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The Top News Stories of 2021: COVID-19 Year 2: With Politicized Public Health, Geography Is Destiny

Molyneux, Jacob

AJN, American Journal of Nursing: January 2022 - Volume 122 - Issue 1 - p 12-13
doi: 10.1097/01.NAJ.0000815380.45552.c6
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Nurses tend to patients in hallways at Houston Methodist The Woodlands Hospital as EDs were overwhelmed due to the sharp increase in Delta variant cases. Photo by Brandon Bell / Getty Images.

The last thing anyone wanted to think about as 2021 ended was COVID-19. Urgent problems needed attention: children reacclimating to classrooms, aging parents in need of help and care after long isolation, a reinvention of the workplace, floods and fires worsened by climate change.

But there's no clear moment of victory with a virus as opportunistic as COVID-19. By the end of November, a new “variant of concern” (Omicron) was filling headlines. Deaths worldwide had raced past 5 million; in the United States, we had reached 776,000 and counting, with daily death counts stalled at a worrisome plateau above 1,000 per day, very near levels seen just before the terrible surge of the previous winter.

The winter surge of 2020-21 was fueled by holiday gatherings in a still unvaccinated population. After Food and Drug Administration emergency use authorization of the first vaccines in December 2020, the rollout effort in the United States steadily gathered steam, pushing new infection numbers down throughout the spring. By midsummer, the majority of those who'd sought vaccination had been able to obtain shots, and it began to seem that the worst of the pandemic might be over.

This was wishful thinking. The more contagious Delta variant became the dominant COVID strain by early July, and as we entered the fall its spread accelerated, particularly in states with lower vaccination rates. Despite plentiful vaccine supplies and even the widespread availability of booster shots many believed should have been sent to more needy countries instead, by mid-November the national rate for full vaccination was 58.8%, still well below the Centers for Disease Control and Prevention's 70% threshold for herd immunity.

Many commentators began to assert that this was now a “pandemic of the unvaccinated”—states in the South and West lagged far behind in vaccination rates at between 40% and 50%; by contrast, most states in the Northeast were at or within five points of 70%.

With the cold weather came closed windows. While case counts began to climb again even in states with high vaccination rates and more aggressive infection control, hospitalizations stayed low, in keeping with the protection provided by immunization.

Meanwhile, behind ICU doors in states with lower vaccination rates, nurses continued to face the brutal realities of a rolling surge of patients struggling for breath, with ICU beds reported in November to be at or near full capacity in Colorado, parts of Texas, and Minnesota.

The groundwork for the growing difference in public health situations had been laid by former President Trump's stance of not following or promoting infection prevention practices endorsed by his own health officials, from dismissing mask wearing to calling for unproven treatments. Even as the federal government under President Biden has pushed vaccination numbers up by mandating vaccination for all federal employees, the counterstrategy of public health refusalism seems to have become endemic. Recently, Governor DeSantis of Florida threatened to withhold funds from school districts that imposed masking requirements, and in Texas, Governor Abbott banned vaccine mandates by any employer, private or otherwise.

Americans ages 65 and older, who have accounted for over 75% of U.S. COVID deaths, and those who are immunocompromised will remain particularly vulnerable to this simmering pandemic as long as ideology undermines science.—Jacob Molyneux, senior editor

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