Why experts like Dr. Fauci think ‘there’s a really good chance’ the worst of the U.S. pandemic is behind us

Feb 25

Why experts like Dr. Fauci think ‘there’s a really good chance’ the worst of the U.S. pandemic is behind us

According to a new Yahoo News/YouGov poll, two-thirds of Americans are either somewhat or very worried about the “newer, potentially more contagious” COVID-19 variants that have triggered huge overseas outbreaks and are now spreading in the United States.

Those concerns are valid. But maybe it’s time for Americans to start worrying a little less.

To be clear, worrying less about variants doesn’t mean abandoning precautions; nothing will suppress cases and shorten the U.S. pandemic like wearing a mask, avoiding indoor gatherings, staying 6 feet apart and getting vaccinated.

Yet in recent days health experts like Dr. Anthony Fauci have begun sounding less pessimistic about the dangers of a fourth, variant-driven wave — and more optimistic about a return to something resembling normal life as soon as this summer.

Asked if the worst of the pandemic was behind the U.S., Fauci told Yahoo News Tuesday that “it might be.”

“I’m not absolutely, 100 percent certain,” he continued, but “there’s a really good chance that we will do fine, at least in the immediate future.”

By now, most Americans are probably familiar with B.1.1.7 (the so-called U.K. variant), B.1.351 (the so-called South African variant) and P.1 (the so-called Brazilian variant). Each of them has spike-protein mutations that confer certain advantages, making them more transmissible (like B.1.1.7) or more likely to evade our immune defenses (like B.1.351 or P.1). Some cases have already been detected in the U.S., and many more have likely gone undetected. As Dr. Eric Topol recently put it, B.1.1.7 in particular could be “our last major obstacle to achieving containment of the virus in the U.S.,” because it is “doubling” roughly every 10 days and is expected to become the “dominant” strain here by the middle of March. And new homegrown variants — including one in California that seems more contagious, and one in New York that could dodge the immune system — seem to make headlines every day, even though scientists have yet to prove they pose significant new risks.

That’s where fears of a fourth wave come from.

Dr Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, speaks during a White House press briefing in January. (Alex Wong/Getty Images)

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, at a White House press briefing in January. (Alex Wong/Getty Images)

At the same time, however, the precautions taken by both individuals and public officials in response to America’s deadly holiday surge have helped turn the tide of transmission. Warming weather means less indoor crowding. More than 13 percent of the U.S. population — a large number of them living or working in medical settings where outbreaks tend to begin — have received at least one dose of an extremely effective vaccine that not only confers near-complete protection from disease and death within weeks but likely reduces transmission of the virus by more than 85 percent. The pace of vaccination is about to pick up, with 140 million doses set for delivery in the next five weeks and an additional 200 million expected by the end of May (followed by another 300 million by July).

Meanwhile, the upside of America’s horrifically high case count, which nearly tripled from 9 million to 26 million between November and February, is that tens of millions of Americans have already acquired some degree of immunity through infection. In Los Angeles County alone, an estimated 35 percent of the population has already had COVID-19; in Miami-Dade County, that number could be more than 50 percent.

As a result, U.S. COVID-19 cases and hospitalizations have been plummeting by 15 to 20 percent a week for the past month and a half, completely reversing their winter spike. Though still too high, today’s average daily case count (68,000) is the lowest since Oct. 24. Deaths, a lagging indicator, are down more than 20 percent during the past two weeks. We’re heading in the right direction.

B.1.1.7 could still capitalize this spring if we let down our guard and go too far in relaxing restrictions. But the current trajectory of the pandemic — and the current prevalence of the virus — does play a role in determining the size and severity of any future wave.

For a variant to qualify as dominant, it simply needs to account for a majority of cases. That sounds scary in a headline, especially when we’re discussing a variant such as B.1.1.7, which is 50 percent more transmissible than earlier versions of the virus (and potentially more deadly). But here’s the thing: 51 percent of a big number is a lot scarier than 51 percent of a smaller number, and the number of cases in the U.S. is getting smaller every day. When figuring out how much we should worry, that’s relevant too.

Consider this example from Youyang Gu, an independent data scientist trained at the Massachusetts Institute of Technology who has proved to be one of the pandemic’s most accurate forecasters. First, on Twitter, Gu made an important distinction. “The claim that the ‘variant is doubling every 10 days’ is false,” he wrote. “It’s the *proportion of the variant* that is doubling every 10 days.” Then he illustrated how if “overall prevalence drops during the studied time period, the true doubling time of the variant is actually much longer [than] 10 days.”

