Via Teleconference 

4:18 P.M. EDT

MR. ZIENTS:  Good afternoon.  And thanks for joining us.  I’ll turn to Dr. Walensky and Dr. Fauci in a moment.  First, I want to provide an update on our whole-of-government response to the pandemic. 

We remain concerned about the continued rise in cases driven by the Delta variant.  These cases are concentrated in communities with lower vaccination rates.  In fact, the seven states with the lowest vaccination rates represent just about 8.5 percent of the U.S. population but account for more than 17 percent of cases.  And one in three cases nationwide occurred in Florida and Texas this past week. 

From the start, we’ve known that this virus is unpredictable.  That’s why we spent the last six months preparing for every scenario.  As a result, we have the tools we need to manage this most — this.  Most importantly — the tool that is most important is the highly effective vaccines.  We have enough vaccines for every American who wants one.  They’re free and they’re easily accessible — within five miles of where 90 percent of where Americans live. 

And in just six months, we’ve already gotten 165 million Americans fully vaccinated — including 80 percent of seniors, who are the most vulnerable.

But we have much more work to do to put this pandemic behind us.  There are still about 90 million eligible Americans who are unvaccinated.  And we need them to do their part, roll up their sleeves, and get vaccinated.  Each and every shot matters. 

And last week, the President laid out several areas where we’re taking additional steps to get more Americans vaccinated.  We expanded the tax credit to help small- and medium-sized businesses provide their employees paid time off to get themselves and also their families vaccinated. 

And we’re working with school districts and pharmacies to bring vaccines to schools to make it as convenient as possible for students to get vaccinated. 

In the past two weeks, we’ve seen a 50 percent increase in the average number of 12- to 17-year-olds getting vaccinated each day.  That’s a very encouraging uptick. 

We’re also working with states to encourage vaccinations through incentives, which have made a difference throughout the vaccination effort.  Last week, the President called on states and local governments to use funding they have received, including from the American Rescue Plan, to give $100 to anyone who gets fully vaccinated.  Minnesota and New Mexico have already stepped up to answer the President’s call. 

If financial incentives like these help us get more shots in arms, we should use them.  But in addition to incentives, it’s time to impose some requirements based on the realities of different risks unvaccinated individuals pose versus those who have been vaccinated. 

Last week, the Department of Veteran Affairs announced it will require doctors and nurses and other healthcare workers who provide medical care to our veterans to get vaccinated.  This is in lockstep with many healthcare employers around the country who are requiring vaccinations and will protect our veterans when they get medical care.

At the President’s direction, the Department of Defense is looking into how and when they will add the COVID-19 vaccination to the list of required vaccinations for the military.

And to protect the federal workforce, their loved ones, and their communities, the President announced that every federal government employee will be asked to attest to their vaccination status.  Any federal employee who does not attest or is not vaccinated will be required to mask, no matter where they work; get tested once or twice a week; socially distance; and, generally, will not be allowed to travel for work. 

We’re taking steps to apply similar standards to all federal contractors.  It’s simple: If you want to do business with the federal government, get your workers vaccinated. 

And the President has called on all employers around the country to protect their own workforces.  And now we’re seeing positive momentum across the private sector.  The Chamber of Commerce, the National Association of Manufacturers, and the Business Roundtable have all applauded the actions we’re taking.  Companies like Google, Walmart, and Disney have announced vaccination requirements for their employees, joining hundreds of universities and hospital systems across the country who are implementing similar requirements. 

With these ongoing efforts, there’s a strong sense of progress.  And you see it in the number of shots we’re getting into people’s arms each day. 

Over the past few weeks, we’ve seen a nearly 70 percent increase in the average number of new people getting vaccinated each and every day.  In the last seven days alone, 3 million Americans have gotten their first shot.  That’s the highest seven-day totals since July 4th.

And just today, we hit 70 percent of adults with at least one shot, including 90 percent of seniors with at least one shot.  These are significant milestones in our fight against the virus. 

And it’s very important to note, in the states with the highest case rates, daily vaccination rates have more than doubled.  The eight states with highest current case rates have seen an average increase of 171 percent in the number of people newly vaccinated each day over the past three weeks. 

