Category Archives: Covid-19

The floor of theNewYorkStockExchange(NYSE) is seen after the close of trading inNewYork, U.S., March 18, 2020. REUTERS/Lucas Jackson

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NEW YORK, Nov 26 (Reuters) - COVID-19 has resurfaced as a worry for investors and a potential driver of big market moves after a new variant triggered alarm, long after the threat had receded in Wall Street's eyes.

Worries about a new strain of the virus, named Omicron and classified by the World Health Organization as a variant of concern, slammed markets worldwide and dealt the S&P 500 index its biggest one-day percentage loss in nine months. The moves came a day after the U.S. Thanksgiving holiday when thin volume likely exacerbated the moves.

With little known about the new variant, longer term implications for U.S. assets were unclear. At least, investors said signs that the new strain is spreading and questions over its resistance to vaccines could weigh on the so-called reopening trade that has lifted markets at various times this year.

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The new strain may also complicate the outlook for how aggressively the Federal Reserve normalizes monetary policy to fight inflation.

"Markets were celebrating the end of the pandemic. Slam. It isn't over," said David Kotok, chairman and chief investment officer at Cumberland Advisors. "All policy issues, meaning monetary policy, business trajectories, GDP growth estimates, leisure and hospitality recovery, the list goes on, are on hold."

The S&P 500 fell by a third as pandemic fears mushroomed in early 2020, but has more than doubled in value since then, though the pandemic's ebb and flow has driven sometimes-violent rotations in the types of stocks investors favor. The index is up more than 22% this year.

Before Friday, broader vaccine availability and advances in treatments made markets potentially less sensitive to COVID-19. The virus had dropped to a distant fifth in a list of so-called "tail risks" to the market in a recent survey of fund managers by BofA Global Research, with inflation and central bank hikes taking the top spots.

On Friday, however, technology and growth stocks that had prospered during last year's so-called stay-at-home trade soared, including Zoom Communications (ZM.O), Netflix Inc (NFLX.O) and Peloton (PTON.O).

At the same time, stocks that had rallied this year on bets of economic reopening may suffer if virus fears grow. Energy, financials and other economically sensitive stocks tumbled on Friday, as did those of many travel-related companies such as airlines and hotels.

The new Omicron coronavirus variant spread further around the world on Sunday, with 13 cases found in the Netherlands and two each in Denmark and Australia, even as more countries tried to seal themselves off by imposing travel restrictions.

First discovered in South Africa, the new variant has now also been detected in Britain, Germany, Italy, the Netherlands, Denmark, Belgium, Botswana, Israel, Australia and Hong Kong. read more

Friday's swings also sent the Cboe Volatility Index (.VIX), known as Wall Street's fear gauge, soaring and options investors scrambling to hedge their portfolios against further market swings. read more

Andrew Thrasher, portfolio manager for The Financial Enhancement Group, had been concerned that recent gains in a handful of technology stocks with large weightings in the S&P 500, including Apple Inc (AAPL.O), Amazon.com Inc (AMZN.O), Microsoft Corp (MSFT.O), were masking weakness in the broader market.

"This set the kindling for sellers to push markets lower and the latest COVID news appears to have stoked that bearish flame," he said.

Some investors said the latest COVID-19 related weakness could be a chance to buy stocks at comparatively lower levels, expecting the market to continue rapidly recovering from dips, a pattern that has marked its march to record highs this year.

"We've had numerous days when economic optimism collapses. Each of these optimism collapses were a good buying opportunity," wrote Bill Smead, founder of Smead Capital Management, in a note to investors. Among the stocks he recommended were Occidental Petroleum (OXY.N) and Macerich Co (MAC.N), down 7.2% and 5.2% respectively on Friday.

One of several wild cards is whether virus-driven economic uncertainty will slow the Federal Reserve's plans to normalize monetary policy, just as it has started unwinding its $120 billion a month bond buying program.

Futures on the U.S. federal funds rate, which track short-term interest rate expectations, on Friday showed investors rolling back their view of a sooner-than-expected rate increase.

Investors will be watching Fed Chair Jerome Powell and U.S. Treasury Secretary Janet Yellen's appearance before Congress to discuss the government's COVID response on Nov. 30 as well as U.S. employment numbers, due out next Friday.

Investors held out hope that markets could stabilize. Jack Ablin, chief investment officer at Cresset Capital Management, said moves may have been exaggerated by lack of liquidity on Friday, with many participants out for the Thanksgiving holiday.

"My first reaction is anything we are going to see today is overdone," Ablin said.

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Reporting by Saqib Iqbal Ahmed; Additional reporting by Chuck Mikolajczak, Megan Davies and Lewis Krauskopf; Writing by Ira Iosebashvili; Editing by Megan Davies, Richard Chang and Alexander Smith

Our Standards: The Thomson Reuters Trust Principles.

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Wall St Week Ahead COVID-19 fears reappear as a threat to market - Reuters

Cases of COVID-19 among children are increasing far faster than all other age groups in Maine, creating concerns among pediatricians that children are spreading the virus to older and more at-risk residents while facing risks to their own health, as well.

Over the last month, Maines overall seven-day case average has increased by 49 percent, from 463 on average in late October to 688 cases on average this week, according to data from the Maine Center for Disease Control and Prevention. Among individuals under the age of 20, however, the increase has been 83 percent during that time, more than 100 cases per day on average.

The larger increase among children makes sense given that they also have the lowest rates of vaccination. Children between the ages of 5 and 11 have only been eligible to get vaccine for a few weeks and those under the age of 5 are still not eligible. By comparison, Mainers with the highest rate of vaccination 60-79-year-olds have seen cases increase by about 19 percent in the last month.

Children and young adults do sometimes become seriously ill from the disease, although the chances are lower than among older age groups. Even if they dont become ill, children can play a major role in keeping the virus transmission line going and can sometimes do so unknowingly because they are not exhibiting symptoms.

Its the same with influenza. Kids are major transmitters, said Dr. Dora Anne Mills, chief health improvement officer for MaineHealth, the state largest health care network. Even if they dont die or get sick, they are carriers, and often silent carriers.

The longer the virus is able to spread, the greater chance other variants might develop, too. Some could be worse than the highly contagious delta variant that is dominating right now, and some could even prove vaccine-resistant. The Associated Press reported last week that estimates by the COVID-19 Scenario Modeling Hub, a collection of university and medical research organizations, suggest vaccines could make a big difference.

The hubs latest estimates show that for November through March 12, 2022, vaccinating a high percentage of 5- to 11-year-olds could avert about 430,000 COVID cases in the overall U.S. population if no new variant arose.

Dr. Gretchen Pianka, a pediatrician with Central Maine Pediatrics, said some of the recent surge in transmission among the young is likely a function of fatigue. Parents have been making decisions constantly for the last year and a half about how best to keep their kids safe, but schools are fully open now and extracurricular activities are far more prevalent than a year ago.

Families are relaxed, she said. They think, I have a healthy child and they should do fine, and it can be hard to expand that lens.

