with Alexandra Ellerbeck

Centers for Disease Control and Prevention advisers will meet tomorrow to discuss who should get coronavirus vaccines first.

One population they may consider prioritizing: Americans who are obese — a major risk factor for severe covid-19 that some experts say has gone under-recognized. 

“Obesity was ignored for the longest time and overweight was completely ignored,” said Barry Popkin, an obesity researcher at the University of North Carolina at Chapel Hill. Now the CDC is talking about both, he said. 

The agency has already laid out four groups that should be considered for priority: health-care personnel, workers in essential and critical industries, older adults, and people with certain underlying medical conditions — including “severe obesity.” But it’s unclear to what extent the CDC’s Advisory Committee on Immunization Practices will prioritize this group.  

Research suggests that obesity increases the chances for hospitalization and death.

There’s been much discussion about how underlying medical conditions such as hypertension and Type 2 diabetes are associated with higher risk of dying from the coronavirus. But these conditions are most frequently found in people who are obese — making it difficult to discern whether the medical conditions or the obesity were the biggest factors at play.

The evidence, Popkin argues, points to extra weight as a bigger risk factor than any individual comorbidity. That’s because people who are overweight or obese have more body fat — which is more hospitable than other tissue to the coronavirus — and they suffer from reduced lung capacity.

“Being an individual with obesity independently increases the risk of influenza morbidity and mortality, most likely through impairments in innate and adaptive immune responses,” according to a paper Popkin wrote over the summer, which analyzed 75 studies on the connection between covid-19 and body mass index.

Popkin and colleagues found that people with obesity were 113 percent more likely to be hospitalized, 74 percent more likely to be admitted to intensive care units and 48 percent more likely to die of covid-19. 

The connection helps explain some of covid-19’s impact on Black and Hispanic Americans, who have died at disproportionate rates from the disease and are also more likely than White Americans to be obese.

Great Britain is prioritizing its most obese population for vaccination.

Its public health agency posted guidance last week saying that morbidly obese people — defined as those with a body mass index over 40 — should be prioritized for vaccines ahead of those younger than 65. This “at-risk” group also includes people with asthma, kidney disease and weakened immune systems.

But the prioritization doesn’t extend to obese people who don't meet this threshold — despite the research showing they may still be at much higher risk for hospitalization, intubation and death from covid-19.

About 28 percent of British people are considered obese. Rates are even higher in the United States, where a record 42 percent of Americans now meet the obesity threshold.

The sense of urgency to get a vaccine approved and distributed is only intensifying.  

The CDC’s Advisory Committee on Immunization Practices announced on Friday that it is holding an emergency meeting tomorrow, presumably due to the speed at which several drugmakers are moving to get their coronavirus vaccines approved by the Food and Drug Administration. A separate panel of advisers to the FDA will meet next week to consider a request from Pfizer for emergency approval, and Moderna has announced it will file a request for emergency use of its vaccine today.

As record numbers of Americans test positive for the virus, health providers are bracing themselves for a post-Thanksgiving bump in cases that experts are calling a surge on top of a surge.

“What we expect, unfortunately … we might see a surge superimposed on the surge we’re already in,” Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said yesterday on CNN.

“The holiday, which is typically one of the busiest travel periods of the year, fell at a particularly dire time in the pandemic,” Sarah Kaplan writes. “Some 4 million Americans have been diagnosed with the coronavirus in November — twice the previous record, which was set last month. More than 2,000 people are dying every day. Despite that, over a million people passed through U.S. airports the day before Thanksgiving — the highest number of travelers seen since the start of the outbreak.”

The weekend brought some bleak indicators. Hospitalizations in the United States exceeded 90,000 people for the first time on Thanksgiving Day. And experts warn it will only get worse in two or three weeks, when infections contracted during holiday travel turn into serious cases of covid-19.

“I fully expect on a national level we will see those trends continue of new highs in case counts and hospitalizations and deaths,” Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security, told Sarah.

Ahh, oof and ouch

AHH: Moderna will ask the FDA today to authorize its coronavirus vaccine.

The biotechnology company's move brings the U.S. a step closer to having two vaccines by the end of the year.

“Moderna’s vaccine was 94 percent effective at preventing illness in a 30,000-person clinical trial, the company said — a performance that exceeds expectations and is on par with the best pediatric vaccines,” Carolyn Y. Johnson reports. “All 30 cases of severe covid-19, the illness caused by the virus, were in a group that received a placebo.”

