Fewer Covid-19 hospitalizations, more vaccinations show US may be turning corner in pandemic but experts warn: ‘We’re still in two Americas’

By Jacqueline Howard, CNN

More than 100,000 hospital beds were filled with Covid-19 patients across the United States, with patients occupying more than 30% of the beds in intensive care units nationwide. An average of 159,000 coronavirus infections was recorded each day and physical brawls broke out over vaccine requirements and mask mandates.

That was America about a month ago — in early September.

Now, fewer than 70,000 hospital beds are occupied by Covid-19 patients, accounting for less than 25% of intensive care unit beds nationwide. The current average of new coronavirus infections has dropped to around 106,000 each day and more than half of the US population — 56% — is fully vaccinated against Covid-19. Just a few months ago in July, under half of the population was fully vaccinated.

“Along with virtually all of my colleagues, we are smiling quietly,” Dr. William Schaffner, a professor in the Division of Infectious Diseases at Vanderbilt University Medical Center in Nashville, Tennessee, told CNN on Thursday. “We haven’t put up a ‘mission accomplished’ banner yet, but for sure we think things are improving. New cases and hospitalizations certainly are down, and here and there, we’re actually seeing a reduction in deaths.”

Yet he added, “it’s obvious that this plateauing and diminution — although you can see it across the country — it is happening more steeply in some parts of the country, the better vaccinated parts, than in other parts of the country, the less vaccinated parts, including my own state of Tennessee. So, although we are clearly making progress, I think we’re still in two Americas.”

What might mark the ‘bookend’ of the pandemic

Signs that the United States’ control of Covid-19 could be improving also can be seen in some data around Covid-19 vaccinations.

Many Americans still oppose vaccine requirements and mask mandates, but in the past month, President Joe Biden has imposed stringent new vaccine rules that affect as many as 100 million Americans. Vaccine mandates seem to have had an impact — currently, 65.7% of people eligible to receive Covid-19 shots are fully vaccinated.

But despite efforts by the federal government and public health officials, there’s been a big drop in the average number of people starting the vaccination process. Data from the US Centers for Disease Control and Prevention shows a more than 40% drop in the number of people getting their first Covid-19 shots over the past two months. The current seven-day average pace of vaccinations is 276,539 people initiating vaccination each day — a 24.5% decline from this metric a month ago, and a 42.5% decline in this number since August 7.

“Today, I’m calling on more employers to act. My message is require your employees to get vaccinated,” Biden said in remarks in Illinois on Thursday.

“With vaccinations, we’re going to beat this pandemic finally,” he said. “Without them, we face endless months of chaos in our hospitals, damage to our economy and anxiety in our schools, and empty restaurants and much less commerce.”

Additionally, vaccine makers Pfizer and BioNTech announced Thursday that they have officially submitted a request to the US Food and Drug Administration to authorize their Covid-19 vaccine at a smaller dosage for children ages 5 to 11.

“Once again, I think we’ll probably see two Americas: parents in some states more frequently taking their children to the pediatrician to get vaccine than others,” Schaffner said. “But in general, I think the approval of the Food and Drug Administration for the Pfizer vaccine for 5- to 11-year-olds will play a role in accelerating the downward slope of new cases, hospitalizations and deaths.”

He added that “mandates will continue to move vaccinations upwards.”

Dr. Scott Gottlieb, a former commissioner of the FDA and a current board member at Pfizer, said Wednesday he thinks a Covid-19 vaccine for children and Merck’s antiviral pill will bookend the pandemic phase of Covid-19.

“For businesses right now, I think they want to see the all-clear, and I don’t think we’re going to see the all-clear until this Delta wave courses its way through the country — that’s probably around Thanksgiving. So, if I was trying to put an endpoint on when this Delta wave kind of has moved through the country, it’s probably Thanksgiving,” Gottlieb said in a CNBC “Squawk on the Street” interview from the 13D Monitor’s Active-Passive Investor Summit.

