It’s the biggest COVID-19 question mark in America right now. Cases, hospitalizations and deaths continue to plummet nationwide. The pace of vaccinations is picking up. Does this mean the worst of the U.S. pandemic is finally behind us? Or will new variants trigger yet another surge of infections this spring?
To find out, Florida — ground zero for Super Bowl revelry this past weekend — is probably the place to watch. That’s because new evidence suggests it may also be ground zero for the spread of the worrisome U.K. variant known as B.1.1.7.
Overall, there’s been a lot of good news about COVID-19 lately. To be sure, the U.S. is still averaging far too many daily cases as it descends from its devastating holiday peak: about 118,000 at last count. But nationally that number has been falling by 15 percent to 20 percent every week, and it’s falling across every state. Hospitalizations are down 25 percent over the last two weeks. And deaths, a lagging indicator, are finally declining too.
Meanwhile, every day more and more Americans are receiving one of two miraculously effective vaccines by Pfizer and Moderna. On Saturday, more than 2.2 million doses were administered, a new U.S. record; 1.6 million were administered Friday. The latest seven-day average of 1.4 million daily doses is fast approaching President Biden’s new goal of 1.5 million shots per day — and many more doses are on the way.
In a perfect world, America’s accelerating vaccination campaign would keep shielding vulnerable populations from serious illness and crushing case counts until, at last, we contain the virus — and end the U.S. pandemic.
But of course, in real life, nothing is that simple. A new study posted online Sunday highlights the real threat posed by B.1.1.7 — and why it could be “our last major obstacle to achieving containment of the virus in the U.S.,” as Dr. Eric Topol recently put it.
According to the study — the first nationwide look at the history of the variant since it arrived undetected in the United States in late 2020 — B.1.1.7 is now spreading so rapidly here that is doubling in prevalence roughly every 10 days and is likely to outnumber all other strains in one month’s time.
“Nothing in this paper is surprising, but people need to see it,” Kristian Andersen, a co-author of the study and a virologist at the Scripps Research Institute in La Jolla, Calif., told the New York Times. “We should probably prepare for this being the predominant lineage in most places in the United States by March.”
Last month, the Centers for Disease Control and Prevention warned that B.1.1.7 could dominate by March if it behaved the way it did in Britain, where it fueled a massive winter wave and was found to be about 50 percent more transmissible than previous versions of the virus. Estimates by Andersen’s team suggest that so far, B.1.1.7’s transmission rate in the U.S. is as much as 45 percent higher than more common variants, confirming the CDC’s projection.
Does all of this augur a deadly spring?
Not necessarily. The existing vaccines all work well against B.1.1.7, so the more people who get inoculated as soon as possible, the better. So far, about 10 percent of the U.S. population has received at least one dose. Over the next month, at least another 45 million doses should be administered, with nearly all of them going to seniors and essential workers. That will help blunt the impact of B.1.1.7 on the most vulnerable Americans. In clinical trials, no one who’s been vaccinated has died from COVID-19. In fact, almost no one has been hospitalized.
In Israel, where more than 35 percent of the population has been vaccinated, B.1.1.7 now accounts for about 70 percent of all cases — yet new data shows the Pfizer vaccine has not been any less effective because of it. Among residents over 60 — three-quarters of whom are fully vaccinated — cases have fallen 50 percent and critical illness has fallen 29 percent over the past three weeks, despite an ongoing surge that has otherwise been hard to contain because of B.1.1.7.
The problem here, however, is that not every American can be vaccinated in the next month, which means that at some point, B.1.1.7 is likely to start propelling case counts upward again.
That’s where Florida comes in.
COVID-19 cases in the Sunshine State have been declining sharply, with the seven-day average dropping Sunday to 8,087, the lowest since Dec. 2. But new data from the CDC also shows that Florida leads the U.S. in confirmed cases of the B.1.1.7 variant, both overall and per capita. The U.S. has reported 690 cases of B.1.1.7 across 33 states, according to the CDC; Florida accounts for 201 of them.
