I'm feeling lazy so no links or 10-chart discussions, just an update on where we're at and what I expect over the coming months.
US STATUS- Glass half full/half empty? Infections are down to half their recent peak, but still double the rate of the 2nd wave peak. So still bad, but the trend is heading the right way in a hurry.
Because of the massive size and duration of the third wave, we've now reached the point where roughly 1 in 3 in the US have been infected. 500k deaths / 120 million is an IFR just above 0.4%, which is right on target with what we've been expecting since last summer.
US B.1.1.7 - It looks like just over 3% of our new cases are the more-contagious and more lethal British variant. That's not enough to make a detectable difference in our case numbers, but it will change quickly. Current estimates are that it will reach 50% around March 23 and dominant status in April. That's probably fast enough relative to our vaccination rate that our declining case rate will probably flatten a bit or possibly even rise...but that may not be a big deal, because of the vaccines.
US VACCINATIONS - As imperfect as our vaccination program has been, we're doing better than almost any countries other than Israel and the UK. With just over 10% of the US vaccinated, we're rapidly approaching the point where the majority of our most vulnerable will have received their first dose. Not enough to crush the new case rate, but enough that our hospitalization load and death count should get dramatically better and stay that way.
MY EXPECTATIONS - Pretty much all states are now starting to vaccinate adults 70+, many states doing 65+, and most are starting or about to start with people with comorbidities. By the end of March, a strong majority of them will have received a first dose, with near-complete protection from severe disease within 7 days or so.
As a result, I expect hospitalizations and death counts to plummet before the end of April, even if cases start a temporary rise. I'm confident we'll be below 500 deaths/day (from today's 3000), and it's entirely possible we'll end April below 200/day, which is literally in the range of a bad flu season.
At that point, it's hard to justify continued restrictions on businesses and churches, as a total re-opening would be unlikely to increase the numbers as vaccinations continue. Masks mandates will probably still be a good idea into May and June, but I expect their repeal to follow political rather than data-driven responses. But in most places, I think we'll be back to "normal" in terms of business openings by the start of May, and mostly unmasked by early summer. Case counts will continue at a lower level, but hospitalizations and deaths will drop to a very low level.
We already have the South African variant spreading in the US. The UK has detected several cases of B.1.1.7 with the E484K mutation added, which is what apparently gives the South African variant it's partial ability to evade vaccines and natural immunity from the previous strains. Given the scope of our outbreak, it's likely we'll end up with E484K strains becoming prominent by summer, infecting vaccinated people and those who already had the original COVID strains. It seems likely that a single mRNA booster will be effective in shutting that down, but we should all expect a "version 1.0a" booster by fall.
MY ADVICE: Stop focusing on case numbers, watch the hospitalization and death curves. Hospitalizations are declining; I think deaths have peaked. Both should continue to decline non-stop through the spring to very low levels. Even if cases are still somewhat high, reopening will make sense once the hospitalization and death rates are low enough, I expect that by April or May at the latest.
Finally, please consider delaying your second vaccine dose until an April time frame so that we can get as many vulnerable people protected with a first dose as quickly as possible. The risks to you appear to be minimal (possibly even a benefit), and it will do a lot to reduce our death count earlier.
This is the strategy the UK is taking, US doctors and epidemiologists are split on the subject, but I think the data is clear on which approach will reduce the death count as quickly as possible.
