Our COVID Future

Spotty Vaccine Coverage and the Delta Variant Will Keep COVID With Us Through the Winter
A boy receives a dose of the Pfizer/BioNTech Covid-19 vaccine at the Clalit Healthcare Services in the Israeli city of Holon near Tel Aviv on June 21, 2021, as Israel begins coronavirus vaccination campaign for 12 to... A boy receives a dose of the Pfizer/BioNTech Covid-19 vaccine at the Clalit Healthcare Services in the Israeli city of Holon near Tel Aviv on June 21, 2021, as Israel begins coronavirus vaccination campaign for 12 to 15-year-olds. - Israel is now urging more 12- to 15-year-olds to be vaccinated, citing new outbreaks attributed to the more infectious Delta variant. (Photo by JACK GUEZ / AFP) (Photo by JACK GUEZ/AFP via Getty Images) MORE LESS

Two stories emerged out of Israel this week which give us a view into the remaining months of 2021 in the United States. There’s nothing special or significant to the stories emerging in Israel. It is simply the most aggressively vaccinated country, using the most effective class (mRNA) of vaccines. Recently Israel had its first week with no COVID fatalities at all since the beginning of the epidemic. In most respects the pandemic is or was truly over in the country. No new fatalities, only a tiny positivity rate in tests, basically all mitigation mandates lifted over the last two weeks. But then starting several days ago there was a new outbreak tied to a group of schools in the north of the country.

Now to be clear, this is an ‘outbreak’ at a much, much smaller magnitude than anything we had seen during the pandemic. It also doesn’t seem to be evading the immunity provided by the Pfizer vaccine any more than expected. But it’s still highly significant and the country is on the verge of bringing back some of the mandates like indoor masking.

The key is the Delta Variant (which first emerged in India). It’s much more contagious than the original virus and hospitalizes a lot more people. It seems to have gotten traction with school children who as a class are not vaccinated. As in the United States no one under age 12 can get the vaccines. But Israel has been more cautious about vaccinating 12 to 16 year olds as well. They’re now rushing to vaccinate as many 12 to 16 year olds as possible before their current supply of vaccines expires in July.

Let me emphasize again that the absolute number of cases is quite low. On Monday there were 125 new cases in the country. But that’s up from recent daily totals in the single digits. Clearly they don’t want to take any chances that it could spread out of control again. But the Delta Variant seems much more virulent and there are still lots of unvaccinated people.

The Delta Variant is already spreading in the US. And there are, as we know, still lots and lots of people who are not vaccinated. Just under half the population nationwide is vaccinated. But that coverage is very unevenly distributed. In the fives states of Mississippi, Alabama, Arkansas, Wyoming and Louisiana less than one-third of the population is vaccinated. Another twelve states have less than 40% of their population vaccinated. Missouri is currently leading the country in new cases and a hospital in Joplin just reopened its COVID ward after closing it down in March. But even in highly vaccinated regions in the Northeast and West Coast at least a third of the population remains unvaccinated in every case.

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And let’s remember that non-vaccination is now entirely a matter of demand or rather choice. There’s no shortage and there’s now really, really little issue of access. Vaccines are available and free in basically every pharmacy in the country and most parts of the country nurses will actually come to your home to give you a vaccine. Children under the age of 12 cannot get vaccinated. A small but non-trivial number of people can’t get vaccinated for specific medical reasons. But overwhelmingly the issue is one of choice. People are either actively refusing vaccination or not taking the time to do it.

In large swathes of the country vaccine resistance has become embedded doesn’t seem to be budging. It seems likely that in the fall we are likely to see another major wave of COVID cases, but one that is much more regionally varied. It won’t be one anywhere near the magnitude of last winter. But it still looks likely to be large and account for tens of thousands of deaths.

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