CDC panel recommends Pfizer, Moderna COVID shots over J&J’s
Most Americans should be given the Pfizer or Moderna vaccines instead of the Johnson & Johnson shot that can cause rare but serious blood clots, U.S. health advisers recommended Thursday. The strange clotting problem has caused nine confirmed deaths after J&J vaccinations — while the Pfizer and Moderna vaccines don’t come with that risk and also appear more effective, advisers to the Centers for Disease Control and Prevention said. It’s an unusual move, and the CDC’s director, Dr. Rochelle Walensky, must decide whether to accept the panel’s advice. Until now, the U.S. has treated all three COVID-19 vaccines available to Americans as an equal choice since large studies found they all offered strong protection and early supplies were limited. J&J’s vaccine initially was welcomed as a single-dose option that could be especially important for hard-to-reach groups like homeless people who might not get the needed second dose of the Pfizer or Moderna options. But the CDC’s advisers said Thursday that it was time to recognize a lot has changed since vaccines began rolling out a year ago. More than 200 million Americans are considered fully vaccinated, including about 16 million who got the J&J shot. New data from unprecedented safety tracking of all those vaccinations persuaded the panel that while the blood clots linked to J&J’s vaccine remain very rare, they’re still occurring and not just in younger women as originally thought. In a unanimous vote, the advisers decided the safer Pfizer and Moderna vaccines are preferred. But they said the shot made by J&J’s Janssen division still should be available if someone really wants it — or has a severe allergy to the other options. “I would not recommend the Janssen vaccine to my family members,” but some patients may — and should be able to — choose that shot, said CDC adviser Dr. Beth Bell of the University of Washington. The clotting problems first came up last spring, with the J&J shot in the U.S. and with a similar vaccine made by AstraZeneca that is used in other countries. Eventually, U.S. regulators decided the benefits of J&J’s one-and-done vaccine outweighed what was considered a very rare risk — as long as recipients were warned. European regulators likewise continued to recommend AstraZeneca’s two-dose vaccine although, because early reports were mostly in younger women, some countries issued age restrictions. COVID-19 causes deadly blood clots, too. But the vaccine-linked kind is different, believed to form because of a rogue immune reaction to the J&J and AstraZeneca vaccines because of how they’re made. It forms in unusual places, such as veins that drain blood from the brain, and in patients who also develop abnormally low levels of the platelets that form clots. Symptoms of the unusual clots, dubbed “thrombosis with thrombocytopenia syndrome,” include severe headaches a week or two after the J&J vaccination — not right away — as well as abdominal pain and nausea. While it’s still very rare, the Food and Drug Administration told health care providers this week that more cases have occurred after J&J vaccinations since the spring. They occur most in women ages 30 to 49 — about once for every 100,000 doses administered, the FDA said. Overall, the government has confirmed 54 clot cases— 37 in women and 17 in men, and nine deaths that included two men, the CDC’s Dr. Isaac See said Thursday. He said two additional deaths are suspected. The CDC decides how vaccines should be used in the U.S., and its advisers called the continuing deaths troubling. In comparing the pros and cons of all the vaccines, the panelists agreed that side effects from the Pfizer and Moderna vaccines weren’t as serious — and that supplies now are plentiful. Nor is J&J still considered a one-and-done vaccine, several advisers noted. The single-dose option didn’t prove quite as protective as two doses of the Pfizer and Moderna vaccines. Plus, with extra-contagious virus mutants now spreading, booster doses now are recommended. Several countries, including Canada, already have policies that give preference to the Pfizer and Moderna vaccines. But J&J told the committee its vaccine still offers strong protection and is a critical option, especially in parts of the world without plentiful vaccine supplies or for people who don’t want a two-dose shot. While blood clots are rare, “unfortunately cases of COVID-19 are not,” J&J’s Dr. Penny Heaton said. The U.S. is fortunate in its vaccine availability, and Thursday’s action shouldn’t discourage use of J&J’s vaccine in places around the world where it’s needed, said CDC adviser Dr. Matthew Daley of Kaiser Permanente Colorado. The FDA also warned this week that another dose of the J&J vaccine shouldn’t be given to anyone who developed a clot following either a J&J or AstraZeneca shot. The committee also heard some of the first data on reported side effects of Pfizer vaccinations in younger children. Early last month, the CDC recommended a two-dose series for that age group, and more than 7 million doses have been given so far. But few problems have been reported. Of the 80 reported cases of serious side effects, about 10 involved a form of inflammation that has been seen in male teens and young adults. Republished with the permission of the Associated Press.