Louisiana has seen a 302 percent increase in the average number of newly vaccinated per day; Mississippi, 250 percent; Alabama, 215 percent; and Arkansas, 206 percent. 

This increase in vaccination rates in states that have been lagging is a positive trend.  Americans are seeing the risk and impact of being unvaccinated and responding with action.  And that’s what it’s going to take to get us out of this pandemic.

With that, let me turn it over to Dr. Walensky and Dr. Fauci.  Dr. Walensky first. 

DR. WALENSKY:  Good afternoon.  Let’s begin with an overview of the data.  As of Saturday, CDC reported the seven-day moving average of daily new COVID-19 cases to be about 72,000 cases per day.  This represents an increase of 44 percent from the prior seven-day average and higher than our peak of last summer.

The seven-day average of hospital admissions is about 6,200 per day, an increase of about 41 percent from the prior seven-day period.  And seven-day average daily deaths have also increased to 300 per day — an increase of more than 25 percent from the previous seven-day period. 

I want to start today by simply stating the obvious.  While we desperately want to be done with this pandemic, COVID-19 is clearly not done with us, and so our battle must last a little longer. 

Many of us have lost loved ones or have been ill ourselves.  All of us have given up things in our lives that we enjoy.  This is hard, this is heavy, but we are in this together.  And as we learn more about COVID, we continue to rely on proven ways to protect ourselves, our children, and our loved ones. 

I told you I would give you scientific information as I have it, when I have it.  Here is what we have learned in the last two weeks about the Delta variant. 

First, the Delta variant is highly contagious.  To put this in perspective, if you get sick with the Alpha variant, you could infect about two other unvaccinated people.  If you get sick with the Delta variant, we estimate that you could infect about five other unvaccinated people — more than twice as many as the original strain. 

Second, infections with the Delta variant result in higher viral loads.  This means that those who are infected have a larger burden of virus that they can spread to others. 

Third, those higher viral loads are seen not just in those who are unvaccinated and infected but also, and importantly, in the small proportion of those who are vaccinated and become infected. 

Last week, we published data on an outbreak in Barnstable County, Massachusetts, where there were 346 confirmed cases of COVID-19 in people who were fully vaccinated. 

During the summer, some towns in Barnstable County can have up to 240,000 visitors per month.  Those with breakthrough infections had viral loads that were similar to people who were infected and unvaccinated. 

This new finding, combined with data from other outbreak investigations and surveillance studies across the country, was critical in our decision to update our guidance for those who are fully vaccinated. 

Since those data were released, several other studies have been released over just this past weekend that have corroborated these findings. 

Taken together, the Delta variant is different from prior strains. 

I understand this is all frustrating news, and I share this frustration.  We continue to learn each day from emerging science and use this evidence to update our recommendations. 

Because of what we now know about the Delta variant and infections in those who are vaccinated, we updated our recommendations, including recommending masks in public, indoor settings in areas with substantial and high transmission, shown in orange and red on this map.  It is also the reason we continue to recommend universal indoor masking in K-through-12 schools throughout the country so our children can safely get back to school and safely stay there.

In all of this, there is still good news.  Our vaccines are working to prevent severe illness, hospitalizations, and death.  Vaccines are providing protection both for individuals and communities across the country. 

As I have said before, this remains a pandemic of the unvaccinated, where the vast majority of spread is — in this country is among those who are unvaccinated. 

I want to be clear: While vaccinated people can spread the virus if they get a breakthrough infection, the odds of them getting sick in the first place are far lower than those who are unvaccinated.  And in fact, places with more vaccination generally have less disease. 

We can see this on a population level on this slide, where we compare case counts and vaccination coverage by state, with vaccination coverage on the horizontal axis and case counts on the vertical axis. 

States with the highest vaccination coverage are the dots furthest to the right on the graph, and states with the highest case counts are the dots closest to the top.  Notice that the states that have lower vaccination coverage — those further to the left — have higher rates of community transmission, as shown in red and orange.  States that have higher vaccination coverage — further to the right — have lower rates of cases, as shown in yellow.

