There has recently been a lot of good news about the pandemic, notwithstanding the fact that it has now killed more than a half-million Americans.
The horrifying surge of coronavirus cases that began last fall has now abated. Two months after the first two COVID vaccines began going into American arms, studies continue to emphasize how remarkably effective they are. And after a haphazard start, the country’s mass-vaccination effort is continuing to ramp up. Suddenly, the latest wave of the pandemic is one of cautious optimism regarding the near future.
Last week at the Atlantic, James Hamblin went so far as to wonder whether or not the country might be able to reach a much happier normal by this summer:
[M]any aspects of pre-pandemic life will return even before summer is upon us. Because case numbers guide local policies, much of the country could soon have reason to lift many or even most restrictions on distancing, gathering, and masking. Pre-pandemic norms could return to schools, churches, and restaurants. Sports, theater, and cultural events could resume. People could travel and dance indoors and hug grandparents, their own or others’. In most of the U.S., the summer could feel … “normal.” … In short, the summer could feel revelatory. The dramatic change in the trajectory and tenor of the news could give a sense that the pandemic is over.
On Sunday, former FDA commissioner Scott Gottlieb — who has been one of the pandemic’s most prescient commentators — said that he too was feeling optimistic about the coming months.
Below, a look at what’s driving this sunnier mind-set, and what serious concerns still linger.
The Arguments for Optimism
COVID cases, hospitalizations, and deaths are all dropping dramatically.
Thanks to what is likely a combination of factors, including seasonality, rising immunity, and behavior change, the number of new coronavirus cases, hospitalizations, and deaths have all fallen significantly from their early-winter peak and are continuing to go down across the U.S. The numbers are still too high, and additional waves of new cases remain possible in the coming months, but if nothing else, the country seems to be getting substantial respite.
The vaccines work really, really well.
The two COVID vaccines currently authorized in the U.S., mRNA vaccines from Pfizer-BioNTech and Moderna, are safe and highly effective — and effectively eliminate the risk of serious illness and death from COVID-19 for anyone who is lucky enough to get them. There is mounting evidence that even one dose of these two-dose vaccines will offer significant protection as well.
The other top vaccines nearing availability in the U.S. — like the one made by Johnson & Johnson, which is expected to be authorized by the FDA soon — are also safe and highly effective at protecting against serious illness and death.
And all of the vaccines are likely going to prevent or limit transmission of the coronavirus in meaningful ways. The vaccines will also likely be effective, or at least effective enough, against the current COVID variants of concern, and all of the vaccines can and will be rapidly updated, relatively easily, to be even more effective against variants. There will be a streamlined FDA-authorization process for those updates, though they may not be available until next year.
The U.S. vaccination effort continues to improve.
America’s vaccine rollout has not gone well in myriad ways, but it has gone better in the U.S. thus far than in all but a handful of other countries, and the vaccination effort continues to steadily pick up steam. More than 64 million Americans have now received at least one dose of one of the two available COVID vaccines, and in mid-February, before wide-reaching winter storms delayed vaccine shipments and disrupted administration efforts, the U.S. had reached an average of 1.7 million vaccinations per day, up from 1 million per day in mid-January. There are now more new vaccinations than there are new COVID-19 cases.
Vaccine eligibility has been gradually expanding across the U.S., and vaccine supply and distribution logistics have also been improving. Additional vaccines that are even easier to distribute should be available soon, and it’s possible there will be enough vaccine supply for all Americans by as early as late May.
Getting vaccinated is going to change people’s personal lives for the better.
It’s not just a shot in the arm. While anyone who has been vaccinated should likely continue to follow precautions to protect anyone who hasn’t yet gotten a dose, vaccination will drastically reduce the risk of COVID-19 for those who have. That is going to allow vaccinated people to safely and responsibly have at least some of their pre-pandemic lives back — from hugs shared with grandparents, to maskless indoor gatherings with vaccinated friends, to working, working out, or dining out without the ever-present anxiety of the virus looming large.
Seasonality may now be working against the coronavirus instead of for it.
Though exactly how seasonality affects the coronavirus is still not fully clear to scientists, most experts studying the virus agree that seasonality (possibly linked to sunlight amounts and vitamin D) has been playing a role in COVID’s spread, as it does with other coronaviruses — which typically drop off around this time of year. This means there may be a window of opportunity for a decisive vaccine counteroffensive against the virus before seasonality shifts back to COVID’s advantage next fall.
