 states have recently lifted their mask mandates.

To some extent, rolling back restrictions is a natural test of whether vaccines prevent coronavirus infections, hospitalizations, and deaths outside clinical trials. But scientists worry that countries with large vaccine rollouts could be lulled into a false sense of security.

“The worst is probably behind us, but I don’t want to suggest that let’s now sit back, relax, and enjoy life, and it’s all going to be fine,” David Dowdy, an epidemiologist at Johns Hopkins Bloomberg School of Public Health, told Insider. “We do still need to maintain some level of vigilance because if the virus has taught us one thing, it’s that it’s difficult to predict the future.”

Two factors, in particular, could hinder progress in the US and UK: the emergence of more contagious variants and vaccine skepticism.

The University of Washington’s Institute for Health Metrics and Evaluation predicts that the US could see an additional 60,000 deaths by August 1 – assuming variants continue to spread and vaccinated people start to behave normally, forgoing masks and social distancing. Under this “worst-case scenario,” daily coronavirus cases could also plateau over the next four months.

A March 30 model from Imperial College London similarly estimates that the UK could see an additional 15,700 deaths by June if the country proceeds with its reopening plan.

The US and UK probably haven’t reached herd immunity yet

vaccine healthcare workers us
A dentist receives the Moderna COVID-19 vaccine in Anaheim on January 8, 2020.

It’s not clear exactly what share of a nation’s population needs to be vaccinated to achieve herd immunity – the threshold beyond which the virus can’t pass easily from person to person – but experts generally estimate that it’s at least 70%.

Only one large country, Israel, is probably near that goal. Around 62% of Israel’s population has been vaccinated so far.

“It would be reasonable to say Israel right now has a very high level of population protection, probably not far from herd immunity,” Eyal Leshem, director at Sheba Medical Center, Israel’s largest hospital, told Insider.

Already, Israel’s cases have fallen 94% since it started vaccinating people in December – even as the country lifted lockdown restrictions. As of last Sunday, people in Israel don’t need to wear masks outdoors anymore and all primary school students can return to in-person learning.

“Despite mass gatherings, parties, meetings, there’s no increasing cases,” Leshem said.

But scientists warn that the US and UK likely haven’t crossed the herd immunity threshold yet.

While daily coronavirus cases are falling in the UK and have remained relatively flat in the US, experts worry that rolling back restrictions could reverse some of these gains.

“Part of the reason that we’re not seeing a spike is still that people are not just going back to the way things were before,” Dowdy said. “And if we remove that effect, we will start to see cases go back up right now.”

In the US, average daily cases are still comparable to those recorded last summer.

“We’re having between 60,000 and 70,000 new infections per day and it would really, I think, not be prudent at all to declare victory prematurely and pull back,” Dr. Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, told CBS’ “Face the Nation” on Sunday.

New variants may pose a continued threat

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

Many scientists caution against lifting mask or social distancing guidelines before nations understand the full threat of coronavirus variants.

In Chile, for instance, 40% of the population has been vaccinated, but average daily coronavirus cases there have more than doubled in the last two months. Scientists attribute this surge, in part, to the spread of P.1 – a variant first discovered in Brazil that seems to partially evade immunity from vaccines or previous infectious.

Studies show that vaccines from Pfizer, Moderna, and Johnson & Johnson protect people from B.1.1.7 – now the dominant strain in the US – but are less effective against P.1 and B.1.351 (a variant first identified in South Africa). AstraZeneca’s vaccine – which has been authorized in more than 130 countries, including the UK – seems to protect people from B.1.1.7 and P.1, but is less effective against B.1.351.

Scientists have also spotted variants in California that appear to be more transmissible than the virus’ original strain and could potentially resist antibodies from vaccines, according to a new study.

More contagious variants could make herd immunity a moving target, Rahul Subramanian, a data scientist at the University of Chicago, told Insider.