World Health Organization warns new virus variant poses ‘very high’ risk
The World Health Organization warned Monday that the global risk from the omicron variant is “very high” based on the early evidence, saying the mutated coronavirus could lead to surges with “severe consequences.” The assessment from the U.N. health agency, contained in a technical paper issued to member states, amounted to WHO’s strongest, most explicit warning yet about the new version that was first identified days ago by researchers in South Africa. It came as a widening circle of countries around the world reported cases of the variant and moved to slam their doors in an act-now-ask-questions-later approach while scientists race to figure out just how dangerous the mutant version might be. Japan announced it is barring entry to all foreign visitors, joining Israel in doing so. Morocco banned all incoming flights. Other countries, including the U.S. and members of the European Union, have moved to prohibit travelers arriving from southern Africa. WHO said there are “considerable uncertainties” about the omicron variant. But it said preliminary evidence raises the possibility that the variant has mutations that could help it both evade an immune-system response and boost its ability to spread from one person to another. “Depending on these characteristics, there could be future surges of COVID-19, which could have severe consequences, depending on a number of factors, including where surges may take place,” it added. “The overall global risk … is assessed as very high.” The WHO stressed that while scientists are hunting evidence to better understand this variant, countries should accelerate vaccinations as quickly as possible. While no deaths linked to omicron have been reported so far, little is known for certain about the variant, including whether it is more contagious, more likely to cause serious illness, or more able to evade vaccines. Last week, a WHO advisory panel said it might be more likely to re-infect people who have already had a bout with COVID-19. Scientists have long warned that the virus will keep finding new ways to exploit weaknesses in the world’s vaccination drive, and its discovery in Africa occurred in a continent where under 7% of the population is vaccinated. “The emergence of the omicron variant has fulfilled, in a precise way, the predictions of the scientists who warned that the elevated transmission of the virus in areas with limited access to vaccine would speed its evolution,” said Dr. Richard Hatchett, head of CEPI, one of the founders of the U.N.-backed global vaccine sharing initiative COVAX. Spain on Monday became one of the latest countries to report its first confirmed omicron case, detected in a traveler who returned Sunday from South Africa after making a stopover in Amsterdam. While the majority of omicron infections recorded around the world have been in travelers arriving from abroad, cases in Portugal and Scotland have raised fears that the variant may already be spreading locally. “Many of us might think we are done with COVID-19. It’s not done with us,” warned Tedros Adhanom Ghebreyesus, WHO’s director-general. Days after the variant sent a shudder through the financial world nearly two years into the pandemic that has killed over 5 million people, and markets had a mixed reaction Monday. European stocks rebounded, and Wall Street steadied itself, while Asian markets fell further. U.S. President Joe Biden called the omicron variant a cause for concern but “not a cause for panic.” He said he is not considering any widespread U.S. lockdown and instead urged mask-wearing and vaccinations, even as a federal judge blocked his administration from enforcing a requirement that thousands of health care workers in 10 states get the shot. Dr. Rochelle Walensky, director of the U.S. Centers for Disease Control and Prevention, reacted to the potential threat by urging everyone 18 and older to get booster shots because “strong immunity will likely prevent serious illness.” Earlier this month, the U.S. opened boosters to all adults but recommended them only for those 50 and older or people in long-term care. The omicron infections have underscored the difficulty in keeping the virus in check in a globalized world of jet travel and open borders. Yet many countries are trying to do just that, against the urging of the WHO, which noted that border closings often have limited effect and can wreak havoc on lives and livelihoods. Some have argued that such restrictions can buy valuable time to analyze the new variant. While the initial global response to COVID-19 was criticized as slow and haphazard, the reaction to the omicron variant came quickly. “This time, the world showed it is learning,” said EU Commission President Ursula von der Leyen, singling out South African President Cyril Ramaphosa for praise. “South Africa’s analytic work and transparency and sharing its results was indispensable in allowing a swift global response.” Late last week, von der Leyen successfully pushed the 27-nation EU to agree to ban flights from seven southern African nations, similar to what many other countries are doing. Cases have been reported in such places as Canada, Germany, Britain, Belgium, Denmark, the Netherlands, and Portugal, where authorities identified 13 omicron infections among members of the Belenenses professional soccer team. Taking no chances, Japan, which has yet to detect any omicron cases, reimposed border controls that it had eased earlier this month. “We are taking the step as an emergency precaution to prevent a worst-case scenario in Japan,” Prime Minister Fumio Kishida said. Israel likewise decided to bar entry to foreigners, and Morocco said it would suspend all incoming flights for two weeks. Britain reacted by expanding its COVID-19 booster program to everyone 18 and older, making millions more people eligible. Up until now, booster shots were available only to those 40 and over and people particularly vulnerable to the virus. The U.K. has reported about a dozen omicron cases. Despite the global worry, doctors in South Africa are reporting patients are suffering mostly mild symptoms so far. But they warn that it is early. Also, most of the new cases are in people in their 20s and 30s,
Vaccines making Thanksgiving easier, but hot spots remain
The U.S. is facing its second Thanksgiving of the pandemic in better shape than the first time around, thanks to the vaccine, though some regions are seeing surges of COVID-19 cases that could get worse as families travel the country for gatherings that were impossible a year ago. Nearly 200 million Americans are fully vaccinated. That leaves tens of millions who have yet to get a shot in the arm, some of them out of defiance. Hospitals in the cold Upper Midwest, especially Michigan and Minnesota, are filled with COVID-19 patients who are mostly unvaccinated. Michigan hospitals reported about 3,800 coronavirus patients at the start of the week, with 20% in intensive care units, numbers that approach the bleakest days of the pandemic’s 2020 start. The state had a seven-day new-case rate of 616 per 100,000 people Monday, the highest in the nation. In the West, New Mexico, Arizona, Colorado, Utah and Montana also ranked high. Some Colorado communities, including Denver, are turning to indoor mask orders to reduce risk, a policy that has also been adopted in the Buffalo, New York, area and Santa Cruz County, California. The statistics in Michigan are “horrible,” said Dr. Matthew Trunsky, a respiratory specialist at Beaumont Health in suburban Detroit. “We got cold and moved indoors and have huge pockets of unvaccinated people,” he said. “You can’t have pockets of unvaccinated people who don’t want to be masked and not expect to get outbreaks, not expect to lose parents, not expect to lose teachers.” During a recent office visit, he encouraged a patient who uses oxygen to get vaccinated. The patient declined and now is in the hospital with COVID-19, desperately relying on even more oxygen, Trunsky said. He said he continues to encounter patients and their family members espousing conspiracy theories about the vaccine. “We’ve had several people in their 40s die in the last month — 100% unvaccinated,” Trunsky said. “It’s just so incredibly sad to see a woman die with teenagers. Especially with that age group, it’s nearly 100% preventable.” In Detroit, where less than 40% of eligible residents were fully vaccinated, Mayor Mike Duggan said hospitalizations have doubled since early November. “We have far too many people in this country that we have lost because they believed some nonsense on the internet and decided not to get the vaccine,” said Duggan, a former hospital executive. Despite hot spots, the outlook in the U.S. overall is significantly better than it was at Thanksgiving 2020. Without the vaccine, which became available in mid-December 2020, the U.S. a year ago was averaging 169,000 cases and 1,645 deaths per day, and about 81,000 people were in the hospital with COVID-19. The U.S. now is averaging 95,000 cases, 1,115 deaths, and 40,000 in the hospital. Airports have been jammed. More than 2.2 million people passed through security checkpoints on Friday, the busiest day since the pandemic shut down travel early in 2020. On some recent days, the number was twice as high as Thanksgiving a year ago. Sarene Brown and three children, all vaccinated, were flying to Atlanta from Newark, New Jersey, to see family. People close to them have died from COVID-19. “I’m thankful that I’m here, and I’m not in heaven, and I’m thankful for my family and that God helped me survive,” said Neive Brown, 7, who got her first dose. More than 500,000 Americans have died of COVID-19 since last Thanksgiving, for an overall death toll of over 770,000. “We would encourage people who gather to do so safely after they’ve been fully vaccinated, as we’ve been saying for months now,” said Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention. “I do think that this is very different because we actually have the tools to prevent the vast majority of cases.” Dr. Eric Topol, head of the Scripps Research Translational Institute, said his optimism is tempered by the delta variant’s ability to jump from person to person, especially among the millions who are unvaccinated or are due for a booster. “That equals very high vulnerability,” Topol said. Denver’s public hospital, Denver Health, is sending people elsewhere because of a lack of beds. Staff members were exhausted from treating COVID-19 patients and others who had postponed other medical needs, chief executive Robin Wittenstein said. “Our system is on the brink of collapse,” she said. Arizona reported at least 2,551 COVID-19 patients in hospitals, far below the peak of last winter but still reason for concern. Officials said beds were limited. Republished with the permission of the Associated Press.
