Few states are tracking dairy farmer worker health protections amid current Bird Flu outbreak

Records from 15 states with confirmed cases of bird flu in dairy cattle in the USA. Nearly 700 dairy cattle have been found infected.
Photo: Kylee Alons/Unsplash

by John McCracken
Investigate Midwest

In May, the Centers for Disease Control recommended that state public health departments, veterinarians and epidemiologists provide personal protective equipment, or PPE, for workers in direct contact with animals and their fluids, such as raw milk, that could be exposed to bird flu.

As of early December, almost 60 people have been infected with the virus, with the majority of cases stemming from human contact with dairy cattle. Nearly 700 dairy cattle herds have been infected.

The most effective way to protect workers is with face shields, latex gloves and respirators, the CDC advised.

However, records from 15 states with confirmed cases of bird flu in dairy cattle reveal inconsistent responses by agencies when it comes to providing farmworkers with personal protective equipment. Most state health agencies, which are often responsible for the human impacts of communicable diseases, have left PPE distribution to local county health officials.

The documents, which Investigate Midwest obtained through multiple public records requests, found:

  • At least a third of state health departments in states with confirmed dairy cattle outbreaks do not track the distribution of PPE.
  • Ohio, Wyoming and New Mexico, which have had active bird flu cases in dairy cattle, have either not tracked requests for farmworker PPE or are currently not accepting requests.
  • Only one dairy farm in Wisconsin, a major dairy state that has not had a confirmed cattle outbreak, has requested PPE from the state’s health department.
  • Minnesota has had few cases of bird flu in dairy cattle, but more than 200 agriculture businesses have received PPE from the state.
  • Michigan and North Carolina, which are also major dairy-producing states, have provided PPE to less than a dozen farms.

“It looks like a failure in how we’re communicating on the public health side to producers,” said Bethany Alcauter, director of research and public health for the National Center for Farmworker Health, a Texas-based nonprofit that provides resources and training to farmworkers and advocacy groups across the country.

Alcauter said farm operators and processors don’t have the same knowledge and outlook as public health officials because sick workers and animals are often part of the job.

“It’s not to say that they’re not getting sick, but because it’s maybe not that different from what they experience normally, it’s not going to change their perception of the risk just because it’s a different pathogen,” she said.


How dairy-producing states differ in providing PPE to workers during bird flu outbreaks

When dairy workers are milking cows, raw milk can come into contact with their hands, faces and bodies, increasing the risk of infection. The CDC advises that dairy workers wear PPE, including gloves, rubber overalls and face shields, to minimize the spread of the virus.

The Occupational Safety and Health Administration, OSHA, states that employers of workplaces where exposure to bird flu viruses could occur are responsible for providing PPE to workers and keeping records on infected animals and employees.

However, OSHA cannot enforce its standards on farms with less than 11 employees, an exemption that has harmed dairy workers in the past when dairy worker deaths and injuries went unreported. This makes the enforcement and responsibility of safety measures hard to pin down, Alcauter said.

“Workers are on their own in terms of actually enforcing anything,” she said.

Michigan and Colorado Workers Aren’t Using or Getting PPE

In a recent CDC study, the agency said that the prevention of human infections is critical to mitigating changes in the bird flu virus that could lead to a pandemic.

Employers can best reduce the risk of infection by providing and educating workers on the use of PPE, as well as monitoring and testing animals and workers for the virus, the study said.

While PPE is a needed tool to prevent the spread, the practical application can be hard for workers who are working long hours and completing repetitive motion tasks in tight corners and hot environments.

Every worker who contracted the virus has been tasked with cleaning and working in milking parlors, according to the study.

After surveying the predominantly Spanish-speaking workers at Michigan and Colorado dairies, the agency found that none of the workers who were infected with the virus reported using PPE. In fact, the use of PPE was low among all workers.

“This investigation identified low PPE adherence among dairy workers, which has been an ongoing challenge in hot, tight spaces where visibility around large animals is important and the use of eye protection can be challenging,” the study states.

Records obtained by Investigate Midwest show inconsistent PPE distribution processes in both Michigan and Colorado, where dairy industries have been wrestling with the virus since early this year.

From January 2023 to late September 2024, records show only 11 dairy farms requested PPE for farmworkers in Michigan. Only 16 other operations requested PPE from the state during this time.

Farms that have requested PPE from the state have had an average of nine farmworkers per dairy farm, according to the self-reported request forms, which Investigate Midwest received through its records requests.

Conversely, the handful of poultry farms that have requested PPE have an average of 60 farmworkers per operation.

In Colorado, 40 dairy farms have requested PPE from the state agency between the beginning of 2023 and September 2024, according to documents and interviews with the agency.