“Let’s say we reach herd immunity next year – it may need to be a constant battle,” he said. “You have to keep maintaining herd immunity in the population by continuously getting people vaccinated.”

Vaccine skepticism could allow coronavirus infections to lurk

anti-vaxx protest
A protest against masks, vaccines, and vaccine passports outside the CDC headquarters in Atlanta, Georgia on March 13, 2021.

The US is currently vaccinating around 3 million people per day, on average. Fauci has said the nation will need to keep up that pace to prevent another surge.

But maintaining the current rate of vaccinations is going to be a challenge, Dowdy added.

“The people who haven’t been vaccinated by now generally are, in many cases, people who don’t want to be vaccinated or have some concerns about being vaccinated,” he said.

A recent poll from Monmouth University found that 1 in 5 Americans still aren’t willing to get a coronavirus vaccine. That’s compared to three-quarters of people in the UK who say they’re “very likely” to get vaccinated, according to a February Oxford University survey.

If unvaccinated people don’t social distance or wear masks, the nations could ultimately struggle to prevent future outbreaks.

“You can vaccinate 50% of the population, but if it’s the wrong 50% – the 50% who are at the lowest risk of getting COVID to start with – then it doesn’t mean that you magically then cross a threshold,” Dowdy said. “The key is to get those numbers high enough so that even in the populations that are at highest risk of getting infection, you’re having enough vaccination to make a difference.”

For now, at least half the people in the US and UK still haven’t had their shots. And it could be several months, at the earliest, before coronavirus vaccines are authorized for children – which make up roughly 20% of the populations in the UK and US.

Until then, scientists said, it’s important to maintain mask and social distancing guidelines.

“Getting people vaccinated is a gradual process,” Dowdy said, “so we need to also make reopening a gradual process, too.”

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Drinks maker Bolthouse Farms is offering 1,800 hourly workers a $500 bonus to get a COVID-19 vaccine

coronavirus vaccine recipient
A coronavirus vaccination site in the US.

  • Bolthouse Farms is paying full-time hourly workers a $500 bonus to get the COVID-19 vaccine.
  • So far, 1,100 California employees out of 1,800 have signed up for the shot.
  • Before the $500 bonus, Bolthouse paid staff an extra $100 for being essential workers during the pandemic.
  • See more stories on Insider’s business page.

Jeff Dunn, CEO of Bolthouse Farms, is offering his full-time hourly employees $500 to get a COVID-19 vaccine, the Wall Street Journal first reported Sunday.

Bolthouse employees must submit a photo of their vaccination cards to the company after they’ve had their shot to receive the bonus, the Journal reported.

The California-based company, known for its smoothies and dressings, has poured tens of millions of dollars into COVID-19 safety measures, including testing, protective clothing, paid time off, and staff cover for anybody who is self-isolating, Dunn told the Journal.

Bolthouse also hosts vaccine events weekly at its main plant in Kern County to deliver shots on-site, Dunn said.

Dunn said his philosophy was to “go bigger now because it gives us the best chance at reaching herd immunity quickly.”

Before the $500 incentive for a COVID-19 shot, Bolthouse paid its full-time hourly workers an extra $100 every week for their role as essential workers during the pandemic. This stopped once the vaccine bonus was introduced, Dunn said.

Workers at Bolthouse are a priority group for getting shots because it is a food and agriculture company, and it has secured shots for all its California essential workers, Dunn said.

The company has about 1,800 hourly workers at its Kern County plant, and 1,100 have signed up for the vaccine, the Journal reported. So far, 475 employees have received at least one shot.

The company also employs about 300 office workers in the area.

Bolthouse hopes to reach “herd immunity”

The company estimates that between 1,300 and 1,400 workers at the plant need to be vaccinated to reach “herd immunity,” which is when immunity in a population, either through vaccination or infection, stops a virus spreading and gives protection to the group.

Company executives told the Journal that it was difficult to know when Bolthouse would reach herd immunity because vaccine supply – and vaccine hesitancy amongst employees – was always fluctuating.

