“Kids aren’t getting caught up on routine shots they missed during the pandemic, and many vaccination proponents are pointing to Covid-19 vaccine hesitancy as a big reason why.
Public health experts, pediatricians, school nurses, immunization advocates and state officials in 10 states told POLITICO they are worried that an increasing number of families are projecting their attitudes toward the Covid-19 vaccine onto shots for measles, chickenpox, meningitis and other diseases.”
“The Biden administration is betting that Covid infections for most people are now so mild that it’s safe for much of the country to go maskless, a strategy helping the White House avoid political backlash against stricter safety requirements.
But that strategy comes with the risk that millions of Americans, including the healthy and vaccinated, could suffer long-term health effects from Covid infections.
The policy could leave millions with a lifetime of little understood disease or medical complications. Those who get infected are at higher risk of brain shrinkage, blood clots, heart disease, strokes and diabetes, studies show. A separate post-viral syndrome called long Covid can cause a range of debilitating symptoms from cognitive dysfunction to extreme fatigue, according to federal estimates.”
“This is why many public health experts say the Biden administration’s focus on preventing hospitalizations over infections is a poor strategy, one that ignores the potential of millions of newly sick or disabled Americans further straining the health care system and potentially worsening the labor shortage.”
“Some public health experts agree with the administration’s approach, noting that for most people, vaccines provide strong protection against severe illness and death, and individuals should manage their own risk.
The country is averaging more than 37,000 infections per day, up about 45 percent over the last two weeks, according to the Centers for Disease Control and Prevention. Those figures are likely undercounted given the prevalence of rapid tests, which aren’t often reported to health departments.”
“Rather than make investments now that could pay off when Covid-19 inevitably surges again, Congress is cutting corners. The cost of this myopia could end up being felt all over the world in the months to come.”
“Under the Public Health Services Act of 1944, codified in Title 42 of the U.S. Code, federal health officials may issue orders intended to curb the cross-border spread of diseases. Rarely invoked before the pandemic, Trump administration officials looked to Title 42 in late March 2020 as a way to stop migrants from crossing U.S. land borders. Would-be migrants could no longer cross into the United States from Canada and Mexico after the CDC’s Title 42 order, ostensibly because they posed contagion risks. The order has been used almost exclusively to expel migrants at the southern border, and CBP officials have carried out 1.7 million expulsions under its authority.
Its implementation has proven to be largely counterproductive and harmful to migrants. Those expelled under Title 42 faced nearly 10,000 incidents of kidnapping, torture, rape, and other violence after being sent to dangerous border towns in Mexico, according to Human Rights First. What’s more, because Title 42 does not penalize repeat crossings, the recidivism rate rose and the total number of CBP apprehensions spiked. This led to inflated reports of chaos and unprecedented migration at the U.S.-Mexico boundary, which only helped fuel the false argument that President Joe Biden is overseeing an open southern border.
Immigration advocates have long criticized the public health order for the barriers it poses to asylum seekers. Under U.S. immigration law, migrants are legally permitted to seek asylum—a process they must begin either on American soil or at a port of entry. An immediate expulsion under Title 42 means that migrants can’t present their cases for asylum, risking a return to the dangerous conditions many of them have fled.
From the very beginning, public health officials have questioned the efficacy of Title 42 in curbing the spread of COVID-19, noting that the virus was already spreading in American communities and that migrants posed a comparatively minor risk. The CDC’s director of Global Migration and Quarantine, Martin Cetron, refused to support the Trump administration’s initial order. Lawyers at the Department of Health and Human Services and CBP pressured the CDC to issue the order, but the agency refused until former Vice President Mike Pence ordered the borders closed. Since that initial scuffle, more than three-quarters of Americans have received at least one COVID-19 vaccine dose, making the health order’s stated justification even more tenuous.”
“Sewage surveillance is becoming more valuable right now as conventional testing is becoming less transparent. More people have been using rapid at-home tests and might not report results to a public health agency. That means the number of positive cases being reported by official sources might not actually provide a full picture of what’s happening with the pandemic.
But no matter how or if they’re testing, infected people — whether they have symptoms or not — flush out the virus when they go to the bathroom, leaving viral RNA that can be detected in wastewater samples. It requires careful collection and testing, but sewage can provide a less biased look at the viral trends in a given community.
Science has not yet reached the point where we can say that X amount of viral load in a community’s sewage means Y number of people are infected in that community. But still, knowing which way viral loads are trending is useful. If they are going up, even before the number of positive tests starts increasing, it could in theory allow public health authorities and the local health system to start preparing for a surge. If they are going down, public health officials (and the general public) can be confident that any waning in official case numbers is real and not the byproduct of, say, less testing.”
