The wave of U.S. coronavirus infections that began in March is subsiding in most of the country, with 42 states and Washington, D.C., reporting lower caseloads for the past two weeks. And the number of Americans fully vaccinated has reached another milestone: 100 million.
Hospitals in hard-hit Michigan and other Upper Midwest states that were flooded with patients in mid-April are discharging more than they're admitting.
The daily average of new infections nationwide has dropped to the lowest level since mid-October. Many cities are rapidly reopening after 14 months of restrictions. The mayor of New York City, Democrat Bill de Blasio, said he plans to have the city fully open by July 1.
The positive trends are not uniform across the map, however. The Pacific Northwest is seeing a surge amid the spread of variants. Oregon is the hottest of the hot spots, and Democratic Gov. Kate Brown declared that the state is moving backward.
The progress has received cautious applause, with public health officials aware that the virus continues to evolve and the vast populations of Brazil, India and the Philippines are enduring catastrophic, late-pandemic surges of infections and death.
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Infectious-disease experts emphasize that the public needs to remain vigilant even as government restrictions on activities are incrementally lifted. The country's seven-day average of newly reported cases is at about 52,000. That's the lowest since Oct. 12, but still many times higher than what public health officials say is necessary if the pandemic is to be declared under control.
Hospitalizations and deaths are also down nationally, although more modestly, as those numbers tend to trail the rate of infections by several weeks. The seven-day average for daily deaths stood Thursday at 686, a high number but about a fifth of the 3,347 daily average recorded Jan. 17 at the peak of the winter surge.
The U.S. death count stood at 575,902 Friday, according to Johns Hopkins University, with the total case count surpassing 32 million.
A number of factors are driving the ebbing of the spring wave, said Natalie Dean, a University of Florida biostatistics expert.
"Things are all very encouraging, even despite the circulation of these variants, because so many people are vaccinated and because there had already been a fair amount of infection, and because we're moving into the spring," she said. "There could be smaller, local flare-ups, but in general things are looking really good as we move into the summer."
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The exceptions can be found mainly in the West. Oregon has shown the sharpest increase in cases, up 42% in the past two weeks, followed by Washington state at 22%, according to a Washington Post analysis of government data. More modest increases have been reported in Arizona, Arkansas, Colorado, New Mexico and Wyoming.
Jeffrey Duchin, health director for Seattle and surrounding King County, where cases have continued climbing, cautioned in an email that it is premature to compose any eulogies for the spring wave.
"I hesitate to prognosticate with certainty about the course of the pandemic," Duchin wrote. "I don't think we fully understand why SARS-CoV-2 does what it does when it does and the vagaries of human behavior."
He noted that in recent weeks, vaccinations have largely protected the most vulnerable population -- the elderly. Now, people age 20-29 outnumber the over-70 patients in hospitals, he said.
In Michigan, the patient count in the Beaumont Health system dropped from about 800 to 540 during the past week, said Nicholas Gilpin, Beaumont's top infectious-disease doctor.
"Everybody's getting a bit of relief right now," Gilpin said. "We were really at our breaking point there about a week ago."
He warned, though, that there remains a large contingent of people vulnerable to infection, and another surge is possible.
"When we're in a period of substantial transmission, such as we are right now, people in the community need to recognize there's a greater-than-ordinary risk," he said. "People need to be more cautious, they need to be sure they're wearing their masks, practicing their social distancing, staying home if they're sick, and getting vaccinated."
Centers for Disease Control and Prevention Director Rochelle Walensky, who just weeks ago expressed alarm about rising infection numbers, this week highlighted the "really hopeful decline" in cases.
One scenario advanced by infectious-disease experts is that the country is entering a warm-weather period in which the virus will struggle to spread, both because of the growing immunity in the population and the environmental conditions that disfavor the spread of respiratory viruses.
But scientists are generally cautious about saying this coronavirus is "seasonal," because it remains novel and has been able to transmit in all conditions -- including last summer, when there was a moderate wave that built in the Sun Belt. Some experts suspect that hot weather drives people indoors and makes them more likely to catch the virus.
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Whether this short-term trend continues to drive down cases in the coming weeks and months depends on multiple factors not easily estimated, including vaccine uptake. The news on that front is mixed.
Nearly 4 in 10 adults are fully vaccinated and more than half have had at least one dose. Older Americans are largely vaccinated. Vaccines that performed well in clinical trials have proved to be just as safe and effective in their full deployment, with post-vaccination "breakthrough infections" rare, as are dangerous allergic reactions.
But vaccination rates have dropped since April 13, when the country hit a peak of 3.4 million daily vaccinations on average. It has dropped since then to 2.7 million. Vaccination is dropping in every state.
At the Wicomico Youth & Civic Center in Salisbury, Md., hundreds of people lined up for shots on the first Monday in April; three weeks later, there were no lines and perhaps one-fifth as many people.
