Hello. This is Russell Kohl, chief medical officer at TMF Health Quality Institute, for the inaugural session of our semi-weekly updates on COVID-19. There has been a whole lot go on this week with regard to COVID, and certainly we’ll jump right into that. We’re actually going to have two sessions this week. One of which is focused on broader COVID issues, and I have a separate session that talks about the recommendations for a booster shot and the literature behind that and what that looks like. But, let’s get started. So, if we look across the region that TMF Health Quality Institute serves, it’s very clear we are seeing the surge of the delta variant. As you look across our states, at where the seven-day case average is, certainly, it is surging across our states. So, in Texas, we see a seven-day average of 14, 764 new cases per day. This is actually tied back in January with what we were seeing of COVID at that time and represents about 67% of the maximum daily cases that have been observed in Texas in a year and a half. If we look at Oklahoma, it’s up to 2,000, which was 50% of the max and looks almost exactly like October of 2020. Arkansas, 2,100 cases, also looking like January with about 77% max. When you look at Nebraska, the numbers are relatively low at 435 new cases per day; however, it is a brand-new surge that is just beginning in Nebraska that we can see. Looking at Mississippi, it is looking at the highest rate of COVID that is has had since the beginning of the pandemic, with 3,418 cases on average, per day, which is another 47% higher than their previous peak. As we look at Puerto Rico and the Virgin Islands, they both are experiencing the outbreaks, with Puerto Rico at 899, tying with March of this year for actually its highest rates of COVID. While as the Virgin Islands, given the size of the islands, is 48 new cases per day, but this is the highest outbreak experienced in the Virgin Islands so far. Now, as we look at the number of cases per day, it is also important to take into account both the state vaccination rates and the number of deaths per day. I think that certainly gives us a better way of thinking about the entire thing. As we look at deaths, in Texas is averaging 39 deaths a day, which is about 41% of where it has been in the worst. Arkansas, 25 deaths per day, which is 65% of its highest, Mississippi at 23 deaths per day, which is 45% of its highest, and Puerto Rico at 57% of its highest, 8 deaths per day. I think this does say a whole lot about the evolution of the treatment of COVID over the past year, and the increasing length of stay we’re seeing for COVID patients who are hospitalized. It is important to recognize that the vast majority of hospitalized patients at this time remain unvaccinated. As we look at how the vaccination rates of the states are reflected in the current data, we can see that the single dose versus the fully vaccinated rate is variable. One of the things that I think is particularly interesting to look at is the difference between the fully vaccinated and single dose rate. The reason behind that is because you will recall with our mRNA vaccines there’s a month between the initial dose and the second dose. So, the larger the gap that you see between the single dose and the fully vaccinated is a little bit of a warning sign that this is an increase in vaccination rates, and we’re seeing that particularly in Texas where the single dose vaccination rate is 55%, but the fully vaccinated is only 45%. So, there’s a 10% difference there, suggesting that there is an increase in vaccinations occurring. We’re seeing the same thing in Oklahoma with 51% and 41%. Arkansas is even greater at 51% single dose and 39% fully vaccinated. Nebraska on the other hand and is 51% and 50%, so you can see that there is not quite as much of a surge in the vaccinations happening there yet, but as we continue to look, Mississippi is 44% and 36%. Puerto Rico is 71% and 61%, and of note, the Virgin Islands, despite having pretty significant rules in regard to getting on and off the islands, the vaccination rate is only 46% single dose and 37% fully vaccinated. Certainly the biggest news this week with regard to COVID and the work we do with TMF is the publishing of a study July 30 in the CDC MMWR that looks at disparities in COVID-19 vaccination coverage among health care personnel working in long-term care facilities. What that study actually found was a significant difference between physicians, nurses, and aides, and their vaccination rates. Noting that the highest vaccination rates within nursing homes were amongst the physicians at 75.1%, but that the aides, who are giving the actually bedside care for patients were only vaccinated at about 45.6%. This study actually led this week for the Biden Administration to announce that they are establishing a new regulation in the Department of Health and Human Services to require employee vaccination as a condition of nursing homes to participate in Medicare and Medicaid. As you are all well aware, that is the primary funding sources for nursing homes, and so, we are waiting to see what that regulation will look like as it rolls out, but it does appear at this point that the mandates are coming for nursing home community. As I said, there has been a lot going on this week, and certainly the discussion of booster shots is an additional one. The goal is to make sure that these sessions remain pretty short, so we will break that off into its own session. I hope you found this information helpful, and I encourage you to reach out with any questions or comments you might have. Until then, keep up the good fight, and keep making the world a better place.