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Considerations When Preparing for COVID-19 in Assisted Living Facilities




Below are changes to the guidance as of May 29, 2020:

  • Assisted living facility (ALF) owners and administrators should refer to guidance from state and local officials when making decisions about relaxing restrictions (e.g., easing visitor restrictions, allowing group activities, or restoring communal dining)
  • State licensing authorities, which have oversight of ALFs, are encouraged to share this guidance with all ALFs in their jurisdiction. State healthcare-associated infections programs are an important resource to assist ALFs with responding to COVID-19 and implementing recommended practices.

Given their congregate nature and population served, assisted living facilities (ALFs) are at high risk for SARS-CoV-2 spreading among their residents. If infected with SARS-CoV-2, the virus that causes COVID-19, assisted living residents—often older adults with underlying medical conditions—are at increased risk for severe illness. CDC is aware of confirmed cases of COVID-19 among residents of ALFs in multiple states. Experience with outbreaks in nursing homes has demonstrated that residents with COVID-19 may not report common symptoms such as fever or respiratory symptoms; some may not report any symptoms. Unrecognized asymptomatic and pre-symptomatic infections likely contribute to transmission in these settings. Therefore, CDC recommends source control measures for all persons, including when in a healthcare setting.  Detailed recommendations, including when facemasks versus cloth face coverings should be used are in the CDC’s Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings

ALFs should refer to guidance from state and local officials when making decisions about relaxing restrictions (e.g., easing visitor restrictions, allowing group activities, or restoring communal dining).  CMS has created Nursing Home Reopening Recommendations for State and Local Officialspdf iconexternal icon.  This guidance was created specifically for nursing homes, but content might also be informative for ALFs.

When relaxing any restrictions, ALFs must remain vigilant for COVID-19 among residents and personnel in order to prevent spread and protect residents and personnel from severe infections, hospitalizations, and death.

Depending on the level of care and services provided in the ALF, recommendations in the following guidance documents may also apply:

To prevent spread of COVID-19 in their facilities, ALFs should take the following actions:

Identify a point of contact at the local health department to facilitate prompt notification as follows:

  • Immediately notify the health department about any of the following:
    • If COVID-19 is suspected or confirmed among residents or facility personnel;
    • If a resident develops severe respiratory infection resulting in hospitalization;
    • If 3 or more residents or facility personnel develop new-onset  respiratory symptoms within 72 hours of each other.

Prompt notification of the health department about residents and personnel with suspected or confirmed COVID-19 is critical.  The health department can help ensure all recommended infection prevention and control measures are in place.  Often, when a new-onset infection is identified, there are others in the facility who are also infected but who do not yet have symptoms. Rapid action to identify, isolate, and test others who might be infected is critical to prevent further spread.

In addition to guidance for health departments addressing case investigation and contact tracing that helps to define who should be considered exposed, CDC has also released SARS-CoV-2 testing guidance for nursing homes, which might be helpful to ALFs.

Educate residents, family members, and personnel about COVID-19:

Have a plan for visitor and personnel restrictions

  • Encourage residents to limit outside visitors; visitor restrictions are to protect them and others in the facility who might have conditions making them more vulnerable to severe illness from COVID-19.
    • In some jurisdictions, a total restriction of visitors might be warranted based on community prevalence of COVID-19 and guidance from local and state officials.
  • Facilitate and encourage alternative methods for visitationpdf icon (e.g., video conferencing) and communication with residents
  • Create or review an inventory of all volunteers and personnel who provide care in the facility, including consultant personnel (e.g., home health personnel, barber, nail care). Use that inventory to determine which personnel are non-essential and whose services can be delayed. This inventory can also be used to notify personnel if COVID-19 is identified in the facility.
    • In some jurisdictions, a total restriction of all volunteers and non-essential personnel including certain consultant services (e.g., barber, nail care) might be warranted based on community prevalence of COVID-19 and guidance from local and state officials.
  • Post signage at all entrances and leave notices for contract service providers at all residences that:
    • Provide information about current visitation policies or restrictions;
    • Remind visitors and personnel not to enter the building if they have fever or symptoms consistent with COVID-19.
  • Consider designating one central point of entry to the facility to facilitate screening (while maintaining social distancing) and establishing visitation hours if visitation is allowed.
  • Designate one or more facility employees to actively screen all visitors and personnel, including essential consultant personnel, for the presence of fever and symptoms consistent with COVID-19 before starting each shift/when they enter the building.
    • Send visitors and personnel home if they have a fever (temperature of 100.0 oF or greater) or symptoms consistent with COVID-19.
  • Implement sick leave policies that are flexible and non-punitive.
  • Personnel with suspected COVID-19 should be prioritized for testing.
  • Create a plan for responding to personnel with COVID-19 who may have worked while ill, which addresses identifying and performing a risk assessment for exposed residents and co-workers.
  • Encourage personnel who work in multiple locations to tell facilities if they have worked in other facilities with recognized COVID-19 cases.

Encourage source control

  • Everyone in the facility should practice source control.
  • Personnel should wear a facemask (or cloth face covering if facemasks are not available or only source control is required) at all times while they are in the facility.
    • When available, facemasks are generally preferred over cloth face coverings for healthcare personnel as facemasks offer both source control and protection for the wearer against exposure to splashes and sprays of infectious material from others. Guidance on extended use and reuse of facemasks is available. Cloth face coverings are not personal protective equipment (PPE) and should NOT be worn instead of a respirator or facemask if more than source control is required.
  • Visitors should wear a cloth face covering while in the facility.
  • Encourage residents to wear a cloth face covering (if tolerated) whenever they are around others, including when they leave their rooms and when they leave the facility (e.g., residents receiving hemodialysis).

Cloth face coverings should not be worn or placed on anyone who has trouble breathing, or anyone who is unconscious, incapacitated, or otherwise unable to remove the mask without assistance.  Additionally, they should not be placed on children under age 2.

Encourage social (physical) distancing

  • Modify or cancel group activities
    • Instead of communal dining, consider delivering meals to rooms, creating a “grab n’ go” option for residents, or staggering mealtimes to accommodate social distancing while dining (e.g., a single person per table).
    • Schedule group activities in a staggered fashion to limit number of residents participating and allow them to remain at least 6 feet apart from each other
    • Remind residents to remain at least 6 feet apart from others when they are outside their room
  • Remind personnel to practice social distancing while in break rooms and common areas, cancel non-essential meetings, and consider alternate methods for essential meetings (e.g., virtual)

Provide access to supplies and implement recommended infection prevention and control practices:

  • Provide access to alcohol-based hand sanitizer with at least 60% alcohol throughout the facility and keep sinks stocked with soap and paper towels.
    • Remind residents, visitors, and personnel to frequently perform hand hygiene
  • Ensure adequate cleaning and disinfection supplies are available. Provide EPA-registered disposable disinfectant wipes so that commonly used surfaces can be wiped down.
    • Routinely (at least once per day) clean and disinfect surfaces and objects that are frequently touched in common areas. This may include cleaning surfaces and objects not ordinarily cleaned daily (e.g., door handles, faucets, toilet handles, light switches, elevator buttons, handrails, handicap access door panels, countertops, chairs, tables, remote controls, shared electronic equipment, and shared exercise equipment).
    • Use regular cleaners, according to the directions on the label. For disinfection, refer to List Nexternal icon on the EPA website for a list of products that are EPA-approved for use against the virus that causes COVID-19. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time).

Rapidly identify and properly respond to residents with suspected or confirmed COVID-19:

  • Designate one or more facility employees to ensure all residents have been asked at least daily about fever and symptoms consistent with COVID-19.
    • Implement a process with a facility point of contact that residents can notify (e.g., call by phone) if they develop symptoms.
  • If COVID-19 is identified or suspected in a resident (i.e., resident reports fever or symptoms consistent with COVID-19):
    • Immediately isolate the resident in their room and notify the health department. The resident should be prioritized for testing.

