Covering COVID-19 is a daily Poynter briefing of story ideas about the coronavirus and other timely topics for journalists, written by senior faculty Al Tompkins. Sign up here to have it delivered to your inbox every weekday morning.

We will learn today what medical experts say is concerning background that swayed the Centers for Disease Control and Prevention to switch its guidance to tell vaccinated people to again wear masks indoors.

The Washington Post and CNN report that the new data will say that there is reason to believe that vaccinated people may — rarely — carry and pass on the virus. When they release the data, the CDC will explain why the delta variant is so different from other strains of the virus that are not shed by vaccinated people.

The Washington Post, which obtained the CDC briefing that was given to some members of Congress Thursday, reports:

One of the slides states that there is a higher risk among older age groups for hospitalization and death relative to younger people, regardless of vaccination status. Another estimates that there are 35,000 symptomatic infections per week among 162 million vaccinated Americans.

The document outlines “communication challenges” fueled by cases in vaccinated people, including concerns from local health departments about whether coronavirus vaccines remain effective and a “public convinced vaccines no longer work/booster doses needed.”

The presentation highlights the daunting task the CDC faces. It must continue to emphasize the proven efficacy of the vaccines at preventing severe illness and death while acknowledging milder breakthrough infections may not be so rare after all, and that vaccinated individuals are transmitting the virus. The agency must move the goal posts of success in full public view.

Biden tells federal workers to get vaccinated or face repeated tests and restrictions

President Joe Biden holds up a mask as he announces from the East Room of the White House in Washington, Thursday, July 29, 2021, that millions of federal workers must show proof they’ve received a coronavirus vaccine or submit to regular testing and stringent social distancing, masking and travel restrictions in an order to combat the spread of the coronavirus. (AP Photo/Susan Walsh)

President Joe Biden announced the federal government will:

• Offer paid leave to get vaccinated. The federal government will reimburse employers for giving employees time off to get themselves and their families vaccinated. The reimbursement was previously just for employees to get vaccinated.
• Encourage states to offer vaccination incentives. Biden called on all state governors to give $100 to anyone who gets fully vaccinated. He said he understands that it may seem unfair to people who have already been vaccinated, but we have to do whatever is necessary to persuade people to get their shots. The cost would be paid by federal relief funds.
• Ask the Department of Defense to figure out how to require vaccinations for all members of the military. The DOD indicated earlier this week that it would rather wait until the Food and Drug Administration fully approves the vaccines, which are currently covered under emergency approval. The DOD says the president’s order to regularly test any unvaccinated federal employees also will apply to the military, just as the order applies to civilian federal workers.
• Require all federal workers to prove they have been vaccinated or undergo weekly COVID-19 testing. Unvaccinated workers also will be restricted from traveling.
• Recommend every school open this fall and every child wear a mask. Biden pushed parents of children over age 12 to get the students vaccinated right away.

Even before the official announcement, some groups of federal workers said they were against President Biden’s order that all federal employees be vaccinated or face weekly tests and travel restrictions.

The Federal Law Enforcement Officers Association, which represents more than 26,000 federal officers, says the order is a civil rights violation. Larry Cosme, president of the association says incentives would work better:

“FLEOA fully supports individuals who voluntarily choose to be vaccinated, agree that it is safe and the most effective means of combatting the pandemic, and encourage our members to be vaccinated,” Cosme explained. “However, forcing people to undertake a medical procedure is not the American way and is a clear civil rights violation no matter how proponents may seek to justify it.”

“We would therefore encourage the administration to work collaboratively with FLEOA and other federal employee groups to incentivize all federal employees to be vaccinated, rather than penalize those who do not,” Cosme continued.

The American Postal Workers Union said any mandate should be negotiated, not ordered. The Professional Managers Association, which represents IRS managers, also weighed in against the president’s mandate. The PMA said, “At this time, no COVID-19 vaccine has received full approval from the FDA, and this may be contributing to vaccine hesitancy across our country. We must ask the administration to craft any such mandate with care and consideration of our members’ individual contraindications as well as their closely held personal and religious beliefs.”

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Could the federal government require everyone else to be vaccinated?

Biden has not even hinted that he might try to force everyone to be vaccinated. But today’s announcement is clearly within established legal guidelines for a public or private employer.