Imagine, Gu went on, that on day zero you have 100 cases, and the variant is responsible for 10 of them. It’s this percentage — as opposed to the raw number of B.1.1.7 cases — that’s doubling every 10 days. Despite all the frightening news alerts, such doubling doesn’t necessarily doom us to a big new wave of infections. Instead, it could look something like this:

Day 0: 100 total cases / 10 variant cases ➡ 10 percent variant

Day 10: 75 total cases / 15 variant cases ➡ 20 percent variant

Day 20: 50 total cases / 20 variant cases ➡ 40 percent variant

In Gu’s hypothetical scenario, the proportion of the variant is doubling every 10 days, and it’s well on its way to becoming dominant. But cases still fall by 50 percent overall.

Of course, the actual U.S. pandemic won’t follow this precise arc. But it’s certainly possible for cases to drop even as an opportunistic variant such as B.1.1.7 inexorably accounts for a larger and larger share of them. For proof, see Tuesday’s plunging curves in the U.K., Denmark, Switzerland, Portugal and Israel — all countries where B.1.1.7 predominates.

The U.S. isn’t as good at maintaining mitigation measures as its overseas counterparts. But it’s better than most at vaccination, and it’s a lot further along at acquiring protection through prior infection. Since B.1.1.7 doesn’t seem to evade either type of immunity, the share of susceptible individuals here is smaller than it is elsewhere, and it’s shrinking every day.

People wait in line to receive Pfizer's coronavirus disease (COVID-19) vaccine at a pop-up community vaccination center at the Gateway World Christian Center in Valley Stream, New York on February 23, 2021. (Brendan McDermid/Reuters)

People wait to receive Pfizer’s COVID-19 vaccine at a community vaccination center in Valley Stream, N.Y., on Tuesday. (Brendan McDermid/Reuters)

Whether these complementary forces keep a fourth wave at bay remains to be seen. Our existing vaccines offer strong protection against variants, but some — like the South African variant and possibly the new New York variant — are better at slipping past our immune system. If they take off in the U.S., updated, tailor-made vaccines — which are already in development and fast-tracked for approval — would be deployed in response.

Either way, Americans should not assume that another spike is inevitable. In fact, the leading forecasting models currently predict a modest “plateau” in infections during March or April followed by continued decline. And even if cases do level off or temporarily rise, deaths and hospitalizations will keep falling as increasing numbers of older, high-risk Americans get vaccinated. As the New York Times reported Thursday, “New cases among nursing home residents” — among the first Americans to get vaccinated — “fell by more than 80 percent” from late December to early February, “nearly double the rate of improvement in the general population.” Deaths inside the facilities fell by 65 percent even as they spiked nationwide.

“We need to outrun the variants by getting people vaccinated as quickly as we possibly can, because the most prevalent variant is the U.K. variant,” Fauci told Yahoo News Tuesday. “And that’s the one that the vaccine is quite good against — I mean, really quite good. So now’s the time to really put the pedal to the floor here and just say, ‘Let’s go get people vaccinated.’”

If we do that, normality may be in sight. Last week, President Biden would only commit to a return to normal “by next Christmas,” saying, “I don’t want to overpromise anything here.”

“I think we’ll be in a very different circumstance, God willing, than we are today,” Biden predicted. “A year from now, I think that there’ll be significantly fewer people having to be socially distanced, having to wear a mask.”

Reaching so-called herd immunity — the theoretical threshold when 75 to 90 percent of the population is protected and the virus runs out of people to infect — might prove to be unattainable in the U.S.; the vaccines won’t be approved for children (roughly 20 percent of Americans) until next year, and another 24 percent of Americans tell Yahoo News and YouGov they won’t get vaccinated at all. Meanwhile, the virus will keep circulating and evolving in countries that, unlike the U.S., can’t afford to reserve enough doses to inoculate their entire population in 2021.

President Joe Biden speaks about lives lost to Covid after death toll passed 500,000, in the Cross Hall of the White House in Washington, DC, February 22, 2021. (Saul Loeb/AFP via Getty Images)

President Biden speaks about lives lost to COVID on Feb. 22. (Saul Loeb/AFP via Getty Images)

Yet Biden’s prediction of a return to normal after Christmas may be a significant underpromise. The end of the U.S. COVID-19 crisis — the state of emergency that has required us to stay home and stay masked to keep hospitals from overflowing and vulnerable people from dying — should arrive sooner. By this summer, vaccines for the virus will be available to all Americans. Around the same time, Gu estimates, the number of “susceptible” Americans — which he defines as anyone older than 45 who lacks immunity — will have fallen from about a third of the population at the start of 2021 to 10 percent or fewer.

At that point, COVID-19 would look less like a pandemic and more like a public health problem on par with familiar flu or cold strains, with little threat of severe illness and zero burden on hospitals. And at that point, we may finally be able to remove our masks and hug our friends and family.

As Gu puts it, “Normality will happen … with or without herd immunity.”

If officials want the buy-in they need to stave off a fourth wave, they might consider spending less time speculating about the possibility of perpetual masking and distancing even after vaccination and more time telling us how soon all of it could end — if we work together toward that common goal.

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