Dunn said the company was expecting a certain level of reluctance, because about 80% of its workforce is Latino. Some polls have suggested that Latino people are more likely to be hesitant about getting vaccines, because of skepticism and mistrust of the US health system, triggered by historical injustices.

Bolthouse started teaching staff about COVID-19 in tents in its plant parking lot before it offered the vaccine on-site, Dunn said.

“You just gotta reach out and help people and understand their concerns,” he said. He hoped that there would be a chain reaction once employees start seeing colleagues get immunized safely at work, he added.

Dunn also told staff that some aspects of work would be easier if herd immunity is reached on the plant, the Journal reported.

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Several patients at a Virginia Kroger clinic received an empty shot instead of COVID-19 vaccine

Vaccine distribution

A Virginia Kroger gave several people “empty” shots that were supposed to contain vaccines for COVID-19, according to ABC 8News.

The healthcare professional who gave the shots to less than 10 people believed that the syringes had been previously filled by a colleague before the appointments started, a spokesperson for Kroger told 8News.

At first, the company told outlets 8News and CBS 6 that the syringes contained saline but later clarified that they were completely empty. That risks pumping air into people’s veins that can cause air embolisms and block blood flow.

Read more: The 4 things the US is doing wrong in the fight against COVID-19, and what we should be doing instead

“All impacted customers were contacted and have received their COVID-19 vaccine. We thank these customers for their understanding and have apologized for their inconvenience,” a spokesperson for Kroger told Insider.

The clinic is investigating the matter to prevent a similar situation from recurring in the future, and the Virginia Department of Health is aware of the incident, they said.

The retail chain aims to double its vaccine capacity to 1 million doses per week.

As of March 13, about 20% of the US population has received at least one dose of the vaccine for COVID-19, Bloomberg data show. More Americans have received vaccines than have tested positive for the virus, that report said. At the current rate, it will only take about 5 months until 75% of the US population, enough for “normalcy,” according to Dr. Anthony Fauci, is inoculated.

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The coronavirus recession is almost over, Wall Street strategists say

Wall Street Coronavirus
New York Stock Exchange.

  • Wall Street strategists are increasingly optimistic that the pandemic is in its final phase.
  • JPMorgan said in February the crisis will “effectively end” in 40 to 70 days.
  • The “recession is effectively over,” Morgan Stanley said Sunday.
  • Visit the Business section of Insider for more stories.

One year after the S&P 500 tumbled nearly 8% on COVID-19 fears, experts on Wall Street see the US bearing down on the finish line of the pandemic.

Declining case counts, vaccine rollouts, and expectations for new stimulus have lifted spirits in recent weeks. Economists have upgraded growth forecasts and investors continue to shift cash from defensive investments to riskier assets more likely to outperform during a rebound. Major banks’ strategists are taking it one step further.

The rapidly improving backdrop and “spectacular” profit growth in the fourth quarter signal “the recession is effectively over,” Michael Wilson, chief investment officer at Morgan Stanley, said Sunday.

“At the current pace of vaccinations and with spring weather right around the corner, several health experts are talking about herd immunity by April,” he said in a note. “It’s hard not to imagine an economy that’s on fire later this year.”

JPMorgan made a similarly bullish claim late last month, telling clients it doesn’t expect new COVID-19 strains to dent its positive outlook. The spread of new variants is still overshadowed by the broader decline in cases, the team led by Marko Kolanovic, chief global markets strategist at JPMorgan, said.

The rate of vaccination implies the pandemic will “effectively end” in the next 40 to 70 days, they added.

To be sure, there’s plenty of progress to make before the pandemic is no longer a public health threat. The US reported 98,513 new COVID-19 cases on Monday, lifting the seven-day moving average to 64,722, according to The New York Times.

And while the country is averaging 2.17 million vaccine administrations per day, reaching herd immunity at the current rate would still take roughly six months, according to Bloomberg data, which gauges how quickly the US can vaccinate 75% of its population.