In fact, just before the Department of Veterans Affairs announced that health care workers in the VA system must be vaccinated, the Justice Department said it seemed clear that federal law does not stop public or private employers from telling workers to get the shots. Politico reports:

The opinion from the department’s Office of Legal Counsel, dated July 6, opens the door for more businesses to require the shots for U.S. workers as Covid spreads among the unvaccinated, and comes two months after the Equal Employment Opportunity Commission released guidance saying U.S. employers could require all employees physically entering an office space to get the vaccine.

But in May, the EEOC avoided the question of whether coronavirus vaccines not having full FDA approval would create a legal issue for employers — a question keeping many businesses from mandating the shots. The Justice Department clarified in its opinion that businesses weren’t prohibited from requiring vaccines under emergency use authorization by section 564 of the Food, Drug, and Cosmetic Act.

NBC News said the courts may still have a say:

It is unclear how much authority the Biden administration could have as far as requiring vaccinations beyond the federal workforce. No federal vaccination mandate has ever been tested in court and none has ever been issued for the general population. Instead, much of the power to require vaccinations has rested with state and local governments following a Supreme Court ruling in 1905 that upheld a city board of health law requiring all adults get vaccinated against smallpox.

That 1905 case, called Jacobson v. Massachusetts, involved a pastor named Henning Jacobson who said “compulsion to introduce disease into a healthy system is a violation of liberty.”

The Supreme Court didn’t agree. In a 7-2 ruling, Justice John Marshall Harlan said states have a role in protecting public health.

The good and welfare of the Commonwealth, of which the legislature is primarily the judge, is the basis on which the police power rests in Massachusetts.

Upon the principle of self-defense, of paramount necessity, a community has the right to protect itself against an epidemic of disease which threatens the safety of its members.

But Justice Harlan added a circumstance that gives vaccine opponents some wiggle room:

“We are not inclined to hold that the statute establishes the absolute rule that an adult must be vaccinated if it be apparent or can be shown with reasonable certainty that he is not at the time a fit subject of vaccination or that vaccination, by reason of his then condition, would seriously impair his health or probably cause his death.”

And notice the 100-year-old ruling has to do with local government powers, not federal mandates.

For examples of that authority, just look to New York City and New York state. The state of New York followed New York City’s lead in requiring all state workers to get vaccinated or undergo weekly tests. State workers have until Labor Day to get the vaccine.

How do people respond to vaccine mandates?

Let’s face it, people do not like to be told what to do. Not in the U.S. or France or the United Kingdom or probably anywhere. But history shows that when governments make vaccines mandatory, most people do comply.

For example, when Houston Methodist Hospital told employees to get the vaccines or be fired, and then when a federal judge sided with the hospital, only 153 employees out of 26,000 resigned or were fired. That’s about a half of 1% of the workers who sat the vaccines out.

Before the mandate, 85% of the staff was vaccinated. Now that number is more than 98%. (About 600 workers were exempted for medical or religious reasons.)

Bloomberg’s Carey Goldberg reports:

Senior housing industry-watchers say vaccine mandates could offer a competitive advantage at a time when occupancy rates are still recovering from the pandemic.

With the delta variant on the rise and concern that cold weather will bring more outbreaks, former New York City associate health commissioner Mark Barnes expects vaccine mandates to spread among office and production workers as well. They are already common at universities.

“We’re going to see more vaccine mandates by large organizations of all kinds as the months go by,” he said.

Some experts say that once the FDA removes the emergency approval label from COVID-19 vaccines, it will make it easier for governments and employers to require workers to take the shots. NBC News points out:

Many institutions, including colleges and universities, have long required certain immunizations. Still, the suggestion of Covid vaccine mandates, whether by local governments for school children or by businesses for their customers, has so far been met with sharp resistance — primarily from conservative lawmakers and activists.

At least 20 state legislatures have passed bills or are considering measures that would ban businesses and state and local governments from placing restrictions on unvaccinated people. Even so, some colleges, concert venues and employers have already started requiring Covid vaccinations.

Cases will increase further before they go down — the latest disturbing estimates

The University of Washington’s Institute for Health Metrics and Evaluation, which has been way out front in estimating what could be next for this pandemic, gives us disturbing new forecasts for the months ahead if we do not significantly ramp up vaccinations and wear masks indoors.