Next on FDA’s agenda: Booster shots of Moderna, J&J vaccines
With many Americans who got Pfizer vaccinations already rolling up their sleeves for a booster shot, millions of others who received the Moderna or Johnson & Johnson vaccine wait anxiously to learn when it’s their turn. Federal regulators began tackling that question this week. On Thursday and Friday, the Food and Drug Administration convenes its independent advisers for the first stage in the process of deciding whether extra doses of the two vaccines should be dispensed and, if so, who should get them and when. The final go-ahead is not expected for at least another week. After the FDA advisers give their recommendation, the agency itself will make a decision on whether to authorize boosters. Then next week, a panel convened by the Centers for Disease Control and Prevention will offer more specifics on who should get them. Its decision is subject to approval by the CDC director. The process is meant to bolster public confidence in the vaccines. But it has already led to conflicts among experts and agencies — and documents the FDA released Tuesday suggest this week’s decisions will be equally difficult. In one earlier vaccine dispute, the CDC’s advisory panel last month backed Pfizer boosters at the six-month point for older Americans, nursing home residents, and people with underlying health problems. But CDC Director Dr. Rochelle Walensky overruled her advisers and decided boosters should also be offered to those with high-risk jobs such as teachers and health care workers, adding tens of millions more Americans to the list. Some health experts fear the back-and-forth deliberations are muddling the public effort to persuade the unvaccinated to get their first shots. They worry that the talk of boosters will lead people to wrongly doubt the effectiveness of the vaccines in the first place. When the FDA’s panel meets to review the Moderna and J&J vaccines, experts will discuss whether a third Moderna shot should contain just half the original dose and what’s the best timing for a second shot of the single-dose J&J vaccine. The panel will also look into the safety and effectiveness of mixing and matching different brands of vaccine, something regulators have not endorsed so far. An estimated 103 million Americans are fully vaccinated with Pfizer’s formula, 69 million with Moderna’s, and 15 million with J&J’s, according to the CDC. Regulators took up the question of Pfizer boosters first because the company submitted its data ahead of the other vaccine makers. Tim Anderson, a U.S. history teacher at a high school outside Louisville, Kentucky, already had his two Moderna shots months before he came down with COVID-19 in August. While his symptoms hit him “like a sledgehammer,” he is convinced that the inoculation saved him and his girlfriend from the more severe effects of the disease. The two are now awaiting clearance of a Moderna booster shot. “Until we can build up enough immunity within our own self and, you know, as a group of humans, I’m willing to do what I need to do,” Anderson, 58, said. The FDA meetings come as U.S. vaccinations have climbed back above 1 million per day on average, an increase of more than 50% over the past two weeks. The rise has been driven mainly by Pfizer boosters and employer vaccine mandates. While the FDA and CDC so far have endorsed Pfizer boosters for specific groups only, Biden administration officials, including Dr. Anthony Fauci, have suggested that extra shots will eventually be recommended for most Americans. In a new review of Moderna’s data, the FDA did not indicate Tuesday if it was leaning toward clearing the company’s booster. It said vaccines used in the U.S. still provide protection, and it raised questions about some of Moderna’s data. The two initial Moderna shots contain 100 micrograms of vaccine each. But the drugmaker says 50 micrograms ought to be enough for a booster for healthy people. A company study of 344 people gave them a 50-microgram shot six months after their second dose, and levels of virus-fighting antibodies jumped. Moderna said the booster even triggered a 42-fold rise in antibodies able to target the extra-contagious delta variant. Side effects were similar to the fevers and aches that Moderna recipients commonly experience after their second regular shot, the company said. As for people who got the J&J vaccine, the company submitted data to the FDA for different options: a booster shot at two months or at six months. The company said in its FDA submission that a six-month booster is recommended but that a second dose could be given at two months in some situations. J&J released data in September showing that a booster given at two months provided 94% protection against moderate-to-severe COVID-19 infection. The company has not disclosed patient data on a six-month booster, but early measures of virus-fighting antibodies suggest it provides even higher protection. Even without a booster, J&J says, its vaccine remains about 80% effective at preventing COVID-19 hospitalizations in the U.S. Scientists emphasize that all three vaccines used in the U.S. still offer strong protection against severe disease and death from COVID-19. The issue is how quickly and how much protection against milder infection may wane. In one recent study, researchers compared about 14,000 people who had gotten their first Moderna dose a year ago with 11,000 vaccinated eight months ago. As the delta variant surged in July and August, the more recently vaccinated group had a 36% lower rate of “breakthrough” infections compared with those vaccinated longer ago. Republished with the permission of the Associated Press.
U.S. health experts urge flu shots to avoid ‘twindemic’
The U.S. is gearing up for a possible bad flu season on top of the continuing COVID-19 crisis, with a plea Thursday for Americans to get vaccinated against both. “I get it: We are all tired of talking about vaccines,” said Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention. But “it is doubly important this year” to get your flu shot, added Walensky, who got her own vaccination earlier this week just as she has every year since she was a medical student in 1995. “We are preparing for the return of the flu.” Flu cases dropped to historically low levels globally over the pandemic, as restrictions designed to slow the spread of the coronavirus helped block other respiratory viruses. But with schools and businesses reopened, international travel resuming, and far less masking, there’s no way to predict how bad a flu season the U.S. might expect this winter. But officials are worried because a different respiratory virus named RSV, which usually attacks young children in the winter, instead roared back last summer as soon as people started dropping their masks. “Is that a harbinger of a worse influenza season? We don’t know, but we certainly don’t want a ‘twindemic,’ both COVID and influenza,” said Dr. William Schaffner of the National Foundation for Infectious Diseases. And if you still need a COVID-19 vaccination — either first shots or a booster dose — you can get it at the same visit as a flu shot. The CDC recommends a yearly flu vaccination for just about everyone starting with 6-month-old babies. Influenza is especially dangerous for older adults, children under age 5, people with chronic health problems such as diabetes, asthma, or heart disease, and during pregnancy. Last fall, about as many Americans overall got their flu vaccination as they did before the pandemic — about half of the eligible population, according to CDC data released Thursday. But Walensky was dismayed by a slight drop in child flu vaccinations last year — and at widening racial and ethnic disparities. Last year, 43% of Black Americans and 45% of Hispanics got a flu vaccination compared to 56% of whites. The CDC expects vaccine makers to deliver 188 million to 200 million doses of flu vaccine. Most Americans with insurance can get one without a co-pay. Options include regular shots, shots that aim to give older adults a little extra protection, and a nasal spray. All offer protection against four different flu strains that global experts predict are the kinds most likely to spread this year. At the same time they get vaccinated against flu, officials also urged older adults and people with chronic illnesses to ask about getting a vaccine against a type of pneumonia that is a frequent complication. Republished with the permission of the Associated Press.
