This will be the thirteenth Doc Gumshoe pronouncement on the COVID-19 pandemic. Lucky or unlucky, I have no idea, but let’s get on with it.
To the question “Where are we now?” the answer depends enormously on exactly where, geographically, we are. The differences in the new case and fatality rates in among the different states in the US are nothing short of staggering. For example, the six states with the highest weekly rate of new cases per 100,000 population have new case rates more than ten times higher than the thirteen states with the lowest new case rates. The new case rates in Florida (the highest), Louisiana, Mississippi, Arkansas, Utah, and Nevada range between 100 and nearly 200 cases per 100,000 population, while the new case rates in the thirteen states with the lowest new case rates range between 8 and 11 new cases per 100,000 population. Those fortunate states are South Dakota, Minnesota, Wisconsin, Michigan, Ohio, Pennsylvania, New York, Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire, and Maine (the lowest).
The fatality rates also differ hugely between states. The two states with the highest weekly fatality rates per 100,000 population are Missouri and Arkansas, where the fatality rates are 1.6 per 100,000 and 1.2 per 100,000 respectively. This contrasts enormously with the weekly fatality rates in South Dakota (0.01 per 100,000), Iowa (0.01 per 100,000), New York (0.01 per 100,000), Connecticut (0 per 100,000) and Vermont (0 per 100,000).
The contrast between fatalities last week in the neighboring states of Iowa and Missouri is staggering. There were zero new deaths in Iowa compared with 52 new deaths in Missouri.
A number of factors account for the exceedingly large differences in both the rate of new cases and the rate of fatalities, but the principal factor appears to be the difference in vaccination rates. For example, Vermont leads the US in vaccination rates, with about 66% of its population having been fully vaccinated. And, perhaps as a consequence of having approached the vaccination level associated with herd immunity, Vermont is also among the leaders in the US in terms of the case rate in that state, an average of less than one new case per 100,000 people each day. This compares with an average of 7.8 new cases per day in those states that have vaccinated fewer than half of their residents.
Nationally, states that have fully vaccinated fewer than half of their residents have an average rate of new COVID-19 cases that is three times higher than in the states that have fully vaccinated more than half of their residents.
I need to point out that these new case rates, although higher now than just a few weeks ago, are far lower than during the pandemic’s huge surge in the fall and winter of 2020.
The ten states with the highest percentage of fully vaccinated residents are: Vermont, leading the nation with 66.17% of its population fully vaccinated, followed by Massachusetts (62.33%), Maine (62.2%), Connecticut (61.39%), Rhode Island (59.58%), New Hampshire (57.05%), Maryland (56.86%), New Jersey (56.03%), Washington (55.55%), and New Mexico (55.35%). (Data as of 07/09/21)
At the other end of the scale, the states with the lowest vaccination rates are West Virginia (38.61%), Utah (37.88%), Tennessee (37.77%), Georgia (37.12%), Idaho (36.45%), Louisiana (35.55%), Wyoming (35.55%), Arkansas (34.68%), Mississippi (33.28%), and bringing up the rear, Alabama (33.1%).
A great many factors come into play in trying to account for the differences in vaccination rates, new cases rates, and fatalities. Willingness to be vaccinated versus “vaccine hesitancy” (as it is politely termed – I would prefer “anti-vax stubbornness”) is only one. But there are obviously others – rural populations are much more difficult to get vaccinated, and the economic resources of the different states have a large impact. The unvaccinated population also tends to have a lower educational level, lower economic status, and include a larger proportion of persons of color.
The influence of well-known individuals, whether from the political or religious or popular culture spheres, is also a factor. For example, Michael Andrews, an ace swimmer who is competing in the Olympics in Tokyo, has stated publicly that he will not be vaccinated. How many of his fans back here in the US will go along with him and refuse to be vaccinated? And will some of those fans contract the deadly coronavirus?
We’re seeing a surge in new cases of COVID-19. Why might this be?
When I began writing this piece about ten days ago, I started out by saying that the recent increase in new COVID-19 cases was not getting as much attention as one might suppose. From where Doc Gumshoe sat in careful observation, it appeared that lot more attention was being focused on “getting back to normal.” However, since the recent surge in cases, mostly due to the Delta variant, there have been a number of statements (including from the CDC) that masks will be required indoors in all the parts of the US where the transmission rates are elevated. I’ve seen announcements that in New York, the Metropolitan Opera, having successfully concluded negotiations with stagehands and choristers, is planning to resume a full schedule of performances before (they hope!) well-attended houses. However, to attend performances at the Met, all audience members must provide proof of vaccination and be masked.