Herd immunity is widely considered the most effective way to defeat COVID-19. Yet Wall Street’s more bullish forecasts suggest a mix of vaccinations and continued precautions could crush the virus in a matter of weeks.

Officials have warned that, while accelerated growth is on the horizon, there’s work to be done before the US stages a complete recovery. Reopening and new stimulus may fuel a sharp increase in inflation, but such a jump will likely be short-lived and fail to meet the Federal Reserve’s target, Fed chair Jerome Powell said Thursday.

The labor market also has “a lot of ground to cover” before reaching the central bank’s goal of maximum employment, Powell added. The chair indicated that, along with a lower unemployment rate, the Fed would need to see improved wage growth and labor-force participation before tightening ultra-easy monetary conditions.

Others are more optimistic. Treasury Secretary Janet Yellen said Monday that the $1.9 stimulus package nearing a final House vote can “fuel a very strong economic recovery.”

“I’m anticipating, if all goes well, that our economy will be back to full employment – where we were before the pandemic – next year,” Yellen said in an interview with MSNBC.

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US coronavirus cases have dropped 70% in the last six weeks. Experts chalk it up to more immunity and better behavior.

Arizona covid-19 testing coronavirus
Physician John Jones, tests administrative assistant Morgan Bassin for COVID-19 at One Medical in Scottsdale, Arizona, June 17, 2020.

  • Average daily coronavirus cases in the US have fallen roughly 70% in the last six weeks.
  • Experts attribute this to two main factors: a buildup of immunity and fewer social interactions after the holidays.
  • Other factors, including state lockdowns and increased mask wearing, could have also played a role.
  • Visit the Business section of Insider for more stories.

Many public-health experts got a surprise this month: US coronavirus cases have fallen roughly 70%, on average, in the last six weeks.

The US has recorded an average of around 68,000 daily cases over the last week. The last time the country saw weekly averages that low was in October. Yet with just 47 million Americans vaccinated so far, many experts assumed it would take longer for infections to plummet. 

So scientists have posited a few theories as to why cases fell: Among the most likely is that many people who are at high risk of exposure or illness have acquired some form of immunity, either through vaccination or natural infection. Cases were also bound to drop after the holidays, once people stopped traveling and congregating indoors as much.

“I think the major reason is that we were just on such a high before, with the surge from Thanksgiving and Christmas, that we’re finally dropping off from that,” Leana Wen, the former health commissioner of Baltimore, told Insider.

A few other factors may have contributed: California was responsible for nearly 14% of US cases from November through January, and the state’s lockdown helped slow transmission there. Increased mask compliance could also have some influence, and a decline in US testing could mean fewer cases are getting recorded. 

Still, experts say there was no magic change that brought cases down.

“I’m not sure that we have learned any lessons other than what we’ve known all along, which is when people congregate, the virus replicates and spreads and we have higher levels of infections,” Wen said.

She also cautioned that the US isn’t out of the woods.

Indeed, daily cases have risen in the last few days, from a recent low of 52,500 on Monday to around 75,500 on Thursday. (Some of that might be delayed test results from the recent winter storms.) Over time, pandemic fatigue and the spread of more contagious variants could still reverse the US’s positive trend.

“We’ll see a substantial decline in infection numbers by May,” Wen said, “but my worry would be: Will people become complacent and then will we see a substantial rebound come the fall?”

Social interactions declined after the holidays

Case counts typically reflect infections contracted about two weeks prior. That means the effects of transmission that occurred over Thanksgiving were likely recorded around the second week in December. Sure enough, average weekly cases in the US rose 25% from November 26 to December 10.

A similar pattern followed Christmas: Average weekly US cases rose 30% from December 25 to January 8. That’s when the nation recorded its highest daily case count ever: more than 312,000.

Then cases began to go down.

“If I were ranking explanations for the decline in COVID-19, behavior would be number one,” Ali Mokdad, a global-health professor at the University of Washington, told The Atlantic. “If you look at mobility data the week after Thanksgiving and Christmas, activity went down.”

