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Signs direct people arriving to get COVID-19 vaccines last week at the Mountain America Expo Center in Sandy, Utah. Spenser Heaps/Deseret News
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Each week, we answer "frequently asked questions" about life during the coronavirus crisis. If you have a question you'd like us to consider for a future post, email us atgoatsandsoda@npr.orgwith the subject line: "Weekly Coronavirus Questions."
I got my first dose, and now I feel invincible! Do Ireallyneed to get the second shot?
Dr. Anthony Fauci devoted his segment of Friday's White House press briefing to the topic of second doses and summed it up like this: "Get vaccinated, and if you're getting a two-dose regimen, make sure you get that second dose."
The good news is that the vast majority of Americans who got the Pfizer or Moderna vaccine are going back for their second dose. (Those who got Johnson & Johnson, of course, are home free after one shot.) New data from the Centers for Disease Control and Prevention shows that 92% are getting both jabs.
"As a society we want everyone to get two, but to have 92% is really good," says Dr. Jill Weatherhead, assistant professor of adult and pediatric infectious diseases at Baylor College of Medicine.
More good news: Even if you miss your second appointment by more than the recommended 42-day window, you can still go back for it.
"If you were to miss the designated time interval, you should still get the second vaccine as soon as possible in order to build a stronger immune response," Weatherhead says. "The vaccine will still be available to you and still provide protection."
But the sooner you can get it after the initial waiting period, the better, she adds, because you're not fully protected in that interval period.
And here's where the more sobering news comes in: Fauci referred to a new report showing there's some confusion on the matter: Twenty percent believe that the vaccines provide strong protection before the second dose, and 36% were unsure.
"The people who are not yet fully immunized are now in the most dangerous phase of the pandemic," says Dr. Gregory Poland, head of the Vaccine Research Group at the Mayo Clinic and editor-in-chief of the journal Vaccine. "They are facing a much greater risk than at any other time. The reason for this is the variants that are circulating are far more transmissible, and the virus will look for those who are not protected."
In addition, he says, some of the treatments for COVID-19 don't work as well against the variants. A study published Friday, for example, shows that a single dose of Pfizer isn't protective against some of the key variants.
"The first dose is meant as a priming dose, and the second is a booster dose," Poland says. "When you get that second dose, you are keeping and improving the quality of your immunity. Until you get that second dose, you remain at risk."
Even though the overall efficacy rate after one dose was 80% in trials, "that will vary widely," Poland notes. "It won't be 80% in a frail 80-year-old. It might be in a healthy 25-year-old. It'll be nowhere near that in someone who is immunocompromised or on chemotherapy."
So why were some experts advocating for spreading out the first and second doses — didn't that work for the whole country of England?
When vaccines were in such high demand that the U.S. didn't have enough doses for everyone who wanted one, some experts — including Poland — championed the idea of getting as many first doses into arms as possible and then following up with second shots when they were available.
"Those conditions no longer hold," Poland says. "Our issue now is we have more vaccine than people who want it."
The only reason people may want to spread out doses is the belief that you could enhance your ultimate immune response, he says.
And while it's possible that could happen — research shows the immune response to the AstraZeneca vaccine was better after an interval of more than 12 weeks than it was at less than six weeks — it's completely theoretical for the approved U.S. vaccines, Poland says, and we don't have that luxury during a pandemic when the trade-off is not being protected between doses.
Ultimately, Weatherhead says, getting vaccinated — fully — is what will get us back to pre-COVID-19 normalcy.
And don't look for excuses to skip the second dose, the experts say. Fauci has noted that college students who get the first dose on campus can schedule their second one in their hometown if they've left school for the semester. And clinics and centers administering doses will do a mix-and-match, offering a second dose of Pfizer or Moderna to someone with proof of a first dose, even if it wasn't delivered on site.
Sheila Mulrooney Eldred is a freelance health journalist in Minneapolis. She's written about COVID-19 for many publications, including Medscape, Kaiser Health News, Science News for Students and The Washington Post. More atsheilaeldred.pressfolios.com. On Twitter: @milepostmedia
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Some former President Trump supporters and anti-vaxxers are forging vaccine cards using a government-issued template to falsely state they received their shots.
NBC Newsreports that people are making their own vaccination cards using an online template and flashcards.
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"It's a cardboard paper card," said Alyssa Miller, a cybersecurity expert. "There's absolutely nothing about it that would prevent you from reproducing it."
Using high-resolution PDFs from the websites on the Wyoming and Missouri health departments, conspiracy and anti-government forums give graphic templates on how to make a convincing vaccination card.
Certain websites, like Patriots.win, formerly known as TheDonald.win, instruct how thick the cardstock needs to be and how some vaccination centers attach stickers on cards to indicate the date. Some websites have printed labels for dates.
The CDC has informed both the Missouri Department of Health and Senior Services and Wyoming’s Health Department, both of which were aware of the misuse a month ago.
"It would be best for states to no longer have that material available online as some were using the card/file for fraudulent use," a spokesperson for the Missouri Department of Health said.
"The initial goal for posting the document was to make things a little easier for community providers," the Wyoming department spokesperson said.
The cards, handwritten and containing very little information, are being exploited by right-wing forums that challenge President Biden's vaccination mandates.
The Biden administration said it was not interested in creating a federal vaccination passport, saying some might have privacy concerns. New York is the only state to have a verification application called Excelsior Pass or the vaccine passport, as reported inBlack Enterprise.
