In this pivotal moment, government officials and the public again face decisions about whether to maintain pressure on the virus or try to return to something approaching normal life — easing the restrictions that can help limit the contagion. The scientific community is urging the public to stick with infection-slowing interventions — social distancing and mask-wearing — to try to stave off a spring surge.
“While it’s great that we’ve made progress, and we certainly should acknowledge that, this is not the time to be spiking the football,” said James Lawler, an infectious-disease physician at the University of Nebraska Medical Center. “Our case counts are still what they were in early November, which at the time we thought was horrendous.”
Covid-19 hospitalizations peaked nationally Jan. 6, with 132,000 patients. That figure has dropped below 80,000 in recent days. The favorable trend follows a sharp drop in new infections. On Thursday, every state recorded seven-day average infection rates at least 30 percent lower than four weeks earlier.
There are multiple potential explanations for the improved numbers, starting with the disastrous scale of the winter wave that by January was killing more than 3,000 people a day. Such a wave inevitably crests.
Vaccines probably played a limited role, experts said. The calendar may have been the biggest factor: As expected, holiday-season gatherings contributed to spikes in hospitalizations, although not at the catastrophic levels that some public health experts feared. Those holidays are now an increasingly distant memory.
The daily death toll has not dropped as quickly as other metrics. Death rates lag changes in infections by several weeks. More than 18,000 people are still in intensive care units across the country battling covid-19, the disease caused by the virus, according to the Centers for Disease Control and Prevention.
The national and state numbers do not necessarily translate to local conditions. The disparities that have marked this pandemic — which has left people of color sickened at several times the rate of Whites — is also seen geographically. On Thursday, more than 100 counties across the country reported that their seven-day averages of new cases had risen by more than 10 percent since a week ago.
'A long way to go'
The situation in Los Angeles County, where last month there were severe oxygen shortages and hospitals teetered at the edge of rationing care, has eased since the aftermath of the winter holidays. California had more than 22,000 hospitalized coronavirus patients every day a month ago, and that has dropped to about 11,000.
Nicholas Testa, chief medical executive for Dignity Health’s southwest division, which operates four hospitals in Los Angeles, said that although numbers have improved, doctors’ caseloads are as elevated as they were during the summer coronavirus wave that struck the Sun Belt.
“Even if you look at the national trends, nationally we are still double where we were in July, and as you remember, people were freaking out in July,” Testa said.
Roger Lewis, who leads the Los Angeles County Department of Health Services modeling team, attributed the turnaround to compliance with restrictions, the administration of 1 million vaccine doses in the county and “partial herd immunity” — a conjecture based on projections showing 1 in 3 county residents may have already contracted the virus and developed some natural immunity.
“The biggest threat is an ill-placed perception that continued decline is inevitable, leading to complacency,” Lewis said.
But throughout the country, governors are loosening restrictions amid the decline in cases.
Iowa Gov. Kim Reynolds (R) is confronting criticism from health experts and local leaders over her decision to lift a mask mandate and limits on gatherings as cases trend downward. The Iowa Public Health Association, an organization of public health professionals, was among the loudest critics this week. The group said more than 400 Iowans would die avoidable deaths by Memorial Day without a mask mandate, citing models.
“We know that masks and social distancing and limiting gatherings have been effective in helping to curtail the spread,” Lina Tucker Reinders, the group’s executive director, said in an interview. “When something is working, it should be reinforced, not abandoned.”
North Dakota Gov. Doug Burgum (R) allowed bars and restaurants to operate at 80 percent capacity instead of 65 percent, effective Jan. 29, citing the lowest caseload since mid-August.
In New York, Gov. Andrew M. Cuomo (D) cited the falling coronavirus numbers in loosening restrictions on businesses. Cuomo allowed New York City restaurants to resume indoor dining Friday, two days ahead of the initial plan, with occupancy at 25 percent.
“We’re watching for variants. We’re watching for increased infections from variants. We’re watching vaccine effectiveness with some of these new variants of interest as they call them,” Cuomo said during a Monday news conference. “But the footrace is clear. It’s rate of vaccination versus rate of infection.”
Even with the recent decline in cases, Arizona hospitals are still at 90 percent of their capacity. Ann-Marie Alameddin, president and chief executive of the Arizona Hospital and Healthcare Association, said doctors, nurses and other front-line workers are still struggling to get time off after a spike in hospitalizations that started in late fall.
“We are relieved that we are not looking ahead to implementing crisis standards of care,” Alameddin said, using the formal term for rationing. “But we still have a long way to go to get covid-19 under control in terms of establishing herd immunity and making sure variants are not getting a foothold in our communities.”