“Moderna’s filing marks the fourth Monday in a row with good news about the vaccine effort and means the United States could have enough vaccine to treat 20 million people by year’s end, between doses of Moderna’s vaccine and those of another candidate that is about a week ahead from Pfizer and German firm BioNTech,” she continues. “The Food and Drug Administration could authorize the vaccines for emergency use by mid- to late December.”

OOF: Health officials are bracing for the logistical challenge of administering a two-dose vaccine regimen.

“A two- or three-dose dose regimen is routine for building immunity against many illnesses, but it is unprecedented in a pandemic when the public health goal is to vaccinate 60 to 70 percent of the population within months to reach herd immunity and stop the virus’s spread,” The Post’s Frances Stead Sellers reports.

It’s not usual for vaccinations that target proteins, such as the spike protein on the coronavirus, to require two or three shots. For many standard vaccinations, people receive a couple of shots meant to prime the immune system, followed by a later shot aimed at boosting the immune system’s memory cells and providing long-term protection. The current leading vaccine candidates require two shots a couple of weeks apart, but as scientists continue researching the vaccines, they may find that a third injection offers longer-lasting protection, or even that a single shot is sufficient.

After making a vaccine for coronavirus, you have to get it to the masses. But that’s not so easy for a so-called cold chain vaccine, requiring exact temps. (The Washington Post)

The two shot regime means that public health officials “will need to keep track of people who have received one dose in order to send a reminder about the need to return a few weeks later. They worry that the first vaccine may make people feel just sick enough that they won’t want to go through the ordeal again,” Frances writes. “And they foresee hitches if people get their first dose at, say, Walgreens and go to CVS for their second, or, worse still, if they cross state borders, moving from one health department’s registration system to another.”

“Two doses more than doubles the logistical challenges of administering the vaccines,” Jeffrey Duchin, public health officer for Seattle and King County, Wash., told The Post. “The moving parts have to align.”

OUCH: Small and medium-size hospitals in surge areas are running out of space for coronavirus patients.

Lenny Bernstein visited a Mayo Clinic hospital in Eau Claire, Wisconsin, which had to send ambulances to other hospitals in town during an influx of people with covid-19 symptoms.

“With more than 91,000 covid-19 patients in their beds, U.S. hospitals are in danger of buckling beneath the weight of the pandemic and the ongoing needs of other sick people,” Lenny writes. “In small- and medium-size facilities like this hit hardest by the outbreak's third wave, that means finding spots in ones and two, rather than adding hundreds at a time as New York hospitals did when the coronavirus swept the Northeast in the spring.”

“In Utah, some doctors acknowledge they are informally rationing care, a euphemism for providing some patients a lower level of service than they should receive,” Lenny writes. “In El Paso, the National Guard has been dispatched to handle the overwhelming number of covid-19 corpses, many held in 10 refrigerated trailers outside the medical examiner’s office.”

“So far, such extreme measures are not widespread, but only because hospitals have spent months preparing for this catastrophe — one expected to grow worse in the weeks to come as the weather turns cold and Americans move indoors.”

More in coronavirus

New York City will reopen schools for special-education students and younger grades.

The move, announced by New York Mayor Bill de Blasio on Sunday, is an abrupt change from a previous plan that forced the entire school system to close just 10 days ago. But it will only impact a fraction of the city’s 1 million public school students, two-thirds of whom have opted for full-time virtual classes. 

“Of those who have chosen the city’s hybrid option, only prekindergarten through fifth-grade students and special-education (District 75) students will be permitted to return. The mayor said he is pushing schools that have sufficient space to reopen five days a week,” The Post’s Moriah Balingit reports.

The city closed the schools after seven-day average positivity rates rose to 3 percent, a threshold the mayor had set for shutting schools. But on Sunday, he said that it would be possible to keep schools open safely for younger students, who appear to be less likely to catch and transmit the virus, and committed to deploying weekly testing for the virus. The change also had the support of teachers unions.

Randi Weingarten, president of the American Federation of Teachers:

“Schools across the country are facing several competing pressures as they weigh whether to reopen schools or keep them closed. Besides New York City, the entire state of Kentucky has ordered school closures amid rising coronavirus infections,” Moriah writes. “But there is also a growing body of evidence that young people can safely return to classrooms without increasing community spread if they wear masks, socially distance and have good ventilation, among other things.”

Emily Oster, a Brown University professor who has been tracking coronavirus infections in schools:

  • Pennsylvania state Sen. Doug Mastriano (R) abruptly left a four-hour-plus maskless meeting in the White House on Wednesday after being informed that he had tested positive for the coronavirus, Mark Scolforo of the Associated Press reports.
  • In a ruling released just before midnight on Wednesday, the Supreme Court’s new conservative majority ruled that religious organizations were unfairly targeted by pandemic-related restrictions in New York, The Post’s Robert Barnes reports.
As Medicaid enrollment surges amid the pandemic, states are looking to cut costs.

