Reality is sinking in among vaccinated Americans that the COVID-19 pandemic isn’t going away anytime soon, and the delta variant’s threat to the unvaccinated is worrying public health officials enough to reintroduce mask wearing and social distancing in high-risk areas.

This new wave of anxiety is coming at a time when many people in both Americas — the vaccinated and the unvaccinated — are weary of the pandemic and ready to return to any semblance of normalcy.  

But across all metrics, the data are telling us that things are getting worse. The seven-day average in the U.S. is 56,816 new cases per day and 281 deaths per day, as of July 26, according to the Centers for Disease Control and Prevention. A month ago, the seven-day average was 12,471 cases per day and 262 deaths per day.

“At 18 months through this pandemic, not only are people tired, they’re frustrated,” CDC director Dr. Rochelle Walensky told reporters on Tuesday. “We have a lot of continued sickness and death in this country. Our health systems are, in some places, being overrun for what is preventable. And I know, in the context of all that, it is not a welcomed piece of news that masking is going to be a part of people’s lives who’ve already been vaccinated.”

The CDC’s recommendation on Tuesday that many vaccinated Americans and all K-12 students and educators begin wearing masks again indoors puts much of the country’s progress in the pandemic at a standstill.

The pandemic now has two fronts. The 49% of Americans who are vaccinated, mostly with very effective mRNA shots, face the possibility of a breakthrough infection but most likely do not have to worry about hospitalization or death even if they contract the virus. But the threat for the unvaccinated is still getting sick enough to end up in the hospital or die. 

One bright spot: The White House says states including Arkansas, Florida, Louisiana, Missouri and Nevada have started to report higher rates of new vaccinations as compared with the national average.

“You can run and you can hide, but it’s going to find everybody,” Dr. Gabe Kelen, who chairs the department of emergency medicine at Johns Hopkins University, told MarketWatch. “The virus knows no politics. There’s no two ways about it. It’s the political views that have halted the whole vaccination program in parts of the country.”

The vaccinated are worried about the virus — again

For vaccinated Americans, the post-vaccine euphoria that had people posting upbeat selfies on social media of their Band-Aided arms, booking airline tickets to visit family members and/or Greece, and partying in dark bars in the wee hours has come to some kind of end. 

There is growing worry about breakthrough infections in vaccinated people, even though such infections are rare and to be expected, since vaccines do not provide 100% protection. However, new data indicate that these cases are, if still rare, more common than previously thought.

Until Tuesday, the most recent data about breakthrough infections came several months ago from the CDC. The agency said then that there had been fewer than 10,000 breakthrough cases out of the 95 million Americans who had been vaccinated as of April 26. But in June 20% of the people who tested positive for the virus in Los Angeles County had been fully vaccinated.

Now the CDC says that perhaps one of 10 people who are vaccinated but exposed to the virus in areas with “high” or “substantial” rates of community transmission may be at risk for a breakthrough infection. Walensky said vaccinated people who test positive for the virus carry the same viral load as those who are unvaccinated and get infected.

Whether it’s dire headlines or anecdotal stories about breakthrough cases, some of the vaccinated are circling back to traditional mitigation measures, like social distancing and wearing masks. Even before the CDC announcement, people (and public health officials) were reassessing social distancing and other behavior and discussing whether masking in certain environments is safer than going sans mask.

Los Angeles County re-implemented masking rules for public indoor places. Philadelphia is now recommending it in places where you don’t know who is vaccinated, as is King County, home to Seattle, in Washington. Provincetown, Mass., is suggesting masks for everyone when indoors. In Alaska capital Juneau, capacity limits were restarted at bars and gyms.

Fewer Americans said they are comfortable working in an office or eating indoors in the week of July 10, compared with what they were saying at the end of June, according to the Axios/Ipsos Coronavirus Index

That said, “Americans are not yet significantly changing their behavior, but the calculation of perceived risk of some out-of-home activities is changing,” the index’s authors wrote July 22. “Paradoxically, the anxiety is being driven mostly by Americans who are already vaccinated.”

For the unvaccinated, the virus remains the same threat it has always been

In regions with low vaccination rates, the pandemic looks very much as it did before vaccines were available.

“The threat is now predominantly only to the unvaccinated,” Jeff Zients, the Biden administration’s COVID-19 response coordinator, said at a White House briefing last week. “The case increases are concentrated in communities with low vaccination rates.”

‘People are dying because other people have chosen on philosophical or other grounds not to be vaccinated.’

— Dr. Gabe Kelen, Johns Hopkins University

Elective surgeries at some hospitals, including Our Lady of the Lake in Baton Rouge, La., are being postponed. Tallahassee Memorial HealthCare reopened its COVID-19 unit and is no longer scheduling elective procedures. In Tennessee, just 13% of ICU beds are available. Baylor Scott & White Health, the largest not-for-profit hospital system in Texas, is limiting the number of visitors that patients can have, citing the delta variant.

“The hospitals are full,” Kelen said. “The staff are saying [they’ve] had it. I never thought we would see that again. …They’re canceling cancer surgeries. People are dying because other people have chosen on philosophical or other grounds not to be vaccinated.”

The one bright spot, albeit the result of the destructive path carved out by delta, is that states including Arkansas, Florida, Louisiana, Missouri and Nevada have started to report higher rates of new vaccinations when compared with the national average, according to the White House. 

According to the CDC, 49.2% of Americans are fully vaccinated. The national rate has largely been stuck around 48% since mid-July, which has led to much hand-wringing by federal and state officials who have been trying to ward off future surges of the virus. 

Coronavirus Update: CDC head takes to the airwaves to sell change on face masks, as delta variant of SARS-COV-2 spreads to 132 countries

Last week at a committee hearing, Sen. Patty Murray, a Democrat from Washington state, said, “for the first time in months, I saw a line of people waiting outside of a pharmacy for testing and vaccines, and it made me wonder whether the recent surge of the delta variant is getting people’s attention and moving them from indecision to action.”

The vaccination campaign in the U.S. can be broken up into three phases: the mad rush among the very eager, the incentive stage (in which free Krispy Kreme doughnuts and lottery tickets were offered in exchange for proof of a shot), and now we’re heading into the mandate period.

A range of employer mandates have been announced in the last week. The Department of Veterans Affairs will require immunizations for all healthcare workers, while New York state said Wednesday will require all state employees to be vaccinated or get tested regularly.

Read on: Biden says requiring all federal employees to be vaccinated ‘under consideration’

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