Public health experts are still cautious, but they say this could be the beginning of the end.

Fourteen months after the Washington region’s first reported case of the coronavirus, daily infections and deaths are trending down as vaccinations take hold. Hospitals are seeing far fewer critically ill patients, and funeral homes are receiving fewer covid-19 victims. A union chief in D.C. says it’s been two months since he’s had to call a bereaved family to brief them on their loved one’s life insurance policy.

“The most difficult moments for me personally were those 25 calls,” said Jaime Contreras, vice president of the Service Employees International Union in the capital area. “They were draining and devastating. But they’ve — thank God — they’ve stopped.”

The seven-day average of new daily cases in D.C., Maryland and Virginia hovered just above 1,000 on Friday, down from a peak of nearly 8,700 in January. All three jurisdictions are now reporting single-digit case rates per 100,000 residents; at the end of January, only Bath and Williamsburg counties in Virginia had per capita case rates that low.

In Montgomery County, test positivity has slipped below 2 percent for the first time since the pandemic started. In Virginia, both Arlington and Alexandria have reported no covid-19-related deaths for the last 10 days. The daily average in covid-related hospitalizations across the region has declined consistently since mid-April. Maryland Gov. Larry Hogan (R) and Virginia Gov. Ralph Northam (D) are lifting their state’s indoor mask mandates as of Saturday, though they still want face coverings for those who have not received their shots. Capacity restrictions will be removed throughout the region in coming days and weeks.

“I’m more optimistic than ever before,” said Boris Lushniak, dean of the University of Maryland School of Public Health. “But I also know that at every stage this virus has surprised us.”

While the region is moving toward herd immunity, it is not there yet, Lushniak said. Pockets of vaccine hesitancy and the looming threat of vaccine-resistant variants still pose a threat. The Baltimore metro region, which saw an uptick in cases after lifting a host of pandemic restrictions in March, is still reporting a steady stream of covid-related fatalities.

And health experts warn that there could be new outbreaks if unvaccinated people eschew mask-wearing indoors.

In addition, Lushniak and other experts warned, fallout from the pandemic — or what some experts are calling a “syndemic,” a confluence of biological and social crises — is only just beginning. It’s not just the lingering symptoms faced by covid-19 “long-haulers," officials say. There’s also widespread grief, exhaustion, untreated chronic conditions, unemployment and more.

“We can’t ignore what went on this year and a half," Lushniak said. "We’ve changed.”

Montgomery County head of emergency management Earl Stoddard put it another way during a news conference Wednesday: “The end of covid transmission represents the proverbial end of us bleeding out," he said. “But we have a long way to go to addressing the trauma.”

Shifting realities

While the virus trends have ebbed and flowed multiple times this past year, there’s a new factor in play now that wasn’t present before: widely available vaccine doses that overwhelmingly can prevent death and serious illness from covid-19.

“The vaccine is doing what it’s supposed to do,” said Allison Ciborowski, chief executive of LeadingAge Maryland, which represents nonprofit long-term-care facilities in the state.

Nursing homes and rehab centers were among the first to receive the shots; as of Wednesday, 76 percent of all long-term-care residents in Maryland, along with 63 percent of all employees, were fully vaccinated. There are still active outbreaks at nursing homes, according to the state’s dashboard, but they are infrequent and small, often involving just one or two employees, Ciborowski said.

Michael Ricci, a spokesman for Hogan, said Wednesday that there had been no covid-related deaths at nursing homes over the previous week, even though facilities have started to welcome in-person visitors and even permit physical contact between patients and their loved ones.

Marché Morris, who runs Morris Funerals & Cremation Services in Northeast D.C., said the flow of coronavirus victims slowed about two months ago. Only two of the three dozen deaths she has handled at her funeral home since March were attributed to covid-19, compared with nearly half of all her clients in 2020.

Last year, one husband called to make arrangements for his wife, only to succumb to the virus himself in the following days, Morris said. Some families sought out her services multiple times in the span of months.

