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The summer wave of Covid-19 cases and deaths is finally starting to fade, but already winter is in sight.
This past December and January, the United States and much of the world experienced the deadliest outbreaks of the pandemic. At one point, more than 3,000 Americans were dying from Covid-19 every day. Almost 250,000 people have died in the United States in December, January and February.
But this winter may be different, at least in America. Last year, almost no one was vaccinated against Covid-19. As of October 7, 56% of the U.S. population was fully vaccinated, according to the New York Times tracker. This includes 84% of people over 65, who are typically the most vulnerable to death from the virus. The Food and Drug Administration will soon consider authorizing a vaccine for children as young as 5, which would increase vaccination rates.
More than half of the vaccinated population is the main reason for optimism for the coming months. A number of unvaccinated people also have natural immunity; To date, 44 million cases of Covid-19 have been recorded in the United States.
At some point, the virus starts to run out of unprotected people to infect. Although there are revolutionary cases in the vaccinated population, these people are significantly less likely to develop severe symptoms than if they were not vaccinated. The main goals at this point are to maintain the capacity of hospitals to ensure that health systems are not so inundated with patients that they need to ration care and prevent deaths. The more people are immune; the fewer deaths we will see. This is the main reason why this winter could be better than last year.
The Covid Scenario Modeling Hub, which is a synthesis of several projections of future numbers of cases and deaths, shows that deaths from Covid-19 in the United States are steadily declining, from an average of nearly 2,000 per day during the last week of September at 90 deaths per day. in the last week of February 2022.
But this assumes that many children get vaccinated and that no new variant emerges that is more transmissible and / or fatal than the delta variant. Under different parameters, if few children are vaccinated and a new variant becomes dominant, the coming winter could be very different. The Covid Scenario Modeling Hub predicts around 650 deaths each day by the end of February in this scenario – and an increasing trend. It’s not as bad as last winter, but it’s still a lot worse than other possible futures. (And to be clear: all scenarios involve significant uncertainty in the specific projected numbers.)
Where we end up in will depend in part on luck (hopefully the virus won’t suddenly become more virulent) and in part on our own decisions (like whether or not to get the vaccine, which can help avoid new variants).
We’ll probably end up seeing the two scenarios play out in different places. Areas with a lot of immunity, whether through vaccination or infection, can have an easier winter. But there are still pockets of people, in areas as small as a city or even a neighborhood, where there isn’t a lot of immunity and where a lot of people are still vulnerable to Covid-19. They face a much harsher winter.
Here’s what will determine how the United States performs during the colder months.
Reasons to be optimistic about Covid-19 this winter
More vaccinations should mean a better winter. Other factors – how many people travel, what precautions they take to distance themselves socially, etc. – will play a role, but nothing is more likely to influence the course of the winter than vaccination rates.
At this point, about 75% of Americans aged 12 and over have received at least one dose of a Covid-19 vaccine. More importantly, 95 percent of people over 65 have received at least one dose, and the federal government has approved booster shots for this age group. And Pfizer has asked the FDA to approve its vaccine for children aged 5 to 11, which paves the way for vaccinations for the school-aged population to begin in a matter of weeks.
President Joe Biden’s administration and many states, cities and employers are doing all they can to encourage more vaccinations. The federal government requires large employers to institute vaccination warrants; some local governments and businesses do the same. Daily vaccination rates are still well below their peak of over 3 million in April, but have increased in recent months from a low of around 500,000 per day on average in mid-July to about 950,000 per day in early October.
“Immunization coverage is increasing and this, combined with natural immunity, offers increasing protection,” Jennifer Kates, director of global health policy at the Kaiser Family Foundation, told me. “Children should soon be eligible. Even with the kids back to school, we don’t see big epidemics. These are all signs we might be over the big bump. “
The United States is entering a new stage in its epidemic. Covid-19 is not going to go away, so we will have to decide, individually and collectively, what level of risk we are willing to tolerate. It is not possible to prevent all infections, but the goal should be to prevent as many serious illnesses as possible so that hospitals are not too overwhelmed to treat all their patients, a worst-case scenario that has been observed. seen in the hardest. hit parts of the country this summer.