Most requests came over the summer when Colorado started seeing repeated outbreaks of bird flu at dairy operations. As of early December, the state has had 64 confirmed cases in dairy herds.

The average number of dairy farmworkers operating on Colorado dairy farms that have requested PPE was roughly 40 people per farm.

“Some farms also reported that they had already purchased PPE and therefore didn’t need to make a request,” David Ellenberger, a spokesperson for the Colorado Department of Public Health and Environment, CDPHE, wrote in an email to Investigate Midwest.

“Additionally, CDPHE has sent bulk orders of PPE to an agricultural workers outreach group, who has relationships with individual workers, and was able to further distribute PPE on an individual level,” Ellenberger added.

Texas, California Take Different Approaches

Earlier this year, Texas was the first state in the country to have a confirmed case of bird flu in dairy cattle and, soon after, became the second site of mammal-to-human transmission of the virus in the country.

Since then, Texas has had nearly 30 cases of bird flu in cattle.

The state’s department of health has eight regional offices and it instructs farmers to contact their local office to request PPE.

“Each region fills them as they come in,” Texas spokesperson Douglas Loveday told Investigate Midwest.

In California, which now leads the country in the number of confirmed dairy cattle cases, the health and agriculture departments do not track or manage the distribution of PPE to farms and affected facilities. This task is left to the state’s 58 local health agencies.

In an email, a California Department of Public Health spokesperson said the state supported a one-time distribution of PPE to dairy farms earlier this year. When local requests can’t be fulfilled, the state agency fulfills the request.

As of early December, the agency has fulfilled or is currently fulfilling 43 PPE requests from dairy farms, six from poultry farms and 11 from farmworker organizations.

A similar system is used in Iowa and Idaho, which have also had numerous cases of bird flu in dairy cattle.

Ken Gordon, Ohio Department of Health spokesperson, told Investigate Midwest that when bird flu was detected in northwest Ohio earlier this year, the state made PPE available as the USDA investigated the outbreak. The state received two requests for PPE from agricultural operations during that time.

Now that the farm is no longer being investigated, the state is no longer offering PPE to farmworkers upon request.

“The state-level Ohio Department of Health made PPE available, via the survey, to farms and agricultural businesses on a temporary basis as the situation was new and evolving,” Gordon said.

Other states have received few requests or do not track disbursements:

  • As of early December, only one Oklahoma farm had requested PPE from the state’s health department to manage bird flu. The state agency used to have a formal request process for PPE, but it has since closed. “The purpose of this program was to support farms as part of the immediate response until these farms were able to ascertain PPE on their own,” an Oklahoma State Department of Health spokesperson wrote in an email to Investigate Midwest. 
  • Idaho Department of Public Health spokesperson AJ McWhorter said the agency worked with the industry group Idaho Dairymen’s Association and local public health districts to identify dairy worker needs for equipment and filled a one-time request for PPE for dairy workers in June.
  • An Iowa health department spokesperson told Investigate Midwest they direct people to local agencies or to the U.S. Department of Agriculture. 
  • In Wyoming, a state with one confirmed affected dairy herd, the health department said it did not track PPE requests or make a request form available to producers. Wyoming Department of Health spokesperson Kim Deti said the state’s poultry and dairy industries are small and PPE requests have been taken on a case-by-case basis.
Few Farms in North Carolina, New Mexico and Wisconsin Request PPE

North Carolina has one confirmed case of dairy cattle infected with bird flu. The state has also seen numerous cases of infected poultry, which is a major industry in the state.

One farm and four farmworkers requested PPE from the state during the ongoing outbreak. The majority of the state’s requests for PPE have come from farmworker organizations and advocacy groups.

The Association of Mexicans in North Carolina requested 2,000 face shields for dairy workers, stating that the association will make PPE available through health fairs aimed at farmworkers and contractors and their families held across the state.

In New Mexico, a state with nine confirmed outbreaks in dairy cattle, only two farms have requested PPE, according to state health department spokesperson David Morgan.

Some major agricultural states are preparing for outbreaks, even if a confirmed case hasn’t been reported.

When dairy workers are milking cows, raw milk can come into contact with their hands, faces and bodies, increasing the risk of infection. The CDC advises that dairy workers wear PPE, including gloves, rubber overalls and face shields, to minimize the spread of the virus. graphic provided by the CDC

In Wisconsin, a major dairy-producing state, the state health agency has received 11 requests for PPE from the beginning of 2023 to September of this year. The state has yet to have a confirmed case of bird flu in dairy cattle or humans.

Only one Wisconsin dairy farm and one egg production company have requested protective equipment for employees.

