The summer surge of U.S. coronavirus cases is ebbing, fueled by sharp drops in Southern states that were hit hard by the highly contagious delta variant.
Although the United States passed the milestone of 700,000 covid-19 deaths Friday, new infections and hospitalizations are declining nationwide.
Hospital admissions nationwide crested above a weekly average of 100,000 in early September and are still at levels not seen since the winter, before vaccines were widely available. New infections plateaued in the first half of September, averaging above 150,000 daily, and are now on track to slip below 100,000.
In places like Tennessee, Alabama, Mississippi and the Carolinas, the latest wave appears to be following a similar pattern of a sharp spike followed by steep plunge similar to that seen in the United Kingdom, India and other places battered by the delta variant.
Epidemiologists say this pattern suggests that the virus is rapidly burning through pockets of unvaccinated people and then hitting a wall.
"In any epidemic wave, you have to have susceptibles," said David Rubin, who monitors coronavirus trends as director of PolicyLab at the Children's Hospital of Philadelphia. "Between increasing vaccination and the sheer number of people infected, they likely reached a level where they don't have any susceptibles left, so the virus is being blocked, and it's one of those disappearing moments."
Experts including Rubin are now paying attention to states in the North and Upper Midwest that are starting to see cases and hospitalizations creep up, which was expected after schools reopened and people gather indoors with few restrictions as chilly weather returns.
Case upticks alone are not cause for alarm if hospitalization spikes do not follow, experts said. Public health leaders have largely accepted that the novel coronavirus will never be vanquished, instead turning into an endemic threat such as the flu and other respiratory viruses.
Experts are hesitant to tout steep declines without any interventions to curb transmission as success stories. It's like suggesting a Category 5 hurricane that barrels through a city in a day is better than a week of heavy rain, they say.
Coronavirus scenes, 10-2-2021
Hospitals across the South and beyond were stretched to their limits and reached all-time highs in admissions, taking a toll on exhausted health care workers. More children have been hospitalized than in any other stage of the pandemic.
Hospitals in Alaska, Idaho and Montana activated crisis standards of care, allowing them to ration health care, one of the worst-case outcomes that had yet to materialize even in the winter wave.
Fairbanks Memorial Hospital said Friday that it activated crisis standards because of a critical shortage of beds, staffing and monoclonal antibody treatments, along with the inability to transfer patients to other facilities. It was the third Alaska hospital to do so.
Nirav Shah, Maine's top public health official, says his hospitals still have enough ventilators, and there are about 50 intensive care unit beds available. But if the system becomes overtaxed with the arrival of flu season and existing routine procedures, there is little leeway to treat more of the unvaccinated, who account for more than 90% of the people in ICUs.
Shah cautioned against relying on monoclonal antibodies, a treatment found to keep people out of hospitals, under such conditions.
"If your backup plan is to be in an ICU bed or get monoclonal antibodies, you are miscalculating," Shah said. "You are doing it wrong."
The U.S. has reported nearly 100,000 new covid deaths since the summer surge started around the Fourth of July, when President Joe Biden celebrated independence from covid-19. More people infected in the latest surge are expected to die in the days and weeks ahead. The country has already hit the grim milestone of losing 1 in 500 residents to the virus.
In Alabama and other states seeing declines in new cases and hospitalizations, experts caution against hasty celebration.
Time and again, people have let their guard down only to see the virus take hold again. And even if that doesn't happen, the falling numbers fail to reflect the reality of the ICU, where people often stay for weeks.
"The lovely graphs are very reassuring," said Jeanne Marrazzo, director of infectious diseases at the University of Alabama at Birmingham's Heersink School of Medicine. "But when you look at toll the ICUs are still bearing, it's really brutal."
People linger there, some of them young, and many suffering from complications like blood clots and antibiotic-resistant infections. Meanwhile, doctors and nurses on regular floors are treating patients who would normally be in ICUs.
About 1% of Alabama's ICU beds are available. The Huntsville Hospital Health System is at "negative seven," according to president and chief operating officer Tracy Doughty, with those seven patients needing ICU care waiting, for now, in the emergency room.
Alabama has the nation's fourth-lowest vaccination rate, with only 43% of the population fully immunized. If those protected people were evenly distributed across the state, they would act as buffers and the virus would have less chance of taking off, experts say. Instead it is ripping through tightknit groups of unvaccinated friends and neighbors who socialize together.
"We've had families who've lost both parents, multiple siblings, husbands and wives, sons and daughters, parents and children," said Tracy Luckhardt, a pulmonary critical care doctor at the University of Alabama at Birmingham.
Republican Gov. Kay Ivey called a special session this week for lawmakers to spend federal coronavirus relief dollars, which she and GOP legislative leaders want to spend on new prisons.
Ivey, who criticized unvaccinated people for the spike in July, has since directed her ire at Biden's plan to compel many employers to require vaccinations or regular testing for workers.
Political polarization poses a barrier to vaccination efforts in Tennessee even as new cases plateau. A Vanderbilt University poll in May found that 94% of Democrats surveyed in Tennessee had been vaccinated against covid-19 or planned to be. The corresponding figure among Republicans was 60%.
