By Marie Rosenthal, MS, and Ethan Covey
New Yorkers are ticked off about COVID-19 vaccination, but the reasons are not what you probably think. According to a survey, 54% are angry with unvaccinated adults and two-thirds support vaccine requirements as a path to full economic recovery. Another survey of vulnerable cancer patients found those undergoing treatment were more likely to believe misinformation about COVID-19 than other people. In other news, rural counties saw 2.4 times more delta variant cases than urban ones last summer. As more and more states lift mask requirements, new data from California suggest that might not be the best course—masks appear useful in reducing transmission. Finally, we take a look at gorillas and the effects of social distancing. Wild mountain gorillas at Volcanoes National Park are not seeing the human respiratory pathogens they saw before COVID-19, which is good news because respiratory illness is the second-leading cause of death in these animals.
Most New Yorkers Think Vaccination Is Key for Economic Recovery
New Yorkers have a strong conviction that vaccines should be required for those seeking to participate in their city’s indoor activities (69%), to work in its service industries (66%) or schools (69%), and even to travel on airplanes (68%).
However, fewer than half (45%) believe restrictions will motivate people to get the vaccine, and 26% believe they will not. More than half of New Yorkers (54%) are angry with those who have not been vaccinated yet.
A new survey conducted by the City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), of 2,500 New Yorkers, confirms a largely vaccinated population that foresees an economic drag due to COVID-19 and continued resistance among unvaccinated adults.
One-third of New Yorkers believe the economy will not recover fully in one year (32%), and another 37% say not until all New Yorkers are fully vaccinated. One in six believe the economy will never fully recover (15%).
The poll results also indicated residual negative effects on a significant segment of the population. Many are experiencing financial and mental health stress. More than one-third of all respondents (34%) said they were worried their food would run out before they had money to buy more, up from 29% a year ago. One in five respondents (18%) have felt down, depressed or hopeless more than half of the days in the last two weeks, and an additional 24% have felt that way for several days over that time period.
The impact of the pandemic was most pronounced in traditionally underserved communities and in certain boroughs of the city.
At the same time, survey results chart a path forward for a healthier city, grounded in an overall trust in the federal and state governments (61%); a commitment to vaccines and testing; and super-majority support for vaccine requirements for employment in schools and service industries, such as restaurants, bars, hair salons and hospitality, and participation in indoor activities, such as indoor dining, movie theaters and gyms.
More than two-thirds support vaccine requirements by the government, including the Supreme Court’s position to enforce vaccination of all workers in healthcare facilities (68%) and the city’s policy for a confirmed COVID-19 vaccination or weekly negative test requirement to return to work in person (68%).
“Trust is fundamental for public health success and the support for vaccine acceptance,” said Scott Ratzan, MD, MPH, MA, a distinguished lecturer at CUNY SPH, who added that New Yorkers’ confidence was encouraging.
Even though the United States lags in vaccination rates and leads in excess deaths among high-income countries, 81% of these New Yorkers are fully vaccinated and/or boosted, with an additional 9% having received one vaccine dose.
Similarly, parents are largely vaccinating their children or planning to: 80% of parents of children 5 to 11 years of age have vaccinated their children (28%) or intend to vaccinate them (52%). Eighty-three percent of parents of children 12 to 17 years old have vaccinated their children (30%) or intend to do so (53%).
“In a city that bore the lethal brunt of COVID-19’s first wave two years ago, New Yorkers remain resilient and resolute on the need for vaccines and masking,” said Ayman El-Mohandes, PhD, the dean of CUNY SPH.
Are Cancer Patients More Susceptible to Misinformation?
Cancer patients undergoing active treatment were more likely to believe misinformation related to COVID-19 than those without a history of cancer, according to a new study led by researchers at Virginia Commonwealth University (VCU) (Patient Educ Couns 2022;105[2]:265-268).