FDA experts among group opposing U.S. booster shot plan
The average person doesn’t need a COVID-19 booster yet, an international group of scientists — including two top U.S. regulators — wrote Monday in a scientific journal. The experts reviewed studies of the vaccines’ performance and concluded the shots are working well despite the extra-contagious delta variant, especially against severe disease. “Even in populations with fairly high vaccination rates, the unvaccinated are still the major drivers of transmission,” at this stage of the pandemic, they concluded. The opinion piece, published in The Lancet, illustrates the intense scientific debate about who needs booster doses and when a decision the U.S. and other countries are grappling with. After revelations of political meddling in the Trump administration’s coronavirus response, President Joe Biden has promised to “follow the science.” But the review raises the question of whether his administration is moving faster than the experts. The authors include two leading vaccine reviewers at the Food and Drug Administration, Drs. Phil Krause and Marion Gruber who recently announced they will be stepping down this fall. Among the other 16 authors are leading vaccine researchers in the U.S., Britain, France, South Africa, and India, plus scientists with the World Health Organization, which already has urged a moratorium on boosters until poor countries are better vaccinated. In the U.S., the White House has begun planning for boosters later this month, if both the FDA and Centers for Disease Control and Prevention agree. Advisers to the FDA will weigh evidence about an extra Pfizer shot Friday at a key public meeting. Georgetown University’s Larry Gostin said the paper “throws gasoline on the fire” in the debate about whether most Americans truly need boosters and whether the White House got ahead of scientists. “It’s always a fundamental error of process to make a scientific announcement before the public health agencies have acted, and that’s exactly what happened here,” said Gostin, a lawyer, and public health specialist. The FDA did not respond to requests for comment Monday morning. The U.S. already offers an extra dose of the Pfizer or Moderna vaccines to people with severely weakened immune systems. For the general population, the debate is boiling down to whether boosters should be given even though the vaccines are still offering high protection against severe disease — possibly in hopes of blocking milder “breakthrough” infections among the fully vaccinated. Last week, CDC Director Dr. Rochelle Walensky said new data showed that as delta surged, the unvaccinated were 4.5 times more likely than the fully vaccinated to get infected, over 10 times more likely to be hospitalized, and 11 times more likely to die. Still, government scientists are also weighing hints that protection is waning among older adults who were vaccinated early last winter. The writers of Monday’s commentary reported reviewing worldwide studies since delta began surging, mostly of U.S. and European vaccines. The team concluded, “none of these studies has provided credible evidence of substantially declining protection against severe disease.” Because the body builds layers of immunity, gradual drops in antibody levels don’t necessarily mean overall effectiveness is dropping “and reductions in vaccine efficacy against mild disease do not necessarily predict reductions in the (typically higher) efficacy against severe disease,” they wrote. The more the virus spreads, the more opportunity it has to evolve into strains that could escape current vaccines. The Lancet reviewers suggest there could be bigger gains from creating booster doses that better match circulating variants, much like the flu vaccine is regularly updated, than from just giving extra doses of the original vaccine. “There is an opportunity now to study variant-based boosters before there is widespread need for them,” the scientists wrote. Republished with the permission of the Associated Press.
U.S. health officials call for booster shots against COVID-19
U.S. health officials Wednesday announced plans to dispense COVID-19 booster shots to all Americans to shore up their protection amid the surging delta variant and signs that the vaccines’ effectiveness is slipping. The plan, as outlined by the chief of the Centers for Disease Control and Prevention and other top health authorities, calls for an extra dose eight months after people get their second shot of the Pfizer or Moderna vaccine. The doses could begin the week of Sept. 20. “Our plan is to protect the American people, to stay ahead of this virus,” CDC Director Dr. Rochelle Walensky said as the agency cited a raft of studies suggesting that the vaccines are losing ground while the highly contagious variant spreads. People who received the single-dose Johnson & Johnson vaccine will also probably need extra shots, health officials said. But they said they are waiting for more data. Officials said that before any booster program starts up, the Food and Drug Administration and a CDC advisory panel would need to evaluate the safety and effectiveness of an extra dose. “We have a responsibility to give the maximum amount of protection,” President Joe Biden said at the White House. He added that extra doses are also “the best way to protect ourselves from new variants that could arise.” The announcement came the same day the Biden administration said it would require nursing homes to mandate vaccinations for staffers in order to continue receiving federal funds. Hundreds of thousands of nursing home workers remain unvaccinated, despite the heightened risk of fatal infections among elderly residents. Officials said it is “very clear” that the vaccines’ protection against infections wanes over time, and they noted the worsening picture in Israel, which has seen a rise in severe cases, many of them in people already inoculated. They said the U.S. needs to get out ahead of the problem before it takes a more lethal turn here and starts leading to increasing hospitalizations and deaths among the vaccinated. Dr. Anthony Fauci, the government’s foremost expert on COVID-19, said one of the key lessons of the coronavirus is that it’s better to “stay ahead of it than chasing after it.” The first boosters would go to people in high-priority groups that received the initial U.S. vaccinations: nursing home residents, health workers, and those with underlying health conditions. Health officials are likely to recommend that the booster be the same brand of vaccine that people received initially. Dr. Mark Mulligan of NYU’s Langone Health center welcomed the announcement, saying: “Part of leadership is being able to see around the corner and make hard decisions without having all the data. It seems to me that’s what they’re doing here.” Top scientists at the World Health Organization bitterly objected to the U.S. plan, noting that poor countries are not getting enough vaccine for their initial rounds of shots. “We’re planning to hand out extra life jackets to people who already have life jackets, while we’re leaving other people to drown without a single life jacket,” said Dr. Michael Ryan, the WHO’s emergencies chief. The organization’s top scientist, Dr. Soumya Swaminathan, said the evidence does not show boosters are needed for everyone, and she warned that leaving billions of people in the developing world unvaccinated could foster the emergence of new variants and result in “even more dire situations.” U.S. Surgeon General Vivek Murthy rejected the notion that the U.S. must choose between “America and the world,” saying: “We clearly see our responsibility to both.” White House officials noted that the U.S. has donated 115 million doses to 80 countries, more than all other nations combined. They said the U.S. has plenty of vaccine to dispense boosters to its own population. Israel is already offering booster shots to people over 50. And European regulators are looking into the idea. Last week, U.S. health officials recommended a third shot for some people