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The coronavirus might not be the worst of it
The Washington PostDemocracy Dies in Darkness

U.S. coronavirus cases drop as spring wave of infections ebbs

A pedestrian wears a mask in Washington on Tuesday, the same day the Centers for Disease Control and Prevention said fully vaccinated people do not need to wear masks outdoors except in crowds. (Matt McClain/The Washington Post)
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The spring wave of coronavirus infections that began in March is subsiding in most of the country, with 42 states and D.C. reporting lower caseloads for the past two weeks. Hospitals in hard-hit Michigan and other Upper Midwest states that were flooded with patients in mid-April are discharging more than they’re admitting.

The daily average of new infections nationwide has dropped to the lowest level since mid-October. Many cities are rapidly reopening after 14 months of restrictions. The mayor of virus-ravaged New York City, Bill de Blasio (D), said he plans to have the city fully open by July 1.

The positive trends are not uniform across the map, however. The Pacific Northwest is seeing a surge in cases amid the spread of coronavirus variants. Oregon is the hottest of the hot spots, and Gov. Kate Brown (D) declared that the state is moving backward.

The progress against the virus has received cautious applause, with public health officials aware that the virus continues to evolve and the vast populations of Brazil, India and the Philippines are enduring catastrophic, late-pandemic surges of infections and death.

Infectious-disease experts emphasize that the public needs to remain vigilant even as government restrictions on activities are incrementally lifted. The country is averaging about 51,000 cases a day, the lowest since the second week of October — but still many times higher than what public health officials say is necessary if the pandemic is to be declared under control.

Hospitalizations and deaths are also down nationally, although more modestly, as those numbers tend to trail, by several weeks, the rate of infections. The seven-day average for daily deaths stood Friday at 689, a dismayingly high number but barely more than a fifth of the 3,347 daily average recorded Jan. 17 during the peak of the winter surge.

Multiple factors are driving the ebbing of the spring wave, said Natalie E. Dean, a University of Florida biostatistics expert.

“Things are all very encouraging, even despite the circulation of these variants, because so many people are vaccinated and because there had already been a fair amount of infection and because we’re moving into the spring,” she said. “There could be smaller, local flare-ups, but in general, things are looking really good as we move into the summer.”

The exceptions can be found, mainly, in the American West. Oregon has shown the sharpest increase in cases, up 42 percent in the past two weeks, followed by Washington state at 22 percent, according to a Washington Post analysis of government data. More modest increases have been reported in Arizona, Arkansas, Colorado, New Mexico and Wyoming.

Jeffrey Duchin, health director for Seattle and surrounding King County, where cases have continued to climb, cautioned in an email that it is premature to compose any eulogies for the spring wave.

“I hesitate to prognosticate with certainty about the course of the pandemic,” Duchin wrote. “I don’t think we fully understand why SARS-CoV-2 does what it does when it does and the vagaries of human behavior.”

He noted that in recent weeks, vaccinations have largely protected the most vulnerable population — the elderly. Now, young people ages 20 to 29 outnumber the over-70 patients in hospitals, he said.

In Michigan, the coronavirus patient count in the Beaumont Health system dropped from about 800 to 540 during the past week, said Nicholas Gilpin, Beaumont’s top infectious-disease doctor.

“Everybody’s getting a bit of relief right now,” Gilpin said. “We were really at our breaking point there about a week ago.”

He warned, though, that there remains a large contingent of people vulnerable to infection, and another surge is possible.

“When we’re in a period of substantial transmission, such as we are right now, people in the community need to recognize there’s a greater-than-ordinary risk,” he said. “People need to be more cautious, they need to be sure they’re wearing their masks, practicing their social distancing, staying home if they’re sick, and getting vaccinated.”

Centers for Disease Control and Prevention Director Rochelle Walensky, who just weeks ago repeatedly expressed alarm about rising infection numbers — at one point going off-script and saying she had a feeling of “impending doom” — this week highlighted the “really hopeful decline” in cases.

One scenario advanced by infectious-disease experts is that the country is entering a warm-weather period in which the virus will struggle to spread, both because of the growing immunity in the population and the environmental conditions that disfavor the spread of respiratory viruses.

Scientists are generally cautious about saying that this coronavirus is “seasonal,” because it remains novel and has been able to transmit in all conditions — including last summer, when there was a moderate wave that built in the Sun Belt. Some experts suspect that hot weather drives people indoors and makes them more likely to catch the virus.

Rural Maryland and Virigina counties once led in vaccinations. No more.

Whether this short-term trend continues to drive down cases in the coming weeks and months depends on multiple factors not easily estimated, including coronavirus vaccine uptake. The news on that front is mixed.

Nearly 4 in 10 adults are fully vaccinated and more than half have had at least one dose. Older Americans, who are most vulnerable to severe illness, are largely vaccinated. Vaccines that performed well in clinical trials have proved to be just as safe and effective in their full deployment, with post-vaccination “breakthrough infections” rare, as are dangerous allergic reactions.

But vaccination rates — a point of pride for the Biden administration as it twice exceeded its goal for getting shots into arms — have dropped since April 13, when the country hit a peak of 3.4 million daily vaccinations on average. It has dropped since then to 2.7 million. Vaccination is dropping in every state.

At the Wicomico Youth & Civic Center in Salisbury, Md., hundreds of people lined up for shots on the first Monday in April; three weeks later to the hour, there were no lines and perhaps one-fifth as many people.

“We got the easy ones out of the way,” said Janis M. Orlowski, chief health-care officer for the Association of American Medical Colleges. “Now, it’s the hard work of getting to the people who are in the middle, who are sort of wishy-washy — ‘Do I want a vaccine or do I not?’ ”

New Hampshire peaked a week earlier than the country and has dropped by 88 percent, to an average of fewer than 4,000 shots a day. Alaska, Mississippi and Nevada are all down by almost ­two-thirds. The Veterans Health Administration reports a decline of more than 60 percent in vaccinations. The Indian Health Service is down more than 50 percent, and the Department of Defense more than 40 percent.

The decline may reflect a combination of factors: The coronavirus vaccine “early adopters,” the most enthusiastic and motivated to get their shots, have succeeded in their quest. Many people who are willing to get vaccinated are in remote locations or have jobs or caregiving obligations that lack flexibility.

And finally, polls suggest that a large cohort of the unvaccinated population does not intend to get vaccinated. Some portion of that population may have a degree of natural immunity to the virus from a previous infection, but vaccines generally trigger a more robust immune response.

The near-term future of the pandemic in the United States depends in part on whether young people — who are typically more mobile and are major spreaders of the virus — seek vaccinations. From the virus’s perspective, it doesn’t matter how old a person is, because the virus just wants hosts in which it can replicate. But individuals calculate their own risk, and young people are significantly less likely to have a severe or fatal case of covid-19 and may feel less motivated to get shots.

Popular podcast host Joe Rogan drew the wrath of public health officials when he told his audience that he would not recommend that a healthy 21-year-old get vaccinated. He later backed off his comment, saying he was not a doctor (“I’m not a respected source of information”).

In the interval between those comments, Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said on NBC’s “Today” that young people are vulnerable to the virus and also need to think about more than just their own interests, because they can spread the virus. If someone focuses solely on personal risk, “you’re talking about yourself in a vacuum then.”

Lenny Bernstein contributed to this report.

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