Infectious Disease

Why are COVID-19 instances falling within the US?

February 18, 2021

5 min read

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Healio interviews

Disclosure:
Adalja, Clancy, Del Rio, Marrazzo and Walensky do not report any relevant financial information.

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CDC director on Wednesday Rochelle Walensky, MD, MPH, reported that COVID-19 cases in the US have decreased for 5 straight weeks and the number of new hospitalizations has steadily decreased since early January.

Deaths had also decreased slightly in the past week, Walensky said, although she warned that the emergence and spread of communicable variants of SARS-CoV-2 “could jeopardize the progress we have made over the past month if we give up our vigilance . ”

Crowd with masks

Experts agreed that the decline in COVID-19 cases in the US is likely due to a combination of factors, including masking.
Source: Adobe Stock

“As cases and hospitalizations continue to move in the right direction, we are still in a very serious pandemic and we still have more cases than before even during the height of last summer,” Walensky said.

Rochelle Walensky

Healio interviewed several infectious disease experts on these and other topics. They agreed that there was no reason for the decline in cases.

Healio: What do you think is driving the current downward trend in the US?

Amesh A. Adalja

Amesh A. Adalja, Senior Scholar, Johns Hopkins Center for Health S.Safety: I think the downward trend is multifactorial and has to do with the fact that travel returns to baseline after an increase in the holiday weeks. People pay more attention to wearing face coverings. There has been a significant proportion of infected people who have immunity and there may also be a small contribution from vaccines.

Cornelius (Neil) J. Clancy

Cornelius (Neil) J. Clancy, MD, Associate Professor of Medicine and Director of the Comprehensive Drug Resistant Pathogen Laboratory and Mycology Program, University of Pittsburgh:: I think it’s multifactorial and involves a combination of behaviors (masking, distancing, restricting travel and masking, getting through the holidays, etc.), seasonality, past cumulative infections, and vaccinations, all of which reduce targets at risk and potentially the number of tests carried out decreases.

Carlos del Rio

Carlos del Rio, MD, FIDSA, Infectious Disease News Member of the editorial board and Executive Associate Dean, Emory University School of Medicine:: The rapid decline in cases in the US is likely due to many causes. The first is that the vacation is over. We had a huge boom because Thanksgiving, Christmas, and New Years were happening in quick succession as the variations unwittingly spread. Now that the holidays are over, people are not gathering as much and transmission has slowed down. We are also more careful; Because of the variations, people wear masks (even double masking). There are tests too. The number of tests has decreased significantly, so fewer cases are detected. After all, there may be an impact on vaccines, but I feel like it’s too early for that.

Jeanne Marrazzo

Jeanne Marrazzo, MD, MPH, FACP, FIDSA, Infectious Disease News Member of the editorial board and director of division of Infectious diseases, University of Alabama at the Birmingham School of Medicine:: I find it complex. We’re far enough away from the super-spreader opportunities that come with the year-end holidays, and I believe the entire community has responded to the December and January spikes by increasing mask use and social distancing in significant amounts Dimensions has escalated. I would like to believe that vaccination efforts have played a role in the last month, especially among the most vulnerable and important (including health care) workers, but it will take some time to see if it does. Finally, I think the level of diagnostic testing will generally decrease as efforts shift to increased vaccination. This could contribute to a decrease in the number of cases that does not necessarily reflect the true underlying disease. Even so, the decline in hospital stays is undeniable, and that is very encouraging.

Healio: Do you fear that people will slack off rather than continue to work, and that states will ease measures further?

Adalja: It is important to remember that we are still in a pandemic and that people must act accordingly. I think it makes sense to relax the restrictions as these measures must be linked to hospital capacity. As hospital admissions decline, relaxation restrictions and guidelines for venues that operate safely in this setting should be the norm.

Clancy: Yes, this will be one of the biggest challenges in the coming weeks and months.

From the river: Very much so. Some states are quick to lift restrictions, while others act as if “business as usual”.

Marrazzo: Yeah, but I think that’s inevitable. We are approaching warmer weather (soon) and as more people are vaccinated they will have a greater sense of personal security, whether it is justified in terms of the duration of immunity of the current vaccines or whether it protects against in-depth vaccinations , new variants arise.

Healio: Will cases in the US rise again because of the variants?

Adalja: It is unclear whether we will see a significant increase with the new variant B.1.1.7 in the USA. It has to be prepared for. However, if we can continue to vaccinate at an increasing rate, we may be able to prevent this from becoming a major problem.

Clancy: Of course nobody knows. I suspect SARS-CoV-2 variants will emerge and circulate, but the disease will not increase as much as it did in winter or in the early stages of the pandemic. There is a chance that COVID-19 will take a back seat, and SARS-CoV-2 and variants reside in the ocean of respiratory viruses that circulate especially during cold months. The disease itself can be very well mitigated, in part due to some immunity from a large section of society.

From the river: Predicting the future is particularly dangerous with this virus. Hopefully not.

Marrazzo: I do not think they would increase if the above measures were continued. That is why it is so important not to let up just yet. We just don’t know how they’re going to affect things.

Healio: Former CDC director Tom Peace, MD, MPH, recently tweeted: “We’re all so tired of COVID. But there is actually a lot of good news. Cases are falling. Vaccines are rolling out steadily, more vaccines are on the way. We just have to stay there a few more months and the worst will be behind us. “Do you agree with this last part?

Adalja: Yes.

Clancy: Yeah I think the worst will be behind us. I also don’t think SARS-CoV-2 or COVID-19 will simply go away completely. As I said, I suspect that it will take a back seat

From the river: One hundred percent. We are in a good position at the moment. Let us continue. The race between vaccines and variants will be crucial.

Marrazzo: I would like. I am still concerned about how new variants might emerge and spread to undermine the excellent effectiveness of the first vaccines. I want to prove myself wrong if I am worried about this.

Healio: What should public health messaging focus on over the next few months?

Adalja: The focus of public health news should be on extolling the benefits of the vaccine and moving from an abstinence-only message to harm reduction, including helping people do risk calculations.

Clancy: We are nearly there. Get vaccinated and keep taking action to limit the spread like we did. Then, as spring unfolds and summer approaches, we could very well be in a place where we can relax the restrictions and resume activities that we have put on hold.

From the river: One of hope, one of encouragement. The people are tired; We cannot go on talking about “darkness and doom”. We need to crouch, but also encourage people to get vaccinated when it’s their turn and look to a better “COVID-free” future.

Marrazzo: Stay on track – we’ve come this far, we’re all vaccinating asap and we won’t be wearing masks forever.

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