Why COVID cases are rising in states with high vaccination rates – and what that means for the coming winter

Coronavirus cases are on the rise in several U.S. states with relatively high vaccination rates, prompting concern among health officials who had hoped inoculations would help curb the COVID-19 pandemic.

The current rise – arriving exactly a year after last winter’s massive COVID wave – appears to be the start of a seasonal rise in cooler weather, spared the worst from the initial US delta rise, which hit the under-vaccinated southern states hardest this summer.

Protesters at a demonstration in Los Angeles, one of the thermes holds a sign that says:

A protest on Monday against the Los Angeles City Council’s COVID-19 vaccine mandate for city employees and contractors. (Mario Tama / Getty Images)

The question now is whether above average vaccination coverage and continued mitigation measures in states such as New Hampshire, Minnesota, Vermont, Illinois, New Mexico, Rhode Island and Colorado – the seven states that have seen the largest increases in COVID cases in the past two weeks – can keep rising infections from becoming the kind of tsunami of hospitalizations and deaths that plagued the entire country last holiday season before vaccines were widely available.

If so, it could signal a new, less dangerous phase of the pandemic, especially in areas with higher levels of immunity.

If not, much of America could soon resemble Florida over the summer, with more residents dying of COVID each day than ever before.

On paper, the latest case figures seem ominous. In Vermont, which has the highest vaccination rate of any state in the state, new daily cases have increased by 49 percent in the past two weeks. More than 72 percent of Vermonters have been fully vaccinated, compared to 59 percent nationwide.

In neighboring New Hampshire, new daily cases have increased by 84 percent in the last two weeks (compared to a jump of 7 percent over the same period nationwide), despite the fact that 63 percent of the population has been fully vaccinated.

In New Mexico, new daily cases have increased by 46 percent in the same period, even though 63 percent of the population is fully vaccinated.

And in neighboring Colorado, new daily cases have increased by 42 percent, despite 62 percent of the population receiving their shots.

A member of Thornton, Colo., Fire Department, wearing gloves, holds a handful of vials of Johnson & Johnson's COVID-19 vaccine.

A member of Thornton, Colo., Fire Department distributes doses of the Johnson & Johnson COVID-19 vaccine. (Michael Ciaglo / Getty Images)

Cases have also risen sharply in Minnesota (50 percent), Illinois (49 percent), Rhode Island (43 percent), New York (27 percent) and Massachusetts (24 percent) – states with more than 6 out of 10 residents full vaccinated. In Massachusetts and Rhode Island, more than 70 percent of the population has received all necessary vaccine doses. Even California is starting to see an increase in cases.

Similar increases started earlier in the fall in European countries with similar vaccination rates – another worrying sign for the United States

Several factors are driving the sharp rise in cases, health officials say: colder weather is forcing people indoors, sometimes without masks; the hypersensitive Delta variant, which can cause breakthrough cases; and diminishing protection against infection for those vaccinated early, especially seniors.

“The first to vaccinate [are] will be the first to experience the declining immunity, ”said Dr. David Scrase, New Mexico’s health and human secretary, to the New York Times.

(Even so-called natural immunity does not guarantee protection. According to a new study, unvaccinated people who had a recent infection were five times more likely to be re-infected than those who were fully vaccinated and did not have a previous infection.)

So far, the number of new daily hospital admissions across the affected states has not increased as fast as new daily cases, and they have increased anywhere from 4 percent in New Hampshire to 20 percent in New Mexico over the past two weeks. (In New York and Massachusetts, hospital admissions continue to fall after this summer’s Delta bump.)

If this pattern continues, it will be welcome news – a sign that significant vaccine coverage (along with new therapeutic agents and safety measures such as public indoor mask rules) is helping to prevent serious outcomes and that the virus is becoming the kind of threat that Americans can live with that in the long run.

People wear face masks as they sail from Mexico to the United States at the San Ysidro Land Port Entry in San Ysidro, California on November 8, 2021. (Frederic J. Brown / AFP via Getty Images)

People wear face masks as they sail from Mexico to the United States at the San Ysidro Land Port Entry in San Ysidro, California, on November 8th. (Frederic J. Brown / AFP via Getty Images)

But hospitalizations lag cases by several weeks, and deaths lag behind hospitalizations. A steep rise in one (and then the other) suggests that too many Americans still lack the necessary immunity – even in states with relatively high vaccination rates – to keep COVID under control while resuming normal life.

Going forward, boosters and childhood vaccinations are likely to make a big difference – though it’s unclear how big a difference they’ll make this winter.

Currently, Americans over the age of 65 and others who consider themselves at high risk are eligible for a third dose six months after receiving the Pfizer or Moderna vaccines, according to guidance from the Centers for Disease Control and Prevention. Americans 18 years of age or older who received the Johnson & Johnson COVID vaccine are eligible two months after receiving the original shot.

Several studies have shown that vaccines become significantly less effective in preventing COVID infections over time and in the light of Delta, and that seniors also tend to lose some protection against serious illness.

In response, Pfizer said earlier this week that it is seeking emergency use permission from the U.S. Food and Drug Administration for a COVID-19 vaccine booster for all persons 18 years and older.

At a briefing by White House health officials’ COVID-19 response team on Wednesday, Jeff Zients, coordinator of the Biden administration’s coronavirus effort, said more than 25 million Americans have received a booster, or about 800,000 a day – an increase of about 50 percent from the daily average a month ago.

“It’s real progress,” Zients said.

Jeff Zients, White House COVID-19 reactionary tsar, speaks as White House Press Secretary Jen Psaki and Dr.  Anthony Fauci of the National Institute of Allergy and Infectious Diseases, listening during a press briefing in the White House, where they talked about a break in the issuance of the Johnson & Johnson Covid-19 vaccine on April 13, 2021 in Washington, DC.  (Brendan Smialowski / AFP via Getty Images)

White House COVID-19 reaction tsar Jeff Zients speaks while White House Press Secretary Jen Psaki and Dr. Anthony Fauci of the National Institute of Allergy and Infectious Diseases listens during a press briefing at the White House in April. (Brendan Smialowski / AFP via Getty Images)

Yet more than three-quarters of the 36 million U.S. seniors now eligible for a booster have still not received one – a large deficit that could make many of them vulnerable this winter (while contributing to higher-than-necessary hospital admissions and death rates in states where vaccine coverage is otherwise robust).

Meanwhile, the CDC approved Pfizer’s COVID-19 vaccine for children ages 5 to 11 last week, making about 28 million children eligible for inoculation – the largest remaining bloc of unvaccinated Americans. So far, about 900,000 children in that age group have received their first dose, the White House said Wednesday.

“Parents and families across the country are breathing great sighs of relief – and we’re just getting started,” Zients said.

Still, the vast majority of younger children simply will not have time to be fully vaccinated before the holidays, so it is unlikely that child vaccinations will immediately change the course of the pandemic. Unvaccinated children have a lower risk of serious illness than adults – but they can still transmit the virus to others.

Eventually, SARS-CoV-2 will become endemic and spread seasonally across the globe in ever-evolving variations that may make many people feel sick for a few days, but in the end would be much less harmful and deadly because everyone would have some degree of immunity through vaccination or previous infection.

As Americans continue to move back to normalcy, and as cases continue to rise, even in places where vaccine intake is strong, this winter will be a test of whether the United States is as close to endemic as many hope – or as far away as others fear.

Explore how the Delta variant correlates with the national political landscape in this Yahoo Immersive Team 3D experience.

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