The future of the American Covid-19 epidemic can now be distilled towards: long-term trust and hope, but short-term uncertainty and maybe even despair.
Vaccines are rapidly rolling out, setting up the country to quell the outbreaks that have skewed our lives over the past year.
But in the short term, maybe next month, the US faces a number of possible avenues. Worst Scenario: A fourth coronavirus surge beats vaccinations and kills thousands more people even as the country nears the finish line with Covid-19. Best option: Accelerated vaccine adoption and continued vigilance will keep the virus at current levels or, hopefully, lead to fewer infections – so the US can cross the finish line safely, with more lives saved. Then there’s a middle ground: cases are rising, but vaccines are protecting the country from further hospitalizations and deaths.
However, America’s path is determined by one of the most unpredictable things of all: human behavior.
The public could be loosening precautions for Covid-19 too quickly, discarding masks and not maintaining social distance until enough people are vaccinated. As has been done in some areas, policymakers could push the country in this direction by ending restrictions before vaccine adoption really reaches critical mass. Either of these things or a combination of the two could result in a fourth spike.
But if Americans hold out just a little longer and vaccination rates keep rising, the US could reach the end of the current major outbreaks – as cases drop near zero – before that happens.
The good news is that an end seems to be in sight. At current vaccination rates, the country could be vaccinating its entire adult population by July, giving us plenty of time over the summer to get our lives back to normal and hopefully celebrate with others. One country that has vaccinated most of its population, Israel, has shown it can be done by reopening its economy while destroying the Covid-19 curve.
“Yes, there are some short-term concerns,” said Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation. “But so far we are – cautious – on the other side. … If we go ahead and really speed up vaccination, we’ll be in a much, much better place by summer. “
The question now is what lies between here and there.
Worst short-term scenario: cases, hospitalizations, and deaths increase in a fourth surge
This is the worst-case scenario – what CDC director Rochelle Walensky said makes her feel “doomed”.
This is how it could turn out: Over the next few weeks, states will continue to relax the restrictions they put in place to fight Covid-19, open stores (especially indoors) and revoke their mask mandates. The public is following suit and welcoming the near end of Covid-19 by going out and engaging in close contact activities with family, friends and strangers, even if they are not yet fully vaccinated. The vaccination campaign is failing to keep up with all of this new social activity, and more people are getting the virus than are being vaccinated.
So the coronavirus is spreading and jumping between all of these at-risk people who are remixing, while at the same time more contagious coronavirus variants are spreading rapidly and driving the wave up even further. (B.1.1.7, the variant that apparently originated in the UK, is now the leading cause of new infections in the US, Walensky said on Wednesday.)
That said, it doesn’t seem like the US as a whole is approaching the worst-case scenario, at least not yet. A recent surge in Covid-19 cases could have reached a plateau. The US still has many new Covid-19 cases every day – almost 500 times the number in Australia after the population was controlled – but it may not get any worse.
Covid-19 cases in the US appear to be plateauing, but that depends on vaccinations outpacing the spread of new variants. Our world in data
The concern is that all of them could change – and quickly – due to the exponential spread, causing infections to grow faster. During the U.S.’s third surge in the fall, it took about a month for the daily incidence to double from about 40,000 to 80,000. However, it only took about two weeks for the number of new cases to double again every day, from 80,000 to 160,000.
This could already happen in Michigan, which has been badly hit by Covid-19 in the past few weeks. The current surge in the state isn’t quite as bad as the previous one, but it is still leading to more hospitalizations and deaths. If it already happens there, it could happen elsewhere.
The middle short-term path: Covid-19 cases are on the rise, but hospitalizations and deaths are not
During the pandemic, Covid-19 deniers have claimed that increases in cases were just “casemic,” meaning cases have increased but hospitalizations and deaths have not, so there was nothing to worry about.
That was nonsense for much of the past year, fueled by a key misunderstanding: Increasing hospital admissions and deaths tend to lag behind the increases as it takes time for people to get sick, end up in hospital, and die after infection.
