‘Zero-Covid is not going to happen’: experts predict a steep rise in US cases this winter

A steep rise in Covid-19 cases in Europe should serve as a warning that the US could also see significant increases in coronavirus cases this winter, particularly in the nation’s colder regions, scientists say.

However, there is more cause for optimism as America enters its second pandemic winter, even in the face of likely rises in cases.

Evidence shows vaccine-conferred protection against hospitalization and death remains high several months after inoculation, vaccines for children older than five can reduce Covid transmission, and new antiviral medications hold the promise of making Covid-19 a treatable disease.

“I do expect to see cases increasing – we’ve started to see this in the last week or so,” said Dr David Dowdy, an associate professor of epidemiology at Johns Hopkins University. “I don’t think what we’re seeing in Europe means we’re in for a huge surge of serious illness and death as we [saw] here in the US,” last winter.

In the last three weeks, new cases have increased in several cold weather states across New England and the midwest. However, vaccines remain roughly 85% effective at preventing hospitalization and death.

“Even if cases go up this winter, we’re very unlikely to see the overcrowded [intensive care units] and morgues of a year ago,” said Dowdy.

Vaccine-conferred immunity against infection may allow cases to rise, he said, but far fewer people will need hospitalization. The vast majority of people who were hospitalized or died from Covid-19 this summer, more than 90% in one CDC study, were not fully vaccinated.

“People can still get Covid, there can still be breakthrough infections, but the great news is if you have been vaccinated you are very much less likely to be hospitalized or have severe infection,” said Rupali Limaye, an associate scientist at Johns Hopkins University and an expert in vaccine communication.

Nevertheless, vaccine distribution is highly uneven across the US. Just 58.6% of the nation is vaccinated, lower than vaccination rates in some European nations now struggling with an increase in Covid-19 cases, such as in Germany and France.

“I’ve been predicting a pretty bad winter wave again, and it looks like it’s starting to happen,” said Dr Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine and co-director of the Texas Children’s hospital’s center for vaccine development.

“There’s just too many unvaccinated and too many partially vaccinated [people]” to stop the “aggressive” Delta variant, Hotez said.

What’s more, even if the impacts of Covid-19 are dampened this winter, there still could be a devastating loss of life. A prediction from among the most respected long-term Covid-19 forecasters in the country found an additional 100,000 people may die between November 2021 and March 2022.

“We see increasing evidence in the northern hemisphere that the expected winter surge has started to unfold,” said Dr Christopher JL Murray, lead modeler at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, as he introduced a new forecast. “Reductions in cases and new infections and hospitalizations have stopped in the US and started to turn around.”

IHME’s projection, which Murray described as “optimistic”, forecast 863,000 cumulative deaths from the pandemic by March 2022. Already, more than 765,000 people in the US have died from Covid-19.

IHME’s worst-case scenario predicts hundreds of thousands more deaths, for more than 1m pandemic deaths by March 2022.

“Many countries in western Europe are even farther ahead of us in the sense that the numbers are going up quite quickly in the places like the Netherlands and Denmark, but also in Germany now and a number of other countries,” said Murray. Nearly two-thirds of the 1.9m new infections globally are on the European continent, the World Health Organization said.

Further, there are few calls and little appetite to reinstate social restrictions. The promise of vaccines that could reduce transmission of Covid-19 prompted local governments around the country to drop social distancing and mask restrictions.

That trend has held even as an emerging body of evidence showed the vaccine’s ability to prevent infection with Covid-19 waned over time, and the focus of vaccine efficacy shifted to the steady protection conferred against hospitalization and death.

The risk of a “fifth wave” and waning immunity has now prompted a call for “booster” shots, or third vaccine doses, for everyone who received mRNA vaccines, those developed by Pfizer or Moderna.

The Food and Drug Administration has already authorized booster doses for people older than 65 or who work in high-risk settings. Everyone older than 18 who received the Johnson & Johnson vaccine is eligible for a second dose, as evidence shows its effectiveness against serious disease may wane over time.

Booster doses are effective at increasing antibody levels, but are not the most effective way to curb transmission of Covid-19. The best way to curb transmission, experts have said repeatedly, is to get new people vaccinated. Experts now widely believe Covid-19 will be endemic and circulate for decades to come, though the severity of infection may wane over many years.

The Covid-19 pandemic may never be “over”, as many conceived early in the pandemic, Dowdy said. “The point is – when can we get this to a point where it’s tolerable to us as a society? And I think we may be closer to that point than we imagine.

“Zero-Covid is not going to happen.”