Plus, a report on the virus's origins could be declassified soon, Nebraska brags that vaccinations aren't required for nurses, and more.  Email not displaying correctly?
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** What happened to all of those COVID contract tracers?
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Joseph Ortiz, a contact tracer with New York City's Health + Hospitals, uses his tablet to gather information as he heads to a potential patient's home, in New York on Aug. 6. 2020. (AP Photo/John Minchillo, File)

Remember a year ago when states were recruiting and hiring lots of COVID-19 contract tracers to track down where people got infected so they could notify others to get tested?

Health departments scaled back those efforts when new cases started to decline. Then the delta variant moved in. Now, county and state health divisions are trying to figure out how to rebuild their contact tracing efforts and, even more difficult, figure out how to use contact tracing when the virus spreads so fast.Kaiser Health News reports ([link removed]) :

“Contact tracing from the start of this pandemic provided us with really kind of invaluable information,” said Dr. Amanda Castel ([link removed]) , a professor of epidemiology at George Washington University. Castel said it’s still “a fundamental part of our response.” As is covid testing, especially for those who are vulnerable or unvaccinated, such as children under age 12. Yet numerous departments now find themselves with fewer contact tracers and less robust programs. Like testing ([link removed]) , contact tracing seems to have fallen by the wayside.

The situation has grown critical in a number of states during the past month or so as local health officials find themselves once again behind the curve as the delta variant drives up case counts.

Resources are already stretched, and the politicization of covid-19 has left these local officials making tough calls regarding whom to trace in places like Missouri and Texas. And some states just don’t have enough personnel to do the job. The army of disease detectives more often than not included temporary staff or civil servants from outside the health department. In Kentucky, the former contact-tracing director ([link removed]) is now the aviation department commissioner ([link removed]) .

Kaiser also reports that Arkansas, Missouri, Texas, Florida and other states that have led the nation in new COVID-19 cases cut back contact tracing. Florida Gov. Ron DeSantis said flatly ([link removed]) that contact tracing “does not work.” Epidemiologists say it is vital to understanding how the virus spreads.

Incidentally, new cases, deaths and hospitalizations in Florida ([link removed]) are still rising.


** Report on origins of COVID virus could be declassified in the next few days
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President Joe Biden now has in his hands the latest report on the origins of the coronavirus. That report may be declassified this week. Journalists who have sources inside the national intelligence agency say ([link removed]) the new report does not have a solid answer about whether the virus came from a Chinese lab or a food market.


** State recruits nurses by bragging that no vaccinations are required
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You have to see the postcard that the state of Nebraska sent out to recruit nurses.
[link removed]
(DrAliSKhan/Twitter)

COVID-19 cases are up about 27% in Nebraska over the last week. Hospitalizations are rising. 51% of the population there is vaccinated. The Washington Post tried to get some answers ([link removed]) from the governor about what the thinking is behind the postcards but didn’t get much of a response.

The Lincoln Star-Journal reports ([link removed]) that the Lincoln-Lancaster County Health Department imposed a countywide mask mandate that begins today. And, the paper says:

Derek Vance, president of CHI St. Elizabeth and CHI Nebraska Heart, said St. Elizabeth has seen record numbers of patients in its emergency room recently, which is “bursting at the seams.”

Bryan Health last week announced it was suspending some elective surgeries to free up more hospital beds for COVID-19 patients and other seriously ill patients.


** Why don’t states pull the licenses of physicians who spread false vaccine information?
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Medscape took on a question ([link removed]) that some of you have asked me over the last year and a half: Why aren’t states pulling the licenses of physicians who spread false vaccine information? YouTube seems to be willing to do more to force physicians to be responsible than state licensing boards. Medscape points out:

Physicians accused of spreading false information include public officials such as Scott Atlas, MD ([link removed]) , who served as President Donald Trump's COVID-19 advisor, and Kentucky Sen. Rand Paul, an ophthalmologist, whose YouTube account was temporarily suspended ([link removed]) in August after he posted a video disputing the effectiveness of masking in stopping the spread of COVID-19.