Pianka said its true children have been at lower risk of serious illness, but shes seen young patients get super sick.

And we still dont have a sense of the long-term effects, she said.

The trend of increasing transmission among children is happening across the country, too. The American Academy of Pediatrics this week released a report that showed, as of last week, pediatric cases of COVID-19 have increased by 32 percent from two weeks earlier. It was the 15th consecutive week that cases among Americans 18 or younger have been above 100,000.

At least some of the virus spread has been happening in schools and extracurricular activities in Maine. During the last school year, many communities took measures to limit the number of children in a classroom and mask mandates were near-universal. Now, fewer measures are in place, although many schools still do require masks.

Over the last 30 days, 5,181 cases of COVID-19 have been reported in public schools and 200 schools have seen an outbreak, which means at least three cases are linked epidemiologically.

According to U.S. Census data, there are approximately 280,000 Maine residents under the age of 20. Thats about 21 percent of the population. Since the pandemic began, there have been 26,524 cases in that age group, or 22.5 percent of all cases. But that number has been rising steadily recently. Younger people make up a higher percentage of cases than ever before.

The Maine CDC also has recorded 76 hospitalizations among those under 25, which is as specific as the agency breaks down COVID-19 patients by age. Maine has not had any pediatric COVID-19 deaths, but nationwide, at least 731 deaths from COVID-19 have occurred in individuals ages 18 or younger, according to the U.S. CDC.

Dr. Mills said past studies have shown that with infectious diseases, especially when vaccines are scarce, its prudent to vaccinate children first because they are the biggest spreaders. That hasnt happened with COVID-19 because it took many months for federal officials to authorize vaccines for children.

The vaccine has only been approved for 5- to 11-year-olds since the beginning of the month. Those between the age of 12 and 15 have been eligible since mid-May.

The rate of vaccination among 12- to 19-year-olds in Maine is 62.6 percent, or about 5 percentage points lower than the states overall rate. Among 5- to 11-year-olds, 26 percent have gotten first doses thus far. Vaccines havent been in use long enough to help slow the spread among that age group.

But as has been the case throughout the states vaccination effort, people are far less likely to get vaccinated in rural, inland Maine counties. For example, 77 percent of all Cumberland County residents age 12 through 19 are fully vaccinated, but just 43 percent of Franklin County residents in that age group are.

Among 5- to 11-year-olds, 45 percent in Cumberland County have gotten a first dose, while just 8 percent of elementary school age children in Somerset County have.

Pianka said she still hears from parents who have concerns about vaccinating their children. She said she listens to those concerns and, if needed, dispels any misinformation.

I tell them it does one thing and one thing only, she said. It sends a message to cells that says Make antibodies to protect against this virus. Thats all it does.

One example of a concern, she said, is risk of myocarditis, an inflammation of heart muscles. Early studies of the vaccines showed a small number of cases of this condition.

But Pianka said subsequent studies have shown that the risk of myocarditis is 10 times greater for those who contract COVID-19 than the general population, and the risk for those who have been vaccinated is actually lower than the risk level for the general population at the moment.

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Children and teens lead surge in COVID-19 cases - Press Herald

Ohio Department of Health Director Dr. Bruce Vanderhoff said Tuesday its difficult to predict COVID-19 patterns, but said the recent numbers do not bode well.

We are heading into the winter with very high levels of disease transmission, he said. And over the last couple of weeks, a definite upturn in the number of cases and the number of hospitalizations. So essentially were heading into the winter already in a surge.

In the weeks leading up to Thanksgiving, the number of patients admitted to Kettering Health hospitals with COVID-19 nearly doubled, said Dr. Jeffrey Weinstein, patient safety officer at Kettering Health. In the three weeks between Nov. 2 and Nov. 23, statewide hospitalizations for COVID-19 increased by 40%.

The severity of these COVID-19 illnesses is very high, and we are unfortunately seeing many deaths, he said. This is tragic as these deaths are largely preventable by the widely available vaccines And the upcoming Thanksgiving travel poses a major risk of spread for both COVID-19 and influenza.

At this point in the pandemic, the majority of hospitalizations and deaths are among the unvaccinated. Statewide this year, about 95% of those hospitalized with COVID-19 and 95% of those who died of COVID-19 were not fully vaccinated. Regional COVID-19 hospitalizations have largely been unvaccinated people, hovering at around 87% of COVID patients in recent weeks, according to the Greater Dayton Area Hospital Association.

Premier Health centers have seen a similar increase in COVID hospitalizations as the rest of the state in recent weeks, said Dr. Roberto Coln, chief medical officer at Miami Valley Hospital.

Unfortunately, there is indeed concern about another significant spike again if we are not careful, he said. The best ways to help avoid further increase is to continue to increase vaccine use and follow mask-wearing recommendations.

How cold weather affects the virus

Respiratory viruses tend to transmit better in weather thats cooler and less humid, Wooley explained. She pointed to studies that show the COVID-19 virus particle survives longer in cooler temperatures.

So its a matter of the virus particle structure being more stable in the cooler temperatures, she said. And also, if you look at peoples susceptibility in their lungs, in this winter weather where its again cooler and drier, even their lungs can become a little bit more dry and more vulnerable to viral infections.

Dawn Wooley, a Wright State University Professor with a doctorate in virology

Other coronaviruses that cause common colds that have been studied for years have seasonal patterns.

So its very likely that this one will have the same pattern, and the data is emerging that it is fitting that same seasonal pattern, Wooley said.

But like other viruses, COVID-19 is present year-round. And it reared its ugly head this summer. Wooley explained there were a number of factors that fueled that surge, which was still smaller than last winters peak.

After over a year of lockdowns, a loosening of the social distancing guidelines and larger gatherings of people contributed to the surge. The more contagious Delta variant came on the scene and made younger people sicker than the original. Although the vaccine was available to everyone by summer, there were many people refusing the vaccine (and they still are), she said.

How traveling, gathering could play a role

Thanksgiving travel rebounded this year. Over 53 million people were predicted to travel for the Thanksgiving holiday, up 13% from last year, according to AAA.

While experts said its safe for most fully vaccinated families to gather, they warned against unvaccinated people traveling and gathering together. But according to a Kaiser Family Foundation poll from October, only 7% of unvaccinated adults said they wont travel for the holidays due to the pandemic or avoid large gatherings (12%).

The large number of people gathering indoors in the winter from different households, especially people from far away, compounds on the cold weather factor to spread respiratory viruses at higher rates, Wooley said.

The more confined spaces with less airflow, theres a higher chance of transmission and susceptible people may breathe in a higher dose, she said.

Not at herd immunity

Until a population acquires enough immunity from a virus, outbreaks will continue.

Theres still a lot of transmission, said Sara Paton, an epidemiology professor at Wright State University. And from what weve seen from other countries, it looks like you need to have 90% or more to really see COVID start to decrease significantly. I also think we have waning immunity. So even those that are fully vaccinated, if they havent gotten their booster, theyre not going to be as immune against COVID as they were a few months ago.

