Over the last two weeks (ending April 24), the COVID metrics for the US have either slightly declined or moved sideways.

Hospitalizations

Hospitalizations have vacillated in a narrow range over the last two weeks.

For the most part, the regional variation in hospitalizations we saw earlier has declined.  There are only a handful of states, most notably Michigan, which have seen a significant rise in hospitalizations over the last month.

Fatalities

Notwithstanding CDC Director Rochelle Walensky’s claim to the contrary, the seven-day average for fatalities has continued to move down but at a considerably slower rate (712→669, -6%).¹ COVID related deaths now account for a little less than 10% of the daily US fatalities.

The IHME model has dialed back its fatality projections, which I mentioned in my last post had become completely unrealistic.  Its base case now has fatalities leveling off for about another two weeks and gradually declining to about 100 per day by the end of August.  Its “worst case” scenario now shows a slight increase in fatalities over the next month and then leveling off through their forecast period.

Vaccines

Well over half of the over-18 population has now received at least one dose of the vaccine and 36% are fully vaccinated, a truly remarkable accomplishment.  However, there is some indication that vaccinations may have peaked about two weeks ago.

This is clearly not a supply issue.  The CDC shows that currently 46 million doses have been shipped to states but not administered and with the return of the J&J vaccine, the US is going to be awash in vaccine supply.  I have seen numerous messages that vaccines are available without an appointment and no wait.

I expressed concern about vaccinations slowing down as infections, and particularly fatalities, began to fall in this post.  Aside from those flatly opposed to getting the vaccine, the urgency to be vaccinated is almost certainly going to decline as COVID subsidies.

The good news is that seniors continue get vaccinated at an almost unbelievable rate.  Almost 82% of those over 65 have now had one dose and 68% are fully vaccinated.  We should really begin to see the effect of this on fatalities over the next few weeks.

Testing

The seven-day average for the CDC’s daily “new case” count tracked higher for a few days in this two-week period and then began to ease again, eventually falling back to below 60,000.  This metric has been stuck within ±10,000 of this number for over a month.  The calculated positivity rate over the two weeks was 4.2%, which is as low as it has ever been.

Summary

It appears that the effect of the national vaccination program is gradually overcoming the effect of reduced containment measures and the variants.  How steeply COVID declines from here is largely a function of how well the vaccination program continues to run.  Israel, whose vaccination program is running about 30-60 days ahead of the US, has seen all its metrics steadily improve.

I have been fascinated by the various narratives which have swept through the media during the course of the pandemic which, of course, were supposedly supported by “the science.”  Most have later been proved wrong.  For example, there was a time when there were scores of stories that declared that no immunity was acquired by recovering from COVID.  That, of course, turned out be completely wrong.  It now appears that natural immunity may be just as effective as immunity acquired by vaccination.

The current narrative de jour is that herd immunity will never be reached.  The argument goes that so many people are refusing the vaccine that it is impossible to reach herd immunity.  None of these stories explain how every epidemic in human history has ended without a vaccine.  That is because we have never had the ability to produce a vaccine fast enough to get one out before the epidemic portion of the outbreak had already passed.  Typically, epidemics, especially respiratory ones, have lasted about 12-18 months.  The COVID vaccines are the first vaccines to ever be approved in less than four years.

Some of problem relates to confusing ending the epidemic portion of a disease outbreak with eradication of a disease and the “herd immunity threshold” with the end of the epidemic.  Diseases can be eradicated (or nearly so) with long-term vaccination campaigns by developing herd immunity over generations.  We are clearly not going to eradicate COVID anytime soon.  But it is equally clear, at least to me, that we reached the “herd immunity threshold” in the US sometime around the end of the year.  That is the inflection point at which the disease begins an inexorable decline.  It does not mean that there will not be occasional outbreaks afterwards or that it will be straight line down.  It does, however, mean the epidemic phase of the disease will fade out in a matter of months.  That is what nearly all of the models are now predicting.  This Association of American Medical Colleges article is a good discussion on the real dynamics of herd immunity and the current status.

Note 1 – On April 19, Dr. Walensky stated at a White House briefing, “the seven-day average of daily deaths are now increasing, with six consecutive days of increases.”  This is statement was not true as was clearly shown on the CDC website at the time.  I sent an email to the CDC regarding the discrepancy.  I almost immediately got a response asking me to site the webpage to which I was referring, which I did.  Since then, crickets.