A cluster of midwestern and southern states have emerged as a new center of Covid-19 outbreaks, as the highly transmissible Delta variant sweeps across poorly vaccinated populations in the US.
The news marks a potentially serious setback for the Biden administration’s attempts to curb and control the pandemic as the Delta variant – which has wreaked havoc in the UK and elsewhere – is starting to spread more widely in America.
It also comes as life in much of the US has started to return to near normal, with many Covid-19 restrictions having been lifted, and as the vaccination program has slowed down.
Rates of Covid-19 cases in Kansas, Oklahoma, Missouri, Arkansas, Louisiana and Mississippi are among the highest in the country, and their vaccination rates among the lowest. Covid also appears to be gaining ground in the American west.
Even so, overall numbers of new Covid-19 cases are low. New infections are less than one-10th the average daily rate at the height of the pandemic in January, even as they have doubled in the last two weeks.
“We are not where we were in April 2020,” said Dr David Dowdy, an associate professor of epidemiology at Johns Hopkins University and an expert in infectious diseases. Nevertheless, he said, “We’ve seen those counts can go up substantially and quickly, so we need to be cautious but without panicking.”
About 55% of all Americans are fully vaccinated against Covid-19, according to the Centers for Disease Control and Prevention (CDC). Vaccines authorized by the Food and Drug Administration remain safe and highly effective against Covid-19 and its variants, including Delta. State officials said the overwhelming majority of people now hospitalized with Covid-19 are unvaccinated.
However, localized outbreaks highlight a growing divide in vaccine adoption among US states, as a complex set of conditions have left Republican-leaning and rural places with lower overall vaccination rates than Democratic-leaning states.
“The people who have not gotten vaccinated so far are a very diverse group,” said Dowdy. “It’s easy to portray it as … a political stripe, but vaccination rates are higher, for example, in those who are older, and that’s irrespective of political leaning.”
Daily vaccination rates nationally have fallen precipitously, from an average peak of 3.4m a day to about 432,000 a day presently. States such as Mississippi and Alabama have some of the worst vaccination rates in the nation, with just about one-third of their populations vaccinated. By contrast, Vermont has vaccinated 67% of its population.
Between April and July, the divide in vaccination rates between counties that voted for Joe Biden versus counties that voted for Donald Trump widened from 2.2% to 11.7%, according to the health research organization the Kaiser Family Foundation. Republicans remain the most vaccine adverse group in the nation. States across the midwestern and southern region now experiencing a Covid-19 outbreak have long ranked worse on a wide variety of health metrics.
At the same time, vaccination has allowed more people to move freely in society, making it difficult to unpick the effect of the Delta variant from that of changed human behavior, Dowdy said.
There remains “a group of conservative people who just don’t want to get it for political reasons”, said Aaron Wendelboe, a professor of epidemiology at the University of Oklahoma, and a former state epidemiologist amid the pandemic in Oklahoma. Nevertheless, experts including Wendelboe warn vaccine hesitancy is complex and multifaceted.
“We have a Republican governor who’s vaccinated, we have Republican leadership who’s vaccinated, and we’re a heavily red state,” said Dr Jennifer Dilaha, the director for immunizations at the Arkansas department of health. “I’m not sure to what degree the political differences in our state play a role, I think it’s likely other factors involved that are playing a heavier role.”
Dilaha said many Arkansans, particularly the young, underestimate the severity of disease caused by Covid-19, and overestimate risks associated with vaccines, which have proven very safe.
“They’re not familiar with the long-term consequences” of Covid-19, “because we’re still learning about them,” Dilaha said. “People do not realize that people with Covid-19 can have permanent lung damage, heart damage, kidney damage, brain damage.”
In recent weeks, more than 98% of people hospitalized with Covid-19 in Arkansas and Oklahoma have been unvaccinated. And in Arkansas, officials are seeing many more people in their 20s, 30s and 40s hospitalized.
While vaccine hesitancy remains complex, conservative lawmakers’ constant attacks on pandemic mitigation measures, intentionally or not, underscore the false idea that Covid-19 is not as severe as public health officials warn.
In Oklahoma, lawmakers have introduced legislation to make school mask mandates far more difficult to implement even as children under 12 remain ineligible for the vaccine, and to ban vaccine mandates. As it stands, most schools are in summer recess, most do not have done away with mask mandates, and none mandate vaccines.
Lawmakers in Tennessee attacked the top vaccine official in the state, eventually leading to her dismissal. After politicians criticized health officials, all vaccine-related messaging was abandoned, even for unrelated vaccine-preventable diseases such as measles and human papilloma virus (HPV). More than 30,000 families missed measles vaccines during the pandemic.
“When the people elected and appointed to lead this state put their political gains ahead of the public good, they have betrayed the people who have trusted them with their lives,” wrote Dr Michelle Fiscus in an editorial in the Tennessean newspaper.
In Missouri, Republican governor Mike Parson lashed out at the Biden administration’s announcement surge teams would help states vaccinate people in a door-to-door effort.
“I have directed our health department to tell the federal government that sending government employees or agents door-to-door to compel vaccination would NOT be an effective OR welcome strategy in Missouri!” Parson wrote on Twitter on Wednesday night.
The speed with which the Delta variant can spread among unvaccinated populations was demonstrated in a recently released investigation into an outbreak in a gymnastics gym in Oklahoma.
In an outbreak investigated by the CDC, 47 people were sickened with Covid-19 in April. Among the 21 people whose test samples could be sequenced, all were found to have the Delta variant.
Among those infected, 85% did not have a Covid-19 vaccine, many of them adolescents who were ineligible to receive the vaccine at the time. The CDC recommends unvaccinated people wear masks, but the gym had poor mask adherence and ventilation. Indoor, high-intensity sports are among the most high-risk activities for unvaccinated people.
“I’m very concerned that we are already seeing a surge in cases,” said Wendelboe, who created his own model to track transmission in the state. He expects Delta to result in five times as many Covid-19 cases in August, and 10 times as many by December.
Even a small increase in vaccine rates could help mitigate this outcome, he said. Otherwise, Oklahoma may, “continue to see just an uptick in cases all the way through the winter”.