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.

The head of the Centers for Disease Control and Prevention, Dr. Rochelle Walensky, overruled her own board of experts and approved COVID-19 booster shots for people who work in places that might put them at high risk of getting infected. The highly unusual move comes after the advisory board on vaccines voted nine to six against giving booster shots to teachers, health care workers and others who come in close contact with people in their jobs.

On Thursday, after two intensive days of hearings, the CDC’s Advisory Committee on Immunization Practices had voted against providing boosters to people in high-risk jobs. They argued that such a recommendation would open the gates to virtually any adult who wanted a booster shot because a “high-risk” position is undefined.

Walensky’s ruling came shortly after midnight Friday morning. It may be the first time a CDC director has ever overruled an ACIP committee’s recommendations. Dr. Amanda Cohn, who oversaw the meetings, notified ACIP members by email that they had been overruled. “I am hoping to share this news with you before you see it in the press,” she said.

Walensky’s ruling means the CDC’s guidelines for how to administer booster shots fall in line with what the Food and Drug Administration recommended earlier this week. The FDA envisioned prison employees, police officers, emergency medical technicians, health care workers and teachers all being given booster shots to increase their immune protection.  Before the ACIP vote, Walensky outlined who she hoped might be eligible for booster shots in addition to seniors and immunocompromised people. She mentioned, for example, a 35-year-old pregnant emergency room doctor — a high-risk individual in a high-risk job.

She did not hint when she gave that example that she felt so strongly about it that she would overrule the panel if it disagreed.

The ACIP experts did approve booster vaccines for senior citizens (age 65 and older) who got their vaccinations at least six months ago. The CDC’s best estimate is that around 11 million Americans fall into that category.

The committee also said adults age 18 and older who have underlying health conditions and who were vaccinated at least six months ago would also be eligible for boosters.

So, to be clear, the FDA and the CDC recommend that those that should get boosters are:

• People ages 65 and older, six months after vaccination
• Long term care residents, six months after vaccination
• People ages 50 to 64 with underlying health conditions, six months after vaccination
• People ages 18 to 49 with underlying conditions should weigh their individual benefits with risks
• People working in high exposure occupations (such as prisons and jails, health care workers, teachers, first responders), six months after vaccination. The list could also include store clerks and anybody who interacts with the public.

This head of the CDC overruling her own advisory panel adds yet another layer of confusion to the nation’s vaccination program. The news that people in “high-risk” jobs and living conditions may get booster shots comes after an entire network news cycle and morning newspapers reported that the panel had rejected that notion. The Biden administration will have to explain the change and the new strategy. All of this follows a month of confusion about boosters that began with the president saying they would be available to everyone this month.

Without a doubt, doctors’ phones will be ringing today as people try to get clarity on whether they should take booster shots.

The FDA and CDC’s votes only affect people who got the Pfizer vaccine. The Moderna vaccine data will soon also come before both the FDA and CDC to consider whether patients who got that vacine should get booster protection. Patients who got the Johnson & Johnson vaccine will wait even longer to get word on whether a booster is needed. The Pfizer booster is authorized by the FDA under an emergency use authorization (not fully approved), so clinicians cannot prescribe it off-label to those who got the Moderna or Johnson & Johnson vaccine.

The CDC panel made it clear that booster shots will not end the pandemic. But they have the potential to prevent more than 2,000 hospitalizations for every million doses given by preventing serious illness among vulnerable populations. Committee members insisted that the most important prevention, by far, is convincing unvaccinated people to get vaccinated.

The FDA approves vaccines as safe and effective while the CDC establishes policies for how a drug should be administered.

While state health departments can make their own rules, most follow the CDC’s guidelines.

And while both the FDA and CDC committees said they will certainly consider updates to their ruling in the months ahead, both said they did not have nearly enough safety data to approve booster shots for young people.

This item was updated from a previous version to reflect Walensky’s overnight ruling.

Do not inhale hydrogen peroxide to fight COVID

The Asthma and Allergy Foundation of America felt compelled to warn you not to inhale hydrogen peroxide to fight COVID-19. The foundation posted this warning:

(Asthma and Allergy Foundation of America)

I worry that even mentioning what you should not do will start more rumors that will lead people to dump the antiseptic in their masks.

The Federal Trade Commission has gone after people who promote the hydrogen-in-the-nebulizer treatment.

One of the people who has promoted the practice is Dr. Joseph Mercola.  He is the same guy that CNN has been tracking down as a “super-spreader” of COVID-19 misinformation. The New York Times called him the “Most Influential Spreader of Coronavirus Misinformation Online,” which is quite a claim to fame. By the way, Mercola also likes the horse wormer treatment for COVID-19 and he sells vitamins.

The real cost of delaying ‘elective surgeries’

The term “elective surgeries” does not accurately describe all of the procedures that hospitals are delaying because they have to give critical COVID-19 care cases priority. The New York Times helps us understand what kinds of cases these “elective surgeries” include:

With precious few available intensive-care beds, Idaho hospitals had largely stopped providing hernia surgeries or hip replacements before the new order. Now they are postponing cancer and heart surgeries, too, said Brian Whitlock, the chief executive of the Idaho Hospital Association. The hospitals there “have been doing their level best,” he said.

In Alaska, the state’s largest hospital, Providence Alaska Medical Center in Anchorage, has also begun rationing care as patients wait for hours to get to the emergency room and doctors scramble to find beds. “While we are doing our utmost, we are no longer able to provide the standard of care to each and every patient who needs our help,” said the hospital’s medical staff in a letter to the community in mid-September.