Most of the state’s requests have come from cheese or dairy product manufacturers in the state, as well as veterinary offices.

In addition to workers on farms with dairy cattle, employees who work in dairy processing plants are at risk of exposure to the virus. The CDC states that employees on dairy and poultry farms, dairy processing plants and poultry slaughter plants, should receive PPE to prevent the spread.  The virus is destroyed when raw milk is pasteurized at a processing plant.

A spokesperson for Dairy Farmers of America, the country’s largest milk co-op and owner of nearly 50 dairy processing plants nationwide, told Investigate Midwest that the company has a safety protocol to provide PPE for workers at their plants.

DFA was not listed as a PPE recipient in the state of Wisconsin, where the company has three plants.

“PPE is (and was) standard protocol at our plants, prior to the bird flu, as many of our employees work around cleaning chemicals, “ a DFA spokesperson told Investigate Midwest in an email. “To date, we’ve had no requests for extra PPE.”

Wisconsin Department of Health Services spokesperson Elizabeth Goodsitt, said the agency has worked alongside the state’s agriculture department to provide updates about bird flu to producers, including information on how producers and industry groups can receive PPE.

“We know from our experience across public health that getting resources to agencies, organizations, and individuals who are most trusted by specific populations is the best way to share important information,” she said.

“Producers should continue to enhance their biosecurity efforts and monitor and control disease in their herds and flocks,” she said in an email to Investigate Midwest.

Minnesota Stands from the Rest

Minnesota’s Department of Public Health has fulfilled more than 200 requests for PPE since May despite the state having far fewer confirmed outbreaks in dairy cattle compared to its peers.

As of December, Minnesota has had 9 outbreaks in dairy cattle herds.

The majority of the state’s requests came from dairy producers, with 138 farms requesting. Twenty poultry farms requested PPE and nearly a dozen processing facilities, either dairy or poultry, requested equipment.


This story was originally published on Investigate Midwest. This article originally appeared in Sentient at https://sentientmedia.org/ppe-dairy-farm-workers-bird-flu/.

Investigate Midwest is an independent, nonprofit newsroom. Our mission is to serve the public interest by exposing dangerous and costly practices of influential agricultural corporations and institutions through in-depth and data-driven investigative journalism. Visit us online at www.investigatemidwest.org

Back-to-school illnesses, kids need their immunizations

by Matt Sheehan
OSF Healthcare

A return to school comes with a return to activities.

But no matter if it’s fall sports, extracurricular activities, or just hanging out with friends, there comes the increase spread of viruses, according to Doug Kasper, MD, an infectious disease specialist with OSF HealthCare.

Photo provided
Dr. Doug Kasper
“Not only are children, but the family unit as a whole is starting to do much more. They’re going to be exposed to each other much more than they have been over the next few months,” Dr. Kasper says.

The three main viruses remain the same as the past few years: Influenza (flu), COVID-19 and respiratory syncytial virus (RSV). But others will arise as well, including adenovirus, rhinovirus/enterovirus (common cold) and more.

When viruses tend to peak
“Influenza in Central Illinois starts to appear around November, and peaks in January,” Dr. Kasper says. “RSV, particularly in young children, starts to show up in September or October. COVID-19 has been a bit more seasonal each year, but we start to predict peaks in October. What you’ll notice is that all of those will start to overlap.”

How vaccinations play a role
As millions of kids are returning to school, Dr. Kasper says it’s time to start scheduling checkups with their pediatrician and discussing back-to-school vaccinations.

“Vaccination now has more of an effect of protecting the individual so they can remain in their activities, school or job as long as possible,” Dr. Kasper says. “We know in most situations there is more than one person in the household and more than one child at home. It's also helping decrease spread within the family unit when these things are brought home."

The flu vaccine, Dr. Kasper says, is recommended for anyone 6 months or older. Whereas the RSV vaccine is only available to certain people.

"RSV is most severe in our younger populations, ages 2 or younger, or in those 60 and older. While vaccination is only offered in select age groups, including pregnant women, there is still benefit to the family unit for the family to make sure those who can be vaccinated against RSV do get those at the appropriate time,” Dr. Kasper says.

The COVID-19 pandemic may have come and gone, but the recommendation for yearly vaccination is starting to resemble the same strategy as the flu vaccine.

"COVID-19 guidance will be a little different,” Dr. Kasper adds. “We're expecting an updated vaccine that will come out in the fall, probably October. We'll have unique recommendations for different age groups or those with medical conditions. But I'd expect the recommendation of one additional COVID-19 vaccine or booster for the fall into winter season.”

