COVID cases keep falling

The number of new daily COVID-19 cases in the United States has plunged 57% since peaking on Sept 1. Almost as encouraging as the magnitude of the decline is its breadth: Cases have been declining in every region.

Forecasting COVID’s future is extremely difficult, and it’s certainly possible that cases will rise again in the coming weeks. But the geographic breadth of the decline does offer reason for optimism.

Past COVID increases have generally started in one part of the country — like the South this summer or the New York region in early 2020 — and then gone national. Today, there is no regional surge that seems to have the makings of a nationwide surge.

Yes, there are some local hot spots, as has almost always been the case since the pandemic began. Several of the hot spots are in northern parts of the country, like Alaska, Idaho, Montana, North Dakota and a few counties near the Canadian border in New Hampshire and Vermont. This pattern has led to some speculation that the onset of cold weather is causing the increases by moving more activity indoors — and that the entire country will soon experience a rise in caseloads.

That does not seem to be the most likely scenario, however. In most colder regions, including both Canada and the densely populated parts of the northern US, cases are still falling. The biggest problem for Alaska and the Mountain West is probably not the weather; it’s the vaccine scepticism. Idaho is the nation’s least vaccinated state, and several other Western states are only slightly ahead of it.

The CDC tracks a range of COVID forecasting models. On average, the models predict that new daily cases in the US will fall roughly another 20% over the next three weeks.

The bottom line: There is no reason to expect another COVID surge anytime soon, but surges don’t always announce themselves in advance.

When the delta variant began spreading this summer, many people worried that it was both much more contagious than earlier versions of the virus and much more severe. Only one of those two fears seems to be true.

Delta is clearly more contagious, which is the main reason that every metric of the pandemic — cases, hospitalisations and deaths — soared this summer. But a typical COVID case during the delta wave was about as severe as a typical case during the earlier stages of the pandemic. During the wave in late 2020 and early this year, about 1.2% of positive cases led to death; during the delta wave, the share was 1.1%.

Scientific studies trying to answer the severity question more precisely have come to conflicting conclusions. Some have found delta to be more severe than other versions of the virus, and others have found that it is not. Until the research becomes clearer, the best guess may be that delta is modestly more severe, which could explain why hospitalisations and death rates have held steady even as vaccination rates have risen.

“Delta may be a little more serious, but not materially so,” Dr Robert Wachter, chair of the department of medicine at the University of California, San Francisco, said.

This pattern can influence how you think about your day-to-day activities. If you are vaccinated (and boosted, if eligible) and you were comfortable socialising indoors and without a mask last spring, you can probably feel comfortable doing so again, now or soon. Wachter adds: “Some older people or those with medical conditions may want to be sure that everybody else indoors with them is vaccinated before removing their mask.”

Despite all the encouraging news, one shadow still hangs over the US: The pandemic does not need to be nearly as bad it is.

About 1,500 Americans have died of COVID every day over the past week. For older age groups, the virus remains a leading cause of death. And the main reason is that millions of Americans have chosen to remain unvaccinated. Many of them are older and have underlying medical conditions, leaving them vulnerable to severe versions of COVID.

For older people, the effects of vaccination are profound. In late August, near the height of the delta wave, 24 out of every 10,000 unvaccinated Americans 65 and above were hospitalised with COVID symptoms, according to the CDC. Among fully vaccinated Americans 65 and above, the number was 1.5 per 10,000.

Even so, many Americans are saying no to a shot. Among affluent countries, the US is one of the least vaccinated, trailing Canada, Australia, Japan, South Korea, Britain, France, Germany, Italy and others. Less vaccination means more death.

The low vaccination rate in the US is another consequence of the country’s polarised politics and its high levels of socioeconomic inequality. Only 67% of American adults without a four-year college degree have received a shot, compared with 82% of college graduates, according to the most recent Kaiser Family Foundation poll. And only 58% of self-identified Republicans are vaccinated, compared with 90% of Democrats.

It is a triumph of misinformation: Offered a lifesaving vaccine to counteract a highly contagious virus, many Americans are instead choosing to take their chances.

© 2021 The New York Times Company