News of high case numbers and overstressed hospitals may also have encouraged people to social distance, avoid crowds, or wear masks more.

“People adhere more to public-health mitigations when they see the cases going off the ceiling, so that’s what probably happened,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told Pod Save America’s Jon Favreau on Monday.

Fauci added that “we haven’t vaccinated enough people to have an impact on the kinetics of the outbreak.”

LOS ANGELES, CA - NOVEMBER 25: Holiday travelers pass through Los Angeles international Airport on Thanksgiving eve as the COVID-19 spike worsens and stay-at-home restrictions are increased on November 25, 2020 in West Hollywood, California. Starting today, travelers arriving to Los Angeles by airplane or train are required to sign a form acknowledging California's recommendation of a 14-day self-quarantine. Los Angeles mayor Eric Garcetti has warned that the virus is "threatening to spiral out of control" in the region, and that at the current rate of new COVID-19 cases and hospitalizations, there will not be enough hospital beds by Christmastime. Despite pleas from health officials to not gather with people outside of ones household, more than 2 million Americans are projected to fly for Thanksgiving. (Photo by David McNew/Getty Images)
Holiday travelers pass through Los Angeles International Airport on November 25, 2020.

Could immunity be more prevalent than scientists thought?

Most scientists don’t believe the US has reached herd immunity – the threshold beyond which the virus can no longer spread easily from person to person. But a few experts think we could be closer than previously realized.

Andrew Noymer, an associate professor of public health at the University of California, Irvine, recently told Insider that the US may be underestimating the prevalence of asymptomatic infections. Indeed, a recent model suggests that just 13% to 18% of COVID-19 cases are symptomatic. Given that asymptomatic people are less likely to seek a test, this could indicate that official case counts are missing a lot of infections.

What’s more, many people who have the highest chance of exposure – including essential workers and residents of homeless shelters and nursing homes – have likely been exposed already, gotten vaccinated, or both.

“It’s probably a combination of things – a combination of there being enough people who are already infected and people getting vaccinated, so there’s some level of protection,” Wen said.

New York waiter
A waiter wears a face mask at a restaurant in New York City on November 10, 2020.

A buildup of immunity – even if not to a herd-immunity threshold – could help slow transmission.

“It’s very likely that acquired immunity is playing a huge role in the falling cases in California and elsewhere,” Marm Kilpatrick, a professor of evolutionary biology at the University of California, Santa Cruz, told Insider.

But experts cautioned that this is still a fragile balance.

“While we might be seeing some effects of immunity now, it’s because a substantial fraction of the population is continuing to distance and isolate,” Dr. Kate Langwig, an infectious disease ecologist at Virginia Tech, told Insider.

She added: “If those people suddenly decided that because cases are going down, they felt more comfortable eating inside at a restaurant or socializing outside their pods, we could potentially erase the reductions that have been made over the past few weeks.”

California’s lockdown, and others, may have slowed transmission

At the peak of its outbreak, California accounted for around 40,000 of the US’s daily coronavirus cases, on average. But the state’s cases declined considerably in late January, after seven weeks of stay-at-home orders.

Similar restrictions across other states may have slowed transmission as well. New Mexico, for instance, implemented an 18-day stay-at-home order starting November 13.

In December, North Carolina also imposed a nighttime curfew that required residents to stay home from 10 p.m. to 5 a.m. The restriction lifted on Wednesday.

Los Angeles Coronavirus
A Covid-19 warning sign in Los Angeles, California.

We’ve gotten better at wearing masks

Langwig said consistent advice on mask wearing and more high-quality masks available could also be helping. 

The Centers for Disease Control and Prevention recently outlined several tips to make face coverings more protective, and even suggested that people double mask

Around 73% of US adults now say they wear a mask every time they leave the house, according to a recent poll from the Kaiser Family Foundation. That’s a considerable increase since May, when only 52% of US adults said they wore a mask every time.