Only about 52% of Ohio is fully vaccinated against COVID-19, and some area counties lag behind. Darke County is about 35% fully vaccinated, Preble County is about 37% vaccinated, Champaign County is about 40% vaccinated and Miami County is about 43% vaccinated.

Given what we have learned about COVID so far, it is unlikely that we will reach herd immunity anytime soon, Paton said. New variants, vaccine hesitancy, waning immunity and human factors all play into this. However, the vaccines have shown to be highly effective at preventing hospitalizations and deaths. It is more realistic to expect that increased vaccination rates will reduce the severity and prominence of the disease, making the virus easier to live with.

Ending the spread of the virus is one way to end the pandemic and return to normal, Paton said.

But another way of ending the pandemic is to prevent severe disease and death, she said.

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Another winter surge of COVID-19 predicted in Ohio - Dayton Daily News

Mayor-elect Eric Adams had planned a weeklong international trip thats now up in the air because of the new Omicron COVID-19 variant, sources familiar with his travel told The Post.

Adams was going to head out of the country to an unknown destination from Nov. 30 through Dec. 8, sources said. The trip had not previously been reported.

But hes now reconsidering the trip since the Omicron variant that originated in Africa has beenfound among travelersin the UK, Germany and the Czech Republic.

Adams itinerary was unclear even to people in his inner circle. Some told The Post he was headed to Europe while others said it was a mystery locale off the beaten path.

The mayor-elect, who will be sworn in at midnight on Jan. 1, is famously guarded about his private life. The retired NYPD captain told reporters through tears on the primary campaign trail in June that he never let his cop colleagues know he had a son fearing for the boys safety because of his status as a police department reformer.

The outgoing Brooklyn borough president last traveled abroad in August during the general election campaign. At the time his reps would only say he was on a personal trip to Europe with family. Politico later reported that he was vacationing in Monaco.

A spokesman for Adams did not return messages seeking comment about the upcoming trip.

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Eric Adams' planned international trip now up in the air due to COVID-19 Omicron variant - New York Post

By Heidi de Marco

It was Saturday morning at Southbay Tattoo and Body Piercing in Carson, California, and owner Efrain Espinoza Diaz Jr. was prepping for his first tattoo of the day a memorial portrait of a man that his widow wanted on her forearm.

Diaz, known as Rock, has been a tattoo artist for 26 years but still gets a little nervous when doing memorial tattoos, and this one was particularly sensitive. Diaz was inking a portrait of Philip Martin Martinez, a fellow tattoo artist and friend who was 45 when he died of covid-19 in August.

I need to concentrate, said Diaz, 52. Its a picture of my friend, my mentor.

Martinez, known to his friends and clients as Sparky, was a tattoo artist of some renown in nearby Wilmington, in Los Angeles South Bay region. A tattoo had brought Sparky and Anita together; Sparky gave Anita her first tattoo a portrait of her father in 2012, and the experience sparked a romance. Over the years of their relationship, he had covered her body with intertwining roses and a portrait of her mother.

Now his widow, she was getting the same photograph that was etched on Sparkys tomb inked into her arm. And this would be her first tattoo that Sparky had not applied.

It feels a little odd, but Rock has been really good to us, Anita Martinez said. Rock and Sparky grew up together. They met in the 1990s, at a time when there were no Mexican-American-owned tattoo shops in their neighborhood but Sparky was gaining a reputation. It was artists like Phil that would inspire a lot of us to take that step into the professional tattoo industry, Rock said.

After Sparky got sick, Anita wasnt allowed in her husbands hospital room, an isolating experience shared by hundreds of thousands of Americans who lost a loved one to covid. They let her in only at the very end.

The tattooed portrait of Philip Martin Martinez on Anitas arm. She chose to get it on her forearm so she could see it every day. (Heidi de Marco/KHN)

I got cheated out of being with him in his last moments, said Martinez, 43. When I got there, I felt he was already gone. We never got to say goodbye. We never got to hug.

I dont even know if Im ever going to heal, she said, as Diaz began sketching the outlines of the portrait below her elbow, but at least Ill get to see him every day.

According to a 2015 Harris Poll, almost 30% of Americans have at least one tattoo, a 10% increase from 2011. At least 80% of tattoos are for commemoration, said Deborah Davidson, a professor of sociology at York University in Toronto who has been researching memorial tattoos since 2009.

Memorial tattoos help us speak our grief, bandage our wounds and open dialogue about death, she said. They help us integrate loss into our lives to help us heal.

Covid, sadly, has provided many opportunities for such memorials.

Juan Rodriguez, a tattoo artist who goes by Monch, preps his clients arm for a memorial tattoo. (HEIDI DE MARCO / KHN)

Juan Rodriguez, a tattoo artist who goes by Monch, has been seeing twice as many clients as before the pandemic and is booked months in advance at his parlor in Pacoima, an L.A. neighborhood in the San Fernando Valley. Memorial tattoos, which can include names, portraits and special artwork, are common in his line of work, but theres been an increase in requests due to the pandemic. One client called me on the way to his brothers funeral, Rodriguez said.

Rodriguez thinks memorial tattoos help people process traumatic experiences. As he moves his needle over the arms, legs and backs of his clients, and they share stories of their loved ones, he feels he is part artist, part therapist.

Healthy grievers do not resolve grief by detaching from the deceased but by creating a new relationship with them, said Jennifer R. Levin, a therapist in Pasadena, California, who specializes in traumatic grief. Tattoos can be a way of sustaining that relationship, she said.

Its common for her patients in the 20-to-50 age range to get memorial tattoos, she said. Its a powerful way of acknowledging life, death and legacy.

Sazalea Martinez, a kinesiology student at Antelope Valley College in Palmdale, California, came to Rodriguez in September to memorialize her grandparents. Her grandfather died of covid in February, her grandmother in April. She chose to have Rodriguez tattoo an image of azaleas with I love you written in her grandmothers handwriting.

The azaleas, which are part of her name, represent her grandfather, she said. Sazalea decided not to get a portrait of her grandmother because the latter didnt approve of tattoos. The I love you is something simple and its comforting to me, she said. Its going to let me heal and I know she would have understood that.

Sazalea teared up as the needle moved across her forearm, tracing her grandmothers handwriting. Its still super fresh, she said. They basically raised me. They impacted who I am as a person, so to have them with me will be comforting.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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Memorial tattoos grow even more widespread in time of COVID-19 - oregonlive.com

Arizona health experts concerned for holiday COVID-19 surge as travelers arrive back from vacations

PHOENIX - It was another busy day of travel on Sunday, Nov. 28 as people are now returning home from Thanksgiving vacations, but health experts say this will have an impact on Arizona's already growing COVID-19 cases.

Sunday morning, Sky Harbor International Airport was packed with travelers, but by nighttime, things calmed down.

Since Nov. 21, more than 14 million passengers passed through TSA checkpoints in the U.S. thats more than double compared to 2020.

Health experts warn Arizona COVID-19 cases could increase, and of course, theyre keeping a close eye on the new variant, omicron.

