with Alexandra Ellerbeck

It’s reasonable to hope the uptick in coronavirus cases might not lead to the usual increases in hospitalizations and deaths, given that 107 million Americans have now been inoculated with highly effective vaccines.

Except there’s one potential wrinkle: the variant first identified in the United Kingdom.

Michigan is showing what can happen when this unfortunate variant spreads widely.

The state has taken its place as the nation’s next coronavirus hot spot. It has seen a 30 percent rise in new cases in the past week, with hospitalizations up 29 percent. More than 6,700 new cases are being diagnosed every day, levels nearing what Michigan saw during last year’s holiday season.

Epidemiologists partially attribute the rapid surge to the spread of the variant first identified in the U.K., which scientists have found to be 30 to 70 percent more transmissible and relatively more deadly.

This variant — now the cause of around 1 in 4 infections in the United States — appears to be spreading in Michigan. After Florida, the state has the highest per capita case rates of the variant, with a current total of 1,649 cases, according to the Centers for Disease Control and Prevention. The variant has been detected in all 50 states.

“The problem with that darn variant is it’s the only one that has this kind of super-spreading capacity,” said Eric Topol, director and founder of Scripps Research Translational Institute. “We just haven’t given it enough respect for what it can do.”

Michigan Gov. Gretchen Whitmer (D) is asking for more vaccines, setting up a test for the Biden administration.

Last week, Whitmer appealed to White House officials to shift away from a strict population-based formula for vaccine allocation and instead rush more doses to hard-hit parts of the country, including her state.

“I know that some national public health experts have suggested this as an effective mitigation tool,” she said during the White House coronavirus response team’s weekly call with governors, according to a recording of the conversation obtained by The Washington Post’s Isaac Stanley-Becker. “And I know we’d certainly welcome this approach in our state.”

Yet the administration seems to be sticking with the population-based distribution system.

President Biden largely hasn’t changed the allocation metrics used by the Trump administration. States are given vaccine doses based on the size of their adult population, regardless of their infection rates or number of elderly people, although some additional vaccine doses are set aside for retail pharmacies, mass vaccination sites and community health centers.

Jeff Zients, the White House’s coronavirus coordinator, told Whitmer the Biden administration is not inclined to change its formula for allocating vaccine doses, Isaac reported. 

“We have to make sure that everything is thought through and on the table,” Zients said.

The Department of Health and Human Services didn’t respond to a question Monday about whether it was considering Whitmer’s request.

The good news is the vaccines being used in the U.S. seem to be effective against the variant.

Vaccinated people aren’t showing up to emergency departments with the variant or any others.

That’s hopeful news, as the pace of vaccine distribution accelerates. More than 4 million Americans received a coronavirus vaccine on Saturday, setting a record for the highest one-day total. Speaking at a news briefing yesterday, White House senior adviser Andy Slavitt said an average of 3.1 million shots were administered each day over the past seven days and nearly 1 in 4 adults are now fully vaccinated. 

Michigan is around the middle of the pack when it comes to the speed with which states are getting vaccine doses administered. 

Around 31 percent of Michigan residents have received at least one dose, while 19.4 percent have been fully vaccinated. 

Associated Press reporter David Eggert:

Yesterday, Michigan announced all of its residents are now eligible to get the vaccines:

But now younger people are showing up in emergency departments in Michigan and elsewhere.

While many of the elderly have been vaccinated, younger people have been kept at the back of the line, for understandable reasons.

Yet now the U.K. variant is proving more deadly for this mostly unvaccinated population. As my colleagues recently reported, some hospitals have reported admitting younger people with more severe disease.

Mike Osterholm, director of the University of Minnesota Center for Infectious Disease Research and Policy, noted the development during a Sunday interview on NBC.

“I think it was a wake-up call to everyone yesterday when Michigan reported out at 8,400 new cases, and we’re now seeing increasing number of severe illnesses, ICU hospitalizations, in individuals who are between 30 and 50 years of age who have not been vaccinated,” Osterholm said.

The hope is that enough Americans can get immunized before coming into contact with the variant.

CDC Director Rochelle Walensky has tearfully pleaded with Americans to keep distancing and wearing masks, pointing to a small increase in coronavirus cases nationally.

Yet the increase in cases appears to have leveled out over the past week. At least so far, deaths nationally are still declining. And experts are divided on whether the nation is poised for a fourth surge.

Osterholm said “we’re just at the beginning of this surge.” Yet former Food and Drug Administration commissioner Scott Gottlieb said he doesn’t expect “a true fourth wave,” citing the number of people already infected, plus the number of people who have been vaccinated.