with weakened immune systems, such as cancer patients and organ transplant recipients. Offering boosters to all Americans would be a major expansion of what is already the biggest vaccination campaign in U.S. history. Nearly 200 million Americans have received at least one shot. Some experts have expressed concern that calling for boosters would undermine the public health message — and reinforce opposition to the vaccine — by raising more doubts in the minds of people already skeptical about the shots’ effectiveness. As for why the vaccines appear to be less effective over time at stopping infections, there are indications that the body’s immune response to the shots fades, as it does with other inoculations. But also, the vaccines simply may not protect against the delta variant as well as they do against the original virus. Scientists are still trying to answer the question. Officials said the eight-month timeframe was a judgment call about when vaccine protection against severe illness might fall, based on the direction of the current data. “There’s nothing magical about this number,” the surgeon general said. Nearly 20 months into the outbreak, the scourge has killed 620,000 Americans. Just weeks after the president declared the country’s “independence” from COVID-19 on July Fourth, emergency rooms in parts of the South and West are overloaded again, and cases are averaging nearly 140,000 per day, quadrupling in just a month. In making its announcement, the CDC released a number of studies conducted during the delta surge that suggest that the vaccines remain highly effective at keeping Americans out of the hospital but that their ability to prevent infection is dropping markedly. One of the studies looked at reported COVID-19 infections in residents of nearly 15,000 nursing homes and other long-term care facilities. It found that the effectiveness of the Pfizer and Moderna vaccines against infection fell from about 74% in March, April, and early May to 53% in June and July. The study examined all COVID-19 infections, with or without symptoms. The researchers said more work is needed to determine if there was a higher incidence of infections that resulted in
New CDC guidelines set off rush to reimpose mask mandates
New guidance from the federal government set off a cascade of mask rules across the nation Wednesday as cities, states, schools, and businesses raced to restore mandates and others pushed back against the guidelines at a time when Americans are exhausted and confused over constantly shifting pandemic measures. Nevada and Kansas City, Missouri, were among the locations that moved swiftly to re-impose indoor mask requirements following Tuesday’s announcement from the Centers for Disease Control and Prevention. But governors in Arizona, Pennsylvania, and South Carolina said they would resist reversing course. The federal recommendations quickly plunged Americans into another emotionally charged debate over the face coverings meant to curb easy transmission of the deadly coronavirus. In Florida, a Broward County School Board meeting devolved into a screaming match between irate parents and board members on Tuesday. Some protesters even took to burning face masks outside the building. In suburban Atlanta, Jamie Reinhold said she would pull her kids from school if the district stuck to the CDC’s guidance, which the 52-year-old believes takes the country “backward” and damages confidence in the vaccines. “If you believe in the masks, go ahead, but don’t try to tell me what to do for my child’s health and safety and immune system,” she said. “It’s my child. It’s my choice.” And in New Orleans, Lisa Beaudean said she was not convinced mask mandates would inspire the unvaccinated — who account for most new infections — to take the virus seriously and get inoculated. “I’m very frustrated,” the St. Louis woman said as she strolled the French Quarter without a mask. “For the last 18 months, I’ve done everything I’m supposed to do, and there are no repercussions for those who haven’t done what they’re supposed to do.” Elsewhere, Ford Motor Co. said it would reinstate mask protocols for all employees and visitors at its Missouri and Florida facilities. The two states are among the hardest hit by the summer surge in which the U.S. is now averaging more than 60,000 new cases a day, driven by the highly contagious delta variant. Google also postponed a planned Sept. 1 return to the office for most of its more than 130,000 employees until mid-October, following a similar move by Apple. Google said Wednesday that it will also eventually require everyone on staff to be vaccinated, a mandate that President Joe Biden said he’s also weighing for federal employees. Other government leaders, meanwhile, said they will hold off reinstating mask rules for now. Pennsylvania Gov. Tom Wolf said he’s not considering imposing a mask mandate in schools or statewide, arguing that such orders were necessary before there was a vaccine. “People have the ability to make the decision to get a vaccine,” the Democrat told a Pittsburgh radio station Tuesday. “If they do, that’s the protection.” The CDC’s new guidance applies to places with at least 50 new cases per 100,000 people in the last week, which is roughly 60% of all U.S. counties, federal officials said. Nearly all of the South and Southwest are subject to the guidance, but most communities in the Northeast — with the exception of major metro areas like New York City and Boston — are exempt for now, according to the CDC’s COVID tracker. The stark partisan divide over mask-wearing set up the potential for a patchwork of regulations within states and counties. In Florida’s Miami-Dade County, Mayor Daniella Levine Cava imposed an indoor mask mandate Wednesday at county facilities. The Democrat’s announcement, which does not apply to businesses or restaurants, comes after Republican Florida Gov. Ron DeSantis signed a new law in May giving the state the power to invalidate local pandemic measures, including mask mandates and limits on business operations. “We have all come too far. We have all sacrificed too much in this past almost year and a half. We cannot turn back now,” Levine Cava said. In Missouri, the St. Louis County Council voted Tuesday to reverse the county’s mask mandate, just a day after it became one of the first reinstated in the country. But Democratic County Executive Sam Page insisted Wednesday that the mandate remained in effect and blamed the pushback on politics. On the other side of the state, Kansas City Mayor Quinton Lucas, a Democrat, reinstated a similar indoor mask mandate for Missouri’s largest city. State Attorney General Eric Schmitt, who is running for the U.S. Senate as a Republican, has sued to block the St. Louis-area mandate and has vowed to do the same for Kansas City’s requirement, saying on Twitter that the mandates are “about politics & control, not science.” The CDC’s updated guidance was prompted by new data suggesting vaccinated people can pass on the virus in rare cases. But the agency’s director, Rochelle Walensky, stressed that the vaccines are working by preventing greater levels of hospitalization and death. Unvaccinated people account for the vast number of new infections. Two-thirds of the vaccine-eligible population in the U.S. has received at least one dose. “I know this is not a message America wants to hear,” Walensky told CNN on Wednesday. “With prior variants, when people had these rare breakthrough infections, we didn’t see the capacity of them to spread the virus to others, but with the delta variant, we now see that you can actually now pass it to somebody else.” In Provincetown, Massachusetts, where officials earlier this week re-imposed an indoor mask requirement following a surge in COVID-19 cases this month, store owner Patrick Patrick says he doesn’t mind asking customers to mask up once more. The owner of Marine Specialties, a long-running Army-Navy store, had been leery of the decision to drop nearly all virus safety mandates ahead of the busy summer season. He even tried to impose his own in-store mask mandate before relenting last month. “If we’d stuck with masks all along, I don’t think we’d be having this conversation,” Patrick said. “We wore them all last summer, and we didn’t have a single case in Provincetown. Now see where we’re at.” As of Wednesday, the town had reported more