The IHME now estimates that another 50,000 Americans will die from COVID-19 before Thanksgiving. That would put the death toll at about 670,000. Put that on a daily death chart and you will see the projection puts the daily death rate at about the same in November 2021 as it was in November 2020, when schools were closed and we spent Thanksgiving at home, afraid to fly.

(IHME)

The estimates are that the intensive care units will be about as full in November this year as they were a year ago.

(IHME)

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The growing list of employers who demand vaccinations

The list of companies that will require employees to prove they have been vaccinated is growing. It includes Google, Facebook, The Washington Post, MGM Resorts and dozens of hospitals. Netflix is requiring vaccinations for actors who are on site. Apple is considering a vaccine requirement but has not formalized it yet.

Shake Shack went further than most. CNBC reports:

People wishing to dine or drink indoors at Union Square Hospitality Group’s Shake Shack restaurants will be required to show that they have been vaccinated against COVID-19.

Danny Meyer, CEO of the group and founder of the popular Shake Shack franchise, made the announcement Thursday on CNBC’s “Squawk Box,” saying the mandate also applies to current and future employees.

The Associated Press reports:

Less that 10% of employers have said they intend to require all employees to be vaccinated, based on periodic surveys by the research firm Gartner.

While other major technology companies may follow suit now that Google has taken its stand on vaccines, employers in other industries still may be reluctant, predicted Brian Kopp, chief of research for Gartner’s human resources practice.

“Google is seen as being such a different kind of company that I think it’s going to take one or two more big employers to do something similar in terms of becoming a game changer,” Kopp said.

Plans to reopen offices now in question following Google and Apple’s delay

The Centers for Disease Control and Prevention’s latest mask guidance makes it tough for companies to establish protocols that stretch across states and counties. Media companies like Tegna, Gray, Nexstar and Gannett, which own TV stations and newspapers nationwide, either must live with a patchwork of guidance based on whether the individual business is in a COVID-19 hot zone, or issue blanket rules that might be seen by some as an overreaction in places where cases have not grown rapidly.

The Washington Post points out how this delicate dance is developing:

Ford Motor told employees it was reinstating mask requirements at a facility in Florida and at its plant in Claycomo, Mo., which manufactures the popular F-150 pickup. Earlier in July, General Motors imposed a similar mandate on workers at its Wentzville, Mo., plant, about 200 miles east of Claycomo.

On the CDC’s online national risk map, all but six of Missouri’s 114 counties are colored red for “high” levels of community transmission, as is the entire state of Florida.

At Equinox, the chain of high-end gyms, for example, mask requirements apply to members in Southern California, but not in Virginia or Texas. Most other locations, including Boston, Chicago and New York, require that only the unvaccinated wear masks, according to the company’s website.

More than a year ago, Apple and Google became barometers for how other companies would react to the pandemic. Both sent workers home to connect remotely. Now, both are delaying their plans to bring workers back to the offices this fall.

Google announced that its 130,000 workers will come back to the offices on Oct. 18, not September as planned. When they do return, they will be required to show proof of immunization. Eventually, the vaccine mandate will spread to more than 40 countries where Google has offices.

The employment website Indeed, which has 11,000 workers, planned to bring people back into the offices in September. Now the company is pushing the recall date to Jan. 3, 2022.

Johnny Taylor, president and CEO of the Society for Human Resource Management, told CBS News that many of its member companies are fighting the spread of the virus by requiring vaccines rather than delaying a return to the office.

“The question has become, ‘How do we address the individuals who are responsible for the spread?’ And the conversation shifts to requiring masks and testing for people who aren’t vaccinated,” Taylor said.

Pfizer says again that its newest data points to the need for a booster shot

Student nurse Dario Gomez pauses for a moment while administering the Pfizer COVID-19 vaccine to patients at Providence Edwards Lifesciences vaccination site in Santa Ana, Calif., Friday, May 21, 2021. (AP Photo/Jae C. Hong)

A new study, not yet peer-reviewed, shows the Pfizer COVID-19 vaccine is 96% effective in protecting people from COVID-19 but, over time, it loses some of its protection. Protection drops to about 84% after four to six months. This means that the senior citizens who got the vaccine earliest might not be as protected now as they were in the spring.  But — and this is important — even at a lower protection rate, the vaccine is still highly effective at preventing severe illness.

