The good news began around mid-August, when COVID-19 hospitalizations and cases began to drop after climbing relentlessly since late June.
It’s now clear that the unprecedented fourth surge of the pandemic has peaked. Compared to a high of over 3,000, less than 1,000 people are now hospitalized.
But heading in the right direction is not the same as arriving at a destination. And in Louisiana, the pandemic is still raging. Nearly every parish has the highest possible risk of COVID transmission, according to the state health department.
About four times more people are hospitalized now than during the spring, when, in the wake of the release of three effective and safe COVID-19 vaccines, it began to feel as if the pandemic might be over.
The trends are “encouraging,” Dr. Joseph Kanter, the state health officer, said this week, but he added that Louisiana is “not out of the woods.” Experts worry that the disease is still raging, infecting people, making them ill and killing them.
The threats are particularly acute for pregnant people. The state reported this week that six pregnant women had died, and 10 pregnancies were lost because of COVID-19, all of them cases where the pregnant person was not vaccinated. The Centers for Disease Control and Prevention warned Wednesday that pregnant people who contract COVID-19 and experience symptoms are 70% more likely to die of COVID-19 than someone who’s not pregnant. It found only one in three pregnant women is vaccinated.
Experts also warned that another surge could erupt.
“There's still tricks that this virus could come up with: grow faster, spread a little better. That's really what we need to be on the lookout for,” said Robert Garry, a professor of microbiology and immunology at Tulane Medical School. “And I just have this feeling that we're not quite done with COVID-19 yet.”
Garry was among those who helped debunk the theory that the SARS-CoV-2 virus is man-made, and he continues to study it and other coronaviruses in anticipation of the outbreak that might come next.
As for why the fourth surge is declining now, Garry said it could be that the delta variant — the most contagious strain of the pandemic — is beginning to run out of people to infect.
“There are just a limited number of people who are not vaccinated, still susceptible. So when it runs through that part of our population, then you start to see numbers come down,” he said.
Infectious disease epidemiologist Susan Hassig agreed.
“I think with delta, we were probably finding even fewer cases than were actually out there,” Hassig said, despite the fact that cases this summer dwarfed every previous surge. “And so we may have gotten a really big dose of natural infection that's going to give us a little short-term protection in the community.”
Natural immunity, which current research shows is less protective than the immunity gained by vaccination, could last for a couple of months, she said, raising the question of what happens next for people who do not get vaccinated.
“We've seen the waves come before, and at the end of each wave, people put their guard down and relax,” Garry said. “They say, ‘OK, it's over,’ and then the next wave comes.”
State epidemiologist Theresa Sokol said a number of things might have led to this point. Dropping cases could be due to the state’s mask mandate or the increased immunity in the population as vaccination rates began to rise over the three months that the delta surge has been raging. About 45% of Louisiana’s population is fully vaccinated, up from 37% before the start of the fourth surge.
The availability of monoclonal antibodies to treat those who contract COVID-19 could be impacting the drop in hospitalizations, she said. And she said that immunity gained from the virus spreading so rapidly among unvaccinated people could also be a factor. Over 80% of hospitalizations, cases and deaths in Louisiana are among unvaccinated people.
The high rate of viral spread in the community means that the state still needs mitigation measures, Sokol said, including the mask mandate, which Gov. John Bel Edwards extended for another 28 days this week.
“The more people we can get vaccinated, honestly, the more we'll be able to peel off these other layers,” she added.
The mask mandate in particular is key to protecting children under the age of 12 who are still not eligible for a vaccine. That age group has also accounted for some of the highest number of cases in the fourth surge.
State data shows that kids aged 5 to 11 account for about the same number of cases as children aged 12 to 17, and both have the most number of cases of any age group.
Along with the lingering fourth surge, new vaccinations in Louisiana have begun to slow down, Kanter said.
Vaccine mandates from employers, for sporting events and bars and restaurants are what could change that, Hassig said.
“We've made, from a public health perspective, all the arguments we can — it's kind of pointless, to some extent,” she said. “I mean, we'll keep trying. Maybe it'll resonate, something, somehow. But I think personally, that's the only thing that's going to move the needle substantively in this part of the country.”
Vaccinations are key to avoiding a future surge of COVID-19 or some new, even more dangerous variant, Garry said.
“These are incredibly safe vaccines, and people need to know if we can get the numbers up to 70% or 75% [vaccination rate], we would basically shut this thing down. And it's just, you know, the last group of people that seem to be resistant to it,” Garry said.
In the meantime, he’s watching the data with some hope.
“The trends are good,” Garry said. “Let's just hope they stay that way.”
