Some fully vaccinated Washingtonians are ditching their masks, cases are falling and restaurants this summer could be packed.
In some Washington state ZIP codes, adult vaccination rates for at least one shot have risen well above 80%.
Summer could feel comfortable — perhaps almost normal — but the pandemic isn’t over.
Most scientists say reaching herd immunity — in which the virus can’t readily be transmitted because so many people are protected — is unlikely.
Instead, many think the virus will become endemic: permanent, with occasional flare-ups.
“I don’t think it’s going to go away,” said Dr. Helen Chu, a UW Medicine virologist.
We don’t need to reach herd immunity to return to our pre-COVID lifestyles, said Dr. Jeff Duchin, health officer for Public Health — Seattle & King County. With widespread vaccination and some precautions like better ventilation, the richness of life can return as the virus simmers at a more tolerable level, he said.
While many of the newly vaccinated contemplate a return to normal, health officials and scientists are settling in for the long haul with this disease.
“There have been way too many premature pronouncements that the COVID … pandemic is on its way to obscurity,” Duchin said, during a recent news briefing. “It’s very difficult to predict the future with a new emerging and evolving infection.”
But there are clues that can help divine our path. Here’s a guide to the variables — the unknowns — that local experts say will determine our collective course with this virus.
Vaccine uptake
More vaccinations means more protection for everyone.
And with some 59% of Washingtonians 16 and older already in receipt of at least one shot, we’ve reached a point where state officials say vaccine supply exceeds demand.
But in some areas, vaccination rates are behind despite ample supply. At this point, convincing those who remain unvaccinated requires outreach and public health campaigns.
It’s slower work that could take months, said Janet Baseman, a professor in the Department of Epidemiology at the University of Washington.
“Are we going to have enough people willing to get the vaccine to keep future outbreaks under control?” Baseman said.
Vaccination rates lag in many smaller, rural counties, according to state data. And some urban areas, such as Spokane and Pierce counties, trail in comparison to other population centers.
Ultimately, some researchers think vaccination mandates could be necessary in certain settings.
The University of Washington and Washington State University, for example, are requiring students to receive the vaccine before classes start in the fall.
“I think there should be vaccine mandates to go back to school and to go back to work. There can be medical exemptions, but I don’t think there should be a personal philosophical exemption,” Chu said. “People need to get vaccinated. It’s going to be what prevents transmission.”
How quickly we vaccinate could largely set the course.
Variants
Variants are the virus’ wild card, and experts are closely watching those with concerning characteristics. These versions of the virus are considered more contagious, harmful or likely to slip past vaccine protection than the original version of the coronavirus.
In Washington, the dominant strain of coronavirus is now the variant first identified in the United Kingdom, which is outcompeting other versions of the virus as it spreads.
“It’s a bully. When it comes to a neighborhood, it overtakes it,” said Ali Mokdad, a professor of health metrics sciences at the University of Washington’s Institute for Health Metrics and Evaluation, which produces modeling of the pandemic. This variant is estimated to be 60% more contagious.
Sounds bad, right? From Mokdad’s perspective, actually “it’s the lesser of evils out there.”
All of the available vaccines offer robust protection against this variant. But it’s possible other variants could change that dynamic and send the pandemic in a new direction.
The state is using genomic sequencing to track emerging variants and see if any particular variant surges in proportion, which could indicate it is more transmissible than others or it is evading the vaccine. More than 11% of coronavirus cases in the state were sequenced last month.
If a new vaccine-escaping variant begins to emerge, say next winter, “we’ll be in a much different position,” Mokdad said.
Variants are created through chance viral mutations. More coronavirus cases mean more opportunity for a new version of the virus to spin off and take flight.
Why worldwide action is needed
Perhaps we are afflicted also with an epidemic of myopia.
As coronavirus conditions in the U.S. improve, other parts of the world are suffering and vaccine access remains limited in many countries, particularly those without the wealth to command supply of vaccine.
Getting other countries vaccinated should be paramount, the scientists agreed.
