Last summer, the coronavirus pandemic exploded in the South even as it retreated from pandemic-battered northern states like New York.
This year, as vaccine hesitancy and refusal solidify in GOP strongholds, a confluence of new factors may place children, adolescents, and young adults living in southern states squarely in the pandemic crosshairs.
COVID-19 transmission in the U.S. is at its lowest since June 2020, and it’s easy to believe that this crisis could end soon. But there are some ominous signs.
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Last year at this time, we also thought things looked good—until we saw a sharp increase in COVID-19 beginning around the July 4 holiday. We hit our lowest point on June 8 at 18,000 cases per day, but by July 1, 2020, that more than doubled to over 40,000 new cases per day. Ultimately, we peaked towards the end of July at over 70,000 new cases daily.
Overwhelmingly, the southern U.S. was the most affected, including states like Louisiana, Alabama, and Mississippi.
Could a summer surge happen again in 2021? Unfortunately, these same southern states have vaccination rates at little more than one-half of some New England and Mid-Atlantic states. But particularly vulnerable are the young adult populations and adolescents and children in the South who appear to represent a large chunk of these least-vaccinated populations.
Now, in addition to not being vaccinated and the fact that they are vulnerable due to their increased exposure to the virus at school, in the workplace, or at entertainment venues, young people also face the prospect of more aggressive virus variants. For example, a May 29 study from Houston Methodist Research Institute found several new variants gaining traction. They included the P.1. variant that emerged in Brazil, where it is associated with high rates of pediatric COVID-19 and possibly childhood deaths, as well as the Delta variant from India. Still another finding is that the B.1.1.7 variant—also known as the U.K. or “Alpha” variant—that now causes most of Houston’s cases has started to acquire a second E484K mutation in its spike protein to make it partially resistant to current vaccines.
The only way to prevent these variants from gaining a foothold is to step up the pace of vaccinating everyone over the age 12 (and hopefully children younger than that by the fall). But in these robust pockets of vaccine resistance, it’s hard to imagine getting anywhere close to full coverage of young people. For example, more than 50 percent of 12- to 17-year-olds are vaccinated (received at least one dose of vaccine) in Massachusetts and Vermont, whereas less than 10 percent of those in this same age group have been vaccinated in Alabama, Louisiana, and Mississippi.
Here’s what might happen if we don’t fully vaccinate the South. First, the number of cases could accelerate in July and August, just as they did last year; NIH Director Francis Collins has recently compared these states to “sitting ducks.” In addition, we might see the new variants rise in frequency and disproportionately affect children, adolescents, and young adults, possibly including a multisystem inflammatory syndrome of children or MIS-C. Some children’s hospitals in the region may already be seeing an acceleration in hospitalizations and ICU admissions. In fact, the CDC just reported on rising hospitalization rates among adolescents this spring.
We are still learning about this virus and its variants, and the overwhelming conclusion so far is that the vaccines we have work against them all. But accelerating vaccination rates in the southern U.S. is the best path to preventing needless illness and hospitalizations, especially among young people.
As ever, this problem has broader implications for the nation. If new variants arising from the southern states are allowed to emerge over the summer, these could accelerate across the rest of the country into the fall. For example, the P.1 variant (and possibly the E484K mutation superimposed on B.1.1.7) appears to be slightly less susceptible to the current vaccines compared to, say, the original lineages, or the B.1.1.7 variant on its own. Regarding the Delta variant, two doses of the mRNA vaccine still appear to work well, whereas a single vaccine dose appears to exhibit reduced efficacy.
We could therefore expect additional so-called breakthrough cases and hospitalizations—even of vaccinated people—into the fall. This is true even in northern and West Coast states that are set to hit the 70-percent-vaccinated-by-July 4 target outlined by the Biden administration.
In this way, high vaccine refusal rates across the South could create a ripple effect to derail COVID-19 control or interruption of virus transmission in the United States.
We must therefore double down on efforts to vaccinate the South; the Biden administration and local governments continue to make myriad efforts along these lines, but we need more. I worry there’s a sense of defeatism or giving up on the South, but this is simply not an option. The nation has to be fully and evenly vaccinated if we are to have any hope of navigating our way out of this epidemic. It’s also the surest way to protect young people in this region, while ensuring that we do not halt all of our hard-fought public health gains nationally.