Researchers conducted a survey of 897 adults, with roughly one-third undergoing treatment for cancer, one-third cancer survivors not currently in treatment, and one-third respondents with no cancer history. They found cancer patients currently undergoing treatment were more likely to believe false information about COVID-19 than the other two groups. Least likely to endorse COVID-19 misinformation were cancer survivors no longer in treatment.
The reasons why cancer patients are more likely to endorse COVID-19 misinformation are unclear. It may be that heightened anxiety is leading them to seek out information on the internet and social media, where they may see more misinformation, according to the researchers.
“Increased information seeking may impact cancer patients’ information-processing abilities, making them more likely to use heuristics or cues, rather than more critical, central processing routes of assessing information credibility,” they wrote.
In contrast, cancer survivors who are no longer in treatment may have more experience evaluating the veracity of the information they read online.
“Our cancer survivors, they’ve gone through this journey and come out the other end, knowing you can’t believe everything you read on the internet. They know you have to talk to your doctor and other people who are knowledgeable about these issues,” said Bernard Fuemmeler, PhD, the Gordon D. Ginder, MD, Chair in Cancer Research at VCU Massey Cancer Center, in Richmond, Va.
A previous study by the researchers found parents of children with cancer were more likely to believe misinformation and unverifiable content associated with COVID-19 than parents of children without a cancer history.
“Our previous study found that parents of pediatric cancer patients were more likely to consider misinformation about COVID-19 as true compared with parents of children with no cancer history,” said Jeanine Guidry, PhD, the director of the Media+Health Lab at VCU and a member of the Cancer Prevention and Control research program at VCU Massey Cancer Center.
“Cancer patients are in an especially vulnerable position, and it’s our duty as healthcare providers to help them weather the ‘infodemic’ of misinformation so they can have the best possible outcome under these challenging circumstances,” added Robert Winn, MD, the director and Lipman Chair in Oncology at VCU Massey Cancer Center and a senior associate dean for cancer innovation at the VCU School of Medicine, in Richmond.
Data for the new study were collected before the rollout of COVID-19 vaccines. However, Dr. Guidry said, the findings are relevant today.
“The COVID-19 vaccines and boosters so far have been very successful in preventing severe disease and mortality because of COVID-19, but infection with the virus and its variants is still a possibility, and misinformation about COVID-19 prevention and treatment is still spreading quickly, both online and in person,” Dr. Guidry said.
Delta Hit Rural America Hard
A new study led by the University of Cincinnati (UC) found rural counties had 2.4 times more infections per 100,000 people than urban areas between July 1 and Aug. 31, 2021, when the delta variant surged across the United States (JAMA Netw Open 2022;5[2]:e2147915. doi:10.1001/jamanetworkopen.2021.47915).
About 82% of rural America has a vaccination rate lower than 30%, according to CDC data. Conversely, rural counties accounted for just 131 of the 376 areas with vaccination rates of 50% or better.
UC Health pharmacist Mary Burns works on the Moderna Vaccine Trial in 2020. Photo by Colleen Kelley/UC CreativeUnlike some countries, the United States has a lot of variation in vaccination rates from state to state and county to county. So, understanding where vaccinations are lagging could help government and health agencies address vaccine hesitancy and shortfalls in healthcare, said Diego Cuadros, PhD, the director of the UC’s Health Geography and Disease Modeling Lab.
Rural areas in the United States face many challenges responding to the pandemic, including less access to healthcare compared with urban areas.
“We found that infections from the delta wave increased much faster in low-vaccination areas. Not only did we have more cases per capita in low-vaccination areas, but the epidemic infection spread much faster compared to high-vaccination areas,” Dr. Cuadros said.
“Although we have long known that the COVID-19 vaccine is safe and effective, this study concludes that communities with higher vaccination rates have slower rates of community spread when an outbreak of COVID-19 does occur,” said Phillip Coule, MD, an associate dean at the Medical College of Georgia at Augusta University.
