1. Kennedy, Maureen Shawn MA, RN, FAAN


Advances against COVID-19 offer hope, but work remains before we can fully move on.


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The pandemic is still very much with us and is surging in some parts of the country. At the end of April, the Centers for Disease Control and Prevention (CDC) noted on the COVID Data Tracker Weekly Review webpage, "Nationally, COVID-19-related emergency department visits as well as both hospital admissions and current hospitalizations have risen among patients ages 18 to 64 years in recent weeks." And while the increase in this age group is concerning, it's an indication that vaccines are working, as the numbers of COVID cases and hospitalizations in older people-those who were vaccinated in the first wave-have fallen. It's also a reminder that, until we get enough Americans vaccinated, we must continue to practice public health prevention measures. We still see, however, too many photos of events with large maskless crowds in some states.

Figure. Maureen Shaw... - Click to enlarge in new windowFigure. Maureen Shawn Kennedy

States that enforced mask wearing and social distancing experienced lowering rates of COVID-19 in their communities. Research published in the August 2020 Health Affairs evaluated the effect of governor-mandated face mask orders in 15 states and Washington, DC, finding that "there was a significant decline in daily COVID-19 growth rate after the mandating of face covers in public, with the effect increasing over time after the orders were signed."


So why are governors of states whose case numbers are climbing removing mask mandates as they open venues? Yes, open up, but keep the mask mandate until cases drop and the majority of the population is vaccinated-the science supports it. Even my five-year-old grandson gets it: "Masks keep my germs in and yours out."


While the vaccines offer hope for a return to travel and social gatherings, they won't be effective unless they are available to everyone-and unless enough people are willing to take them. While estimates have varied as to how many adults would need to be vaccinated to approach herd immunity, many health experts are using 70% to 80% as a goal. As of this writing, 52% of adults in the United States had gotten at least one dose of a vaccine, according to the CDC. But some recent reports have suggested that, as a country, we are close to the tipping point where demand for rather than supply of vaccines will be our next hurdle. Included among those who are hesitant are health care workers-according to a March Kaiser Family Foundation/Washington Post survey, just over half of frontline health care workers say they have received at least one dose of a COVID-19 vaccine, leaving 48% who have not.


In addition to vaccine hesitancy, there is the question of access. The pandemic has shone a bright spotlight on disparities in access to both vaccines and health care. COVID-19 hit communities of color the hardest, causing more hospitalizations and deaths than among Whites. According to the CDC, compared with White non-Hispanics, the risk of hospitalization was three and a half times higher among Native Americans, three times higher among Hispanics or Latinos, and just under three times higher among Blacks; the risk of death for Native Americans, Hispanics or Latinos, and Blacks was also higher, at 2.4, 2.3 and 1.9 times that of Whites.


On April 8, in a statement to the media on racism and health, CDC director Rochelle Walensky declared racism a public health threat, noting that "racism is not just the discrimination against one group based on the color of their skin or their race or ethnicity, but the structural barriers that impact racial and ethnic groups differently to influence where a person lives, where they work, where their children play, and where they worship and gather in community."


I hope the resources allocated for vaccine distribution will align with the CDC's acknowledgment of racism as a barrier to health-that means vaccine distribution in the hard-hit communities by providers from the community, and outreach efforts like mobile units and public health nurses to vaccinate those in rural areas and the homebound. Such community-based initiatives could continue to provide access for health care delivery in the future. It behooves all of us to get behind these initiatives. None of us will be safe until all of us are safe from COVID-19.