As virus cases wane, U.S. optimism rises

Rate of new infections at 11-month low

New coronavirus cases across the United States have tumbled to rates not seen in more than 11 months, sparking optimism that vaccination campaigns are stemming both severe cases and the spread of the virus.

As the seven- day average for new cases dropped last week below 30,000 per day, Rochelle Walensky, the director of the Centers for Disease Control and Prevention, noted that case numbers have not been this low since June 18. The average number of deaths over the past seven days dropped to 552 — a rate not seen since July.

“As each week passes and as we continue to see progress, these data give me hope,”

Walensky said Friday at a news conference.

Health experts credit an efficient rollout of vaccines for the turnaround. More than 60% of people over 18 have received at least one shot, and almost half are fully vaccinated, according to the CDC.

But demand for vaccinations has dropped across much of the country. President Joe Biden’s administration is trying to persuade other Americans to sign up for shots, using a message that vaccines offer a return to normal life. Ohio, New York, Oregon and other states are enticing people to get vaccinated through lottery prizes of up to $5 million.

Across the country, venues and events have reopened after shuttering for much of the past year.

On Saturday, Karen Stetz prepared to welcome what she hoped would be a good crowd to the Grosse Pointe Art Fair on Michigan’s Lake St. Clair.

With natural ventilation from the lake and with mask and capacity restrictions easing, Stetz was optimistic that artists who make their living traveling a show circuit that ground to a halt last year would begin to bounce back. The event usually draws 5,000 to 10,000 people.

“I feel like most people are ready to get out,” Stetz said before opening the fair. “It seems like people are eager, but it’s hard to know still.”

In Mobile, Ala., thousands of joyful revelers competed for plastic beads and trinkets tossed from floats Friday night as the port city threw a Mardi Gras-style parade. But only about a quarter of the county’s population is fully vaccinated. Many people went without masks, though health officials had urged personal responsibility.

James L. Hurst said he was jubilant to be out partying after a difficult year.

“We didn’t get a chance to celebrate our Mardi Gras last year because it was canceled because of the covid-19,” Hurst said. “It feels great to be out. We have our vaccines, and we are ready to go.”

He called it the start of a new era, adding: “My momma had the covid, and it was like three months before I got to see her before she got over it. She made all of us get our vaccines.”

Alabama’s vaccination rate — 34% of people have received at least one dose — is one of the lowest in the country. It’s part of a swath of Southern states where vaccine uptake has been slow. Health experts worry that areas with low vaccination rates could give rise to virus variants that are more resistant to vaccinations.

“My biggest concern is new strains of the virus and the need to remain vigilant in the months ahead,” said Boston College public health expert Dr. Philip J. Landrigan.

A medical center in Louisiana reported Friday that it has identified the state’s first two cases of a covid-19 variant that has spread widely since being identified in India. The covid-19 variant has been classified as a “variant of concern” by Britain and the World Health Organization, meaning there is some evidence that it spreads more easily between people, causes more severe disease, or might be less responsive to treatments and vaccines. The variant has been reported in several other states, including Tennessee, Nebraska and Nevada.

Though Landrigan said the big drop in cases nationwide was “the best news we’ve had on the pandemic” and showed that vaccines are working, he warned that people should remain vigilant for local flareups of new cases.

Many states have largely dropped orders to wear masks and stay distanced from other people.

Texas Rangers baseball fans filled Globe Life Field after it was opened for 100% capacity, droves of college students crowded Florida beaches for spring break, and Walt Disney World has reopened its gates.

But in Vermont — the state with the highest percentage of people who have received at least one shot — Gov. Phil Scott has tied the lifting of restrictions to the vaccination rate. He offered to lift all remaining restrictions before a July 4 deadline if 80% of those eligible get vaccinated.

“The benefit of 50 different states is you sort of get a natural experiment of what happens when states take a different approach,” said Dr. Jennifer Vines, the health officer for Multnomah County in Oregon.

POSITIVE TRENDS

Landrigan figured it will take a nationwide vaccination rate of at least 85% to snuff out the virus. More than 60% of adults have had at least one shot of a vaccine, putting the country on a path of reaching Biden’s 70% target by July 4.

Administration officials are increasingly confident that the pandemic will be brought under control in the coming months, although infections will not plunge to zero, and there remains the threat of mutated variants as the virus continues to circulate globally.