The U.S. will restrict travel for non-U.S. citizens from South Africa and seven other countries starting Nov. 29.

The U.K. government is also tightening restrictions once again as face coverings will be mandatory in shops and public transportation. Travelers returning to the U.K. will require PCR testing and proof of a negative COVID-19 test.

Over in Israel, theyve decided to completely shut their borders to tourists.

Coronavirus in Arizona: Latest case numbers

More restrictions are expected up north. Its been just 20 days since the Canadian border reopened to the U.S. and some travelers say they're expecting changes, again.

Derek Wicks is traveling to Alberta, Canada from Phoenix.

"Seeing that its already spread Belgium, Germany, Hong Kong its a great idea to take precautions, for sure," he said.

Ghalid Ahmed is headed to the same destination and says, "If it happens, it happens. So after all the issues, after almost two years of this, I think you just take it in stride and if theres a fifth wave or sixth wave. or whatever, then so be it. We just take it in our stride."

Charles Kaplan was traveling to New York from Phoenix. He says, "We are all vaccinated and boosted, as was our family here."

Adding, "We will see really how bad it is. Theyre saying be cautious, masks, distance. Maybe theyll make new vaccines, but I think its a little too I mean it can change in weeks, right? But its a little too soon to change what we had to do this week."

The World Health Organization on Sunday urged countries around the world not to impose flight bans on southern African nations due to concerns over the new omicron variant.

WHO's regional director for Africa, Matshidiso Moeti, called on countries to follow science and international health regulations in order to avoid using travel restrictions.

"Travel restrictions may play a role in slightly reducing the spread of COVID-19 but place a heavy burden on lives and livelihoods," Moeti said in a statement. "If restrictions are implemented, they should not be unnecessarily invasive or intrusive, and should be scientifically based, according to the International Health Regulations, which is a legally binding instrument of international law recognized by over 190 nations."

A number of pharmaceutical firms, including AstraZeneca, Moderna, and Pfizer, said they have plans in place to adapt their vaccines in light of the new variant. Pfizer says it expects to be able to tweak its vaccine in around 100 days.

Hand sanitizing stations remain set up around Sky Harbor airport. There are also vending machines that sell protective gear, COVID-19 testing sites and free masks available.

Tip: Check to see if there are any travel restrictions or tests required wherever your traveling to.

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Arizona health experts concerned for holiday COVID-19 surge as travelers arrive back from vacations - FOX 10 News Phoenix

Significance

Plastic waste causes harm to marine life and has become a major global environmental concern. The recent COVID-19 pandemic has led to an increased demand for single-use plastic, intensifying pressure on this already out-of-control problem. This work shows that more than eight million tons of pandemic-associated plastic waste have been generated globally, with more than 25,000 tons entering the global ocean. Most of the plastic is from medical waste generated by hospitals that dwarfs the contribution from personal protection equipment and online-shopping package material. This poses a long-lasting problem for the ocean environment and is mainly accumulated on beaches and coastal sediments. We call for better medical waste management in pandemic epicenters, especially in developing countries.

The COVID-19 pandemic has led to an increased demand for single-use plastics that intensifies pressure on an already out-of-control global plastic waste problem. While it is suspected to be large, the magnitude and fate of this pandemic-associated mismanaged plastic waste are unknown. Here, we use our MITgcm ocean plastic model to quantify the impact of the pandemic on plastic discharge. We show that 8.4 1.4 million tons of pandemic-associated plastic waste have been generated from 193 countries as of August 23, 2021, with 25.9 3.8 thousand tons released into the global ocean representing 1.5 0.2% of the global total riverine plastic discharge. The model projects that the spatial distribution of the discharge changes rapidly in the global ocean within 3 y, with a significant portion of plastic debris landing on the beach and seabed later and a circumpolar plastic accumulation zone will be formed in the Arctic. We find hospital waste represents the bulk of the global discharge (73%), and most of the global discharge is from Asia (72%), which calls for better management of medical waste in developing countries.

Plastics have an excellent strength to weight ratio, and they are durable and inexpensive, making them the material of choice for most disposable medical tools, equipment, and packaging (1, 2). The COVID-19 pandemic has demonstrated the indispensable role of plastic in the healthcare sector and public health safety (2). As of August 23, 2021, about 212 million people worldwide have been infected with the COVID-19 virus with the most confirmed cases in the Americas (47.6%) and Asia (31.22%) followed by Europe (17.26%) (3). The surging number of inpatients and virus testing substantially increase the amount of plastic medical waste (4). To sustain the enormous demand for personal protective equipment (PPE, including face masks, gloves, and face shields), many single-use plastic (SUP) legislations have been withdrawn or postponed (2). In addition, lockdowns, social distancing, and restrictions on public gathering increase the dependency on online shopping at an unprecedented speed, the packaging material of which often contains plastics (5, 6).

Unfortunately, the treatment of plastic waste is not keeping up with the increased demand for plastic products. Pandemic epicenters in particular struggle to process the waste (7), and not all the used PPEs and packaging materials are handled or recycled (8, 9). This mismanaged plastic waste (MMPW) is then discharged into the environment, and a portion reaches the ocean (10). The released plastics can be transported over long distances in the ocean, encounter marine wildlife, and potentially lead to injury or even death (1114). For example, a recent report estimated that 1.56 million face masks entered the oceans in 2020 (15). Earlier studies have also raised the potential problem of COVID-19 plastic pollution and its impact on marine life (1618). Some cases of entanglement, entrapment, and ingestion of COVID-19 waste by marine organisms, even leading to death, have been reported (19, 20). The plastic debris could also facilitate species invasion and transport of contaminants including the COVID-19 virus (2123). Despite the potential impacts, the total amount of pandemic-associated plastic waste and its environmental and health impacts are largely unknown. Here, we estimate the amount of excess plastic released during the pandemic that enters the global ocean and its long-term fate and potential ecological risk.

As of August 23, 2021, the total excess MMPW generated during the pandemic is calculated as 4.4 to 15.1 million tons (Fig. 1). We use the average of scenarios with different assumptions as our best estimate (Methods), which is about 8.4 1.4 million tons. A dominant fraction (87.4%) of this excess waste is from hospitals, which is estimated based on the number of COVID-19 inpatients (24) and per-patient medical waste generation for each country (25). PPE usage by individuals contributes only 7.6% of the total excess wastes. Interestingly, we find that the surge in online shopping results in an increased demand for packaging material. However, we find that packaging and test kits are minor sources of plastic waste and only account for 4.7% and 0.3%, respectively.

Global generation of mismanaged plastics from different sources (hospital medical waste, test kits, PPE, and online packaging) attributable to the COVID-19 pandemic. High- and low-yield scenarios are considered for each source (Methods).