There is any direct correlation with vaccine coverage and case rates.  And I think it’s worth reiterating that public health prevention strategies, including masks, continue to work while you’re unvaccinated. 

In the following outbreaks of cases in Barnstable County and in subsequent public health follow-up, we saw the power of vaccines and masks. 

Over the month of July, there were a total of 934 confirmed cases of COVID-19 linked to the outbreak in Barnstable County.  With 73 percent of these infections in people who were vaccinated, there were only seven hospitalizations and no deaths.

Our vaccines did exactly what they were supposed to do: prevent severe disease, hospitalization, and death.

Furthermore, as cases increased, local public health officials implemented a package of public health prevention strategies, including increased testing, contact tracing, and indoor mask wearing.  And within two weeks, test positivity fell from a peak of 15.1 percent to 4.6 percent.  Public health prevention strategies work.

Let me end by reiterating three things you need to know. First, our vaccines are working to prevent severe illness, hospitalization, and death.  And if you are not vaccinated, please protect yourself and get vaccinated.

Second, masks will protect you and your family.  If you are in an area of substantial or high transmission, please wear a mask in public indoor settings, regardless of your vaccination status.

And third, we need to keep our children safe and in school. Get everyone in your family over the age of 12 vaccinated and please wear masks in school.

Finally, we stand here with you, providing science and updated guidance in real time, to keep you and your families safe. 

Thank you.  I’ll now turn it over to Dr. Fauci.

DR. FAUCI:  Thank you very much, Dr. Walensky.  I’d like to take up on the theme that Dr. Walensky started with.

If I could have the first slide.

I’m going to be spending a couple of minutes addressing two issues that are very much on the attention of people throughout the country and the world.

The first is, as Dr. Walensky mentioned, the real-world effectiveness of vaccines in the context of the Delta variant, and, second, breakthrough infections, what they mean.  And let’s discuss them a bit.

Next slide.

Let’s look at the real-world effectiveness against the Delta variant.  If you look at the three components of PCR-confirmed infection, it’s 79 percent in a UK study.  Symptomatic infection is 88 percent.

And just as Dr. Walensky mentioned, the vaccines are doing exactly what we’re asking them to do when it comes to keeping you out of the hospital, out of serious disease, and certainly preventing your death.

Just a quick comment on the 79 percent: That may look a bit low, but remember, the efficacy of the clinical trials that were published by the trials that gave you something like 94 or 95 percent was against clinically apparent disease.  What we’re talking about here is just infection, so you would expect it to be a bit lower.  This has important implications when you get into the discussion of what we call “breakthrough infections.”

Next slide.

Now, if you take these data and look at them across multiple countries but ask the question, “What does a full component of a Pfizer mRNA provide with regard to protection against Alpha versus Delta in three separate countries?” — the data on the left are essentially the data I just showed you; Alpha now is in blue and Delta is in red. 

When you get to Canada, you see a similar protection against hospitalization, which is the area a bit to the right in that middle panel, compared to symptomatic disease.  When you get to Israel, you see what we now know from reports from Israel: that you see a diminution at around 64 percent for confirmed and symptomatic disease.  This is likely due to the fact that Israel has started their vaccination program before the other countries, so you’re seeing a little bit down the pipe from the beginning.  But note, again, the 93 percent consistently showing protection against advanced disease.

Next slide.

Now if you ask the question, “What about the reduced risk of either symptomatic infection, hospitalization, or death when you compare vaccinated individuals with unvaccinated people, what is the fold reduction when you’re in red, with unvaccinated, versus in blue, with full vaccinated?”  As you can see for disease itself, it’s an eight-fold reduction.  For hospitalization, 25-fold reduction.  And for death, 25-fold reduction.

Let’s move on now to breakthrough infections.  Just a couple of comments. 

We can pass this slide.  Go to the next slide, please.

The breakthrough infections: We have — no vaccine is 100 percent effective, and so you can expect breakthrough infections.  So, even with a high vaccine effectiveness, most of these infections are going to be asymptomatic or mild.  And we know that.  We’ve already seen that from the experience in Massachusetts, in Provincetown, and we see it in all other situations.

