Total US deaths from Covid may reach 1 million by spring as vaccination rates remain lower than 60%

Activists, many of who brought ashes of relatives who died from Covid, gather outside the US Capitol to call for action to prevent future pandemics. Photograph: Bonnie Cash/UPI/REX/Shutterstock

A steep rise in Covid-19 cases in Europe should serve as a warning that the US could also see significant increases in coronavirus cases this winter, particularly in the nation’s colder regions, scientists say.

However, there is more cause for optimism as America enters its second pandemic winter, even in the face of likely rises in cases.

Evidence shows vaccine-conferred protection against hospitalization and death remains high several months after inoculation, vaccines for children older than five can reduce Covid transmission, and new antiviral medications hold the promise of making Covid-19 a treatable disease.

“I do expect to see cases increasing – we’ve started to see this in the last week or so,” said Dr David Dowdy, an associate professor of epidemiology at Johns Hopkins University. “I don’t think what we’re seeing in Europe means we’re in for a huge surge of serious illness and death as we [saw] here in the US,” last winter.

In the last three weeks, new cases have increased in several cold weather states across New England and the midwest. However, vaccines remain roughly 85% effective at preventing hospitalization and death.

“Even if cases go up this winter, we’re very unlikely to see the overcrowded [intensive care units] and morgues of a year ago,” said Dowdy.

Vaccine-conferred immunity against infection may allow cases to rise, he said, but far fewer people will need hospitalization. The vast majority of people who were hospitalized or died from Covid-19 this summer, more than 90% in one CDC study, were not fully vaccinated.

“People can still get Covid, there can still be breakthrough infections, but the great news is if you have been vaccinated you are very much less likely to be hospitalized or have severe infection,” said Rupali Limaye, an associate scientist at Johns Hopkins University and an expert in vaccine communication.

Nevertheless, vaccine distribution is highly uneven across the US. Just 58.6% of the nation is vaccinated, lower than vaccination rates in some European nations now struggling with an increase in Covid-19 cases, such as in Germany and France.

“I’ve been predicting a pretty bad winter wave again, and it looks like it’s starting to happen,” said Dr Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine and co-director of the Texas Children’s hospital’s center for vaccine development.

“There’s just too many unvaccinated and too many partially vaccinated [people]” to stop the “aggressive” Delta variant, Hotez said.

What’s more, even if the impacts of Covid-19 are dampened this winter, there still could be a devastating loss of life. A prediction from among the most respected long-term Covid-19 forecasters in the country found an additional 100,000 people may die between November 2021 and March 2022.

“We see increasing evidence in the northern hemisphere that the expected winter surge has started to unfold,” said Dr Christopher JL Murray, lead modeler at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, as he introduced a new forecast. “Reductions in cases and new infections and hospitalizations have stopped in the US and started to turn around.”

IHME’s projection, which Murray described as “optimistic”, forecast 863,000 cumulative deaths from the pandemic by March 2022. Already, more than 765,000 people in the US have died from Covid-19.

IHME’s worst-case scenario predicts hundreds of thousands more deaths, for more than 1m pandemic deaths by March 2022.

“Many countries in western Europe are even farther ahead of us in the sense that the numbers are going up quite quickly in the places like the Netherlands and Denmark, but also in Germany now and a number of other countries,” said Murray. Nearly two-thirds of the 1.9m new infections globally are on the European continent, the World Health Organization said.

Further, there are few calls and little appetite to reinstate social restrictions. The promise of vaccines that could reduce transmission of Covid-19 prompted local governments around the country to drop social distancing and mask restrictions.

That trend has held even as an emerging body of evidence showed the vaccine’s ability to prevent infection with Covid-19 waned over time, and the focus of vaccine efficacy shifted to the steady protection conferred against hospitalization and death.

The risk of a “fifth wave” and waning immunity has now prompted a call for “booster” shots, or third vaccine doses, for everyone who received mRNA vaccines, those developed by Pfizer or Moderna.

The Food and Drug Administration has already authorized booster doses for people older than 65 or who work in high-risk settings. Everyone older than 18 who received the Johnson & Johnson vaccine is eligible for a second dose, as evidence shows its effectiveness against serious disease may wane over time.

Booster doses are effective at increasing antibody levels, but are not the most effective way to curb transmission of Covid-19. The best way to curb transmission, experts have said repeatedly, is to get new people vaccinated. Experts now widely believe Covid-19 will be endemic and circulate for decades to come, though the severity of infection may wane over many years.

The Covid-19 pandemic may never be “over”, as many conceived early in the pandemic, Dowdy said. “The point is – when can we get this to a point where it’s tolerable to us as a society? And I think we may be closer to that point than we imagine.