Table 1 shows the distribution of COVID-19 cases across different continents (Asia, Europe, North America, South America, Oceania, and Africa). About 70% of COVID-19 cases are found in North and South America and Asia (Table 1). We find that MMPW generation does not follow the case distribution, as most MMPW is produced in Asia (46%), followed by Europe (24%), and finally in North and South America (22%) (Table 1 and Fig. 2E). This reflects the lower treatment level of medical waste in many developing countries such as India, Brazil, and China (range between 11.5 and 76% as the low- and high-end estimates) compared with developed countries with large numbers of cases in North America and Europe (e.g., the United States and Spain) (0 to 5%) (Fig. 2A). The MMPW generated from individual PPE is even more skewed toward Asia (Fig. 2C and SI Appendix, Table S1) because of the large mask-wearing population (26). Similarly, the MMPW generated from online-shopping packaging is the highest in Asia (Fig. 2D). For instance, the top three countries in the express-delivery industry of global share are China (58%), United States (14.9%), and Japan (10.3%) followed by the United Kingdom (4%) and Germany (4%) (27).

Percentage of the confirmed COVID-19 cases (as of August 23, 2021), the generated mass of pandemic-associated MMPW ending up in the environment, and the pandemic-associated MMPW that is transported to river mouths for different continents

Accumulated riverine discharge of pandemic-associated mismanaged plastics to the global ocean. Panels are for the discharges caused by (A) hospital medical waste, (B) COVID-19 virus test kits, (C) PPE, (D) online-shopping packaging material, and (E) the total of them. The background color represents the generated MMPW in each watershed, while the sizes of the blue circles are for the discharges at river mouths.

Based on the MMPW production from each country and a hydrological model (28), we calculate a total discharge of 25.9 3.8 (12.3 as microplastics [< 5 mm] and 13.6 as macroplastics [> 5 mm]) thousand tons of pandemic-associated plastics to the global ocean from 369 major rivers and their watersheds (Fig. 2E). We believe that the 369 rivers (account for 91% of the global riverine plastic discharge to the sea) considered here include a vast majority of the global pandemic-associated plastic discharge. The top three rivers for pandemic-associated plastic waste discharge are Shatt al Arab (5.2 thousand tons, in Asia), Indus (4.0 thousand tons, in Asia), and Yangtze River (3.7 thousand tons, in Asia) followed by Ganges Brahmaputra (2.4 thousand tons, in Asia), Danube (1.7 thousand tons, in Europe), and Amur (1.2 thousand tons, in Asia). These findings highlight the hotspot rivers and watersheds that require special attention in plastic waste management.

Overall, the top 10 rivers account for 79% of pandemic plastic discharge, top 20 for 91%, and top 100 for 99%. About 73% of the discharge is from Asian rivers followed by Europe (11%), with minor contributions from other continents (Table 1). This pattern is different from that of the generation of MMPW (Table 1) because of the different ability of rivers to export plastic load to the ocean, which is measured as the yield ratio (defined as the ratio between the plastic discharges at the river mouth and the total MMPW generation in the watershed). The yield ratio is influenced by factors such as the distribution of plastic release along rivers and the physical conditions of rivers (e.g., water runoff and velocity) (28). The top five rivers with the highest yield ratios are the Yangtze River (0.9%), Indus (0.5%), Yellow River (0.5%), Nile (0.4%), and Ganges Brahmaputra (0.4%). These rivers have either high population density near the river mouth, large runoff, fast water velocity, or a combination of them. The combination of high pandemic-associated MMPW generations and yield ratio for Asian rivers results in their high discharge of MMPW to the ocean.

We simulate the transport and fate of the 25,900 3,800 tons of pandemic-associated plastic waste by the Nanjing University MITgcm-Plastic model (NJU-MP) to evaluate its impact on the marine environment. The model considers the primary processes that plastics undergo in seawater: beaching, drifting, settling, biofouling/defouling, abrasion, and fragmentation (29). The model reveals that a large fraction of the river discharged plastics are transferred from the surface ocean to the beach and seabed within 3 y (Fig. 3). At the end of 2021, the mass fraction of plastics in seawater, seabed, and beach are modeled as 13%, 16%, and 71% respectively. About 3.8% of the plastics are in the surface ocean with a global mean concentration of 9.1 kg/km2. Our model also suggests that the discharged pandemic-associated plastics are mainly distributed in ocean regions relatively close to their sources, for example, middle- and low-latitude rivers distributed in East and South Asia, South Africa, and the Caribbean (Fig. 4 and SI Appendix, Fig. S2). The beaching and sedimentation fluxes are mainly distributed near major river mouths (Fig. 4 and SI Appendix, Fig. S2). This suggests that the short-term impact of pandemic-associated plastics is rather confined in the coastal environment.

Projection of the fate of discharged pandemic-associated plastics (including both microplastics and macroplastics) in the global ocean. (A) The mass fractions and average concentrations in the surface ocean. (B) The mass fractions in the seawater, seabed, and beaches.

Modeled spatial distribution of mass concentrations of COVID-19-associated plastics in the surface ocean (AC, JL), on the beaches (DF, MO), and the seabed (GI, PR) in 2021, 2025, and 2100, respectively. The black boxes on the Top panel indicate the five subtropical ocean gyres (North Pacific Gyre, North Atlantic Gyre, South Pacific Gyre, South Atlantic Gyre, and Indian Gyre). Panels AI are for the microplastics, while JR are for the macroplastics.

The model suggests the impact could expand to the open ocean in 3 to 4 y. The mass fraction of plastics in the seawater is predicted to decrease in the future while those in seabed and beach are modeled to gradually increase. At the end of 2022, the fractions of riverine discharged, pandemic-associated MMPW in seawater, seabed, and beach are modeled as 5%, 19%, and 76%, respectively, and the mean surface ocean concentration sharply decreases to 3.1kg/km2. In 2025, five garbage patches in the center of subtropic gyres merge, including the four in North and South Atlantic and Pacific and the one in the Indian Ocean (Fig. 4 and SI Appendix, Fig. S2). Hot spots for sedimentation fluxes are also modeled in the high-latitude North Atlantic and the Arctic Ocean in 2025 (Fig. 4 and SI Appendix, Fig. S2), reflecting the large-scale vertical movement of the seawaters (SI Appendix, Fig. S3).

We find a long-lasting impact of the pandemic-associated waste release in the global ocean. At the end of this century, the model suggests that almost all the pandemic-associated plastics end up in either the seabed (28.8%) or beaches (70.5%), potentially hurting the benthic ecosystems. The global mean pandemic-associated plastic concentrations in the surface ocean are predicted to decrease to 0.3 kg/km2 in 2100, accounting for 0.03% of the total discharged plastic mass. However, two garbage patches are still modeled over the northeast Pacific and the southeast Indian Ocean, exerting persistent risk for ecosystems over there. The fate of microplastics and macroplastics are similar but with a higher fraction of macroplastics ending up in the beaches due to their lower mobility (Fig. 4 and SI Appendix, Fig. S1).

The Arctic Ocean appears to be a dead-end for plastic debris transport due to the northern branch of the thermohaline circulation (30). About 80% of the plastic debris discharged into the Arctic Ocean will sink quickly, and a circumpolar plastic accumulation zone is modeled to form by 2025. In this year, the Arctic seabed accounts for 13% of the global plastic sedimentation flux, but this fraction will increase to 17% in 2100. The Arctic ecosystem is considered to be particularly vulnerable due to the harsh environment and high sensitivity to climate change (31, 32), which makes the potential ecological impact of exposure to the projected accumulated Arctic plastics of special concern.

