Cases are rising sharply in several different cities, but the patterns look different. In Michigan, some smaller, whiter counties have vaccination rates twice as high as in Detroit, where rising cases are concentrated and the vaccination rate among the city’s mostly Black population is still low. According to national survey data, in line with political divergences over masks and social distancing, vaccine hesitancy is now highest among Republicans and white evangelical Christians. In Philadelphia, zip codes that are relatively whiter but have lower educational attainment have experienced the most case growth over the past 30 days. Baltimore’s outbreak is growing too, but the data are messy.
In these places, and in other hot spots around the country, the rise in cases is an acute crisis that public-health officials should battle with all the available tools, as my colleague Zeynep Tufekci noted this week. CDC Director Rochelle Walensky spent her weekly press conference on Monday pleading with the American people, noting “the recurring feeling I have of impending doom.” She asked the country to “work together to prevent a fourth surge,” and compared the pandemic’s path here to the experience of Germany, Italy, and France, where cases have spiked dramatically in the past few weeks.
But the United States might chart its own, very unequal track in the coming weeks. Three distinct factors are now shaping this country’s pandemic experience.
First, the United States did a terrible job preventing transmission of the disease. The country's level of excess death—the margin over the number of deaths expected in a typical year—has been high, signaling that the pandemic's true toll has been even steeper than the officially tabulated COVID-19 deaths. Most other countries did not experience the same levels of consistent transmission. A year of unchecked spread means that our 30 million reported cases are a fraction of the total number of people who have been infected. Most estimates place the number closer to 100 million, and possibly tens of millions more.
So unlike in Germany, for example, which fairly effectively suppressed the virus, tens of millions of people in the U.S. have some level of immunity. While reinfection may be more common with some current or future variants, it has been rare so far. That high level of past infection should now help reduce transmission of the virus via population immunity.
Second, the U.S. is vaccinating people quite efficiently. It has given out the largest absolute number of doses in the world, and trails only a few much smaller countries (Israel, the U.K., and Chile among them) in the percentage of the population that’s been vaccinated. Almost three-quarters of the U.S. population over 65 has received at least one dose of the vaccine, with nearly half now fully inoculated. On a percentage basis, the U.S. has immunized nearly three times the number of people that Germany, Italy, and France have, and in two months, the U.S. will almost certainly have a very large percentage of vaccinated adults.