After enduring a steep, nationwide surge over the holidays — followed by a decline in cases that was just as steep and just as widespread — America has entered a strange new phase of the COVID-19 pandemic.
How strange? Just look at the wildly uneven outbreaks unfolding right now in California, Florida and Michigan.
Nationally, the pace of vaccinations continues to accelerate, with an average of 3 million doses being administered every day. Yet the spread of variants such as B.1.1.7 — a strain that’s more contagious and deadly than earlier versions of the virus — is accelerating too. As a result, cases have started to level off or even inch up nationally, and experts are debating whether a so-called fourth wave is upon us.
It’s a race between the vaccines and the variants, they say.
But the truth is a bit more complicated — and perhaps a bit less scary. Zooming in on California, Florida and Michigan helps explain why.
These big states have some things in common. All three previously experienced large waves of infection. All three have at least partially vaccinated about a third of their residents, with California at 35 percent, Michigan at 31 percent and Florida at 31 percent, in line with the U.S. overall. And all three appear to be rife with variants; nationwide, Florida, Michigan and California currently rank No. 1, No. 2 and No. 6, respectively, in the number of B.1.1.7 cases detected to date.
Yet their COVID-19 outbreaks couldn’t be more different.
On one end of the spectrum — the sunniest end — is California. “California now has the lowest positivity rate in the country,” Democratic Gov. Gavin Newsom tweeted Monday, and he’s right: Just 1 percent of the state’s COVID tests are coming back positive at the moment, half the rate of the next closest state. New cases (current average: 2,700 per day) have fallen to their lowest level since last June, and hospitalizations (current average: 2,500) are lower than they’ve been since last April, at the very start of the pandemic. On Tuesday, Newsom announced that California — which has spent the last few months steadily advancing through a tiered reopening system while keeping its public mask mandate in effect — will “fully” reopen on June 15 if current trends continue.
Florida is closer to the center of the spectrum. There, masks are not mandatory, bars and restaurants have been open for months — and test positivity (9.5 percent) is more than nine times as high as California’s, with a daily case count that’s twice as high in absolute terms (5,500, on average) and nearly four times as high on a per capita basis. Infections are also heading in the wrong direction, rising 20 percent over the last two weeks — just like the U.S. as a whole. Hospitalizations may be starting to tick up as well.
And then there’s Michigan.
The Great Lakes State is currently suffering through the worst COVID outbreak in America. Over the last two weeks, Michigan’s average number of new daily cases has soared by 88 percent, to 6,700, and hospitalizations have risen even more (114 percent). The percentage of residents currently hospitalized in Michigan is five times as high as in California and nearly twice as high as in Florida.
Statewide, hospitalizations have been doubling every 12 to 14 days for the last three weeks, and the absolute increase in hospitalizations over the last week — about 1,000 patients — represents the biggest weekly change since the spring 2020 surge. Unless something changes soon, Michigan is on track to surpass its winter peak for cases and hospitalizations later this month.
So how to account for the enormous differences right now among the COVID outbreaks in California, Florida and Michigan? All three have a relatively high level of variant spread. All three have the same level of vaccination. It doesn’t compute to say the only two factors here — the only two contestants in the race — are variants and vaccines. There’s more going on.
What exactly is going on, however, is harder to unravel. Democrats might credit Newsom’s more cautious approach, citing GOP Florida Gov. Ron DeSantis’s rush to fully reopen indoor drinking and dining late last year — and the spring-break revelry it invited — as the cause of today’s rising case counts. There’s probably some truth to the idea that California’s caution has helped — mask mandates and capacity limits work — but ultimately viruses aren’t partisan.
For instance: Michigan Gov. Gretchen Whitmer is a Democrat who reopened indoor entertainment venues in December and indoor bars and restaurants in February — later than Florida. Her state’s new daily cases per capita are now two and a half times higher than DeSantis’s. The three other states with the most daily COVID cases — New York, New Jersey and Pennsylvania — are all run by Democrats, and many of the states with today’s best positivity numbers (Arizona, Missouri, Arkansas, Indiana) are run by Republicans.
Epidemiologists would go further. They would start by agreeing that reopening always gives the virus an opportunity to spread. But they would also note that now, with pretty much every state approaching full reopening, the key variable is really how prevalent new, more contagious variants have become in particular jurisdictions.