That fleeting sense of complacency was no doubt largely due to the “success” of the vaccination effort. By the middle of July, more than 160 million Americans had been fully vaccinated. That’s not bad, but it’s less than 50% of the US population.
Some of the big increase in new cases was no doubt due to a sense of complacency, the idea that “we’re on our way to beating this thing.” Or perhaps in part due to fatigue – “I’m sick and tired of wearing this damned mask.” Or, “I can’t wait to be in contact with my friends.” Or, speaking for myself and my wife, “We’re keenly looking forward to rehearsing and performing with our chorus.” (But we won’t do it unless we can be absolutely certain that every single member is fully vaccinated!)
All of this is going on at the same time as a surge in new cases. The average of new cases per day on June 30th was 11,000. By July 15th it had increased to 26,000 per day, and on July 29th there were almost 52,000 new cases. The current daily average of new cases is rising very steeply.
However, it seems pretty clear at this point that a major part of the increase in new cases is due to the spread of the variants, especially the one labeled the Delta variant. Let’s take a look at the variant picture as a whole.
The coronavirus variants – how big is that threat and what can we do about it?
A variant is a mutation of the virus that in some way benefits the virus and leads to increased survival – of the virus, but certainly not of the host. When viruses reproduce (which they can only do when they have taken residence in a host and appropriated some of the host’s cells to aid in their reproductive process), the process inevitably results in transcription errors. Most of these errors are meaningless. A few are fatal to the virus. But the occasional transcription error leads to a mutation that is beneficial to the virus, such as making it easier for the virus to infect another host. Those mutations form what we call “variants.”
Even though the coronavirus (SARS-CoV-2) arose in China, it seems that most of the first cases of infection in the US due to this virus came from a mutation that emerged in the UK back in December of 2019. That variant, initially designated B.1.1.7, has now been named the Alpha variant.
- Alpha (B.1.1.7). This variant emerged in the UK, and is responsible for most COVID-19 infections in the US. Alpha is the coronavirus strain against which the Pfizer and Moderna vaccines were initially tested and found to be about 95% effective.
- Beta (B.1.351). Emerged in Africa. Mutations in the spike protein help it bind more tightly to human cells and thus make it more infective. Beta also has the E484K mutation, which helps it avoid antibodies at least partially and thus makes it more resistant to vaccines. For example, the Pfizer vaccine is only 72% to 75% effective against Beta. In the US, Beta accounts for only about 0.1% of COVID-19 cases.
- Gamma (P.1) First identified among travelers from Brazil at the beginning of January 2021 during routine screening at an airport in Japan. Shortly after the initial identification of Gamma, it became the dominant strain in Brazil. It has now been identified in at least 37 different countries and in 31 states in the US. Gamma can be almost twice as transmissible as some of the other variants. Like Beta, Gamma contains the N501Y and K417T mutations, both of which give the virus a tighter grasp on human cells. It also carries E484K, a mutation known to help the virus evade certain types of antibodies. Vaccines, therefore, may offer less protection against the Gamma variant than others. In Washington State, Gamma was responsible for 16.3% of new COVID-19 cases.
- Delta (B.171.2) Emerged in India and was first detected in October 2020, but did not become a variant of concern until the surge in India in the spring of 2021. Delta spread globally very fast and is now by far the dominant strain in the US. As of 20 July, 83% of the new COVID-19 cases in the US that had been sequenced to determine the specific infective strain were due to Delta. This is up from about 50% of new cases at the beginning of July. Delta is considered responsible for the recent spike in new cases and fatalities. Delta has been found to be about 64% more transmissible than the Alpha strain, which was already estimated to be about 50% more transmissible than the original wild virus. According to a study in Scotland, the risk of hospital admission was 85% higher in patients with the Delta variant compared with the Alpha variant.
- Lambda (C.37) First identified in Peru in December 2020, and has since been reported in 29 countries. In Peru, 81% of new COVID-19 cases since April 2021 have been associated with Lambda. In Chile, La