47: State of the COVID-19 Response

Dr. Nirav Shah, ASTHO President and Director of the Maine Center for Disease Control and Prevention, addresses the state of the campaign against COVID-19; Kim Martin, ASTHO’s Director of Immunizations, says more approved booster formulas would be...

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Dr. Nirav Shah, ASTHO President and Director of the Maine Center for Disease Control and Prevention, addresses the state of the campaign against COVID-19; Kim Martin, ASTHO’s Director of Immunizations, says more approved booster formulas would be welcomed additions to the pandemic response; and ASTHO continues to gather workforce input for its PHWins survey.

FDA News Release: FDA to Hold Advisory Committee Meetings to Discuss Emergency Use Authorization for Booster Doses and COVID-19 Vaccines for Younger Children

CDC Webpage: Advisory Committee on Immunization Practices

Website: Public Health Departments Need 80,000 New Employees. But That’s Not Enough for Another Pandemic

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This is Public Health Review Morning Edition for Friday, October 15th, 2021. I'm Robert Johnson.

Here's today's news from the Association of State and Territorial Health Officials.


October is an important month in the COVID-19 pandemic timeline: the FDA and CDC consider approval for two booster shot formulas; the debate over a vaccine for younger kids begins later this month; just this week, regulators were asked to approve an anti-COVID pill; and flu season is about to get underway—the first in two years.

With so much going on, we invited ASTHO president Dr. Nirav Shah to address the state of the campaign against COVID. It's the morning conversation.

Delta appears to be on the decline. We've not heard much about new variants.

Where are we in the timeline of the pandemic? Is there a chance we can move to endemic status soon?


Well, that's, Robert, certainly the discussion on the table right now.

Some epidemiologists think and hypothesize that the Delta wave, which seems to be receding a bit, will be the last significant wave of COVID-19. They look at that noting that vaccination rates are high—though not as high as any of us would like.

And they're also suspecting that vaccination rates, coupled with the baseline level of natural immunity in different populations, may mean that the surge that we have seen—and may be on the backend of—might be the last one, which then leads to a discussion of whether we may be in a position to look at the virus being endemic in the same way that we do with influenza.

What that means, and what degree of cases and other harmful quality we might have even an endemic state? That's really the big question on the table.


Speaking of the flu, how does flu figure into this equation when you think about the rest of this year, early part of 2022?


The flu is a risk this season, although it's anybody's guess to what extent there will be a significant flu season.

Again, some of the epidemiologists fear that, because of the social distancing and masking in many parts of North America, flu rates were low, which leaves people without any degree of built up immunity from last year's flu season going into this year. That gives rise to concerns that there might be higher than average rates of flu, coupled with the fact that there might be lower than average rates of immunity.

So, that makes flu a risk this season. It comes on top of an 18- or 20-month period in which healthcare systems and healthcare workers, to say nothing of state and governmental public health departments, have been stressed and strained to the max.

It bears worth—I don't have to say to this crowd that getting your flu shot is an important thing, but that's certainly the message that we should all be amplifying externally.

JOHNSON: One tool you didn't have last year was the mandate. Now, you have the mandate. Have those been helpful?


Well, you know, I think of the requirements for vaccination is just that—requirements or conditions of employment, not distinct from other conditions of employment that we ask healthcare workers, educators, and others to undertake as part of their jobs.

Here in Maine, our success, we've seen success with our healthcare worker condition of employment for COVID-19 vaccine. Indeed, we released data yesterday showing that rates of vaccination amongst healthcare workers have been climbing since we first announced this requirement about two months ago.

I think what we are seeing now is that requirements of this nature operate most on individuals who were not necessarily opposed to vaccine, but for whom there wasn't a strong imperative to take time out of their day to go get it done. Essentially, it brings folks who were not necessarily opposed, but just busy with other things in life onto the side of being vaccinated.

That's a really important feature. It provides that removal of inertia. That's really critical to getting more and more folks vaccinated. And, as a result, I think we'll continue to see them be used. The question there is how much more broadly.


We'll have more from Dr. Shah on Monday.


An FDA panel gets back to the table today, discussing a proposed amendment to the emergency use authorization for the Johnson & Johnson COVID vaccine. The request is for permission to administer a booster dose. The panel debated a similar request for the Moderna vaccine yesterday.

Kim Martin is director of immunizations at ASTHO. She's looking forward to the deliberations—adding the new boosters would be a welcomed addition to the pandemic response.


I know the booster may be of some help. We also still know that those that are fully vaccinated are at less risk of hospitalization and death than unvaccinated; so, it still remains important for us to get more people fully vaccinated.

And I think it's also important to remember that, while vaccination is one tool in our box, there are other tools such as masks or improving medications to help end the pandemic.



Finally today, a new analysis says public health departments would need to add 80,000 workers nationwide just to deliver basic public health services. The de Beaumont Foundation helped compile the report.

The nonprofit also is working with ASTHO to field a new workforce survey. The PH WINS survey will gather information from thousands of public health professionals, checking job satisfaction and career plans. Those results are expected next summer.


Find links to the stories mentioned today in the show notes.


Also, remember to follow us on Apple podcasts or Spotify, or listen on Alexa or Google assistant.

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Join us Monday morning for more ASTHO news and information.

I'm Robert Johnson. You're listening to Public Health Review Morning Edition.


Kimberly Martin

Director, Immunization, ASTHO

Nirav Shah MD JD

Director of the Maine Center for Disease Control and Prevention; President of ASTHO