Respiratory virus symptoms
The Centers for Disease Control and Prevention (CDC) lists a dozen symptoms you may potentially experience if you become sick with one of the abovementioned viruses.

  • Fever
  • Chills
  • Fatigue (tiredness)
  • Cough
  • Runny or stuffy nose
  • Decrease in appetite
  • Sore throat
  • Vomiting
  • New loss of taste or smell
  • Headache, muscle or body aches
  • Diarrhea
  • Weakness
If you have trouble breathing or chest pain, seek emergency medical care immediately.

The CDC’s current recommendation is to stay home and away from others until at least 24 hours after you are fever-free, and your symptoms are improving. Remember to wash your hands and improve airflow by opening windows and bringing in fresh outside air, purifying indoor air or spending time outdoors. Make sure to routinely change your central heating, ventilation and air conditioning system filters every few months.


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Florida defies CDC advice telling parents it's okay to send unvaccinated kids to school during recent outbreak

by Amy Maxmen
Kaiser Health News
Ladapo sent parents a letter granting them permission to send unvaccinated children to school amid the outbreak

With a brief memo, Florida Surgeon General Joseph Ladapo has subverted a public health standard that’s long kept measles outbreaks under control.

On Feb. 20, as measles spread through Manatee Bay Elementary in South Florida, Ladapo sent parents a letter granting them permission to send unvaccinated children to school amid the outbreak.

The Department of Health “is deferring to parents or guardians to make decisions about school attendance,” wrote Ladapo, who was appointed to head the agency by Florida Gov. Ron DeSantis, whose name is listed above Ladapo’s in the letterhead.

Ladapo’s move contradicts advice from the Centers for Disease Control and Prevention.

“This is not a parental rights issue,” said Scott Rivkees, Florida’s former surgeon general who is now a professor at Brown University. “It’s about protecting fellow classmates, teachers, and members of the community against measles, which is a very serious and very transmissible illness.”

Most people who aren’t protected by a vaccine will get measles if they’re exposed to the virus. This vulnerable group includes children whose parents don’t get them vaccinated, infants too young for the vaccine, those who can’t be vaccinated for medical reasons, and others who don’t mount a strong, lasting immune response to it. Rivkees estimates that about a tenth of people in a community fall into the vulnerable category.

Measles is so contagious. It is very worrisome.

The CDC advises that unvaccinated students stay home from school for three weeks after exposure. Because the highly contagious measles virus spreads on tiny droplets through the air and on surfaces, students are considered exposed simply by sitting in the same cafeteria or classroom as someone infected. And a person with measles can pass along an infection before they develop a fever, cough, rash, or other signs of the illness. About 1 in 5 people with measles end up hospitalized, 1 in 10 develop ear infections that can lead to permanent hearing loss, and about 1 in 1,000 die from respiratory and neurological complications.

“I don’t know why the health department wouldn’t follow the CDC recommendations,” said Thresia Gambon, president of the Florida chapter of the American Academy of Pediatrics and a pediatrician who practices in Miami and Broward, the county affected by the current measles outbreak. “Measles is so contagious. It is very worrisome.”

Considering the dangers of the disease, the vaccine is incredibly safe. A person is about four times as likely to die from being struck by lightning during their lifetime in the United States as to have a potentially life-threatening allergic reaction to the measles, mumps, and rubella vaccine.

Nonetheless, last year a record number of parents filed for exemptions from school vaccine requirements on religious or philosophical grounds across the United States. The CDC reported that childhood immunization rates hit a 10-year low.

In addition to Florida, measles cases have been reported in 11 other states this year, including Arizona, Georgia, Minnesota, and Virginia.

Only about a quarter of Florida’s counties had reached the 95% threshold at which communities are considered well protected against measles outbreaks, according to the most recent data posted by the Florida Department of Health in 2022. In Broward County, where six cases of measles have been reported over the past week, about 92% of children in kindergarten had received routine immunizations against measles, chickenpox, polio, and other diseases. The remaining 8% included more than 1,500 kids who had vaccine exemptions, as of 2022.

Broward’s local health department has been offering measles vaccines at Manatee Bay Elementary since the outbreak began, according to the county school superintendent. If an unvaccinated person gets a dose within three days of exposure to the virus, they’re far less likely to get measles and spread it to others.

For this reason, government officials have occasionally mandated vaccines in emergencies in the past. For example, Philadelphia’s deputy health commissioner in 1991 ordered children to get vaccinated against their parents’ wishes during outbreaks traced to their faith-healing churches. And during a large measles outbreak among Orthodox Jewish communities in Brooklyn in 2019, the New York City health commissioner mandated that anyone who lived, worked, or went to school in hard-hit neighborhoods get vaccinated or face a fine of $1,000. In that ordinance, the commissioner wrote that the presence of anyone lacking the vaccine in those areas, unless it was medically contraindicated, “creates an unnecessary and avoidable risk of continuing the outbreak.”

