Things will get worse amid surge in unvaccinated Covid delta

Dr. Anthony Fauci has a sobering prediction: “Things will get worse.”

The White House chief medical adviser made the remarks amid the rise in Covid cases nationwide, largely due to the newly dominant and more transmissible delta variant of the virus, during a interview with ABC “This Week” Sunday. While it’s hard to imagine a more serious situation than the current outbreak in the country, “we expect pain and suffering in the future because we see cases increasing,” Fauci said.

Delta has raged across the United States in recent weeks, surpassing the peak of new daily cases last summer and hitting the country’s relatively large unvaccinated population particularly hard – 50% on Thursday afternoon. Experts suggest that the United States needs a 90% vaccination rate to achieve herd immunity, given the delta’s great spreading capacity.

If that doesn’t happen, Fauci told McClatchy DC on Wednesday that the virus will continue to spread through the fall and winter – giving him “every chance” to develop another, worse variant.

So how “worse” is? Here’s what could happen in the coming months and what can be done to stop it:

As long as a virus can spread, it can mutate and create more dangerous variants. And while the Covid vaccines used appear to work well against current variants, “there could be a lingering variant that can rule out the delta,” Fauci told McClatchy.

If a more vaccine-resistant variant emerges, people may need booster shots. Countries like Israel, Germany and France have already started giving third doses of mRNA vaccines as boosters – although the World Health Organization said on Wednesday it was too early to move forward with boosters until vaccine inequalities are corrected around the world.

“We are talking about recalls in countries that have access to the vaccine,” Keri Althoff, epidemiologist at the Johns Hopkins Bloomberg School of Public Health, told CNBC. “While we still have people all over the world who don’t have access, at this point even to the first dose.”

Much of the virus’s current ability to spread in the United States – which has an abundant supply of vaccines – is due to America’s large population of unvaccinated people. About 30% of the adult population in the United States has not received at least one dose, and about 33% of eligible children aged 12 to 17 have yet to receive a vaccine.

New data from the CDC has also raised concerns about breakthrough cases, where people vaccinated can sometimes pass the delta variant to others. The CDC only tracks breakthrough cases that lead to severe hospitalizations and death, but most breakthrough cases tend to be mild or asymptomatic – leading some experts to say the agency might lack crucial data in real time on their prevalence and their ability to promote new variants.

“The concern has to be that something new is going to evolve, call it epsilon or some other variant, and we have to watch that very carefully,” Dr Ezekiel J. Emanuel, vice-president of global initiatives and co-director of Health Transformation Institute at the University of Pennsylvania, said Tuesday in a briefing with the Infectious Diseases Society of America.

“Sadly, if you’re missing breakthrough infections, maybe you’re missing an evolution here, that would be very important for us to keep up with,” Emanuel said.

A key indicator that Covid will continue to worsen, according to Fauci: The national seven-day average for new daily cases is currently on the rise.

“Remember, just a few months ago we had about 10,000 cases a day,” Fauci told McClatchy. “I think you’re probably going to end up with between 100,000 and 200,000 cases.” The average is currently above the peak of last summer, before the authorization and use of the vaccines. The seven-day moving average of daily cases was 84,389 on August 2, according to CDC data. Last year, the CDC reported about 68,700 new cases per day.

There is some evidence that the wave is pushing people to get vaccinated. Louisiana, which has the highest rate of Covid cases per capita, has seen the number of people vaccinated quadruple in recent weeks.

But even with this vaccination bump, people will not be considered “fully vaccinated” for some time. The CDC defines “fully vaccinated” as two weeks after the second dose of a two-dose regimen like Moderna or Pfizer, or two weeks after receiving the Johnson & Johnson single-injection vaccine. “Even though we’ve vaccinated everyone today, we’re not going to see an effect until mid-September to the end of September,” Fauci told McClatchy.

Complete lockdowns from last year are unlikely to return as the country’s vaccine supply is large and experts now know more about how Covid is spreading, Fauci told ABC. But as long as vaccines aren’t available to everyone – like school-aged children, for example – non-pharmaceutical prevention measures like masking and social distancing may return.

In late July, the CDC reversed its mask guidelines for fully vaccinated people, recommending that everyone wear masks in indoor public places in counties where there is “substantial or high transmission,” such as determined by the agency’s data tracker. Masks are also a good idea in areas with high vaccination rates, Althoff said, to help prevent cases of rupture and curb transmission.

“Masking is protecting you and others, and with a really communicable variant, masking on the inside is really important right now,” she said.

Restrictions on large indoor and outdoor gatherings could also return – because while canceled parties and six-foot markers in stores are certainly inconvenient, they could help prevent more restrictive measures.

“Nobody wants to go back to what we had before with the blockages,” Althoff said.

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