Hospitals nationwide say they are still backlogged from delaying surgeries and treatments during 2020. Now, patients who were not treated sooner are arriving with more difficult problems.

10,000 TSA employees have been infected

TSA agent Patrisa Johnson assists travelers as they clear security for flights out of Love Field in Dallas, Wednesday, June 24, 2020. (AP Photo/Tony Gutierrez)

It is hard to put this one in context, and the raw numbers may not tell us what you might think at first blush. This is a list of how many TSA workers employed at various airports around the country have been infected.

(WUSF)

You will notice that three of the top five are in Florida. But we cannot tell from this data whether there is a direct connection between the TSA job, the airport where the person works and the infection. It might just be that the number of infections is a reflection of the number of infections in that community. The numbers also show more cases where more workers are stationed, such as New York City and Los Angeles. In other words, it is not a surprise that you will find the most cases where you find the most people.

Prepare for a federal government shutdown

Is this just a dramatic move to ratchet up tensions for the weekend news programs or should we really begin girding for a federal government shutdown? Congress has a week to come to an agreement on an appropriations bill.

The Committee for a Responsible Federal Budget answers questions you hoped you would not have to ask:

• What is a government shutdown?
• What services are affected in a shutdown and how?
• Is the government preparing for a shutdown?
• How would federal employees be affected?
• How and why do mandatory programs continue during a shutdown?
• How many times has the government shut down?
• Does a government shutdown save money?
• How can Congress avoid a shutdown?
• What is a Continuing Resolution?
• How often does Congress pass CRs?
• What are the disadvantages of using CRs?
• How is Congress addressing funding?
• How does a shutdown differ from a default?
• How does a shutdown differ from “sequestration” or “sequester”?
• More information

The Federal News Network, which covers issues related to federal employees, explains:

Shutdowns are when most workers and contractors are sent home without pay, while others are forced to work, but also without pay. Shutdowns tend to happen at the start of the fiscal year, which is October 1. And they tend to last longer than experts usually predict. In December 1995, the shutdown lasted 21 days. That meant delayed paychecks and retirement benefits for millions of feds. Merry Christmas from the folks you sent to represent you.

Shutdowns are not just an inside-the-beltway problem. Most of the federal workforce and the much bigger group of contractors, is in New York, Pennsylvania, Utah, Alabama, Texas and California. In many communities, the federal government — an IRS or social security service center, military base, federal prison or VA facility — is the financial heartbeat of the community. Most people there, and for that matter most people here, don’t understand or appreciate the legal and legislative game that triggers a shutdown.

While members of Congress and the White House are using the threat of a shutdown to win a budgetary or political victory, the pawns are you. Career federal workers and millions of contractors. Politicians continue to get paid. Furloughed feds usually get reimbursed for the time they were locked out of their jobs. But it can take weeks or even months to get the back pay. Or the first full annuity payment after retirement.

Extended furloughs can really put a damper on the holiday season. Not to mention food and rent obligations while there is no money coming in.

Then there is the debt ceiling issue, which is different from the appropriations bill. Congress has until sometime in October to increase the national debt ceiling or the government will be in default. Economists warn that would be devastating. The debt ceiling does not authorize new spending, but instead allows the government to pay for legislation that lawmakers already passed under both Presidents Trump and Biden.

The immoral, impolite, dark and popular online collection of anti-vaxxers who died of COVID

Slate’s headline will rock you back: “The Unbelievable Grimness of HermanCainAward, the Subreddit That Catalogs Anti-Vaxxer COVID Deaths.”

Online communities that name and “celebrate” the deaths of people who oppose COVID-19 vaccines are growing. The groups that once were tiny now have thousands, in one case 278,000 members. The leader of one group had a message to journalists; who members “don’t want to F-ing be here.” One brutal site posts photos and quotes from people who died from COVID-19 while rejecting vaccines and other safety measures. The site says, “The goal of this list is educational. Please share to help keep more people from making the same mistake.”

Slate explains the prevailing tone of the Reddit community that is growing by the tens of thousands daily:

If that rate is any indication, rage is growing toward anti-vaxxers deliberately prolonging the pandemic out of an anti-social and deadly understanding of their rights. Now, it’s true that not everyone on the subreddit assents to its spiteful premise: One exhausted nurse wrote a long post about how much one of her anti-vax patients suffered, as an attempt at counterbalance. She acknowledged her own compassion fatigue but also urged readers to think harder about how we got to this sorry pass. Plenty of the discussions do orbit around that basic question. But most of the comments are angry. A collection of screenshots generally elicits a common sentiment: The person got their just desserts.

Lest you think that these are just vicious and angry posts about people caught in the clutches of the pandemic, Slate writer Lili Loofbourow, who has been plowing through the subreddit’s posts, says reading the evolution of COVID-19 victims’ thought processes from being virus deniers or anti-vaxxers to COVID-19 victims has been instructive:

I understand the disease more deeply because I have read so many viciously curated “stories” in which ordinary people blathering about politics end up narrating their decline from it — with help from their families — as optimistically as they can. They are younger than COVID patients used to be. Trying to put a positive spin on things. Soliciting prayers. Generally avoiding conversions. They do not expect to die. It’s relentless reading. And it keeps ending up the same way. Only health care workers have seen this many people decline and die.

Loofbourow adds that as unfair, indecent and unkind as the posts can be, and despite the fact the site makes no attempt to persuade or convert anybody, their darkness may serve as “as a truly frightening look at what COVID can really be like. What hundreds of stories about deaths told through mean-spirited screenshots reveal is that the disease — when it gets bad — is worse than even the most pro-vax person really understood.”

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