The FBI released a public warning in March, asserting created or bought fraudulent vaccine cards are illegal.
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Oregon officials announced another 990 confirmed and presumed cases of the coronavirus in Oregon Friday, as well as four new deaths.
During a news conference Friday, Gov. Kate Brown cited new cases and hospitalizations to explain her decision to temporarily restrict certain business activities and gathering sizes in more than a dozen counties.
“As your governor, I chose to save lives,” Brown said.
Vaccines: Oregon reported 49,029 newly administered doses, which includes 34,063 Thursday and the remainder from previous days. The current rolling average is 35,329 doses every day.
Where the new cases are by county: Baker (2), Benton (22), Clackamas (99), Clatsop (3), Columbia (5), Coos (6), Crook (11), Curry (2), Deschutes (81), Douglas (7), Grant (12), Harney (1), Hood River (1), Jackson (56), Jefferson (12), Josephine (16), Klamath (78), Lake (2), Lane (88), Lincoln (8), Linn (51), Malheur (2), Marion (93), Morrow (1), Multnomah (178), Polk (13), Tillamook (6), Umatilla (9), Wallowa (4), Wasco (8), Washington (101) and Yamhill (12).
Who died: Oregon’s 2,492nd death connected to COVID-19 is a 97-year-old Clackamas County woman who died April 12, 2020 at her residence.
Oregon’s 2,493rd death is a 49-year-old Josephine County man who tested positive April 10 and died April 29 at Asante Three Rivers Medical Center. He had no underlying medical conditions.
Oregon’s 2,494th death is an 81-year-old Malheur County man who tested positive April 24 and died April 28 at St. Alphonsus Regional Medical Center, in Boise, Idaho.
Oregon’s 2,495th death is a 78-year-old Crook County woman who tested positive April 20 and died April 26 her residence.
Unless noted above, each person had underlying health conditions or state officials were determining if the person had medical conditions.
Hospitalizations: 334 people with confirmed cases of COVID-19 are hospitalized, down five from Thursday. That includes 73 people in intensive care, up two from Thursday.
Since it began: Oregon has reported 184,812 confirmed or presumed infections and 2,495 deaths, among the lowest per capita numbers in the nation. To date, the state has reported 2,983,316 vaccine doses administered, fully vaccinating 1,253,053 people and partially vaccinating 566,276 people.
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The Centers for Disease Control and Prevention (CDC) has concluded that dozens of Johnson & Johnson vaccine recipients experienced adverse physical reactions because of anxiety and not the vaccine itself, according to a report published Friday.
The agency investigated clusters of anxiety-related events, with a total 64 incidents out of 8,624 doses administered, reported to the CDC by five mass vaccination sites across five different states.
Researchers said that these anxiety-related cases “can occur after any vaccination” if a person has a physical reaction within 15 minutes of inoculation due to their worries about getting the shot.
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The incidents were reported between April 7 and 9, about five weeks after the Food and Drug Administration (FDA) issued its emergency authorization approval for the Johnson & Johnson vaccine.
These anxiety-related reactions are not related to the rare cases of blood clots that led the CDC and FDA to recommend pausing administration of the Johnson & Johnson vaccine across the country. The anxiety-related cases occurred before the pause, which ended last week.
In response to the anxiety-related cases, which included 17 cases of fainting, or syncope, four of the five mass vaccination sites temporarily shut down during an investigation.
In total, the CDC determined that the reporting rate of fainting after a Johnson & Johnson vaccine to the Vaccine Adverse Events Reporting System was 8.2 per 100,000 doses. In comparison, the rate for the 2019-2020 flu shot was 0.05 per 100,000 doses, about 164 times less common.
Recipients who underwent anxiety-related events most commonly reported light-headedness or dizziness, sweating, fainting, nausea or vomiting, and hypotension. Thirteen of the patients were taken to the emergency department for additional care.
Researchers noted that because Johnson & Johnson is the only single-dose shot available in the U.S., it may be selected more by those who have needle aversion and therefore more likely to have anxiety-related incidents post-vaccination.
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They called on vaccine providers to be “aware” on anxiety-related incidents after the shot and observe all recipients for any reactions for at least 15 minutes after the vaccine was administered.
The Associated Press identified the five states where the incidents occurred as California, Colorado, Georgia, Iowa and North Carolina.
The anxiety-related events were different from the at least 17 recipients of the Johnson & Johnson vaccine who developed rare blood clotting in unusual places and low levels of platelets. Last week, the FDA included a warning for these clotting cases, mostly in women aged 18 to 49, as it resumed the Johnson & Johnson vaccinations.
Johnson & Johnson vaccine recipients have also reported less severe side effects, such as sore arm, fatigue and headache, as have those who received the Pfizer-BioNTech and Moderna vaccines.
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The report, published on Friday by the US Centers for Disease Control and Prevention, notes that the safety profile of the vaccine so far has been similar to what was seen in clinical trials, but safety monitoring during the vaccine's rollout quickly identified the blood clot incidents.
"A rare but serious adverse event occurring primarily in women, blood clots in large vessels accompanied by a low platelet count, was rapidly detected by the U.S. vaccine safety monitoring system," CDC researchers wrote in the report. "Monitoring for common and rare adverse events after receipt of all COVID-19 vaccines, including the Janssen COVID-19 vaccine, is continuing."
