Majority of Americans live in COVID hot spots

Infections rapidly spread beyond areas with low vaccination rates

Two-thirds of Americans in highly vaccinated counties now live in coronavirus hot spots, according to an analysis by the Washington Post, as outbreaks of the highly transmissible delta variant — once concentrated in poorly vaccinated pockets — ignite in more populated and immunized areas.

The Post analysis illustrates how rapidly the state of the pandemic changed in July from a problem for the unvaccinated to a nationwide concern.

The Post classified the highest top quarter of counties as high vaccination, with at least 54 percent of the population fully vaccinated. The lowest quarter of counties were classified as low vaccination, with fewer than 40 percent of the population fully vaccinated. The Centers for Disease Control and Prevention identifies hot spots as areas with high and rising caseloads, as compared with areas with moderate or low COVID-19 outbreaks.

On the Fourth of July, just 4 percent of residents of highly vaccinated communities lived in hot spots, compared with 13 percent of people in low-vaccination areas. The outbreaks initially grew in the poorly vaccinated areas, where 28 percent of residents lived in hot spots as of July 14, compared with 13 percent of residents in highly vaccinated communities.

The gap narrowed in recent weeks as cases surged in major West Coast cities, South Florida urban centers and the New York-toBoston corridor. By August, it closed. About two-thirds of residents living in both highly and poorly vaccinated counties are now in hot spots with high and rising caseloads.

Their experiences are not the same. It’s like the difference between being in a trailer and a house in a hurricane: Both might get hit, but one harder than the other.

Living in a hot spot while vaccinated today is much safer than living in a hot spot while unvaccinated last summer. High-vaccination states have one-third the number of new cases per capita as low-vaccination states.

Hospitalization rates in states with less than 40 percent of their population fully vaccinated are four times higher than states that are at least 54 percent vaccinated, the Post found.

Oregon is seeing such differences as hospitalizations reach all-time highs and Portland, in a county where two-thirds are fully vaccinated, is a hot spot alongside sparsely vaccinated rural counties.

“We are dealing with a new foe that’s so much more contagious, so it doesn’t require that high of a percentage of unvaccinated people to spread but it is spreading faster in those parts of the state seeing lower vaccination rates,” said Dean Sidelinger, Oregon’s state epidemiologist. “Those counties with higher vaccination rates have a fairly slow rise in hospitalizations, but the counties with the lower vaccination rates have a much steeper rise in hospitalizations.”

Public health leaders in highly vaccinated hot spots attributed the outbreaks to several reasons.

Even urban areas that can boast high vaccination rates have hundreds of thousands or millions of susceptible unvaccinated residents who are at greater risk of contracting the virus than during earlier spikes because businesses have reopened. Masks are often not required in public, and the delta variant spreads more easily. Well-vaccinated areas are not bubbles: Infected visitors are spreading the virus and residents are traveling to more poorly vaccinated places and getting sick. Breakthrough infections do not appear to be as extremely rare as hoped, accounting for more than a fifth of new recent infections in Los Angeles; New Haven, Conn.; and Oregon, officials said.

“Don’t think just because your county and your city is well vaccinated that this can’t affect you,” said Jennifer Avegno, director of the New Orleans Department of Health. “Do the things you need to do, particularly with schools returning and large festivals happening. Get ready. I hope you are spared, but we didn’t think it would be this bad.”

Louisiana, where less than 38 percent of residents are fully vaccinated, is confronting the nation’s worst surge with 120 new daily cases per 100,000 residents. In Orleans Parish, home to New Orleans, 53 percent of residents have been fully vaccinated, but it has still been pummeled during the surge, with 89 new daily infections per 100,000 residents.

“The problem is when you have such a large reservoir of unvaccinated individuals surrounding an island of a highly vaccinated place you are just going to have a lot of transmission,” Avegno said.

That doesn’t mean the city’s vaccination efforts are for naught.

Residents of Orleans Parish have a far lower hospitalization rate at 16 per 100,000 versus statewide at 46 per 100,000, according to COVID Act Now data cited by health officials. But the city’s hospitals are still under strain as COVID-19 patients from sparsely vaccinated rural areas that lack quality hospitals arrive for care.

While the city doesn’t have reliable data on the prevalence of breakthrough infections, Avegno suspects they may be common.

She cited the recent CDC study of an outbreak in Provincetown, Mass., where three-quarters of the infected were fully vaccinated, bolstering suspicions vaccinated people are more easily spreading the delta variant even in vaccinated communities.