“Let’s think back to the very beginning of the pandemic. What is it about our behavior as a species that allowed this outbreak to spread so quickly,” Baseman said. “It was airplanes, right? This virus was all the way around the world before anybody had a good idea of what was happening.”
The same applies for variants, which are more likely to emerge in places with widespread transmission.
In India, for example, confirmed cases climbed to more than 400,000 each day at times this month and only 3% of the population is fully vaccinated, according to The New York Times. Each case represents a minuscule chance for a new variant.
“Inevitably, a strain that emerges in India under unchecked conditions will emerge in the United States,” Chu said. “For us to be able to deal with this locally, it has to be dealt with globally. You can’t have local control if there are countries with unchecked spread and porous borders.”
Kids, ‘an unvaccinated reservoir’
No matter how fast we vaccinate this summer, a portion of us will almost assuredly remain unvaccinated: younger kids.
“I’m following the pediatric data really closely,” said Chu, who awaits more information on when clinical trials will determine if a vaccine is safe and effective in children 11 years old and younger. The federal Food and Drug Administration gave emergency authorization earlier this month to vaccinate children ages 12 to 15.
The latest science suggests that children can contract the coronavirus, but in general, they don’t get as sick, Chu said. Still, as life potentially returns to a more normal cadence into this fall, children could represent “an unvaccinated reservoir that could transmit to others,” particularly with more transmissible variants circulating.
And some children have compromised immune systems, which puts them more at risk.
Chu hopes vaccines will be available to all school-age kids before the school year begins and social and extracurricular activities pick up.
In general, “when children get coronavirus, they’re not picking it up at school,” Chu said, because precautions are generally strictly enforced. Instead, “they’re getting it at play dates, church camps, at sporting events.”
Vaccine booster shots?
How long vaccine protection will last remains something of a mystery. As more time passes, scientists are growing more confident that protection lasts many months and might persist beyond a year. But booster shots — or even a reformulation of the vaccine — could be necessary.
“Are we going to need a booster? Are we going to need an entirely different vaccine to account for new variants of concern? I don’t know,” Baseman said. “I think there’s a good chance.”
If a variant develops to evade protection, the mRNA vaccines (Pfizer and Moderna) could be adjusted relatively quickly toward protecting against particular strains of coronavirus, Mokdad said.
In that situation, “we’re chasing a moving target and the fact is the virus is always ahead of us,” Mokdad said.
Seasonality and masks
Respiratory viruses, like the one that causes COVID-19, tend to spike during fall and winter, as we saw last year.
“A normal summer doesn’t mean a normal winter,” Mokdad said.
In fall and winter, “people’s behavior changes,” Baseman said. They spend more time inside, where the risk of coronavirus infection increases by many multiples — perhaps 19 times, according to one scientific review.
Baseman said this seasonal pattern could become worrisome if science still lacks clarity on how long immunity lasts and if booster shots are needed, if troublesome new variants have emerged or if younger kids still aren’t authorized for vaccination.
Mokdad predicts: “In winter, we’ll have a surge.”
That could affect holiday plans.
How impactful a surge could become will likely boil down to vaccine coverage, mask use and the characteristics of the dominant variants, Mokdad said.
“If the surge is high by November, yes we will ask people to wear masks, watch their distance, and avoid gathering,” Mokdad said, adding that lockdowns can’t be ruled out if vaccine-escaping variants are circulating.
Mokdad views the recent guidance from the Centers for Disease Control and Prevention saying the vaccinated can mostly forgo masks as confusing to the public and irresponsible.
“Masks are key,” he said.
Things are looking good
Don’t mistake these experts’ sober analysis as cause for despair. Things are looking much better.
“I don’t want to be the public health person who is all doomsday,” Baseman said. “I’m excited about people getting vaccinated.”
They peer into the unknown to prepare.
“It’s quite possible that we’ll get this pandemic under control for the long term,” Duchin said recently, adding that vaccination has us moving in the right direction but not necessarily to the “end game” just yet.
Meantime, get vaccinated, they said.
“Protect yourself,” Mokdad said. “You’re doing your part for your community, your economy, your country.”
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