It’s official: After falling for more than two straight months, the average number of daily COVID-19 cases across the U.S. has begun — just barely — to rise again, inching up from a low of 54,059 earlier this week to 57,322 on Wednesday.
In emerging hot spots such as Michigan, meanwhile, the pattern is more pronounced. There, cases have soared by 121 percent over the last two weeks, and hospitalizations are up by 81 percent over the same period.
So is this the start of the variant-driven “fourth wave” that Americans have been fearing ever since the end of our horrific holiday surge?
The answer, reassuringly, appears to be no — at least not if America’s path out of the pandemic looks anything like Israel’s.
To date, more than a quarter of the U.S. population (25.3 percent) has received at least one dose of a safe and effective COVID-19 vaccine. In Israel, that number is more than 57 percent. Because of its rapid vaccine rollout — and because the more contagious “U.K. variant” known as B.1.1.7 that’s now spreading in the U.S. has already been dominant in Israel for months — experts have been eyeing Israel for early signs of how the pitched battle between vaccination and variants is likely to play out in America.
And so far the evidence is clear: Rising case counts and even rising hospitalizations in certain populations and pockets of the U.S. do not necessarily portend another big wave of infection.
In fact, the same bumps in the road surfaced during the initial stages of Israel’s vaccine rollout — and today, they’re no longer an issue as cases continue to fall.
Consider the data. When Israel launched its vaccination campaign on Dec. 19, the virus was already surging; a few days later, the country entered its third national lockdown. Over the next month, however, cases continued to climb another 150 percent. By Jan. 25, B.1.1.7 had superseded all other strains in the country.
“The vaccine works against the British mutation, but the virus infection rate is much faster than the vaccine rate,” Sharon Alroy-Preis, head of public health at the Health Ministry, told the Knesset. “We are at a record number of people on ventilators. It’s unprecedented.”
Before long, the nation’s strict lockdown had its desired effect, and Israel’s curve finally began to bend downward. But that’s when researchers realized something else as well: The curve was bending even more among the first seniors to be immunized. Distancing wasn’t the only factor at play. Vaccination seemed to be working.
In early February, Israeli authorities started to ease some lockdown restrictions. Cases were still near their all-time highs — and by then, B.1.1.7 accounted for nearly 100 percent of them. Yet due to Israel’s rapid rollout, a staggering 90 percent of Israelis age 60 or older had already received at least one vaccine dose at that point. Among younger Israelis, that number was much lower: about 35 percent.
The result, as reopening ramped up and Israelis gathered to celebrate holidays such as Purim, was two different downward curves: (1) a smoother, steeper decline in case counts and hospitalizations among the earliest to be vaccinated, like Israelis over 60; and (2) a more gradual and much bumpier decline among those who were next in line, including Israelis under 60.
Meanwhile, the country’s overall curve wound up with lots of temporary peaks and plateaus as well, for the simple reason that younger Israelis outnumber older Israelis. (Continuing outbreaks in more hesitant communities also contributed to these fluctuations.)
But despite moments during the winter when it seemed as if Israel’s case count was leveling off or even rebounding, vaccination access, eligibility and uptake continued to increase — and another wave never arrived. Now more than 50 percent of Israelis have been fully vaccinated, and the country is averaging fewer than 1,000 new daily cases for the first time since November — a number that has plummeted nearly 75 percent over the last two and a half weeks alone.
Crucially, that sharp drop in infections came after Israel partially reopened in February, and it has continued in the weeks since the country fully reopened on March 7. Forty days after the end of Israel’s previous lockdown, estimates the Weizmann Institute’s Eran Segal, the average number of additional people infected by each person with COVID was already at 1.15 and rising, indicating exponential spread. (Anything over 1.0 means an outbreak is growing.) Today it’s at 0.62, and it’s continuing to fall.
Some force, in other words, is beating B.1.1.7 at its own game. That force is vaccination (combined with existing immunity from prior infection and perhaps some seasonal effects).
There’s little reason to suspect America’s path out of the pandemic will diverge much from Israel’s. An estimated 30 to 35 percent of Americans have already contracted COVID, meaning they also enjoy some degree of immunity. Warming weather and the increasing ease of outdoor gathering seems to be counteracting B.1.1.7’s ferocious spread; epidemiologists say the variant probably accounts for 20 to 30 percent of U.S. samples being sequenced today, compared with 100 percent in Israel.
At the same time, America is currently administering 2.5 million vaccine doses per day, on average. Moderna, Pfizer and Johnson & Johnson have pledged to deliver a total of 240 million doses by the end of March, and more than twice that by the end of May — enough to inoculate every adult in America. Likewise, governors and public health officials in more than 40 states have said they will meet or beat President Biden’s goal of making every adult eligible for a vaccine by May 1, according to the New York Times, and at least 30 states plan to start universal eligibility in March or April. Plus a full 70 percent of U.S. seniors have now received at least one vaccine dose, drastically reducing the risk of hospitalization and death going forward.
In short, if the last phase of the U.S. pandemic is a race between the variants and the vaccines, the vaccines appear to have the upper hand — just as they did in Israel.
Which isn’t to say that Americans should throw caution to the wind. Reopening is one thing, and it’s likely to continue even as case counts fluctuate; economic necessity is a powerful incentive for politicians, businesses and workers alike. But nothing heightens the threat of another surge more than reckless, maskless indoor gatherings — at full-capacity restaurants, crowded bars or private parties — with lots of unvaccinated people. The U.S. has to strike a balance.
It’s also not to dismiss the very real dangers of the variants. Scientists believe B.1.1.7 is as much as 50 percent more transmissible than earlier versions of the virus, and a study published last week in the journal Nature suggests that it is 61 percent more likely to cause severe disease or death. Some experts even think B.1.1.7 can spread to and sicken children and young adults more readily than other variants. Infections (and in some cases hospitalizations) are beginning to tick up in places such as Michigan, Minnesota, New Jersey, New York, Rhode Island, Massachusetts, Connecticut, Tennessee, South Carolina and Florida, in part because of such variants and in part because of reopening. Mitigation shouldn’t be off the table.
But at this late stage of the U.S. pandemic, Americans would be wise to stay calm and keep any coming plateaus, bumps or local outbreaks in perspective — as reminders of the hard work that still needs to be done on vaccination rather than harbingers of the next catastrophic wave of infection.
Put another way: America has almost certainly entered its final descent out of the pandemic. Some turbulence is to be expected. But the plane is going to land.
“I haven’t felt this optimism in 12 months,” Los Angeles Mayor Eric Garcetti said Sunday on CBS’s “Face the Nation.” “Here in Los Angeles, we have a positivity rate of 1.9 percent, and we estimate that anywhere between half and two-thirds of our population has antibodies in it now, either because of exposure to COVID-19 [or] vaccination.
“So it is a very different context than when openings happened last July or when openings didn’t happen in December,” Garcetti continued. “It’s time to get things moving. It’s time to get our economy started. It’s time to start hugging our loved ones again. And certainly that comes from getting a vaccine.”
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