“Surveillance programs could watch for other pathogens, too, such as influenza, hepatitis, and norovirus for early warnings of emerging outbreaks. Julianne Nassif, an expert on wastewater surveillance with the Association of Public Health Labs, said we could also monitor for bacteria, viruses, and other microbes that are resistant to current treatments. Public health officials could try to get ahead of an outbreak of antibiotic-resistant bacteria in a nursing home, for example, with the information gleaned from downstream sewage.
Johnson envisioned communities monitoring for narcotics, to better tailor their public health campaigns. Wastewater could be tested to determine whether cocaine or opioid use is rising in a given sewage shed. It could even determine what kind of opioids are being used, which could be helpful to health departments. Widespread heroin use might require a different intervention than diverted prescription opioids or black-market fentanyl.
The possibilities sound almost endless, extending to research that could help us better understand human health. Dennehy described to me one hypothetical experiment that could be run with sewage monitoring, looking for the viral markers associated with colon cancer. By comparing the results from one community with, say, a nearby nuclear power plant and another community somewhere else, we could get a better understanding of how the surrounding environment affects people’s health.
But for all of this potential to be realized, these efforts would require sustained support. The CDC bet on the wastewater boom, launching a national Covid-19 surveillance system in the fall of 2020. But dedicated investments in infrastructure and a workforce would be necessary if the country were to begin conducting wastewater surveillance on a more permanent basis.
In general, the US has not appeared willing to make big investments in public health. Scientists working on these programs hope that the same may not be true of wastewater surveillance, given the opportunities it presents.
“We learned a lot of hard-won lessons with the Covid pandemic. We got caught with our pants down at the beginning. A lot of things that we did were too late,” Dennehy told me. “The hope is we can remember these lessons for the next time this comes around, which may not be that long.””
“U.S. Customs and Border Protection has been using the policy implemented at the onset of the pandemic to immediately expel migrants apprehended at the border, while progressives, pro-immigration activists and institutions such as the United Nations and Doctors Without Borders have rebuked the policy for shutting the door on thousands of desperate families and stranding them in unsafe camps with limited options.
Almost everyone in this debate recognizes that the necessity of Title 42 to prevent Covid transmission is a pretense. Public health experts have long contended that the rule is scientifically baseless. In fact, officials in the previous administration explored enacting the policy before the pandemic by using the flu and measles as justification. But the benefits of repealing or leaving in place Title 42 are not as straightforward as either border security or human rights advocates claim, which both sides would be wise to understand as they argue the political merits of the administration’s next moves. If approached smartly, rescinding Title 42 could lead to a more secure and prosperous America rather than the chaos that some warn of.
Proponents of keeping Title 42 in place assert that the quick expulsions are needed because they give officials greater ability to intercept and turn back more migrants. A recent report from the Migration Policy Institute notes that Title 42 expulsions can take as little as 15 minutes, while removals under standard immigration law, which require more procedures and paperwork, can often take an hour and half.
But the procedural steps that Title 42 bypasses are critical for the U.S.’s ability to target smuggling networks and discourage repeat crossings. This is why Border Patrol agents warned in a 2021 report from the Government Accountability Office that Title 42 “negatively affected enforcement” because the expulsions gave them no time to collect intelligence from migrants concerning nearby smugglers and other illegal activity.
The quick expulsions under Title 42 also cut corners in ways that prevent authorities from deterring migrants as they attempt to reenter the country. Before the pandemic, officials were able to use criminal prosecution, fines and other penalties to deter people from repeatedly crossing the border. This is because apprehended migrants were being processed under standard immigration law. Title 42, however, is a provision that exists under health law, which means that authorities are incapable of issuing penalties for reentry against migrants who are expelled under this provision. Border Patrol officials have stated that because of Title 42, migrants now try to cross multiple times a day. Since the pandemic expulsions began, repeat crossings jumped from 7 percent in 2019 to 26 percent in 2020. It’s not unheard of for people to make as many as 30 attempts at crossing in just the span of a few weeks.”
“But even when considering all the security liabilities that Title 42 is responsible for, proponents of the policy are correct in saying that Biden needs a plan in place as he works to rescind the program. This plan must include interagency coordination that rapidly expands capacity as more families arrive to claim asylum. The administration must also work with humanitarian organizations to ensure that they’re in the best position possible to monitor and shelter migrants — and that their capacity is being fully utilized.
