More Americans are dying of Covid-19 than at any time during the pandemic, the most complex mass vaccination campaign in history is off to a rocky start, and more transmissible strains of the coronavirus are emergent. January is going to be a bleak month.
The most pessimistic outlook published by the US Centers for Disease Control and Prevention (CDC) predicts up to 438,000 people may be killed by Covid-19 by the end of the month in a staggering upward trend.
However, even in this bleak outlook, epidemiologists said there are still reasons for optimism, buoyed by the power of changing human behavior.
“My hope is this month will be the peak and things will start to look better in February,” said Caitlin Rivers, an assistant professor at Johns Hopkins University whose work focuses on pandemic response. “I don’t think it will be vaccination that will bend the curve. It will be washing your hands and staying home.”
Predictions of a horrific death toll come from the CDC’s “ensemble” forecast, which takes in predictions from three dozen academic centers, all considering different criteria. Ensemble forecasts are known to be more accurate than single forecasts.
It is this ensemble model which shows between 405,000 and 438,000 Americans may be killed by Covid-19 by the end of January. Predictions are made in four-week increments.
Forecasting further into the future is considered unreliable, because the pandemic can change course so quickly. For example, majorities of Americans across the political spectrum are changing their behaviors to wear masks “every time” they leave the house, according to a recent tracking poll from the Kaiser Family Foundation.
But growing discontent could undermine these improvements. In a counter example, some restaurants are breaking indoor dining bans in defiance of government regulations, arguing they cannot survive another lockdown. The CDC considers indoor dining “particularly high risk”.
Further, a mass vaccination campaign now underway holds the promise of altering the pandemic, though it has stumbled. The vaccination campaign is not likely reflected in existing forecasts, because only about 3% of the population has been vaccinated.
US officials had planned to vaccinate 20 million people before the end of 2020, a goal they have since walked back. To date, only about 9 million people have been vaccinated, representing about one-third of all vaccine doses distributed.
Experts attribute this failure to a disengaged White House which pushed vaccine planning to states, a lack of timely federal funds, and failure to conduct public education campaigns to combat vaccine hesitancy. These failures have led to wide discrepancies between states.
The differences are, “not a red versus blue state thing,” Dr Ashish K Jha, dean of the Brown University School of Public Health, said on Twitter. “It’s a lack of federal leadership thing.”
Again, we’ve turned pandemic response into state by state effort
And we see large gaps in how states are doing
The Dakotas, West Virginia each vaccinated >5% of their population
Alabama, GA, MS each under 2%
Not Red vs Blue state thing
Its a lack of federal leadership thing
— Ashish K. Jha, MD, MPH (@ashishkjha) January 12, 2021
Herd immunity, likely requiring near-universal vaccine uptake among US adults, is seen as the ultimate goal of the vaccination campaign. But a tipping point, when the vaccine has observable positive effect, is likely to come earlier. If the Biden-Harris administration can successfully speed up vaccinations, it is possible a reduction in deaths could be the first positive outcome of the vaccination campaign.
“We will likely see the positive effects of the vaccination campaign in deaths before new cases,” said Rivers. That is because, “we are specifically targeting people who are at highest risk of severe illness” for vaccination.
The Biden-Harris administration is also likely to have more vaccines at their disposal. Janssen Pharmaceuticals is expected to report clinical trial data at the end of January. That data could lead to emergency authorization.
Further, a vaccine candidate developed by AstraZeneca and Oxford University which is already in use in the UK is expected to report trial data in February. If it is favorable, that could bring two more vaccines online in the US.
The emergence of new, highly transmissible Covid-19 variants is likely to strain these optimistic developments. The B117 variant discovered in the UK is thought to be up to 70% more transmissible, and has been in the US perhaps as early as October. That will require even greater adherence to social distancing measures.
“It’s very early days in the US, but we should expect this to be the dominant variant in certain areas of the US (eg, CA) within the next 6-8 weeks (late February/early March),” said Professor Kristian G Andersen, a professor of immunology at Scripps Research Institute on Twitter.
While there are 72 lab-confirmed cases of B117 in the US according to the CDC, the true prevalence is unknown. To find that out, the US would need to have a systematic genomic sequencing surveillance program. That is not happening. And B117 is not the only variant of concern.
“I’m also quite worried about B1351,” said Rivers. “There is early evidence it is more transmissible [than dominant strains] and we’re looking for that one even less than B117,” she said.
The future of Covid-19 outbreaks in the long-term is difficult to predict. The majority of scientists believe Covid-19 will not be eliminated – right now it is too widespread and transmissible. However, several factors could influence the severity of future outbreaks.
That includes unknowns, such as whether infection by other coronaviruses confers immunity or partial immunity to Covid-19, the length of time vaccines protect people against the coronavirus, and seasonal variations of the virus.
Those unknowns may require, “prolonged or intermittent social distancing … into 2022.”