A high school prom in Hawaii where masked dancers weren’t allowed to touch. A return to virtual city council meetings in one Colorado town after the mayor and others tested positive following an in-person session. A reinstated mask mandate at skilled nursing facilities in Los Angeles County after 22 new outbreaks in a single week.
A COVID-19 surge is underway that is starting to cause disruptions as the school year wraps up and Americans prepare for summer vacations. Many people, though, have returned to their pre-pandemic routines and plans, which often involve travel.
Case counts are as high as they’ve been since mid-February and those figures are likely a major undercount because of unreported positive home test results and asymptomatic infections. Earlier this month, an influential modeling group at the University of Washington in Seattle estimated that only 13% of cases were being reported to U.S. health authorities.
Hospitalizations are also up and more than one-third of the U.S. population lives in areas that are considered at high risk by the Centers for Disease Control and Prevention. The Northeast has been hit the hardest.
Yet vaccinations have stagnated and elected officials nationwide seem loath to impose new restrictions on a public that’s ready to move on even as the U.S. death toll surpassed 1 million people less than 2 1/2 years into the outbreak.
“People probably are underestimating the prevalence of COVID,” said Crystal Watson, public health lead in the Johns Hopkins Center for Health Security’s Coronavirus Resource Center. “I think there’s a lot more virus out there than we recognize, and so people are much, much more likely than they anticipate to be exposed and infected.”
A major metric for the pandemic — the seven-day rolling average for daily new cases in the U.S. — skyrocketed over the last two weeks, according to data from Johns Hopkins University. The figure was about 76,000 on May 9 and jumped to nearly 109,000 on Monday. That was the highest it had been since mid-February, when the omicron-fueled surge was winding down.
Deaths are still on the decline and hospital intensive care units aren’t swamped like they were at other times during the pandemic, likely because vaccinations and immunity from people who have already had the disease are keeping many cases less severe.
“The nature of the disease has changed. Two years ago I was seeing a steady flow of bad pneumonia cases. Now we are in a situation where people should be able to avoid that outcome by taking advantage of vaccines, pre-exposure prophylaxis (for high risk), and early anti-viral therapy,” said Dr. Jonathan Dworkin, a clinical infectious diseases physician in Hawaii, said by email.
In Hawaii, which once had one of the nation’s lowest rates of infection, hospitalization and death, new cases are surging among the state’s 1.4 million residents.
With cases climbing for eight straight weeks, Hawaii has the second highest infection rate of any state, trailing only Rhode Island. But because positive home test results aren’t counted in official data, Hawaii’s health department estimates that the case count is actually five or six times higher.
Despite its surge, visitors have been flocking to Hawaii’s beaches, especially in recent months.
Yaling Fisher, owner of Hawaii Aloha Travel, said bookings to the islands haven’t slowed during the surge. On the contrary, they’ve increased.
“Even now we are still busy,” she said. “We don’t see any cancellations.”
Samantha Hanberg, who was in Hawaii this week with her newlywed husband, said the couple left their masks at home in California when left for vacation. She said she contracted COVID-19 early in the pandemic and subsequently got fully vaccinated, so she too feels safe.
“Nobody wants to get sick, but it’s definitely not at the forefront of my thought process anymore,” she said, snacking on shave ice on Waikiki Beach. “I’m to the point now where I just I want to go back to living and enjoying life, and not being so worried.”
Officials initially shut down Hawaii’s tourism industry by requiring all incoming passengers to quarantine. They shifted to a testing requirement and then a vaccination exemption before dropping all restrictions in March.
Hawaii was the last state in the nation to drop its mask mandate, though it remains the only state to require all public school students to wear masks while indoors — a rule that will remain in effect throughout the summer and possibly into the next school year.
Nearly two years after California Gov. Gavin Newsom imposed the nation’s first statewide stay-home order, the state formally shifted to an “endemic” approach in February. Like Hawaii and many other states, its weekly infection rate has risen dramatically of late.
The new surge led the school districts in Pacific Grove and Berkeley to reinstate their indoor mask mandates, while an outbreak at a Northern California long-term healthcare facility had sickened at least 12 people by Friday.
Some Northeastern school districts have also revived their mask mandates, including those in Philadelphia and Providence, Rhode Island.
However New York, which was once the U.S. epicenter of the pandemic, doesn’t seem likely to follow suit. The city is dealing with another surge in cases, but Mayor Eric Adams has all but ruled out bringing back a citywide mask mandate unless hospitals get inundated again.
The city’s school district jettisoned its practice of closing classrooms if multiple students test positive, merely recommends that masks be worn and even abandoned its requirement that students need to be vaccinated to attend prom.
U.S. births bumped up last year, but the number of babies born was still lower than before the coronavirus pandemic.
The 1% increase was a bit of a rebound from 2020, the first year of the pandemic, which witnessed the largest one-year drop in the U.S. births in nearly 50 years.
But there were still about 86,000 fewer births last year than in 2019, according to a government report released Tuesday.