One prominent model, from the Institute for Health Metrics and Evaluation at the University of Washington, forecasts fewer than 7,000 daily cases by mid-August and fewer than 120 deaths, which is about one-fifth the current number — levels not seen since March 2020, soon after the virus first seeded itself in the United States.

The same modelers believe the virus will have some form of resurgence in the colder months that follow, and people who had stopped wearing masks would need to resume wearing them to limit viral spread.

“I’m sure that we can control it,” said Anthony Fauci, Biden’s chief medical adviser on the pandemic. “Somewhere between control and elimination is where we’re going to wind up. Namely a very, very low level that isn’t a public health hazard that doesn’t disrupt society.”

In a separate, livestreamed interview with The Washington Post, Fauci said it is too soon to know if and when people who have been vaccinated might need a booster shot.

The encouraging statistical trends come even as experts debate the kind of metrics they should be monitoring.

On May 1, the CDC halted its effort to monitor post-vaccination “breakthrough infections” that do not result in hospitalization or death. The agency’s website explained that the shift “will help maximize the quality of the data collected on cases of greatest clinical and public health importance.”

The new policy has drawn criticism from some public health experts, who worry the CDC may miss important signals embedded within the infections among asymptomatic or mildly symptomatic people who have been fully vaccinated.

Breakthrough infections are defined by the CDC as those that occur 14 or more days after a person has completed vaccination, which means either both doses of the Pfizer- BioNTech and Moderna vaccines, or a single dose of the Johnson & Johnson vaccine.

Many states including Virginia and Maryland, as well as the District of Columbia, are continuing to gather this information. Vaccine producers also are collecting it as their clinical trials continue.

Breakthrough cases are rare. As of April 26, the CDC had documented 9,245 among 95 million vaccinated Americans, although the agency acknowledged that the actual number is probably higher and simply hasn’t been documented through testing.

Kavita Patel, a primary care physician and nonresident fellow at the Brookings Institution, said she saw a breakthrough case last week, a woman with persistent itchy eyes, a sore throat and a bit of a cough who, she initially believed, was suffering from seasonal allergies. But a test confirmed the patient had covid-19 despite inoculation with the Johnson & Johnson vaccine.

Patel said she recommended that the woman isolate and rest, but she will not recommend hospitalization unless the woman’s symptoms worsen.

Patel cites many reasons to monitor all breakthrough cases. At the most basic public health level, monitoring of all data for a disease can be critical. Covid-19 should be treated the same way, she said, to provide real-world evidence of how effective vaccines are. Continuing to show the public the rarity of breakthrough cases will buttress faith in the vaccines, she said.

When school begins, Patel added, unvaccinated children will be routinely mingling with vaccinated adults. Monitoring the effect of breakthrough cases among school staffs also will be important, she said.

When asked at a media briefing Tuesday about the reasons for the data-monitoring change, Walensky said the “vaccines were studied to prevent severe illness, hospitalization and death, and as we look at these breakthrough infections, those are the ones we are most concerned about.”

Walensky also cited a technical issue: People with asymptomatic breakthrough infections often do not have enough virus in their bodies to permit genetic sequencing.

Eric Topol, a professor of molecular medicine at Scripps Research in San Diego, agreed with Walensky that asymptomatic breakthrough cases are not as important to follow. Nonetheless, he argued, the CDC should monitor those people, along with hospitalizations and fatal cases, to determine whether and how virus variants might evade vaccine protection; help discover new variants; and track how well certain vulnerable groups, such as the immunocompromised, are shielded by vaccines.

If there is a spreading event caused by an unvaccinated person spending a prolonged period of time indoors with vaccinated people, then it will be important to investigate that as well, Topol said, even if no one is hospitalized or killed. Antibody levels may also wane over time, he noted.

But it may be time to pay less attention to infections and to focus instead on people who become sick enough to be hospitalized or who succumb to covid-19, Fauci said.

“The breakthrough infection number is not particularly relevant as long as they don’t spread the infection to anybody else,” he said. “If you are vaccinated and you do get a breakthrough infection, it is very likely that you will be without symptoms, and it is unlikely that you will transfer it to anybody else.”

He added, “The only number that you will absolutely be able to follow is the number of hospitalizations. … That might actually turn out to be the most reliable, followable parameter.”

Information for this article was contributed by Stephen Groves, Carolyn Thompson, Gerald Herbert and Zeke Miller of The Associated Press; and by Lenny Bernstein and Joel Achenbach of The Washington Post.