September 2021

The Delta variant dominates September. Hospitals across the American South and Mountain West fill with COVID-19 patients, and by mid-month Idaho, Alaska, and Montana begin openly rationing care. Reports describe a 73-year-old Alabama man who died after being turned away from 43 full ICUs, and children’s hospitals warn they are near capacity as the school year begins. The surge is severe, though it arrives after a spring in which officials had suggested vaccinated Americans could largely resume normal life.

The limiting factor at most overwhelmed facilities is staffing, not beds or ventilators. Many nurses are quitting from exhaustion or leaving for lucrative travel contracts, and the wave of vaccine mandates announced this month pushes more of them out the door, thinning the same workforce the hospitals cannot spare.

The phrase “pandemic of the unvaccinated” hardens into the month’s official refrain. The AP itself runs a piece questioning the catchphrase, noting that vaccinated people are also catching and transmitting Delta. The slogan casts the unvaccinated as the reason the pandemic continues, a framing that is politically useful for justifying the coercive measures that follow.

On September 9, President Biden announces vaccine mandates covering roughly 100 million Americans. He signs Executive Order 14043 requiring vaccination for federal employees, and directs OSHA to draft an emergency rule forcing every business with 100 or more workers to require vaccination or weekly testing. Biden voices open frustration with the unvaccinated and says the plan will “turn the tide” of the virus.

The legal footing is shaky from the start. OSHA’s emergency-standard authority has rarely been used and is meant for grave workplace hazards, and critics ask how a general public-health measure fits that box. The Cato Institute argues the case for expanding federal power is weak, states line up to sue, and the rule is later stayed and eventually struck down at the Supreme Court in January.

The mandates carry real costs. New York hospitals suspend staff, dozens of Massachusetts state troopers resign, and in France some 3,000 health workers are suspended after a September 15 deadline, all as those systems complain of shortages. Workers seeking religious exemptions are widely treated in the press as insincere, with one bioethicist quoted saying he doubts most of the claims are genuine.

The moralizing register grows sharper. The ACLU, long wary of state coercion, publishes an op-ed arguing that vaccine mandates protect freedom rather than limit it, a reversal from its usual posture on bodily autonomy. Late-night host Jimmy Kimmel jokes that hospitals should turn away unvaccinated patients who took ivermectin. Coverage increasingly sorts people into the responsible and the reckless.

Boosters expose a rift between the White House and its own regulators. Two senior FDA vaccine officials announce their departures on September 1 and go on to co-author a paper arguing the data do not yet justify boosting the general population. On September 17 an FDA advisory panel votes 16 to 2 against broad boosters for everyone 16 and up, backing them only for people 65 and older and those at high risk. CDC director Rochelle Walensky then overrules part of her own advisory committee on September 23 to add workers with occupational exposure, and Biden gets his booster on camera on the 27th. The push leans heavily on early Israeli rollout data whose durability is still unknown.

Ivermectin runs through the month. Podcast host Joe Rogan says he took it among other treatments after testing positive, poison-control centers report a jump in exposure calls, and coverage frames the anti-parasitic as the anti-vaccine movement’s new totem. A widely shared Guardian and Rolling Stone story claiming Oklahoma ERs were so clogged with ivermectin overdoses that gunshot victims waited for care later collapses when the hospital said it had not treated such patients.

A large randomized trial in Bangladesh, spanning some 340,000 people across 600 villages, is promoted as gold-standard proof that masks work. The reported effect is modest, cloth masks show no clear benefit, and later reanalyses argue the study cannot distinguish masking from the other interventions bundled with it. It is nonetheless used to rebut Florida Governor Ron DeSantis and others who doubt masks curb transmission in schools.

Schools reopen and mask policy becomes a courtroom fight. DeSantis’s ban on school mask mandates is struck down, then reinstated on appeal, while judges in Iowa, New Jersey, and Arizona rule against similar bans. Biden dangles federal money for districts that defy state prohibitions, escalating a dispute that turns local health decisions into a national loyalty test.

The WHO flags a new “variant of interest” called Mu early in the month, prompting a round of ominous headlines before officials concede Delta is the real concern and Mu fades from view. On September 20, the U.S. death toll is said to pass the estimated 675,000 of the 1918 flu, a comparison that ignores a tripled population and very different case definitions. More than 600,000 white flags go up on the National Mall.

Natural immunity stays awkward for the messaging. A Washington Post piece argues that protection from prior infection is strong and that policymakers seem afraid to say so, while Johns Hopkins and others insist vaccination beats waiting for illness. Around the same time, a study reported by the Guardian suggests teenage boys face a higher risk of vaccine-linked myocarditis than of hospitalization from COVID, a finding the booster campaign largely passes over.

The crackdown on “misinformation” escalates. YouTube announces on September 29 that it will remove all content it deems vaccine misinformation, the surgeon general presses tech companies to do more, and Fauci publicly rebuts rapper Nicki Minaj after she relays a secondhand vaccine claim. Meanwhile documents obtained by The Intercept through a FOIA suit revive scrutiny of U.S.-funded gain-of-function research in Wuhan, and Senator Rand Paul says Fauci deserves prison for what he told Congress about it.

Key Dates and Stories:

• September 1: Two senior FDA vaccine leaders step down as agency faces decision on boosters, CNN
• September 4: Poison Control Centers Are Fielding A Surge Of Ivermectin Overdose Calls, NPR
• September 6: New Details Emerge About Coronavirus Research at Chinese Lab, The Intercept
• September 9: Sweeping new vaccine mandates for 100 million Americans, AP
• September 9: Rand Paul says Fauci deserves a five-year prison sentence, The Hill
• September 12: England vaccine passport plans ditched, Sajid Javid says, BBC
• September 16: 3,000 Health Care Workers In France Have Been Suspended For Not Getting A COVID Shot, NPR
• September 17: More Than 600,000 White Flags On The National Mall Honor Lives Lost To COVID, NPR
• September 20: COVID has killed about as many Americans as the 1918-19 flu, AP
• September 23: A CDC Panel Backs Booster Shots For Older Adults, NPR
• September 27: Dozens of Massachusetts State Police Have Resigned Over a Vaccine Mandate, NPR
• September 29: YouTube Is Banning All Content That Spreads Vaccine Misinformation, NPR