Vaccinations rise in some states with soaring infections
Vaccinations are beginning to rise in some states where COVID-19 cases are soaring, White House officials said Thursday in a sign that the summer surge is getting the attention of vaccine-hesitant Americans as hospitals in the South are being overrun with patients. Coronavirus coordinator Jeff Zients told reporters that several states with the highest proportions of new infections have seen residents get vaccinated at higher rates than the nation as a whole. Officials cited Arkansas, Florida, Louisiana, Missouri, and Nevada as examples. “The fourth surge is real, and the numbers are quite frightening at the moment,” Louisiana Gov. John Bel Edwards said on a New Orleans radio show. Edwards, a Democrat, added: “There’s no doubt that we are going in the wrong direction, and we’re going there in a hurry.” Louisiana reported 2,843 new COVID-19 cases Thursday, a day after reporting 5,388 — the third-highest level since the pandemic began. Hospitalizations are up steeply in the last month, from 242 on June 19 to 913 in the latest report. Fifteen new deaths were reported Thursday. Just 36% of Louisiana’s population is fully vaccinated, state health department data shows. Nationally, 56.3% of Americans have received at least one dose of the vaccine, according to the Centers for Disease Control and Prevention. Aly Neel, a spokesperson for Louisiana’s health department, said the state has seen “a little bump” in vaccinations recently, adding that details would be available Friday. Warner Thomas, president and CEO of the Ochsner Health system serving Louisiana and Mississippi, said the system had seen a 10% to 15% increase in people seeking vaccination over the past week or two. It has administered vaccines at churches, the New Orleans airport, basketball games, and the mall. “We see each person we get vaccinated now as a victory,” said Dr. Katherine Baumgarten, director of infection prevention and control for the 40-hospital system, noting that it has been bringing in traveling nurses and that projections show its ICUs could fill up at the current rate of infection. Dr. Catherine O’Neal, chief medical officer and an infectious disease specialist at Our Lady of the Lake regional medical center, said Thursday that the most shocking aspect of the surge has been its speed. The caseload has roughly tripled in the course of a week, she said. On Sunday, the medical center stopped taking transfers of coronavirus patients from hospitals in other parts of the state because they simply did not have the capacity, she said. In Missouri, which is second only to Arkansas and Louisiana in the number of new cases per capita over the past 14 days, officials have rolled out a vaccine incentive program that includes $10,000 prizes for 900 lottery winners. The state lags about 10 percentage points behind the national average for people who have received at least one shot. Hospitals in the Springfield area are under strain, reaching pandemic high and near pandemic high numbers of patients. “Younger, relatively healthy, and unvaccinated. If this describes you, please consider vaccination,” tweeted Erik Frederick, chief administrative officer of Mercy Hospital Springfield, noting that half of the COVID-19 patients are ages 21 to 59, and just 2% of that group is vaccinated. The surge that began in the southwest part of the state, where some counties have vaccination rates in the teens, has started to spread to the Kansas City area, including at Research Medical Center. “I don’t want to keep putting my life on the line just because people don’t want to get vaccinated or listen to what health care professionals are recommending,” lamented Pascaline Muhindura, a registered nurse who has worked on the hospital’s COVID-19 unit for more than a year. “A lot of them don’t even believe in COVID-19 to begin with. It is incredibly frustrating. You are helping someone that doesn’t even believe that the illness that they have is real,” Muhindura said. Dr. Jason Wilson, an emergency physician with Tampa General Hospital, also has watched the rise in cases with frustration. Unlike earlier in the pandemic, when many patients were in their 70s, he has seen the median patient age fall to the mid-40s. “I spent a lot of time this fall and last summer saying, ’We’ve got to do these things, these social mitigation strategies until we get that vaccine. Just hang in there,” Wilson said. Hospitals initially were hopeful as cases declined. But then, he said, “Things just fell flat.” Conservative Utah reported Wednesday that almost 300 people were hospitalized due to the virus — the highest number in five months. Intensive care units reached 81.5% capacity. Health officials renewed their pleas for residents to get vaccinated. One of Arizona’s biggest hospital systems issued its own call for vaccinations, citing an increase in seriously ill COVID-19 patients in just a few weeks. Dr. Michael White of Valleywise Health said doctors were mostly treating people with moderate symptoms, but that began to change two weeks ago. Now patients arrive acutely ill. “This delta at the moment it is honing in on largely unvaccinated persons,” said Dr. William Schaffner, a professor of infectious diseases in the health policy department at the Vanderbilt University School of Medicine in Nashville. The variant, which originated in India, now accounts for an estimated 83% of coronavirus samples genetically identified in the U.S. It is the predominant strain in every region of the country and continues “spreading with incredible efficiency,” the director of the CDC, Dr. Rochelle Walensky, told reporters at the White House. She said the mutation is more aggressive and much more transmissible, calling it “one of the most infectious respiratory viruses we know of.” “We are yet at another pivotal moment in this pandemic,” she warned. “We need to come together as one nation.” The CDC has not changed its guidance that vaccinated people do not need to wear masks. But in Georgia, Atlanta Public Schools announced Thursday that it will implement a “universal mask-wearing” policy in all of the system’s school buildings when fall classes begin. Just 18%
Pfizer to discuss vaccine booster with U.S. officials Monday
Pfizer says it plans to meet with top U.S. health officials Monday to discuss the drugmaker’s request for federal authorization of a third dose of its COVID-19 vaccine as President Joe Biden’s chief medical adviser acknowledged that “it is entirely conceivable, maybe likely” that booster shots will be needed. The company said it was scheduled to have the meeting with the Food and Drug Administration and other officials Monday, days after Pfizer asserted that booster shots would be needed within 12 months. Pfizer’s Dr. Mikael Dolsten told The Associated Press last week that early data from the company’s booster study suggests people’s antibody levels jump five- to 10-fold after a third dose, compared to their second dose months earlier — evidence it believes supports the need for a booster. On Sunday, Dr. Anthony Fauci didn’t rule out the possibility but said it was too soon for the government to recommend another shot. He said the Centers for Disease Control and Prevention and the FDA did the right thing last week by pushing back against Pfizer’s assertion with their statement that they did not view booster shots as necessary “at this time.” Fauci said clinical studies and laboratory data have yet to fully bear out the need for a booster to the current two-shot Pfizer and Moderna vaccines or the one-shot Johnson & Johnson regimen. “Right now, given the data and the information we have, we do not need to give people a third shot,” he said. “That doesn’t mean we stop there. … There are studies being done now