It is speculated that the pandemic will not be completely controlled in a couple of years, and many of the containing policies will continue to be implemented (33). By the end of 2021, it is conservatively estimated that the number of confirmed cases will reach 280 million (34). The generated pandemic-associated MMPW will reach a total of 11 million tons, resulting in a global riverine discharge of 34,000 tons to the ocean. The MMPW generation and discharge are expected to be more skewed toward Asia due to record-breaking confirmed cases in India (3). Given the linearity between the discharge and ocean plastic mass, the fate and transport of the newly generated plastic discharge can be deduced from our current results.

There are substantial uncertainties associated with our estimate of pandemic-associated MMPW release due to the lack of accurate data (e.g., the number of used masks and online-shopping packages and the fraction of mismanaged waste under the over-capacity conditions). For example, our estimate for the discharge from face mask usage is much lower than that of Chowdhury etal. (35), which assumes that a person uses a single mask daily while we assume a mask lasts for 6 d based on survey data (Methods). We thus consider multiple scenarios to cap the actual situations (Methods). The estimated MMPW as hospital medical waste varies by 53%, while that from packaging and PPE vary by 25% and a factor of 3.5, respectively. The estimated amounts of riverine MMPW discharge to the ocean have also uncertainty as they are based on a coarse resolution (i.e., watershed-wise) hydrological model (28). In addition, factors such as the fragmentation, abrasion, and beaching rate of plastics in NJU-MP also have a substantial influence on the simulation results (29). Despite these uncertainties, the spatial pattern of the pandemic-associated releases and their relative fate in different compartments of the ocean is more robust.

The pandemic-associated plastic discharge to the ocean accounts for 1.5 0.2% of the total riverine plastic discharges (28, 36). A large portion of the discharge is medical waste that also elevates the potential ecological and health risk (37) or even the spreading of the COVID-19 virus (38). This offers lessons that waste management requires structural changes. The revoking or delaying of the bans on SUPs may complicate plastic waste control after the pandemic. Globally public awareness of the environmental impact of PPE and other plastic products needs to be increased. Innovative technologies need to be promoted for better plastic waste collection, classification, treatment, and recycling, as well as the development of more environmentally friendly materials (15, 39). Better management of medical waste in epicenters, especially in developing countries, is necessary.

We develop an inventory for the excess plastic waste generated due to the COVID-19 pandemic. We consider four categories of sources: hospital-generated medical waste, virus testing kits, PPE used by residents, and online-shopping packages.

For hospital-generated medical waste, we estimate the amount by the number of hospitalization patients (nH) and per-patient healthcare waste generation rates (HCWGR). The nH is estimated based on the number of COVID-19 infections (nI) and the global average hospitalization rate (HR) of this disease:nH=nIHR.[1]

The nI and HR data are based on the statistics of the World Health Organization (3). The HCWGR of COVID-19 patients is approximately two times higher than that of general patients (40), which is calculated as a function of life expectancy (LE) and CO2 emissions (CDE) based on Minoglou etal. (25):HCWGR=2(0.014LE+0.31CDE).[2]

This relationship was developed based on the statistical data from 42 countries worldwide and can explain 85% of the variability of the HCWGR data (25). The LE data are from Roser etal. (41), and the CDE data are from Worldometer (42).

The virus testing kitsgenerated medical waste is estimated based on the number of conducted tests and the amount of waste generated per test. The former data are from Ritchie etal. (43) while the latter is from Cheon (44) and ShineGene (45). Depending on the specifications of the testing kits, the waste generated per test ranges 21 to 28 g/test.

For the PPE used by residents, we consider only face masks, as other items such as gloves and face shields are less commonly used. We use two ways to estimate the number of used masks: consumption-based and production-based. For the former way, we first assume an ideal condition that each person uses a new mask every 6 d (46), and we assume that the actual mask usage lies 25 to 75% of this situation. The population data are from United Nations (26). For the latter way, we assume that all masks produced are used up. The global production (PW) is estimated based on the mask production in China (PC), which is the largest mask producing country (54 to 72%) in the world (47):PW=PCp,[3]where p is the share of Chinese-produced masks (47). We also consider two scenarios for the mass of waste generated by each mask (for surgical masks or N95 masks).

The online-shopping packaging (np) in this study refers to the excess part that is caused by lifestyle changes during the pandemic compared to the normal situation (no COVID-19 pandemic) (nno-covid):np=nactualnnocovid,[4]where nactual is the actual online package usages from 2020 to the first quarter of 2021 and is estimated based on the financial report of the top six e-commerce companies worldwide (Taobao, Tmall, Amazon, Jingdong, eBay, and Walmart) (4852). The nno-covid is calculated based on the package numbers in 2019 and an average annual growth rate in recent years (53). The mass of generated plastic waste (m) is then estimated based on the average mass of plastics in the packaging material (mp) (54):m=npmp.[5]

The amount of MMPW for each source (i) can be calculated based on the waste generation rate of the above four sources (Rw), the fraction of plastic waste in the total waste (Pp), and the fraction of mismanagement waste in the total waste (Pm):MMPW=i=14RwiPpiPmi.[6]

We consider the former two source categories as medical waste while the latter two as municipal waste. The Pm for each country is specified according to the waste type. The Pm of municipal waste is based on Schmidt etal. (28). There is no solid data for the Pm of medical waste, and we use the data of Caniato etal. (55) as a function of the economic status (56) and the level of treatment and disposal of waste for individual countries. The dataset includes two scenarios, and we consider an additional scenario that is 50% lower than the lower one to account for the uncertainty of this fraction.

We estimate the river discharge of pandemic-associated MMPW to the ocean based on the watershed model developed by Schmidt etal. (28), which calculates the yield ratio of plastic discharge at the river mouth to the total MMPW generated in the entire corresponding watershed. We assume this ratio is the same for pandemic-associated plastic waste and other wastes. We consider a total of 369 major rivers and their watersheds in this study. We split the country-specific, pandemic-associated MMPW data to each watershed based on the amount of regular MMPW (28).

