Covid case counts are down in U.S., yet bad signs abound

More and cheaper at-home tests in works

Cole Downing receives the Johnson & Johnson vaccine during a drive through vaccine clinic in downtown Little Rock on Saturday, Aug. 7, 2021. The clinic was hosted by the Junior League of Little Rock, in partnership with the Arkansas Department of Health and ExpressRx. (Arkansas Democrat-Gazette/Stephen Swofford)
Cole Downing receives the Johnson & Johnson vaccine during a drive through vaccine clinic in downtown Little Rock on Saturday, Aug. 7, 2021. The clinic was hosted by the Junior League of Little Rock, in partnership with the Arkansas Department of Health and ExpressRx. (Arkansas Democrat-Gazette/Stephen Swofford)

Tumbling covid-19 case counts have some schools around the U.S. considering relaxing their mask rules, but deaths nationally have been ticking up over the past few weeks, some rural hospitals are showing signs of strain, and cold weather is setting in.

In a development Monday that health experts say could be especially beneficial as winter approaches, the Biden administration announced additional steps to increase the availability of rapid at-home coronavirus tests and bring down their cost.

The biggest change is a $70 million investment by the National Institutes of Health -- using money from the American Rescue Plan Act -- to help manufacturers navigate the Food and Drug Administration's regulatory process. The institutes program aims to speed up the authorization process for new tests by helping manufacturers produce the data that regulators need. It will also identify rapid tests that have the potential to be produced and distributed on a large scale.

The at-home tests could be particularly useful during what experts predict may be a bad flu season, particularly in settings such as schools, long-term care facilities and nursing homes. The tests, some of which return results within minutes, can help distinguish between flu and coronavirus -- for which symptoms can be highly similar -- and help ensure those most at risk, including the elderly and immunocompromised, are protected.

The administration's efforts to increase testing come just as it is expected to finalize a rule requiring businesses with more than 100 employees to mandate vaccinations for all employees or else face weekly testing. Experts have said the at-home tests could play a crucial role in the implementation of that rule for employees who opt for regular testing instead of vaccination. The rule is expected to cover 100 million employees.

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"This is all extremely good news, and I love that they are expanding the validation efforts so that there won't just be more tests, but high-quality tests," said Gigi Gronvall, a senior scholar at the Johns Hopkins Center for Health Security. "Unfortunately, testing is one of those things that we can't just leave up to the market to decide -- things could change in the pandemic that make testing more or less a priority for individuals."

FALLING CASES

The number of new cases nationally has been plummeting since the delta surge peaked in mid-September. The U.S. is averaging about 73,000 new cases per day, less than half of the nearly 173,000 recorded on Sept. 13. And the number of Americans in the hospital with covid-19 has plummeted by about half to around 47,000 since early September.

In Florida, Miami-Dade County's mask mandate could be loosened by the end of October if the encouraging numbers continue, and nearby Broward County will discuss relaxing its requirement today. The superintendent in metro Atlanta said he will consider waiving mask requirements at individual schools.

A high school outside Boston became the first in Massachusetts to make masks optional after it hit a state vaccination threshold. With about 95% of eligible people at Hopkinton High inoculated, school leaders voted to allow vaccinated students and staff members to go maskless for a three-week trial period starting next week.

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As schools weigh easing restrictions, Moderna said Monday that a low dose of its covid-19 vaccine is safe and appears to work in 6- to 11-year-olds, as the manufacturer joins its rival Pfizer in moving toward expanding shots to children.

SHOTS FOR KIDS

Pfizer's kid-size vaccine doses are closer to widespread use. They are undergoing evaluation by the FDA for youngsters in nearly the same age group, 5 to 11, and could be available by early November. The FDA's advisers will weigh Pfizer's evidence in a public meeting today.

Moderna hasn't yet gotten the go-ahead to offer its vaccine to teens but is studying lower doses in younger children while it waits.

Researchers tested two shots for the 6- to 11-year-olds, given a month apart, that each contained half the dose given to adults. Preliminary results showed vaccinated children developed virus-fighting antibodies similar to levels that young adults produce after full-strength shots, Moderna said in a news release.

The study involved 4,753 children 6 to 11 who got either the vaccine or a dummy shot. The study was too small to spot any extremely rare side effects, such as heart inflammation that sometimes occurs after either the Moderna or Pfizer vaccines, mostly among young men.

In a related development Monday, the Biden administration announced that vaccination will not be required for those younger than 18 to travel to the United States once officials lift a ban on international visitors, but they will have to show proof of a negative coronavirus test before boarding a flight.

With roughly two weeks to go before the United States lifts a travel ban on visitors from 33 countries -- on Nov. 8 -- federal health officials offered more specifics for travelers and airlines. While vaccination won't be required for children, most noncitizens and nonimmigrants arriving by air will have to show both proof of vaccination and proof of a negative coronavirus test taken at least three days before departure.

