Surging COVID-19 cases in Europe, Brazil signal warning for US

Substantial surges in new coronavirus cases and hospitalizations in Europe and Brazil offer a worrying preview of what the United States faces in the coming weeks and months as the plummeting number of cases here begins to level off.

The United States has reported an average of 54,740 cases per day over the past week, a steady decline from the apex of the outbreak in January, when the daily case count was about five times higher. Daily case counts stand about where they were in mid-October, and close to the apex of the summer surge that hit Sun Belt states particularly hard.

But the precipitous drop that occurred through February is now nearing a plateau, one that could presage yet another spike in cases just as optimism about the course of the pandemic begins to take hold.

Public health experts are nervously watching European nations, where a surge in cases is once again straining health care systems. European nations have reported 242 cases per million residents, a rate about 50 percent higher than the United States and one that has climbed by about a third since mid-February.

The increase appears to be driven by spread among younger people, and by the emergence of the B.1.1.7 variant that studies show is substantially more infectious, even among children. That raises the specter that the variant will continue spreading widely even as older and more vulnerable people receive doses of vaccine.

“Even if we are able to reduce the number of cases in the older age population of serious disease, we will pick up more in younger populations, which is exactly what we’ve seen in Europe,” said Michael Osterholm, director of the Center for Infectious Disease Research and Prevention at the University of Minnesota.

The situation in Brazil is even more frightening. Hospitals in all but two of Brazil’s 27 states are north of 80 percent capacity, and more than 2,000 people are dying on a daily basis from COVID-19. Brazil’s seven-day average of new cases stands at 71,800, higher than at any point during the pandemic.

President Jair Bolsonaro has continuously downplayed the threat of the virus. In remarks last week, he told Brazilians to “stop whining” about the virus that has killed more than 280,000 of his constituents.

“What’s happening in Brazil is a tragedy,” Osterholm said. 

That level of crisis is not likely to return to the United States in the coming weeks, as more than 2 million people every day receive doses of one of the three vaccines approved by the Food and Drug Administration. But some models project more spread in the coming weeks, concentrated in the Upper Midwest, the Northeast and the mid-Atlantic.

Hospital visits are rising in Detroit, Flint and Macomb County, Mich. Midwestern cities such as Minneapolis and Chicago are likely to see spikes in the coming weeks, as are the Washington metro area and New York City, according to the PolicyLab at the Children’s Hospital of Philadelphia. Positivity rates are rising in Phoenix, San Diego, Los Angeles and Las Vegas, a worrying sign of a potential spike.

“Our country remains very much in a period of sustained COVID-19 transmission. Although increases in transmission are somewhat expected as communities begin to reopen, these trends are concerning and a reminder that this pandemic is far from over,” the PolicyLab researchers wrote. “The regions of most concern right now are metropolitan areas. This is likely because they are more densely populated, facilitating easier viral transmission and making it more difficult to achieve higher population-level vaccination rates.”

The race to vaccinate as many Americans as quickly as possible represents the first time in the entire pandemic that the United States has been on the leading edge of the battle against the coronavirus. Americans are being vaccinated at a faster pace than any nation other than Chile, Israel, the United Arab Emirates and Bahrain. 

Americans are being vaccinated twice as fast on a per capita basis than are Canadians, and three times faster than the best-performing European nations.

The Biden administration has said it will send millions of doses of a vaccine developed by AstraZeneca and Oxford University, one that has not been approved by the Food and Drug Administration, to Canada and Mexico.

In testimony to the House Foreign Affairs Committee on Thursday, health experts told Congress the United States needs to step up its multilateral efforts to end the pandemic overseas as fast as possible. 

“We live in a deeply interconnected, interdependent world, and an outbreak anywhere can quickly become an outbreak everywhere,” said Ashish Jha, dean of the Brown University School of Public Health. “We need a vigorous, multipronged, multilateral approach to bring this pandemic to an end by vaccinating a large majority of the world.”

Dozens of low- and middle-income nations have not even received their first doses of vaccine, raising the frightening prospect that unchecked spread could lead to new variants that might evolve a more successful means of evading vaccine effectiveness. 

“If you have billions of people in low-income countries that are getting infected with this, that is where you’re going to spit out variant after variant that could very well challenge the integrity of our vaccines,” Osterholm warned. “These variants are going to just keep spinning out. This is why we’re not done yet.”