Most Americans Still Not Fully Vaccinated
As Variants and Heat Rise Across Nation
The U.S. is unlikely to reach President Biden’s goal of having 70% of adults vaccinated for COVID-19 by July Fourth, but we’ll be close – an estimated 68%. The seven-day average for coronavirus cases has dropped to 11,672 as of June 24, the lowest figure in 15 months, and deaths are down to 314, or an average of six per state, a decline of more than 90% since the January peak.
But serious threats remain:
Dormant or Resurgent
We may not be getting good data, either. There has been a big decline in testing: just 500,000 on June 14, compared with 1.8 million on April 1. A lot more people could have COVID than we know, including people who have been vaccinated but have asymptomatic infections and can spread the disease further. In addition, the CDC is no longer tracking transient infections.
Also, understand that the proportion of Americans over age 18 with at least one shot, currently 66%, isn’t the whole story. The figure for all Americans who are fully vaccinated (two Pfizers or Modernas, or one J&J) is 45%. And in lightly vaccinated states, especially, cases are on the rise. According to CDC data, the states with the highest number of new cases per 100,000 over the past seven days are, in order: Missouri (far and away the worst), Wyoming, Utah, Nevada, Arkansas, Florida, Louisiana, and Colorado.
The essential question is whether the pandemic is dormant and will reemerge in the late summer and fall – when we will have a difficult time reviving mask-wearing and distancing measures -- or whether we have beaten it down for good. But when it comes to mitigating interior spread of the virus, it really doesn’t matter. Even if the SARS-CoV-2 bug leaves, there are many others that need addressing.
As COVID Falls, Other Illnesses Rise
As the pandemic is waning, a new and surprising problem is arising: Americans are getting sicker with non-COVID diseases. We know because of data gathered by California-based Kinsa, a young tech firm that has developed a network of two million smart thermometers that provide early-warning notice of illness around the country.
Kinsa recently took a close look at Texas, as a possible harbinger: “On March 10, 2021, as any other states braced for another wave of the epidemic, Texas took the bold steps of lifting mask mandates and removing other precautionary measures designed to slow the spread of COVID-19.”
COVID cases continued to decline after March 10 in Texas, although at a slightly slower rate than before. But something else happened:
Following the loosening of restrictions, Texas experienced the highest levels in Kinsa’s overall illness signal in more than a year, driven not by COVID, but by other common contagious illnesses like strep, RSV and even some flu, according to diagnostic data.
Especially alarming in Texas has been the sharp increase in RSV, or respiratory syncytial virus, which produces only mild symptoms that last about one or weeks in most people but can be dangerous to infants and the elderly. RSV positivity soared from 0.1% of tests in early April to over 5% by late May, according to Kinsa. The Centers for Disease Control (CDC) notes that “RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lung) in children younger than one year of age in the United States.”
The precautions taken to prevent COVID also prevented other infectious diseases, but when those precautions were lifted, the other illnesses spiked. From late March to early May, for example, the total Texas population with a fever rose from 0.4% to 1.5%. “Though [it is] initially alarming to see so much illness,” writes Kinsa’s Matt Albasi, “this is simply a return to normal…. The road back to normal is paved with illness.”
While much of the media is missing this story, an article in STAT News last month predicted a resurgence in non-COVID viruses -- “perhaps a big one.” The piece, on May 27, quoted Ben Cowling, an infectious disease researcher at Hong Kong University saying, “When they come back there’s going to be vulnerability and probably greater levels of infections.”
In an Axios piece on June 7 with the headline “America’s Next Big Wave of Sick,” Ryan Langlois, associate professor in the microbiology and immunology department at the University of Minnesota, made the point that “you’ve lost one pathway to immunity, which is natural infection” from the previous flu season, when people were masked and socially distant and flu was at the lowest levels on record. "We’ve never been in this situation."
Improving Indoor Air as an Antidote
But should the road back to normal be “paved with illness”? While we can’t expect mask-wearing to persist, now appears to be the time for those responsible for schools, office buildings, hotels, restaurants, theatres and all indoor spaces to improve the quality and safety of indoor air. Two lessons from the COVID pandemic are that, first, this pathogen, like nearly all pathogens, spreads most effectively through indoor air, and, second, our indoor air is not nearly as clean and safe as it should be.
