With coronavirus case rates on the downswing nationally — and especially in California — there’s growing optimism that the highly infectious Delta variant may finally be starting to lose its months-old grip.
Still, COVID-19’s presence, while not as potent as earlier in the year, looms large, especially heading into the fall and winter.
“We seem to have turned a corner in our fight against COVID. But we’ve turned corners before only to run into oncoming trains,” Dr. Robert Wachter, chair of UC San Francisco’s Department of Medicine, said at a recent campus forum. “Part of the challenge for us relates to the fact that Delta is far better at its job of infecting people than the original virus was. So our future will be determined in part by the answer to this question: Is Delta as bad as it gets?”
The even bigger question, though, is what’s the endgame, what’s the path out of the pandemic?
It’s virtually impossible to imagine a scenario in which the coronavirus would be eradicated worldwide, experts say.
“There’s been only one disease that’s a human disease that’s been eradicated, and that is smallpox,” said Dr. Anthony Fauci, the U.S. government’s top infectious disease expert.
It’s also unlikely that the coronavirus will be “eliminated” — meaning there is no year-round transmission of the disease nationwide — any time soon, if ever, Fauci said. It’s doubtful that in the near future, the U.S. will achieve the same sort of victory over COVID-19 as it eventually did with polio, which is no longer diagnosed nationally but is still a threat in other countries.
A more likely situation, at least in the near term, is getting COVID-19 under “control,” meaning “there’s a low level of infection that doesn’t disrupt society in any meaningful way,” Fauci said this week.
Some African countries, for instance, have achieved that level of general protection against malaria.
The United States, however, remains far away from doing the same with the coronavirus.
Fauci has set a goal of fewer than 10,000 new COVID-19 cases a day nationally.
And while the new U.S. case rate has dropped more than 40% since the peak of the Delta surge, daily counts remain nine times above Fauci’s aspirational threshold.
And California, for all its progress, is still classified as having “substantial” community transmission, the second-worst category on the four-tier scale set by the U.S. Centers for Disease Control and Prevention.
Statewide, new daily coronavirus cases have fallen by 66% from the Delta peak: from about 15,000 new cases a day to a little over 5,000 cases a day.
There are still about 1,500 Americans — and about 100 Californians — dying of COVID-19 every day. Those rates are nowhere near the height of the winter surge, but the toll is still devastating to those who’ve lost loved ones.
How do we get control
So how do we get there?
“Obviously, you know what the answer is: It’s vaccination,” Fauci said during a briefing.
Unless vaccination rates improve dramatically, some experts have said, it’s possible the pandemic could still roar back — especially later in the year, when more people are traveling and gathering indoors during the holiday season.
“To avoid the cycle of surges every few months, we do need to see a significant increase in vaccination coverage,” Los Angeles County Public Health Director Barbara Ferrer said last month.
Overall, more than 56% of Americans and 60% of Californians of all ages have been fully vaccinated, according to the CDC.
But there is still a long way to go. Vaccination rates among adolescents, teenagers and younger adults need the most improvement.
Vaccinating more adults will help protect children
With children younger than 12 still not eligible to get vaccinated, there’s increasing data showing that getting more teens and adults inoculated will help protect children from infection.
A study from Sweden cited by CDC Director Dr. Rochelle Walensky examined nearly 2 million people from 800,000 families. The study found that as the number of family members with COVID-19 vaccinations increased, the risk to family members who remained unvaccinated decreased.
“Families with three or more family members vaccinated provided greater than 90% protection for those who were unvaccinated,” Walensky said Wednesday.
Lowering the community transmission levels also protects children. A CDC-led study published in the journal JAMA Pediatrics that looked at the risk of COVID-19 in children during periods of high transmission found “children had similar infection rates compared with adults — confirming that risk in community translates to risk inside the household,” Walensky said.
Currently, only people 12 and older are eligible to be vaccinated. But a decision to authorize the shots for children ages 5 to 11 could come by early November, U.S. Surgeon General Vivek Murthy said during a briefing this week.
An advisory committee to the U.S. Food and Drug Administration will meet Oct. 26 to discuss the topic and then offer recommendations to the agency. The FDA will then decide whether to authorize the vaccine for use on an emergency basis.
A CDC advisory committee will meet Nov. 2 and submit its own recommendations. The agency will then offer its own clinical recommendations to healthcare providers.
That timetable means young children could be partially vaccinated by Thanksgiving and fully protected by Christmas.