“We’re still not returning to pre-pandemic levels,” said Dr. Denise Jamieson, chair of gynecology and obstetrics at Emory University School of Medicine.
U.S. births had been declining for more than a decade before COVID-19 hit, and “I would expect that we would continue to see small, modest decreases,” she said.
Officials think last year’s uptick reflects births from pregnancies that had been put off during the uncertain early days of the pandemic. Deliveries were way down in January 2021, but improved as the year went on, said Brady Hamilton of the U.S. Centers for Disease Control and Prevention. Much of the increase was seen in older moms.
“These are births that were postponed,” said Hamilton, lead author of the new report.
The report is based on a review of nearly all birth certificates issued last year.
Some of the key findings:
— Nearly 3.7 million births were reported last year, up from the roughly 3.6 million recorded in 2020.
— Birth rates dropped again for teens and for women younger than 25, but rose 3% for women in their early 30s, 5% for women in their late 30s, and 3% for women in their early 40s.
— Birth rates rose 1% for Hispanic women and 3% for white women. But they fell 1% for Asian women, 3% for Black women, and 4% Native American and Alaska Native women. That may reflect the pandemic’s harsher impact on the health and lives of some racial groups, experts said.
—The U.S. was once among only a few developed countries with a fertility rate that ensured each generation had enough children to replace itself — about 2.1 kids per woman. But it’s been sliding, and in 2020 dropped to about 1.6, the lowest rate on record. It rose slightly last year, to nearly 1.7.
—The percentage of infants born small and premature — at less than 37 weeks — rose 4%, to about 10.5%. It was the highest it’s been since 2007.
The premature birth rate had declined slightly in 2020, and health officials aren’t sure why the increase occurred. But older moms are more likely to have preterm births, as are women infected with COVID-19, said the CDC’s Joyce Martin, a study co-author.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
China is trying to navigate its biggest coronavirus outbreak without a tool it could have adopted many months ago, the kind of vaccines that have proven to offer the best protection against the worst outcomes from COVID-19.
As early as the spring of 2020 a Chinese pharmaceutical company, Fosun Pharma, reached an agreement to distribute — and eventually manufacture — the mRNA vaccine made by Pfizer and BioNTech. It still has not been cleared in mainland China, despite being authorized for use by separate authorities in Hong Kong and Macao.
Now health experts say that delay — a result of putting politics and national pride above public health — could lead to avoidable coronavirus deaths and deeper economic losses because whole cities would be locked down to insulate the country’s unprotected population.
“The biggest issue is about the delay of the reopening,” said Xi Chen, a health economist at Yale University’s School of Public Health. “The consequences will be huge, the supply chain disruption, the disruption to all kinds of service sectors.”
Studies have consistently shown that vaccination with mRNA vaccines made by Pfizer-BioNTech and Moderna offer the best protection against hospitalization and death from COVID-19. Chinese vaccines made with older technology proved fairly effective against the original strain of the virus, but much less so against more recent variants.
As this evidence became clearer, even countries that initially used Chinese vaccines and some other less effective Western-made vaccines have turned to mRNA vaccines for booster shots and new vaccinations.
Not China. Regulators have not publicly said why they have not acted — the mRNA vaccines are authorized in much of the world and have proven safe and effective in hundreds of millions of people. But a Chinese health official and another person directly involved in the negotiations told The Associated Press that authorities have held back because they want to master the technology in China and not depend on foreign suppliers. Both spoke on condition of anonymity, given the sensitive nature of the issue.
For more than a year, the approach seemed defensible. The country was able to keep the virus at bay better than any other large nation with its strict “zero COVID” approach that isolates infected people and locks down communities when infections pop up.
But now, the highly transmissible omicron variant is testing that strategy, requiring ever wider and longer lockdowns that are taking a greater economic and human toll. While other countries are able to operate close to normal because their people are protected by vaccination or previous infection, China is left with only its lockdown strategy to avoid huge numbers of hospitalizations and deaths.
China may be changing its mind. The Communist Party-owned Global Times newspaper reported last month that Fosun Pharma is still working with health authorities on its approval and Shanghai authorities recently issued new policies that could allow the import of COVID-19 vaccines. Fosun, based in Shanghai, did not respond to questions about the announcement.
China’s National Health Commission directed questions to the country’s drug regulator, the National Medical Products Administration. That agency did not respond to a faxed request for comment.
In the meantime, hopes for a Chinese-developed mRNA vaccine center on Abogen Biosciences, a startup founded in 2019 by Bo Ying, an American-trained scientist who once worked for Moderna.
The company has partnered with more established companies in the country such as Walvax, a private company founded in 2001, and the Academy of Military Medical Sciences, the military’s medical research facility. Abogen has raised more than $1.7 billion since 2020.
The company’s vaccine candidate succeeded in eliciting an immune response in a small, preliminary test in humans designed to evaluate safety, according to a study published in the journal Lancet Microbe.
