Covid 19 coronavirus: Delta surge drives home painful truth - Covid isn't going away

Taking a Covid-19 saliva test. Photo / Jenn Ackerman, The New York Times

As alarm mounted over the coronavirus ripping through the country, Mayor Lori Lightfoot of Chicago was barraged with warnings: Lollapalooza was looking increasingly risky. The annual four-day music festival would draw hundreds of thousands of people downtown, unmasked, crowded into mosh pits, city parks, restaurants and L trains, setting up the threat of a superspreader coronavirus event in the Midwest.

The mayor insisted that the festival go on.

The decision to host the event, which injected a dormant downtown with energy and freely spending tourists at the end of last month, reflected a shifting response to the continuing pandemic. One year ago, Chicago was a muted version of itself: Businesses were restricted, schools were preparing to teach remotely, the police blocked access to beaches on Lake Michigan and Lollapalooza was cancelled.

But in recent days, even as the highly contagious delta variant ravages the South and has caused upticks in all 50 states, mayors, governors and public health officials have treaded lightly when considering whether to reimpose restrictions. With more than twice as many new virus cases being reported nationally compared with last August, baseball games, music festivals and state fairs have forged ahead, and restaurants, gyms and movie theaters have stayed open. In many places, people have been largely left to decide for themselves whether to start wearing masks again or change the ways they work, socialise and vacation.

About 130,000 cases are being reported across America each day, almost twice as many as last summer's highest levels. Photo / Rozette Rago, The New York Times

Americans have entered a new, disheartening phase of the pandemic: when they realize that Covid-19 is not disappearing anytime soon. A country that had been waiting for the virus to be over has been forced to recalibrate.

"We can't expect it to go away where we never have to think about it anymore," said Emily Martin, a public health researcher at the University of Michigan. "We've seen that it ebbs and flows. Sometimes we need to be more vigilant than others."

Scientists had warned for months that the coronavirus was likely to become endemic and that herd immunity was increasingly unlikely. But even though the vaccines remain effective, the virus has mutated and spread at a pace that has surprised some experts.

This summer started out on a hopeful note. The United States was reporting the lowest coronavirus case totals since the pandemic's start, and officials had given permission for vaccinated people to shed their masks in most situations. Then came a worrying cascade of outbreaks, overflowing hospitals and fears over what the virus would bring next.

Hospitalisations have reached their highest levels since winter. And in parts of the South, including Mississippi, Louisiana and Florida, the delta variant has shattered case records and overwhelmed intensive care units.

"I think we all took a step back and thought things were getting better," said Anthony Monteiro, 30, of Tampa, Florida, whose job in medical device sales frequently brings him into hospitals. "There are so many Covid patients, I feel like Covid is in the air everywhere I go now."

Anthony Monteiro, who works in medical device sales, switched to wearing a simple surgical mask when Covid cases dropped. Now he's using an N95 mask again. Photo / Octavio Jones, The New York Times

About 130,000 cases are being reported across America each day, almost twice as many as last summer's highest levels. Even as some of the first hot spots of this summer, including Missouri and Nevada, show glimmers of progress, much of the country continues to see explosive case growth.

During the latest surge, the United States is armed with vaccines that are highly effective in preventing severe illness and death, and are available to anyone 12 years and older. But only about half of Americans are fully vaccinated, and daily vaccination rates have risen only modestly, to about 700,000 doses a day, since the delta surge began.

The worst surges have so far been concentrated in Southern states with underwhelming vaccination numbers, but infections have also been rising in places with far better vaccine uptake. Oregon and Hawaii, both of which have relatively high vaccination rates, have set weekly case records in recent days, and daily case rates have more than doubled in recent weeks in highly vaccinated parts of New England. Whether cases there eventually reach Louisiana-like levels will be seen as a test of whether vaccinations can make a significant difference on not just the number of deaths but in the size and strength of surges.

Most of the country remains fully open, and aside from Hawaii, where the governor recently imposed restrictions on social gatherings and restaurants, most officials have so far steered away from restricting or shuttering businesses, leaning instead on mask rules or vaccine requirements or, more commonly, nothing at all. Louisiana and Oregon have reinstated mask mandates. San Francisco will require proof of vaccination to patronise restaurants, bars and gyms. Several school districts and cities have returned to universal masking, while more employers and colleges have announced plans to require vaccines.

In Jackson, Mississippi, Mayor Chokwe Antar Lumumba kept a mask mandate in place even after the Centers for Disease Control and Prevention announced in May that fully vaccinated people could go most places without masks, guidance it later reversed. In recent days, with cases in Mississippi reaching record levels and Hospitalisations rising, he announced that municipal workers would soon have to submit proof of vaccination or be tested regularly. Lumumba said restrictions, including limits on businesses, were under consideration but have yet to be put in place.