We’re not testing as much

Average daily coronavirus tests have declined 27% in the last six weeks. That could indicate that the US isn’t confirming some new coronavirus cases – which might mean infections haven’t dropped as dramatically as it seems.

“I worry that it’s at least partly an artifact of resources being moved from testing to vaccination,” Eleanor Murray, a professor of epidemiology at Boston University School of Public Health, wrote earlier this month.

But the number of daily positive tests has declined since early January. At the peak of the outbreak, the percentage of coronavirus tests coming back positive was nearly 14%. Now that number is less than 5% – an acceptable level to start loosening restrictions, according to most scientists.

Plus, if cases were still high, experts would expect hospitalizations and deaths to remain high, too. In the last six weeks, however, average daily hospitalizations have fallen 57%, while average daily deaths have fallen 39%.

Andrew Dunn contributed reporting.

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The supply of COVID-19 vaccines in the US is about to get a big boost, according to drug makers

COVID 19 vaccine
Dado Ruvic/Reuters

  • Pfizer and Moderna have made manufacturing improvements to ramp up COVID-19 vaccine deliveries.
  • Combined, the two companies now plan to deliver 600 million doses to the US by the end of July.
  • Pharmaceutical executives spoke to a House subcommittee Tuesday on production and delivery goals. 
  • Visit the Business section of Insider for more stories.

Drug makers are ramping up deliveries of COVID-19 vaccines in the US, executives told the House Energy and Commerce oversight and investigations subcommittee in a Tuesday hearing.

Pfizer and Moderna fell short of expectations after their two-dose vaccines received emergency approval in mid-December, the Washington Post reported. But on Tuesday, executives from both companies touted their manufacturing improvements as putting them ahead of schedule in delivering millions of vaccines to the US. 

Pfizer Chief Business Officer John Young said the company, which has delivered 40 million doses total as of a week ago, has made “significant investments” in its US manufacturing. He expects to increase the number of weekly doses delivered to 13 million from 4 to 5 million by mid-March.

Moderna President Stephen Hoge said the company has shipped 54 million vaccines in total from its December approval to last week. Now, with its scaled up productions, the company is on track to double deliveries to more than 40 million doses per month by April.

Moderna now anticipates delivering the second 100 million doses by the end of May, and the third 100 million doses by the end of July, two months ahead of schedule.

The new timeline means Pfizer and Moderna could deliver 600 million doses to the US by the end of July, enough to vaccinate 300 million Americans with both shots. 

“We will fight every step of the way until this devastating pandemic is under control,” Young said.

The two drugmakers plan to deliver 220 million doses to the US combined by next month. An executive from Johnson & Johnson, whose single-dose vaccine may soon receive emergency approval, told committee members that it’s on track to deliver 20 million doses next month, putting total US vaccines at 240 million at the end of March.

The improved vaccination projections come after the US hit 500,000 deaths caused by COVID-19, the virus which took hold of the country almost a year ago. Since the vaccine rollout began more than two months ago, 44 million people, or 13% of the US population, have received one or more doses, and the country has yet to reach herd immunity

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A Johns Hopkins professor predicts the US will reach herd immunity by April, but many experts aren’t so optimistic

COVID Vaccine Line
People wait in line in a Disneyland parking lot to receive COVID-19 vaccines.

  • In an op-ed in the Wall Street Journal, Johns Hopkins professor Martin Makary wrote that COVID-19 would be “mostly gone” in the US by April.
  • The US’s drop in coronavirus cases suggests it’s close to reaching herd immunity, Makary said.
  • But many doctors and scientists say herd immunity is still a long way off in the US.
  • Visit the Business section of Insider for more stories.

The US’s daily coronavirus cases have declined 65% in the last month – a record drop in the course of the nation’s outbreak. New cases reached an all-time high of 312,000 on January 8. Since then, they’ve fallen to a weekly average of around 73,000 per day.

