As COVID-19 rises again, what experts say millions of unvaccinated

As Americans begin to pack bars and live venues again in the era of mass COVID-19 vaccination – with many abandoned masks and social distancing measures – a disturbing reality check is underway .

Health officials and frontline workers, especially in areas of the country with relatively low vaccination rates, are once again warning the public that they are witnessing an influx of unvaccinated patients who are falling seriously ill.

“It’s the worst I’ve ever seen,” Emily McMichael, a nurse at Mercy Hospital in Springfield, Missouri, told ABC News.

Nationwide, more than 17,000 patients are currently receiving care nationwide, the highest number in more than a month, according to data from the Centers for Disease Control and Prevention.

The average number of new COVID-19 hospital admissions has also increased significantly – to nearly 2,800 admissions per day – up 35.8% last week.

And the breakdown is fairly widespread: more than a dozen states have seen a significant increase in the number of patients entering their hospitals in need of care, including Arkansas, which has seen a 76.4% increase in hospitalizations. over the past two weeks, and Florida. , with an increase of almost 90%.

Experts say the outlook for the country is mixed – while there probably isn’t a national wave like spring 2020 or last winter, there is a possibility of regional outbreaks in unvaccinated areas. And this spread may present certain dangers to the vaccinated population, especially to those who are vulnerable and in the possible creation of new variants that may attenuate or escape the vaccines.

“Wicked” delta variant

Although there were still far fewer patients receiving care than the peak in January, when 125,000 patients were hospitalized, experts warn the rise is concerning, especially as the delta variant continues to spread rapidly in the USA.

The highly infectious COVID-19 strain, which the nation’s leading infectious disease expert Dr Anthony Fauci has called “nasty,” is now estimated to account for more than 57% of new cases nationwide. At the end of May, the variant was estimated at just over 3% of new cases.

While it’s still unclear whether the delta variant is more deadly than the other variants, experts say it’s more dangerous, given how quickly it spreads between people, causing more infections, and therefore more illness and death overall.

This rapid spread has resulted in an increase in cases in almost every state across the country, according to data from Johns Hopkins University, with the national average of cases having doubled in the past three weeks.

However, given the variation in immunization levels from state to state and even from community to community, its effects have varied considerably.

“The impact of the more transmissible delta variant will not be felt evenly across the country. The main pockets of unvaccinated people will continue to be the main hosts that will allow this virus to circulate,” said John Brownstein , Ph.D., the director of innovation at Boston Children’s Hospital and an ABC News contributor.

“While vaccines will likely prevent a major national wave, tens of millions of Americans without prior immunity still remain susceptible to the delta variant,” he added.

Communities with fewer vaccinations see significantly higher case rates

A new ABC analysis found that over the past week, states that have fully immunized less than 50% of their total population reported an average weekly rate of coronavirus cases three times higher than in states that have fully immunized. vaccinated more than half of their residents.

States that have fully vaccinated more than half of their residents reported an average of 15.1 new cases of COVID-19 per 100,000 people over the past week, compared to an average of 45.1 cases per 100,000 people in states that have vaccinated less than half of their residents.

The 14 states with the highest case rates have all fully immunized less than half of their total population, and 10 of the 11 states with the lowest case rates have fully immunized more than half of their total population, to except South Dakota.

“In unvaccinated communities where you have increased mobility and reduced mask use and social distancing, we will continue to see flare-ups and, sadly, unnecessary hospitalizations and deaths,” Brownstein said.

With nearly 90% of Americans 65 and over vaccinated with at least one dose, young Americans appear to be behind this recent increase. According to CDC data, 18 to 24 year olds currently have the highest rate of new cases in the country, with just 41.6% of the age group fully vaccinated.

Widespread national impact

For now, experts say they don’t anticipate a nationwide increase.

“It is likely that COVID-19 is now entering a phase where it is a regional problem and not a systemic problem for the country, due to the vaccination differential. Fully vaccinated areas are going to see a very big impact. blunt delta, ”said Dr. Amesh Adalja, principal investigator at the Johns Hopkins Center for Health Security.

Dr Angela Rasmussen, a virologist at the Georgetown Center for Global Health Science and Security, agrees, telling ABC News that “an increase in Missouri probably doesn’t mean much to states with high vaccination rates in terms of hospitalizations “.

However, large regional increases in areas with low vaccination rates could trigger major problems for states with fewer healthcare resources, making the emphasis on hospital capacity urgent, experts said.

But outbreaks in under-vaccinated areas may pose a broader risk nationwide for those who are fully vaccinated but remain vulnerable.

“Uncontrolled transmission and population mobility mean additional infections in vulnerable populations, whether or not they are in a state with good immunization coverage,” Brownstein said.

That’s why some local health departments are considering reinstating restrictions again, in hopes of containing infections. On Tuesday, the Chicago Department of Public Health announced that unvaccinated travelers from Arkansas and Missouri, both of whom have recently experienced significant outbreaks of COVID-19, will either need to self-quarantine for 10 days, or present a negative COVID-19 test result.

In Los Angeles County, the country’s largest, authorities on Thursday reinstated a mandatory indoor mask warrant – regardless of vaccination status.

Brownstein also stressed the critical importance of containing the virus, because “unmitigated transmission further increases the likelihood that a variant with vaccine evasion properties can emerge.”

While Rasmussen thinks we’re unlikely to see the emergence of a variant that will escape vaccines altogether, it’s possible that a new variant will reduce efficacy enough to be problematic. In such a case, she said, reminders would become necessary.

Ultimately, said Adalja, “I think it must be made very clear to people that the delta variant is a disease of the unvaccinated. The breakthrough infections that occur in vaccinated people are very, very rare and usually not clinically significant. “