What’s Ahead for Spring: The Good, the Bad, and the Ugly

The pandemic isn’t over, even if we’re over it

A person walks by a sign that reads, “Dining room now open” outside a restaurant in Times Square.
Photo: Noam Galai/Getty Images

I’m writing weekly for Medium about my experiences as an emergency medicine doctor during the Covid-19 pandemic. You can read my previous posts on vaccine inequities, the return to “normal” life, and more, here.

A month ago I wrote that the next phase of the pandemic hinged on vaccines, variants, and how well we followed the public health measures necessary to keep Covid-19 in check. Since then it’s become increasingly clear this summer will be amazing (even if a little weird). What’s less clear is how this spring will shake out with respect to Covid in the U.S.

So let’s take stock of how we’ve done since my last story and what likely lies ahead. Spoiler alert: There’s some good, some bad, and some ugly.

Vaccines

If any aspect of this pandemic deserves unbridled optimism, it’s the current state of the vaccine rollout.

When I was vaccinated against Covid last December, there were more new cases of Covid than people vaccinated against it every day. Early on, the vaccine rollout was slow and inefficient, not wholly unexpected for a massive nationwide campaign to get shots into arms.

When then-President-elect Biden pledged in January 2021 to get 100 million vaccinations in his first 100 days as President, there was concern even amongst his advisers that his promise would come up short owing to logistical challenges and unforeseen vaccine supply chain ruptures.

If the trajectory of the pandemic in the U.S. was determined only by vaccinations, we’d be in great shape. But it isn’t.

However, we met the 100 million shot goal in 58 days. And recently the president doubled the pledge to 200 million vaccinations by the 100-day mark.

The steadily increasing supply of vaccines is responsible for much of the recent improvement in the rollout. Moderna has already delivered 100 million doses of its vaccine and will deliver another 100 million more by the end of May. Johnson & Johnson’s production capacity is picking up, now putting it on track to deliver 20 million doses of its single-shot vaccine by the end of March.

More supply means more doses are getting shipped to states. This week alone 33 million doses are available to vaccinators, a substantial increase from 27 million the week before (itself a 20% increase from the week prior).

After getting shipped out, these doses are quickly getting into arms. The U.S. is now averaging over 2.7 million vaccinations a day. On many days, more than 3 million Americans are getting vaccinated, nearly 1% of the total U.S. population.

And with more supply on hand, more states are expanding who can get a shot, in line with President Biden’s goal of having every adult American eligible for a vaccine by May 1 and enough vaccines readily available for them by the end of May.

If the trajectory of the pandemic in the U.S. was determined only by vaccinations, we’d be in great shape. But it isn’t.

Variants

Variants of the virus that causes Covid-19 are crashing what should be a joyous spring party. That’s because, in the race between vaccinations and variants, the variants are winning.

After weeks of falling cases, the daily number of new Covid-19 infections started to plateau at the end of February. In mid-March, the seven-day average of new cases dropped to 52,000 per day, the lowest since October 2020. But now cases have started climbing again. 36 states are reporting rising case counts, and nationally the U.S. is averaging 65,000 new infections per day, comparable to the highs we saw in July 2020 during the summer surge. Sure, that’s significantly less than the 250,000/day we saw just a few months ago, but it still means there’s a lot of virus circulating in our communities.

This increase is driven by multiple factors, including pandemic fatigue and loosening restrictions. But variants are also undoubtedly to blame.

Many of the variants now circulating in the U.S., including B.1.1.7 (first discovered in the U.K.), B.1.351 (South Africa), and P.1 (Brazil), have recently fueled outbreaks around the world.

Here in the U.S., the B.1.1.7 variant is currently the most concerning and widespread. This variant is known to be 30%–50% more transmissible and likely more deadly, too. It has now been identified in every U.S. state and accounts for nearly a third of all cases in the U.S. This is likely contributing to the recent surges in cases and hospitalizations in places like Michigan and the Northeast.

Even more alarming is that younger age groups are driving the uptick in hospitalizations. Over the past month, hospitalizations in adults 40–49 years old have increased by nearly 800% in Michigan.