Ahh, oof and ouch

AHH: Nearly 6 in 10 health-care workers say they would support their boss requiring a vaccine.

The finding comes from a recent Washington Post-Kaiser Family Foundation poll of health-care workers. The poll found that, among health-care workers who are not self-employed, a little over 4 in 10 would oppose a coronavirus vaccine mandate in their workplace. 

The issue of whether employers should require their workers to get a coronavirus vaccine was largely hypothetical when shots were scarce, but as the distribution of doses ramps up, some businesses are mandating them. At least half a dozen companies housing the elderly or infirm have recently announced imminent vaccine mandates, The Post’s Amy Goldstein reports.

The Post-KFF poll also found health-care workers are experiencing significant stress during the pandemic, with more than half saying that they feel “burned out” going to work.

One of the greatest causes of stress cited by workers was a fear of infection for themselves, family members or patients, The Post’s Scott Clement, Cece Pascual and Monica Ulmanu report.

Some health-care workers also cited discomfort in using personal protective equipment, exhaustion over changing rules and the challenges in comforting patients who are isolated from their family members. Despite the stress, many workers also say that they are feeling hopeful and optimistic now.

OOF: Dads in Utah will be required to cover half of pregnancy costs under a new law.

The bill is the first of its kind in any state and applies to a pregnant woman’s health insurance premiums and pregnancy-related medical costs. 

“The bill’s sponsor has presented the measure as an effort to decrease the burden of pregnancy on women and increase responsibility for men who have children. But some critics argue the new legislation won’t help women who are most vulnerable and could make abusive situations even more dangerous for pregnant women,” the Associated Press’s Sophia Eppolito reports.

Utah state Rep. Brady Brammer (R) told the AP that he pursued the bill because he was frustrated with the number of antiabortion measures going through the state legislature, and he wanted to make it easier to have a child.

“We want to help people and actually be pro-life in how we do it as opposed to antiabortion,” Brammer said. “One of the ways to help with that was to help the burden of pregnancy be decreased.”

But some critics have questioned whether the bill is the best way to support women. Planned Parenthood spokeswoman Katrina Barker has said that expanding Medicaid, access to contraception and providing paid parental leave would be better ways to meet women’s needs. Other critics pointed out women able to navigate the legal system to compel payment of pregnancy-related costs are more likely to be wealthy.

OUCH: It’s time to stop the pandemic theater, according to the CDC.

The CDC released revised guidance on Monday stating that, while it is possible for people to be infected with the coronavirus by contacting contaminated surfaces, the risk is low.

The agency also said that in most cases, water and soap were sufficient for cleaning surfaces, as opposed to using more specialized disinfectants.

Despite a scientific consensus that the coronavirus is spread almost exclusively by airborne and aerosolized particles, businesses and schools have often insisted on strict, sometimes costly sanitation protocols, Yahoo News’s Alexander Nazaryan reports. In some cases, schools even shut down for an entire day of deep cleaning.

“The persistence of such practices has led to the advent of a derisive term — ‘hygiene theater’ — to describe rituals that appear to do little to stop the virus from spreading. It is not clear if the CDC’s new guidance will lower the curtain on those theatrics, given how entrenched some of those practices have become,” Alexander writes.

On the Hill

House Democrats want to include paid family and medical leave in Biden’s infrastructure package.

House Ways and Means Chairman Richard E. Neal (D-Mass.) vowed to ensure that paid leave is part of the package in a letter to Democratic members of the committee.

The letter, which was obtained by Politico’s Myah Ward, also calls for expanding the “caring infrastructure” that supports participation in the workforce and says that child care should be a guarantee.

“If it is the road that gets you to work, it is the child care that gets you through the day, and workers are counting on these supports,” Neal writes.

More in coronavirus news

Norwegian Cruise Line Holdings is begging the CDC to sign off on its plan to start sailing again.

Yesterday the company's CEO Frank Del Rio rolled out a plan to start sailing again from the United States with fully vaccinated passengers and crew. A big catch: He still needs the CDC to sign off, more than a year after the agency prohibited cruising in the United States.

The move is a bold salvo amid the cruise industry’s escalating frustration with the CDC, whose allegedly “outdated” rules have been the target of complaints in recent weeks, Hannah Sampson reports. Last Friday the agency said travel for vaccinated people was low risk — but also laid out a raft of additional conditions, under a “conditional sailing order,” that cruise lines need to meet before getting permission to operate from U.S. ports.

