State of Affairs: Nov 1, 2021

The United States’ case rate has begun to plateau. On a global scale, Europe has a sharp incline in cases. For once, though, the incline isn’t due to the UK but rather everyone else (Ireland, Greece, Denmark, Germany, Norway, Russia).

This is not welcome news going into the winter months. Last year, before our biggest wave yet, cases started to increase in late October 2020. Obviously the landscape has changed thanks to vaccines, but we still have a large proportion of a vulnerable Americans: 5.5 million are immunocompromised and 50 million are under the age of 12. During the recent UK surge, the hardest hit were those aged 5-14 years old.

Regardless of global surges, fully vaccinated, non-US citizens will be allowed in the States starting November 8. Travelers will need a FDA approved/authorized or World Health Organization listed vaccine. Much more information can be found on the CDC website here and here. I think this is a welcome, but cautious opening of borders.


Back in the states, all eyes are on the West. Alaska continues to be the case leader (89 cases per 100,000), but has declined nicely (28%) in the past 14 days. Montana (71 per 100K), North Dakota (68 per 100K) and Wyoming (68 per 100K) closely follow in case rates.

Cases are increasing fastest in Arizona (43% incline in 14 days), followed by New Mexico (31%), California (27%), Utah (23%), and Colorado (17%). The Southwest was largely untouched by Delta, so it may be their turn in this game of whack-a-mole.

Cases continue to be largely among the unvaccinated.


In the United States, cases are still 100% the Delta variant. We’ve been watching AY.4.2 variant in the UK (a sublineage of Delta that I talked about here). AY.4.2 is increasing, but certainly not explosive. We’ll keep an eye on this variant, but I’m not concerned.


Boosters are ramping up in the U.S. with more than 18.6 million doses administered. This equates to 9.7% of our vaccinated population. Those with a primary J&J vaccine seem to be opting for a Moderna (46%) booster followed by Pfizer (36%) and J&J (18%). Those with a primary mRNA series are largely sticking to their original vaccine sponsor for the booster.

And while booster momentum is great, it’s not going to get us out of this pandemic. We really need to be focused on the unvaccinated. According to the Kaiser Family Foundation, more than 2/3 of unvaccinated adults are under the age of 50. Among unvaccinated, 6/10 identify as Republican or lean Republican. Almost half of unvaccinated adults have a high school education or less (45%). Thirty percent of unvaccinated change their minds because of conversations with their family and friends. If you need some guidance on where to start, go to my previous post here.

For unvaccinated kids, all eyes are on the ACIP meeting tomorrow. This meeting is important for policy: who will be eligible for the 5-11 year old vaccine (my guess is everyone). According to the Kaiser Family Foundation, 1/3 of parents will “wait and see” and 1/3 will “definitely not” get the vaccine. Note the number of “right away” parents has decreased since September.

Parents have really amazing questions and are craving evidence-based information. Yesterday I was honored to join a rabbi and pediatrician at a local synagogue to answer parents’ questions. These upcoming weeks and months will have to be a grassroots effort. Whether it’s a crowd of 1 or 20,000 we all have a role to play. If you need help finding the words, you can start here: 1-pager of common parental concerns.

I’ll be back tomorrow with ACIP cliff notes. Hang tight!

Love, YLE