An important point to bring up is that the greater percentage of people that are vaccinated, even with a high degree of protection, the absolute number of breakthrough infections might appear high.  That’s not the critical number. The critical number is what is the proportion of the vaccinated people who, in fact, are getting breakthrough infections.  And that’s the critical one. 

The bottom line of what we are saying is that — next slide — get vaccinated.  I say that every single time.  We all say it.  The COVID vaccines give strong protection against the Delta variant, and it protects you, your family, and your community.

Back to you, Jeff.

MR. ZIENTS:  Thank you, Dr. Fauci, and thank you, Dr. Walensky.  

As you both stated, it’s never been more important to get vaccinated.  That’s how we stop the spread of the Delta variant.  And each and every shot matters.

And while we work to get more people vaccinated, the federal government is also helping states and communities respond to outbreaks. 

Since launching our COVID-19 surge teams, we’ve been working directly with 10 states to support their efforts to combat rising cases with federal assistance and support.

Last week, we reiterated to all governors that we stand ready to help them in meeting this moment, whether that be through more testing, increasing treatments, vaccine access and uptake, or other state-specific needs.

For example, in Missouri, CDC experts are on the ground providing epidemiology, data analysis, and other public health support.  FEMA in Missouri is helping to expand ambulance capacity, and HHS and FEMA are helping the state address their hospital needs.

We’re working with states like North Carolina on mobile vaccination clinics.  In Tennessee, on public health staffing. And the administration is doing extensive outreach in states like Wyoming and Arizona to encourage more physicians to use lifesaving monoclonal antibody treatments — antibody treatments.  Those are really effective, and we need to deploy them more and more where they’re needed.

The bottom line is, we’re doing everything we can to help more Americans get vaccinated and to help states fight the spread in their communities.

With that, let’s take a few questions.

First question.

MODERATOR:  And a reminder —

DR. FAUCI:  Could I please interject something?  Jeff, I want to just add one thing.  One of the slides was deleted — a technical difficulty that I’d just like to spend maybe 15 seconds.

MR. ZIENTS:  Please.

DR. FAUCI:  I think it’s really important.  When we talk — it was mistakenly deleted, and that’s the reason why I skipped by that other slide. 

When you look at breakthrough infections, as I mentioned, they’re expected and usually asymptomatic. 

As of July 26th, the CDC received 6,587 reports of breakthrough infections that resulted in hospitalization or death among 163 — fully vaccinated — million people.  That is a percentage of 0.01 percent or less.

And when you look at the breakthrough cases, the percent of breakthrough cases in multiple locations, like D.C. and Virginia, the percent ranges from 0.26 to 0.03. 

So, I’m sorry that was left out.  The bottom line is they are rare, and they rarely result — not rarely, but unusually result in hospitalization or death.

Thanks, Jeff.

MR. ZIENTS:  Thank you, Dr. Fauci. 

Okay, first question, please.

MODERATOR:  Please keep your question to one question.  We’re very limited on time.

Jeff Mason, Reuters.

Q    Hi, thanks very much.  Jeff, you said earlier that it was time to do — to have requirements with relation to the vaccine, and then you went on to list basically what you said last week about the VA and the — and DOD.  Are there more requirements coming?  Do you think that there should be more requirements coming?  And can you respond broadly to the impression that you are playing down the breakthrough cases?  Thank you.

MR. ZIENTS:  Okay.  Well, I’ll take the — the first part of the question, and then I’ll turn it to Dr. Fauci because he just talked about breakthrough cases.

Jeff, as you know, in the federal government, we’ve now put forward a strong system that if you’re vaccinated, you can come back to work as normal.  If you’re not vaccinated, there are quite strict rules that you need to follow around testing, social distancing, and masking.

The Department of Veterans Affairs, as you said, is an example of a vaccine requirement for all of their caregivers to our veterans.  The President has asked the Department of Defense to look into how they will add COVID to the list of mandatory vaccinations for our armed forces — how and when they would do that.  We will be looking, across the federal government, in other areas that could require these types of req- — mandates, if you will, for vaccination.

