with Alexandra Ellerbeck

Hello! Welcome to The Health 202. I’m your new author, Rachel Roubein, and I'll guide you through everything from the high-stakes health policy battles on Capitol Hill to the sobering coronavirus surge sweeping the nation. I’m coming to you from Politico, where I wrote plenty about health policy and the pandemic. I’ve covered health for nearly a decade and love doing so because what happens in Washington has huge stakes for the entire country.

So please, don’t be a stranger. My inbox is always accepting news, tips, criticisms and — of course — compliments.

The level of concern in the administration and the White House is high as the delta variant surges. Both privately and publicly, federal officials are admitting a hard truth: they don’t know exactly when — and how — this wave will end.

The delta variant, which is more than twice as contagious as previous strains, has fundamentally altered the course of the coronavirus in the United States, replacing President Biden’s hope for a “summer of freedom,” with warnings of a rough road ahead.

“Delta came along, and it's almost like we have a new pandemic now,” Francis Collins, head of the National Institutes of Health, told The Health 202. “Everything we thought we knew about covid-19 has to be revised.”

“I think we're in a world of trouble for at least the next couple of months, but exactly what the shape of that trouble looks like, I can’t tell you,” he added.

Biden’s strategy to curtail the still-raging pandemic hinges on vaccinations.

And that effort got a potential boost yesterday. The Food and Drug Administration granted full approval to Pfizer’s coronavirus shot — a milestone officials hope will persuade holdouts to get vaccinated and drive more employers to implement mandates. This comes as vaccinations are on the rise in recent weeks amid delta fears.

Cyrus Shahpar, covid-19 data director for the White House:

“I would certainly hope that this announcement will further increase that, but it's going to have to increase pretty steeply if we’re going to make up for the deep hole that we’re in right now,” Collins told me yesterday.

The delta variant may be more dangerous to the unvaccinated than some other iterations of the virus. According to studies out of Canada and Scotland, patients infected with the delta strain were more likely to be hospitalized. Across the United States, hospitals are once again grappling with overwhelmed ICUs and fatigued health providers. (Administration officials are quick to message this as a “pandemic of the unvaccinated.” Biden said it three times in his 11-minute remarks on the vaccination effort yesterday.)

Yet, the administration was caught flat-footed by this surge in cases, forcing officials to revise decisions on masks, vaccines and other key issues, my colleagues Annie Linskey, Yasmeen Abutaleb and Tyler Pager reported over the weekend. During that time, Americans’ approval of how Biden is handling the pandemic dipped from 66 percent to 54 percent — largely due to decreased support from independents and Republicans.

So, when will the delta surge end? Assessments from inside the administration are blunt.

“We’re just hoping it starts to turn, but no one is holding their breath here,” a senior Biden official said.

Projections of case counts next month are all over the map — and Collins conceded such models make assumptions about human behavior that researchers haven’t been good at predicting throughout the pandemic. But some experts, such as former FDA commissioner Scott Gottlieb, say they see positive signs in Florida and the South.

Yet, scientists still don’t know all the reasons the surge in delta infections in some countries, including the U.K. and India, suddenly peaked and then took a nosedive. Some experts theorize that the virus is so contagious it quickly reaches the susceptible population and then runs out of fuel.

What’s old is new again. Public health experts point to the same measures — masking, social distancing and vaccinations — as the key way to drive down a surge. But those measures have been politicized for more than a year.

“Everything tells us that the only way that you get a surge down is to mitigate,” the senior Biden official said. “The states and local governments that are hit the hardest are not doing a lot of mitigation these days.”

More on Pfizer's full approval

The FDA’s approval of the Pfizer vaccine ushered in a wave of new vaccine requirements.

Hospital systems that have been holding out on mandates for their workers may follow suit. Janis Orlowski, chief health-care officer with the Association of American Medical Colleges, told The Health 202 that she has spoken with a number of health-care CEOs who now plan to mandate vaccinations in their institutions.

Biden urged on the wave of mandates. “If you're a business leader, a nonprofit leader, a state or local leader, who has been waiting for full FDA approval to require vaccinations, I call on you now to do that — require it,” he said.

Full approval may present a conundrum for some GOP leaders who have emphasized the emergency-use status of the vaccines in opposing mandates. Texas Gov. Greg Abbott (R) has been outspoken against coronavirus vaccine mandates, signing an executive order last month that banned public schools and government institutions from requiring the vaccines. But that ban covered only vaccines under emergency use authorization, and his office has not said what he will do now, my colleague Aaron Blake reports.

