Why declaring victory over COVID now is risky

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In Monroe County’s weekly COVID-19 briefing last Thursday, public health chief Michael Mendoza began on a positive note, saying the vaccines are working, with new cases and deaths among people 60 and older down significantly compared with the start of this year.

But Mendoza’s tone quickly shifted, turning darker. He noted the rising number of cases in people younger than 60, particularly the 18-29 age group, which now accounts for 25 percent of all new cases.

“It was shortly after we saw increases like this last fall that we began to see our numbers increase dramatically,” Mendoza said, “leading to our winter surge and the Finger Lakes region having the highest positivity and new-case rates in the state.”

Right now, he said, “our numbers are at a precarious point.”

Positive cases by day (blue) and seven-day average (orange) in Monroe County

Mendoza identified two factors that he believes are driving the current increase in cases. One is the likely presence here of more contagious variants such as the B.1.1.7 strain first identified in the United Kingdom. The second factor is COVID fatigue. The pandemic “is getting really old,” he acknowledged, and with the number of people vaccinated increasing steadily, some people are tiring of wearing masks, observing physical distancing and avoiding large gatherings.

But nearly two-thirds of Monroe County residents have not received even one dose of a COVID vaccine, and less than one-quarter are fully vaccinated. We aren’t anywhere close to herd immunity.

“At this point this is a race between the vaccine and the variants,” Mendoza said. “How quickly can we get as many people vaccinated versus how much longer can we work together to limit community transmission to contain the COVID variants while we all look to return to some semblance of normalcy.”

Even though we lack herd immunity, is Mendoza overstating the threat of another deadly surge? With daily infection and death tallies sharply lower than two months ago, and vaccinations opening up to all adults, it’s tempting to think that the worst of COVID is behind us. 

History offers lessons, however, about the price of declaring victory over a pandemic too soon. 

When the 1918 flu pandemic struck, Rochester moved quickly and effectively to limit spread of the highly contagious and often-deadly disease. In early October, the city’s public safety commissioner closed all public, private, and parochial schools. Other closures—ranging from movie houses, skating rinks, bowling alleys to churches, ice cream parlors and saloons—followed.

By the end of the month, more than 10,000 cases of influenza had been reported and nearly 450 patients had died, notes the University of Michigan Center for the History of Medicine in its Influenza Encyclopedia.

But the restrictions lasted only until the first week of November. With the closures causing substantial economic hardship, officials moved quickly after the first signs of ebbing infections to reopen the city. 

“Rochester’s epidemic was much less severe than that of many other American cities,” the Influenza Encyclopedia says. Acting swiftly and decisively clearly had saved lives. 

But did lifting restrictions so soon cost lives? The Influenza Encyclopedia doesn’t tackle this question, but the numbers seem to speak for themselves. By the end of the flu pandemic, Rochester had suffered nearly 30,000 cases—and more than 1,000 deaths.

So, more people got sick and died of the flu after the 1918 restrictions were lifted than during the monthlong period at the height of the pandemic when the community was locked down.

To paraphrase an observation Mendoza made about the COVID pandemic last week, Rochester may have been done with the flu pandemic, but it was not done with Rochester. 

Monroe County is hardly the only community today that is struggling with the need to remain vigilant against COVID. Nor was Rochester unusual a century ago in its eagerness to return to normal.

J. Alexander Navarro, assistant director of U-M’s Center for the History of Medicine, wrote recently about the parallels between the 1918 flu and COVID pandemics. 

“For the vast majority of Americans,” he writes, life once the 1918 flu pandemic restrictions were lifted “seemed to be a headlong rush to normalcy. … They packed into movie theaters and dance halls, crowded in stores and shops, and gathered with friends and family.”

The pandemic numbers did not spike again to the heights seen in the second wave of October 1918, but the flu did not go away, either. A third deadly wave stretched through the spring of 1919, and a fourth wave hit in the winter of 1920. Many more people died, but “normal” life had resumed.

While the COVID pandemic mirrors the devastating 1918 flu outbreak in many ways, there are big differences too. None is bigger than the historic rapid development of vaccines against SARS-CoV-2, the virus that causes COVID. As Navarro notes, “the influenza virus would not be discovered for another 15 years, and a safe and effective vaccine was not available for the general population until 1945.”

The fact that we have highly effective vaccines—and have boosted vaccinations to a rate of more than 3 million a day—should be all the incentive we need to hold on a bit longer.

As Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said a few weeks ago: “Don’t spike the ball on the five-yard line. Wait until you get into the end zone. We are not in the end zone yet.”

Toward the end of his briefing last week, Mendoza turned positive again. “We can and should turn this around,” he said. “If we can manage to keep community transmission low, not only will we protect those who are not immune, but we will also prevent the wider spread of known and unknown variants of COVID-19.”

If not, the current numbers for Monroe County—more than 56,000 confirmed COVID cases and 1,200 deaths—will be only one more milestone on a much longer journey.

Paul Ericson is Rochester Beacon executive editor.

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