Nov 11, 2021 - Health

America’s COVID future has arrived

Change in COVID-19 <span style="background:#d9840c;padding:2px 5px;border-radius:5px;color:white;">cases</span> per 100k people in the last two weeks
Data: N.Y. Times; Cartogram: Kavya Beheraj/Axios

The U.S. and COVID-19 are settling into a long, but hopefully manageable future together.

The big picture: The worst of the pandemic is likely behind us, but the virus is here to stay. We’re entering a new phase — one in which the country’s overall experience with this virus will be less like having a heart attack, and more like managing a lifelong chronic condition.

  • Experts have been saying for a long time that there’s almost no chance COVID-19 would disappear. Rather, they’ve been expecting it to become endemic — meaning it will stick around, possibly forever, but at more predictable, manageable levels.
  • That transition appears to be happening right now.

By the numbers: The U.S. is averaging about 74,000 new infections per day. That is, unfortunately, a 4% increase over the past two weeks.

  • The CDC defines a “low” rate of COVID transmission, measured at the county level, as an average of fewer than 10 new cases per 100,000 people per day.
  • If you applied the same rubric to states, only four would qualify as having a low rate of transmission. In most of the country — nearly 40 states — the average infection rates are between 10 and 50 new cases per day per 100,000 people.

Experts disagree about what is or isn’t “over.” Former FDA Commissioner Scott Gottlieb has said over the past week that “we're close to the end of the pandemic phase of this virus.”

  • Even if cases increase this winter, he said, the number of vaccinated Americans, plus the fact that infected people will soon have access to two highly effective treatments, will prevent another cascade of death and suffering.
  • The other side: “One too many smart people has told me or said on TV this week that the pandemic is over,” Andy Slavitt, a former Biden adviser on COVID, said on Twitter.

Reality check: Both sides have a point.

  • The end of the pandemic phase isn't going to mean the end of COVID. There will still be rising and falling waves of infection.
  • They’ll probably be worse during colder weather, because people spend more time indoors, and in areas where vaccination rates are low. But they likely won’t be as big, or as deadly, as last winter or this summer.
  • Breakthrough infections will continue to occur, but only a small portion of those cases will be severe.

A lot of that basic framework is already here.

  • Vermont, for example — the most vaccinated state in the U.S. — has seen a significant spike in cases. It’s now averaging just over 50 cases per 100,000 people per day.
  • But its hospitals have not seen a rash of new COVID patients.
  • In the Mountain West, on the other hand, vaccination rates are lower, cases are consistently among the highest in the country, and more of those patients are in the hospital.

Between the lines: About 58% of the U.S. population is fully vaccinated.

  • Mandates and vaccines for kids may help nudge that number up, but it’s otherwise not moving. The vaccination rate increased by less than 1 percentage point last week, according to the CDC. Nationally, we’re a long way from the 70% or higher that experts had hoped to see.
  • Millions more Americans have some immunity because they had COVID, but experts say the protection from a vaccine is more durable.
  • "There is more than enough human wood for this coronavirus forest fire to burn," the University of Minnesota’s Michael Osterholm told NPR. He estimates that 70 million Americans are at risk from the virus.

The bottom line: As long as no new variant emerges — which is a big "if," but there doesn’t seem to be one heading for us right now — we have a pretty good idea of where we’re headed, and that overall landscape isn’t likely to change too dramatically.

Editor's note: This story has been corrected to note that Vermont now averages just over 50 cases per 100,000 people each day, not per capita.

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