Janssen is the vaccine arm of Johnson & Johnson. In February, the Johnson & Johnson vaccine was authorized for emergency use in the United States. Use of the vaccine was paused temporarily in mid-April due to reports of extremely rare yet severe blood clotting events in the brain's venous sinuses following vaccinations. The pause lifted last week.
The new CDC report summarizes the latest safety data on the vaccine, which includes 13,725 incidents reported through the agency's Vaccine Adverse Events Reporting System. The data showed that 97% of the events have been nonserious.
Overall, there were 17 events consistent with what has been described as thrombosis with thrombocytopenia syndrome, or blood clotting with low blood platelet levels -- including 14 that were cerebral venous sinus thrombosis and three that did not involve the brain's venous sinuses among women younger than 60 during the vaccine pause, according to the report.
The data also included 88 deaths reported after vaccination. Among those deaths, three occurred in patients with cerebral venous sinus thrombosis and CDC researchers wrote that, after preliminary reviews, "no other deaths appear to have an association with vaccination."
Increased number of 'anxiety-related events'
Additional new data published Friday from the CDC suggests that administration of Johnson & Johnson's Covid-19 vaccine in early April may have also been connected to an increased incidence of "anxiety-related events" in the 15-minute waiting period post-vaccine.
All of these anxiety-related events occurred before reports came out of thrombosis with thrombocytopenia syndrome connected to the Janssen vaccine.
In a study published Friday in the CDC's Morbidity and Mortality Weekly Report, researchers examined data from five mass vaccination sites which reported increased anxiety-related events, including rapid heart rate, rapid breathing, and fainting, following administration of Johnson & Johnson's Janssen Covid-19 vaccine from April 7-9.
Researchers tallied 64 anxiety-related events out of 8,624 vaccine recipients. The rate of syncope, or fainting, was found to be 8.2 incidences per 100,000 doses, which is 164 times the rate of fainting following the flu vaccine, the researchers wrote.
All of the events were reported to Vaccine Adverse Event Reporting System, and none were considered "serious" by VAERS standards. Over half of the reported fainting events occurred in women. For four out of the five sites observed, these events happened on the first day of Janssen shot administration.
Study authors suggested that because the Janssen Covid-19 vaccine is a single-dose shot, people with a fear of needles may be more inclined to get this shot over one of the two-dose options. Out of all fainting cases, 20% of those reported occurred in people who had already informed vaccination site staff they had a history of needle aversion.
Half of the reports of fainting occurred in people ages 18 to 29, and fainting associated with injections is more common in adolescents and young adults. Researchers cited similar fainting rates in administration of the human papillomavirus vaccine, largely given to young people. The HPV vaccine has a fainting rate of 7.8 per 100,000.
Researchers said tracking anxiety event rates will be important information for health care providers as the Covid-19 vaccine reaches more and more young people.
"Anxiety-related events can occur after any vaccination," study authors wrote.
"It is important that vaccination providers are aware that anxiety-related adverse events might be reported more frequently after receipt of the Janssen COVID-19 vaccine than after influenza vaccination and observe all COVID-19 vaccine recipients for any adverse reactions for at least 15 minutes after vaccine administration," the researchers wrote. "As use of COVID-19 vaccines expands into younger age groups, providers should be aware that younger persons might be more highly predisposed to anxiety-related events after vaccination than are older persons."
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GREENEVILLE, Tenn.— “So have you gotten the vaccine yet?”
The question, a friendly greeting to Betty Smith, the pastor’s wife, lingered in the air as the four church women sat down for their regular Tuesday coffee and conversation at Ingle’s Market.
Mrs. Smith hesitated, sensing a chilly blast of judgment from a never-mask, never-vax companion. She fumbled through a non-reply.
Recalling the moment later, she sighed, “We were there to get to know each other better but the first thing on the table was the Covid vaccine.”
The subject makes her husband, the Rev. David Smith, even more uncomfortable. “Honestly, I wish people wouldn’t ask,” he said, chatting after Wednesday night prayer at Tusculum Baptist Church. “I think it’s none of their business. And it’s just dividing people.”
As the beautiful Appalachian spring unfurls across northeastern Tennessee, the Covid-19 vaccine is tearing apart friends, families, congregations, colleagues. “It’s a muddy mess,” said Meredith Shrader, a physician assistant, who runs an events venue with her husband, another pastor, and who notes that the choice has become about much more than health care. “Which voice do you listen to?”
Communities like Greeneville and its surroundings — rural, overwhelmingly Republican, deeply Christian, 95 percent white — are on the radar of President Biden and American health officials, as efforts to vaccinate most of the U.S. population enters a critical phase. These are the places where polls show resistance to the vaccine is most entrenched. While campaigns aimed at convincing Black and Latino urban communities to set aside their vaccine mistrust have made striking gains, towns like these will also have to be convinced if the country is to achieve widespread immunity.
Betty Smith and her husband, Pastor David Smith, of Tusculum Baptist Church, worry the vaccine has become a divisive issue in the community.
Downtown Greeneville, population 15,000, the county seat of Greene County, Tenn., in southern Appalachia.
Sunday worship at Old Fashion Gospel House, Bulls Gap, Tenn.