This unclean and unsafe air might be seen as an indictment of the ventilation industry, whose HVAC systems do a good job of keeping rooms at a comfortable temperature but, we are learning, have been inadequate to prevent disease.
These two lessons about interior air should also be seen in the context of a changing environment of public awareness. The pandemic has made people much more conscious of the air around them, and they are almost certain to demand its improvement – COVID or no. The good news is that the funds that the federal government is providing states and localities to battle airborne SARS-CoV-2 in schools and other buildings will also support combatting other pathogens.
If you deploy the right technology, the COVID virus, in fact, is among the easiest pathogens to inactivate because it is an enveloped virus with a vulnerable shell. Harder to kill are non-enveloped viruses, bacteria, and mold spores.
A Future 'New Norm' in India
India has had a rough spring, mainly because of variants and a lack of vaccinations, but in the past two weeks, new cases of COVID-19 have dropped 49%. The experience inspired Rachna Aggarwal to imagine a future world that’s changed because of the pandemic. In the venerable daily New Delhi-based national newspaper The Pioneer, Aggarwal wrote on June 21:
Air purification systems which regulate the PM [particulate matter] level of air are now passe; we must upgrade to technologies that can eliminate biological aerosol contents from the air…. The recent turn of events will bring in a ‘new norm’ wherein air quality certification will be required to gain people’s trust.
Will the public want to enter any building whose air isn’t trusted, in India or anywhere else? It’s doubtful.
‘Meeting Code’ Is Not Enough, Says Harvard’s Allen
Joseph Allen, an expert on interior environments at the Harvard T.H. Chan School of Public Health, puts the situation well, “If you’re still feeling uncomfortable or anxious, that’s totally understandable. “This pandemic has affected all of us in profound ways, and people are going to be ready to re-enter life again or re-enter interacting with people at different times.”
Quoted in a June 11 New York Times article, Allen advised, “One thing you can do before you go back to work is simply [to] ask them what they’ve done. And if you hear things like, ‘Yes, we’re meeting code,’ then that’s a flag that something’s not right. They should be going above and beyond the bare minimum ventilation and filtration rates.”
The article continued:
Although the ideal ventilation rate varies, in general, employers should maximize the amount of fresh air coming in from outdoors, he said. In a relatively small space — say, the size of a typical school classroom — employers should aim for four to six air changes per hour, meaning that the air inside the space is being completely refreshed every 10 to 15 minutes.
Few HVAC systems produce such vigorous air changes, and upgrading a system to do so, as well as to carry heavy-duty filters, means added power – and potentially added damage to the environment. One good solution is supplementing ventilation with air-cleaning technologies that can either be added to an HVAC system without causing a pressure drop or arrayed in stand-alone devices.
Confidence and Caution: ‘This is Not Just a COVID Thing’
In an article headlined, “Consumer expectations: Restoring confidence in the travel experience,” Adam Perkowsky of HotelBusiness.com wrote that hoteliers and guests are, of course, concerned about “air quality as it relates to the transmission of COVID-19 particles and other airborne pathogens.”
The piece quoted one industry expert as saying, “This is not just a COVID thing. The links between air quality and cognition and susceptibility for long-term disease are supported by years and years of research. The pandemic was an ignition switch to raise awareness that what we breathe matters—that indoor air quality is oftentimes a lot worse than outdoor air quality and that needs to be addressed.”
Actually, it is rare that indoor air quality is not worse than outdoor air quality. The aim of the best air purification systems is to produce chemical changes to render indoor air as clean as outdoor, which has the advantage of solar cleansing.
Unfortunately, while many devices make claims, few are effective and safe enough to have 501k FDA clearance as a Class II Medical Device. One that does have such clearance is the Medical Guardian, which deploys the same Advanced Photocatalysis (AP) technology used in all products made by Dallas-based ActivePure, whose corporate roots go back nearly a century. AP technology evolved from photocatalytic oxidation (PCO), a process which, unlike proprietary AP, can, in its more rudimentary early forms, generate ozone and volatile organic compounds (VOCs).