Amid job losses triggered by the coronavirus, sign-ups to the federal program for low-income and disabled people are expected to surge by more than 8 percent in fiscal year 2021, according to data compiled by the Kaiser Family Foundation. States, however, are ill-equipped to absorb the increased costs, as they face slumping tax revenue, Stephanie Armour of the Wall Street Journal reports.  

“Some state leaders may try to narrow the gap between the revenue they need to balance the budget and shortfalls they face by cutting vision and dental benefits, or payments to doctors and other providers,” Stephanie reports.

Although Congress authorized a 6.2 percentage-point increase in federal matching funds for the program, state governors say the measure, which is set to expire March 2021, falls short of what is needed. 

“The Medicaid burden on state budgets will pose a challenge for President-elect Joe Biden, who wants to expand Medicaid and reduce the number of uninsured people in the U.S. Amid the coronavirus pandemic, a politically divided Congress faces pressure to further increase federal matching funds to states, a proposal that Mr. Biden has also said he would support,” Stephanie writes.

Coronavirus by the numbers

Experts are warning against putting too much stock in coronavirus case numbers over the holiday weekend.

The numbers of coronavirus cases reported have fluctuated over the holiday weekend, going from 127,563 cases on Thursday to a record 197,686 cases on Friday, before dipping over the weekend, according to data from The Washington Post. But experts warn against reading too much into the day-to-day movement of coronavirus cases.

“Data-reporting delays caused by the Thanksgiving holiday and long weekend may provide a veneer of comfort — a seeming dip in cases — when the actual course of the pandemic in the coming days will almost certainly be much bleaker than the reported numbers show,” the Atlantic’s Joanna Perlstein and Whet Moser write

The number of new cases reported tends to drop over weekends, probably the result of more doctors’ offices and public health departments having less staff around to conduct, process and report tests. As the testing structure “catches up” to the data, higher-than-average cases are reported later in the week. This pattern could be further exacerbated by a holiday weekend. The numbers could be particularly erratic this week as many people rushed to get tested before Thanksgiving travel, despite public health warnings that a negative test result does not constitute a green light for socializing without social distancing precautions. The rush for testing slowed down processing times in many places.

It will probably take a couple of weeks to measure whether holiday travel has contributed to a spike in new infections, and even then, most deaths linked to infections spread during the Thanksgiving holiday are not likely to be reported until Christmas. 

The Atlantics Ed Yong:

Some states, however, have already reached a particularly grim milestone. In at least nine states, more than 1 in 1,000 people have died of coronavirus-related causes. The states that have passed that marker include South Dakota, New York, New Jersey, Massachusetts, Connecticut, Louisiana, Rhode Island, Mississippi and North Dakota, The Post’s Marisa Iati and Hannah Knowles report.

Trump takes credit

Trump’s claim that he “came up with vaccines” is sparking a debate over how much credit the president should get. 

“I came up with vaccines that people didnt think wed have for five years,” President Trump said in an interview with Fox News on Sunday. 

The statement echoed a claim that the president made during a Thanksgiving videoconference with members of the military, in which he begged people not to let President-elect Joe Biden “take credit for the vaccines.” 

Operation Warp Speed, the administration’s $10 billion push to fast-track a vaccine, has been a rare bright spot in the federal government’s coronavirus response, but Trump claiming primary credit for the vaccine is an exaggeration. While Moderna worked closely with government scientists and received $1 billion from Operation Warp Speed for development of its highly promising vaccine candidate, Pfizer did not receive money from the vaccine program. However, Pfizer did have an agreement that the federal government would purchase doses of any successful vaccine.

The New York Timess Maggie Haberman:

Elsewhere in healthcare

  • Biden is expected to nominate Neera Tanden, the chief executive of the left-leaning Center for American Progress, as director of the influential Office of Management and Budget, Annie Linskey and Jeff Stein report. Tanden, the president of the Center for American Progress, a liberal think tank, served as a top health-care official during the Obama administration and helped craft the Affordable Care Act.
  • Members of the Congressional Hispanic Caucus Hispanic are lobbying for New Mexico Gov. Michelle Lujan Grisham to be named health and human services secretary, Hans Nichols of Axios reports.
  • Biden has a hairline fracture on his foot after slipping while playing with his dog, Amy B Wang reports.

Sugar rush