Nebraska's COVID-19 cases, hospitalizations and deaths all hit their highest point in nearly a year last week with the delta surge showing no signs of abating.
As of Thursday, 611 Nebraskans statewide were hospitalized with COVID, the highest figure since Dec. 15, 2020, according to a World-Herald analysis of federal Centers for Disease Control and Prevention data. That was a time before vaccines were available.
By Sunday, the statewide total had dipped slightly to 601, according to the state's hospital capacity dashboard. But that included 342 COVID patients in Omaha-area hospitals, with nearly 100 in intensive care, according to the Douglas County Health Department's dashboard.
For the week ending Thursday, Nebraska posted 7,008 new cases of COVID-19, the first time weekly cases have surpassed 7,000 since the first week of January. Nebraska also reported 80 COVID-related deaths last week, the highest since the second week of January.
Nebraska's case rate put it at No. 19 among a group of mostly Northeastern and Midwestern states experiencing the fall surge. Four states now have called in their National Guards to help staff hospitals or nursing homes.
In Nebraska, the delta surge began in June, just as Nebraska Gov. Pete Ricketts lifted the COVID-19 state of emergency.
The surge is the most extended the state has seen during the pandemic, with hospitalizations plateauing at a high level during much of September and October before beginning a steep climb last month.
Ricketts said in a statement Monday that Nebraska hospitals had 987 COVID-19 patients in November 2020 and provided excellent care. The current count is about 60% of last year's peak. "Doctors and nurses across the state continue to provide great care for Nebraskans," he said.
Nebraska Medicine officials on Monday further limited the type of surgeries performed at the Nebraska Medical Center because of the demand for inpatient beds and the effects of COVID-19. As of Monday, the hospital was operating six COVID units and anticipated opening a seventh this week.
Dr. James Lawler, a co-executive director for the University of Nebraska Medical Center's Global Center for Health Security, said the delta surge may not slow for a couple of weeks. He also expects to see more omicron cases in late December or January and for influenza cases to begin piling up.
Health systems have nowhere near the resilience and capacity they had last fall, he said. Hospitals were able to clear a lot of beds ahead of that anticipated surge. But this fall, they have seen increases in patients seeking regular and delayed care on top of the COVID influx. Hospital staff are burned out, and some have left hospitals across the state.
"There's much less reserve and flexibility now than we had a year ago, and I think we're only entering the really bad part of this respiratory (virus) season," Lawler said. "I think we're going to get the triple whammy of delta, omicron and flu."
Several local doctors also tweeted over the weekend about the toll of working in their hospitals' intensive care units and seeing so many patients critically ill.
Nebraska continues to lag in vaccinations, according to CDC data. Only 58.7% of Nebraskans now are fully vaccinated, below the 60.8% U.S. rate and ranking 25th among states.
Ricketts again urged vaccination as the best available tool to reduce the likelihood of severe illness and hospitalization, noting that more than 90% of Nebraskans over age 65 have been vaccinated. "I encourage Nebraskans to consult their doctor about vaccination, especially those at higher risk from the virus due to age or medical condition," he said in his statement.
The percentage of Nebraskans fully vaccinated is inching up, gaining .8% last week over the previous week.
"There still are adults who've been eligible for a long time who are getting vaccinated," Lawler said. "It's not a hopeless cause. Our community leaders could have a huge impact if they could advocate strongly for vaccinations."
But of the 75,000 new doses administered last week, nearly two-thirds were boosters. Only 35.6% of Nebraska children ages 5 to 17 have received at least one dose. That's less than half the rate of top-ranking states and ranks 28th among the states.
Lawler said most patients hospitalized with COVID are younger people who are unvaccinated, older people who haven't gotten boosters and people who are immunocompromised. He also encouraged masking in public indoor places.
State health officials said last week that people who are not fully vaccinated now are 14 times more likely to be hospitalized with COVID-19 than those who are fully vaccinated.
Colorado Gov. Jared Polis last week spoke more bluntly about the mostly unvaccinated patients filling up that state's hospitals.
“Everybody had more than enough opportunity to get vaccinated,” Polis told Colorado Public Radio’s Ryan Warner, adding: “At this point, if you haven't been vaccinated, it's really your own darn fault. … Those who get sick, it's almost entirely their own darn fault.”
Virus Q&A: Answers to common questions about COVID-19 vaccines, travel and more
What's the status of the COVID-19 vaccine mandate in the US?
It's on hold indefinitely because of legal challenges, but employers can still require the shots.
To control the spread of COVID-19, President Joe Biden previously said businesses with 100 or more employees would need to require COVID-19 vaccination or have workers get tested weekly for the virus. The rule was to take effect Jan. 4, affecting about 84 million workers nationwide.
But soon after the rule was issued by the U.S. Occupational Safety and Health Administration, it faced multiple legal challenges from businesses, conservative groups and Republican attorneys general that said the agency doesn't have the authority to mandate vaccines.
On Nov. 6, a federal appeals court in New Orleans put the rule on hold, saying it was "a one-size fits-all sledgehammer" that was too broad. Ten days later, all challenges to the requirement were consolidated in another appeals court in Cincinnati.
In a court filing, lawyers for the Biden administration said the mandate was needed to reduce transmission of the virus in workplaces. It asked that it be allowed to move ahead with the rule.