The Federation of State Medical Boards recently warned physicians ([link removed]) who spread false information that they could face charges. FSMB told members:

Physicians who generate and spread COVID-19 vaccine misinformation or disinformation are risking disciplinary action by state medical boards, including the suspension or revocation of their medical license. Due to their specialized knowledge and training, licensed physicians possess a high degree of public trust and therefore have a powerful platform in society, whether they recognize it or not.

My friend, medical ethicist Dr. Art Caplan, says, “Unless you can show a harm to an individual patient, it’s pretty tough to get the boards to do much. I wish they would, but they just don’t.”

Medscape says state medical boards are reluctant to do much more than try to persuade doctors to be more responsible because any enforcement requires a complaint followed by a lengthy investigation. States usually only take fast action when the public’s safety is in peril. And, in all likelihood, irresponsible doctors who broker fake COVID-19 information will claim “free speech” rights, which would be difficult to combat. Medscape includes this insightful passage:

“We have free speech and you can get away with a lot of stuff,”said Stephen Barrett, MD ([link removed]) , who for many years has critically documented examples of medical fraud on his website, Quackwatch ([link removed]) . “Some doctors would sue if they were challenged by medical boards, and I'm not sure the boards would win that court fight. People have written books with advice that killed people, and I’m not aware of a single case where the author was disciplined.”

In addition, it’s not clear that US physicians who are not government officials have any legal obligation — as opposed to a moral obligation — to the government or the public to promote public health, saidJonathan Moreno, PhD ([link removed]) , a professor of medical ethics at University of Pennsylvania, Philadelphia, Pennsylvania. “Is transmitting misinformation about COVID-19 public health malpractice?” he asked. “Do we as a society see physicians having a special role as guides in an emergency? I’d like to think we do, but we don’t have a strong tradition like that in the US.”

Still, some states are taking action against irresponsible doctors. California passed a law ([link removed]) that allows the state to discipline doctors who freely hand out medical exemptions for vaccinations to people who do not need them.

Talk with your state’s medical board to find out how willing it would be to fight disinformation from licensed health care providers. Is there any case that would show the state does or does not have the teeth to act? Are there any pending complaints in your state as people show up at public hearings to oppose masks, mandatory vaccinations or testing?


** Airline will charge unvaccinated employees more for health insurance
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Delta Air Lines passenger jets rest on the tarmac, Wednesday, July 21, 2021, at Boston Logan International Airport, in Boston. (AP Photo/Steven Senne)

Employers have tried the carrot approach to encourage people to get vaccinated against the coronavirus. Now, they are using the stick.

Delta Air Lines told employees ([link removed]) that if they choose to remain unvaccinated and participate in the company’s health insurance program, it will cost them an extra $200 a month. Delta CEO Ed Bastian dropped the news in a staff memo in which he said 75% of employees are vaccinated and, if you have to be off work for COVID-19 and have not been vaccinated, you won’t be paid. The memo says:

* Beginning Nov. 1, unvaccinated employees enrolled in Delta’s account-based healthcare plan will be subject to a $200 monthly surcharge. The average hospital stay for COVID-19 has cost Delta $50,000 per person. This surcharge will be necessary to address the financial risk the decision to not vaccinate is creating for our company. In recent weeks since the rise of the B.1.617.2 variant, all Delta employees who have been hospitalized with COVID were not fully vaccinated.
* Effective Sept. 30, in compliance with state and local laws, COVID pay protection will only be provided to fully vaccinated individuals who are experiencing a breakthrough infection.

It is a different approach from United Airlines, which made vaccines mandatory.


** Dentists say patients are back
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Dr. Rhea Reyes wears a personal protective suit, double masks, face shield, lab gown and gloves to prevent the spread of COVID-19 as she performs a dental procedure on her patient who is also required to wear a protective suit at their clinic in metropolitan Manila, Philippines on Monday, July 6, 2020. (AP Photo/Aaron Favila)

The pandemic kept a lot of people away ([link removed]) from the dentist’s chair in 2020. So far in 2021, dentists say,patients are back despite the virus ([link removed]) .