Older people with COVID-19 may not show common symptoms such as fever or respiratory symptoms. Less common symptoms can include new or worsening malaise, headache, or new dizziness, nausea, vomiting, diarrhea, loss of taste or smell. Identification of symptoms consistent with COVID-19 should prompt isolation and further evaluation for COVID-19.

    • Encourage all other residents to self-isolate, if not already doing so, while awaiting assessment to determine if they are also infected or exposed.
    • Maintain social distancing (remaining at least 6 feet apart) between all residents and personnel, while still providing necessary services.
    • For situations where close contact with any (symptomatic or asymptomatic) resident cannot be avoided, personnel should at a minimum, wear:
      • Eye protection (goggles or face shield) and an N95 or higher-level respirator (or a facemask if respirators are not available). Cloth face coverings are not PPE and should not be used when a respirator or facemask is indicated.
      • If personnel have direct contact with a resident, they should also wear gloves. If available, gowns are also recommended but should be prioritized for activities where splashes or sprays are anticipated, or high-contact resident-care activities that provide opportunities for transfer to pathogens to hands and clothing of personnel (e.g., dressing, bathing/showering, transferring, providing hygiene, changing linens, changing briefs or assisting with toileting, device care or use, wound care).
    • Personnel who do not interact with residents (e.g., not within 6 feet) and do not clean resident environments or equipment do not need to wear PPE. However, they should wear a cloth face covering or, if PPE supplies are sufficient, a facemask for source control.
    • Personnel who are expected to use PPE should receive training on selection and use of PPE, including demonstrating competency with putting on and removing PPE in a manner to prevent self-contamination.
    • CDC has provided strategies for optimizing personal protective equipment (PPE) supply that describe actions facilities can take to extend their supply if, despite efforts to obtain additional PPE, there are shortages. These include strategies such as extended use or reuse of respirators, facemasks, and disposable eye protection.
  • A resident with COVID-19 might be able to remain in the facility if the resident:
    • Is able to perform their own activities of daily living;
    • Can isolate in their room for the duration of their illness;
    • Can have meals delivered;
    • Can be regularly checked on by staff (e.g., checking in by phone during each shift; visits by home health agency personnel who wear all recommended PPE);
    • Is able to request assistance if needed.
  • It might also be possible for residents with COVID-19 who require more assistance to remain in the facility if they can remain isolated in their room, and on-site or consultant personnel can provide the level of care needed with access to all recommended PPE and training on proper selection and use.
  • If the resident with COVID-19 requires more assistance than can be safely provided by on-site or consultant personnel (e.g., home health agency), they should be transferred (in consultation with public health) to another location (e.g., alternate care site, hospital) that is equipped to adhere to recommended infection prevention and control practices. Transport personnel and the receiving facility should be notified about the suspected diagnosis prior to transfer.
    • While awaiting transfer, residents should be separated from others (e.g., remain in their room with the door closed) and should wear a cloth face covering or facemask (if tolerated) when others are in the room and during transport.
    • Appropriate PPE (as described above) should be used by personnel when coming in contact with the resident.
  • If residents are transferred to the hospital or another care setting, actively follow up with that facility and resident family members to determine if the resident was confirmed or suspected to have COVID-19. This information will inform need for contact tracing or implementation of additional infection prevention and control recommendations.

Report COVID-19 cases, facility staffing, and supply information to the National Healthcare Safety Network (NHSN) Long-term Care Facility (LTCF) COVID-19 module weekly

  • While ALFs do not have the same federal requirement to report to NSHN as nursing homes, their participation is encouraged.
  • CDC’s NHSN provides LTCFs with a customized system to track infections and prevention process measures in a systematic way. ALFs can report into the 4 pathways of the COVID-19 module including:
    • Resident impact and facility capacity;
    • Staff and personnel impact;
    • Supplies and personal protective equipment;
    • Ventilator capacity and supplies.