Ladapo moved in the opposite direction with his letter, deferring to parents because of the “high immunity rate in the community,” which data contradicts, and because of the “burden on families and educational cost of healthy children missing school.”

Yet the burden of an outbreak only grows larger as cases of measles spread, requiring more emergency care, more testing, and broader quarantines as illness and hospitalizations mount. Curbing a 2018 outbreak in southern Washington with 72 cases cost about $2.3 million, in addition to $76,000 in medical costs, and an estimated $1 million in economic losses due to illness, quarantine, and caregiving. If numbers soar, death becomes a burden, too. An outbreak among a largely unvaccinated population in Samoa caused more than 5,700 cases and 83 deaths, mainly among children.

Ladapo’s letter to parents also marks a departure from the norm because local health departments tend to take the lead on containing measles outbreaks, rather than state or federal authorities. In response to queries from KFF Health News, Broward County’s health department deferred to Florida’s state health department, which Ladapo oversees.

“The county doesn’t have the power to disagree with the state health department,” said Rebekah Jones, a data scientist who was removed from her post at the Florida health department in 2020, over a rift regarding coronavirus data.

DeSantis, a Republican, appointed Ladapo as head of the state health department in late 2021, as DeSantis integrated skepticism about covid vaccines into his political platform. In the months that followed, Florida’s health department removed information on covid vaccines from its homepage, and reprimanded a county health director for encouraging his staff to get the vaccines, leading to his resignation. In January, the health department website posted Ladapo’s call to halt vaccination with covid mRNA vaccines entirely, based on notions that scientists call implausible.

Jones was not surprised to see Ladapo pivot to measles. “I think this is the predictable outcome of turning fringe, anti-vaccine rhetoric into a defining trait of the Florida government,” she said. Although his latest decision runs contrary to CDC advice, the federal agency rarely intervenes in measles outbreaks, entrusting the task to states.

In an email to KFF Health News, the Florida health department said it was working with others to identify the contacts of people with measles, but that details on cases and places of exposure were confidential. It repeated Ladapo’s decision, adding, “The surgeon general’s recommendation may change as epidemiological investigations continue.”

For Gambon, the outbreak is already disconcerting. “I would like to see the surgeon general promote what is safest for children and for school staff,” she said, “since I am sure there are many who might not have as strong immunity as we would hope.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.


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Area COVID-19 Dashboard for January 5, 2022

The Champaign-Urbana Public Health District announced four deaths due to the COVID-19 pandemic. Two males and two females, all over the age of 40, are the latest victims. Two of the deceased were from Urbana, one from Mahomet and one from St. Joseph.

There are now 5,737 individuals required to isolate under the CDC's current guidance that began on December 26. ** Under the previous 10-day rule, there would be 6,935 residents required to stay at home.


Active Champaign County Cases:

5,737

Net change in the county: 602

**Total that should be insolated: 6,935



Current local cases 1/5/22
Number in parenthesis indicates new cases since 1/4/22

Ogden • 40 (5)
Royal • 4 (1)
St. Joseph • 178 (48)
Urbana • 2,040 (323)
Sidney • 43 (4)
Philo • 57 (15)
Tolono • 145 (12)
Sadorus • 13 (3)
Pesotum • 22 (6)


Total Active Local Cases:

2,542

Net change in local cases: 286



Total Local Confirmed Cases: 16,088

New cases: 417


The information on this page is compiled from the latest figures provide by the Champaign-Urbana Public Health District at the time of publishing. Active cases are the number of confirmed cases reported currently in isolation. Local is defined as cases within the nine communities The Sentinel covers.

** "Total that should be insolated" is our best estimate of the number of people who would be in isolation under the CDC's 10-day isolation requirement in place prior to December 26. Current CDC policy states that anyone testing positive is required to isolate for just five days.

** Publisher's Note / January 6: After careful consideration of the data used to determine these figures appear to be inaccurate. The Sentinel is modifying the methodology used to determine the number of individuals that would be in isolation under the CDC guidelines prior to December 27, 2021.

CDC relaxes COVID isolation protocols

Earlier today, the Centers for Disease Control and Prevention announced a recommendation that individuals who exhibit no symptoms after testing positive for Covid-19 need only to isolate for five days instead of the previously recommended 10 days.

The CDC justified the new guidance in a press release. "Both updates come as the Omicron variant continues to spread throughout the U.S. and reflects the current science on when and for how long a person is maximally infectious."