Yet those figures, which are limited by America’s meager genetic surveillance efforts, vastly understate B.1.1.7’s actual spread. According to the study posted Sunday, the variant is already responsible for more than 4.5 percent of Florida cases, compared to 2.1 percent cases nationally. The research also showed that the number of B.1.1.7 cases in Florida is doubling every 9.1 days.
And Florida, it seems, is doing everything in its power to help B.1.1.7 along. As the New York Times reported Monday, “the streets of Tampa, Fla., teemed with boozy revelers into the wee hours of Monday, many of them ignoring pleas from medical experts to socially distance and wear masks, after the Buccaneers crushed the Kansas City Chiefs in Sunday’s Super Bowl.” Before that, bars and restaurants were open for indoor drinking and dining, and Republican Gov. Ron DeSantis, who has resisted mask mandates, issued an order that prevents local governments from collecting coronavirus fines and penalties.
“It is a little frustrating because we have worked so hard,” Tampa Mayor Jane Castor, a Democrat, said during an early Monday morning news conference with the Super Bowl Host Committee. “At this point in dealing with COVID-19, there is a level of frustration when you see that.”
What you’re seeing in Florida is precisely the sort of environment in which B.1.1.7 thrives. Experts believe the variant spreads more readily by generating higher viral loads in the upper respiratory tract, so they recommend countering it with better masks, greater distance and less indoor gathering. Even if you maintain the status quo, they warn, the variant will spread faster. But if like Florida you actually move in the opposite direction and loosen up — fewer masks, less distance and more indoor gathering — then things could get out of control very quickly.
Ashish Jha, dean of the Brown University School of Public Health, cites Ireland as an example of how dangerous B.1.1.7’s exponential spread can be. “B117 is much more contagious,” he tweeted Sunday, “so it can quickly overwhelm a nation.” Until mid-December, the outbreaks in Ireland and Germany looked similar; both had reversed previous surges with restrictions. On Dec. 10, Germany appeared to be in worse shape than Ireland, with an average of about 25 cases per 100,000 people compared with Ireland’s 5.8 cases per 100,000.
But B.1.1.7 was quietly circulating in Ireland and starting to grow. By Dec. 17, the count had ticked up to 7.9 new cases per 100,000 people; by New Years Day it had climbed to 27.3. Then, suddenly, it exploded, quadrupling over the next week to 132 cases per 100,000 people. As Jha notes, the “US has never seen numbers like that. Only the Dakotas had infection rates that high. Our holiday ‘surge’ was small in comparison.”
In Germany, meanwhile, cases continued to fall. Why? Because B.1.1.7 wasn’t really circulating there yet. On Friday, the head of Germany’s public health institute announced even now, the U.K. variant accounts for only about 6 percent of their infections. Given that Germany remains “in a pretty tight lockdown,” says Jha, “they may see only a modest spike” in the end.
The U.S., however, has taken a different tack — “pretty open,” as Jha puts it. As cases fall, mask mandates are expiring, indoor dining is resuming and Americans are letting down their guard.
To stay ahead of B.1.1.7, Jha says, “we need to act very quickly if we see infections starting to inch up.” Florida could very well be the place where we see them start to inch up first.
If and when that happens, the whole U.S. needs to immediately mask up — or maybe even double-mask — and severely limit indoor activity. And we need to do it before the situation deteriorates in our own neck of the woods.
Because that’s the thing about exponential spread, especially with a more transmissible variant: By the time the numbers start to look scary, it’s already too late to stop it.
“This is the time to gear up,” Topol warned Sunday. “Not when we are on the steep part of the curve.”
In that sense, Florida could be a canary in the B.1.1.7 coal mine — the warning sign that keeps the rest of the country on the right path this spring.
“B.1.1.7 will become widespread in the U.S.,” Jha concluded. “But it need not flatten us. We have the tools to beat it.”
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