Interim Additional Guidance for Infection Prevention and Control for Patients with Suspected or Confirmed COVID-19 in Nursing Homes

Strategies to Optimize the Supply of PPE and Equipment

Strategies to Mitigate Healthcare Personnel Staffing Shortages

Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease (COVID-19)

Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance)

Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19 (Interim Guidance)


Source Control: Use of a cloth face covering or facemask to cover a person’s mouth and nose to prevent spread of respiratory secretions when they are talking, sneezing, or coughing.  Facemasks and cloth face coverings should not be placed on children under age 2, anyone who has trouble breathing, or anyone who is unconscious, incapacitated, or otherwise unable to remove the mask without assistance.

Cloth face covering: Textile (cloth) covers that are intended to keep the person wearing one from spreading respiratory secretions when talking, sneezing, or coughing. They are not PPE, and it is uncertain whether cloth face coverings protect the wearer. Guidance on design, use, and maintenance of cloth face coverings is available.

Facemask: Facemasks are PPE and are often referred to as surgical masks or procedure masks. Use facemasks according to product labeling and local, state, and federal requirements. FDA-cleared surgical masks are designed to protect against splashes and sprays and are prioritized for use when such exposures are anticipated, including surgical procedures. Facemasks that are not regulated by FDA, such as some procedure masks, which are typically used for isolation purposes, may not provide protection against splashes and sprays.

Respirator: A respirator is a personal protective device that is worn on the face, covers at least the nose and mouth, and is used to reduce the wearer’s risk of inhaling hazardous airborne particles (including dust particles and infectious agents), gases, or vapors. Respirators are certified by the CDC/NIOSH, including those intended for use in healthcare.



Enerkon (ENKS) Appoints AJSH and Co. Inc. a PCOAB firm with Maryland office in USA, as Auditor for 2018-19-20 and Q1 21 – in addition to the appointment of Berkowitz Pollack Brant (BPB) As Senior Advising CPA Firm for Up List Plans




New York, New York, April 21, 2021 – OTC PR WIRE – Enerkon Solar International (OTC Pink: ENKS) announces today the appointment of AJSH and Co. Inc.  a PCOAB firm with Maryland office in USA, as Auditor for 2018-19-20 and Q1 21 – in addition to the appointment of Berkowitz Pollack Brant (BPB) As Senior Advising CPA Firm for Up List Plans.

Enerkon Solar International Inc (ENKS) Chairman Mr. Benjamin Ballout Stated: “Today, ENKS Appointed AJSH and Co. Inc.  a PCOAB firm with Maryland office in USA, as Audit Firm for 2018-19-20 and Q1 21 – whereby the Engagement agreement was signed by all parties and started as of today in addition we appointment the Firm Berkowitz Pollack Brant (BPB) As Senior Advising CPA Firm for Up List to Plans as of this afternoon.”

“Enerkon looks forward to success with regulatory agencies and Market Up List to NASDAQ – including the FDA as to the EUA Application for the SARS2- COVID19 15 Sec Insta Test (Patent Owned by Graphene Leaders Canada and Distributed by KrowdX of Canada –) CO sales with our 100% wholly owned Corporate subsidiary Coviklear Holdings Intl., Lt (UK) and others interlocutors”

“We look forward to a timely Audit completion over the coming period and advisory support for up listing”

Mr. Ballout continued: “Lastly, our March 31 Quarterly report will be posted within about 10 days, with Positive Earnings and Asset Growth, in line for the last 4 years averages and we shall announce the progress of our various interactions with the Governments of Ukraine, Libya and other countries, covering the next quarter plans and operations”

“Upon Up List in the coming period, we will hire a professional IR/PR Firm to gain exposure of the company with the Investment community, since we have never actively promoted the company officially, over the past 4 years and therefore the PPS and Valuation in our opinion, does not reflect the actual Valuation of the company or the correct PPS valuation, due to the OTC Market Conditions and again, the main reason for our Up List Plans.