Six million people lost their dental care coverage ([link removed]) when they lost their jobs in the pandemic. Dentists said they were seeing a significant increase in the number of patients who had damaged their teeth by grinding, probably because of stress.


** Is it ethical for a doctor to refuse to treat people who refuse COVID vaccines?
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Medical ethicist Art Caplan, who I have included as a guest teacher at many of my Poynter events over the years, weighs in with a thoughtful piece ([link removed]) about the ethics of refusing treatment for people who refuse vaccines and get COVID-19.

The argument, Caplan says, comes down to the motivation of the doctor or hospital involved. If the doctor is doing it out of anger or frustration, it would not be ethical to deny service to an unvaccinated person. But if the concern is medical — for example, if the infected person endangers caregivers — then it could be justifiable. Here is a sample of what he wrote:

It would be unethical if a doctor were to refuse treatment because of anger, resentment or frustration, including over a patient’s decision not to get vaccinated. Doctors, and health care professionals more broadly, are bound by moral obligations to prevent illness and restore health for anyone without regard to certain objections they may have about them.

The issue arose when an Alabama doctor said ([link removed]) he would not treat unvaccinated people. This made me think about the other things we all do that compromise our health, like eating too much, exercising too little, smoking or drinking, or having ice cream parties every night. All of those could create preventable ailments. But do doctors refuse to treat patients who don’t do all they can to protect themselves? For that matter, would they refuse treatment to people who don’t take flu shots or other vaccinations?

I know I have some readers who host radio talk shows. This would be an interesting topic. Caplan’s opinion piece included one other strong point:

There is also a broader question about what physicians can do to encourage vaccinations in the first place and specifically how threats to refuse service come into play. Encouraging vaccination as a condition to keep unvaccinated patients might seem ethical on its face, but it is easily revealed as coercive. However, when such inducement is made to protect family members of the unvaccinated, other patients, schoolmates and office staff members from Covid infection, it can meet ethical requirements, because it’s being done to prevent illness for others.


** Afghanistan faces a COVID crisis with depleted supplies
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The Afghan people have one more thing to worry about. The World Health Organization ([link removed]) says the country has about one week’s worth of medical supplies and, of course, no supplies are allowed in. COVID-19 cases in Afghanistan are low but the virus is spreading elsewhere in the Middle East. Iran had seen a record number of new cases ([link removed]) , for example.


** Virus spreading and more infectious
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New Zealand ([link removed]) and Australia, which have done a great job controlling covid until now, are setting records for new cases.

Korean officials say ([link removed]) the people who get infected now have 300 times more virus in their systems than people did a year ago with the first form of the virus. After 10 days, the levels return to about the same as the previous virus, but it is a signal of just how potent the delta variant is.


** The danger of disaster/pandemic empathy burnout
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What happens when we get so burned out by the nonstop news of disaster after disaster on top of a year and a half of a pandemic? Will we shut down, stop caring, turn it off just when an earthquake hits Haiti, or Afghanistan’s government collapses, or wildfires burn through the west, droughts dry crops and floods sweep through a Tennessee town?

The Atlantic ([link removed]) spoke with Kang Lee, a developmental neuroscientist at the University of Toronto ([link removed]) , who reminds us that even small children tend to get empathetic and generous after disasters.

But most of the studies about generosity have been focused on short-term disasters and recoveries, not the kind of nonstop trauma you have been living through since 2019.

Charitable giving hit an all-time high in 2020 ([link removed]) but these bursts of empathy usually wear down. And when money gets tight, we tend to be most charitable to those who look like us and to people who are closer to where we live. And, Lee says, history teaches us that even when we grow hard-hearted by repeated or enduring disasters, we tend to return to our normal, more empathetic way of being.

It may turn out, he says, that the pandemic will not fundamentally change us, which the Atlantic noted, “Is both very reassuring and not reassuring at all.”

We’ll be back tomorrow with a new edition of Covering COVID-19. Are you subscribed? Sign up here ([link removed]) to get it delivered right to your inbox.
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