The country missed its chance to stomp out the virus early this year by failing to get vaccinated in high enough numbers, letting Delta run rampant.

 

COVID’S KNOWN UNKNOWNS — Covid will always be with us. And one day, it will become an endemic disease — one that is more predictable and less lethal. But that day won’t come for Americans this fall or winter. We’re still in a pandemic. Covid, on this first day of autumn, is unpredictable and deadly. That’s likely to be the case for months to come. “We are still in the acute phases,” Syra Madad, an infectious disease epidemiologist at Harvard and New York City’s public health system, said. “The only constant variable is change.” But can things get worse? And if so, just how much worse? Even with 55 percent of the U.S. population fully vaccinated, daily Covid caseloads in the U.S. are at their highest levels since last winter. The current surge started rippling across the Southwest and then the Southeast. Now as cases are declining in the South, they are rising in Alaska and the Northeast. The virus is still claiming 2,000 American lives every day — almost exclusively people who didn’t get vaccinated. “It’s migrating like viral lava,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

People walk through ‘In America: Remember,’ a public art installation commemorating all the Americans who have died due to Covid-19, on the National Mall in Washington, D.C. | Drew Angerer/Getty Images

One of the biggest sources of uncertainty is whether winter — with its holiday parties and travel and, in cooler climates, indoor gatherings — will accelerate the current Covid surge. Osterholm predicts that about 50 to 70 million Americans lack Covid immunity from either natural infection or vaccination. That’s plenty of fuel, as he puts it, to keep the fires burning. Then there is the uncertainty of the dance between the vaccine and the virus, including new variants that arise from the vast unvaccinated parts of the globe. Vaccines still seem effective at preventing severe Covid cases. The unsettled debate over boosters is really an unsettled debate about how long that vaccine protection lasts. We know how Covid is transmitted, but we still don’t understand the pattern of cases, Osterholm said. It’s not seasonal like the flu. It’s unclear why West Virginia’s cases are surging now, weeks after cases peaked in the Southeast. Alessandro Sette, an infectious disease expert at the La Jolla Institute for Immunology, told Nightly that he thinks it’s unlikely Covid will evolve to evade vaccine defenses — that would require a lot of mutations and it’s not to the evolutionary advantage of the virus to become more lethal. It is, however, to the virus’s advantage to become more transmissible. Still, vaccinated people have less reason to worry about a breakthrough Covid case becoming fatal. Finally, humans are even more unpredictable than the virus. A winter Covid surge is entirely preventable, said Gigi Gronvall, an immunologist at the Johns Hopkins Center for Health Security. But it’s hard to believe that Americans who sat out the 2020 holiday season will turn down the invitations for Thanksgiving turkey and Christmas eggnog and New Year’s champagne this year. Travel has already bounced back. Nor has the United States adopted frequent, rapid testing, which could stem some spread. The country missed its chance to stomp out the virus early this year by failing to get vaccinated in high enough numbers, letting Delta run rampant. Experts hope that case surges, vaccine mandates and the authorization of a Covid shot for kids will lift the country’s vaccination rate. But it’s clear that vaccine resistance is entrenched in certain segments of the population. About a quarter of Texans said they likely won’t get vaccinated according to a recent poll from The Dallas Morning News and The University of Texas at Tyler. Things could have been different. Last year it seemed like we would be in a better place than we are now, with a disease that is manageable, like the flu. “This winter might mark a different turning point,” said Saskia Popescu, an epidemiologist and biostatician at George Mason University and the University of Arizona. Instead of the end of the pandemic and the start of an endemic, this winter might introduce us to a different, and unsettling, stage. One where we are no longer in lockdown but learning to treat a deadly virus as a normal part of our lives. One, where with any luck, the virus finally runs out of people to infect.