“I’d like to hear an argument why we couldn’t sail,” Del Rio told Hannah. “If everyone on board is vaccinated and following the protocols, there is absolutely no need for the conditional sail order to exist as it is known today.”

Anthony Fauci is pushing back on GOP criticism, calling it “bizarre.”

Several high-profile Republicans have criticized Fauci in recent weeks, The Post’s Paulina Villegas reports. The nation’s top infectious-disease doctor said he isn’t letting the criticism distract him.

On Friday, Sen. Lindsey O. Graham (R-S.C.) urged Fauci in a series of tweets to visit the U.S.-Mexico border, calling an influx of migrants the nation’s “biggest super spreader event.”

“I have nothing to do with the border,” the White House chief medical adviser told Fox News anchor Neil Cavuto on Friday. He called it a “very difficult situation,” but rejected the idea he should go down and visit. “Having me down at the border, that’s really not what I do,” he said.

It’s not the only Republican jab Fauci has had to face. In a Fox News interview last week, former Trump trade adviser Peter Navarro called Fauci a “sociopath and a liar” and the “father of the actual virus.” In late February, Sen. Marco Rubio (R-Fla.) said it was not Fauci’s job to “mislead or scare” Americans.

Fauci has called some of the comments “bizarre.” “I’ve become sort of, for some reason or another, a symbol of anything they don’t like” related to anything “contrary to them or outside of their own realm,” Fauci told Fox News.

Secretary of State Antony Blinken has appointed a veteran diplomat to run the Biden administration’s global coronavirus response.

Pledging to support the more equitable production and distribution of vaccines, Blinken announced the appointment of Gayle Smith, former director of the U.S. Agency for International Development, as global covid-19 coordinator.

“This pandemic won’t end at home until it ends worldwide,” Blinken said, adding that the U.S. will “work with global partners on manufacturing and supplies to ensure there will be enough vaccine for everyone, everywhere.”

“We have a duty to other countries to get the virus under control here in the United States,” Blinken said. “But soon, the United States will need to step up our work and rise to the occasion worldwide.”

The Biden administraton is helping AstraZeneca find a new manufacturing partner.

The move comes after the contractor Emergent BioSolutions mixed up ingredients for two Covid-19 vaccines it's simultaneously producing, a senior health official told Politico's Sarah Owermohle.

The administration “already told Johnson & Johnson to directly take over vaccine manufacturing at Emergent’s Maryland plant after reports that the manufacturer had contaminated 15 million Johnson & Johnson doses with ingredients for AstraZeneca’s shot,” Sarah writes. “But now, officials are telling AstraZeneca to cut ties with Emergent entirely, worried about the prospect for more mishaps that could erode public confidence in Covid vaccines, the official said. They added that the administration has identified two potential partners for AstraZeneca to work with on future production.”

Hospital finances

Many wealthy hospitals were flush with money amid the pandemic.

Last May, Baylor Scott & White Health, the largest nonprofit hospital system in Texas, laid off 1,200 employees as it braced for the spread of the coronavirus and the cancellation of lucrative elective procedures. 

But by the end of 2020, the hospital system, which received $454 in federal relief funds, was thriving. It had acquired $815 million in surplus, $20 million more than in 2019, Kaiser Health News reports.

“Like Baylor, some of the nation’s richest hospitals and health systems recorded hundreds of millions of dollars in surpluses after accepting the lion’s share of the federal health care bailout grants, their records show. Those included the Mayo Clinic, Pittsburgh’s UPMC and NYU Langone Health. But poorer hospitals — many serving rural and minority populations — got a tinier slice of the pie and limped through the year with deficits, downgrades of their bond ratings and bleak fiscal futures,” KHN's Jordan Rau and Christine Spolar report.

Much of the lopsided distribution stemmed from the way HHS allocated funding. HHS used a formula that favored hospitals that had higher shares of patients with private insurance and also did not take into account which hospitals already had enough in existing assets to weather the pandemic. 

Nonprofit hospitals spend less on average for charity care, compared to their for-profit counterparts.

A recent study, published in the journal Health Affairs, found that nonprofit hospitals spent $2.30 of every $100 of expended on charity care, less than the $4.10 spent on average by government hospitals or the $3.80 spent by for-profit hospitals.

Lead study author Ge Bai said that the findings suggest that nonprofit hospitals’ spending on charity care is “badly out of sync with the favorable tax treatments that these hospitals enjoy.” 

“Government and nonprofit hospitals should not have their cake and eat it, too,” Bai, an associate professor at the Johns Hopkins Carey Business School and an expert on health-care finances, said in a statement.

Sugar rush