Doctors may face their own difficult choices. Full approval frees them up to prescribe vaccines off-label. That means a doctor could legally prescribe a booster shot to a patient before the week of Sept. 20, the timeline federal officials are hoping to roll out third doses for the general population.

  • A pediatrician might be able to legally offer a shot to an 11-year-old, even though no vaccine is authorized for this group. But federal health officials have urged against such prescribing, and doctors could face legal liability if a patient had an adverse outcome to a vaccine prescribed off-label. The American Academy of Pediatrics cautioned that there was not enough data to allow doctors to safely give an adult vaccine dose to children under 12.

Ahh, oof and ouch

AHH: The Biden administration asked the Supreme Court to save the CDC’s eviction moratorium.

The administration called the moratorium a “lawful and urgently needed response to an unprecedented public emergency.”

A coalition of landlords and real estate trade groups in Alabama and Georgia are challenging the latest moratorium, issued Aug. 3 by the CDC and set to run through Oct. 3. The groups have asked the justices to block it, arguing that Congress never intended to grant the CDC such sweeping power.

The high court might agree with them, The Post’s Robert Barnes reports. In June, five justices narrowly voted to leave in place a previous version of the eviction ban, which was set to wind down in July. But even though Justice Brett M. Kavanaugh voted with the majority, he said the CDC lacked the authority to impose a new ban without congressional authorization.

But the Biden administration has argued that the situation now looks far worse than it did at the end of June, as the spread of the delta variant has caused a surge in coronavirus cases.

OOF: The U.S. vaccination drive relied on an army of consultants.

“The American vaccination drive came to rely on global behemoths such as McKinsey and Boston Consulting Group (BCG), with downsized state and local health departments and even federal health agencies relying on the private sector to make vaccines available to their citizens,” The Post’s Isaac Stanley-Becker reports.

The consulting groups say they provided a vital expertise to overstretched public agencies, but critics worry the reliance on private contractors eroded capacity in the public health system and delivered few clear results. Because the internal documents of private consulting firms aren’t subject to public records laws, taxpayers have little insight into what they're getting from these companies.

The contracts also raise concerns of favoritism: Blue Shield of California helped fund the political campaign of Gov. Gavin Newsom (D). The governor awarded the Oakland-based company a $15 million no-bid contract to help roll out vaccines in the state.

OUCH: The most popular Facebook post at the beginning of the year cast doubt on the coronavirus vaccine.

The top performing link on the social media’s platform from January through March was a factual article from the South Florida Sun Sentinel about the CDC investigating the death of a doctor two weeks after he received a coronavirus vaccine. (The medical examiner’s office later concluded there was not enough evidence to say whether the vaccine played a role in his death).

Facebook has faced harsh criticism from Biden and other politicians, who say the platform has allowed misinformation about the coronavirus to flourish. But the social media company argues that the definition of health misinformation is less clear-cut than some claim.

“Facebook’s leadership has long felt that skepticism about any subject, including vaccines, should not be censored in a society that allows robust public debate,” The Post’s Elizabeth Dwoskin reports. “The challenge is that certain factual stories that might cast doubt on vaccines are often promoted and skewed by people and groups that are opposed to them. The result is that factual information can become part of an ideological campaign.”

Inside the agencies

FIRST in The Health 202: Biden will boost Medicare payments for doling out shots in certain small group homes and assisted-living facilities.

The Centers for Medicare and Medicaid Services plans to announce today that Medicare will pay providers up to $175 more when fewer than 10 older adults living together get the shot on the same day – an effort to vaccinate harder-to-reach adults.

In a statement, CMS Administrator Chiquita Brooks-LaSure said the move is aimed at removing barriers to vaccinations by paying providers more to vaccinate people in their communities who aren't able to receive the shot in traditional settings.

On the Hill

Today we're watching House Democrats' efforts to break the stalemate over the $3.5 trillion budget framework.

The plan has huge implications for Biden’s health agenda. At least five centrists are still resisting a deal with Democratic leadership that would ensure passage of the Senate-passed bipartisan infrastructure bill by Oct. 1, Politico's Heather Caygle, Sarah Ferris and Nicholas Wu report.

Senators are questioning the FDA on its work with a consulting firm that helped businesses sell opioids.

Several senators, including Maggie Hassan (D-N.H.) and Charles E. Grassley (R-Iowa), sent a letter to the FDA asking about potential conflicts of interest in its work with the consulting firm McKinsey and Co., the Associated Press's Tom Murphy reports.

While helping the government, McKinsey “also worked for a wide range of actors in the opioid industry, including many of the companies that played a pivotal role in fueling the opioid epidemic that our country now faces,” the letter says.

Sugar rush