In some cases, the issue is that people don't want their friends and neighbors who oppose the vaccine to know they want to get the shots.
"There is pressure in these close-knit communities -- rural communities, as well as urban communities -- where people are willing to vaccinate, but in secret," said Donald Alcendor, an associate professor of microbiology and immunology at Meharry Medical College, a historically Black medical school in Nashville that offers discreet vaccinations, including in people's kitchens.
Infections among children appear to be a driving factor in the nationwide summer wave particularly in states including Tennessee, which reported more than 75,000 cases in school-age children in August and September.
Pfizer recently submitted data to federal regulators demonstrating that its vaccine is safe and effective for children ages 5-12, raising the possibility that those children can become vaccinated by the end of the year.
Widespread childhood vaccination could provide a buffer against future virus waves. But it's by no means a given, with only 17% of eligible adolescents and teenagers vaccinated in Tennessee, compared with more than half nationwide.
On Saturday, Biden issued a statement recognizing the grim milestone of virus deaths, saying "the astonishing death toll is yet another reminder of just how important it is to get vaccinated."
"Hundreds of thousands of families have been spared the unbearable loss that too many Americans have already endured during this pandemic," Biden said. "If you haven't already, please get vaccinated. It can save your life and the lives of those you love. It will help us beat covid-19 and move forward, together, as one nation."
It was not lost on public health officials that many of the recent deaths could have been avoided had more Americans chosen to be vaccinated.
The majority of 100,000 Americans who died in the past 3½ months were unvaccinated even though vaccines were plentiful and available to all adults. The three vaccines in use in the U.S. have been shown to reduce the risk of hospitalization and death.
About 76% of people in the U.S. who are eligible to be vaccinated have gotten at least one dose, and 65% are fully vaccinated, according to The New York Times. The CDC also reported that about 4.7 million fully vaccinated people have received an additional vaccine dose since Aug. 13, the day after the Food and Drug Administration opened up eligibility for third shots for some people with weakened immune systems.
The FDA on Friday scheduled three days of public meetings with its panel of independent vaccine experts for later this month, as the agency prepares to make high-profile decisions on whether to authorize emergency use of the Pfizer-BioNTech vaccine for children ages 5-11 and booster shots for adult recipients of the Moderna and Johnson & Johnson vaccines.
The FDA typically issues its decisions within a few days of advisory committee meetings, during which members discuss safety and efficacy data. The timing of the coming meetings indicates that the agency intends to move quickly to decide whether to authorize both the booster and children's shots.
The committee will meet Oct. 14 and 15 to discuss booster doses, and is tentatively scheduled to discuss Pfizer's pediatric vaccine Oct. 26, the agency said.
The Arizona Supreme Court on Friday agreed to hear an appeal of a lower court ruling that found that new laws banning schools from requiring masks and a series of other measures were unconstitutional.
The high court decision came two days after the justices turned down Republican Attorney General Mark Brnovich's request that the provisions in state budget legislation be allowed to take effect.
The laws will remain blocked until the court hears the case and issues a ruling. The court set arguments for Nov. 2 after agreeing to Brnovich's request to bypass the Court of Appeals.
Maricopa County Superior Court Judge Katherine Cooper issued a ruling Monday blocking the school mask ban and a host of other provisions in the state budget package from taking effect as scheduled Wednesday. She sided with education groups that argued that the bills were packed with policy items unrelated to the budget and violated the state constitution's requirement that subjects be related and expressed in the title of bills.
At least 29 of the state's public school districts issued mask mandates before the laws were set to take effect, and some immediately extended them after Cooper's ruling. The districts account for about a third of the 930,000 Arizona students who attend traditional public district schools.
PARENTS SUE DISTRICT
Four parents are suing the Cobb County School District on behalf of their children, saying the failure of Georgia's second-largest school district to require masks means their students cannot safely attend in-person classes because of their disabilities.
The suit was filed Friday in federal court in Atlanta. It says the 107,000-student suburban Atlanta district is violating federal law, including the Americans with Disabilities Act and Section 504 of the Rehabilitation Act. Those laws govern how students with disabilities are treated in public schools.
"Rather than using the known and available tools to mitigate the threat of covid-19 and protect plaintiffs' access to school services, programs, and activities, the district has acted with deliberate indifference to plaintiffs' rights to inclusion, health, and education," the complaint alleges.
Earlier this week, when the Southern Poverty Law Center threatened the lawsuit on behalf of the students, Cobb district schools told The Atlanta Journal-Constitution that "as is the case with any issue, individual student needs are supported on a student-by-student basis, and we actively encourage any student or family to discuss their needs with their local school."
Information for this article was contributed by Fenit Nirappil, Lindsey Bever, Frances Stead Sellers and Jacqueline Dupree of The Washington Post; by James C. McKinley Jr. and Sharon LaFraniere of The New York Times; and by Bob Christie, Jeff Amy and Mark Thiessen of The Associated Press.