The requirement for employers is among several challenges to the Biden administration's vaccine rules. Federal judges also have placed a hold on a mandate for health care workers in the Medicare and Medicaid programs.
Is travel safe during the pandemic this holiday season?
It depends. It can be safe if you're fully vaccinated against COVID-19, but officials say people who haven't gotten the shots should delay travel.
Regardless of vaccination status, all travelers should keep taking precautions like avoiding indoor, unmasked crowds, says Dr. Keith Armitage, an infectious disease expert at Case Western Reserve University.
"The delta variant has really brought us back to an earlier time in the pandemic," he says.
The U.S. Centers for Disease Control and Prevention says not to travel if you're sick, or if you tested positive for COVID-19 and your isolation period isn't over yet — even if you're fully vaccinated. Unvaccinated people who decide to travel should get a COVID-19 test one to three days before travel and three to five days after returning.
All travelers must still wear masks on trains, planes and other indoor public transportation areas, the agency says.
Airlines say plane cabins are low risk since they have good air circulation and filtration. However, there is no requirement for vaccination or testing before domestic flights, and passengers can remove their face masks while eating or drinking.
Hotels aren't risky for the vaccinated as long as they wear masks around strangers, Armitage says. More fraught are family gatherings with unvaccinated individuals, particularly for those who are older or have health problems.
Health experts suggest looking at the case levels and masking rules in the place you are visiting before you travel.
Why can't some COVID-19 vaccinated people travel to the US?
Because they might not be vaccinated with shots recognized by the U.S. Food and Drug Administration or the World Health Organization.
When lifting overseas travel restrictions in November, the U.S. required adults coming to the country to be fully vaccinated with shots approved or authorized by the FDA or allowed by WHO.
Among the most widely used vaccines that don't meet that criteria are Russia's Sputnik V vaccine and China's CanSino vaccine. Sputnik V is authorized for use in more than 70 countries while CanSino is allowed in at least nine countries. WHO still is awaiting more data about both vaccines before making a decision.
Vaccines recognized by the FDA and WHO undergo rigorous testing and review to determine they're safe and effective. And among the vaccines used internationally, experts say some likely won't be recognized by the agencies.
"They will not all be evaluated in clinical trials with the necessary rigor," said Dr. William Moss, executive director of the Johns Hopkins International Vaccine Access Center.
An exception to the U.S. rule is people who received a full series of the Novavax vaccine in a late-stage study. The U.S. is accepting the participants who received the vaccine, not a placebo, because it was a rigorous study with oversight from an independent monitoring board.
The U.S. also allows entry to people who got two doses of any "mix-and-match" combination of vaccines on the FDA and WHO lists.
Can at-home COVID-19 tests make holiday gatherings safer?
Yes, combined with vaccination, home test kits for COVID-19 can add a layer of safety and reassurance by providing on-the-spot results during this second year of pandemic holidays.
"We will be using rapid tests to doublecheck everybody before we gather together," says Dr. Emily Volk, president of the College of American Pathologists, who is planning a holiday meal with six vaccinated family members. "We'll be doing it as they come in the door."
Home kits are not as accurate as the PCR tests done in hospitals and at testing sites, Volk says. But they have the advantage of giving results within minutes instead of days.
Testing kits are available at drugstores without a prescription, and a box with two tests typically costs about $25. Swabs, testing solution and instructions are included.
Adults and teens can test themselves. An adult can test a child as young as 2. How-to videos on product websites can be helpful.
Most tests require swabbing about a half inch inside both nostrils, so it may tickle but doesn't hurt. You will get a positive result if the test detects a viral protein in your sample.
Home tests will miss some infections and in rare cases mistakenly indicate an infection. One popular test misses around 15 out of 100 infections — these are called "false negatives" — and gives a false positive result in about 1 in 100 people who aren't infected.
Test shortages were widely reported during the last COVID-19 surge, but new options have recently hit the market and major manufacturers such as Abbott Laboratories have ramped up production.
The Centers for Disease Control and Prevention offers other tips on ways to enjoy the holidays safely. Vaccination remains the best way to protect against the coronavirus.
Are COVID-19 boosters the same as the original vaccines?
Yes, COVID-19 boosters use the same recipe as the original shots, despite the emergence of the more contagious delta variant. The vaccines weren't tweaked to better match delta because they're still working well.
The vaccines work by training your body to recognize and fight the spike protein that coats the coronavirus and helps it invade the body's cells. Delta's mutations fortunately weren't different enough to escape detection.
The increased protection you might get from a booster adjusted to better match the delta or other variants would be marginal, says Dr. Paul Goepfert, director of the Alabama Vaccine Research Clinic at the University of Alabama at Birmingham.
Manufacturing doses with a new formula would have also delayed the rollout of boosters.
Moderna and Pfizer are studying boosters tweaked for the delta and other variants to be ready if one's ever needed. Health authorities would have to decide if and when a vaccine formula swap would be worthwhile.
"What we don't know," Goepfert noted, "is if you have a delta vaccine compared to the regular vaccine, does it actually work better in preventing transmission or asymptomatic infection?"
The U.S. has authorized booster doses of the Pfizer, Moderna and Johnson & Johnson vaccines for certain people, and a few other countries also are using boosters of those shots or other COVID-19 vaccines.