Where are we with COVID? Summer shots can save us from another fall spike

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As our COVID-19 W­inter gives way to Vaccination Spring, the United States finds itself in an extraordinary position of both strength and fragility.

With nearly half of all Americans having received at least one vaccine shot, COVID-19 cases are declining nationally. This is the beginning of the end of our national epidemic. But nearly 600 Americans are still dying every day — a death toll that looks tolerable only in comparison to the brutal toll of COVID-19’s winter. And for the unvaccinated in America, this remains an extraordinarily dangerous time with highly contagious variants widespread.

There is little doubt that the drop in cases is due to vaccination (and immunity among those who have been infected) when our situation is compared to that in other highly vaccinated nations, particularly the United Kingdom and Israel, where cases have declined consistently since national vaccination rates approached 50 percent. While true herd immunity remains an elusive goal, both of these nations have witnessed large drops in cases, what epidemiologists call “exponential decay” in rates of infection. Exponential decay describes the rapid decline in cases that occurs when the combination of vaccination, prior infection and non-pharmaceutical measures, such as masks, reduce rates of infection. Just as uncontrolled spread leads to massive spikes in cases, exponential decay means that case numbers can fall precipitously. In the U.S., the seven-day case average fell by more than 13 percent last week — and may fall faster in the weeks to come.

While this is good news, these declines also are not beyond reversal or stalls. We still have more than 35,000 infections daily, almost all among the 170 million Americans who have yet to receive a single dose of the vaccine. If vaccinations slow, the variants continue to rage, and we relax all public health measures, we can easily see a resurgence of cases, hospitalizations and deaths. But here’s the key part: Progress to date is not even across the nation. While nearly 64 percent of all Vermonters have received at least one shot, it’s about half that (32 percent) in Mississippi. The uneven progress means that as public health measures relax and as behavior changes, many places will remain vulnerable.

The threat of a resurgence in low vaccination states should not be underestimated. It was precisely this time last summer, as the weather got too hot to be outside, that we saw a surge of infections. While fewer people are vulnerable this year than were last year, we also have new variants that are far more contagious.

As May turns into June into July, we should expect people in many Southern states to spend more time inside. With their low vaccination levels, they will not have enough population immunity and cases are likely to surge. It will be a bad time to be unvaccinated.

So, what can be done? We need to focus on improving the ground game on vaccinations. To prevent a summer surge in the South or one in the fall in New England, we must push further on vaccinations. 

Most experts agree that we probably need to get 80 percent or more Americans immune to get to a point where the virus doesn’t mount any return when public health restrictions are gone.  That means reaching Americans who have struggled to access vaccines — through primary care doctors, pop up clinics, mobile vaccine sites and door-to-door outreach. We must reassure Americans who have fallen prey to misinformation about the safety and efficacy of these vaccines by providing good information about their extraordinary ability to keep their communities safe and allow normal life to return.

The decision of the Food and Drug Administration (FDA) to approve Pfizer’s vaccine for young people ages 12 to 15 years old, provides another potent weapon in this campaign by making another 17 million Americans eligible for protection. Vaccinating this group will drive the number of cases even lower. But it will not be easy.

Some will suggest that getting younger teenagers vaccinated isn’t worthwhile because they face much lower individual risks from COVID-19 than older people — which is wrong, we need protection in all age groups, as soon as possible. Surveys suggest that some parents are unsure about vaccinating their children; others will struggle to access vaccination, particularly families of color and those experiencing poverty or homelessness. Efforts to reach out and make vaccinations easy and accessible for these populations must be part of our national strategy.

We have made immense gains against the virus and are in a position to vanquish it conclusively with an effective summer vaccination campaign. But, as pent-up demand for vaccines has been sated, each future shot will require more work to reach the arm that needs it. Vaccinations mean that we will never see a surge like last spring or this past winter ever again, but the virus is not done with us. If we celebrate this summer without aggressively pursuing vaccination — both at home and abroad — we will pay a deadly price in the fall. The choice is ours, and it is clear: more vaccines in more arms.

Dr. Ashish K. Jha, MD, is a physician, health policy researcher and dean of the Brown University School of Public Health. Previously, he was the K.T. Li professor of Global Health at the Harvard T.H. Chan School of Public Health and Director of the Harvard Global Health Institute (HGHI). Follow him on Twitter: @ashishkjha.

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