The NJU-MP model has a resolution of 2 latitude 2.5 longitude horizontally with 22 vertical levels and is driven by ocean physics from the Integrated Global Systems Model with 4-h time step (29). The model considers five categories of plastics with different chemical composition, and the density of each category is predetermined: polyethylene (PE, 950 kg/m3), polypropylene (PP, 900 kg/m3), polyvinyl chloride (PVC, 1,410 kg/m3), polyurethane (PU, 550 kg/m3), and others (1,050 kg m3). The plastics densities are modeled to increase when biofouled but decrease when defouled (57). The densities determine their buoyancy as low-density polymers float, whereas high-density polymers sink to the sediment (58, 59). Each category has six size bins: four belong to microplastics: <0.0781 mm, 0.0781 to 0.3125 mm, 0.3125 to 1.25 mm, and 1.25 to 5 mm, and two belong to macroplastics: 5 to 50 mm and >50 mm. There is thus a total of 60 plastic tracers in the model. We assume all the plastic debris as spheres for simplicity. The pandemic-associated MMPW discharge from rivers are released as half 5 to 10 mm and half >50 mm for macroplastics, while the largest size bin (i.e., 1.25 to 5 mm) for microplastics. After their discharge into the ocean, the plastics undergo removal by beach interception (57) and sinking to the deeper ocean and eventually on the seafloor. Biofouling of light plastic types (PE and PP) is modeled following Kooi etal. (60) but adjusted for more realistic scenarios. Three types of plastics with different degrees of biological attachment are considered. In addition, the model considers the removal processes including ultraviolet degradation, fragmentation, and abrasion.

The MMPW generation and river discharge datafor all the countries are provided in the Environmental Biogeochemistry Modeling Group (EBMG), https://www.ebmg.online/plastics (61). All study data are included in the article and/or SI Appendix.

This research was funded by the National Natural Science Foundation of China (Grant Nos. 42177349 and 41875148), the Fundamental Research Funds for the Central Universities (Grant No. 0207-14380168), Frontiers Science Center for Critical Earth Material Cycling, Jiangsu Innovative and Entrepreneurial Talents Plan, and the Collaborative Innovation Center of Climate Change, Jiangsu Province. We are grateful to the High Performance Computing Center of Nanjing University for doing the numerical calculations in this paper on its blade cluster system.

Author contributions: A.T.S. and Y.Z. designed research; Y.P. and P.W. performed research; Y.P. and P.W. analyzed data; and Y.P., A.T.S., and Y.Z. wrote the paper.

The authors declare no competing interest.

This article is a PNAS Direct Submission.

This article contains supporting information online at https://www.pnas.org/lookup/suppl/doi:10.1073/pnas.2111530118/-/DCSupplemental.

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A man walks in front of a fire in a street of The Hague during a demonstration against the Dutch government's coronavirus measures on November 20, 2021. DANNY KEMP/AFP via Getty Images hide caption

A man walks in front of a fire in a street of The Hague during a demonstration against the Dutch government's coronavirus measures on November 20, 2021.

A resurgence of COVID-19 restrictions in a number of countries has resulted in protests, with some demonstrations turning violent and leading to dozens of arrests.

On Saturday night, the Netherlands saw protests at The Hague, with demonstrators lighting fires throughout the area, defacing property and pelting officers with rocks and fireworks, according to police. The disruption went on until around 1 a.m., and police took 19 people into custody before the night was over.

That demonstration also ended with five officers injured, according to the Associated Press. One officer suffered a knee injury as well as a concussion, and others sustained hearing damage, police said on Twitter.

Other COVID-related protests also took place across the Netherlands on Saturday, including in the cities of Amsterdam, Breda, and Katwijk. In Alkmaar and Almelo, fans broke into two soccer games, defying recent lockdown orders, the AP reported.

The night before, protests broke out in the Dutch city of Rotterdam with hundreds attending. Protestors are alleged to have thrown rocks at officers patrolling the scene in addition to setting off fireworks, according to local authorities. As events spiraled into disarray, authorities issued an emergency order and tried to clear the area with the use of a water cannon, officials said. Some in attendance are also alleged to have set fire to police cars and damaged property.

The protests have come in response to a three-week partial lockdown announced last weekend following a spike in COVID-19 cases.

Ahmed Aboutaleb, the mayor of Rotterdam, said that police "felt it necessary to draw their weapons to defend themselves," according to an Associated Press report. Three protestors were shot and are currently being treated at a hospital, police said in a statement. Authorities also claimed that they fired warning shots initially and that officers were also injured; one had to be hospitalized for a leg injury and another needed to be treated by a paramedic.

Police arrested 51 people on Friday on charges that include public assault, incitement, and violation of the emergency order, and around half of those taken into custody were minors, authorities said.

Friday's activities prompted criticism from Justice Minister Ferd Grapperhaus.

"The riots and extreme violence against police officers, riot police and firefighters last night in Rotterdam are disgusting to see," he said in a statement obtained by the Associated Press. He added, "Protesting is a great right in our society, but what we saw last night is simply criminal behavior. It has nothing to do with demonstrating."

Thousands of protesters opposing the Pandemic Legislation being tabled in the Victorian Parliament are seen with placards and flags in Flagstaff Gardens on November 20, 2021 in Melbourne, Australia. Darrian Traynor/Getty Images hide caption

Thousands of protesters opposing the Pandemic Legislation being tabled in the Victorian Parliament are seen with placards and flags in Flagstaff Gardens on November 20, 2021 in Melbourne, Australia.

Protests in the Netherlands are reminiscent of what's occurring in numerous other countries across Europe in recent days. In Austria, citizens have been protesting the government's recent decision to impose a nation-wide lockdown beginning on Monday, as well as plans to make vaccinations compulsory in February.

Thousands joined a demonstration in Vienna on Saturday, with around 35,000 people gathering in the city's Heroes' Square, The Guardian reports.

Days earlier, hundreds of protestors had gathered outside the Austrian embassy in France, according to Reuters. Meanwhile, on the island of Guadeloupe, a French territory, rioters have set fires in the streets, shot at police, destroyed property, and looted places of business, prompting French officials to deploy around 50 members of their special forces to help restore order on the island, according to an Al Jazeera report.

In Belgium, police estimated that around 35,000 people gathered for a protest on Sunday near a train station in Brussels. Events turned hectic, however, with protestors throwing objects at officers and police resorting to using water cannons and tear gas on the crowd, Politico reports. Italy and Croatia have also been the site of demonstrations regarding COVID restrictions, and in Melbourne, Australia, heated protests against vaccine mandates are entering their second day.

Amid the backlash, some health officials are worried that many countries should brace themselves for even more COVID-related deaths. Dr. Hans Henri P. Kluge, the World Health Organization's regional director for Europe, said earlier this month that Europe and central Asia are again "at the epicenter" of the COVID-19 pandemic. He warned that failure to act could result in half a million deaths by early next year.

"We are at another critical point of pandemic resurgence. Europe is back at the epicentre of the pandemic, where we were 1 year ago," Kluge warned. "The difference today is that we know more and we can do more. We have more tools and means to mitigate and reduce the damage to our communities and society."

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Protests have broken out across Europe in response to tightened COVID-19 restrictions - NPR

(The Hill) COVID-19 cases are climbing nationally as the U.S. barrels into its second holiday season during the pandemic, with most families planning this year to gather for Thanksgiving.

The U.S. is in better shape than at this point last year, when authorities confirmed well over 160,000 COVID-19 cases every day.

The daily average of new cases stands below 100,000 and almost 200 million Americans are fully vaccinated. They can feel good about enjoying a typical holiday season, top infectious diseases expertAnthony Faucisaid this week.

But with millions still unvaccinated and cases rising, experts are urging Americans, particularly the unvaccinated, partially vaccinated and vulnerable, to exercise caution when gathering with others.

