US could be on the cusp of a surge in Covid-19 infections, but vaccinations will limit the damage

The US may be on the cusp of another Covid-19 case surge, one expert says — but the mass vaccination of the most vulnerable Americans is likely to limit its human cost.

“I think we are going to see a surge in the number of infections,” emergency physician Dr. Leana Wen told CNN on Wednesday night. “I think what helps this time though is that the most vulnerable — particularly nursing home residents, people who are older — are now vaccinated. And so we may prevent a spike in hospitalizations and deaths.”

Health officials have repeatedly warned about a potential fourth surge as state leaders eased restrictions and several lifted mask mandates. The first warning sign came when case numbers, after weeks of steep declines, appeared to level off — with the country still averaging tens of thousands of new cases daily. That kind of plateau previously predicted surges, some experts have said.

Cases of the worrying variants — notably the highly contagious B.1.1.7 variant — have also climbed and are set to become the dominant strain by the end of March or early April.

Meanwhile, governors and local leaders have eased restrictions on indoor gatherings, citing fewer Covid-19 cases and more vaccinations. And spring break crowds are gathering in Florida and nationwide air travel numbers are hitting pandemic-era records.

Now, as the country inches closer to 30 million reported infections, cases are rising by more than 10% in 14 states this week compared to last week, according to Johns Hopkins University data — with half of those states seeing a rise of more than 20%.

If Covid-19 cases continue to rise, the mass vaccination of our most vulnerable are likely to limit increases in hospitalizations and deaths. People age 65 and older make up more than 80% of all Covid-19 deaths, according to Centers for Disease Control and Prevention data. Yet 66% of people 65 and older have had at least one vaccine dose, and about 39% are fully vaccinated, which sharply cuts down on the risk of hospitalization and death.

Dr. Wen still has her concerns, though.

“I think we’re going to see an increase in the number of infections, but not necessarily an increase in hospitalizations and deaths, which again is a really good thing,” she told CNN on Thursday. “But we also note that many governors are not going to reimpose restrictions unless we see our hospitals becoming overwhelmed.

“So we could see a situation of a lot more infections outpacing the ability of our vaccines to work and people letting down their guard but not having the restrictions in place to curb it. And I fear that we may lose, as a result, this race of variants versus vaccines.”

In schools, three feet is the new six feet

The CDC is expected to update its physical distancing guidelines for schools from six feet to three feet on Friday, an administration official confirmed to CNN.

US health officials have pointed to a study published last week that showed Massachusetts schools requiring three feet of distance between people had no difference in Covid-19 rates compared to those keeping students six feet apart. All staff and students above second grade were still required to wear masks.

The change to three feet is key to safely reopening schools because most don’t have the space for six feet of distancing with all students present. An analysis of studies on reopenings published last week found that school districts in Indiana, Virginia, and Massachusetts have all adopted a three-foot standard instead of six feet.

Those states “have not seen a surge of cases that you would expect if somehow that protection was less adequate,” education and policy expert John Bailey wrote.

In a Senate hearing Thursday, CDC Director Dr. Rochelle Walensky said that the science on this issue had evolved over time.

“Indeed, because six feet has been such a challenge there, science has leaned in and there are now emerging studies on the question between three feet and six feet,” she told Sen. Susan Collins, Republican of Maine. “This is an urgent issue.”

The World Health Organization has recommended physical distancing in schools of at least one meter, or about 3 feet.

You asked, we answered: Your top questions about Covid-19 and vaccines

Nearly 1 in 8 Americans fully vaccinated

Meanwhile, vaccinations have accelerated as officials race to get as many shots into arms as quickly as possible.

About 75 million Americans have received at least one dose of a Covid-19 vaccine, according to CDC data. And about 41 million people are fully vaccinated, or roughly 12% of the US population.

But challenges — including vaccine hesitancy, disinformation and inequities — remain, and it’s not entirely clear when the US will hit herd immunity — the point at which enough people are protected against the virus to suppress spread.

On Wednesday, both Fauci and Walensky pushed back against questions about herd immunity, saying a lot depended on how quickly Americans take vaccines.

“Let’s just keep pushing to get as many people vaccinated as we possibly can,” Fauci said. “And as we do that, you will see the type of infection, the dynamics of the outbreak, get less and less and less, so whatever that time is — middle of the summer, end of the summer, early fall, we’ll be much, much better off than we are now.”

The US should soon have plenty of vaccines on hand and will need to start persuading reluctant people to get vaccinated, a top Health and Human Services Department official said Thursday.

“We will have, within 90 days, in essence quadrupled our vaccine supply,” Dr. David Kessler, Chief Science Officer for COVID Response at HHS, told a Senate hearing. “I believe that we’re going to be shifting from a supply issue to a demand issue pretty soon.”

In addition, the CDC will soon release more guidance on what people can safely do once they’re fully vaccinated, Walensky said Thursday.

“We’re revisiting what we should do regarding travel for those who are vaccinated and that should be coming forward soon. That’s going to likely be the next step in this regard,” Walensky told a hearing of the Senate Health, Education, Labor and Pensions Committee.

The issue is not what’s safe for those who are vaccinated, but what’s safe for their contacts, she said.

“We are still looking at data regarding whether people who are vaccinated can be asymptomatically infected and potentially transmit to other people,” Walensky said. Doctors note that people who are vaccinated can potentially still breathe in virus and have it living in the nose and throat — and could exhale, cough or sneeze infectious virus onto others.