Vaccines continue to offer strong protection against serious illness for most people, and many people for whom the vaccine’s effectiveness is more likely to decline are now eligible for booster shots. The more people are vaccinated, the more we can allow life to return to normal (or normal) without risking overwhelming hospitals.
According to the Kaiser Family Foundation’s September survey, about half of unvaccinated American adults are ready to get the vaccine, saying they always take a “wait and see” approach or will get it when needed. Most people who get vaccinated say they would get a booster if and when they were eligible. And about a third of parents of children aged 5 to 11 now say they will get their child vaccinated right away, up from 26% who said the same thing in July.
All of these trends suggest that there is room for the overall vaccination rate in the United States to increase before the cold really sets in. That would portend a better winter than last year, although experts warn it’s still possible to see a small bump in cases under a best-case scenario.
Their goal is to vaccinate as many cases as possible of people with mild symptoms that do not require a trip to the hospital. That way, life could go on in relative safety.
“It’s no secret that Covid will likely remain endemic and always hurt people,” Kumi Smith, an epidemiologist at the University of Minnesota, told me. “But if we can reliably send children to school and give our health systems a fighting chance, I think that will be a big step.”
The reasons for pessimism in the face of a coming winter wave
But in the same data, there are trends that could lead to a more difficult winter, a winter in which many Americans remain unprotected against Covid, fully vulnerable to the delta variant – or, in the worst-case scenario, a more virulent successor. .
According to the KFF September poll, about 12% of Americans say they “definitely won’t” get the vaccine under any circumstances. They seem unlikely to be affected by any incentives or demands; some of them have become part of the anti-vaccine and pro-miracle community that has grown during the pandemic and is not convinced by the mainstream consensus.
Many parents also seem reluctant to have their young children vaccinated, even after the expected FDA approval: according to the Kaiser poll, 32% of parents said in September that they “would wait and see”; 7 percent say they will vaccinate their child only if necessary, and 24 percent say they will “definitely” not allow their child to be vaccinated. Such a large proportion of parents hesitant about a new vaccine is actually not unique to Covid-19. As Aaron Carroll wrote for Atlantic, it took years for chickenpox vaccination rates to reach 90% in the United States.
There will therefore be pockets of the population that will remain fully vulnerable to Covid-19. It does not seem likely that the United States will be able to achieve sufficient vaccination levels to completely stop transmission of the virus. And even vaccinating many more children may not help as much as vaccinating more older adults would reduce severe cases overall.
“Even in the most vaccinated US states, there will always be a reservoir of people susceptible to the virus,” Josh Michaud, associate director of global health policy at the Kaiser Family Foundation, told me. “No state has achieved a level of population immunity that could interrupt the spread – and that might not even be possible, given the highly transmissible delta variant.”
However, different places will have different levels of vulnerability, depending on the degree of immunity from previous vaccinations and infections. Some states have vaccinated more than 99% of their population over 65; others, like West Virginia and Wyoming, still come close to 80%, meaning that many of those most at risk for Covid-19 have no immunity to the virus.
This gap extends to the local level. Wayne County, Michigan is considered highly vulnerable to Covid-19, according to the CDC’s Social Vulnerability Index, which uses various socio-economic measures to assess a location’s risk. The county’s vaccination rate is stuck at 46%, well below the state’s overall rate, and one in four people over 65 is not vaccinated.
Bill Hanage, an epidemiologist at Harvard University, told me that this kind of micro-trend is one of the reasons that clusters of cases continue to appear even in heavily vaccinated areas.
“One obvious and important reason is the clustered nature of sensitive individuals,” he said. “If you’re 95 percent vaccinated in your town, but the unvaccinated 5 percent is all in the meat plant, that’s not good. “
So the United States could end up experiencing the best and worst cases simultaneously this winter, depending on where you live and who you are. But experts are consistent in saying that more vaccinations should lead to less risk – and help avoid what they see as the worst-case scenario for winter if vaccinations are delayed.
“The worst case scenario is that another variant emerges,” Kates said. “Covid has already deceived us and can still do it. And if people let their guard down – by masking the shutdown too early, for example – we might see another surge, especially as we move into winter. “
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