“A Convertible Preferred Share Exchange may also be offered to Shareholders, which will include an 8% Dividend, in cash or kind and the effect of this conversion, will be a further contraction of outstanding shares / float – making market manipulation / shorting more difficult and giving a better PPS and valuation (Market Cap) to the Company as it deserves based on fundamentals”

The foregoing statements are forward-looking statements, and as such, they may or may not reflect the results which could transpire in the future which should be negative or not transpire at all due to circumstances or other reasons and investors, shareholders, or others should not rely on these forward-looking statements to ascertain any value if any of ENKS or to make any investment decisions and to take note that this is not an offer to buy or sell securities or an endorsement of ENKS for investment purposes as all investment carry a risk of loss sometimes a total loss of your investment in Micro cap shares markets or any market and therefore such statements or plans should not be relied upon for any business decisions of any kind – Approval and permissions required by federal regulations may or may not be approved and if not approved may result in the loss of all value and all investments in products requiring such regulatory permissions to market and sell. These statements are made as forward-looking statements for educational purposes only in accordance with the rules and regulations which pertain to the same.

Enerkon Solar International Inc.

New HQ Address in New York at:
Enerkon Solar International Inc
477 Madison Avenue
New York, NY 10022 USA

Tel. +1 (877) 573-7797
Tel. +1 (718) 709-7889


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FDA Inspection Finds Numerous Problems At Facility Intended To Make J&J Vaccine




The Emergent BioSolutions Bayview Campus plant in Baltimore has stopped producing vaccine material following an FDA inspection that found numerous problems. The plant was slated to become part of the Johnson & Johnson COVID-19 vaccine production process. Tasos Katopodis/Getty Images hide caption

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Tasos Katopodis/Getty Images

Peeling paint. Cracked buckets. Employees dragging unsealed bags of medical waste. Procedures ignored. Inadequately trained staff.

All of these were problems noted by U.S. Food and Drug Administration inspectors at the Emergent BioSolutions factory in Baltimore – a facility that is intended to produce materials for the Johnson & Johnson COVID-19 vaccine. That plan is on hold, following a problem last month with a batch of a vaccine ingredient there, and now a range of documented issues at the facility.

The Emergent factory does not yet have FDA authorization to be part of the coronavirus vaccine supply chain, but was ramping up to be.

The FDA initiated an inspection of the company’s factory in Baltimore’s Bayview neighborhood on April 12. Four days later, the agency asked Emergent to stop manufacturing any new material at the facility, and to quarantine all existing vaccine substance already made there. The company complied, pending results of the inspection and any necessary remediation.

The results of that inspection were released Wednesday by the FDA, and they aren’t pretty. The FDA’s inspection report listed several troubling observations from visits to the facility and its review of video footage.

The inspection found that Emergent had not thoroughly examined what had led to the documented cross-contamination episode in March, and “did not include a thorough review of personnel movements in and around the facility as a potential source of contamination.”

“There is no assurance that other batches have not been subject to cross-contamination,” the report stated.

Other observations included:

  • The factory was not maintained in a clean and sanitary condition. Equipment wasn’t cleaned and maintained appropriately.
  • Procedures to prevent cross-contamination weren’t followed. It noted several instances of employees mishandling unsealed bags of special medical waste. Employees were also seen taking off outer protective garments on the warehouse floor where raw materials were staged for manufacturing.
  • Components and containers were not handled or stored in a manner to prevent contamination.
  • Inadequate written procedures to assure that drugs manufactured have the identity, strength, quality and purity they should.
  • Employees were not trained in the specific operation they performed or in current best practices related to their job function. Inspectors found Emergent had failed to adequately train personnel to prevent cross-contamination between products it was making for different, unnamed clients – presumably Johnson & Johnson and AstraZeneca.
  • It noted peeling floors and rough surfaces in sampling rooms and elsewhere, which “do not allow for adequate cleaning and sanitation.” It also noted paint flecks on the floor of corridors and damaged walls.
  • The factory used equipment too small for its intended purpose, describing labs overcrowded with samples.