In Wisconsin, a long-running dispute between Republican state legislators and Gov. Tony Evers (D) has escalated into maneuvering over a statewide mask mandate. The legislature last week attempted to overturn the governor’s order, but Evers circumvented legislators by issuing a new order to keep the mandate in effect. A Republican donor is asking the conservative-leaning state Supreme Court to put the order on hold until a constitutional challenge over the governor’s powers is resolved.
Bud Chumbley, executive director of the Wisconsin Medical Society, said lawmakers are sending the “wrong message at the wrong time” as the state is on track to drive down infections.
“We had 600,000 people get covid in this state and 6,000 died” since the start of the pandemic, Chumbley said in an interview. “I’m not sure all those people would think this is the right time to bring up a constitutional question in the middle of a pandemic, but that’s their rationale.”
The wild cards are the mutated variants of the virus. The B.1.1.7 variant that first spread explosively in the United Kingdom has been detected in 37 states and, according to a new study based on genomic sequencing, is doubling in prevalence among positive test results every week and a half.
An even more worrisome variant, B.1.351, which spread rapidly in South Africa and contains a mutation that may help the virus partially evade natural and vaccine-induced antibodies, has not been detected widely so far. As of Thursday, there were at least 14 cases identified in United States, including the first case in the nation’s capital.
The scientific community collectively is sounding a warning against complacency. Vaccination of vulnerable populations should save lives, but the vaccine rollout may be too slow to stay ahead of the spreading variants.
“I am really quite worried that we’ll have another surge,” said Albert Ko, an epidemiologist at the Yale School of Medicine.
The winter surge could not go on forever, because the success of the virus began to work against it.
“You’ve removed the driest wood, the most combustible fuel for the fire,” Lawler said. “Now it has to burn through much wetter, greener wood, and that goes a lot slower.”
Jeffrey Shaman, an epidemiologist at Columbia University, said: “Outbreaks are self-limiting. As you burn through susceptibles, as more people become infected and transition to recovered or deceased, there are fewer people who can be infected in the short term. So the natural shape that an outbreak takes is a bell-shaped curve.”
Experts expressed uncertainty about what happens next. The United States is still ramping up its system for tracking the variants through genomic sequencing. The country has limited battlefield awareness as the variants spread.
“We don’t know what we don’t know,” said Janis M. Orlowski, chief health-care officer at the Association of American Medical Colleges.
The pandemic was simpler to forecast a year ago, before multiple variants emerged and essentially no one on the planet had immunity. A vaccine remained aspirational then. Now, multiple factors — including uncertainty about the variants and the duration of acquired immunity post-infection — make predictions inherently squishy.
“This is probably the most uncertain part of the pandemic that we’ve faced yet,” Lawler said.
A celebration muted
Here’s one certainty: New Orleans is readying for a Mardi Gras like no other.
The city’s premier celebration became a superspreader event last year, with the virus migrating unseen among revelers and accelerating the U.S. outbreak at the start of the pandemic.
This year, with local officials on high alert over the B.1.1.7 variant circulating in Louisiana, bars and liquor stores will be closed, the sale of to-go drinks prohibited and major intersections along Bourbon Street barricaded at night. The crackdown will last five days and end on Mardi Gras Day, on Tuesday.
“To those who are upset about these restrictions, know that when it comes to our health and our people, especially our workforce, our hospitality workforce, I’d rather be accused of doing too much than doing too little,” Mayor LaToya Cantrell (D) said at a Feb. 5 news conference.
Authorities pointed to the consequences of last year’s Mardi Gras as part of what motivated their thinking. City Council President Helena Moreno said it was “tremendously painful to see what happened in our city.”
Although the business community prepared for scaled-back celebrations, the level of restrictions came as a surprise, said Brittany Mulla McGovern, executive director of the French Quarter Business Association.
“But,” she added, “we are walking a fine line between keeping our residents and our employees and our visitors safe, as well as celebrating a holiday that’s so ingrained in our DNA.”
Council member Jay H. Banks said Mardi Gras “is not dead — it is just different.” He said residents are still encouraged to boil crawfish, cook ribs, fry chicken and take part in other traditions — but from the safety of home and in small groups. He spoke about the danger of the virus in stark terms.
“For those of you who have sent me stupid emails criticizing me on my stance on this, I get it,” he said. “Perhaps I am paranoid. Perhaps I am overly cautious. But my personal list of dead people is 23. Two-three.”