Why COVID cases are surging in states with high vaccination rates — and what it means for the winter ahead

·7-min read

Coronavirus cases are surging in several U.S. states with relatively high vaccination rates, prompting concern among health officials who had hoped inoculations would help curb the COVID-19 pandemic.

The current uptick — arriving exactly one year after last winter’s massive COVID wave — appears to be the start of a seasonal spike in places with cooler weather that were spared the worst of the initial U.S. Delta surge, which hit undervaccinated Southern states hardest this summer.

Protesters at a rally in Los Angeles, one of therm holding a sign that says,
A protest on Monday against the Los Angeles City Council's COVID-19 vaccine mandate for city employees and contractors. (Mario Tama/Getty Images)

The question now is whether above-average vaccination coverage and continued mitigation measures in states such as New Hampshire, Minnesota, Vermont, Illinois, New Mexico, Rhode Island and Colorado — the seven states that have seen the largest increases in COVID cases during the past two weeks — can keep rising infections from turning into the kind of tsunami of hospitalizations and deaths that plagued the entire country last holiday season, before vaccines were widely available.

If so, it could signal a new, less dangerous phase of the pandemic, particularly in areas with higher levels of immunity.

If not, much of America could soon look like Florida over the summer, when more residents were dying of COVID each day than ever before.

On paper, the latest case numbers seem ominous. In Vermont, which has the highest vaccination rate of any state in the country, new daily cases are up 49 percent in the past two weeks. More than 72 percent of Vermonters have been fully vaccinated, compared with 59 percent nationally.

In neighboring New Hampshire, new daily cases are up 84 percent in the past two weeks (compared with a 7 percent jump over the same period nationwide), despite 63 percent of its population being fully inoculated.

In New Mexico, new daily cases are up 46 percent in the same period, even though 63 percent of its residents are fully vaccinated.

And in neighboring Colorado, new daily cases are up 42 percent, despite 62 percent of its population having received their shots.

A member of the Thornton, Colo., Fire Department, wearing gloves, holds a handful of vials of Johnson & Johnson's COVID-19 vaccine.
A member of the Thornton, Colo., Fire Department distributes doses of the Johnson & Johnson COVID-19 vaccine. (Michael Ciaglo/Getty Images)

Cases are also up significantly in Minnesota (50 percent), Illinois (49 percent), Rhode Island (43 percent), New York (27 percent) and Massachusetts (24 percent) — states where more than 6 in 10 residents are fully vaccinated. In Massachusetts and Rhode Island, more than 70 percent of the population has received all necessary vaccine doses. Even California is starting to see a rise in cases.

Similar spikes started earlier this fall in European countries with corresponding vaccination rates — another worrisome sign for the U.S.

Several factors are driving the sharp increase in cases, health officials say: colder weather forcing people indoors, sometimes without masks; the hypercontagious Delta variant, which can cause breakthrough cases; and waning protection against infection for those who got vaccinated early, especially seniors.

“The first ones to vaccinate [are] going to be the first ones to experience the waning immunity,” Dr. David Scrase, New Mexico’s health and human services secretary, told the New York Times.

(Even so-called natural immunity doesn’t guarantee protection. According to a new study, unvaccinated people who had a recent infection were five times more likely to be reinfected than those who were fully vaccinated and didn’t have a prior infection.)

So far, new daily hospitalization numbers across the affected states have not shot up as rapidly as new daily case numbers, rising anywhere from 4 percent in New Hampshire to 20 percent in New Mexico during the past two weeks. (In New York and Massachusetts, hospitalizations continue to fall after summer Delta bumps.)

If this pattern persists, it will be welcome news — a sign that substantial vaccine coverage (along with new therapeutics and safety measures such as public indoor mask rules) is helping to prevent severe outcomes, and that the virus is becoming the kind of threat that Americans can live with in the long term.

People wear face masks upon entry from Mexico into the United States in San Ysidro, Calif.
People wear face masks upon entry from Mexico into the United States in San Ysidro, Calif., on Monday. (Frederic J. Brown/AFP via Getty Images)

But hospitalizations lag cases by several weeks, and deaths lag hospitalizations. A steep rise in one (and then the other) would suggest that too many Americans still lack the necessary immunity — even in states with relatively high vaccination rates — to keep COVID under control while normal life resumes.

Going forward, boosters and childhood vaccinations are likely to make a big difference — though it’s unclear how much of a difference they’ll make this winter.

At the moment, Americans over the age of 65 and others who consider themselves high risk are eligible for a third dose six months after receiving the Pfizer or Moderna vaccine, according to guidance from the Centers for Disease Control and Prevention. Americans 18 years or older who received the Johnson & Johnson COVID vaccine are eligible two months after receiving the original shot.

Numerous studies have shown that the vaccines become substantially less effective at preventing COVID infections over time and in the face of Delta, and that seniors tend to lose some protection against severe illness as well.

In response, Pfizer said earlier this week that it is seeking emergency use authorization from the U.S. Food and Drug Administration for a COVID-19 vaccine booster for all individuals 18 and older.

At a briefing from health officials on the White House COVID-19 response team Wednesday, Jeff Zients, coordinator of the Biden administration’s coronavirus effort, said that more than 25 million Americans have received a booster, or about 800,000 a day — up about 50 percent from the daily average a month ago.

“That's real progress,” Zients said.

Jeff Zients, the White House's COVID-19 response czar; White House press secretary Jen Psaki; and Dr. Anthony Fauci of the National Institute of Allergy and Infectious Diseases at a press briefing in April.
Jeff Zients, the White House's COVID-19 response czar, with White House press secretary Jen Psaki and Dr. Anthony Fauci of the National Institute of Allergy and Infectious Diseases during a press briefing in April. (Brendan Smialowski/AFP via Getty Images)

Yet all told, more than three-quarters of the 36 million U.S. seniors who are now eligible for a booster still haven’t received one — a huge shortfall that could leave many of them vulnerable this winter (while also contributing to higher-than-necessary hospitalization and death rates in states where vaccine coverage is otherwise robust).

Meanwhile, the CDC authorized Pfizer’s COVID-19 vaccine for children ages 5 to 11 last week, making about 28 million kids eligible for inoculation — the largest remaining bloc of unvaccinated Americans. So far, about 900,000 children in that age group have received their first dose, the White House said Wednesday.

“Parents and families across the country are breathing giant sighs of relief — and we are just getting started,” Zients said.

Still, the vast majority of younger kids simply won’t have time to get fully vaccinated before the holidays, so childhood inoculations are unlikely to immediately alter the trajectory of the pandemic. Unvaccinated children face less risk of serious illness than adults — but they can still transmit the virus to others.

Ultimately, SARS-CoV-2 will become endemic, spreading seasonally around the globe in ever-evolving variations that might make a lot of people feel ill for a few days but would be ultimately much less damaging and deadly because everybody would have some degree of immunity through vaccination or prior infection.

As Americans continue to inch back toward normalcy, and as cases continue to rise even in places where vaccine uptake is strong, this winter will become a test of whether the U.S. is as close to endemicity as many hope — or as far away as others fear.

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