COVID-19 cases drop, but variants point to dangers ahead

The number of Americans testing positive for the coronavirus has dropped substantially from an early January zenith, easing the strain on hospitals across the nation that faced danger over the winter holidays.

But new and more transmissible strains of the coronavirus are circulating more widely across the world, and public health experts caution that, even with the beginnings of mass vaccination programs, the public must be more vigilant than ever in protecting themselves and reducing the spread.

“This is the calm before the real storm. I think the darkest days of the pandemic are just ahead of us,” said Michael Osterholm, who directs the Center for Infectious Disease Research and Prevention at the University of Minnesota. 

More than 25 million Americans have tested positive for the coronavirus, in what is likely only a fraction of the true number of those who have been infected. More than 107,000 Americans are currently hospitalized with the virus. Almost 420,000 Americans have died of the virus, a toll far higher than any other nation on earth.

Nearly 20,000 people have died in just the week since President Biden was inaugurated.

“I think it potentially could get worse,” Anthony Fauci, director of the National Institute of Allergy and Infectious Disease, said Thursday morning on MSNBC.

The pace of infections has followed a steady and disturbing pattern in the year since the virus was first identified in the United States: Cases rise alarmingly, first in core epicenters and then across the nation, followed by a plateau and a slight decline, before the cycle begins again. 

What worries epidemiologists and health experts is that the declines have so far stalled at successively higher baselines, leading to larger spikes when infections begin accelerating anew.

The current decline in case counts has an average of 162,000 people testing positive in the United States over the past week — the same level as were testing positive in late November, and nearly triple the number who were testing positive during the worst of the summer surge.

The pattern is likely to accelerate once again as two more transmissible strains — one known in the scientific literature as B.1.1.7 and first identified in the United Kingdom, the second known as B.1.351 and first identified in South Africa — begins spreading faster. The Centers for Disease Control and Prevention (CDC) estimates those strains will become dominant in the United States in the coming weeks. On Thursday, the CDC said it had identified the first two strains of the South African variant in South Carolina.

“Unless we truly, as a nation, come together and follow public health guidance to flatten the curve, as that strain becomes more commonplace, we will see the numbers go up dramatically, we will see hospitalizations go up, and we will see deaths go up,” said Rich Besser, a former CDC director who now runs the Robert Wood Johnson Foundation.

The crisis situation that California hospitals experienced in December and January has ebbed as local governments have opened new surge facilities and case counts have eased. But the baseline from which a new surge may begin in the coming weeks is far higher than at any previous point in the outbreak.

More than 80 percent of intensive care unit beds are already occupied in 18 states and the District of Columbia, according to state data. Many hospitals are reporting critical staffing shortages. Test positivity rates have fallen, but they remain around 11 percent on average, far higher than epidemiologists say is acceptable. Despite the positive trajectory, a new surge in cases still threatens to overwhelm health care systems.

“If keeping our hospitals functional is the outcome we want, we’ve got a challenge because we’ve already got hospitals in this country that are under duress,” Osterholm said. “Just trying to keep hospitals whole is going to be a major challenge.”

There are early signs of a new surge in some parts of the country that have already gone through a mammoth outbreak. Models from the PolicyLab at the Children’s Hospital of Philadelphia forecast new surges in New York City and in Washington, D.C., and its surrounding suburbs. Parts of Texas and Florida show signs of increased transmission, the models suggest.

The glimmer of hope represented by the rollout of two groundbreaking vaccines has become an increasing source of frustration for state and local governments as they run into delays from the federal government, hesitancy from the most at-risk communities that are eligible to receive a shot, and errors or confusion in delivering shots once they are deployed.

The federal government has distributed about 47 million doses of vaccine, and just more than half of those doses have been administered, according to federal data. The Biden administration told governors earlier this week it would boost the number of vaccine doses it ships to states.

About 6 percent of Americans have received at least one shot, but just 1 in 100 has received both required doses — a pace that puts the goal of widespread vaccination back several months.

Several other vaccines are nearing the end of their final trials. One potentially promising candidate, developed by Johnson & Johnson, would require only one dose and can be stored more easily than the two already on the market, though it remains unclear exactly how effective that candidate is at preventing infection.

“Having potentially a third vaccine, and then hopefully a fourth vaccine assuming that many of those doses will be available here could be huge,” Besser said. “We need an urgency around vaccinating people quickly.”

A part of the recent decline in cases, some suggest, is widespread behavior changes among members of the public. Many may see the light at the end of the tunnel, and may be hunkering down just a little more to reach the end safely. Health experts hope those behavior changes continue, though they caution that there is still plenty of tunnel to traverse before it ends.

Osterholm cast the initial tunnel as leading to the summer and fall of 2021.

“Our race is a marathon here,” Osterholm said. “Our job is to get the country vaccinated by next summer and next fall.”