But a week here in Greene County reveals a more nuanced, layered hesitancy than surveys suggest. People say that politics isn’t the leading driver of their vaccine attitudes. The most common reason for their apprehension is fear — that the vaccine was developed in haste, that long-term side effects are unknown. Their decisions are also entangled in a web of views about bodily autonomy, science and authority, plus a powerful regional, somewhat romanticized self-image: We don’t like outsiders messing in our business.
According to state health department statistics, 31 percent of the vaccine-eligible population in Greene County has gotten at least one dose of a Covid vaccine, still below Tennessee overall, which has one of the lowest rates in the country, and far below the Centers for Disease Control and Prevention’s national tally of 55 percent. While many older residents have been inoculated, now that eligibility is open to all adults, vaccination sites are almost desolate.
Still, conversations here show that for many people, resistance is not firm. Roiled by internet fallacies, many hunger for straightforward information from people they trust. Others have practical needs, like paid time off to recover from side effects, which the Biden administration has urged employers to offer, or the opportunity to get the shot from their own doctor.
What’s also lacking is a groundswell that might encourage the hesitant to make the leap: Many people who have gotten vaccinated are remaining tight-lipped.
Daybreak in the Appalachians, as seen from Viking Mountain, Greeneville, Tenn.
A matter of trust
Greene County is carpeted with hundreds of evangelical churches that range from steepled 19th-century edifices to backroads barns. People scrape by on subsistence farming, jobs in small factories, welfare checks and cash flow from retirees who are moving onto the cheap, vista-blissful land. Drug busts for heroin and methamphetamine sustain a humming cottage industry of lawyers and bail bonds services.
Covid smacked the region hard this winter. Eleven people in Jim and Rita Fletcher’s extended circle died from it.
But no, the Fletchers, lifelong Greenevillians, will not get the vaccine.
What’s the point, they ask? The government still wants you to wear a mask indoors. “I just don’t see any benefits,” said Mrs. Fletcher, as the couple waited to see their family doctor.
Neither the science nor statistics of the new vaccine daunt them. Now retired and in their 70s, Mr. Fletcher was a telecom engineer, Mrs. Fletcher, a secretary and accounting clerk.
But the Fletchers, Free Will Baptists, worry the vaccine includes aborted fetal parts (it doesn’t). They don’t trust the government, convinced it has long manipulated Covid case numbers.
“I just think we have been hornswoggled,” Mr. Fletcher said.
Greene County is carpeted with hundreds of churches that range from steepled edifices to backroads barns.
The counter crowd at Tipton’s Cafe in downtown Greeneville, where the coronavirus hit hard last winter.
Jim and Rita Fletcher see many reasons not to take the Covid vaccine.
People don’t put much stock in pronouncements by politicians, but they do trust Walt Cross, the proprietor of the Mustard Seed, a shop in Newport just over the county line, that takes its name from the Gospel of Matthew and carries herbs, nutritional supplements and local produce.
Mr. Cross, who is also a volunteer fire chief for Cocke County, is a tall, lanky east Tennessean with a blue-eyed focus and a warm mountain drawl, whether he’s describing his preferred method to rouse people who have overdosed (ammonia rather than Narcan) or answering questions from Covid patients about how to treat their symptoms (hydrate, eat, take herbal extracts, apply hot and cold compresses).
Before going to the doctor, many people phone Mr. Cross. Or after the doctor’s medicines don’t seem to be working.
Although his father died of Covid, Mr. Cross won’t get the vaccine. “We jumped into bed with the vaccine too fast!” he said. While he won’t tell people to get it or not, he says pointedly, “Do your due diligence.”
Mr. Cross, who lectures around the country and in Rwanda about preventive wellness, is studying for an advanced degree in naturopathic medicine. His shop evokes themes dear to Appalachians, with people calling these early April weeks the “redbud winter” — the spring chill during which redbud trees swell with mauve-pink blossoms. A store wall is lined with Mason jars filled with herbaceous plants like jewelweed, passionflower and elderberry, which Appalachians were taught to use by the Cherokee.
He scoffs at the perception that people here are vaccine-hesitant simply because they, like him, are Republicans.
“That doesn’t make sense to me,” he said. “Trump brought the vaccine in.” If this was about political affiliation, he continued, “you’d jump and take it!” Instead, he said, people think the vaccine is too entwined with politics.
In Appalachia, Mr. Cross explained, the fervor with which people sidestep the vaccine is ratcheted up by history and tradition. For centuries, Scots-Irish settlers tucked into the mountains to evade army conscription and tax collectors.
The Ballad Health community vaccine center in Elizabethton. Immunization clinics in the county have been desolate recently.
People often go to the Mustard Seed shop in Newport, Tenn. to ask Walt Cross about herbal remedies for ailments, including Covid.
The people of Greene County are emphatically Republican and overwhelmingly Christian.
Jeremy Faison, a longtime Republican state representative who grew up in the area, agrees: “Throughout the pandemic, there are a lot of us who are like, ‘It’s a serious situation but me and my family can take care of ourselves.’ ”
Mr. Faison, a libertarian and an evangelical Christian, added, “So we take exception with the government putting mandates on us, pressuring us to do something.”
That view is bolstered by a religious, near-joyous fatalism. People say that if they haven’t caught Covid a year into the pandemic, they will take their chances. True, they might get Covid and die. But either way, a win-win: longer life on Earth or, for the faithful, eternal life in Heaven.
“There’s a time appointed for every person to die,” said Reuben Smucker, a Mennonite pastor in Greeneville who works as a garage-door installer. “We should take care of our bodies physically, emotionally and spiritually, but if it’s my time to go and it’s by Covid, well then, it’s my time to go.”
