It’s true that 2021 has been a marked improvement over 2020 in the U.S. But maybe the champagne flutes are out a little too early. The country likely won’t meet President Joe Biden’s goal of getting 70 percent of adults vaccinated by July 4, and the regional vaccine gap is stark. There’s also yet another new, more contagious variant spreading across the country. To decide whether it’s time to ask the coronavirus to concede defeat on the deck of the USS Harry S Truman, Nightly called two of our go-to experts and asked them the same questions, separately, about everything from variants and vaccines to what Covid may look like next winter. This conversation has been edited. How dangerous is the Delta variant? Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security: The Delta variant is more contagious and will likely find it easy to infect unvaccinated individuals who have no prior immunity from natural infection. But it depends upon who these individuals are. Are they high-risk for severe consequences? Remember, even in the face of the Delta variant, if the high-risk population is fully vaccinated or has immunity, you’re not likely to see an increase in deaths reminiscent of the early days of the pandemic. Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine: Mother Nature has already told us what she has in store for us. We saw what happened in India when the Delta variant emerged that swept over South Asia, the Indian subcontinent. Then, when it hit the U.K., it out-competed even the B117 variant. And now it’s here. About 6 to 10 percent of U.S. cases are Delta and so the prediction is, as we move into the summer, we’re gonna see a big surge in the South, just like we saw last year after the July 4 holiday. That’s my big worry. And it’s going to look different because if you’re fully immunized, two doses, then you do pretty well in terms of cases and illness. But if you only had a single vaccination or if you’re unvaccinated, you’re highly vulnerable. What are the chances of a vaccine-resistant variant emerging? Adalja: I think it’s very low. I think it’s very difficult for the virus to develop, to mutate into a variant that completely evades all vaccine protection. And remember the goal of vaccines wasn’t to get to Covid zero. Hotez: I think of course, it’s possible, but I doubt we’ll see that. I think what we’ll see is — we already know if you look at variants like the P1 or the South African variant — that there are more breakthrough infections. So I think that’s a possibility down the line. And I think the way you manage it is you give a booster. What’s your biggest concern with unvaccinated regions of the U.S.? Adalja: I have less concern about cases, more concern about hospitalizations. In parts of the country where vaccination rates are very low, like Mississippi, they are going to continue to have more circulation until they reach a high level of population immunity through a combination of whoever’s vaccinated and natural infection. Hotez: I worry about two Covid nations emerging, the North and the South, the blue and the red. I mean it looks like a Civil War map of the Union and the Confederacy, that’s how awful it looks. Adalja: I think we’re gonna still top out at what Michigan looked like in the late winter, when they were having an increase in cases and hospitalizations in their unvaccinated populations. Hotez: Yes, I think that’s fair to say it won’t be as terrible, but it still could be pretty terrible. And so I think what’s going to happen is Delta is going to finish the job that the others, that the original lineages started — pretty much anyone who’s been left uninfected and unvaccinated is going to get infected over the next few months with Delta. How much natural immunity exists in the U.S.? Adalja: I know that we probably underestimated. Because if you look at the models — the CDC ensemble models didn’t predict as much of a decline in cases, and I think it might have to do with underestimating natural immunity. I know that, for example, Mississippi got hit hard in the summer of last year. There have been less mitigation measures in places like Mississippi, which probably means they’ve had more people get infected and they have, I would suspect, on a per capita basis maybe more natural immunity than other states. I haven’t seen that data though. That’s a hypothesis. Hotez: It’s hard to know. And you don’t know with this Delta variant how much it will respect that previous infection and recovery. It seems to have some immune invasion capacity. What’s the best way to get more people vaccinated? Adalja: I think now it comes down to almost like a politician going door knocking. Just literally walking door to door, knocking on every door and saying, “Does anybody need vaccine?” Almost like one more vote. That’s how I’ve approached it with people that I’m friends with. Hotez: For a while, I was going on conservative news outlets, and I have been pretty much cut off of that of late. That’s what I was working on. The Biden administration needs to try to push for greater outreach to those groups, and the way you do that I think is identify champions that will help you in this — people who are respected by conservative groups. Will Covid be seasonal? Adalja: I do think that this is going to exhibit seasonality, that when it gets colder, when it gets less humid, when it gets less sunny, when people are doing more activities indoors, you’re going to see acceleration of transmission in the unvaccinated population. But it’s established itself in the human population. It’s not going anywhere. Many people keep thinking, “When is it going to go back to pre-pandemic?” You can go back to your pre-pandemic life, but that pre-pandemic life is going to be one in which Covid-19 is there. And that’s why we get vaccinated. Hotez: All we really have to go on is the past year of the pandemic. And what we saw last year was a big July 4 surge that lasted until September in the South, so I think we have to anticipate that. Then I think we have to anticipate a fall surge in the Upper Midwest again, in the Plains states, particularly in those unvaccinated areas of Wyoming and Idaho. And if you look at Marc Lipsitch’s models from Harvard, way back in the early part of the pandemic, he predicted annual January peaks, and he was certainly right about the last one. And that may be how this works — we’ll continue to see surges and cases at different times of the year, in different parts of the country, until everybody’s either been vaccinated or infected. Welcome to POLITICO Nightly. You might’ve heard POLITICO editor Carrie Budoff Brown is headed to a new opportunity. (We hear it’s some sort of thing where it matters If It’s Sunday or not.) Congrats to CBB, and to the folks at NBC News, who are getting an incredible colleague and leader. Reach out with news, tips and ideas for us at mward@politico.com, or on Twitter at @MyahWard.
| 