We may not have reached herd immunity, but there is now undoubtedly more immunity in many hard-hit locales.
The protection offered by natural immunity may not be as robust as the immunity conferred by vaccination, and it has taken more than 28 million infections (that we know of) to get to this point in the U.S., but the antibodies carried by COVID-19 survivors are likely making a difference in slowing the spread of the coronavirus in many places. In addition, research continues to indicate that people who have recovered from coronavirus infections may only require one dose of the current mRNA vaccines for an effective booster shot against reinfection.
Most Americans now have a whole lot of experience protecting themselves and others from COVID-19.
While there continue to be people who don’t take the threat of the coronavirus as seriously as they should, and there have been many missteps in both public-health messaging and public-health policy measures throughout the pandemic, there is now more public knowledge and experience dealing with COVID-19 than ever before. Precautions that would have seemed unthinkable a little more than a year ago are now second nature for most people, and the most basic — wearing face masks, social distancing, and avoiding close indoor contact with people from multiple households — work, and will continue to work no matter what.
Donald Trump is no longer in charge of the U.S. pandemic response.
Having any new president and presidential administration following Trump’s mishandling of the pandemic is an upgrade. So far, President Biden and his administration are taking the pandemic far more seriously, are addressing it far more competently and scientifically, and plan to direct a lot more money into the effort. It’s still early, and the Biden team will undoubtedly screw up too, but having more effective federal leadership may make an enormous difference in the country’s fight against the pandemic over the next year.
The economy (or at least parts of it) might come roaring back if COVID can be kept at bay.
There have been signs that the U.S. could be primed for a post-COVID boom, as Ben Casselman summarized at the New York Times on Monday:
Economists surveyed by the Federal Reserve Bank of Philadelphia this month predicted that U.S. output will increase 4.5 percent this year, which would make it the best year since 1999. Some expect an even stronger bounce: Economists at Goldman Sachs forecast that the economy will grow 6.8 percent this year and that the unemployment rate will drop to 4.1 percent by December, a level that took eight years to achieve after the last recession …
The growing optimism stems from the confluence of several factors. Coronavirus cases are falling in the United States. The vaccine rollout, though slower than hoped, is gaining steam. And largely because of trillions of dollars in federal help, the economy appears to have made it through last year with less structural damage — in the form of business failures, home foreclosures and personal bankruptcies — than many people feared last spring. Lastly, consumers are sitting on a trillion-dollar mountain of cash, a result of months of lockdown-induced saving and successive rounds of stimulus payments. That mountain could grow if Congress approves the aid to households that President Biden has proposed.
The pandemic has also worsened inequality in many ways, and a post-COVID boom wouldn’t reverse all the damage nor benefit everyone equally. As Casselman notes, “Other economists fear that the rebound will primarily benefit those at the top, compounding inequities that the pandemic has widened.” But a post-pandemic boom would undoubtedly make the country’s overall economic recovery easier.
The Arguments for Caution
We don’t actually know why COVID cases, hospitalizations, and deaths have suddenly dropped off.
The possible factors include seasonality (which can relate to both weather and community behavior during certain seasons), behavior and policy changes driven by fear, higher levels of natural immunity, less COVID testing, and, least likely, some impact of vaccinations. Most likely, it’s some combination of factors. There has been a global drop-off as well, but mainly due to steep downward curves in just six case-saturated countries. The sharp reduction is worth celebrating, but the mystery doesn’t inspire confidence that the improvement was much more than luck. Dr. Paul Sax points out another problem in a post at the New England Journal of Medicine’s HIV and ID Observations blog:
It could be all of the above explanations, in various proportions, and different in various regions — plus things no one has considered. And the uncertainty about why cases are dropping again hearkens back to this great H.L. Mencken quotation, which over time has morphed into this profound statement: “Every complex problem has a solution which is simple, direct, plausible — and wrong.”
I stress the importance of being humble about not knowing why the cases are dropping simply because reliance on one of these factors over another could get us into trouble …
Warning — if anyone tells you with confidence that they know precisely why cases are dropping, and that they have an accurate crystal ball showing that by April we’ll be safely out of this pandemic — please view it with the appropriate scientific skepticism it deserves.