After Mr. Cross, an elder in a Seventh Day Adventist Church, counsels Covid patients, he prays with them. “That’s the most important thing,” he said. “Because it’s God who does the healing.”
Although Covid shots are more accessible, some people prefer that their doctor administer them.
A topic too volatile
So charged have the Covid shots become that many people have adopted a resigned silence. A vaccinated 20-something barista has given up trying to persuade her not-now, not-ever father. A retired postal worker just lets her doctor assume she’s gotten the shots, because he is a family friend. But she hasn’t — and won’t.
Mary Hayes, who drove into Greeneville for a reunion lunch with a large group of vaccinated friends, is accustomed to speaking her mind. But she has a moral quandary: should she advocate for the vaccine or keep quiet? She got the vaccine early, because so many doses went unclaimed. In her remote corner of the county, people already look at her warily.
“A lot of times I have to temper my opinions in order to fit in,” Ms. Hayes said, tears welling in her eyes. “I’m walking a line between people refusing to socialize with me or not.”
Ms. Hayes grew up here, left, and returned to care for her mother. Late in 2019, while teaching English online to students in China, she noticed that some were disappearing from her computer monitor. They were succumbing to a mysterious virus.
Later, when her family went into lockdown, neighbors dismissed her fears.
“Appalachians were raised to believe they must work and can’t get sick, no matter what,” said Ms. Hayes, who has a graduate degree in Appalachian studies. She wept in frustration as familiar names appeared on her prayer chain, deathly ill from the virus.
On the door of her church, someone recently posted a newspaper letter. It derided Covid mask mandates, “the Prophet Fauci” and vaccines “made in part from aborted children.”
The topic of the vaccine has even muted the most influential leaders in Greene County: evangelical pastors. There are many who have been vaccinated, like Mr. Smith at Tusculum Baptist, but won’t use the pulpit to support it. He doesn’t want to risk alienating anyone, he explained, at a time when he hopes people will return to the church itself to worship. After a year of Zoom services, which people call “pajama church,” he fears in-person attendance will drop.
Mary Hayes struggles over whether to vociferously defend the Covid vaccine.
Rev. Smith wants people to return to worship in church rather than by Zoom.
During the pandemic, Mr. Shrader would preach to the hard-of-hearing from their porch steps.
Eva Fields is not yet persuaded by Dr. Theo Hensley to get the Covid shot.
Daniel Shrader, who leads a small Baptist congregation, is all in on the vaccine. He wants church to be safe for the older, hard-of-hearing ladies to whom he’s been preaching during the pandemic by shouting from their porch steps.
In conversation, he’ll share his vaccine views; in larger gatherings, he sticks to prayer.
The pastors’ perspectives run the gamut. Mr. Smucker, the Mennonite pastor, believes that natural herd immunity — let the disease run its course — is a better path than vaccination. But he won’t preach about it.
Chelsea Daugherty’s father, a Free Will Baptist pastor, is unsure about getting vaccinated. Ms. Daugherty, a sophomore at Tusculum University who got the shot, said her father tells worshipers: “The Lord gave us common sense, so we’ve got to use it.” Make up your own mind.
So which trusted person will speak for the vaccine? Eva Fields?
She is a nurse-practitioner who treated one of the first local patients to die from Covid. Greeneville-raised, she has 24 relatives who had the virus.
When she asks patients if they will get vaccinated, about half reply, “No and I’m not going to.” Assuming she’ll be angry, they add, “I’m so sorry if that upsets you!”
Miss Fields responds, “That’s OK, honey. I’m not planning to, either.”
Her gut tells her to believe a video someone sent her from a far-right misinformation group, in which a ranter said studies showed that vaccines caused plaque in the brain.
Like others here, she is suspicious of Bill Gates’s involvement in vaccine development. One evening at supper, Dr. Theo Hensley, a vaccine proponent in her office, retorted: “I don’t know Bill Gates but I do know that Dolly Parton gave a million bucks.” (Ms. Parton is northeast Tennessee’s favorite daughter.)
“Well, she’s probably OK,” Miss Fields allowed.
“When someone pushes something really hard, I sit back, because I don’t like people telling me, ‘This is what you need to do,’ ” Miss Fields said. Echoing many others, she added, “I need to do my own research.”
For now, she neither urges nor discourages patients to get the vaccine.
Persuasion
The day the Fletchers, the retired couple, spoke about the vaccine with their family physician, Dr. Daniel Lewis, was the one-year anniversary of the day he was put on a ventilator with a severe case of Covid.
Dr. Lewis, 43, remained hospitalized for over a month. He was so gravely ill that he recorded farewell messages for his five children.
Over his 13 years in Greeneville, Dr. Lewis, a volunteer physician for school sports teams and chief medical officer for four Ballad Health regional hospitals, accrued a wide community of support. During his illness, people dropped off meals and restaurant gift cards on his porch and kept up a surging prayer chain. They mowed his lawn, mulched his flower beds, fixed his truck.
Dr. Daniel Lewis, who nearly died from Covid-19 last year, discusses the ordeal in his backyard in Greeneville, Tenn.
Dr. Lewis posted a dire hospital update. The community showered his family with support, including a prayer chain.
Dr. Lewis discusses the Covid vaccine with the Fletchers, who are deeply skeptical.
