Varied COVID vaccination rates may lead to ‘two Americas’

June 23, 2021 – Will differences in COVID vaccination rates across the country ultimately divide America?

The highly transmissible delta variant of the coronavirus is on the increase in the United States, which has led the CDC to predict that this strain of concern will soon prevail.

This prospect raises the question of whether areas of the country with lower vaccination rates might experience worse outcomes. And if so, could the disparity lead to “two Americas”?

“COVID-19 and its variants, including the delta strain, will be a part of our lives for the foreseeable future,” said David Hirschwerk, MD, infectious disease expert at Northwell Health in Manhasset, NY. Medscape.

“So far, everything is fine,” Hirschwerk adds, addressing research on vaccine efficacy against different strains of SARS-CoV-2. For the unvaccinated, however, “this is a major concern because the current variants that are circulating are much more contagious and can make people much sicker.”

Theo Vos, MD, PhD, professor of health metrics science at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle, agrees.

“The delta variant appears to be more infectious than its precursor variants and that means it may take less for explosive spread, especially among populations with low vaccination coverage,” he said.

Clear differences?

Variants and differences in vaccination rates will require vigilance, Hirschwerk says. “Hot spots are likely to occur in areas where vaccine delays in absorption, ”he warns.

When asked if a ‘two Americas’ scenario is possible, “there are clear models with less willpower in the Midwest and Southwest. [and] with a worse picture in rural zip codes, ”Vos says.

Whether regional differences in vaccination rates will translate directly into differences in morbidity and mortality from COVID-19 depends on several factors.

“Unfortunately, a low willingness to vaccinate is often associated with poor compliance with precautionary measures” such as distancing and masks, for example, Vos says. “What mitigates this to some extent is that the spread is easier in densely populated urban areas than in rural areas.”

Risk assessment

As of June 11, an estimated 150 million U.S. adults (45%) are fully vaccinated against the coronavirus, according to CDC data. But the rate in some states is still lower. For example, only 28% of people in Mississippi are fully vaccinated, as are 30% in Alabama and 32% in Arkansas and Louisiana.

Although the vaccination rate is slightly higher in Missouri at 36%, this state now has the highest rate of new cases of COVID-19. In fact, during the week of June 13 to 20, one in 1,349 people in Missouri was diagnosed with COVID-19. .

There are several counties in Missouri that are seeing an increase in COVID-19 activity, ”said Lisa Cox, communications director for the Missouri Department of Health and Seniors Services. Medscape in an email.

The department is working with public health agencies in affected counties and with the CDC to report variants and follow agency guidelines, Cox said.

In addition, state health officials are working on more targeted efforts to get businesses, employers, schools and churches to provide community immunizations.

“We are also engaged in targeted and aggressive public education efforts encouraging unvaccinated Missourians to do so,” Cox adds. “It’s the ‘Show-Me State’ and Missourians are skeptical.”

Protect the unvaccinated

On a more positive note, the higher the proportion of a population vaccinated, the lower the test positivity rate among the unvaccinated, new evidence shows.

Researchers in Israel found that for every 20% increase in the proportion of residents vaccinated, the rate of positive tests among unvaccinated people decreased by about twice. The researchers compared the rates of unvaccinated adolescents and children under 16 to those of those 16 to 50 vaccinated.

“The more people are vaccinated in a community, the more unvaccinated individuals in the same community appear to be protected,” said lead author Oren Milman. Medscape in an email.

“This protection is in addition to the high protection of the vaccinees themselves”, adds Milman, researcher at the Technion Institute of Technology in Haifa,Israel.

the study was published online on June 10, 2021 in Natural medicine.

Although acquired naturally immunity could have altered their results, Milman and his colleagues adjusted for this potential confounder by only including communities across Israel where test positivity rates remained below 10%.

“By extrapolating our results, communities with higher immunization levels could benefit from significantly lower infection rates,” Milman said.

The research did not assess any SARS-CoV-2 variants, however. In addition, actual infection rates could differ from positive test results from community to community and over time, another possible limitation.

“While the observed protection associated with the vaccine in the unvaccinated population is encouraging,” the researchers note, “further studies are needed to understand if and how vaccination campaigns might support the prospect of collective immunity and the eradication of the disease. “

No variation in vaccine advice

Although the variants of concern change over time, the protective measures do not change. “The most effective way to fight the transmission of COVID – regardless of the predominant variant – is to get vaccinated,” says Cox, of the Missouri Department of Health and Senior Services.

“Our biggest defender against the virus is vaccination,” agrees Hirschwerk. “We must continue to step up vaccination efforts. ”

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