“Then on the back end of that, we’re going to have, hopefully, a vaccine available for children, and at some point before the end of the year, we probably will have the orally available drug from Merck if things go well and that undergoes a favorable review,” Gottlieb said.

“I think those two things are going to be sort of the bookend on the sort of pandemic phase of this virus,” he said. “And we’re going to be entering the more endemic phase, when this becomes an omnipresent risk but doesn’t represent the extreme risk that it represents right now.”

Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Texas, told CNN’s Ana Cabrera on Thursday that he “certainly” hopes Gottlieb is right in that the nation is approaching the end of the pandemic phase.

“But we have some hard realities, especially in this part of the country,” Hotez said.

“Only 33% of the 12- to 17-year-olds were given the Covid-19 vaccine here in the South, in most of the southern states, compared to 80% in the northeast. So once again, you have this geographic divide where parents are holding back on vaccinating their adolescents,” Hotez said. “I have to believe they’ll probably hold back on vaccinating the younger kids as well.”

‘We absolutely do not want to let down our guard yet’

Overall, most experts agree that it remains unclear when the pandemic will end, but it likely will occur when transmission of the coronavirus shifts from pandemic levels to being endemic — when the virus takes permanent hold but circulates at lower levels.

“This virus is not going to just disappear,” Schaffner said.

Some physicians, including Schaffner, remain hopeful that the country may be approaching that transition from pandemic to endemic — but say it’s not quite there yet.

“I think we’ll know it when we see it,” Schaffner said. “Once there is a very low rate, less than 5% of tests that are positive on a daily basis, and once the rate of new cases is very low and sustained over a period of time, I think we will, at that point, know it.”

Schaffner said that’s when he and his colleague will smile “broadly” instead of smiling quietly.

On the national level, the weekly Covid-19 test positivity rate in the United States fell from nearly 10% in early September to around 6% in early October. But as of Sunday, test positivity remains as high as nearly 20% in some states, including Idaho, Montana and South Dakota.

“I think it’s an interesting idea, but I would want to fill up the picture with what does that really mean — 5% forever? Five percent that we hope to keep driving down with a serious push, no matter whether we call it pandemic or endemic? If we go to the 5% level, does it have to be in each county, or is it a generality for the whole country?” Art Caplan, professor of bioethics at NYU Langone Health in New York said in response to Schaffner’s comments. Caplan added that test positivity rates globally should be considered as well.

“I’m always nervous to treat Covid as a US phenomenon,” Caplan told CNN Thursday. “It is an international phenomenon. Travel is increasing. The possibility of new strains reoccurring is great.”

For now, “it’s too early” to claim that the United States is reaching that transition point from pandemic to endemic, Caplan said.

“I’ll make this forecast — not this year, not this winter, not until next year will we be talking about this in any serious way,” he added.

“We’re about to go back indoors. We know this disease took off in the winter when people were mingling and gathering more inside in closer quarters in many parts of the US. So I’m not ready to say we’re shifting in our level of disease or incidence of disease or severity of disease. In fact, I worry that message may undercut efforts to push vaccination right now,” Caplan said. “We absolutely do not want to let down our guard yet.”

So, a downturn in Covid-19 hospitalizations in the past month is “good news,” but the United States could see a spike in cases again this winter, particularly around the holidays, Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security, told CNN on Thursday.

“I think we’re making some important progress in terms of increasing vaccinations, but the fact of the matter is there are still dangerous gaps in immunity throughout the country and as long as that’s the case, there are still pathways for the virus to spread,” Nuzzo said.

“I’d like to think that the worst is behind us, just given how much we’ve already endured in terms of high numbers of cases but also increasing progress in increasing vaccination. So, I don’t think that a rise in cases in the winter will be as bad as last year’s winter surge, but there’s nothing built into the decline that means that the momentum will be sustained,” she said.

“What we will see is really up to us.”

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CNN’s Virginia Langmaid and Naomi Thomas contributed to this report.