When he left the hospital, 34 pounds thinner, weak and wobbly, he and his wife, devout Baptists, struggled to figure out God’s purpose behind the ordeal.
Patients kept telling him, “I didn’t take Covid seriously until you got sick.”
So Dr. Lewis began using that hard-earned credibility to speak about the vaccine, visiting nursing homes, addressing churches, making videos. He honed his pitch to meet every pushback, from faux-scientific to conspiratorial to spiritual.
Although many Appalachians used to resist seeing the doctor, family medicine practitioners like Dr. Lewis are becoming trusted figures. But discussing vaccines with patients takes time, which many doctors can’t afford, and an established relationship, which many poor patients don’t have.
Dr. Lewis gives a soft sell that sometimes works. A patient will say, “So are you going to give me the vaccine now?”
He has to respond, “I don’t have it here.” The patient shuts down. “Then I’m not going to take it.”
Could Dr. Lewis persuade the Fletchers to get the vaccine?
Mr. Fletcher doesn’t fret about long-term side effects. His prostate cancer has returned, one more blow in a Job-like year that saw the unexpected death of his younger son, a paraplegic, and the death of a nephew, an emergency room physician. A year in which dear friends severed their relationship with the Fletchers because of the couple’s Covid skepticism.
“When you get older, you think you have no more tears, but then something causes them to come back,” he said in a subdued voice.
Dr. Lewis patiently addressed the Fletchers’ questions, delineating between what researchers do and don’t yet know.
“How can we be sure there are no chips in the vaccine, like the things you put in your dog?” Mr. Fletcher asked.
“We can’t make microchips that small,” Dr. Lewis countered.
“Well, it’s like a grain of rice,” said Mr. Fletcher.
“I couldn’t inject a grain of rice with a needle,” Dr. Lewis said.
Dr. Lewis held up his smartphone. If you’re worried about being tracked, he said, all the technology is right here, in the very thing you pick up every day. Every hour.
The Fletchers looked abashed.
“It’s your decision,” Dr. Lewis said gently. “I just want you to be able to make an informed decision and I want to do the best I can to help you.”
Mr. Fletcher replied, “Well, we have to spend some time in discussion.”
Later, Dr. Lewis was optimistic: “I think I can eventually persuade them.”
To date, the Fletchers say they will not take the vaccine.
Early morning mist in Greeneville, Tenn. Whether people here can be persuaded to take the Covid vaccine is uncertain.
President Biden has not ruled out requiring military personnel to get a COVID-19vaccine, saying it will be a "tough call."
Biden has said that when it comes to the military, he will leave it to the Armed Forces to decide, but that he hasn’t ruled out requiring the vaccine.
"I’m not saying I won’t," Biden told "The Today Show" on Friday. "I think you’re going to see more and more of them getting it. And I think it’s going to be a tough call whether or not they should be required to get it in the military, because you’re in such close proximity with other military personnel."
The push to vaccinate America has defined the first 100 days of Biden’s presidency: After rapidly surpassing his initial goal of 100 million doses administered in 100 days, Biden watched as 200 million Americans received vaccinations.
Biden’s comments came in response to a recent survey that found that 40% of Marines will not take the vaccine. That translates to around 48,000 of the 123,000 Marines declining the shot when offered the chance to receive it.
The requirement would only be after the vaccine receives final approval. Currently, vaccines are being distributed with "emergency use authorization" by the Food and Drug Administration (FDA).
So far, more than 237 million doses of the jab have been administered nationwide, with around 50% of Americans having received at least the first shot of a vaccine.
Why it matters: That's 38% of the country's adult population — and 55% of the adult population has had at least one shot. All told, the U.S. has administered nearly 240 million shots.
That is an enormous success, in such a short time. But, of course, it only gets harder from here — both domestically and globally.
What's next: Moderna is planning to dramatically expand its manufacturing capacity, both to keep up with the extreme global demand and to start making booster shots to address COVID-19 variants.
The company upped its minimum expected output for this year, saying it now expects to make at least 800 million doses, and that it'll be able to make as many as 3 billion doses in 2022.
Between the lines: The U.S. has a stranglehold on the Pfizer and Moderna vaccines doses right now, and Moderna said it's increasing its domestic manufacturing capacity by 50%.
But it's also making big investments in overseas facilities, which will allow it to serve more of the world.
For the first time, Pfizer is now exporting some of the doses it's making in the U.S., Reuters scoops.
Has-been rock star Ted Nugent told the world last week that he has COVID-19. Nugent’s announcement was an oddity because he previously called the viral pandemic a “leftist scam to destroy” former president Donald Trump. As I watched Nugent’s Facebook Live post, in which he repeatedly hocked up wads of phlegm and spit them to the ground, I got emotional when he described being so sick he thought he “was dying.” But when he trashed the COVID-19 vaccine and warned people against taking it, I realized that the emotion I was feeling was not empathy, it was anger.
For the better part of a year, as the coronavirus racked up hundreds of thousands of American deaths, the flickering light at the end of the tunnel was herd immunity — the antibody force-shield that comes when enough people have survived the illness or have been vaccinated against it. "Go get vaccinated, America," President Biden said in his speech to Congress this week, referring to the shot as "a dose of hope.”