Dr. Martin Makary, a professor of surgery at the Johns Hopkins School of Medicine, suggested in The Wall Street Journal that the most likely explanation for the decline is that the US could be close to reaching herd immunity.

In a Thursday op-ed, Makary predicted that COVID-19 would be “mostly gone” by April.

He wrote that infections have likely been far more widespread than data suggests – so much so, in fact, that the US will soon hit a threshold beyond which the virus won’t be able to pass easily from person to person. 

“The consistent and rapid decline in daily cases since January 8 can be explained only by natural immunity,” Makary wrote. “Behavior didn’t suddenly improve over the holidays; Americans traveled more over Christmas than they had since March.”

He added that vaccines “don’t explain the steep decline” since early January, because “vaccination rates were low and they take weeks to kick in.” 

But many other doctors and public-health experts continue to caution that herd immunity is still a long way off in the US – particularly as more contagious variants spread.

“We’re nowhere near community immunity or population immunity or whatever people want to call it at this point,” Dr. Cindy Prins, an epidemiologist at University of Florida, told Insider. “We’re nowhere near that yet.”

Could 55% of Americans have natural immunity already?

mask coronavirus herd immunity

Researchers generally estimate the coronavirus’ reproductive value – that of the original strain, at least – to be between 2 and 3 in the absence of vaccines or public-health measures. That means that to achieve herd immunity, around 50% to 67% of a population would need to have some immunity to the virus – whether through vaccination or natural infection. 

“In theory, the numbers are around 70% – some say 65%, some say 75%, 80% – but it’s generally around those numbers. So it takes a while before you can get there,” Dr. Eyal Zimlichman, deputy director general at Sheba Medical Center, Israel’s largest hospital, told Insider in January. 

But Makary’s op-ed suggested that “observational data” indicates the US is close to the herd immunity threshold.

Assuming testing only captures 10% to 25% of infections, he said, about 55% of Americans would have natural immunity already, based on the number of tests reported. Add to that 15% of Americans who have been vaccinated so far, he wrote, “and the figure is rising fast.”

Makary didn’t respond to Insider’s request for comment on this story.

Other factors could explain the drop in US cases

mask shield airport
A couple wearing face shields and masks at Newark International Airport on November 25, 2020.

Experts say herd immunity isn’t the only possible explanation for the US’s falling case count. 

California’s second lockdown, which started in December, may have partially contributed to the decline. At the peak of its outbreak, California accounted for around 40,000 of the US’s daily coronavirus cases, on average.

Other factors like mask wearing, social distancing, and decreased travel after the holidays likely played a role as well.

“If I were ranking explanations for the decline in COVID-19, behavior would be number one,” Ali Mokdad, a global-health professor at the University of Washington, told The Atlantic. “If you look at mobility data the week after Thanksgiving and Christmas, activity went down.”

Thompson has also pointed out that certain communities may have greater shares of immunity than others. 

“Immunity is probably concentrated among people who had little opportunity to avoid the disease, such as homeless people, frontline and essential workers, and people living in crowded multigenerational homes,” he wrote. “It might also include people who were more likely to encounter the virus because of their lifestyle and values, such as risk-tolerant Americans who have been going to eat at indoor restaurants.”

Even if the US is nowhere near herd immunity, then, it’s possible that high levels of immunity among those with frequent social interactions could help slow transmission.

But there’s no concrete data yet to suggest that the majority of Americans are immune to the coronavirus.

The Centers for Disease Control and Prevention estimates that one-quarter of the US population has been infected with the coronavirus so far. Even in New York City, where the virus spread widely in the beginning of 2020, studies found that 22% of the city’s population had been infected by April. A more recent study found that by mid-November, around 14% of the US population had coronavirus antibodies.

“Even after adjusting for underreporting, a substantial gap remains between the estimated proportion of the population infected and the proportion infected required to reach herd immunity,” the authors wrote.