ongoing as we speak about looking at the feasibility about if and when we should be boosting people.” He said it was quite possible in the coming months “as data evolves” that the government may urge a booster based on such factors as age and underlying medical conditions. “Certainly it is entirely conceivable, maybe likely at some time, we will need a boost,″ Fauci said. Monday’s planned meeting between Pfizer and U.S. health officials was first reported by The Washington Post. Currently, only about 48% of the U.S. population is fully vaccinated. Some parts of the country have far lower immunization rates, and in those places, the delta variant is surging. Last week, Dr. Rochelle Walensky, the CDC director, said that’s leading to “two truths” — highly immunized swaths of America are getting back to normal while hospitalizations are rising in other places. Fauci said it was inexplicable that some Americans are so resistant to getting a vaccine when scientific data show how effective it is in staving off COVID-19 infections and hospitalizations, and he was dismayed by efforts to block making vaccinations more accessible, such as Biden’s suggestion of door-to-door outreach. Gov. Asa Hutchinson, R-Ark., agreed Sunday that there is vaccine resistance in Southern and rural states like his because “you have that more conservative approach, skepticism about government.” Describing his efforts to boost vaccinations in his state, which is seeing rising infections, Hutchinson said, “no one wants an agent knocking on a door,” but “we do want those that do not have access otherwise to make sure they know about it.” The grassroots component of the federal vaccination campaign has been in operation since April when supplies of shots began outpacing demand. It was outlined and funded by Congress in the $1.9 trillion COVID-19 relief bill passed in March and overwhelmingly is carried out by local officials and private-sector workers, and volunteers. Rep. Adam Kinzinger, R-Ill., blasted opposition to vaccination efforts from some GOP lawmakers as “absolute insanity.” He said House Republican leader Kevin McCarthy of California and others in the party need to speak out against “these absolute clown politicians playing on your vaccine fears for their own selfish gain.” Fauci appeared on CNN’s “State of the Union,” ABC’s “This Week,” and CBS’ “Face the Nation”; Hutchinson spoke on ABC, and Kinzinger was on CNN. Republished with the permission of the Associated Press.
Nearly all COVID deaths in U.S. are now among unvaccinated
Nearly all COVID-19 deaths in the U.S. now are in people who weren’t vaccinated, a staggering demonstration of how effective the shots have been and an indication that deaths per day — now down to under 300 — could be practically zero if everyone eligible got the vaccine. An Associated Press analysis of available government data from May shows that “breakthrough” infections in fully vaccinated people accounted for fewer than 1,200 of more than 853,000 COVID-19 hospitalizations. That’s about 0.1%. And only about 150 of the more than 18,000 COVID-19 deaths in May were in fully vaccinated people. That translates to about 0.8%, or five deaths per day on average. The AP analyzed figures provided by the Centers for Disease Control and Prevention. The CDC itself has not estimated what percentage of hospitalizations and deaths are in fully vaccinated people, citing limitations in the data. Among them: Only about 45 states report breakthrough infections, and some are more aggressive than others in looking for such cases. So the data probably understates such infections, CDC officials said. Still, the overall trend that emerges from the data echoes what many health care authorities are seeing around the country and what top experts are saying. Earlier this month, Andy Slavitt, a former adviser to the Biden administration on COVID-19, suggested that 98% to 99% of the Americans dying of the coronavirus are unvaccinated. And CDC Director Dr. Rochelle Walensky said on Tuesday that the vaccine is so effective that “nearly every death, especially among adults, due to COVID-19, is, at this point, entirely preventable.” She called such deaths “particularly tragic.” Deaths in the U.S. have plummeted from a peak of more than 3,400 per day on average in mid-January, one month into the vaccination drive. About 63% of all vaccine-eligible Americans — those 12 and older — have received at least one dose, and 53% are fully vaccinated, according to the CDC. While vaccine remains scarce in much of the world, the U.S. supply is so abundant, and demand has slumped so dramatically that shots sit unused. Ross Bagne, a 68-year-old small-business owner in Cheyenne, Wyoming, was eligible for the vaccine in early February but didn’t get it. He died June 4, infected and unvaccinated, after spending more than three weeks in the hospital, his lungs filling with fluid. He was unable to swallow because of a stroke. “He never went out, so he didn’t think he would catch it,” said his grieving sister, Karen McKnight. She wondered: “Why take the risk of not getting vaccinated?” The preventable deaths will continue, experts predict, with unvaccinated pockets of the nation experiencing outbreaks in the fall and winter. Ali Mokdad, a professor of health metrics sciences at the University of Washington in Seattle, said modeling suggests the nation will hit 1,000 deaths per day again next year. In Arkansas, which has one of the lowest vaccination rates in the nation, with only about 33% of the population fully protected, cases, hospitalizations, and deaths are rising. “It is sad to see someone go to the hospital or die when it can be prevented,” Gov. Asa Hutchinson tweeted as he urged people to get their shots. In Seattle’s King County, the public health department found only three deaths during a recent 60-day period in people who were fully vaccinated. The rest, some 95% of 62 deaths, had had no vaccine or just one shot. “Those are all somebody’s parents, grandparents, siblings, and friends,” said Dr. Mark Del Beccaro, who helps lead a vaccination outreach program in King County. “It’s still a lot of deaths, and they’re preventable deaths.” In the St. Louis area, more than 90% of patients hospitalized with COVID-19 have not been vaccinated, said Dr. Alex Garza, a hospital administrator who directs a metropolitan-area task force on the outbreak. “The majority of them express some regret for not being vaccinated,” Garza said. “That’s a pretty common refrain that we’re hearing from patients with COVID.” The stories of unvaccinated people dying may convince some people they should get the shots, but young adults — the group least likely to be vaccinated — may be motivated more by a desire to protect their loved ones, said David Michaels, an epidemiologist at George Washington University’s school of public health in the nation’s capital. Others need paid time off to get the shots and deal with any side effects, Michaels said. The Occupational Safety and Health Administration this month began requiring health care employers, including hospitals and nursing homes, to provide such time off. But Michaels, who headed OSHA under President Barack Obama, said the agency should have gone further and applied the rule to meat and poultry plants and other food operations as well as other places with workers at risk. Bagne, who lived alone, ran a business helping people incorporate their companies in Wyoming for the tax advantages. He was winding down the business, planning to retire, when he got sick, emailing his sister in April about an illness that had left him dizzy and disoriented. “Whatever it was. That bug took a LOT out of me,” he wrote. As his health deteriorated, a neighbor finally persuaded him to go to the hospital. “Why was the messaging in his state so unclear that he didn’t understand the importance of the vaccine? He was a very bright guy,” his sister said. “I wish he’d gotten the vaccine, and I’m sad he didn’t understand how it could prevent him from getting COVID.” Republished with the permission of the Associated Press.