'LIKE A WAR ZONE'

Along with cooling weather, other troubling trends showed up in national news reports. With required mask use reduced in much of the United States, the University of Washington's influential covid-19 forecasting model is predicting increasing infections and hospitalizations in November.

Also, deaths per day have begun creeping back up after a decline that started in late September. Deaths are running at about 1,700 per day, up from close to 1,500 two weeks ago. The toll has seemed especially high recently in rural hospitals.

In sparsely populated Wyoming, which has one of the nation's lowest vaccination rates, hospitals are coping with more patients than at any other point in the pandemic.

"It's like a war zone," public health officer Dr. Mark Dowell told a county health board about the situation at Wyoming Medical Center, the Casper Star Tribune reported. "The ICU is overrun."

The vast majority of hospitalized patients in Wyoming haven't gotten the vaccine; the state's vaccination rate is about 43%, and only West Virginia ranks lower.

In rural Minnesota, a man waited two days for an intensive-care bed and later died. Bob Cameron, 87, had gone to to his hometown hospital in Hallock with severe gastrointestinal bleeding and covid-19. Officials searched for space in a larger center.

The bleeding exhausted the hospital's blood supply, and state troopers drove 130 miles with more, but his condition worsened after surgery and he died Oct. 13, the Minneapolis Star Tribune reported.

"We can't say for certain, of course, that if he got to an ICU bed sooner that he would have survived, but we just feel in our hearts that he would have," said Cameron's granddaughter, Janna Curry.

During a three-week stretch this month, rural hospitals in Minnesota were caring for more covid-19 patients than those in the state's major urban center, Minneapolis-St. Paul.

The strain on hospitals in Colorado forced a second county to reinstitute an indoor mask mandate last week, the Denver Post reported. Nearly 80% of covid-19 patients in Colorado hospitals are unvaccinated.

LITTLE INFLUENCE

A new study now shows that financial incentives and other nudges by local governments and employers have failed to increase vaccinations among Americans who are hesitant about getting the shot.

Such measures actually decreased vaccination rates among some groups, underscoring fears about a public backlash, according to the paper circulated by the National Bureau of Economic Research.

States and cities including California and Chicago have offered gift cards to encourage people to get the vaccine, while employers have offered a range of incentives including cash bonuses. Several states have run lotteries for people who get vaccinated, with prizes of $1 million or more.

The bureau paper, based on surveys in Contra Costa County in California, found that public health messages did have a positive impact on vaccination intentions but no real impact on actual vaccination rates.

"Reaching a goal of very high vaccination rates likely requires much stronger policy levers, such as employer rules or government mandates," wrote the authors, who include Tom Chang and Mireille Jacobson of the University of Southern California.

Information for this article was contributed by Lindsay Whitehurst and Lauran Neergaard of The Associated Press; by Yasmeen Abutaleb and Lori Aratani of the Washington Post; and by Reade Pickert of Bloomberg News.

FILE - In this Oct. 25, 2021, file photo, registered Nurse Carisa Vincent, and Hope Rose Kelly prepare pool tests for COVID-19 behind a mountain of supplies at Reid Middle School in Pittsfield, Mass. Tumbling COVID-19 case counts have some schools around the U.S. considering relaxing their mask rules, but deaths nationally have been ticking up over the past few weeks, some rural hospitals are showing signs of strain, and cold weather is setting in. (Ben Garver/The Berkshire Eagle via AP, File)
FILE - In this Oct. 25, 2021, file photo, registered Nurse Carisa Vincent, and Hope Rose Kelly prepare pool tests for COVID-19 behind a mountain of supplies at Reid Middle School in Pittsfield, Mass. Tumbling COVID-19 case counts have some schools around the U.S. considering relaxing their mask rules, but deaths nationally have been ticking up over the past few weeks, some rural hospitals are showing signs of strain, and cold weather is setting in. (Ben Garver/The Berkshire Eagle via AP, File)
FILE - In this Oct. 7, 2021, file photo, Sarah Staffiere adjusts a face covering on her daughter, Natalie, before school in Waterville, Maine. Tumbling COVID-19 case counts have some schools around the U.S. considering relaxing their mask rules, but deaths nationally have been ticking up over the past few weeks, some rural hospitals are showing signs of strain, and cold weather is setting in. (AP Photo/Robert F. Bukaty, File)
FILE - In this Oct. 7, 2021, file photo, Sarah Staffiere adjusts a face covering on her daughter, Natalie, before school in Waterville, Maine. Tumbling COVID-19 case counts have some schools around the U.S. considering relaxing their mask rules, but deaths nationally have been ticking up over the past few weeks, some rural hospitals are showing signs of strain, and cold weather is setting in. (AP Photo/Robert F. Bukaty, File)