Friends don't let friends spread COVID
Anthony Fauci, the nation’s top infectious disease doctor, suggested in December that if 75% to 85% of the population got vaccinated, we could reach herd immunity by June. And with herd immunity, we’d return to a measure of “normalcy,” meaning indoor dining, movie theaters and hugs.
But herd immunity is slipping away because a quarter of Americans are refusing to get the COVID-19 vaccine. Dr. Gregory Poland, director of the Mayo Clinic's Vaccine Research Group recently said: “There is no eradication at this point, it’s off the table. …We as a society have rejected” herd immunity. Hmm, no! “We” have not rejected anything. A quarter of the country is ruining it for all of us.
It’s not just wacky former rockers who have put herd immunity out of reach. It is white evangelicals (45% say they won't get vaccinated). And it is Republicans (almost 50% are refusing the vaccine). In Texas, 59% of white Republicans have said “no” to the vaccine. You can slap the euphemism “vaccine hesitancy” on the problem, but in the end the G.O.P., and the children of G.O.D., are perpetuating a virus that is sickening and killing people in droves.
A big part of the problem stems from the cultish relationship many evangelicals and Republicans have with former President Donald Trump. They absorbed his endless efforts to downplay the danger of the virus and turn public health precautions into a political freedom movement. But the time for analyzing why these human petri dishes have chosen to ignore the medical science that could save them, and us, is over. We need a different strategy. I propose shunning.
COVID-19 vaccination site on April 27, 2021, in Los Angeles.
Biden’s wildly successful vaccine rollout means that soon everyone who wants a vaccine will have one. When that happens, restaurants, movie theaters, gyms, barbers, airlines and Ubers should require proof of vaccination before providing their services.
And it shouldn’t stop there. Businesses should make vaccination a requirement for employment. A COVID outbreak can shut down a business and be financially devastating. And failure to enforce basic health and safety measures is not fair to employees who have to work in offices, factories, and stores where close contact is required. Things should get personal, too: People should require friends to be vaccinated to attend the barbeques and birthday parties they host. Friends don’t let friends spread COVID.
As I’m writing this I can almost see the Twitter rebuttals: “If people want to risk being microchipped by the deep state, they can protect themselves by getting a vaccine without making me do the same.” Nope. In its real life application, the vaccine is about 90% effective. Sure, that’s impressive, but if the roulette wheels makes you one of the unlucky 10%, it’s little consolation.
There have already been several thousand documented “breakthrough” cases of COVID-19 infections in people who have been vaccinated. Some have died. And with coronavirus variants popping up across the globe, for which the vaccine is less effective, we should expect to see more infections in vaccinated people.
Half-witted personal autonomy
Unwilling to miss an opportunity to flout common sense, Republican leaders from Florida, Pennsylvania, Wisconsin, Arkansas and other states want to prevent businesses from requiring customers to be vaccinated. Florida Gov. Ron DeSantis has already issued an executive order “prohibiting businesses from requiring patrons or customers to show vaccine documentation.”
There are decades of state laws that require vaccination before children can attend schools. There are seatbelt and helmet laws, no-texting-while-driving laws, and countless other laws that restrict individual freedoms to ensure safety for the public at large. Despite this, vaccine requirements designed to curb a global pandemic that has cost us more than 570,000 American lives is the hill on which Republicans want to die.
When states pass these laws, designed to tell private companies how to run their businesses, there should be immediate legal challenges. Surely, if a bakery can refuse to provide its services to a gay couple getting married, they can refuse to bake a cake for people who choose to place themselves, the bakery staff and its customers at risk of contracting a deadly illness.
As a country, America has become too tolerant of half-witted individual autonomy that ignores the existential needs of the vast majority of its citizens. While writing this column I caught a TV promo for a new documentary in which Cher saves an elephant. It made me think of her performance in "Moonstruck." Vaccine hesitancy? We need Cher to slap us in the face and tell us to “snap out of it.”
