Declining COVID-19 cases stir cautious optimism

Health experts say the U.S. could be turning the corner on COVID-19, while cautioning that the pandemic is far from over.

The spike in coronavirus infections from the delta variant of the virus is slowing and cases are beginning to decline. Experts think the U.S. could be on the back end of the wave, even as deaths and hospitalizations remain high.

But low vaccination rates in many areas of the country are giving them pause, with some arguing that another seasonal surge after holiday travel is likely, even if it isn’t as high as last winter. There could also be regional spikes, as some areas worsen while others rebound more quickly.

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According to the Centers for Disease Control and Prevention, the seven-day average of U.S. cases has been declining for the past two weeks. On Sept. 14, the daily average of new cases was just under 150,000. As of Tuesday, it was down to about 95,000.

Former Food and Drug Administration Commissioner Scott Gottlieb said during a recent CNN interview that the decline is most prominent in the southern states, where the delta variant has essentially run out of people to infect.

This could be the “last major surge” in the U.S., but Gottlieb cautioned that the wave is not over yet.

“I don’t think this has run its course,” he said. “This has been a highly regionalized epidemic from the very beginning ... but I think on the back end of this delta surge of infection around the country, after we get through this, this may be the last major wave of infection.”

Gottlieb estimated that by Thanksgiving, COVID-19 will become endemic with much more manageable case levels. The pace of the decline will be quicker if children are permitted to be vaccinated sooner, he said.

David Dowdy, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, said it’s important to put the declining case numbers in perspective. Just because they are decreasing, he said, doesn’t mean the country is done with the pandemic.

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“Every time in the past that we’ve thought we were done and out of the woods, we’ve been wrong. So I would be very hesitant to say that,” Dowdy said. “I think it’s also important for people to realize that right now, even though cases are going down, the number of cases that we’re seeing is still quite high. I think that things are trending in the right direction, but it’s a little too early to declare victory.”

The U.S. has seen several different periods of peaks and valleys throughout the course of the pandemic. Many were hopeful that the low point in July, coming after many states relaxed COVID-19 precautions and vaccines became widely available, signaled the beginning of the end of the pandemic.

But then infections began to spike, as the delta variant became the dominant strain across the country. The people with the most severe cases were largely the unvaccinated, and the states impacted the most by the surge had the highest numbers of unvaccinated residents.

Even if the delta surge has peaked, it will be some time before the hospitals being overwhelmed with unvaccinated coronavirus patients see relief.

Hospitalizations and deaths tend to lag case counts by a couple weeks or more, as it takes time for people to become infected with the virus and then become sick enough to need urgent care.

Celine Gounder, an epidemiologist and infectious diseases specialist at New York University and Bellevue Hospital, said on CNN this week she agreed with Gottlieb that the delta surge is waning, but she expects at least another wave this winter in the post-holiday travel period.

“Whenever people travel and create what are essentially new social networks and new transmission networks you will see a bump,” Gounder said.

She said that last winter, the nation experienced a “triple-humped surge” between Thanksgiving, Christmas and New Year’s.

“I don’t think it will be anywhere near as bad as last year’s. I do think we’ll see a surge in transmission around the holidays ... then I think we’ll turn a corner, assuming more people get vaccinated,” she said. 

All experts agreed that improving vaccination rates is the key to stopping transmission and making COVID-19 a much more manageable disease.

“At some point in time, the surge will end, but it will end more quickly if we get more people vaccinated,” Dowdy said.

Natural immunity among people who were previously infected can help a little, but the levels of protection vary considerably.

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“Infection produces a range of outcomes. Some people produce really good protection, and other people don’t. It’s much more consistent if you give people a vaccine,” said William Hanage, an epidemiologist at Harvard’s T.H. Chan School of Public Health.

Hanage said the most optimistic part of the current situation is that there are plenty of available vaccines that can keep people out of the hospital. But that’s also the most frustrating aspect.

“If you’d have told me a few years ago that we would be looking at a winter like what we are seeing now, I would have been pretty horrified. However, I also have in my mind how much worse it could be, if we did not have the vaccines,” Hanage said.