"We got the easy ones out of the way," said Janis Orlowski, chief health care officer for the Association of American Medical Colleges. "Now it's the hard work of getting to the people who are in the middle, who are sort of wishy-washy -- 'Do I want a vaccine or do I not?'"
New Hampshire peaked on vaccinations a week earlier than the country and has dropped by 88%, to an average of fewer than 4,000 shots a day. Alaska, Mississippi and Nevada are all down by almost two-thirds. The Veterans Health Administration reports a decline of more than 60%. The Indian Health Service is down more than 50%, and the Department of Defense more than 40%.
The decline may reflect a combination of factors. The vaccine early adopters, the most enthusiastic and motivated to get their shots, have succeeded. Many people who are willing to get vaccinated are in remote locations or have jobs or caregiving obligations that lack flexibility.
And finally, polls suggest that a large cohort of the unvaccinated population does not intend to get vaccinated.
The near-term future of the pandemic in the U.S. depends in part on whether young people -- typically more mobile and major spreaders of the virus -- seek vaccinations. From the virus's perspective, it doesn't matter how old a person is, because the virus just wants hosts where it can replicate. But individuals calculate their own risk, and young people are significantly less likely to have a severe or fatal case of covid-19 and may feel less motivated to get shots.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said on NBC's "Today" that young people are vulnerable and also need to think about more than just their own interests, because they can spread the virus. If someone focuses solely on personal risk, "you're talking about yourself in a vacuum then."
CRUISES TO RESUME
Cruise lines Friday welcomed the news that they could be sailing again in the U.S. by midsummer, as optimism rises.
Shut down since March 2020, cruise lines were informed that the CDC is committed to resuming sailing and is adjusting some of the rules to speed the process.
The CDC said in a letter to the industry this week that it will let ships cruise without going through practice trips first if 98% of the crew and 95% of the passengers are fully vaccinated.
"The voices of community leaders and the wider cruise community are being heard -- and we are very grateful for that," said Laziza Lambert, spokeswoman for the Cruise Lines International Association.
Thirty-nine percent of the nation's adult population has been fully vaccinated, according to the CDC. More than 55% of adults have received at least one dose, up from 30% a month ago.
However, about 8% of those who have gotten one dose of either the Pfizer or Moderna vaccine have not returned for their second shots, officials said. Fauci said it is important to complete the course to gain maximum protection.
"Make sure you get that second dose," he said at a White House briefing.
Dr. Leana Wen, former Baltimore health commissioner and a visiting professor of health policy at George Washington University, said fully vaccinating about 40% of American adults is a great achievement but not enough.
"The hardest part is ahead of us," she said. "I'm very concerned that we are not going to come anywhere close to reaching herd immunity in 2021."
Wen noted that Fauci has estimated 70% to 85% of the U.S. population needs to be vaccinated to achieve herd immunity. She said better weather and falling case counts will make it harder to reach people who have not been vaccinated yet.
"Those people who are on the fence about getting a vaccine may have less reason to get one now because they don't see coronavirus as an existential crisis anymore," she said.
CDC officials also reported Friday that it was anxiety -- not a problem with the shots -- that caused fainting, dizziness and other reactions reported in 64 people at vaccine clinics in five states in early April. None got seriously ill.
SHOTS FOR CHILDREN
Meanwhile, Pfizer Inc. and BioNTech have submitted a request to the European drug regulator for the approval of their vaccine to be extended to include children 12-15, in a move that could offer younger and less at-risk populations in Europe access to the shot for the first time.
In a statement Friday, the two companies said their submission to the European Medicines Agency is based on an advanced study in more than 2,000 adolescents that showed their vaccine to be safe and effective. The children will continue to be monitored for another two years.
BioNTech and Pfizer have previously requested that their emergency-use authorization with the U.S. Food and Drug Administration be extended to those 12-15.
German Health Minister Jens Spahn welcomed the news: "This can make a further real difference to our vaccine campaign if approval is granted," he said on the sidelines of a visit to a vaccine manufacturing plant in the town of Reinbek.
Most covid-19 vaccines being rolled out worldwide are for adults, who are at higher risk from the coronavirus. But vaccinating children of all ages will be critical to stopping the pandemic.
Children represent about 13% of covid-19 cases documented in the U.S. And while children are far less likely to get seriously ill, at least 268 have died in the U.S. and more than 13,500 have been hospitalized, according to a tally by the American Academy of Pediatrics. That's more than die from the flu in an average year. A small number have also developed a serious inflammatory condition.
Immunizing children might also give authorities more confidence in reopening schools, as getting children to comply with physical distancing and mask-wearing has been challenging.
Other covid-19 vaccine manufacturers including AstraZeneca, Moderna and Johnson & Johnson are also studying whether their shots can safely be used in children.
Information for this article was contributed by Joel Achenbach, Dan Keating, Jacqueline Dupree and Lenny Bernstein of The Washington Post; and by David Koenig, Amy Taxin, Mae Anderson, Frank Jordans and staff members of The Associated Press.