The results were “promising,” said Dr. Vineeta Bal, who studies immune systems at the Indian Institute of Science Education and Research in Pune, India, although she said that a direct comparison of the immune response the shot triggered with the Pfizer and Moderna vaccines would have helped scientists better evaluate its performance.
But large studies that are needed to show whether the shot works to prevent infections or symptoms have not been completed. Abogen did not respond to requests for an interview.
Even if the studies can be completed and the vaccine proves effective, manufacturing the millions of doses required will be a challenge, experts say. Abogen built a manufacturing facility in December 2020 with a projected capacity of up to 120 million doses a year.
Manufacturing that vaccine and ensuring quality at scale will be a difficult hurdle to clear because mRNA is still a new technology, said Scott Wheelwright, chief operating officer at BioInno Bioscience, a Chinese biopharmaceutical contract manufacturer who has held conversations with Abogen.
In the meantime, Chen, the Yale health policy expert, said the Chinese government should better protect its elderly population by both approving the Pfizer vaccine and encouraging booster shots.
Using a Chinese phrase that means “giving up completely,” Chen said the change from “zero COVID” does not have to be all or nothing. “It doesn’t have to be tang ping or sticking to zero COVID,” Chen said. “I don’t think there are only two solutions, and we can stick to a middle ground.”
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Ghosal reported from New Delhi. Associated Press journalist Dake Kang in Beijing contributed to this report.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
Total Doses Distributed = 741,676,155. Total Doses Administered = 584,449,398. Number of People Receiving 1 or More Doses = 258,174,992. Number of People Fully Vaccinated = 220,933,970.
A federal appeals court is being asked to reconsider its decision allowing the Biden administration to require that federal employees get vaccinated against COVID-19.
A panel of the 5th U.S. Circuit Court of Appeals last month vacated a lower court ruling blocking the mandate and ordered dismissal of a lawsuit challenging the policy, which was ordered by President Joe Biden in September.
However, that 2-1 ruling by the appellate panel doesn’t take effect until May 31. On Saturday, opponents of the mandate, led by a group called Feds for Medical Freedom, filed a petition asking that the April ruling be vacated and that the full 17-member court hear new arguments in the case.
On Monday, the 5th Circuit asked the government to respond by June 2; it was unclear if the court would take any action before then.
Biden issued an order Sept. 9 that more than 3.5 million federal executive branch workers undergo vaccination, with no option to get regularly tested instead, unless they secured approved medical or religious exemptions.
U.S. District Judge Jeffrey Brown, who was appointed to the District Court for the Southern District of Texas by then-President Donald Trump, issued a nationwide injunction against the requirement in January. At the time, the White House said 98% of federal workers were already vaccinated.
In February, one 5th Circuit panel refused to block Brown’s ruling pending appeal. After hearing arguments in March, a different panel ruled 2-1 that Brown didn’t have jurisdiction in the case and those challenging the requirement could have pursued administrative remedies under Civil Service law.
Judges Carl Stewart and James Dennis, both nominated to the court by Democratic President Bill Clinton, were in the majority. Judge Rhesa Barksdale, a senior judge nominated by Republican President George H.W. Bush, dissented, saying the relief the challengers sought does not fall under the Civil Service Reform Act cited by the administration.
Parents hoping to get their youngest children vaccinated against COVID-19 got some encouraging news Monday.
Pfizer said three small doses of its vaccine offers strong protection to youngsters under 5, according to preliminary data. That news comes a month after Moderna said it would ask regulators to OK its two doses tor the youngest kids.
But a few steps remain before the shots are available. Health officials and their expert panels must first decide they are safe enough and provide enough protection to authorize them.
FDA REVIEW
U.S. Food and Drug Administration vaccine chief Dr. Peter Marks has pledged the agency will “move quickly without sacrificing our standards” in evaluating tot-sized doses from both Pfizer and Moderna.
The FDA has tentatively set a June 15 date for its scientific advisers to publicly review the two companies’ vaccines. After the advisers weigh in, the FDA determines whether to authorize the shot.
Moderna is seeking clearance for two low-dose shots for children under age 6 while Pfizer hopes to offer three extra-low doses to kids under age 5 — differences due to how each company studied its vaccine. Currently the U.S. recommends vaccinations for everyone age 5 and older, and Pfizer is the only option for those children. Moderna for now is used only in adults in the U.S.
CDC REVIEW
If either vaccine is cleared for the littlest kids, the Centers for Disease Control and Prevention would have to recommend whether all babies, toddlers and preschoolers should receive them or only those at high risk of a serious illness.
The CDC would convene its own panel of advisers to debate the recommendation before issuing its official guidance.
ROLLOUT
The Biden administration has said the shots will roll out rapidly, and most tots are expected to be vaccinated in pediatricians’ offices or health clinics. It’s not clear how much demand there will be to vaccinate the youngest kids, however. Pfizer shots for 5- to 11-year-olds opened in November, but only about 30% of that age group have gotten the recommended initial two doses.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