The variants remain a real threat.
Opinions vary among many coronavirus experts on how dangerous the current variants of concern are, but the bottom line is that the coronavirus, having now been given more than 112 million opportunities to adapt to the human body over the past year, has evolved much faster than anyone expected. In the process, it has simultaneously evolved variants with dangerous mutations on different continents that have apparently made it more infectious, more virulent, and better equipped to evade immune response — though not all in the same strain yet (that we know of). There is also still a significant lack of genetic surveillance being done in the U.S. to identify and track COVID variants.
A strain that is already posing a major threat in the U.S. is the much more infectious B.1.1.7 (U.K.) variant, which has now been detected in more than 40 states and may become the dominant strain in the country as soon as next month, according to the CDC. As a result, the U.S. vaccination effort is effectively in a race against B.1.1.7.
One of the scientists continuing to sound the alarm about coronavirus variants is Michael Osterholm, the director of the University of Minnesota’s Center for Infectious Disease Research and Policy and a member of President Biden’s COVID-19 task force. In an interview with Minnesota Public Radio last week, Osterholm explained why the variants have him so worried:
[The variants] have fundamentally changed the game with this particular pandemic. And we have to respect them; we have to try to understand what they mean. I actually think I know less about these viruses today than I did six weeks ago … So expect we’re going to see many, many more variants. There was a confusing article in the media just in the last two days about a series of new variants here in the United States. And the researchers that did the work were absolutely right on target; their message was correct. But they said these variants aren’t causing us any unique problems, meaning that they weren’t one of the three buckets. The media took that to mean variants don’t cause problems. And I just come back to reaffirm: Some of them are real big problems.
Current vaccines (and their eventual updates) seem likely to provide protection against the current variants, based on existing research — but much more research, and continued vigilance, is needed. Hopefully, the vaccines, at the very least, prevent serious illnesses and death from the current variants of concern, and whatever other ones emerge. In a recent interview with Intelligencer, Harvard epidemiologist Michael Mina argued that the entire process for developing the vaccines was flawed from the start, leaving them vulnerable to immunity escape mutations:
The entire evaluation process was based on symptomatic disease. The major trials didn’t even consider transmission … All of the major vaccines that we are building all present the exact same spike protein. They’re all clones of each other — no difference for the most part. Nobody ever took a step back to say, “What if this virus mutates?” We are vaccinating with a narrow-spectrum vaccine against one piece of the virus. If that piece mutates, it would be able to escape all of our vaccines. And all it needs to do is mutate once, somewhere in the world. And then all of our major vaccines are moot. Why was that not considered?
Mina also said that he is worried about tentative thinking among the scientific community regarding the evaluation of the variant threat, while Osterholm warned that government officials are prematurely letting down their guard, calling the present moment a “lull before the storm”:
What this has done is given us this false sense of security: We’ve won. If you just think about this right now, we’re loosening up everything — governors and mayors are under such pressure to loosen up everything. When you look at vaccine, it’s coming, and it’s in right now with the B.1.1.7. This vaccine will work, but we’re not going to have nearly enough in time. Our studies have shown that if we keep up the current vaccine efforts we’re doing now, by the end of March we will still have 30 million out of 54 million persons in this country over age 65 who have not had a drop of vaccine. Those people are going to be at high risk for this virus. And I think it’s going to take off in early to mid-March. And we’re gonna see that next big peak, and it will very possibly exceed what we saw in January.
A lot of Americans don’t want the shot, and kids can’t get it yet.
As many as one in three Americans remain reluctant to get a coronavirus vaccine. The hesitancy is particularly prevalent among Black and Latino Americans — communities that have already been disproportionately affected by the pandemic, and where there is already a disparity in the rate of vaccination here in the early phases of the U.S. vaccine rollout. Vaccine hesitancy is also significant among conservatives, long-term-care-facility workers, and several other groups — and anti-vaccine activists have been working to exploit (unfounded) fears about the safety of the COVID vaccines.
