Worst of US pandemic likely behind us but we can’t drop our guard, experts say

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<span>Photograph: Shannon Stapleton/Reuters</span>
Photograph: Shannon Stapleton/Reuters

The number of new Covid cases and deaths in the United States has been in a steady decline since early September, prompting many infectious disease experts to conclude that the worst impacts of the pandemic in America are probably in the past.

But in the same breath, those experts also caution that it’s not yet safe to abandon safeguards against the virus. That’s because parts of the US population and much of the world remain unvaccinated, which could allow for outbreaks and dangerous new variants of the virus to emerge.

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“My most optimistic assessment is that if we keep vaccinating, sometime during late fall, into the winter, the pandemic phase of Covid will be substantially reduced over much of the United States,” said William Schaffner, an infectious diseases expert at Vanderbilt University School of Medicine.

He added: “We could move from pandemic to endemic, and endemic means that the virus remains in the community, akin to influenza, smolders along, keeps being transmitted, but the rate of disease that occurs is profoundly diminished, and the impact on individuals and health systems is very much controlled.”

In early September, the seven-day average of daily new cases in the United States was 166,000, according to data compiled by the New York Times. On 20 October that figure was 76,000, representing a 54% decrease. The seven-day average of new deaths has also declined by 26% over the last month, according to New York Times data.

“We have highly effective vaccines – which, yes, the new [Delta variant] impacts, and we may need to get boosters to protect people who are vulnerable and high-risk – but we have made big strides compared to this time last year, going into colder weather, at least in the northern hemisphere,” said Nahid Bhadelia, director of Boston University’s Center for Emerging Infectious Diseases Policy and Research.

Bhadelia also credits some of the “defanging” of the virus to the emergence of new antiviral drugs that reduce some of the worst effects of Covid for infected patients.

Still, while new cases and deaths have declined across much of the US, there have still been surges in some states. For example, Alaska, which trails the US average in its vaccination rate, has seen a significant increase in the number of hospitalizations and deaths over the last month, a trend that forced hospitals to postpone non-emergency surgeries and import staff from other states.

In states with lower vaccination rates, “it’s unclear what the baseline immunity from infections is,” and “that’s going to determine whether or not there are surges and how big those surges are,” Bhadelia said, though she did not expect something on the scale of previous waves.

There are also parts of the world, such as Africa, where only a small percentage of the population has been vaccinated against Covid, largely because of a lack of access to the doses, according to health officials and African leaders.

That could allow new variants of the virus to emerge.

A new variant “could reduce the effectiveness of our current vaccines, which would mean that we would need to re-engineer the vaccines and give everybody boosters again,” Bhadelia explained.

The other factor that complicates when people can stop worrying about the virus is the lack of a clear nationwide goal in terms of the number of cases, other than zero, said Justin Lessler, an epidemiology professor at the University of North Carolina. There have been 23 cases per 100,000 in the United States over the last week, according to the New York Times.

For Lessler, the goal is one case per 100,000 people, because then the risk of hospitalizations due to the virus is relatively negligible and the chances of meeting someone who is infected will be extremely low, he said. Then, Lessler said, he would be willing to eat indoors at a restaurant.

“I think that’s a reasonable number to have in your head as a goal, and I wish we had more of a national conversation about what the goal should be,” Lessler said. “It gives people a sense of what to expect.”

Bhadelia also hopes that the country retains limits on large indoor gatherings in communities with low vaccination rates and high transmission of the virus.

“We have done this every single time – starting with Memorial Day last year – where we just open up too fast, and I think this time, maybe we should be a bit more cautious,” said Bhadelia, who recommended retaining requirements for masks and proof of vaccination or a negative Covid test to attend events.

When asked whether people should attend large indoor gatherings, such as basketball games, Schaffner, the infectious diseases expert at Vanderbilt University, said he would not declare an event is safe “because it implies complete safety”.

Instead, he suggests people at higher risk from Covid, such as seniors and those with underlying conditions like lung disease, conduct a “personal risk assessment: Would I rather stay home and watch it on TV?

“Or am I ready to go, and if I go, will I wear a mask? They will be reducing their risk [with a mask], but if you go to a congregant event, where there are lots of people indoors – particularly if they are excited and cheering – there will be some risk,” Schaffner said.

Also, not everyone in epidemiology is convinced that the US has turned a corner in this pandemic. Shaman described himself as “very neutral” on the subject, in part because of uncertainty over when immunity from vaccines or infections wanes.

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That is “going to be very important to understanding how frequently we are going to see new outbreaks of Covid in our communities,” Shaman said. “I’m cautious and waiting for the evidence. If you wanted me to make a prediction for where we will be this winter, I can’t even begin to tell you.”

The infectious disease experts, of course, hope more people in America will continue to get vaccinated. They also hope some safety measures become fixtures of society even after the pandemic. That includes an emphasis on handwashing – even though scientists determined that the virus rarely spreads through touch – and people no longer coming into the office when sick because they see it as a badge of honor.

“We all are a little flippant about when we are sick. People go to their jobs and are, like, ‘It’s just a cough. It’s just a stuffy nose.’ And I would hope that people at least start wearing masks when they are sick. That has become the behavior in a lot of the world, and I think it would be nice if that was something we do” in the United States, said Lessler.

Still, the experts also acknowledge that some people no longer want to hear that they need to be cautious.

“People are exhausted by this,” Shaman said. “The complacency in society is totally understandable, and there are only so many times you can tell people: ‘The virus doesn’t care.’”

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