New purveyors of air-cleaning products are popping up, and the HotelBusiness article urges caution: “There are so many gimmicks out there. [There is a] need to separate fact from fiction as it relates to manufacturers’ claims on what their units can do.”
An article in a Missouri newspaper on June 21 noted that Kansas City schools purchased devices that rely on technology that involves emitting ions that cause particles in the air to cluster, which, the manufacturer says, makes them easier to trap in an HVAC system. The company behind the technology, says the article, “is facing a federal lawsuit filed by a consumer who bought one of its devices, alleging the company ‘continues to defraud consumers by concealing material information regarding the true performance’ of its products.” (The company says the suit is baseless.)
In another example, a study by researchers from Colorado State University, Portland State University and the Illinois Institute of Technology found that in chamber and field tests “an ionizing device led to a decrease in VOCs [such as] xylenes, but an increase in others, most prominently oxygenated VOCs (e.g., acetone, ethanol) and toluene, substances commonly found in paints, paint strippers, aerosol sprays and pesticides.”
A release issued by Colorado State about the study stated:
According to the EPA, exposure to VOCs has been linked to from eye, nose and throat irritation, headaches, loss of coordination and nausea, to damage to liver, kidney and central nervous system, and some organics can cause cancer in animals, some are suspected or known to cause cancer in humans. The study, published May 15 in the journal Building and Environment, mimicked real-world operating conditions for these ionization devices to test the effectiveness and potential to form chemical byproducts in environments similar to where we all live, work, and learn.
Former Surgeon General’s Advice
The reference to “real-world operating conditions” is important, and it reminds us of the set of five questions that former Acting Surgeon General Kenneth Moritsugu posited in an article we cited in our newsletter No. 6. The original piece appeared on the RealClearHealth site on May 20, and its aim was to help the many school, state, city and country administrators, as well as owners of private businesses and facilities managers that have to decide the best way to mitigate the dangers of SARS-CoV-2 and other pathogens.
Ventilation is part of the answer, but another layer of protection is needed. Here are the five questions from Dr. Moritsugu:
Survey Finds Big Mitigation Outlays With Limited Success
Reinforcing the need to ask the right questions is a recent survey of 430 facilities managers, reported June 23. It found that 60% improved their HVAC systems to battle COVID-19. But, according to a CleanLink article, “HVAC upgrades are quite expensive, typically costing more than $500,000 and in some cases as much as $5 million.” The survey found that managers “vastly underestimated” the cost of these improvements. The article continued:
Additionally, for an upgraded HVAC system to improve air quality, it must operate continuously while the building is occupied, which is very expensive. In other cases, businesses felt compelled to try relatively new and unproven ionization technologies, which are increasingly under attack from academics and government agencies for being ineffective and possibly dangerous.
The survey found that 60% of surveyed companies spent more than $500,000 upgrading or installing HVAC systems and that nearly all respondents took some kind of measure to stop interior spread. But, said the article, the survey found that the managers “often made subpar investments, spending millions of dollars with limited success.”
Said Paul de la Port, the CEO of Omni ClearAir, a commercial manufacturer of air purification systems and sponsor of the survey: “The noisy environment, lack of transparent and easily understood real-world efficacy data, and unscrupulous COVID-19 opportunists appear to have clouded the landscape so much that many businesses simply were unable to make informed investment decisions about indoor air quality solutions.”
He added, “What many businesses don’t realize is that HVAC systems, even when they can eliminate the virus, require large amounts of electricity to operate, so the long-term cost will be very burdensome and the resulting air often won’t be adequately cleaned.”
COVID Solutions Bulletin
Our mission is to educate people on innovative solutions to the COVID-19 crisis in America. We need to get back to work, to school, to play – to enjoying life. We can’t get there without thwarting the current pandemic and preparing for the possibility of other pathogens to come.
COVID Solutions Bulletin is a publication providing regular updates on new and existing technologies that can help stop the spread of COVID-19, and help clear the air to open America back up.