People are getting vaccinated, but it’s not happening quickly enough. Case counts are dropping fast, but a near-record number of people are still sick. Do we have reason for optimism? Or could optimism still get us in trouble?
Alexis Madrigal and Robinson Meyer, staff writers and co-founders of the COVID Tracking Project at The Atlantic, join James Hamblin and Maeve Higgins this week to discuss. Listen to their conversation here:
What follows is a transcript of the episode, edited and condensed for clarity:
James Hamblin: With vaccines rolling out and case numbers going down, there’s good news in the air. Are we at the peak nationally, in terms of cases and hospitalizations?
Alexis Madrigal: I’ll leave it to Rob to put in the caveats. I feel remarkably optimistic right now, at least for the next month or two. The numbers are really dropping. We’re seeing the lowest case numbers that we’ve seen since November and December. We’re seeing hospitalizations way off their peak and dropping really rapidly. We think deaths are going to have a different path, [given] the lag time between when somebody dies and when it’s reported. I think it could be some weeks before we really start to see deaths really come down. But those things have basically already happened by this point.
Obviously, I’m sure the variants seem like this big question mark. But the thing that isn’t a question mark is that there’s been a lot of vaccinations of older people, particularly in the long-term-care facilities, which we think make up 40 to 50 percent of the deaths. And so those two things combined—the falling cases and [having] so many older folks vaccinated—has made me feel pretty good.
Maeve Higgins: Rob, I read your piece, and this line, really, it’s been haunting me: “The allure of vaccination is beginning to stymie mitigation policy in some places.” That’s like getting a cut and hearing the nurse is on the way, so you remove the bandages and let it bleed. Can you explain this?
Robinson Meyer: Yeah. So Arizona has basically been an epicenter twice: It was one of the worst states during the summer surge, and it was one of the worst states during this current surge. But the governor, Doug Ducey, basically refused to put in any of the public-health measures that he put in in the summer, which did seem to play a role in successfully mitigating the summer surge. He refused to put them in this time, because he said there’s a vaccine on the way, and the vaccine is the true end to this pandemic. So it doesn’t make sense to do anything else, basically.
We’ve seen governors and mayors from both parties loosening the measures before cases have fallen. Here in D.C., indoor dining is being allowed again. You can eat indoors now in Baltimore, in Chicago, and in all of Michigan. We’re seeing a general loosening of measures. And the trajectories are moving in the right direction, but the overall levels of illness and infection are still pretty high. There’s still more than 100,000 people hospitalized with COVID in the country right now. That’s more than there ever were over the summer.
But the trajectories are really positive. They’re changing really quickly. You can say the trajectories are what matter because hospitalizations are dropping so quickly that we’re going to be back to an encouraging level soon. The problem is that “soon” is still two, three, or four weeks away. In terms of whether we just saw the peak of hospitalizations in the pandemic, period, I think there’s still a big question about whether basically we have time. If you look at the vaccination schedules we expect right now, and barring the arrival of another vaccine, the question is, do we have time for another surge?
Madrigal: I’m sure I’ll feel regretful about saying this: I would be stunned if we saw a surge at the same level, unless things turn around really soon. If we follow the pattern of previous surges—which maybe we won’t; there’s question marks about these variants—it’s not like we’ve seen major metro areas have a surge and then three weeks later have another surge. That’s not how it has worked. And at this point, there were so many places that were hit hard in the fall and winter that it would take really different behavior at a population level to see things get really bad again in the next month or two.
And during that time is when we’re expecting these vaccines to roll out to people who are 70-plus in fairly large numbers. At a million a day, you’re talking about vaccinating another 30 million people or so. That’s going to be a lot of the deaths. And so even if you were to see some other kind of surge, you’d be in better shape there in terms of the hospital system. Hospital workers will, by and large, be vaccinated.
The chance that we have passed the very worst is extremely high, in my view. I’m optimistic about the direction, but the shape of the tail of this is something that I don’t think we have a firm fix on yet.
Higgins: Speaking of the new variants, I’m in Ireland at the moment, and what we’re calling the “U.K. strain” has totally taken over our country. The prime minister here said it’s spreading at a rate that’s surpassed the most pessimistic models available to us.
Meyer: This is why I might have marginally more concern than Alexis. There are two types of questions here. The first is: How widespread is the U.K. variant in the U.S.? How transmissible is it? Is it so transmissible that populations that have been playing it pretty safe so far are now going to get it using the COVID-avoidance regime that worked previously? Are we suddenly going to open up new populations to the virus?
And the second is: Is the U.K. strain the only strain we have to worry about in the U.S.? We’re just not doing that much genomic surveillance of the virus in the U.S. What that means is: If there were, say, an Illinois strain or a Florida strain, we wouldn’t necessarily know. We do know there’s a California strain, but it’s still unclear whether that particular variant is more transmissible in the same way the U.K. strain is, or whether this California strain just got lucky, had a few fluke super-spreading events, and happened to dominate California.
