By Tom Rosenthal

Since the bivalent boosters to protect against both the original SARS-CoV-2 and omicron BA.4 and BA.5 subvariants were approved in September, only 4% of the eligible population has received the shot, according to Chrissie Juliano, MPP, the executive director of the Big Cities Health Coalition (BCHC).

The COVID-19 pandemic is not over, Ms. Juliano said. 

“There are still 400 to 500 people dying each day, and that’s why everyone who is eligible, which is now a lot of people, should make a plan to get boosted,” she said during a media briefing on the day CDC Director Rochelle P. Walensky, MD, MPH, expanded the use of updated (bivalent) COVID-19 vaccines to children who are between 5 and 11 years of age.

Dr. Walensky’s action followed the FDA’s authorization of the updated COVID-19 vaccines from Pfizer-BioNTech for children aged 5 through 11 years, and from Moderna for children and adolescents aged 6 through 17 years.
Speakers at the media briefing warned that the rise of COVID-19 infections in Europe poses a threat to the United States and underscored the need to get the updated bivalent booster. 

According to the U.K. Office for National Statistics, the percentage of people testing positive for COVID-19 in England is increased to 2.78% in the week ending Oct. 3. Overall hospital admissions also increased to 10.65 per 100,000 people, but ICU and high-dependency unit admissions remained low at 0.26 per 100,000. Deaths are also climbing, the agency said. 

The Infectious Diseases Society of America (IDSA) said the increase of COVID-19 cases in Europe and other parts of the world was a sign that another surge in the pandemic could occur in the United States. “IDSA urges everyone who is eligible to get boosted now,” the IDSA said in a statement.

Don’t Forget Flu

Ms. Juliano said everyone who is eligible should plan to get the annual flu shot at the same as the COVID-19 booster. She called this one-stop shopping “the best way to protect ourselves, our families and, in particular, the most vulnerable among us.”

Polling has indicated that about one-third of adults, and nearly half of seniors, say they plan to get boosted eventually, Ms. Juliano said. The public health officials in the 35 large American cities that comprise the BCHC have been using every tool at their disposal during the past two years of the pandemic to get vaccines out quickly and equitably, she said.

“Big city health departments know how to respond to infectious disease outbreaks and other public health crises,” Ms. Juliano said, but their efforts are hampered by the failure to properly fund the nation’s public health system, particularly at the local level, “which really inhibits health departments from putting their best knowledge into practice and their best plans into action.”

BCHC and its partners continue to urge Congress to not only fund the ongoing COVID-19 response as well as allocate resources for the monkeypox outbreak, but also to fund the governmental health system at predictable and sustained levels “so that we can strengthen infrastructure across the country to truly protect and promote the public’s health,” she said.

COVID-19 has risen to one of the top causes of death, diminishing the nation’s progress in life expectancy,” said Raynard Washington, PhD, MPH, the public health director in Mecklenburg County, in North Carolina, a BCHC member and a panel participant.

“While I know some people believe the pandemic’s over, we still have people going to the hospital. We still have people dying,” Dr. Washington said. “I want to remind everyone that we’re still dealing with COVID. It’s not over. We have to continue to remind people about the importance of this virus. Our response to it must remain vigilant and cannot be shortsighted.”

To remain vigilant in their messaging, Dr. Washington said public health officials in his county are informing the public they can receive both the COVID-19 bivalent booster and a flu shot during the same “one-stop shopping” visit, as Ms. Juliano termed it. “We’ve had to mobilize a lot of community grassroots efforts to be able to vaccinate.”

Dr. Washington said an issue confronting public health officials in getting booster shots into the public’s arms is “we’ve had a lot of folk who’ve had recent [COVID-19] infections. They want to wait longer, so there’s some desire to delay getting the booster.” 

Another issue is the growing shortage of nursing staff across the country, Dr. Washington said, noting that, fortunately, there has been flexibility regarding clinicians being able to administer the booster, and the vaccines are available at local pharmacies.

Firefighters, EMTs to the Rescue

David E. Persse, MD, the health authority/chief medical officer for the Houston Health Department, as well as the EMS Physician Director for the Houston Fire Department, described the innovative program he deployed of using trusted ambassadors to get the word out and promote vaccination.

At the beginning of the pandemic, Dr. Persse said, “we knew that our nursing home patients were going to be some of the most at-risk people for contracting and dying from COVID. We also knew that when the health department shows up at a nursing home, everybody panics.”

Since fire department personnel, particularly emergency medical personnel and paramedics show up at nursing homes at least once per week, nursing home residents were familiar and comfortable with firefighters arriving. Teams of firefighters and health department personnel visited the approximately 300 nursing homes and long-term care facilities in the greater Houston area to talk about the pandemic and begin inoculations when the vaccines became available.

“We had created a big enough army that we could hit almost all the nursing homes in a two-week period, and then we would go back and visit them again,” he said. 

As a result, while 40% of COVID-19 deaths nationally were nursing home residents, in the Houston area the death rate among that population was about 25%, according to Dr. Persse.

“We need to look at all the tools in our toolbox,” he said. “You can use a tool in a way it wasn’t originally designed. You just need to be creative.”