Variants make herd immunity a moving target

covid abbott rapid test swab
A medical worker conducts a rapid COVID-19 test in Brooklyn, New York, on August 27, 2020.

Zimlichman said the very idea that a nation can reach herd immunity with the coronavirus has “never been put to the test.” That’s because the required threshold is often a moving target – and it can rise as new, more contagious variants spread.

Studies have shown that the more contagious coronavirus variant discovered in the UK, called B.1.1.7, may increase the virus’ reproductive value by 0.4 to 0.9. In that case, up to 75% of the US population would likely need to develop some form of immunity.

“When you have a new variant of COVID, if the reproductive number is higher, that means that the virus is going to be able to spread even if fewer people are susceptible,” Rahul Subramanian, a data scientist at the University of Chicago, recently told Insider.

With that in mind, he said, “I would hesitate to say that we’ve reached herd immunity.”

Reaching herd immunity could be even more difficult if vaccines prove less effective against new variants or if people refuse to get shots.

Some research suggests that vaccines may not work as well against the more infectious variant discovered in South Africa. And 13% of adults in the US say they won’t get a coronavirus shot, according to a recent survey from the Kaiser Family Foundation. 

“Obviously you’ll have issues with people that refuse to get vaccinated for whatever reason,” Zimlichman said, “so getting herd immunity by vaccination is a hard one to achieve.”

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Biden describes closed schools and women leaving the workforce as ‘a national emergency’

Joe biden
President Joe Biden speaks before signing executive orders on his first day in White House on January 21, 2021.

  • President Biden described school closures and women leaving the workforce as “a national emergency.”
  • “I think it’s time for schools to reopen safely,” he said during a CBS interview.
  • Biden voiced concern about the mental health crisis that has been accelerated by the pandemic.
  • Visit the Business section of Insider for more stories.

President Joe Biden said in an interview that aired on Sunday that long-term school closures and women leaving the workforce during the coronavirus pandemic are “a national emergency.”

While speaking with “CBS Evening News” anchor Norah O’Donnell at the White House, Biden also voiced concern about the mental health crisis that has been accelerated by the COVID-19 pandemic.

O’Donnell noted that roughly 20 million schoolchildren have been out of the classroom since for almost a year, and a recent CBS News report showed that nearly 3 million women have dropped out of the labor force since last year.

“It is a national emergency,” Biden said of all three issues. “It genuinely is a national emergency.”

When asked if schools should reopen, Biden stressed that they should reopen cautiously.

“I think it’s time for schools to reopen safely,” he said. “Safely. You have to have fewer people in the classroom. You have to have ventilation systems that have been reworked.”

“Our CDC commissioner [Rochelle Walensky] is going to be coming out with science-based judgment, within I think as early as Wednesday as to lay out what the minimum requirements are,” the president added.

Read more: Inside the 7-minute virtual workouts the Biden transition team used to stay connected as staffers prepared to demolish Trump’s policies

Last month, Biden signed an executive order for the Departments of Education and Health and Human Services to devise guidelines to reopen schools safely within his first 100 days in office.

Biden said that he and his staff have had to get a handle on the work left by former President Donald Trump’s administration when it came to the rollout of vaccines.

Dr. Anthony Fauci, the top US infectious-disease expert, said, in order to reach herd immunity, about 75% of Americans will need to be vaccinated.

O’Donnell said CBS News calculated that it would take until the end of 2021 to reach that level at the current vaccination rate of 1.3 million doses a day.

“We can’t wait that long,” Biden said. “One of the disappointments was when we came into office is the circumstance relating to how the administration was handling COVID was even more dire than we thought. We thought that indicated there was a lot more vaccine available, and that didn’t turn out to be the case. That’s why we’ve ramped up everywhere we can.”

He added: “But the idea that this can be done and we can get to herd immunity much before the end of this summer is very difficult.”

Since the pandemic began in the US, nearly 27 million people have been infected and over 463,000 people have died, according to the latest data compiled by Johns Hopkins University.

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