FORT LAUDERDALE, Fla. — A race is on between vaccinations and highly contagious mutations of the COVID-19 virus, as Florida enters a critical period in the fight against the disease.
The best-case scenario: No further variants of the virus show up, allowing existing vaccines to reduce the disease’s spread. New doses arrive in Florida in sufficient numbers to deal with the highly contagious U.K. variant spreading through the state. Spring break comes and goes without the packed beaches and bars that spread the disease last year. Masks, social-distancing and hand-washing all continue at the same level, causing infection rate to plummet.
The worst case: Stronger variants of the virus emerge, blunting the effectiveness of vaccines. The U.K. variant spreads faster than vaccines can arrive, filling hospital beds with COVID patients. The declining case numbers from February lead people to get lax about masks and social distancing, allowing the disease to get a second wind going into summer.
Which scenario is most likely? Scientists are generally optimistic, given the decline in case numbers, success of vaccines, and prospect of more vaccines to come in the immediate future. But they say much depends on the public’s willingness to maintain safe practices and take vaccines once they become available.
“We’re in a little bit of a waiting game,” said Amira Roess, professor of global health and epidemiology at George Mason University. “In the best-case scenario we will see high compliance to mask wearing, practicing social distancing, and vaccination among the majority of the U.S. population. That would lead to an exponential decrease in cases and deaths by the end of the spring.”
“However, in reality more than half of the U.S. population is not complying with mask wearing or social distancing guidelines. In addition a similar percentage are hesitant to get the vaccine. What is working for us is that we are heading into the spring, and the vaccination campaign started mid-December in some parts of the country. These two together are contributing to the exponential decrease in cases.”
The news in recent weeks has been almost all good: Daily new case counts in Florida have dropped by half since early January. Hospitalizations are down 30%. The test positivity rate has been below 10% for nearly two weeks.
For the next two or three months, here are the major things to watch:
Vaccines: Good news so far
The pace of vaccinations will accelerate in the coming weeks, with at least one more vaccine likely to join the two currently authorized in the United States.
But experts say resistance to vaccines could grow in significance, creating safe havens for the virus.
“There is a substantial percentage of our population, about 40% to 60% depending on the poll, that is declining to get vaccinated or is reporting vaccine hesitancy,” said Roess, the George Mason University epidemiologist. “This will mean that it is possible to see a large percentage of our population would not have been vaccinated and will continue to be susceptible.”
More than 2 million people, accounting for more than 9% of Florida’s population, have received at least the first dose of the vaccines, both of which require two doses for full effect, according to the Florida Department of Health. How fast that percentage increases will largely determine the course of the disease in the state.
“It’s going to be especially important to vaccinate front-line workers in the minority communities who disproportionately bear the brunt,” said Dr. Roger Duncan, vice chief of anesthesia at Palms West Hospital in Loxahatchee and president of the Palm Beach Medical Association. “I am paying close attention to the number of vaccines in arms. That’s the biggest thing for me. We have two vaccines, but more are on the way. How quickly they can make them available is going to be a big indicator of the direction this is going to go.”
Dr. Anthony Fauci, President Biden’s top COVID adviser, said this week that vaccinations should be open to the general public by March or April. By then, he said on NBC’s Today Show, enough doses will be available for a “mass vaccination approach.”
“Virtually everybody and anybody in any category could start to get vaccinated,” he said.
Although vaccinating as many people as want it will still take months, he estimated it could be done by mid- to late summer.
A third vaccine from Johnson & Johnson may be authorized later this month, with others in the pipeline. Although less effective at preventing infections, the Johnson & Johnson vaccine is highly effective in preventing serious illness. It also requires only a single dose and is easier to transport and store than the vaccines from Moderna and Pfizer.
“If the Johnson & Johnson vaccine gets to our state quickly and people take it, I think that’s a game changer,” said Zucai Suo, professor of biomedical science at Florida State University. “If you have some antibodies and got infected, the disease will not progress. The death rate will be lower.”
The threat of mutated viruses
A “dark cloud,” as one scientist put it, hangs over all the good news about vaccines and declining case numbers: mutated forms of the virus known as variants.
“The best-case scenario is one where the variants we know about are the ones we continue to see and that there won’t be any others,” said Gigi Gronvall, senior scholar at the Johns Hopkins Center for Health Security. “While there might be some reduced efficacy of the vaccines, they’re starting at a pretty high level of efficacy and they will continue to be effective.”
The principle variant of concern now is B.117, known as the U.K. variant, which has turned out to spread more easily than the earlier forms of the COVID-19 virus. Although it’s expected to become the dominant form of the virus in Florida within weeks, vaccines so far have turned out to be effective against it.
Any variants that turn out to resist the vaccines in use or in the pipeline would be “concerning,” she said. But so far, she said, that hasn’t been the case.
“I think right now the data are remarkably good that the vaccines are going to have a lot of efficacy,” she said.
Dr. Conor Delaney, chief executive of Cleveland Clinic Florida, said a crucial question is whether vaccine doses can arrive fast enough to halt the spread of the U.K. variant. While there’s no indication that the U.K. variant causes more severe illness, rising case numbers could again stretch hospital resources.
“If 200 people are sick instead of 100, that means maybe four people instead of two may need hospitalization,” he said. “The more who have it, the more who will be getting sick. From a hospital perspective that’s twice as many filling hospital and ICU beds, and the potential for not enough caregivers. Hospitals could get slammed again, but hopefully they won’t. That’s why we have to mask and stay careful.”
Without masks, the disease can still win
While no one can control the virus’s mutations, the public can control how many opportunities the virus has to spread and replicate.
Experts worry that the favorable news of the past month, the dropping number of cases and growing availability of vaccines, will tempt people to go out and mingle with strangers, leaving their masks at home. The good news, paradoxically, could provide just the assist the disease needs at a time when it’s under attack from vaccines.
“A lot will depend on whether everyone follows the implementation of small measures such as masking and social distancing,” said Dr. Duncan of the Palm Beach Medical Association.
“The most effective public health measure is cutting transmission to buy us time. We are not used to having restrictions on our activity but if you were at the bedside of someone taking their last breath or someone being intubated, you would understand the benefit of a little discomfort.”
Although many universities canceled their spring holidays this year, online courses allow students to attend class as easily from a hotel in Fort Lauderdale as a dorm in Gainesville.
“Students who are taking all the classes remotely will decide to have their own spring break and come to Fort Lauderdale, Miami Beach to party and bring who knows what,” said Dr. Mary Jo Trepka, chairwoman of the Epidemiology Department of Florida International University.
City and county officials are discussing curfews and increased police patrols to try to prevent gatherings that would become superspreader events.
But even with the threat of spring break, the uncertainties over variants and all the other unknowns, scientists are becoming more optimistic that the disease’s grip on the state will diminish dramatically in the next few months.
Thomas Hladish, research scientist at the University of Florida’s Emerging Pathogens Institute, said the pattern of peaks have become less steep over time, indicating the population is developing resistance.
“We can observe immunity accumulating in the population; each wave has become broader,” he said. “The growth phase is less aggressive. I’m confident, with masking and social distancing, a certain level of herd immunity is driving down transmission. Vaccines will help that along. At some point it will help it along a lot.”