The study is based on the results from 42,000 drug trial volunteers in a half-dozen countries.

84% is still, by usual vaccine standards, remarkably effective protection. Experts say the degradation may not be enough to warrant the Herculean effort to get hundreds of millions of people back to vaccination center to get boosters when just convincing some people to get the first two shots has proven way more difficult than anybody hoped. Still, Pfizer says it may ask the FDA for an emergency use authorization for a booster dose next month.

Neither the FDA nor the World Health Organization has endorsed the notion of a booster shot yet, but some countries are already planning to give booster shots to select populations, such as senior citizens.

The Pfizer data was part of an earnings report given to stock investors. A booster, of course, would be worth billions of dollars to Pfizer’s sales. Pfizer says the COVID-19 vaccine generated $7.8 billion in sales in the second quarter of this year.

Vaccines for younger children are about eight weeks away

Pfizer also told Wall Street analysts that the company should have enough data to apply for approval to vaccinate children ages 5 to 11 by the end of September.

What Simone Biles meant when she said she had ‘the twisties’

Simone Biles, of the United States, performs on the vault during the artistic gymnastics women’s final at the 2020 Summer Olympics, Tuesday, July 27, 2021, in Tokyo. (AP Photo/Ashley Landis)

There is so much that the rest of us will never understand about being an elite athlete who operates at a level as high as Simone Biles has for years. But other athletes heard her say she was feeling the “twisties,” and they know exactly what she meant.

The Washington Post explains in a really insightful piece:

When gymnasts have the “twisties,” they lose control of their bodies as they spin through the air. Sometimes they twist when they hadn’t planned to. Other times they stop midway through as Biles did. And after experiencing the twisties once, it’s very difficult to forget. Instinct gets replaced by thought. Thought quickly leads to worry. Worry is difficult to escape.

“Simply, your life is in danger when you’re doing gymnastics,” said Sean Melton, a former elite gymnast who dealt with the twisties throughout his career. “And then when you add this unknown of not being able to control your body while doing these extremely dangerous skills, it adds an extreme level of stress. And it’s terrifying, honestly, because you have no idea what is going to happen.”

When Biles mentioned that she had struggled with the twisties, former gymnasts flooded social media with empathy. Some detailed injuries they suffered after getting lost midway through a skill. One person called the twisties “the scariest, most uncontrollable sensation.”

“It’s like a nonserious stroke,” 1988 Olympian Missy Marlowe tweeted.

It’s hard to explain the twisties to someone who doesn’t do gymnastics, but it’s a mental block and it’s real. I had it happen twice, when I was 12 and 20. You cannot fix it quickly – can take months, if at all. It’s like a non-serious stroke, you’re brain and body disconnect

— Melissa Anne Marlowe OLY (@MissyAMarlowe) July 27, 2021

CNN’s Elle Reeve explains:

Flipping and twisting at the same time can be extremely disorienting — you can’t just watch where you are with your eyes. You have to feel it. This is proprioception, a sense of where your body is in space and what it’s doing.

In gymnastics, this is called “air sense.” And Biles is famous for how good hers is. “She’s always had incredible air sense, which is what you need in this sport,” her former coach Aimee Boorman told Houstonia magazine in 2015. “She doesn’t crash very frequently. Other kids, you’ll just see them splat, or get lost in the air. That doesn’t happen with her.”

Her natural talent is why her missed vault is so stunning. But her decision to scratch makes a lot of sense. When the twisties set in, it’s hard to know when they’ll go away. But Biles’s decision to protect herself marks a shift from the old way gymnastics worked in the US.

I found how common series injuries are even for young gymnasts. Stop Sports Injuries says, “Over 86,000 gymnastics injuries each year require professional treatment at a hospital, clinic, or doctor’s office.” And the National Athletic Trainers Association says, “Nearly 70% of gymnastics injuries happen during apparatus events, with floor exercise (41.9%) and the uneven bars (28.2%) being the most dangerous.”

These remarkable athletes make it look so effortless. The best of the best do that in every pastime, vocation and profession. You just can’t see the blisters, bruises, broken bones and the injuries that don’t show up on X-ray.

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