The change comes on the heals of a plea from the airline and healthcare industries who are experiencing labor shortages due to employees having to observe isolation guidelines.

Press release from the CDC:

Given what we currently know about COVID-19 and the Omicron variant, CDC is shortening the recommended time for isolation from 10 days for people with COVID-19 to 5 days, if asymptomatic, followed by 5 days of wearing a mask when around others. The change is motivated by science demonstrating that the majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after. Therefore, people who test positive should isolate for 5 days and, if asymptomatic at that time, they may leave isolation if they can continue to mask for 5 days to minimize the risk of infecting others.

Additionally, CDC is updating the recommended quarantine period for those exposed to COVID-19. For people who are unvaccinated or are more than six months out from their second mRNA dose (or more than 2 months after the J&J vaccine) and not yet boosted, CDC now recommends quarantine for 5 days followed by strict mask use for an additional 5 days. Alternatively, if a 5-day quarantine is not feasible, it is imperative that an exposed person wear a well-fitting mask at all times when around others for 10 days after exposure. Individuals who have received their booster shot do not need to quarantine following an exposure, but should wear a mask for 10 days after the exposure. For all those exposed, best practice would also include a test for SARS-CoV-2 at day 5 after exposure. If symptoms occur, individuals should immediately quarantine until a negative test confirms symptoms are not attributable to COVID-19.

Isolation relates to behavior after a confirmed infection. Isolation for 5 days followed by wearing a well-fitting mask will minimize the risk of spreading the virus to others. Quarantine refers to the time following exposure to the virus or close contact with someone known to have COVID-19. Both updates come as the Omicron variant continues to spread throughout the U.S. and reflects the current science on when and for how long a person is maximally infectious.

Data from South Africa and the United Kingdom demonstrate that vaccine effectiveness against infection for two doses of an mRNA vaccine is approximately 35%. A COVID-19 vaccine booster dose restores vaccine effectiveness against infection to 75%. COVID-19 vaccination decreases the risk of severe disease, hospitalization, and death from COVID-19. CDC strongly encourages COVID-19 vaccination for everyone 5 and older and boosters for everyone 16 and older. Vaccination is the best way to protect yourself and reduce the impact of COVID-19 on our communities.

As Covid cases surge across the country, CDC only tracks a fraction of breakthrough cases


Jenny Deam and Jodi S. Cohen, ProPublica


Meggan Ingram was fully vaccinated when she tested positive for COVID-19 early this month. The 37-year-old’s fever had spiked to 103 and her breath was coming in ragged bursts when an ambulance rushed her to an emergency room in Pasco, Washington, on Aug. 10. For three hours she was given oxygen and intravenous steroids, but she was ultimately sent home without being admitted.

Seven people in her house have now tested positive. Five were fully vaccinated and two of the children are too young to get a vaccine.

As the pandemic enters a critical new phase, public health authorities continue to lack data on crucial questions, just as they did when COVID-19 first tore through the United States in the spring of 2020. Today there remains no full understanding on how the aggressively contagious delta variant spreads among the nearly 200 million partially or fully vaccinated Americans like Ingram, or on how many are getting sick.

The nation is flying blind yet again, critics say, because on May 1 of this year — as the new variant found a foothold in the U.S. — the Centers for Disease Control and Prevention mostly stopped tracking COVID-19 in vaccinated people, also known as breakthrough cases, unless the illness was severe enough to cause hospitalization or death.

Individual states now set their own criteria for collecting data on breakthrough cases, resulting in a muddled grasp of COVID-19’s impact, leaving experts in the dark as to the true number of infections among the vaccinated, whether or not vaccinated people can develop long-haul illness, and the risks to unvaccinated children as they return to school.



If you’re limiting yourself to a small subpopulation with only hospitalizations and deaths, you risk a biased viewpoint.


"It’s like saying we don’t count,” said Ingram after learning of the CDC’s policy change. COVID-19 roared through her household, yet it is unlikely any of those cases will show up in federal data because no one died or was admitted to a hospital.

The CDC told ProPublica in an email that it continues to study breakthrough cases, just in a different way. "This shift will help maximize the quality of the data collected on cases of greatest clinical and public health importance,” the email said.

In addition to the hospitalization and death information, the CDC is working with Emerging Infections Program sites in 10 states to study breakthrough cases, including some mild and asymptomatic ones, the agency’s email said.

Under pressure from some health experts, the CDC announced Wednesday that it will create a new outbreak analysis and forecast center, tapping experts in the private sector and public health to guide it to better predict how diseases spread and to act quickly during an outbreak.

Tracking only some data and not releasing it sooner or more fully, critics say, leaves a gaping hole in the nation’s understanding of the disease at a time when it most needs information.