Public health measures

In their race against vaccinations, variants are getting an assist from our variable adherence to public health measures and from politicians loosening restrictions all across the country.

There have been some obviously egregious examples of people pretending like we’re still not in a pandemic, like the maskless partygoers in Miami whose bacchanal forced the city to implement a curfew during spring break. But mostly what we’ve seen is a gradual pulling back on restrictions on masks and other protective measures.

Last month, I noted how a few states had recently lifted their mask mandates and that others would soon follow. A few days later, Texas and Mississippi did exactly that.

And despite President Biden’s plea for everyone to wear a mask for 100 days, other states have followed suit. This week, hours after the President pleaded with “every governor, mayor, and local leader to maintain and reinstate the mask mandate,” Arizona and Arkansas went the other way and repealed theirs.

In the past few weeks, Covid has provided a timely and important reminder: The pandemic isn’t over, even if many of us are over it.

Travel between states is also a mixed bag: Even if Biden’s mask mandate isn’t being heeded in all places, one of his administration’s first moves was to pass an executive order requiring masks to be worn on air travel and trains in accordance with CDC guidance.

This has the potential to be very impactful, given the massive surge in travel recently. For the last three weeks, the Transportation Security Administration (TSA) has screened over a million passengers every day, the highest number since the pandemic began, including the travel surges around last Thanksgiving and the winter holidays.

And American Airlines recently announced travel bookings have reached 90% of pre-pandemic levels. Many of these passengers are vaccinated against Covid-19. But undoubtedly, many aren’t, and are bringing the virus with them on the plane and to their destination.

Many paint this uneven public health response as a political issue between red and blue states. The narrative is often simplified by stating Republican-led states are loosening too quickly, while Democrat-led states are loosening too slowly. Even the map of mask mandates by state overlies the 2020 electoral map pretty well. The problem, though, is that this simple narrative is wrong.

In the heavily Democratic Northeast, states are opening quickly despite having the highest rates of new Covid cases in the country. In New York, indoor dining is back at 75% (50% in NYC). Movie theaters, professional sports games, and even indoor gyms are open (albeit at limited capacity). Even if mask mandates are still in place, many other restrictions on indoor events and other higher-risk activities are being pulled back in surrounding states as well, even as cases continue to rise.

Where this all leads

So, where are we now in this delicate dance of vaccines, variants, and adherence to public health measures? And what does the future have in store?

Well, I have a lot of hope for the long term, but also some worry for the short term. In the past few weeks, Covid has provided a timely and important reminder: The pandemic isn’t over, even if many of us are over it.

A fourth wave seems inevitable. It’s only a question of magnitude at this point.

Yet again, new cases of Covid are on the rise in the U.S. (and globally). Hospitalizations and deaths are trending upward as well. Since the start of the pandemic, this combination has invariably preceded a major surge of the virus across the country.

Even if the vaccine rollout has been remarkable, it isn’t complete. To date, only 16% of Americans are fully vaccinated. In those 65 and older, the population most vulnerable to Covid’s most severe outcomes, only half are fully vaccinated. This means much of the country is still susceptible to Covid. The virus still has a lot of space to spread.

And even as vaccination is speeding up, so is the threat from variants. When accompanied by the relaxation of public health measures nationwide, the threat of another surge is real. A fourth wave seems inevitable. It’s only a question of magnitude at this point.

That’s exactly why the CDC director, Dr. Rochelle Walensky, recently went off-script in a briefing to the public to beg the nation to “just please hold on a little while longer.”

With all the optimism and improvement of getting shots into arms, it’s been easy to believe that the vaccines will outpace the variants. And as this pandemic drags on, it is understandable that many are tired of wearing a mask and following the public health measures needed to slow the spread.

But as Walensky noted, we need to hold on a little while longer. We know the summer is going to be great. But the spring doesn’t have to be horrible.

NYC ER doctor | Ebola Survivor | Director of Global Health in Emergency Medicine at Columbia University | Public Health Professor | Doctors Without Borders BoD

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