But something like this could happen now, thanks to the vaccines. So far, the population groups that are more vulnerable to Covid-19 due to their age have received more vaccines. The result is that more than 76 percent of adults 65 and over received at least one dose and more than 57 percent were fully vaccinated (either with the Johnson & Johnson one-shot vaccine or a Moderna two-shot vaccine, or Pfizer). Last year, this age group accounted for around 80 percent of all Covid-19 deaths in the United States.
With a large proportion of those at risk being vaccinated, an increase in Covid-19 cases may not lead to a significant increase in hospital admissions and deaths. Younger people can become infected with the virus, but they won’t show up to the hospital or die at the same rate as older people. The virus would lose the race against the vaccines.
Therefore, the US could still see a fourth surge in some cases. But as Amesh Adalja of the Johns Hopkins Center for Health Security told me, “It will taste different from previous waves” because the vaccines “defeated the virus,” including the variants discovered so far.
This is still speculative.
“I think it’s a little early to say,” said George Mason University epidemiologist Saskia Popescu of this scenario. Reducing a fourth spike to a “case chemistry” still requires action to ensure that vaccines continue to run out quickly, especially for vulnerable populations.
The best short-term scenario: No fourth climb
That scenario – where cases, hospitalizations, and deaths stay stable or continue to decline – depends on policymakers not reopening their states too quickly, the American people continue to follow public health guidelines like social distancing and masking, and adoption of the vaccine improved, or at least maintained the current pace.
In the coming weeks, warmer weather in most parts of the country could help Americans do more outdoors, where the virus is not as easy to spread.
History may not give much cause for optimism. America in general has done a poor job with its political approach and compliance with public regulations throughout the pandemic (hence America’s high death toll compared to many of its developed counterparts). As Popescu put it, “The US really has problems with staying vigilant when the finish line is in sight.”
But the country could do it. If Americans hold out a little longer – maybe just a few weeks – we could suddenly find ourselves in a world where most adults in the US got at least one shot of the vaccine. If we get there and avoid the first scenario on this list, it could result in tens of thousands more of us there to celebrate.
The longer-term scenario is safer – and more hopeful
For all the short-term uncertainty, there is a longer-term scenario that seems very likely: thanks to the vaccines, the US will reach the end of the major outbreaks and summer will be the beginning of our return to normal.
There is a real example that should fill Americans with hope: Israel. Thanks to good planning and flexibility, Israel has fully vaccinated more than 56 percent of its population, including the vast majority of the elderly. This allows him to almost fully reopen his economy as Covid-19 cases drop to levels that have not been seen since the summer of 2020.
Covid-19 cases in Israel show a decline almost to pre-pandemic levels following successful vaccination efforts. Our world in data
That is incredibly encouraging. It shows that the vaccines are working and really are a way out of the pandemic. “It’s there,” said Adalja. “The real data shows what future we will ultimately achieve if everything stays on the right track and we continue to vaccinate.”
The US is well on its way to getting to that point. More than 19 percent of the US population is already fully vaccinated. With more than 3 million doses per day, the country will be able to fully vaccinate the majority of its population in just over a month – and all adults in three months. If this trend continues, the US could reproduce Israel’s squashed curve in just months or even weeks.
Then it will finally happen. We find ourselves at family parties, dinners with friends, and in cinemas with strangers. What was considered too risky months ago will be the normal what we wished for a year.
“I assume that this point will become obvious in retrospect,” Bill Hanage, an epidemiologist at Harvard, told me earlier. “We’ll suddenly find ourselves laughing inside with people we don’t know and whose vaccination status is unknown, and we’ll think, ‘Wow, that would have been inconceivable back then when …'”
There are still great challenges ahead of us. Avoiding the deadliest of the short-term scenarios could save tens of thousands of lives. It will be crucial to ensure that enough people are vaccinated – by both improving access and addressing vaccine hesitation. And it’s a race against time: the likelihood that worse variants will occur increases as the virus continues to spread and mutate.
It’s important to help the rest of the world in their efforts too – not just for humanitarian reasons, but because the coronavirus and its variants could return to the US from other countries.
Still, the happier future now looks to the point in time, not the if. After a year in which our future seems so uncertain, we can now look forward to this breathing space – and it is probably only a matter of time.