"They are missing a large portion of the infected," said Dr. Randall Olsen, medical director of molecular diagnostics at Houston Methodist Hospital in Texas. "If you’re limiting yourself to a small subpopulation with only hospitalizations and deaths, you risk a biased viewpoint."

On Wednesday, the CDC released a trio of reports that found that while the vaccine remained effective at keeping vaccinated people out of the hospital, the overall protection appears to be waning over time, especially against the delta variant.

Among nursing home residents, one of the studies showed vaccine effectiveness dropped from 74.7% in the spring to just 53.1% by midsummer. Similarly, another report found that the overall effectiveness among vaccinated New York adults dropped from 91.7% to just under 80% between May and July.

The new findings prompted the Biden administration to announce on Wednesday that people who got a Moderna or Pfizer vaccine will be offered a booster shot eight months after their second dose. The program is scheduled to begin the week of Sept. 20 but needs approval from the Food and Drug Administration and a CDC advisory committee.



No vaccine is 100% percent effective against transmission, health officials warned.


This latest development is seen by some as another example of shifting public health messaging and backpedaling that has accompanied every phase of the pandemic for 19 months through two administrations. A little more than a month ago, the CDC and the FDA released a joint statement saying that those who have been fully vaccinated "do not need a booster shot at this time.”

The vaccine rollout late last year came with cautious optimism. No vaccine is 100% percent effective against transmission, health officials warned, but the three authorized vaccines proved exceedingly effective against the original COVID-19 strain. The CDC reported a breakthrough infection rate of 0.01% for the months between January and the end of April, although it acknowledged it could be an undercount.

As summer neared, the White House signaled it was time for the vaccinated to celebrate and resume their pre-pandemic lives.

Trouble, though, was looming. Outbreaks of a new, highly contagious variant swept India in the spring and soon began to appear in other nations. It was only a matter of time before it struck here, too.

"The world changed," said Dr. Eric Topol, director of the Scripps Research Translational Institute, "when delta invaded."

The current crush of U.S. cases — well over 100,000 per day — has hit the unvaccinated by far the hardest, leaving them at greater risk of serious illness or death. The delta variant is considered at least two or three times more infectious than the original strain of the coronavirus. For months much of the focus by health officials and the White House has been on convincing the resistant to get vaccinated, an effort that has so far produced mixed results.

Yet as spring turned to summer, scattered reports surfaced of clusters of vaccinated people testing positive for the coronavirus. In May, eight vaccinated members of the New York Yankees tested positive. In June, 11 employees of a Las Vegas hospital became infected, eight of whom were fully vaccinated. And then 469 people who visited the Provincetown, Massachusetts, area between July 3 and July 17 became infected even though 74% of them were fully vaccinated, according to the CDC’s Morbidity and Mortality Weekly Report.

While the vast majority of those cases were relatively mild, the Massachusetts outbreak contributed to the CDC reversing itself on July 27 and recommending that even vaccinated people wear masks indoors — 11 weeks after it had told them they could jettison the protection.

And as the new CDC data showed, vaccines continue to effectively shield vaccinated people against the worst outcomes. But those who get the virus are, in fact, often miserably sick and may chafe at the notion that their cases are not being fully counted.

"The vaccinated are not as protected as they think," said Topol, "They are still in jeopardy."

The CDC tracked all breakthrough cases until the end of April, then abruptly stopped without making a formal announcement. A reference to the policy switch appeared on the agency’s website in May about halfway down the homepage.

"I was shocked," said Dr. Leana Wen, a physician and visiting professor of health policy and management at George Washington University. "I have yet to hear a coherent explanation of why they stopped tracking this information.”

The CDC said in an emailed statement to ProPublica that it decided to focus on the most serious cases because officials believed more targeted data collection would better inform "response research, decisions, and policy."

Sen. Edward MMarkey, D-Mass., became alarmed after the Provincetown outbreak and wrote to CDC director Dr. Rochelle Walensky on July 22, questioning the decision to limit investigation of breakthrough cases. He asked what type of data was being compiled and how it would be shared publicly.

It is unclear how often breakthroughs occur or how widely cases are spreading among the vaccinated.

"The American public must be informed of the continued risk posed by COVID-19 and variants, and public health and medical officials, as well as health care providers, must have robust data and information to guide their decisions on public health measures," the letter said.

Markey asked the agency to respond by Aug. 12. So far the senator has received no reply, and the CDC did not answer ProPublica’s question about it.

When the CDC halted its tracking of all but the most severe cases, local and state health departments were left to make up their own rules.