Michael J. Stern, a member of USA TODAY's Board of Contributors, was a federal prosecutor for 25 years in Detroit and Los Angeles. Follow him on Twitter: @MichaelJStern1
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Misinformation and lack of information during the pandemic have made it even harder for people to assess risk. Xesai/Getty Images The decision to pause and then restart the Johnson & Johnson vaccine underscores how hard it is even for experts to gauge health risks. It’s been still harder for everyday people, most of whom have no medical background and little experience analyzing risks and benefits. People have experienced confusion about mask-wearing, physical distancing, travel, remote work, financial assistance measures and more. Now people are weighing uncertainty about vaccines. Further, some members of historically marginalized groups are skeptical of vaccine safety, as retired NFL star Marshawn Lynch detailed in a recent interview with Dr. Anthony Fauci, chief medical adviser to President Biden. We are informatics and regulation researchers who study intersections among information, policy and human behavior. We have recently studied the intensive “risk work” individuals are doing amid the COVID-19 pandemic. Our research, which is scheduled to be published next month, provides insight into how people in the U.S. perceive pandemic-related risks and how they draw on information to assess and manage them. Worry beyond COVID-19 To understand people’s perceptions of risk, we conducted interviews that allowed people to explain their beliefs and experiences in detail. We recruited this sample using nationwide group email lists and social media. Based on an initial short intake form, we selected participants to create a sample that was diverse in terms of age, geographic location and self-reported difficulties that people were facing during the pandemic. We conducted interviews with 40 people, and we paid them for their time. These interviews revealed that people conceive of COVID-19 risks as more diverse and complex than popular narratives about managing “health versus the economy” suggest. Though illness and economic risks were dominant concerns of our interviewees, people also spoke about risks from secondary illness, threats to social and behavioral well-being and the erosion of key institutions. Risk of COVID-19 illness included apprehension about the prospect of being unwell, suffering with a severe disease and dying. Participants worried about becoming severely sick with COVID-19, but they differed in their perceptions of who was more likely to become gravely ill. There was general agreement that elderly people and people who had underlying medical conditions were at higher risk. Wanting to know which groups were especially “at risk” was very important for many people we interviewed. They talked about dangers of illness for “society,” “everyone,” “elderly people,” and “people in a certain socioeconomic group.” They also discussed risks to themselves or their close social contacts, such as references to “my dad who is elderly and sick” and “my son-in-law who is a deputy sheriff and encounters homeless people with COVID symptoms.” Concern about other illnesses and stress Participants associated “secondary” illness risks with health care resource shortages. Many described the increased likelihood of death from other serious conditions if the health care system became overrun with COVID-19 patients. They understood that an overstretched system would not be able to provide normal levels of care and that it also meant that patients would be more likely to suffer or die. They described multiple interrelated threats to social and behavioral well-being. Social and behavioral risks included things like anxiety, depression, stress, damaged relationships and career setbacks. Mental illness, for example, emerged as a potential risk from widespread and personal social isolation, which could lead to loneliness and depression. Interviewees understood estrangement in personal relationships as a risk for themselves and others. A grandmother who used to take care of her grandchild two days a week thought her personal relationship with her young granddaughter could fray through the lack of in-person contact during the pandemic. Other participants felt there was a risk in terms of delays in life trajectories – for example, careers derailed or set back years and developmental delays among children whose schooling was canceled or altered. Economic risks spanned concerns about job and income loss, recession and the inability to find work. As with illness risks, participants framed economic risk both broadly in terms of society and specifically in relation to certain populations they perceived as being “at-risk,” such as recent graduates, millennials, business owners and poor people. Many participants characterized the wider economic implications as potentially disastrous, explaining the risks as similar to or greater than the virus itself. Some even described an economic threat that could dwarf the Great Depression of the 1930s or the global financial crisis of 2007-2008. They also mentioned specific threats, such as business closures, sweeping losses to retirement income and declines in home values. The ticket office for Broadway shows closed March 13, 2020. Lev Radin/Pacific Press/LightRocket via Getty Images Changes to institutions, and even the arts Another identified risk was crumbling institutions. Participants saw the pandemic as a threat to public health, the health care system, educational systems, the arts, the federal government and business. They believed that if these systems fell apart there would be long-term ramifications. As a 22-year-old resident of Arizona said, “I was more worried about the societal changes than the actual virus, if that makes sense.” Many interviewees reflected on institutional failures. For example, one participant, interviewed in 2020, explained how the pandemic had led to a crisis of leadership for the country, with states left to fend for themselves to manage the effects of COVID-19 without adequate federal support. Others felt that institutions being at risk meant core rights and privileges that Americans typically enjoyed – such as privacy – were also at risk. [The Conversation’s science, health and technology editors pick their favorite stories. Weekly on Wednesdays.] Helping people manage COVID-19 risks Our participants reported that most of the information about COVID-19 risks available to them addressed only COVID-19 illness and not other types of risks associated with the pandemic, and often contained conflicting recommendations. As a result, our participants said they received little helpful information about how to manage the multiple forms of risk they were perceiving. According to our research, not having information to validate these other perceived risks had a spillover effect: It fueled a sense that authorities were not addressing urgent threats. Advice on managing COVID-19 illness that fails to acknowledge other risks contributes to a loss of trust and, in turn, may undermine compliance with guidelines. Studies show that people perceive messaging about COVID-19 to be fragmented and conflicted. This is dangerous, because past studies show that exposure to health massages that are conflicting leads to decreased trust in authoritative sources of information. Our findings led us to the same conclusion. They made clear that the issue is even broader, because people are receiving inadequate information about multiple pandemic risks, not just COVID-19 illness. In addition, our participants said that authoritative sources of risk information tend to be too general. People said that they often turned to individuals in their social networks to help them obtain relevant information and better understand risk – for example, a cousin who is a nurse working on the front lines. We found that these informal communications with experts are important but often overlooked. Acknowledging the informal work that these experts do and developing strategies to support this labor could inform individuals’ risk management. It could also alleviate anxiety during this uncertain time. For example, clinicians receive information updates from local, state and national health agencies and the organizations where they practice. Clinicians often translate this information for their social contacts through informal communications. Alongside clinical updates, they could receive information sheets describing COVID-19 risks and risk management strategies that they could distribute via social media and other channels to their networks. Picture an easily understandable breakdown of the risks and benefits of the Johnson & Johnson vaccine that clinicians could share broadly with the click of a button to group chats and social media accounts.This article is republished from The Conversation, a nonprofit news site dedicated to sharing ideas from academic experts. It was written by: Kathleen H. Pine, Arizona State University; Kathryn Henne, Australian National University, and Myeong Lee, George Mason University. Read more:How worried should you be about coronavirus variants? A virologist explains his concernsTwo gaps to fill for the 2021-2022 winter wave of COVID-19 cases Kathryn Henne receives funding from the Australian National University Futures Scheme.Kathleen H. Pine and Myeong Lee do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
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