“Zero-Covid is not going to happen.”

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Conflicts mount on easing COVID-19 restrictions amid autumn case spikes

By Peter Sullivan

The Hil

An uptick in COVID-19 cases as winter approaches is setting off a debate about if a new era of living with the virus has arrived or whether heightened restrictions and caution are still needed.

Cases in the U.S. have risen to more than 80,000 per day as the weather in much of the country gets colder. There are about 1,000 people dying every day from the virus, according to Centers for Disease Control and Prevention (CDC) figures, largely among the unvaccinated.

At the same time, the widespread availability of vaccines and booster shots has made the individual risk for many people far lower.

The result is a sometimes-confusing picture where individuals and localities are trying to figure out what level of risk to accept.

Washington, D.C., for example, on Tuesday announced it is lifting its mask mandate.

“We are learning to live with COVID,” said LaQuandra Nesbitt, director of D.C.’s health department. She said the virus is becoming “endemic,” meaning it is fading into a fact of life in the background. “It’s really my way of trying to stress to people that we’ve moved away from this goal of getting to zero cases,” she said.

Other experts, though, worried the move was premature heading into the winter and with cases and deaths still at a high level.

“The way I view it is this is the last part of the crisis phase,” said Walid Gellad, professor of medicine at the University of Pittsburgh. He said it would make sense to wait a few more weeks to allow more children under 12 to be vaccinated and to give time for powerful new antiviral treatments from Pfizer and Merck to be authorized.

D.C.’s move, he said, could be like taking “your foot off the gas right before you’re over the finish line.”

Many experts, though, said it is warranted to at least somewhat change thinking about the virus given the strong protection from vaccines, especially once people get their booster shots, and the fact that the virus is not going to be completely eliminated anytime soon.

“I am now approaching it as if now is a reasonable version of what the future is likely to look like,” said Bob Wachter, chair of the department of medicine at the University of California, San Francisco.

He said if someone is unwilling to do a certain activity now because of COVID-19, one is “making a statement you’re not going to do it next year or the year after.”

“It’s no longer a short-term sprint,” he said, while noting it still could be prudent to wear masks in crowded public areas where it is unclear whether everyone is vaccinated.

Ashish Jha, dean of the Brown University School of Public Health, said it is “reasonable to start thinking about lifting mask mandates.”

But, he said, “if you can hold off on lifting these restrictions until early January I think that’s better.” That would give time to get through any holiday spike and for more children to get vaccinated.

Jha said a similar timeline could work for school mask mandates, which have been a major source of controversy.

“I would keep those masks on probably through the holiday season,” he said. “Once every school-age child has had a chance to get vaccinated I think it’s totally reasonable to lift mandates.”

Of course, many parts of the country abolished their mask mandates months ago.

Jha said that for people who are vaccinated and have gotten a booster, the risk of severe illness from COVID-19 is generally on par with the risk from the flu.

Biden administration health officials are not ready yet to give the green light to relaxing restrictions and entering a new phase of dealing with the virus.

CDC Director Rochelle Walensky told reporters Wednesday her agency still recommends that localities be in low levels of COVID-19 transmission for several weeks “before releasing mask requirements.”

She noted that over 85 percent of counties in the U.S. are still in “substantial” or “high” transmission, meaning the CDC recommends masking indoors in public.

Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, likewise said cases and deaths are not yet low enough to accept the virus as “endemic” and a fact of life.

“We want control, and I think the confusion is at what level of control are you going to accept it in its endemicity,” he told reporters. “And as far as we’re concerned, we don’t know really what that number is, but we will know it when we get there; it certainly is far, far lower than 80,000 new infections per day and it’s far, far lower than 1,000 deaths per day, and tens of thousands of hospitalizations.”

Another consideration for even vaccinated people is that there is still a chance of getting lingering “long” COVID-19 symptoms from a breakthrough infection, though that risk is substantially less than for unvaccinated people.

Wachter said there are not fully precise figures but estimated that the chance of long COVID-19 is about half as much for vaccinated people who get breakthrough cases compared to unvaccinated people, and could be about 1 in 10 breakthrough cases.

“That’s enough of a risk that if you told me I had COVID now even though I’m fully vaccinated, I’d say at least I’m not going to die, but I’d still be pretty unhappy,” he said.

But as the overall COVID-19 situation improves, with vaccines, boosters and now new antiviral treatments coming, the proper level of precaution is becoming more of a situation where, he said, “reasonable people could disagree.”

The post ‘Zero-Covid is Not Going to Happen’: Experts Predict a Steep Rise in US Cases, Growing Conflicts Over Restrictions appeared first on The St Kitts Nevis Observer.