At the same time, advocates for ending Title 42 as well as the Biden administration must acknowledge that the overwhelming majority of people who are being expelled under the policy haven’t been families seeking asylum, but rather single adults fleeing extreme economic deprivation and in search of work. In February alone, more than 90 percent of Title 42 expulsions were single adults — the vast majority from Mexico. Mexican President Andrés Manuel López Obrador has acknowledged this reality and urged Biden several times last year to work with him to expand guest worker programs for the U.S., Mexico and the Northern Triangle. Though the Biden Administration recently suggested a willingness to do so, it has not yet provided any details.
It’s critical that Biden’s post-Title 42 strategy includes increased access to guest worker programs. Extensive research shows that when expanded legal channels are paired with border security measures, illegal immigration rapidly declines. This was exactly what happened in the mid-1950s when the U.S. government expanded their agricultural worker program for Mexicans, which caused illegal immigration to collapse by 95 percent in just 5 years. Border Patrol saw the success of the agricultural program and warned that restricting it would cause “a large increase in the number of illegal alien entrants into the United States.” But in 1960, the Department of Labor did just that, causing employer use of the program to drop by 30 percent in just one year while Mexican apprehensions increased by 55 percent. When the program was eliminated altogether, apprehensions continued to grow, reaching nearly 1 million in 1976.”
“With a surge at the border and a shortage of workers, maintaining Title 42 has done nothing to solve either crisis — aside from creating more jobs for human smugglers. Though the Biden administration is right to rescind Title 42, chaos at the border will continue to drive headlines and the U.S. economy will limp forward until Biden prioritizes expanding legal channels for those in pursuit of a better life.”
“Immigrant advocates and public health experts — and many top Democrats — for months have pushed back on the Biden administration’s continued use of Title 42, calling it unlawful, inhumane and not justified by public health considerations. They’ve argued that the policy, enacted in March 2020, has been utilized not to keep Covid-19 out of the U.S., but to keep migrants from seeking asylum, a legal right under U.S. and international law.
“It’s long overdue for Title 42 to end,” Senate Majority Leader Chuck Schumer and Sen. Alex Padilla (D-Calif.) said in a joint statement. “Title 42 is a public health regulation that should never have been used as a border enforcement policy, and its misguided implementation put countless people in danger and wreaked havoc on our asylum system that desperately needs repair.””
“Hong Kong saw its Covid-19 death rate become the highest in the world, topping 37 deaths per million people. The recent outbreak was a brutal shock to the 7.4 million residents of the bustling metropolis, which had until recently kept Covid-19 cases to admirably low levels. Hong Kong was once applauded for its response to Covid-19. Then it became the global epicenter of the pandemic.”
“the most important is the vaccination problem in Hong Kong, the extremely low vaccination rates among the elderly, especially those older than 80 years old. The vaccination rate for them was only about 20 percent by the end of 2021. That’s the most vulnerable population, and they’re not protected at all. The data from our pandemic on this wave is very clear: Those elderly who were not vaccinated actually had a much, much higher, death rate than those with the vaccination.
Another reason is the incidence of infection in Hong Kong was so low in the past. By the end of 2021, we had about 12,000 cases out of 7.3 million people in Hong Kong, which is less than 0.2 percent. So basically in Hong Kong, very, very few people have natural immunity against the virus.
Third, in the past waves, you got about a hundred or so cases in a day, and that’s already a lot. But in those days with only a hundred cases, you can actually put everybody in the hospital, in isolation, in quarantine camps. But when they are not hundreds but thousands of cases per day, then people can only be quarantined at home.
And, you know, Hong Kong is very crowded. Basically most people live in apartments and many of them live in very, very small apartments. Unfortunately, there are many poor people who actually share a flat with many other people. So this space is kind of impossible for you to do any preventive measures in those settings.
And of course, the virus this time is very different. In the past, we in Hong Kong see the virus, we see infections, and then we isolate people. Usually, the spread is very limited once you do that. But this time, especially at the beginning of the omicron wave, when we still had very, very few cases, we did a lot of investigations into each of the clusters.
You can see that in a restaurant, an infected patient sitting in one corner of the restaurant and another customer sitting at the other end of the restaurant got infected. It’s not just spreading to people around you, but can actually spread over long distances. For example, there are cases in apartment buildings. And what people have found is that spread is not because of direct contact between neighbors but because infected air that got removed from a flat from an exhaust fan can go up through the air to the other apartments.”
“If Hong Kong was much, much better vaccinated, then I believe this wave could’ve been prevented.”