The United States is ending 2021 in a pandemic posture similar to how the nation ended 2020: cases and hospitalizations—while far less this year than last year—are increasing and a new variant first identified on the other side of the globe is threatening to drive even greater surges.
The United States reported nearly 913,000 new cases through Sunday, an increase over the prior week but still below the 1.5 million cases reported during the same week last year, according to data from the Johns Hopkins Coronavirus Resource Center. Hospital admissions last week stood at 68,000, with 16,200 into intensive care units, a slight weekly increase but just half of the number of hospitalizations in late December 2020 when the delta variant was first detected in India.
The current mortality rate, however, is far less than it was in 2020 thanks to vaccinations, said Beth Blauer, associate vice provost of public sector innovation and data lead for the Coronavirus Resource Center. Weekly deaths through Sunday were reported as 8,443—down from more than 19,000 this week in 2020.
"We are not seeing the same level of mortality," Blauer said during a recent online briefing from the Coronavirus Resource Center. "Deaths have decreased by almost 50%. This can be attributed to the mass distribution of safe and effective vaccines globally. Vaccines significantly reduce the risk of severe disease and hospitalization."
But, she cautioned, deaths are a lagging indicator that need to be monitored as new information emerges about omicron, the variant first identified by scientists in South Africa in November that is now found across the United States and the world.
William Moss, the vaccinology lead for the Coronavirus Resource Center, agreed about the benefits of vaccines and shared Blauer's concern about what impact omicron will have on the pandemic's 2022 trajectory.
"A year has passed since Dec. 14, 2020 when Sandra Lindsay, a nurse and director of patient services at the Long Island Jewish Medical Center's ICU, became the first person in the United States to be vaccinated against COVID-19," said Moss, executive director of the International Vaccine Access Center. "In that year we have had more than 200 million people fully vaccinated. That is a remarkable achievement."
But, he cautioned, "it is still only about two-thirds of those eligible over the age of 5. A third of the population still has not been vaccinated. They are in target part responsible for continued transmissions and certainly for hospitalizations."
The delta variant remains the nation's "major problem" and research has shown the vaccine is effective at preventing severe disease and hospitalizations. Still, he added, "we expect the omicron variant to catch up soon in the coming weeks."
Brian Garibaldi, the clinical lead for the Coronavirus Resource Center, provided frontline evidence of the effectiveness of vaccines.
"We are seeing mostly unvaccinated individuals among those hospitalized with COVID-19" at Johns Hopkins Hospital, said Garibaldi, medical director of the Johns Hopkins Biocontainment Unit. "The breakdown is about 70% unvaccinated to 30% vaccinated."
People who are vaccinated and hospitalized share common traits, Garibaldi said.
"They are typically either older or have an underlying health condition that makes it less likely for them to have responded to a COVID-19 vaccine or at higher risk for a bad outcome from COVID," he said. "We are not seeing many patients who are fully vaccinated and boosted getting hospitalized, but there have been a few cases."
Moss cautioned that the nation is still learning about omicron but that early research shows the vaccines are still the best protection against severe disease even though they may be less effective at limiting infection.
"What we're seeing is that vaccine effectiveness against infection is markedly lower against omicron than against prior variants," Moss said. "It was 70-80% against prior variants and is down to about 30% with Omicron."
He added that vaccines are continuing to display impressive protection against severe disease from omicron even while less than the protection offered against delta.
"We are going to see some decrease against severe disease from about 80-90% to about 70%," he said.
Boosters will help increase protection against infection and severe disease but "we may need more frequent booster doses or an omicron-specific booster," Moss said. "Boosters are going to be helpful but not are not going to get us out of the surge that we're going to see in the coming weeks and months with delta and overtaken by omicron."
The public needs to continue to practice masking indoors and in public spaces and other public health measures to avoid overwhelming "our already exhausted and overburdened health care workers," he added.
Blauer sounded a warning that official data from local, state, and federal agencies remains inadequate to accurately provide the best real time intelligence on emerging COVID-19 hot spots.
"The frequency of COVID-19 case reporting continues to stall even in the midst of this new surge," said Blauer, who leads the Pandemic Data Initiative that was started to highlight the problems with public health data. "As of today, we have 37 states and territories that are not releasing daily data."
Due to a hack of the Maryland Department of Health's network, the state has been unable to release data on cases and deaths data critical for determining which communities are facing surges.
"This created a very dangerous situation from a public policy perspective as we're heading into the holidays not knowing what the case activity is," Blauer said. "These hackers took away the ability for us to use data to drive decision making."
Other states, however, have simply chosen not to share enough data needed to mount effective public health responses to limit the spread of COVID-19.
"We are continuing to see limited availability of data," Blauer said. "Many states are not reporting data in a way that we can access it. This is doing to hamstring our ability to monitor what is happening in the United States, particularly around the holidays when we know people are going to be traveling and spending time with friends and family."