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Experts Speak Out
On The Current Status of the Pandemic In The US
Everyone Wants To
Know--Where Do We Go From Here? How Does This End?
The steady decline of cases, hospitalizations, and
deaths attributable to COVID-19 has created a proliferation of
interviews and articles seeking to explain and to predict the
trajectory of the pandemic from this point forward.
Undercount
In the US, some have asserted the decline in the
pandemic is due to vaccination or having achieved certain level of
herd immunity because of the estimated number of persons in the US who
have already been infected. For example, a study out of Columbia
University led by Jeffrey Shaman estimates that the number of
active cases of COVID-19 is ten times higher than the number of
confirmed cases on any given day. According to this computer model, an
estimated one third of the US population has already been infected.
Current Status
One of the most informative sources continues to be the
Institute for Health Metrics and Evaluation which has recently issued
policy briefings about its predictions for each region of the world
and some individual countries.
In the latest briefing for the US dated late February,
IHME asserts that the main driver for the decline in the US is
seasonality aided by expanding levels of vaccination. Reported mask
use remains high at 77%. In contrast to the Columbia model, the IHME
estimates that only 18% of people in the US have been infected as of
mid-February.
Michigan Example
In Michigan where the declines have been very marked,
one report identified cold weather and decreased mobility as factors
explaining the drop. Other reasons included people double-masking or
wearing more effective masks. In Michigan, vaccination levels were not
considered high enough yet to explain the declining rates. An
estimated 15% of Michigan residents have had coronavirus.
Projections
In seeking to predict the trajectory of the pandemic
over the short term between now and next summer, IHME notes that the
B.1.1.7 coronavirus variant is expected to increase from 20% of
infections today to 80% by late April. Most important in projecting
cases over the near term is actually the behavior of Americans.
According to IHME, “If most individuals remain careful, maintaining
mask-wearing through April or longer we expect…a cumulative death toll
of 589,000. More rapid increases in mobility or reductions in mask use
can easily lead to increasing cases and deaths in many states in
April…
...Managing the epidemic in the next four months
depends critically on scaling up vaccination, trying to increase the
fraction of adults willing to be vaccinated above three quarters, and
strongly encouraging continued mask use and avoiding situations where
transmission is likely, such as indoor dining, going to bars, or
indoor gatherings with individuals outside the household. Despite the
favorable trends in the epidemic we do not expect to reach herd
immunity prior to next winter.”
Normalcy
The steep declines in cases, hospitalizations, and
deaths are also fueling discussion about how the pandemic will end and
when we can return to normal life. A recent feature article in the
Atlantic queried a variety of experts to get their opinions about what
life will be like over the next four seasons. Bottom line—the article
summarizes its prediction by stating “an uncertain spring, an amazing
summer, a cautious fall and winter, and then finally, relief.”
This assessment has a lot to do with the uncertainty
about the impact the virus variants will have this spring and the
expectation that vaccinations and warmer weather will allow many
aspects of life to return to normal this summer, but not the return of
indoor concerts, dining in at crowded restaurants, full attendance at
large sporting events, and international travel. Taking the longer
view requires making assumptions about the impact of the variants and
the ability to adjust
vaccines
to keep them effective. In the longer term, the article guesses that
the coronavirus will be less lethal and more like the flu during the
colder months but without wide uncontrolled spread.
White
House Take On Future
Leaders
of the White House pandemic effort recently took part in a
conversation sponsored by the American Public Health Association and
the National Academy of Medicine entitled “A
New Year of COVID: The State of the Pandemic and U.S. Strategy in
2021”. Speakers included CDC’s new Director Rochelle Walensky,
Marcella Nunez-Smith, Chair, COVID-19 Equity Task Force, and
Andy Slavitt, White House Senior Advisor on COVID-19 Response.
Georges Benjamin, APHA president and moderator asked
how is the administration thinking about how this ends? He noted
there's several possible futures from endemic disease to seasonal
disease to this being a false reduction and getting another fourth
surge.
No
Crystalballing
Nunes-Smith
resisted the idea of using a crystal ball to project how and when we
get to our new normal. She answered as follows “What we know now is
that we have the benefits of great scientific discovery and
breakthrough in the authorized vaccines and quite frankly in the
therapeutics that are underutilized...
...We
have tools in the toolbox. We know basic health things that work.
Masking, still socially distancing, all of that. So I think it is
early to say exactly where we will end up and will we end up with an
endemic sort of COVID-19. What we do know is that our immediate issue
is to try to reduce pressure on the virus to mutate in ways that are
clinically significant. And the best way we can do this is to be
efficient and equitable in our vaccination work.”
As
leader of the White House response, Slavitt suggested”…we have to have
much better real-time ability to see what's happening, where it's
happening and to react to it. Second is, we have to do scenario
planning …We can all wish for this to be the last wave. But we
wouldn't be doing our jobs if we weren't actively focused on
containment measures for the variants, if we weren't actively focused
on how might therapeutics help to minimize the effect of the
variants. How might we make sure that if we do have another wave it
feels different?
...So
all of this to say the question you're asking is a good one. And as
Dr. Nunez-Smith said, we won't predict the future internally, we do
feel like we have to prepare for each of those scenarios and also not
try to answer the unknowable questions.”
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