Public health experts encouraged Americans to continue social distancing and wearing masks at a potentially critical inflection point in the pandemic – one in which highly effective vaccines could provide relief, but fervor to reopen public life could unintentionally spread new Covid-19 variants.
The warnings come the same week Texas and Mississippi flung open the doors to normal social life in their states.
Coronavirus cases have declined across much of the United States since mid-January, a point when the peak of the third wave saw upwards of 4,000 Covid-19 deaths a day. However, cases remain “extremely high” according to data watchers, and could plateau at a point equivalent to the peak of summer 2020.
“Everybody’s focused on the big declines in the number of cases, pretending the plateau is not really substantive, and oblivious to the impact of B117,” a highly transmissible variant first identified in the UK, said Dr Peter Hotez, a vaccine researchers and dean for the national school of tropical medicine at College of Medicine in Houston, Texas.
The potential plateau, highly transmissible new variants, and decision to reopen when vaccines have reached relatively few people “has all the makings of a fourth wave, and gives me a lot of pause for concern,” said Hotez.
On Wednesday, following a crippling winter ice storm Greg Abbott, the Republican governor of Texas, ended all pandemic restrictions and opened the state “100%”. The Republican governor of Mississippi soon followed suit, and lifted mask mandates on all activities except schools and large arenas.
Just 16.3% of the US population has been vaccinated against Covid-19, or roughly 54 million people according to data from the US Centers for Disease Control and Prevention (CDC). In Texas, vaccines have reached just 13.6% of the population.
The moves prompted immediate outcry. Houston’s mayor, Sylvester Turner, called lifting pandemic restrictions a “systemwide state leadership failure”, while Joe Biden called the decision “Neanderthal thinking”.
Nevertheless, intense pressure to reopen businesses has also led many Democratic-led cities and states to begin tiptoeing toward reopening. Massachusetts ended capacity limits in restaurants, though social distancing remains in place, and allowed live music to resume.
New York City is expected to reopen movie theaters this Friday with restrictions. Because New York City is a leading Hollywood market, the move is likely to pressure Los Angeles to do the same. And San Francisco reopened aquariums, fitness centers, indoor dining and museums this week.
The changes happened even as the CDC director, Dr Rochelle Walensky, warned reopening too quickly could threaten “the hard-earned ground we have gained”.
Hotez said people should know, “The message is: vaccines are here, just hang on.” That message was echoed by the CDC, which in draft guidelines this week said fully vaccinated Americans could gather in small groups without masks, while continuing to wear masks and social distance in public.
At the same time, a series of reports from the CDC this week highlighted the ongoing dangers of Covid-19. One CDC report tracked the travel of one of the first patients diagnosed with the B117 variants in the US – and the variant’s ability to spread even with restrictions in place.
The patient in question traveled to the UK for the holidays, encountered a sick relative at a family gathering on Christmas Eve, and developed mild Covid-like symptoms immediately before taking a transatlantic flight back to Dallas, Texas. A few days before the flight, the patient tested negative for Covid-19, but used a low-specificity antigen test.
Once the patient arrived in Dallas, they drove eight hours across the state; stopped five times for food, gas and groceries; they arrived home with worse symptoms, and eventually tested positive for the B117 variant of Covid-19.
In another report issued by the CDC this week, the agency found the rate of Covid-19 among children in Mississippi was probably 10 times worse than the number of reported cases, and had infected perhaps as many as one in six children by last September.
A third report highlighted the association between restaurant dining, mask mandates and Covid-19 transmission. The agency found mask mandates drove down transmission and death rates, while any on-premises restaurant dining tended to drive up transmission and death rates.
To stop the spread of Covid-19 entirely, a nuanced concept called “herd immunity”, scientists believe the US would need to vaccinate the vast majority of adults. Even if vaccine manufacturers are able to produce enough doses to reach all American adults by the end of May, as Biden has promised, vaccine hesitancy, poor distribution and logistical barriers could still derail the immunization campaign.