U.S. coronavirus cases are falling, leading to cautious optimism the nation can make it out of its “bleak winter” while sparking debate from coast to coast over how much to let up on business restrictions, given still-high rates of transmission.
Hospitalizations for COVID-19 are down 25% from two weeks ago, and the daily death toll, while elevated, is starting to flatten.
Newly reported cases have been on a clear downward trajectory for three weeks, producing striking visuals on charts and leading to debate about why.
Tens of millions of Americans have been infected by the virus and recovered, while nearly 30 million people have received at least one dose of an approved vaccine. But while early vaccinations appear to be reducing cases in long-term care facilities, scientists don’t think the U.S. has achieved enough immunity to reach a tipping point in the pandemic in society at large.
A pair of other scenarios are more likely — Americans are hunkering down and following safety guidelines, with the promise of being vaccinated in the coming weeks or months, or the U.S. is seeing a sudden downslope from a crest around the holidays, when Thanksgiving and Christmas gatherings led to spikes despite federal warnings not to travel.
“Even in places like Massachusetts which have seen a very large amount of disease, such that more than one in every 500 residents have been lost to the virus, we don’t think immunity is enough to turn it around,” said William Hanage, an associate professor of epidemiology at the Harvard T. H. Chan School of Public Health. “It is plausible that we are seeing a combination of the other two. Long may it continue.”
Arthur Caplan, director of the division of medical ethics at the New York University Grossman School of Medicine, said there may be some nascent benefit from vaccines and natural immunity, but people don’t seem to be going out as much in the bitter, snowy weather — at least in the Northeast. He added that the transfer of power in Washington may have improved compliance with mask wearing.
“I have a hunch it’s gone up,” he said.
Officials are sure of one thing — they don’t want America to ruin the trend, especially not for a football game.
“Whichever team you’re rooting for and whichever commercial is your favorite, please watch the Super Bowl safely, gathering only virtually or with the people you live with,” said Rochelle Walensky, director of the Centers for Disease Control and Prevention.
The tsk-tsking over parties is based on recent experience. The virus began to crest at the onset of the cold season, as feared, and surged twice after the Thanksgiving and Christmas holidays, peaking at a rolling average of nearly 260,000 cases on Jan. 8.
“COVID-19 cases have declined steadily since hitting a peak on Jan. 8th,” Dr. Walensky said. “Cases are now back to the level we were before Thanksgiving.”
Some parts of the country are easing restrictions they imposed before the holidays on activities such as indoor dining, as local numbers improve, hoping to strike a balance with economic concerns even as some leaders fear they’ll forfeit hard-won gains.
D.C. Mayor Muriel Bowser and most counties in Maryland recently allowed restaurants to serve indoors up to 25% capacity.
Neighboring Montgomery County, Maryland, could restart Feb. 9, though not everyone is on board.
“I feel like I’m in like ‘The Twilight Zone’ here,” At-Large Council member Will Jawando said at a council meeting this week. “We should keep the progress we’ve made.”
“It just seems totally backwards that we would say, ‘We’ve made a couple of weeks of progress, and we’re going to open indoor dining,’” he said.
California Gov. Gavin Newsom recently lifted a ban on outdoor dining as cases eased in Los Angeles County and other parts of the state. He was under enormous pressure from critics who said the outdoor dining ban didn’t seem driven by science.
Yet the decision caused new whiplash, since the situation — while getting better — remains worse than it was when county and state orders took effect.
L.A. County reported an average daily tally of about 4,000 cases when the Nov. 22 order on outdoor dining took effect in late November. The county’s average peaked at about 15,000 cases per day Jan. 8 and around 7,300 by Jan. 20, shortly before the outdoor dining ban was lifted.
To be sure, the national picture remains daunting amid signs of hope.
Newly reported infections are still twice the levels seen during the “Sun Belt surge” over the summer, although increased testing might explain part of the gulf. Fast-spreading variants are popping up in many states, making scientists leery and sparking calls to double-down on physical distancing, mask-wearing and other precautions.
“Not wearing masks and participating in in-person social gatherings have contributed to the variant spread,” Dr. Walensky said. “We must take prevention, intervention seriously. Now is not the time to let our guard down.”
More than 3,000 people are still dying from the disease each day. Yet the toll’s rise is starting to flatten out, signaling a turn for the better.
“While deaths have continued to increase, their pace appears to be slowing,” Dr. Walensky said. “And the recent decline in hospitalizations gives us hope that the number of deaths should start to decrease in the coming weeks.”
About 91,000 people are hospitalized for COVID-19 in the U.S., down from a peak of 132,000 in early January. The number of people hospitalized has decreased every day since Jan. 12, according to COVID Tracking Project data.
Nursing homes, hit early and hard by the pandemic, are seeing far better case numbers.
Trends in long-term care facilities tend to reflect transmission in the broader community.
Plus, at least 1.5 million residents and 1 million staff members have received at least one dose of vaccine after getting federal and state priority in the rollout that began in December.
Nursing homes reported roughly 15,000 cases in the week ending Jan. 24, continuing a steady decline from a peak of 33,600 in the week ending Dec. 20.
Long-term care advocates say vaccination clinics are accelerating the slowdown.
Vaccinated nursing homes saw a 48% decline in new resident cases three weeks after their clinics, compared to a 21% drop at non-vaccinated sites, according to a study by the Center for Health Policy Evaluation in Long Term Care that looked at nearly 800 nursing homes.
The data suggest vaccines not only stave off disease but also reduce transmission. There is only limited data on that among vaccines being studied and approved around the world.
“If verified with additional data, this could expedite the reopening of long term care facilities to visitors, which is vital to residents’ health and wellbeing,” said Dr. David Gifford, chief medical officer for the American Health Care Association. “Given the disproportionate impact COVID-19 has on long-term care residents, we must continue to prioritize vaccinating the elderly in these settings.”