'The last major wave of infection': Do falling COVID cases signal the end of the U.S. pandemic?

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New COVID-19 cases are now falling across most of the country, and experts predict that the U.S. pandemic may finally be starting to peter out.

While the virus may never fully disappear, it is expected to become endemic — just another less dangerous and disruptive threat that humans coexist with.

“Barring something unexpected,” former Food and Drug Administration Commissioner Scott Gottlieb told the New York Times earlier this week, “I’m of the opinion that this is the last major wave of infection.”

The experts, of course, have been wrong about COVID before; even now, few are willing to rule out another sizable winter surge. The Times's David Leonhardt noted that the virus seems to follow a cycle: surge for two months, decline for two months. The U.S. just crossed 700,000 deaths, a testament to COVID’s continued lethality.

But the latest trends are especially encouraging, and the dynamics of immunity and infection suggest they could foreshadow the end of America’s COVID emergency.

Luis Mostacero receives a Covid-19 test from testing technician Jamie Kunzer at Doctors Test Centers at Chicago's O'Hare International Airport on Thursday, May 20, 2021. (Chris Sweda/Chicago Tribune/Tribune News Service via Getty Images)
Luis Mostacero receives a COVID-19 test from technician Jamie Kunzer at Chicago's O'Hare airport in May. (Chris Sweda/Chicago Tribune/Tribune News Service via Getty Images)

Consider the data. Exactly three weeks ago, America’s summer wave — fueled by stalling vaccination rates and the hypercontagious Delta variant — peaked at an average of nearly 176,000 cases per day. That average daily case count has since plummeted 41 percent, to roughly 104,000. The number of COVID patients in hospitals, a lagging indicator, has been shrinking for the last month; it’s down 25 percent since Sept. 4. And COVID deaths, which lag even further, are now decreasing as well.

Overall, fewer and fewer COVID tests nationwide have been coming back positive: less than 6.5 percent currently, compared with more than 10 percent in late August.

For weeks, the cautious response to these improvements has been to remind people of what happened last year. That summer, the virus surged and subsided as well — before it came roaring back in October. Three excruciating months later, it peaked at a horrific 250,000 cases and 3,300 deaths a day.

Why assume we’ll be spared another surge, the skeptics say — especially now that Americans are taking fewer precautions than ever while cooling weather is again driving them indoors and another holiday season is right around the corner?

The skeptics have a point. But so do optimists like Gottlieb, who think this winter will be a lot better than last winter, and that this summer’s Delta surge could be the virus’s last big gasp.

There are two main differences between 2020 and 2021 that give the optimists hope. The first is vaccination. On Oct. 5, 2020, no Americans had been vaccinated. Today, exactly one year later, a full 64 percent have received a vaccine dose. Among adults, that number is 77 percent.

A man wearing a face mask passes a mural of heart-shaped patterns in the Brooklyn borough of New York, the United States, Oct. 2, 2021. (Michael Nagle/Xinhua via Getty Images)
A man passes a mural in Brooklyn, N.Y. (Michael Nagle/Xinhua via Getty Images)

To be sure, vaccinated people can still test positive for Delta and transmit it to others — but not as frequently or as easily as unvaccinated people. Meanwhile, the largest remaining bloc of unvaccinated Americans, 28 million kids ages 5 to 11, should be eligible for shots before Thanksgiving. And while data from Israel and elsewhere has shown that vaccine effectiveness against mild and moderate infection wanes over time and in the face of Delta — especially for early Pfizer recipients — the most vulnerable Americans are already getting boosters, and the rest of the country may not be far behind.

Vaccination, in other words, is giving the U.S. a massive head start over the virus this time around. That wasn’t the case last year.

The second difference between then and now is Delta itself. The main reason the variant has sickened so many Americans and evaded at least some vaccine protection is that it’s roughly twice as transmissible as the strain that was spreading in the U.S. a year ago. That’s the bad news. The “good” news (if you can call it that) is that a variant as infectious as Delta effectively crowds out other worrisome variants while rapidly generating a lot of infection-induced immunity in its wake.