Some of these problems, such as inadequate training of employees, may take considerable time to fix.

Emergent said in a statement on Wednesday that it is “committed to working with the FDA and Johnson & Johnson to quickly resolve the issues identified. … While we are never satisfied to see shortcomings in our manufacturing facilities or process, they are correctable and we will take swift action to remedy them.”

In an earlier statement on Monday, as it filed a notice with the U.S. Securities and Exchange Commission that it was pausing production at the Baltimore facility, Emergent said that it recognizes “the confusion these recent events may have caused our customers, our employees, and the public. We are steadfastly committed to full compliance with the FDA’s strict requirements. We acknowledge that there are improvements we must make to meet the high standards we have set for ourselves and to restore confidence in our quality systems and manufacturing processes.”

The administration of Johnson & Johnson COVID-19 vaccine in the U.S. was already put on hold last week due to concerns about a very rare blood clotting disorder that was found in a small number of people who had received the vaccine. Six cases were identified out of nearly 7 million administered doses.

The FDA said Wednesday that “it is often in the public’s best interest that the FDA work with firms to quickly resolve compliance matters to ensure that the public has access to medical products that meet the agency’s high standards for quality, safety and effectiveness.”

“We are doing everything we can to ensure that the COVID-19 vaccines that are given to the people of this nation have met the agency’s high standards for quality, safety and effectiveness. We know that every time an American, including members of our own families, receives a COVID-19 vaccine dose, they are putting their trust in us. We are working hard to maintain that trust,” the agency said.

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Masks Remain Extremely Effective Indoors, But Are They Necessary Outside?




Most evidence points to the risks of coronavirus transmission outdoors as very low, according to Dr. Ashish Jha of Brown University’s School of Public Health. Karen Ducey/Getty Images hide caption

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Karen Ducey/Getty Images

Scientists and public health experts agree that masks are effective at lowering the spread of the coronavirus indoors, where the vast majority of transmission is likely to occur.

But what about outside?

About two dozen states have statewide mask mandates that generally require people to wear masks outside when they’re not able to stay at least 6 feet apart. Many cities have their own rules.

But with vaccinations accumulating, some health experts and journalists are arguing that now is a good time for authorities to ease up on outdoor mask requirements. Studies have linked transmission to indoor settings far more than outdoor ones, though data is limited and there are plenty of caveats.

Dr. Ashish Jha, dean of Brown University’s School of Public Health, notes that case numbers aren’t going down and they’ve been largely stagnant for the past month or two. But he says the situations driving it are groups of people gathering indoors without masks.

“Once you get outside, it starts becoming really, really uncommon for the virus to spread,” he tells NPR’s All Things Considered.

Some exceptions could involve people at packed rallies, standing or sitting close together for long periods of time. But beyond those scenarios, “there really just is not much spread happening outdoors.”

This interview has been edited for length and clarity.

Interview Highlights

Is there a number we can put on this? How uncommon it would be to pick up a case of COVID-19 if you were outside?

There are estimates that suggest maybe 1 in 1,000 infections happen outside. There are reasons to believe that if you just think about your risk, if you’re just out and about walking around, it’s probably even much less than that. So those rare instances occur in those contexts of sort of the large, packed rallies. I don’t know that we’ve seen really any cases of somebody who was just, let’s say, out for a walk or out for a run and picked up the infection that way. I think you really have to have a lot more exposure than that.

I am a jogger. … Do we know how much the risk increases when you’re breathing really hard, when you’re huffing and puffing, trying to get up that hill?

I think if somebody were right next to you and spending, let’s say, 10, 15 minutes running in that little stream of breath that you’re exhaling, there might be a risk. But somebody you’re running by who is there for just a second, the risk is — it’s extremely rare.

