Los Angeles County is once again enforcing a mask mandate. Good for them. Because across the country COVID-19 is making a completely unnecessary comeback, and the courage to do what’s necessary to fight this new wave is proving all too rare.

In mid-June, the number of new COVID-19 cases each day in the United States had fallen to 12,000, the bottom of a long slope that started with over 250,000 cases a day at the start of the year. It was completely understandable that Americans from coast to coast felt as if the shadow of 2020 was lifting. Restaurants reopened, ballparks filled to capacity, and rental cars sold out across the nation as seemingly everyone made a mad dash to make up for everything missed during the long months of pandemic.

Only the pandemic isn’t over. It never was. At this point, only 48% of the U.S. population has been fully vaccinated. 56% have had at least one shot. But that’s not even close to the level necessary to prevent community spread of a virus as easily transmitted as SARS-CoV-2, especially considering that the latest variants are over twice as contagious as the virus that originally spread across the nation.  

The vaccination program was critical to the drop in cases that occurred over the last six months, but the truth is that community spread of COVID-19 was only controlled by a combination of vaccines, masks, and restrictions. Vaccine levels are not high enough to shoulder that burden alone.

So as soon as those other restrictions were removed and more and more of the burden was placed on vaccines alone, the decline flattened out. Then trends began to reverse. That’s particularly true in areas where vaccination lagged far behind the national average. Had the U.S. maintained the masks-and-restrictions part of the equation just weeks longer, the pandemic might be down to nothing but embers in this nation. We didn’t. 

And now there are fires breaking out all over.

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            Friday, Jul 16, 2021 ·  4:50:44 PM +00:00

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      Mark Sumner
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The seven-day moving average of new cases in the United States is now over 28,000 per day. That still seems small compared to the worst of the winter, but it’s up more than 100% in two weeks. And for some areas of the nation, it represents a genuine new wave of COVID-19 cases, one that is once again filling local hospitals and taxing an exhausted health care infrastructure.

For example: Missouri.

Show me everything that can go wrong

Missouri is seeing a new wave of cases that is rising more steeply than any point since the worst weeks of the winter surge.

Missouri represents what may be a worst-case scenario. Not only is the overall rate of vaccination for the state well below the (already too low) national average, that number is deceptive. Vaccination levels in Kansas City and St. Louis may be over 50%, but in many rural counties, the level of vaccination is astoundingly low. McDonald County in the state’s southwest corner has just 14% of the population fully vaccinated. It’s just one of a dozen counties where vaccination rates are below 20%. In Mercer County, not only has just 20% of the population been vaccinated, but the total doses of vaccine administered over the last week was … eight.

Now add to this a governor who has refused to issue any statewide mandates on masks or other restrictions. And who spent the last week making it clear that federal outreach to expand vaccination is not welcome in his state, including promoting conspiracy theories about efforts to send volunteers door to door. For the icing on top, in mid-June—just about the time that new wave really started to go up—Republican Gov. Mike Parson signed a new law passed by the Republican-dominated legislature that prevents county health officials from taking any effective action against disease. Among other things, this law halts any public funds to counties or cities that attempt to require proof of vaccination for any reason. It also blocks county officials from imposing business restrictions or mask mandates. Since Parson has no intention of passing any such restrictions, Missouri is fully open for the virus to spread without limit.

And it has. This is how the nation looked when it came to community spread of COVID-19 on June 19, the day Missouri passed that new law blocking counties from taking effective action.

Level of community spread of COVID-19 by county as of June 19, 2021.

The cluster of red counties in the center of the country represents a series of counties in southwest Missouri and northern Arkansas where the rate of vaccination was low, restrictions were off, and COVID-19 was already spreading rapidly. Now, fast forward four weeks.

Level of community spread of COVID-19 by county as of July 15, 2021.

That cluster of counties has exploded into a wave of cases that is overwhelming both Missouri and Arkansas. If Missouri were to order a statewide mask mandate and limit some indoor events, this could be brought back under control quickly, even with the very low rate of vaccination. However, Republican officials have dug in their heels against taking any action, have villainized the vaccination program, and are doing nothing to push back against constant conspiracy theories over vaccine safety and efficacy. 

But looking at these maps, it’s clear that Missouri and Arkansas are not the only states in trouble. Nevada, where vaccination rates at a county level are low and the delta variant is already dominant, is seeing a wave of hospitalizations; vaccinations in the state have slowed to the point where it won’t reach 70% of people with at least one shot until December.

Then there’s Florida.

Let the sunshine in

Beset by the twin plagues of COVID-19 and Gov. Ron DeSantis, Florida is seeing its own new wave of cases, and that wave is rising fast.

Florida has kicked off a fourth wave of disease during DeSantis’ latest victory lap.

Throughout the pandemic, DeSantis has insisted on taking one victory lap after another, bragging about how he’s done zip, and also diddly, to stop the pandemic, and hey—not everyone has died! Of course, DeSantis has been backstopped by county officials in the largest population areas that issued mandates and restrictions that kept the state from going fully off the rails.

As a whole, 55.2% of Floridians have received at least one dose of vaccine, putting it only slightly behind the national average. However, considering  there’s a very high level of vaccine in most urban areas and in counties dominated by massive retirement communities, that means Florida is also chockablock with low vaccine counties—though good luck figuring that out. Florida has long since taken down anything that looks like a comprehensive COVID-19 dashboard and replaced it with a report that does an excellent job of hiding data. Fortunately, there are alternatives. What those alternatives show is a dozen counties, including several in the Republican-dominated panhandle, where vaccination rates are below 25%.

But one thing is different about Florida: Even counties with relatively high levels of vaccination are currently seeing substantial or high levels of community spread as the delta variant becomes the most common. That’s leading to a surge of hospitalizations across the state—up by 33% in just seven days. Of course, that won’t interrupt DeSantis’ auto-back-patting machine. But it should. In fact, it should worry everyone. Because as the percentage of cases attributed to the delta variant grows, Florida is seeing substantial levels of community spread even in counties where vaccination rates are above 70%. Which strongly indicates that nowhere in the nation have vaccination levels reached a point where vaccination alone is sufficient to halt spread of COVID-19.

Right now, way too many states (and counties, and cities) have placed “getting back to normal” above “keeping citizens healthy.” The costs of those decisions are currently falling mostly on counties where vaccination rates are low, and with over 99% of deaths in May being among the unvaccinated, the highest price will remain with the unvaccinated. But everyone is going to pay a cost unless the nation uses vaccination + mask mandates + restrictions to push COVID-19 down to a point where cases can be genuinely tracked and controlled.

The best way to do that is at the federal level, by applying a nationwide mask mandate. Unfortunately, things are going to get worse before anyone gives that serious consideration.