New COVID-19 cases plummet to lowest levels since last June
New coronavirus cases across the United States have tumbled to rates not seen in more than 11 months, sparking optimism that vaccination campaigns are stemming both severe COVID-19 cases and the spread of the virus. As cases, hospitalizations and deaths steadily dropped this week, pre-pandemic life in America has largely resumed. Hugs and unmasked crowds returned to the White House, a Mardi Gras-style parade marched through Alabama’s port city of Mobile and even states that have stuck to pandemic-related restrictions readied to drop them. However, health experts also cautioned that not enough Americans have been vaccinated to completely extinguish the virus, leaving the potential for new variants that could extend the pandemic. As the seven-day average for new cases dropped below 30,000 per day this week, Rochelle Walensky, the director of the Centers for Disease Control and Prevention, pointed out cases have not been this low since June 18, 2020. The average number of deaths over the last seven days also dropped to 552 — a rate not seen since July last year. It’s a dramatic drop since the pandemic hit a devastating crescendo in January. “As each week passes and as we continue to see progress, these data give me hope,” Walensky said Friday at a news conference. Health experts credit an efficient rollout of vaccines for the turnaround. More than 60% of people over 18 have received at least one shot, and almost half are fully vaccinated, according to the CDC. But demand for vaccines has dropped across much of the country. President Joe Biden’s administration is trying to convince other Americans to sign up for shots, using an upbeat message that vaccines offer a return to normal life. White House health officials on Friday even waded into offering dating advice. They are teaming up with dating apps to offer a new reason to “swipe right” by featuring vaccination badges on profiles and in-app bonuses for people who have gotten their shots. Ohio, New York, Oregon, and other states are enticing people to get vaccinated through lottery prizes of up to $5 million. Across the country, venues and events reopened after shuttering for much of the last year. On Saturday, Karen Stetz readied to welcome what she hoped would be a good crowd to the Grosse Pointe Art Fair on Michigan’s Lake St. Clair. With natural ventilation from the lake and mask and capacity restrictions easing, Stetz was optimistic that artists who make their living traveling a show circuit that ground to a halt last year would begin to bounce back. The event usually draws from 5,000 to 10,000 people. “I feel like most people are ready to get out,” Stetz said by phone shortly before opening the fair. “It seems like people are eager, but it’s hard to know still. I’m sure there’s a percentage of people that are going to wait until they’re comfortable.” In Mobile, thousands of joyful revelers, many without masks, competed for plastic beads and trinkets tossed from floats Friday night as Alabama’s port city threw a Mardi Gras-style parade. But only about a quarter of the county’s population is fully vaccinated. Many went without masks, though health officials had urged personal responsibility. Alabama’s vaccination rate — 34% of people have received at least one dose — is one of the lowest in the country. It’s part of a swath of Southern states where vaccine uptake has been slow. Health experts worry that areas with low vaccination rates could give rise to new virus variants that are more resistant to vaccinations. “My biggest concern is new strains of the virus and the need to remain vigilant in the months ahead,” said Boston College public health expert Dr. Philip J. Landrigan. A medical center in Louisiana reported Friday it has identified the state’s first two cases of a COVID-19 variant that has spread widely since being identified in India. The COVID-19 variant has been classified as a “variant of concern” by Britain and the World Health Organization, meaning there is some evidence that it spreads more easily between people, causes more severe disease, or might be less responsive to treatments and vaccines. The variant has also been reported in several other states, including Tennessee, Nebraska, and Nevada. Though Landrigan said the big drop in cases nationwide was “the best news we’ve had on the pandemic” and showed that vaccines are working, he warned that people should remain vigilant for local flare-ups of new cases. Many states have largely dropped orders to wear masks and stay distanced from other people. Meanwhile, even places such as California — the first state to issue a statewide shutdown as the virus emerged in March 2020 — prepared to remove restrictions on social distancing and business capacity next month. State health director Dr. Mark Ghaly said Friday the decision was based on dramatically lower virus cases and increased vaccinations. But in Vermont — the state with the highest percentage of people who have received one shot — Gov. Phil Scott has tied the lifting of restrictions to the vaccination rate. He offered to lift all remaining restrictions before a July 4 deadline if 80% of those eligible get vaccinated. Landrigan figured it will take a nationwide vaccination rate of at least 85% to snuff out the virus. But for now, the steep drop in cases gave him hope that pandemic-level infection rates will soon be a thing of the past. “It is getting to the point to where by the Fourth of July we might be able to declare this thing over,” he said. Republished with the permission of the Associated Press.