There will be people listening to us who are screaming at their radios right now saying it’s still spreading and the variants are out there and so far, most people aren’t fully vaccinated. You shouldn’t be having this conversation yet. What do you say to them?

I understand that first of all. But it’s really important to be able to have a nuanced discussion of what is safe and what is not. Because one of the problems is if we can’t have that discussion, then some people will adhere to all the rules, even ones that are not necessarily very useful, and other people will just ignore all of them.

And right now, while cases are spreading, while the variants are out there and very contagious ones like B.1.1.7 [are] really dominant, I do want people to do things that are safe. And part of that is telling people, you know, what restrictions they can let go of. And so I think it’s critically important that we keep indoor mask mandates in for a while. We can’t give up on those, not while infection numbers are high. But it also means telling people what they can relax on. And wearing masks outside, again, unless you’re in a very, very crowded space for extended periods of time, probably doesn’t do much to protect you or protect others.

Ayen Bior, Courtney Dorning and Elena Burnett produced and edited the audio interview.

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Supply vs Demand: When Will the Scales Tip on COVID-19 Vaccination in the U.S?




For months, the main challenge with COVID-19 vaccine roll-out in the U.S. was that demand greatly outstripped supply. Indeed, limited supply, coupled with restricted eligibility in many parts of the country, meant that most people couldn’t get vaccinated if they wanted to. Now, with supply having increased significantly and eligibility fully open to adults in all states as of April 19, the main question has become, when will supply outstrip demand? While timing may differ by state, we estimate that across the U.S. as a whole we will likely reach a tipping point on vaccine enthusiasm in the next 2 to 4 weeks. Once this happens, efforts to encourage vaccination will become much harder, presenting a challenge to reaching the levels of herd immunity that are expected to be needed.

Our polls, and others, have shown that the share of adults who have either received one vaccine dose or want to get vaccinated as soon as they can has continually increased. As of March 21, it was 61% (up from 55% the month before). This increase reflects a shift from those saying they want to “wait and see” into the vaccine enthusiasm group. In fact, the share saying they want to “wait and see” has consistently fallen, as more people become enthusiastic about getting vaccinated.

If we use 61% as a current “outer edge” of vaccine enthusiasm, it translates into about 157 million adults. The latest data from the CDC indicate that almost 131 million adults (or 50.7% of all adults), had received at least one vaccine dose as of April 19. That leaves an additional 27 million adults to go before we hit up against the “enthusiasm limit”. At the current rate of first doses administered per day (using a 7-day rolling average, as of April 13) – or approximately, 1.7 million per day – we would reach the tipping point in about 15 days.  Of course if the pace of vaccination picks up, it could be sooner.  However, if those who say they want to get vaccinated right away face challenges in accessing vaccination, it could take longer.

Estimated Number of Days It Will Take to Reach All Adults in the U.S. Who Want a Vaccine With at Least One Dose (as of April 19, 2021)​

We also know that, over time, people have moved from the “wait and see” group to the vaccine enthusiasm group, suggesting that the 61% may be a floor, not a ceiling.  If about a third of the “wait and see” group moves into the enthusiasm group (comparable to what happened last month), the “outer edge” of vaccine enthusiasm would increase to 170 million people (or 66% of all adults); at the current rate of vaccine doses administered per day, it would take 22 days to reach the point at which supply outstrips demand.  If half of the “wait and see” group move, it would take about 28 days to reach the tipping point.

Thus, on average across the country, it appears we are quite close to the tipping point where demand for rather than supply of vaccines is our primary challenge. Federal, state, and local officials, and the private sector, will face the challenge of having to figure out how to increase willingness to get vaccinated among those still on the fence, and ideally among the one-fifth of adults who have consistently said they would not get vaccinated or would do so only if required. Now that supply has increased and eligibility has expanded, it will take a concerted effort to reach a sufficient level of vaccination for herd immunity, and to do so in a way that achieves equity goals as well.

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