There is now little consistency from state to state or even county to county on what information is gathered about breakthrough cases, how often it is publicly shared, or if it is shared at all.

"We’ve had a patchwork of information between states since the beginning of the pandemic,” said Jen Kates, senior vice president and director of global health and HIV policy at Kaiser Family Foundation.

She is co-author of a July 30 study that found breakthrough cases across the U.S. remained rare, especially those leading to hospitalization or death. However, the study acknowledged that information was limited because state reporting was spotty. Only half the states provide some data on COVID-19 illnesses in vaccinated people.

"There is no single, public repository for data by state or data on breakthrough infections, since the CDC stopped monitoring them,” the report said.

In Texas, where COVID-19 cases are skyrocketing, a state Health and Human Services Commission spokesperson told ProPublica in an email the state agency was "collecting COVID-19 vaccine breakthrough cases of heightened public health interest that result in hospitalization or fatality only."

Other breakthrough case information is not tracked by the state, so it is unclear how often breakthroughs occur or how widely cases are spreading among the vaccinated. And while Texas reports breakthrough deaths and hospitalizations to the CDC, the information is not included on the state’s public dashboard.

"We will be making some additions to what we are posting, and these data could be included in the future," the spokesperson said.

I thought, ‘COVID is over and I’m going to Disney World,’

South Carolina, on the other hand, makes public its breakthrough numbers on hospitalizations and deaths. Milder breakthrough cases may be included in the state’s overall COVID-19 numbers but they are not labeled as such, said Jane Kelly, an epidemiologist at the South Carolina Department of Health and Environmental Control.

"We agree with the CDC,” she said, "there’s no need to spend public health resources investigating every asymptomatic or mild infection.”

In Utah, state health officials take a different view. "From the beginning of the pandemic we have been committed to being transparent with our data reporting and … the decision to include breakthrough case data on our website is consistent with that approach," said Tom Hudachko, director of communications for the Utah Department of Health.

Some county-level officials said they track as many breakthrough cases as possible even if their state and the CDC does not.

For instance, in Clark County, Nevada, home of Las Vegas, the public health website reported that as of last week there were 225 hospitalized breakthrough cases but 4,377 vaccinated people overall who have tested positive for the coronavirus.

That means that less than 5% of reported breakthrough cases resulted in hospitalization. "The Southern Nevada Health District tracks the total number of fully vaccinated individuals who test positive for COVID-19 and it is a method to provide a fuller picture of what is occurring in our community,” said Stephanie Bethel, a spokesperson for the health district in an email.

Sara Schmidt, a 44-year-old elementary school teacher in Alton, Illinois, is another person who has likely fallen through the data hole.

"I thought, ‘COVID is over and I’m going to Disney World,’" she said. She planned a five-day trip for the end of July with her parents. Not only had she been fully vaccinated, receiving her second shot in March, she is also sure she had COVID-19 in the summer of 2020. Back then she had all the symptoms but had a hard time getting tested. When she finally did, the result came back negative, but her doctor told her to assume it was inaccurate.

"My guard was down," she said. She was less vigilant about wearing a mask in the Florida summer heat, assuming she was protected by the vaccination and her presumed earlier infection.

On the July 29 plane trip home, she felt mildly sick. Within days she was "absolutely miserable." Her coughing continued to worsen, and each time she coughed her head pounded. On Aug. 1 she tested positive. Her parents were negative.

Now, three weeks later, she is far from fully recovered and classes are about to begin at her school. There’s a school mask mandate, but her students are too young to be vaccinated. "I’m worried I will give it to them, or I will get it for a third time," she said.

But it is doubtful her case will be tracked because she was never hospitalized. That infuriates her, she said, because it downplays what is happening.

"Everyone has a right to know how many breakthrough cases there are," she said, "I was under the impression that if I did get a breakthrough case, it would just be sniffles. They make it sound like everything is under control and it’s not."

This story was originally published by ProPublica on August 20, 2021. ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.

CDC issues new guidelines for American K-12 schools

The Center for Disease Control announced new guidelines for schools Kindergarten through the 12th grade.

With the very real prospect of the COVID-19 pandemic continuing into the next academic year, the purpose of the flow chart is guide school administrators in making the right choices when it comes to opening their districts and the schools within them.

The document reminds school officials that "it is important to check with state and local health officials and other partners to determine the most appropriate actions while adjusting to meet the unique needs and circumstances of the local community."



When schools reopen, teachers and staff member, many who have become techno conferencing wizards over the past two months, will also have to add health administration to their skill set. The national public health organization suggest schools come up with daily routine and set of procedures to check students and employees for COVID-19 symptoms.

Click on the graphic above to read the CDC's new learning tree.


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