Medical Examiner

What’s Going to Happen With COVID Cases Next?

Vaccines aren’t yet stopping us from another surge. Here’s what might.

Full tables of diners inside a restaurant with floor-to-ceiling windows overlooking the Hudson River and the New York City skyline
Indoor dining at the restaurant Molos in Weehawken, New Jersey, on Feb. 6. Kena Betancur/AFP via Getty Images

At the end of last week, if you opened up a coronavirus tracker, you might have noticed that the U.S. national 14-day average case rates appeared pretty flat. After a roller coaster of a fall, in which they were mostly going up, and then a surge in January after the holidays, they’d gone down considerably, and then appeared to be leveling off. But rates were still pretty high: about 59,000 new cases per day, much higher than the 35,000 new cases per day we saw in September or the 21,000 we saw in mid-June. The relative low was also short-lived. Now, even as nearly 3 million doses of vaccines go into arms each day, rates of cases are climbing again, up 19 percent over the last 14 days.

Advertisement
Advertisement
Advertisement
Advertisement

As with many facets of the pandemic, this was very preventable. “We have seen that as soon as the vaccine was announced and cases were on the decline, a lot of states made the decision to open back up,” says Matthew Fox, an epidemiologist at Boston University. “A better decision would’ve been to wait.” Angela Rasmussen, a virologist at the Georgetown Center for Global Health Science and Security, agrees. “It’s a bad sign,” she says. “Part of me feels like, here we go again.” But even though it’s a bad time to willy-nilly indoor dine and workout with a group, there’s also good reason to hope that we’re not still stuck on the same roller coaster that we have been for the past year.

Advertisement

Though cases are worrisome, the national death rate is still declining, down 26 percent over the last 14 days. This is because a lot of the current transmission is coming from younger adults, says Rasmussen. Though more and more states are expanding eligibility, people under 50 are not yet eligible for vaccinations in many states, unless they qualify for health or job reasons, making them more vulnerable to infection. In Florida for example, a third of hospitalized cases are from people under 45. It might have once seemed like it would be enough to get to a point where older people were protected, and the virus was no longer threatening to overwhelm hospitals and forcing doctors to think about rationing care. Now we know that it’s not enough to simply “flatten the curve”: While young people are more likely to have milder symptoms, they can still suffer enduring, debilitating effects, like the chronic fatigue, blood clots, and memory problems of “long COVID.” Still, cases shifting away from older people is good news.

Advertisement
Advertisement
Advertisement

With vaccines, we’re better prepared than ever to reduce spread. “They’re the only thing that’s really gone right during this whole pandemic, and people should get a vaccine as soon as it’s available to them,” says Rasmussen. “That’s the ticket out of this.” Not only did we get vaccines relatively quickly—given that they typically take years to develop—the data that we continue to get about them is excellent. Recently released data based on following trial participants in the real world show both the Pfizer and Moderna vaccines yield a 90 percent reduction in all COVID infections—including asymptomatic ones. And while we don’t yet have vaccines for people under 16, Pfizer shared Wednesday that its shot is “extremely effective” in adolescents, according to a report in the New York Times. Even the variants aren’t likely to outfox vaccines: If future variants can infect vaccinated people (a big if), they likely won’t get as sick as unvaccinated people, explains Rasmussen. An infection in a vaccinated person might tend to look more like the common cold.

Advertisement

Still, as cases creep up again, we’re at something of an inflection point where we can collectively decide just how bumpy our exit from the pandemic will be. And while Rasmussen and Fox were generally optimistic about the future, both spoke with urgency about the present. “We need to get transmission down now,” says Rasmussen. “We need to stop these new surges in their tracks.” Fox agrees: “Slowing down the process of reopening until we have a greater percentage of the population vaccinated would be a wise move.” That’s because whether we can get case rates down in the short term will help determine the trajectory of the next few months to a year. More cases now just inevitably fuel more cases later. “Everything you do now pays off greater over the longer term,” explains Fox. This means continuing to follow health guidance to wear masks and distance, except for activities that are either essential or outdoors, unless you’re fully vaccinated. It won’t be forever; just a couple of months will make a big difference, Rasmussen expects.

Advertisement
Advertisement
Advertisement

What exactly that trajectory looks like over the next six months to a year depends on a few other factors, too: how many adults choose to get vaccinated, how many kids get vaccinated (when those vaccines are available), and whether the variants evolve to become more concerning than they are right now. “A big change in any one of those could lead to big changes” in case rates, says Fox.

Given all these unknowns, what kind of case rates should we be looking for to tell us it’s OK to resume our regular lives? It’s not enough for case rates to be flat. It’s not enough for them to be decreasing. They have to be low. It might be tempting to see a dropping line or even a flat one as a relief and a reason to loosen up. But 59,000 new cases a day—the relative low point at which things had “settled” last week—means 59,000 new people got COVID each day. That’s tens of thousands of people, each with a chance of being personally affected by the virus. But also, that’s tens of thousands of people who could host a new variant, spread it to others, and keep us all living carefully and anxiously even longer.

Advertisement