“It was just hit after hit,” she said. “That was when I was like, wow, people are really hurting.”

Even as the numbers plummet, however, hundreds of people are still testing positive for the virus daily in Virginia, Maryland and the District. And dozens are dying.

Many who are getting infected are unvaccinated and younger than in previous phases of the pandemic, said Clifford Mitchell, director of the Environmental Health Bureau in the Maryland Department of Health. Since early April, Marylanders younger than 40 have accounted for more than 60 percent of all cases. And contact-tracing suggests that more people are becoming infected at large social gatherings, Mitchell said.

In Virginia, officials are seeing more outbreaks in school settings and among younger individuals who only recently became eligible for the vaccine, said Carrie Holsinger, director of the Virginia Department of Health’s Division of Surveillance and Investigation. Infection rates are higher in the rural southwest than in cities and suburbs elsewhere, Holsinger said, a trend that probably correlates to the slowing vaccination rates in rural areas.

And the initial clamor for vaccine has slowed across all three jurisdictions, as health providers struggle to reach those who are hesitant or who face challenges in getting to a vaccination site. The decline began in mostly rural counties, where the average daily rate has dropped to 200 shots per 100,000 residents, compared with about 500 vaccinations per 100,000 residents in early March. Rates in mostly urban areas peaked at about 800 vaccinations per 100,000 residents in mid-April and are now just below 400 vaccinations per 100,000 residents.

Trauma and grief remain

Jordan Asher, chief physician executive of Sentara Healthcare, which operates in Virginia and North Carolina, said staff members are still swamped even though the number of covid-19 patients at the system’s 12 hospitals has dropped from a peak of 550 in February to 110 this week

More people are emerging from their isolated bubbles to seek medical care for chronic conditions — many of which have worsened in the past year, he said. Doctors are finding heart conditions and vascular diseases that have deteriorated rapidly without medical intervention, growing cancers that went undetected for months, and mental impairments that have grown more acute.

“I’d call this another covid wave," Asher said. “A wave due to covid, but not of covid.”

This influx of patients also means that medical staff who have been on the front lines of the crisis since the start of the pandemic have not been able to relax, Asher said. “On a day-to-day, they’re still very busy."

At Holy Cross Hospital in Silver Spring, which treated the first covid-19 patient hospitalized in Maryland, about half of the 30 intensive-care beds are still occupied by coronavirus patients. Leola Saucier, who serves as the director of the surgical intensive care unit that treats coronavirus patients, said she worries about the young nurses on her team, who have seen more death in the past year than she did in a 34-year career. For relief, she sometimes sends them to an “oasis” room set up by hospital leaders mid-pandemic. It has a recliner and soft music for employees who need to unwind.

“Overwhelmingly, people are tired,” said Ciborowski, the industry advocate for long-term-care facilities. Many of the Black and Latino women who disproportionately make up the workforce at nursing homes left their jobs during the pandemic to care for children who were home from school, she said. Among those who remained, thousands caught the virus.

The vaccinations brought some reprieve, Ciborowski said, but persistent staffing shortages mean many caregivers are still “burned out.”

Even outside the medical industry, the relief and joy of post-vaccination reunions is tinged with economic anxiety or, for some, an acute sense of loss.

Chris Kocher is the executive director of Covid Survivors for Change, an organization that represents thousands of covid-19 survivors, including several hundred in the Washington region. He said some people are only now beginning to process their grief, which was “frozen” as they hunkered down during the worst months of the pandemic.

Siblings who mourned their parents separately, for example, are now reuniting, unlocking a sense of devastation they hadn’t felt before.

“People are thankful that the beginning of the end is in sight because they know firsthand what the virus was like,” Kocher said. “But at the same time, it’s heartbreaking to see a return to normal that they’ll never be able to access.”

As of Wednesday, more than 20,000 people in D.C., Maryland and Virginia had died of covid-19.