- The Washington Times - Friday, July 30, 2021

U.S. hospitalizations for COVID-19 are averaging over 31,000, a whopping 45% increase over the prior reporting week but still far below the pandemic peak in early January.

The nation as a whole is also seeing over 300 deaths per day from the disease, on average — a sharp increase from roughly 170 earlier this month but far below the 2,000 daily deaths in spring 2020 and 3,000 at the winter apex.

The upshot is a mix of good and bad news as President Biden, governors and mayors try to reel in a delta variant that is making a national July 4 victory lap against the pandemic seem premature.

Metrics remain below the nightmare levels the U.S. saw prior to the vaccine rollout, but they are worsening fast in pockets of the country, raising fears about what’s around the corner and how to salvage the economic recovery sparked by the lifting of prior restrictions.

Cases are rising due to the delta variant, reaching a daily average of 70,000 — the highest level since April and on par with “Sun Belt” surge last summer. But there is debate about whether cases are a key statistic anymore, since nearly half of the country is fully vaccinated.

Despite media prominence given to so-called “breakthrough” infections that strike the vaccinated, public health analysts say that is not a significant worry.

“Asymptomatic breakthrough infections really are not of any medical significance. These are actually evidence of the vaccine working because it is attenuating infection, not allowing it to cause symptoms,” said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.

Experts say the public will need to get used to a new reality in which virus is detected in a lot of people’s noses regardless of vaccination status, so the question is whether the shots still provide protection against severe disease, hospitalization and death, and the extent to which the virus penetrates that shield or reaches the unvaccinated.

“I think we ought to separate people sick enough to be in the hospital from those with mild symptoms,” said William Schaffner, an infectious disease specialist at Vanderbilt University.

Internal documents from the Centers for Disease Control and Prevention show officials are getting skittish about the extent of breakthrough infections in vaccinated persons, even as they continue to highlight the overall effectiveness of the shots.

The document, obtained by The Washington Post, said the delta variant spreads as easily as chickenpox and may cause more and more serious illness in the vaccinated than previously thought. It concludes the “war has changed” and that CDC leadership must retool its messaging, especially given data that say vaccinated persons could transmit the virus as easily as unvaccinated persons.

Those findings were the foundation for a reversal in CDC guidance this week, in which officials said vaccinated persons should once again wear masks indoors in some places. Critics said it was confusing for the public to see the recommendations before the research is published.

State officials and doctors say vaccinated persons can still land in the hospital with COVID-19, especially the elderly or immuno-compromised people, but the overwhelming majority of patients now are unvaccinated.

“It’s really about 98% are either unvaccinated completely or received one dose,” Dr. Schaffner said. “It’s unusual for a vaccinated person to require hospitalization.”

According to the CDC, the level of hospitalization for the past reporting week was 31,148 — higher than the 21,464 reported in the prior week.

It is still 75% lower than the 123,865 reported during the peak week of Jan. 5-Jan. 11, raising hopes that levels of vaccination — while disappointing — will stem the kind of nightmare that upended the country last year.

Even so, poor vaccination rates in parts of the country and the fast-moving delta variant are proving to be a toxic mix.

“The spread is exponential,” said Dr. Catherine O’Neal, a doctor at Louisiana State University, told CNN. “Last year’s variant, that we thought was bad enough, was far less contagious than this variant, and that’s resulting in just an exponential number of patients coming into the hospital.”

Florida has the most hospitalized patients overall, at 7,763, and the most as a share of the population, at 36 per 100,000. That’s fueling debate around the best approach to virus management at this juncture, with Republican Gov. Ron DeSantis saying it is better to leave it to personal choice than revert to 2020-style mandates and mask rules, especially now that people are able to opt for vaccination.

Nevada, Arkansas, Missouri and Louisiana are next on the list of states with the worst rates of hospitalization per population, according to a New York Times tracker. Their vaccination rates trail the nationwide rate of 49%, with Louisiana only at 37%.

Dr. O’Neal said about half of her patients in Louisiana are under age 50. They are “all unvaccinated,” she said.

Elderly patients, especially those over age 80, account for most of the breakthrough cases of the vaccinated who arrive in her ward.

“These are patients that we don’t expect to make great antibodies,” she said. “We don’t expect them to respond to the vaccine.”

The share of Americans who succumb to the disease after testing positive, or case-fatality rate, in the U.S. is 1.8%, according to a Johns Hopkins tracker.

That’s the same rate measured in December, on the cusp of the vaccine rollout. Experts say some high-risk persons likely remain unvaccinated and are driving the rate up even though immunization and new therapies are available to help patients survive.

The U.S. case-fatality rate is better than in Mexico (8.5%), Italy (3%) and Germany (2.4%) and on par with France and Spain.

However, the case-fatality rate is a quirky stat in that the true number of infections in a nation is unknown, so the denominator is higher and the rate of mortality from COVID-19 should be lower and less scary.

Also, comparing nations can be difficult because the mortality rate goes down if a country has rampant spread and a big denominator of reported cases.

The U.S. has lost 186 persons per 100,000 of the population from COVID-19, roughly on par with Mexico but slightly worse than France (166) and far worse than Germany (110) or South Korea (only four), yet better than the U.K. (194) and far better than Brazil (162) and Peru (603).

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