President Biden on March 29 called on governors and businesses to reinstate mask mandates to guard against the coronavirus. (Video: The Washington Post)

President Biden and top health officials on Monday urged an impatient public to remain vigilant against the coronavirus, as daily case counts continued to rise, younger people replaced seniors in some U.S. hospitals, and the United States moved beyond the milestone of 30 million cases since the outbreak began.

Even as the nation’s immunization program continued to pick up speed and new research showed coronavirus vaccines are highly effective in real-world conditions, Biden said states should suspend reopening plans and governors who had rescinded mask mandates should reinstate them.

“Please, this is not politics,” Biden said. “Reinstate the mandate if you let it down, and businesses should require masks as well. A failure to take this virus seriously — precisely what got us into this mess in the first place — risks more cases and more deaths.”

An emotional Rochelle Walensky, director of the Centers for Disease Control and Prevention, went off script at a briefing Monday morning to demonstrate her alarm. Her words brought to mind a prescient warning from another CDC official, Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, who told Americans more than 13 months ago that their lives would dramatically change as the pandemic exploded in the United States.

“I’m going to reflect on the recurring feeling I have of impending doom,” Walensky said at a White House news briefing Monday. “We have so much to look forward to, so much promise and potential of where we are and so much reason for hope. But right now, I’m scared.”

Troubling signals abounded Monday. Daily case counts continued their trend in the wrong direction. The seven-day rolling average of infections, which is considered the most reliable measure of daily case counts, rose for the seventh consecutive day, finishing just below 64,000, according to reports from state health departments analyzed by The Washington Post.

Some hospitals reported admitting younger people with more severe disease. That is evidence that vaccines are protecting people older than 65 who once were the most vulnerable but leaving the unvaccinated exposed. A new variant of the virus that is more contagious and causes more severe disease is taking hold across the country.

At Connecticut’s Yale New Haven Health System, for example, admissions of covid-19 patients ages 35 to 44 are up 41 percent in the past seven weeks, while admission of people 65 and older is down more than 70 percent. At Grady Memorial Hospital in Atlanta, inpatients older than 65 have largely disappeared, replaced by a younger population. And among the patients in Michigan’s Henry Ford Health System, the median age has declined to 58, years younger than during previous surges of the virus.

“Younger people aren’t vaccinated,” said Tom Balcezak, chief medical officer at Yale New Haven, where 30 percent of people with covid-19 tested positive for the new variant that originated in the United Kingdom. “They’re being exposed, if you will — blasted, if you will,” by the variants.

Coronavirus variant tracker

As a result, more of them need intensive care than during earlier parts of the pandemic. “Last week we admitted and intubated a 21-year-old. That’s really unusual for us,” he said.

“Speed is of the essence here,” Balcezak added. “Anything that slows vaccine distribution down is going to cause excess mortality.”

Eduardo Oliveira, executive medical director for critical-care services for AdventHealth in central Florida, said the situation there is still dramatically better than it was from November to January when the hospital had 70 or 80 patients on mechanical ventilation. Now there are about a dozen in the ICU, he said.

Oliveira said he has not seen any elderly patients coming to the ICU in weeks. Instead, he said, the new ICU patients are people he calls the “working middle aged,” individuals in their 40s to 60s who typically have co-morbidities.

“It is because of the reopening we are seeing more of this population,” he said.

Greg Martin, chair of critical care at Grady Memorial Hospital in Atlanta and a pulmonology specialist at Emory University School of Medicine, said most patients 65 and older have disappeared, probably because of vaccinations, but younger people continue to stream in.

“It’s not dropping the way it dropped before,” Martin said.

Emory has not found that new variants are driving the trend in the Atlanta area. “It’s still the typical things that have been circulating in Atlanta for months, not the variants we have seen out of the U.K., South Africa or Brazil,” he said.

Martin said 10 to 15 percent of covid-19 patients who are hospitalized now are winding up in the ICU, a smaller percentage than in the past. That may be because younger patients have fewer underlying health conditions.

“I think it’s not the illness that has changed. It’s the people who are developing the illness.”

Overall, hospitalizations are still declining despite the upticks in certain places, according to CDC surveillance data. But hospitalization rates, like deaths, tend to follow jumps in case counts and could once again challenge the health-care system if a fourth surge of the pandemic develops.

The U.S. trajectory mirrors trends a few weeks ago in Europe, where cases have risen sharply in Germany, Italy and France.

Unraveling the mystery of Europe’s uneven covid surges

“Please hold on a little while longer. I so badly want to be done,” Walensky said at the briefing. “I know you all so badly want to be done. We are just almost there, but not quite yet.” The country does not have the “luxury of inaction” to prevent a fourth surge, she said.

Walensky, an infectious-diseases physician at Massachusetts General Hospital before her CDC appointment, continued: “I know what it’s like as a physician to stand in that patient room gowned, gloved, masked, shielded and to be the last person to touch someone else’s loved one, because their loved one couldn’t be there.”

Throughout the pandemic, older people have accounted for the vast majority of hospitalizations and deaths from a pathogen that preys on those with underlying health problems and weaker immune systems.

But now 73 percent of people older than 65 have received at least one shot, according to CDC data. Health authorities had hoped that younger people would continue to ward off the worst effects of the virus. Instead, the eventual toll appears to depend largely on how quickly vaccinations can be carried out. More than 95 million Americans have received at least one shot as of Monday, CDC data show.

Infectious disease expert Anthony S. Fauci on March 28 said that virus variants and the lifting of coronavirus restrictions are contributing to a rise in cases. (Video: Reuters)

“It will be a race between the vaccine and what’s going on with the dynamics of the outbreak. And we can win this by just hanging in there a bit longer,” Anthony S. Fauci, the nation’s top infectious-disease specialist, said at Monday’s briefing.

Tracking the coronavirus vaccines

Biden told Americans that they stand at a precipice — and would only see the benefits of the nation’s accelerating immunization campaign if they took a step back and renewed their commitment to basic mitigation strategies.

“With vaccines there’s hope, which is a very good thing,” he said. He promised that his administration would double the number of retail pharmacies offering coronavirus vaccines within the next three weeks, by which time 90 percent of adults in the United States will be eligible for the shots.

With additional locations established by April 19, virtually all residents will live within five miles of a vaccination site, Biden said, calling the immunization campaign the “American turnaround story.” But there was no guarantee of a positive outcome, the president warned, saying conditions could easily become “worse, not better.”

One bit of good news on Monday was the vaccine effectiveness study released by the CDC. It found that among 4,000 health-care personnel, police, firefighters and other essential workers, vaccines reduced the risk of infection by 80 percent after one shot and 90 percent after two.

The findings are consistent with clinical trial results and studies in Israel and the United Kingdom that have demonstrated how well the vaccines work.

Jacqueline Dupree contributed to this report.

Correction: A previous version of this article misspelled the last name of the director of the National Center for Immunization and Respiratory Diseases. She is Nancy Messonnier, not Messonier.

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Tracking covid cases, deaths: Covid-19 was the fourth leading cause of death in the United States last year with covid deaths dropping 47 percent between 2021 and 2022. See the latest covid numbers in the U.S. and across the world.

The latest on coronavirus boosters: The FDA cleared the way for people who are at least 65 or immune-compromised to receive a second updated booster shot for the coronavirus. Here’s who should get the second covid booster and when.

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