Nearly two years into the pandemic, Europe is facing a new wave of infections and death, with parts of Eastern Europe already well under water. This week, Russia, Ukraine and Romania each broke national daily death and case records. There has been a discernible uptick in well-vaccinated Western European countries as well. Cases in the United Kingdom, where more than two-thirds of the population is fully vaccinated, are fully out of control, never having dropped significantly since the country reopened in July.
The factors at play in the European wave are the same factors that we face here in the United States: vaccine hesitancy and fading immunity, a triad of new more transmissible variants, and a failure to implement the ABCs of public health. If past is prologue and the history of the pandemic is a guide, the next target is the United States. In my view, the only way to stop the approaching storm is to shift our behavior and our response, building higher walls of protection around us that may, if we’re lucky, keep us safe.
The first challenge is with vaccines. The high death toll in Eastern Europe is partly due to low vaccination rates in the region. In Ukraine, only 16% of the adult population is fully vaccinated; Russia has barely reached one-third; and in other countries with rising new cases and hospitalizations, the vaccination rate is somewhere in between. Now, those countries are feeling the tragic effects of their inaction, as not only cases reach all time highs, but also hospitalizations and deaths.
In Western Europe and in the US, vaccination rates are higher. But people in those countries are facing another key issue: fading immunity. Israel, the country with arguably the best vaccine rollout in the world, was the first to face this problem in the summer. Despite nearly 60% of their population being fully vaccinated with the top of the line mRNA vaccines, they too faced a wave of new infections. Further studies found that the increase in cases was tied to waning vaccine-induced immunity, which had begun to decline about four to six months after Israelis had received their initial vaccines. That waning immunity coincided with the introduction of a new and more transmissible variant, Delta. To contain the new outbreaks, Israel reinstituted some of the restrictions they had lifted and pursued another solution that many Western European countries and the US are now playing catch-up on: boosters, or as I prefer to think of them, a necessary third dose of the Covid vaccine regimen.
After making boosters available to all adults, Israel showed a dramatic and near immediate improvement: after 14 to 20 days, there was a 70-84% reduction in the risk of infection; shortly after, hospitalizations and deaths began to drop dramatically as well. This is a signal to those of us not yet subsumed by the next Covid wave, especially those of us in the US who are facing down colder temperatures and the increase in indoor activities that those temperatures bring: we need to renew efforts to vaccinate the unvaccinated and accelerate the approval and delivery boosters to all individuals, not just those deemed high-risk.
What we can’t control is the possibility of new, more transmissible variants taking root. As I wrote about previously, the waves of infections that have washed over us since the emergence of SARS-CoV-2 have been driven by new variants. First the Triad variant that drove infections last summer, then the regional variants — Alpha, Beta, and Gamma — that took root last winter and bled into spring. This summer, it was Delta that gained dominance and now new Delta variants — AY.4, AY.4.2 and AY.33.1 — appear even more transmissible than its predecessor and may drive larger waves of new infections this fall and winter.
While higher vaccination rates and boosters will protect us to a good degree, we cannot overlook the basic public health protection measures that, when strictly implemented, have been able to protect countries like China from every single variant we have ever faced: mask-wearing, comprehensive testing, tracing and quarantine, and a willingness to impose stricter measures like lockdown to contain emerging outbreaks.
The story unfolding in Europe tells us that we still know too little about the virus and our own immunity to make reliable predictions about how the new Delta variants or other emerging variants may affect us over the cold winter months. Today, I am not optimistic about our winter Covid season here in the United States. I hope I am mistaken. What I do know, without a doubt, is that stricter adherence to basic public health measures — wearing masks indoors in any public space, avoiding large gatherings indoors, testing ourselves regularly and quarantining if we know we’ve been exposed — could help us limit what could become a repeat tragedy, and another season of death the likes of which we saw last winter.