Madrigal: Going into the winter, there were a lot of questions about seasonality: what seasonality is, whether it would have a major effect ... And I’m not sure that what seasonality is has been answered satisfactorily. However, clearly, the winter was really bad. And worse than even anticipated in the U.S. And if seasonality was a significant factor, then that should be wind at our back.
I feel like I’ve been quite gloomy at times throughout the pandemic about what lay ahead of us. And I guess I think vaccination is being underplayed as a factor in reducing [the] death rate. And it just seems like this mysterious entity of seasonality as a factor also isn’t really coming into a lot of the discussions right now. Maybe that’s just because the variant is sufficiently scary that we don’t want anyone to let up. But that kind of tactical communication—and I’m not saying that’s what Rob’s doing; I think Rob is genuinely concerned about the variants.
Meyer: No, I agree with you. I think there is a lot of communication happening right now that’s like Don’t let up, don’t let up, don’t let up that is not as justified by the data. But if you want me to stake my credibility to saying we just saw the absolute worst ever, I would just want to attach a few more unknown unknowns.
If we do have another surge, it will be later than we might expect. It’s like looking at distant stars. If you look at a star that’s a hundred light-years away, you’re looking at the star as it was a hundred years ago. Because not everyone gets tested and because it takes time for the virus to incubate, it just takes a lot of time for us to see changes in the world in our data. When we look at cases going down, what we’re really looking at is infections going down a week ago. And if we expect a surge, by the time we even start to see that in the data, it would have to be, like, six weeks from now just because of how long it takes these things to show up in the data.
And I think there is a chance that at the very moment that vaccinations really open up to the general public in April, we also see our last peak of cases. I do think Alexis is right though, that we’ll have vaccinated a lot of the most vulnerable population by then. What we’d be more worried about in that final surge is not so much deaths as just: This is not a fun illness to get. There’s a lot of long-term problems that we don’t fully understand. And if we could, [we should] avoid another 50,000 people potentially having to deal with those problems.
Hamblin: So you’d be pretty confident saying that we might have another surge in cases, but that we probably passed our peak of hospitalizations and deaths?
Meyer: Unless there’s something really wrong with the vaccination data, it would be really hard to get more deaths.
Hamblin: So that’s the message people are hearing. It sounds very optimistic. And yet these numbers are still very high, and the way we play this out between now and the summer, it’s easy to lose track of those stakes because the numbers are already so high. Alexis, could you talk about California specifically? Are we potentially letting up on the basis of this future that’s just not quite here yet?
Madrigal: The policies that states have enacted have not always had, to me, a totally clear and explicable relationship with what is happening in that state’s data. Some of that is the lagginess that Rob was talking about. California has pulled out of shelter in place. I think the thing that’s really tough for me is: We went into shelter in place a fairly long time ago and it’s hard to see the inflection there [for] the state making an ask of its population, and then [later] them doing something differently.  Right now, the numbers in California are borderline unbelievable [in how] encouraging the last, say, five days [have been]. Even a week ago, it was still looking quite bad. And now we’re seeing case numbers that we haven’t seen since November.
Hamblin: So was California wrong or right to let up on restrictions?
Madrigal: I think there’s such a level of exhaustion that people are kind of just doing what they were going to do anyway. We ran a great story by Julia Marcus about the way that European public-health authorities are playing the vaccine, versus the way we’re playing it in the U.S. European public-health authorities are saying the vaccines are going to make life much better.
And I think a burst of Yes, good things are on the way and focusing on the brightness of the light, instead of the darkness of the tunnel, is certainly what I’m telling myself. I’m not sure that I would be able to tell anyone else how they should be feeling right now. But it’s what I need right now in order to maintain the sort of COVID countermeasures that I have been in for what feels like five lifetimes.
Higgins: You’ve put so much work into the COVID Tracking Project. Are you going to close it down? Are you going to switch to vaccines?
Madrigal: I think, eventually, we’ll stop doing data compilation. From literally the very first day, we [felt] that when the federal government is in play here, that is the correct place to do what we’ve been doing. We’re, like, filling a gap here, not trying to become a federal agency.
If we wanted to build the organization as a permanent entity, we could have done vaccine tracking or expanded internationally. But honestly, I want the U.S. government to do these things. I want them to feel responsible for it.
Meyer: The irony of all of this is that we started out doing testing data. And we started doing testing data because the CDC actually did publish testing data until February of last year, at which point it stopped for, I think, still-unknown reasons. Of course, we know [former President Donald Trump] was never thrilled with the testing data that came out. At first, we hoped that we would shame the U.S. government into releasing data that we thought they had inside. And then it turned out that they didn’t, in fact, have this data inside, and that the effort of creating it was very labor-intensive and difficult and required hundreds of volunteers and the ad hoc construction of expertise.
Madrigal: Yeah. By far the most shocking thing is that the government didn’t have the data inside. And when we came to realize that, [it] was probably one of the worst days of the pandemic, just because of what it said about the overall capacity of the federal government to do this response.