“This virus is telling us, loud and clear, it is not done with us. It is not done with us.” Dr. Michael Osterholm, CIDRAP podcast, May 6, 2021

            “The spring wave has not really materialized. I’ve been describing it as this spring plateau, if you look at numbers across the country… We’re actually looking at a really good July ahead of us… So this is the time for masks, distancing, outdoors versus indoors, limiting group sizes, all these non-pharmaceutical interventions as we call them, and vaccination…” Dr. Daniel Griffin, “This Week in Virology” podcast, May 6, 2021

The United States is following Israel and the UK in winning the vaccination vs. variants battle, with evidence that nationwide and even in states like Michigan, where signs were ominous, the number of cases, hospitalizations, and deaths is slowly declining. The feared fourth surge has not materialized. The faster-spreading variants have not proved resistant to the vaccines or to natural post-infection immunity so far.

We plateaued at too high a level after the winter surge plummeted, and a few weeks ago we began to rise from that too-high plateau. But vaccinations had doubled from one to two million per day and then doubled again to four million. This stopped the fourth surge and the slow decline began. We are still not yet below the high March plateau, but with a continued slow decline we could be in a better place soon.

Vaccinations have dropped back to between two and three million a day and may drop further until they are deployed to children. Vaccine stupidity, euphemistically known as vaccine hesitancy, explains this.

Still, the country has fought the virus to a standstill on a hill some feared we couldn’t hold, and we fought it down the hill. If we can fight it down further off the high plateau, we might just win the war. As always of course, this involves not just vaccinations but other precautions, especially those against swapping air.

But the situation in India is heart-breakingly bad and worsening by the day. Latin America is also going in the wrong direction. It is still reasonable to fear that these epidemiologically chaotic and tragic situations will allow the virus to evolve new variants over time that can come back to haunt us.

For this reason it is not just a humanitarian imperative but a self-protective one to help these suffering overseas populations in every way we can. The US may be steadily improving, but how we keep safe in the long run in a world in danger is a question we have not yet answered.

Good News

1. The one-dose Johnson & Johnson vaccine that probably caused an extremely small number of blood clots has been reapproved by the FDA and the CDC and redeployed for emergency use alongside the two two-dose mRNA vaccines, along with instructions for monitoring and treating the rare clots. It may not be needed in most US situations but it is very important for the world.
2. The CDC has expanded its list of what fully vaccinated people can safely do. It does not represent a complete return to normality, but it certainly adds many freedoms and reinforces the desirability of getting vaccinated.
3. All US adults are now eligible for vaccinations regardless of age or other conditions contributing to vulnerability. There is plenty of vaccine for everyone.
4. Pfizer has applied for full rather than emergency use approval for its vaccine. This will take time but adds to the correct perception that the vaccines are safe.
5. Pfizer is expected to be authorized this week to vaccinate adolescents 12 to 15 years of age, a group where the vaccine has proved extremely effective and safe. This has great implications for school openings and is essential if we are ever to achieve “herd immunity.”
6. Both Moderna and Pfizer are conducting clinical trials in children under 12. Completion and approval will take some time, but the positive implications are very similar.

Bad News

1. Vaccine “hesitancy” and refusal—largely associated with political views—are causing a serious slowdown in vaccinations and will surely prevent the US from developing “herd immunity” to the extent that that is even possible. Many parents are expected to refuse vaccination for their children.
2. Two days ago the CDC, following the lead of the WHO one week earlier, finally acknowledged that SARS-CoV-2 the virus that causes COVID-19, is transmitted in aerosolized form. It is airborne. This means that all enclosed indoor spaces can spread the virus in forms that float in the air for a long time, farther than a distance of six feet. I don’t understand what took them so long, as the signs of airborne transmission (not just droplets that gravity pulls to the ground in short order) have been fairly clear since the beginning.
3. School reopenings remain challenging and controversial. Schools were involved in the Michigan surge, although frequently the virus was brought into the schools from the community rather than the other way around. The CDC’s latest guidelines for school reopenings are confusing and too expensive and difficult for many, perhaps most schools, to implement. Everyone agrees that the cost of keeping schools closed is great. We need more clarity about the risks and costs of opening.
4. India is in by far the worst phase of its epidemic so far, and has the worst statistics in the world. Hospitals have been overwhelmed for weeks. Since there is no way to take care of or even evaluate all the country’s cases, nor any room in hospitals for people with life-threatening cases, all these terrible statistics are gross underestimates. Expert calls for a national lockdown go unheeded. Vaccines are scarce. Spread to Pakistan, Nepal, and other neighboring countries is happening fast. Thailand and Laos are also experiencing surges.
5. Latin American virus statistics are also ominous. Brazil’s statistics, among the worst in the world for many months, has experienced some improvement, but remains in crisis. Uruguay, Argentina, Costa Rica, and Colombia are four of the ten worst-off countries in the world for COVID-19.
6. SARS-CoV-2 continues to evolve new variants of concern, and each one presents potentially serious new challenges. The international situation now and over the next months will provide many new evolutionary opportunities for the virus.

There is a myth that the virus does not affect children. Children make up a large and increasing minority of US cases today. Thousands of children have been killed by the virus in Brazil. Why? New variant? Careless failure to protect them? We don’t know.

I don’t sympathize with people who spit in subway stations, smoke in restaurants, refuse to use seatbelts, mock the use of masks, crowd together, or turn their backs on vaccines. They are a clear and present danger to themselves and all around them.

So is anyone who fails to see that this pandemic is global and that the virus will evolve globally, continuously, and unpredictably going forward.

Stay safe, enjoy the American spring.

Dr. K

PS: Please don’t just rely on me. Dr. Michael Osterholm’s weekly podcast from CIDRAP, the Center for Infectious Disease Research and Policy of the University of Minnesota drops on Thursdays. He combines realistic assessments and warnings with uplifting stories about how people are finding light and small victories in the pandemic. The best resource on what is happening specifically in the state of Georgia is Dr. Amber Schmidtke’s Daily Digest. More generally, I recommend the following: The Bill & Melinda Gates Foundation COVID-19 Update, aka The Optimist; for the science of viruses, especially the new coronavirus, This Week in Virology (TWiV) podcast; Dr. Sanjay Gupta’s podcast, Coronavirus: Fact vs. Fiction; COVID-19 UpToDate for medical professionals; and for the current numbers: Johns Hopkins University (JHU); Institute for Health Metrics and Evaluation (IHME); Our World in Data (OWiD); The New York Times Coronavirus Resource Center (NYT). For uncannily accurate warnings, follow @Laurie_Garrett on Twitter. I also recommend this COVID-19 Forecast Hub, which aggregates the data from dozens of mathematical models, and this integrative model based on machine learning. For an antidote to my gloom, check out the updates of Dr. Lucy McBride, who doesn’t see different facts but accentuates the positive.