At the same time, I think it’s really encouraging that we’re seeing the private sector follow.  I mentioned Walmart, Disney, and Google all announcing vaccine requirements, and there’s dozens of other companies that are doing these types of actions to protect their workers as they come back to work — universities, other health systems.

So, Jeff, I think you’re going to see a continued increase in vaccination requirements as people bring employees back to work. 

Second question was around breakthroughs.  Dr. Fauci.

DR. FAUCI:   Yeah.  I’m sorry, what was the exact question about breakthrough, Jeff?  I missed that.

MR. ZIENTS:  This is Jeff Zients.  Jeff Mason was asking: Are we downplaying, in some way, the number of breakthrough infections that are happening across the country?

DR. FAUCI:  No, no, we’re actually not, Jeff — Jeff Mason, that is.  (Laughs.)  I — as I mentioned in the discussion, when you look at the numbers — the total absolute numbers when you’re dealing with a cohort that you’re examining, that is a very high percentage of people who are vaccinated or large numbers — by definition, even with a high degree of efficacy, you’re going to see absolute numbers that are high. 

The critical issue is: What is the relative number — the percent that I mentioned?  And that’s the reason why — I apologize — I wanted to interject that slide that was left out: to show you the lower percentage of people who are in that category.

MR. ZIENTS:  Next question, please.

MODERATOR:  Is Sheryl Stolberg, New York Times.

Q    Hi, thanks for doing this call.  A lot of Americans remain very confused about the recommendations.  They don’t understand why vaccinated people need to start wearing masks again.  They’re confused about what this means for their children in schools.  And I’m wondering if you think your messaging has been clear enough to the public.  And what, if anything, are you going to do to try to address the confusion and maybe simplify things for ordinary Americans out there who don’t follow every nuance of the science?

MR. ZIENTS:  Dr. Walensky? 

DR. WALENSKY: Yeah, thank you, Sheryl.  So maybe I’ll start with the children and say I think our guidance is very clear about where we should be in schools.  And that is: Everyone who is in a K-through-12 school in the fall should be masked.  Everyone across the country — adults, children, vaccinated, or unvaccinated — everyone should be masked.
In terms of the question about guidance for vaccinated people wearing masks, there are two components to what we’re trying to do here.  One, is, we’re trying to save lives with our vaccines.  And they’re working to do so, and that’s terrific.  What they weren’t studied in the clinical trials is to whether they prevent transmission.  Initially, they did with Alpha.  Unfortunately, they no longer do with Delta.

The good news is that the vaccines really do work to prevent getting sick.  However, for those people who do get sick, we are suggesting — the data suggests that you could potentially transmit.  And for that reason, we are suggesting both vaccinated and unvaccinated, in areas of high disease burden — orange or red on the map — continue to wear masks so they don’t bring the disease home or to others who are unvaccinated. 

MR. ZIENTS:  I would just add that, from day one, the President said we would lead with science and facts, and that continues to be the approach at CDC.  And our other health experts are doing just that: leading with science and facts.

We never said that this was going to be easy, but the best thing we can do right now is listen to the science and get more people vaccinated and follow the CDC public health recommendations.

Next question.

OPERATOR:  Let’s go to Erin Billups at Spectrum.

Q    Hi, thanks so much for taking my question.  I was wondering how much of any surveillance is being done to determine the amount of asymptomatic spread?  Experts I’ve spoken to say not enough of this is happening. 

Also, to help people get a sense of how much protection previous COVID infections offer — that’s something I’ve heard a lot of people point to as a reason they don’t need to be vaccinated.  Is there any data on the number of people infected with Delta who had previous COVID infections, and whether that offered them any protection?

MR. ZIENTS:  Okay.  Dr. Walensky, first.  And then, Dr. Fauci.

DR. WALENSKY:  Great.  Yeah.  So, we have numerous cohort studies that are examining exactly that.  So we have several cohorts — tens of thousands of people across the country — where some of them are actually doing weekly PCR testing.  These are cohorts of essential workers and healthcare workers.  So we can actually examine how much disease is occurring in people who might be asymptomatic.  That is the best epidemiologic way to study exactly that question.

DR. FAUCI:  The —

MR. ZIENTS:  Dr. Fauci. 