Vaccination is a far safer and more effective way to acquire immunity than infection, of course. But if more unvaccinated people get the virus now, fewer of them will be vulnerable over the winter.

The practical implications could be huge. One concern about Delta was how it would interact with so-called seasonality. In the summer of last year, the virus slammed Southern and Southwestern states harder than their Northern and Midwestern counterparts, perhaps because hotter temperatures drove more people inside. Then the entire country, including the North and Midwest, was clobbered during the holidays.

Shana Alesi administers a COVID-19 booster vaccine to Marine Corps veteran Bill Fatz at the Edward Hines Jr. VA Hospital on September 24, 2021 in Hines, Illinois. (Scott Olson/Getty Images)
Shana Alesi administers a booster shot to Bill Fatz in Hines, Ill., on Sept. 24. (Scott Olson/Getty Images)

After Delta ravaged the South this summer, some feared that history was about to repeat itself — especially with masking and distancing on the decline and kids crowding back into classrooms.

But this year’s pattern doesn’t match last year’s. Because Delta spreads so much more quickly and efficiently than its predecessors, the variant hasn’t been waiting for winter to head north. Instead, it looks like it’s already burning through all the unprotected hosts it can, wherever they might be.

Vermont is a good example. This time last year, the Green Mountain State was recording just 10 COVID cases per day, on average; the virus didn’t start surging there until November. Yet from this July to this September — months when its curve flatlined in 2020 — Vermont actually endured its largest surge yet, which just peaked at 219 cases per day (even though it’s America’s most vaccinated state). The same thing is happening next door in Maine.

Many other states that survived the summer of 2020 relatively unscathed have seen swelling case counts in recent weeks. Alaska, for instance, is America’s worst COVID hot spot by far; its current wave is twice as bad as its previous bout with the virus. That earlier surge started last October and peaked last December. This one started in July and appears to have peaked in late September.

Ohio is similarly now coming off a surge that was nearly as big as last winter’s. West Virginia, Washington state and Oregon have struggled with their biggest surges yet. New York, New Jersey, Pennsylvania, Delaware, Maryland — all of them have seen summer virus surges this year.

None of these states had to deal with waves last summer.

Safeway pharmacist Ashley McGee fills a syringe with the Pfizer COVID-19 booster vaccination at a vaccination booster shot clinic on October 01, 2021 in San Rafael, California. (Justin Sullivan/Getty Images)
Pharmacist Ashley McGee fills a syringe with the Pfizer COVID-19 booster vaccination at a clinic in San Rafael, Calif. (Justin Sullivan/Getty Images)

One could interpret this information pessimistically and predict that an even bigger, badder winter wave is looming. But kids have already been back in school for a month; the data seems to confirm that they aren’t driving new surges. At a certain point, enough Americans will have acquired at least some immunity through either vaccination or infection to slow Delta down — and to make any subsequent infections significantly less dangerous. The pandemic will end; the virus will become endemic.

The question is when. Already, case counts are not falling just across the undervaccinated South, which drove the summer surge. And they’re not falling just in Alaska or West Virginia, the latest undervaccinated hot spots. They’re also falling or plateauing in the other, more vaccinated states that recently experienced their own smaller, seemingly premature surges.

Could it be that because Delta spreads so easily, it may have already infected — or is now in the process of infecting — most of the unvaccinated Americans it’s going to infect, regardless of region or season?

Could it be that the bulk of whatever wave might have hit the U.S. this coming winter has basically hit already — and that by the time winter comes, Delta will have fewer and fewer unprotected Americans left to infect?

That’s the hopeful argument Gottlieb and others are making. Soon enough, Americans will know if they’re right. At the moment, Delta appears to have spread as far north as it can go; the reddest counties on the map of U.S. hot spots trace a wintry arc along the Canadian border from Maine to Montana before descending into the rural, undervaccinated Mountain West.

If cases keep rising in chilly areas, it could portend more widespread transmission once colder weather hits everywhere. But if the northernmost U.S. starts to improve as well, this holiday season is likely to be safer than last year’s. It could even signal the beginning of the end.


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