The issue doesn’t just pose a threat to the health of the skeptics, as Vox’s German Lopez explains:
The views of one-third of Americans may not always amount to a national crisis, but those views matter a lot when the country needs to do something that requires nearly everybody onboard. That’s the case with the COVID-19 vaccination campaign, where 70 or 80 percent — or more — of the country will need to get vaccinated to reach herd immunity. So surveys that show as many as one-third of Americans are skeptical amount to a real public-health crisis.
Compounding that is the reality that a COVID-19 vaccine still hasn’t been approved for children — and that might not happen until later this summer or even 2022. Given that kids make up 22 percent of the population, herd immunity probably can’t happen without them. But even if herd immunity only requires the lower estimate of 70 percent of Americans, that still will be impossible if more than 30 percent of adults refuse a vaccine.
COVID isn’t going to go away or be eradicated.
A recent Nature survey of 100 immunologists, infectious-disease researchers, and virologists working on the coronavirus found that “almost 90% of respondents think that the coronavirus will become endemic — meaning that it will continue to circulate in pockets of the global population for years to come.” As Intelligencer’s David Wallace-Wells recently explained:
What has long been the dream of most Americans enduring the pandemic — a point at which “all of this is over,” with COVID-19 as much a historical artifact for us as, say, SARS is in East Asia — may never come to pass precisely as imagined. Instead, in the medium term and perhaps even the long term, a likelier endgame is one in which large portions of the population are protected, from at least severe disease produced by at least some variants, but, with immunity falling short of the herd threshold, the disease continues to circulate — infecting even some of those who’ve been vaccinated, threatening the lives of those who haven’t, and continuing to evolve, perhaps in some scary ways. For most of those who’ve received a vaccine, the disease will fade into the background, joining the ranks of other endemic diseases, but as a social fact the coronavirus will nevertheless remain.
Regardless of what humans do, COVID will still have free rein in the animal kingdom.
Another aspect of COVID becoming endemic is that the coronavirus will continue to seek out, and evolve in, alternate hosts — particularly as vaccinated human bodies become less hospitable. In a comprehensive Wired piece about COVID-19’s likely permanence in the world and what that will entail, Maryn McKenna highlights the risk of interspecific transmission:
Eradication campaigns for diseases beyond [smallpox and Rinderpest] have faltered because vaccinations can’t penetrate the places the organisms shelter in the world: for yellow fever, in monkeys; for malaria, in mosquitoes; for tetanus, in soil. (Polio, the target of a 32-year international campaign, can hide quiescently in the guts of asymptomatic people. It got very close to eradication, but when the pandemic halted vaccination efforts, cases rebounded again.)
The COVID-19 virus has similar shelters: in the bats it originally jumped from, in some probable intermediate (and still unidentified) animal that helped it adapt from bats to humans, in the minks that have been identified as harboring it in several countries — and in whatever percentage of the human population remains unprotected by natural immunity or vaccine.
So there is no way to cast a net around COVID-19 and tighten it to nothing; its animal hosts will always provide it an escape hatch. However, it’s not actually useful to start thinking about alternate hosts until all of a disease’s potential human victims have been protected by vaccination — and so far, we are not remotely close. As long as people somewhere in the world are still waiting for their first shots, Covid-19 will have human hosts to reproduce in. And also, potentially, to mutate in, creating the kind of variants that are now appearing across the globe.
The coronavirus is still novel.
We’re just over one year into this new COVID reality, and there remain a lot of questions that have, at best, incomplete answers. That is to be expected, as Jennifer Beam Dowd wrote about at Slate last week:
[D]espite our best scientific efforts, we must humbly admit that human understanding of SARS-CoV-2 infection dynamics in the real world is limited. The uniformity of the recent drops across U.S. states as well as globally points to something — a rhythm, a natural ebb and flow, a viral boom-and-bust cycle. This “natural” cyclicality is surely a complex interaction of the factors above, each contributing to push the reproductive rate below that critical threshold for which the exponential momentum starts to work in our favor. Things that are cyclical like the economy or epidemics are cyclical because we don’t fully understand how to control them. If we did understand them, we’d always have 7.2 percent GDP growth and low unemployment. Human behavior is beautifully adaptive but with such individual diversity that it is not easily modeled. … [W]hile we should avoid the temptation to cherry-pick our favored explanations for every twist and turn of the epidemic curve, neither should we be fatalistic.
And we probably shouldn’t start making post-pandemic plans for the Fourth of July just yet either.