"There's a likelihood, or at least a probability, that there could be other measures implemented," Lumumba said. "Whether that's a re-implementation of old protocol or the establishment of new protocol within the city, everything's on the table."

A local rapper who performs as Libsey was part of a sidewalk hip-hop concert aimed at getting people excited and informed about the coronavirus vaccines. Photo / Matt Cosby, The New York Times

But other officials have been hostile to new restrictions, or have worried that rules could backfire and further politicise the pandemic. The CDC has recommended that some vaccinated Americans wear masks in public again, but has not suggested shutting down businesses.

A Gallup poll conducted in late July, when cases were starting to spike, found that 59% of respondents thought it was good advice for healthy people to go about life normally, compared with 41 per cent who thought it was better to stay home as much as possible.

"I don't believe that a public health order in the future is going to be any more effective than they were in the past — and they weren't effective enough," said Dan Partridge, director of the Lawrence-Douglas County Health Department in Kansas, who said he wanted to encourage masking and vaccination without issuing mandates or cancelling events.

Governor Andy Beshear of Kentucky, a Democrat, said in an interview that he worried this could turn into the deadliest phase of the pandemic, but he was not considering a return to lockdowns. About 1,400 coronavirus patients are hospitalised in the state, up from around 300 a month ago, and case levels continue to rise. Roughly 47 per cent of Kentuckians are fully vaccinated.

"The fact that in this surge we have vaccines means that there shouldn't ever be a need for another shutdown, and we shouldn't have to look at capacity restrictions," said Beshear, who recently announced that masks would be required in Kentucky schools and raised the possibility of a broader mask mandate. "Between people getting vaccinated and wearing a mask when we need to during the surge, then we ought to be able to fight this one off."

One center of the summer surge is Florida, with the country's worst hospitalisation rate. Gov. Ron DeSantis, a Republican, has largely blocked local governments from putting restrictions in place.

Unlike in the pandemic's early months, there are no state-ordered limits on visitation at nursing homes, leaving each facility to make its own decisions based on CDC rules and its own circumstances. Nick Van Der Linden, the communications director for LeadingAge Florida, a trade organization for nursing homes, said nursing homes and assisted living facilities were starting to treat the coronavirus as "something we live with for the long run."

Providers have established daily infection protocols for Covid-19 as they have for other communicable diseases, such as the flu and norovirus, in addition to federally mandated protocols, such as twice-weekly testing of staff members and residents given Florida's virus surge. "Are we going to treat it like it's here to stay? Yes," Van Der Linden said. "Covid-19 is not going away. But we're not in the 2020 pandemic anymore, either."

Americans who live in cities that once seemed to have beaten the virus said they were suddenly realising that it had never really left.

In New Bedford, Massachusetts, a fishing town of about 100,000 people an hour's drive south of Boston, coronavirus cases had fallen to an average of fewer than five per day in June. Now cases have risen to about 40 a day but there has been no move to lock down the city or restrict businesses.

"I don't know when, or if ever, life is going to get back to the way we knew it," said Stephen Silva, a cab driver in New Bedford. Photo / Matt Cosby, The New York Times

Stephen Silva, 65, a taxi and limousine driver, said that since the onset of the pandemic, he has been "cautious in every possible way" — wearing a mask, getting vaccinated and avoiding large gatherings.

Through it all, the goal he kept in mind was returning to some semblance of normal. Now, he said, he is starting to lose hope.

"I don't know when, or if ever, life is going to get back to the way we knew it," Silva said.

In Santa Monica, California, Sandi Burnett, 71, said she had resumed shopping at the grocery store after months of getting food deliveries. But she continued to worry about her grandchildren, who are too young to be vaccinated.

"We're only doing outdoor activities," Burnett said.

Two weeks after Lollapalooza, Dr. Allison Arwady, the commissioner of the Chicago health department, said in an interview that she believed the decision to hold the festival was the right one. Officials said that 203 coronavirus cases had been traced to the event. At least 90 per cent of the people who attended were vaccinated, Arwady said, reflecting a requirement that attendees show proof of inoculation or a negative test result.

Arwady said she was continuing to monitor the city's hospitals to make sure that the health system did not become overwhelmed. But beyond that, she said, she saw no reason to interfere with events in Chicago that had been canceled the year before. "You're never going to eliminate Covid risk," she said.

This article originally appeared in The New York Times.

Written by: Julie Bosman and Mitch Smith
Photographs by: Matt Cosby, Octavio Jones Rozette Rago and Jenn Akerman
© 2021 THE NEW YORK TIMES