DR. FAUCI:  Yeah.  With regard to the second question that if you’re dealing with the same variant, if you get infected with an Alpha variant or another variant, and that you recover from that, you are pretty well protected for a reasonable period of time from reinfection.  It isn’t perfect, but it’s — it’s good protection.  You can’t doubt that.

The situation changes when you’re dealing with the evolution of a new variant, such as the Delta variant.  And what we are seeing right now that there are reinfections.  The protection you get from the original infection still exists somewhat, but reinfections occur at a much greater rate among individuals now than we did against the original Alpha.

So, bottom line is: When you’re dealing with a variant, you don’t get the kind of protection that you would have hoped to have gotten from a previous infection.

Regarding the issue of vaccinating people: There’s no doubt when you vaccinate someone who has had an original infection and who has recovered, not only do you increase the depth of the protection, not only do you increase the duration, but you also increase the breadth of it so that you cover not only the original, but the variants. 

And that’s the reason why the recommendation still holds that even though you’ve been infected previously, in the context of variants, it’s a good idea to get vaccinated anyway.

MR. ZIENTS:  Next question. 

MODERATOR:  Go to Rachel Cohrs at STAT news.

Q    Hi there.  I had a question for Director Walensky about, you know, whether the CDC is tracking COVID-19 booster shots that may be authorized by physicians. 

DR. WALENSKY:  We are just — thank you for that question, Rachel — we are just starting to gather data and get data on — and we can discern between people who have gotten second and third shots.  We are trying hard to encourage people to report on the safety side if people have taken the initiative to get their third shot — again, not yet recommended — but we have the capacity and are looking at those data right now. 

MR. ZIENTS:  Dr. Fauci, anything to add there?

DR. FAUCI:  No, nothing to add.  She said it very well.

MR. ZIENTS:  Next question. 

MODERATOR:  Alright.  We got to do last question.  Let’s go to Zeke with AP.

Q    Thank you all for doing this.  I’m just following up on Jeff Mason’s question earlier for you, Jeff Zients, on the additional requirements.  It seems what you’re trying to do here is impose some sort of cost on people who are unvaccinated as a stick there and sort of get them to roll up their sleeve and get the shot.  So why isn’t the federal government going further on some of these — you know, whether it be mandating vaccination requirements for travel — across the federal workforce, for instance.  You know, how far is the administration willing to go to sort of, you know, turn up the pressure on the unvaccinated to actually get shots?

MR. ZIENTS:  Well, Zeke, I think we’ve taken significant steps here to make it difficult to come back to work, or more difficult to come back to work, if you’re not vaccinated.  There’s so many reasons to get vaccinated that we’ve talked about — to protect yourself and to protect your loved ones.  And it’s also a really straightforward way to return to work. 

So for all federal employees, the path back to work if you’re vaccinated is straightforward.  If you’re not vaccinated or you’re not willing to attest to being vaccinated, then you — we’re doing the right thing to protect the workforce, to protect the individual, their family, and their colleagues, which is rigorous testing, social distancing, and masking. 

There are mandates at the VA for vaccination for their healthcare workers — their doctors and their nurses and other healthcare providers who take care of our veterans.  That’s consistent with a lot of health systems across the country and a growing number of health systems that are requiring vaccination for their healthcare workers who are on the frontlines. 

As I said earlier, the Department of Defense is looking into how and when they’ll add COVID to the list of mandatory vaccinations for active-duty military. 

At the same time, we will continue to look across the federal government at other areas where requirement- — requiring vaccines, everyone be vaccinated may make sense, particularly in the healthcare setting. 

And we’re seeing it in the private sector.  More and more companies are coming up with systems that are modeled after our system or similar to our system, or requiring vaccinations across the board. 

You’re seeing it at universities.  You’re seeing it in health systems.  So I think that this requiring of individuals to be vaccinated in order to come back to work or to go back to school is a growing trend and makes a lot of sense, given that we’re going to beat this pandemic by getting more and more people vaccinated. 

I want to thank everybody for today.  I look forward to the next briefing.  Thank you. 

4:52 P.M. EDT

To view the COVID Press Briefing slides, visit

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