There is concern that the rate of infection spreading is already so high as we head into the holiday season, said Amber DSouza, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health.

Were definitely headed into our next surge, she added.

Nationally, the seven-day average for new COVID-19 cases is nearing 95,000, a 33 percent increase from two weeks prior, according to data from The New York Times. In the past two weeks, cases have increased in 39 states and D.C., and they have doubled in Massachusetts and Rhode Island.

Certain areas like the Midwest, New England and the Southwest in particular are dealing with surges.

The daily average of about 48,000 hospital admissions is flat from two weeks ago, while the 1,100 fatalities per day has dipped by 1 percent.

The case upticks come as many across the country plan for intergenerational gatherings next week, prompting public health experts to call on Americans to consider safety measures for their events.

The risk of different Thanksgiving gatherings vary, as indoor events are more dicey than outdoor and including unvaccinated guests poses more danger than limiting to fully vaccinated attendees. In the end, experts said it ultimately depends on how much risk individuals want to take.

Researchers, including Joshua Weitz, a professor of biological sciences at the Georgia Institute of Technology, have developed a tool to help figure out the localized risk that at least one infected person will be at an event.

For events with 50 people, the calculator shows eight states have counties with an at least 95 percent risk level.

Even if we are fatigued, the reality is that cases are rising, and there remains far too many individuals who are unvaccinated, and that is contributing to increased spread as well as severe outcomes, said Joshua Weitz, a professor of biological sciences at the Georgia Institute of Technology.

I think we should all be concerned that the things that we hold dear, that we enjoy doing may inadvertently lead to increases in cases and severe outcomes, he added.

About57 million people aged 12 and older remain unvaccinated and at higher risk of contracting and spreading COVID-19, in addition to ending up hospitalized or killed by the virus.

Still, experts dont expect any potential surge to reach the levels of last year with the majority of the country having immunity against the virus.

Almost 196 million Americans are fully vaccinated, and 32 million have received a booster dose, according to Centers for Disease Control and Prevention (CDC) data. Among adults aged 65 and older who are more at risk for severe illness, 86.2 percent are fully vaccinated and 38 percent have gotten their booster.

Even with most Americans protected with the vaccine, however, the shots are not 100 percent effective, meaning breakthrough cases can still emerge. Experts also said waning immunity from the vaccine over time and high community transmission could lead to more breakthrough cases.

Although its too late to initiate any vaccinations to be fully protected by Thanksgiving next week, experts said hosts and visitors can still take precautions to mitigate spread during the holiday, including having attendees take rapid tests, hosting events outdoors and increasing ventilation.

Justin Lessler, an infectious disease epidemiologist at the University of North Carolinas Gillings School of Global Public Health, said even people going to fully vaccinated events can take steps to protect attendees.

I think that extra layer of doing a rapid test or something or other activities to try to help you make doubly sure that your dinner doesnt become a super spreading event is still worth doing, he said.

Older, immunocompromised and other vulnerable people should really consider a safety plan, he said, while adding but I dont think that safety plan has to be: call off the gathering altogether.

The U.S. has already made booster shots available to these at-risk populations in recent months, and the Food and Drug Administration expanded booster authorization for all adults on Friday.

The CDCs holiday guidance updated last month suggests for all eligible people to get vaccinated in order to protect those who cant, such as children, and those at risk.

For children aged 5 to 11, the Pfizer vaccine recently became available earlier this month so a vast majority will not be fully vaccinated by next week. Children younger than 5 are still not eligible for a shot.

To protect these children, Lori Handy, the medical director of infection prevention and control at Childrens Hospital of Philadelphia, recommended implementing additional layers of protection and ensuring that those with exposures or symptoms do not attend.

For children at risk due to medical conditions, she said its time to kind of be mama bear and protect your kids for a bit more this pandemic.

I would recommend people be as cautious as possible, she said. Find ways to get joy and happiness in the holiday season, but dont overdo it with very large gatherings where you could regret that event.

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COVID-19 cases rise with Thanksgiving gatherings on the way - NewsNation Now

Not everyone who meets Carmen Lerma at community events knows what she's been through.

I thank God every day for being alive, and for giving me one more day to do something positive, Lerma said. When I wake up in the morning, thats the first thing I do. I give thanks and say please give me the strength to do as much as I can today.

On Saturday, at an event outside UMOS that Lerma helped organize, families were able to get free Thanksgiving turkeys, groceries, Walmart gift cards, and other resources. There was also a vaccine clinic, offering the flu shot, COVID-19 vaccine and booster shot.

A long-time community advocate born in Puerto Rico and raised in Milwaukee, Lermas mission is to get more of the city's Latino population vaccinated.

I am Latina, and being Latina, I understand that sometimes we're hesitant to do certain things for certain reasons," Lerma said. My mission is to educate as many people as I can that the COVID-19 vaccine is safe. Its meant to protect you enough for you to not go through what I went through.

It's been a little more than year since Lerma survived a double lung transplant, after her battle with COVID-19 did irreversible damage to her lungs. She's still practicing how to do normal things like cough and yawn.

The only thing I notice different is my chest and my lung areas are tighter, so whenever I sneeze or breathe, I can feel them expand, Lerma said. Many people dont realize after a lung transplant you have to relearn how to cough, yawn and sneeze. Those things dont just come naturally anymore.

Lerma has returned to working for UMOS part-time, mostly from home. She likes to keep busy but admits its remarkably harder to do so.

People need to understand what the coronavirus does and causes, Lerma said.

Lerma gets blood drawn every week, and takes 52 pills a day, to help keep her body from rejecting her new lungs.

She says her battle with COVID, and the toll it took on her body, also prompted other conditions, like hair loss, diabetes and a thyroid disorder.

At the end of October, Lerma needed emergency surgery for a stomach complication.

Doctors put me under to check on my lungs, and they found something wrong in my stomach, Lerma said. I dont remember much of it, but I have 30 staples in my stomach. Doctors told me I got very sick, very quick.

A passion to live and to help people continues to fuel Lerma through all the health challenges.

The trauma she's been through, though, has prompted insomnia and anxiety.

I'm not embarrassed to say that I need the help because it's really affecting me emotionally, Lerma said. Im supposed to wear a machine every night to help me breathe, and I cant get myself to put it on because it takes me right back to feeling like Im trapped under a mask in intensive care, like I was for 45 days last year.

The pain she still deals with and fights to overcome, giving her a new purpose.

I just want to make a difference, Lerma said. Not only have I suffered the repercussions of COVID, but I have friends and family who have died from it. People need to know how they can protect themselves and their families.

Carmen is working closely with Anthem Blue Cross Blue Shield, and has helped plan nearly 40 vaccination clinics and discussions through the end of this year on Milwaukee's south side, which is home to Wisconsin's largest concentration of Latino families.

Our state's Latino population is among the community's hit hardest by the COVID-19 pandemic, and vaccination rates among this group are lagging.

Right now, about 45 percent of Wisconsin's total Hispanic and Latino population has been fully vaccinated.

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