A new, widely feared COVID surge appears to be upon us. In some big, largely urban states that were hit hard by the pandemic a year ago, especially Michigan, the daily rates of new cases are roughly as high as they were at the peak of the previous—and worst—surge this past winter. The main reasons for the trend are pretty clear. New and more transmissible variants of the novel coronavirus are becoming dominant across the United States. Republican and Democratic governors and mayors alike are rushing to loosen restrictions on businesses and gatherings. Meanwhile, superspreader events such as Spring Break and college parties have seeded fresh outbreaks in communities that, after a year of widespread restrictions, have grown weary of masks, limited restaurant capacities, and bans.
But another reason is less obvious. In a sense, the current spike in infections is the result of a vaccination strategy that prioritized saving lives.
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If that seems paradoxical, consider what kinds of people account for a growing proportion of cases: otherwise healthy younger workers, many of whom have no choice but to come in close contact with other people. Just as important, most of them either still are not or were not eligible for vaccination until very recently.
Why? Because states were reserving jabs for older and more vulnerable residents, even if that meant allowing the disease to continue running amuck among other groups. “Older people were prioritized because they have poorer outcomes from infection, but we know that younger people contribute more to the spread of COVID-19,” Cindy Prins, a University of Florida epidemiologist, told The Daily Beast.
The consequences of that strategy are perhaps most evident in Michigan. The urban, industrial state of 9.9 million people registered 6,400 new COVID cases a day last week, a rate approaching its worst week so far, back in early December. That number crossed 8,000 over the weekend.
Under Gov. Gretchen Whitmer, a Democrat, Michigan locked down tight last year, undoubtedly saving thousands of lives. But Whitmer—like most governors of both parties—has reopened the state faster than some health experts advised.
Bars, restaurants, and casinos are open. So are schools. Not only are professional sports up and running, Whitmer recently relaxed capacity rules for the Detroit Tigers’ home games. Michigan’s college students—it’s hard to say how many—have undoubtedly been mixing it up at Spring Break destinations. “We have a pretty reckless attitude towards the control of spread,” Irwin Redlener, the founding director of Columbia University’s National Center for Disaster Preparedness, told The Daily Beast.
The resulting crowds have helped to spread new novel coronavirus variants or “lineages”—especially B.1.1.7, which first appeared in the United Kingdom in the fall and has since spread all over the world. B.1.1.7 is more transmissible than older forms of the pathogen owing to a “stickier” spike protein that helps it to grab onto and enter our cells. Some evidence also suggests it is more deadly.
The very same dynamics are at work in New York, another urban, industrial state with a large population of 19.5 million. Just two weeks ago, authorities in Albany counted 8,500 new cases in a single day—the same rate the state registered in early February as its winter surge was finally ebbing.
The spikes in infections could mean long-term health problems for some people. Loss of smell and taste. Fatigue. Cardiac and neurological problems. And some of them will die.
But so far, the surge in cases isn’t leading to a commensurate surge in fatalities. Lately, Michigan has been racking up as many new infections per day as it did back in the winter, but it’s counting just a quarter as many deaths. Likewise, New York is reporting around the same number of new infections per day as it did in February, but only half the deaths.
To be clear, spikes in COVID deaths usually lag spikes in COVID infections by a few weeks. But the spring surge is at least two weeks old and, so far, the death rates in the worst-hit states just aren’t keeping up with the case rates.
Jeffrey Klausner, a USC clinical professor of preventive medicine who previously worked at the U.S. Centers for Disease Control and Prevention, said he’s not surprised. “We must recognize that young people are at low risk of severe complications and death,” he told The Daily Beast. “Most will be asymptomatic or have a very mild, short duration of illness.”
That gap between infections and deaths is, to an extent, part of the plan. As they organized their vaccine-distribution tiers last fall, states made a risky bet.
Following guidance from the U.S. Centers for Disease Control and Prevention, they gambled they could hold off on vaccinating younger workers who, broadly speaking, tend to weather COVID, in order to put more jabs in the arms of those at highest risk of hospitalization and death. That is: seniors and people with serious comorbidities.
“The tradeoff is between SARS-CoV-2 spread and reduced hospitalizations and deaths,” Lawrence Gostin, a Georgetown University global-health expert, told The Daily Beast. “Speeding up vaccination of the young would probably reduce spread a little more, but vaccinating the vulnerable has a powerful impact on the death rate.”
Even as numbers veer in a disturbing direction, that gamble is showing signs of paying off. Nationwide, hospitalizations and deaths are way down compared to their winter highs. The groups at greatest risk are also the groups with the highest vaccination rates. In many states, more than half of residents over 65 are fully vaccinated.
In short, the U.S. has protected its seniors’ lives at the cost of some of its younger workers’ health. A spokesperson for the Michigan Department of Health and Human Services told The Daily Beast, “The state is moving forward with plans to ramp up testing for schools, businesses and nursing homes. We are expanding a mandatory testing protocol for all student athletes. And we have increased our vaccine program over the last couple of weeks, which has helped us reach an historic milestone of four million vaccines in under four months.”
A spokesperson for the New York State Department of Health stressed the importance of wearing a mask and avoiding crowds.
It was the right tradeoff, Klausner said. “Let’s not fuel the panic by getting too concerned about case numbers in young adults. As young people get back to life, cases will increase. That’s OK.”
And now that American seniors are highly vaccinated, states are beginning to get shots in the arms of younger people. Michigan dropped its eligibility age from 65 to 50 starting in mid-March—and then to 16 on Monday. On March 30, New York dropped its minimum age to 30.
Authorities should move even faster to offer jabs to all adults, Edwin Michael, an epidemiologist at the Center for Global Health Infectious Disease Research at the University of South Florida, told The Daily Beast. “Given that seniors and other vulnerable groups have already largely been vaccinated, vaccinations should now be made accessible to all people over the age of 16 years,” he said.
“Yes, we still have supply problems,” Michael added, “but even a random vaccination strategy—i.e., first come, first served—targeting all the rest of the groups will have a big impact on reducing community transmission faster than following the age-based phased approach.”
All that said, the spring surge—even if it may seem unlikely to result in a huge death toll—underscores what health experts have been saying for a while now. While vaccination rates have exceeded anyone’s expectations, the United States could still be months away from achieving population-level “herd” immunity.
A lot of people could get sick or even die between now and then. Even after we beat the current surge, new spikes in cases are possible, especially if new and more dangerous lineages crop up and state and local leaders continue unwinding common sense public-health rules.
The pandemic isn’t over. Until you’re fully vaccinated—and until much more of the population is fully vaccinated—you’re still at risk. Stay home if you can. Wear a mask. Keep your distance.
“We’re at the 10-yard-line,” Eric Bortz, a University of Alaska-Anchorage virologist and public health expert, told The Daily Beast, echoing a metaphor used by Dr. Anthony Fauci. “Not the time to spike the ball.”