Now researchers are studying the impact of the omicron variant this winter. Preliminary data, which were not part of the published study, suggest this variant, known for being highly contagious, spread more quickly in congested urban areas. But because far more people per capita in these counties were vaccinated, fewer people in urban areas have died than in rural areas where vaccinations are lagging.
While the latest surge of infections is worse in urban America, omicron is still wreaking havoc on the health of rural America, causing more per-capita hospitalizations and deaths there than in urban areas.
“Vaccination still protects you from complications from infection, hospitalization and death,” Dr. Cuadros said.
Masks Greatly Reduce Risk for Transmission
The use of face masks, or N95/KN95 respirators, greatly reduces the risk for COVID-19 transmission, according to a study of real-world data from California.
The findings come at a time when many states are easing mask-wearing restrictions (MMWR Morb Mortal Wkly Rep 2022;71[6];212-216).
The study assessed the use of masks among 652 case participants who had received positive test results for SARS-CoV-2, and 1,176 matched control participants who received negative test results. All of the participants reported being in indoor public settings during the two weeks prior to testing, and reported no known contact with anyone with confirmed or suspected SARS-CoV-2 infection during that time.
Overall, mask usage was strongly associated with lower odds of testing positive for COVID-19 than not wearing a mask.
Although all masks provided significant benefit, there were large differences in effectiveness depending on the type of mask worn.
Among 534 participants who reported the type of mask they used, cloth masks were determined to reduce odds of testing positive by 56%, surgical masks by 66%, and N95 or KN95 respirators by 83%.
“Masks, especially N95s or KN95s, continue to be an effective tool to reduce the spread of COVID-19, along with getting vaccinated and boosted,” said Erica Pan, MD, a state epidemiologist at the California Department of Public Health (CDPH).
“Getting vaccinated and boosted remains our best tool to reduce the impact of COVID-19 on our communities,” a CDPH spokesperson added. “Masking also remains one of our most effective tools in the fight against COVID-19 when transmission rates are high.”
A COVID-19 Silver Lining for Great Ape Conservation
Respiratory illness outbreaks among wild mountain gorillas in Volcanoes National Park, in Rwanda, have declined since the start of COVID-19, according to a report from Gorilla Doctors and the Rwanda Development Board (Nature 2022 Feb 10. doi:10.1038/d41586-022-00331-z).
Mountain gorillas in Rwanda’s Volcanoes National Park have experienced better respiratory health since the COVID-19 pandemic began, due in part to protective health measures in the park. Photo by Skyler Bishop for Gorilla Doctors.Mountain gorillas are susceptible to human-transmitted respiratory pathogens. Respiratory illness is the second-leading cause of death in wild, human-habituated populations.
In the five years before March 2020, the Volcanoes National Park population averaged 5.4 respiratory illness outbreaks in gorilla family groups annually. In contrast, from March 2020 through December 2021, the population averaged 1.6 respiratory illness outbreaks in the family groups each year. To date, SARS-CoV-2 has not been detected in samples collected from mountain gorillas with respiratory illness.
The decline in respiratory illness outbreaks in mountain gorillas during the COVID-19 pandemic correlates with an overall reduction in the number of people coming into close proximity of the gorillas, and with additional health protection measures taken to reduce the risk for disease transmission from humans to gorillas.
“Respiratory illness outbreaks are common in wild, human-habituated mountain gorillas, and considering that gorillas are susceptible to SARS-CoV-2, this preliminary analysis is such a welcome finding,” said co-author Kirsten Gilardi, DVM, the executive director and chief veterinary officer at Gorilla Doctors, and the director of the Karen C. Drayer Wildlife Health Center at the UC Davis School of Veterinary Medicine, in California. “It is a testament to the early and decisive action of park authorities to help protect mountain gorillas and humans.”
Gorilla ecotourism was temporarily suspended at the start of the COVID-19 pandemic. The Rwanda Development Board mandated masks at all times when in close proximity to gorillas and increased the minimum distance to 10 meters, or nearly 33 feet.