Unfortunately, we don’t have that information.
To be sure, the U.S. Centers for Disease Control and Prevention can tell us that California has detected 873 B.1.1.7 cases, Michigan has detected 1,649 and Florida has detected 3,192. But it can’t tell us how many B.1.1.7 cases each state hasn’t detected — a vastly larger number. As such, the CDC also can’t tell us whether the reason Michigan’s outbreak is worse than Florida’s is that it actually has more undetected B.1.1.7 going around.
In other words, reopening timelines and variant numbers are important, but they’re not the end of the story. Weather probably matters too, both in terms of how it affects the virus and how it affects behavior. (Michigan, it turns out, is a lot colder than Florida, which makes it harder to gather outdoors in March and April.)
Previous waves shape the current situation as well; California experienced a much larger winter surge than Michigan or Florida — a surge amplified by its own homegrown variant — meaning that its population could be benefiting from a higher level of fresh, infection-induced immunity.
And chance is also a major factor — perhaps the major factor. Michigan, it seems, was unlucky enough to encounter B.1.1.7 as indoor school sports were getting underway; spread in prisons surged at the same time. The state’s outbreak spiraled from there.
On the surface, the apparent randomness of this stage of the U.S. pandemic — the fact that no simple formula can explain why the virus is afflicting a state like Michigan while sparing a state like California — seems frightening. Who’s to say that what’s happening in Michigan today won’t happen somewhere else tomorrow?
But in another, deeper sense, today’s uneven pandemic should be taken as a sign of progress — and a source of optimism. “Based on our most recent estimates from CDC surveillance, the B.1.1.7 variant is now the most common lineage circulating in the United States,” CDC Director Rochelle Walensky announced Wednesday. Despite that, cases remain low — lower, on average, than 15 new daily cases per 100,000 people over the past week — in roughly half the states.
Test positivity in many of the states with the highest case counts, meanwhile, is still below 5 percent — see: New York (3.6 percent), Connecticut (4.3 percent), Maryland (4.7 percent), Rhode Island (2.4 percent) and Massachusetts (2.5 percent) — suggesting that the virus might not be as prevalent there as the overall numbers make it seem. While a handful of states are worth worrying over — Pennsylvania, New Jersey and Minnesota, for instance, have both relatively high case counts and positivity — nowhere is spiking like Michigan.
And far from skyrocketing, the national daily case numbers have actually held steady at about 65,000 for the last week, while national hospitalizations have leveled off at about 40,000.
Given all the variables at play, it is of course possible that the U.S. pandemic will take another turn for the worse. Even if roughly half the country already has some degree of immunity through infection or immunization, the other half doesn’t. That’s more than 100 million potential hosts.
Yet the chances are a turn for the worse now wouldn’t be nearly as devastating as America’s previous waves. Every day, the U.S. is vaccinating another 1 percent of its population; eligibility is open to everyone in more than half the states, and the rest should follow by April 19. Hundreds of millions of additional vaccine doses — all of which have proven effective against variants — will be flooding the zone this spring. More than three-quarters of all Americans over 65 have received one shot; nearly 60 percent have been fully vaccinated.
The effect of this protection is already apparent in the data, with emergency room visits and hospitalizations among seniors — previously the most vulnerable age group — continuing to fall nationwide. Today, younger, still-unvaccinated Americans comprise a growing share of reported cases. But that means COVID deaths — down 20 percent over the last two weeks to an average of fewer than 800 a day, the lowest level since October — are unlikely to ever again reach winter’s terrible highs.
And soon younger Americans will be vaccinated too.
In short, America’s overall COVID situation might resemble Florida’s at the moment: uncertain and unsettling. New Michigans may or may not arise in the weeks ahead, in states or communities where variants, vaccine hesitancy, indoor activity, lingering cold weather, lack of prior immunity and plain bad luck conspire to trigger an outbreak, and the response there (and anywhere else that’s suffering) might have to be as asymmetrical as the pandemic itself. Experts have suggested surging vaccines to hot spots or delaying second doses to maximize immunity while minimizing mortality and serious illness in at-risk communities.
As a result, America’s final descent out of the pandemic will be bumpy, just as it was in Israel, where more residents have been vaccinated than anywhere else. But it will be a final descent all the same. The country, it would seem, is heading in California’s direction.
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