Where and Why COVID-19 Cases Are Surging in the United States

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Experts say low vaccination rates and a lack of mask wearing have fueled the latest surge in COVID-19 cases. Mood Board/Getty Images

• Researchers say COVID-19 cases are surging in places like Arkansas and Los Angeles County due to low vaccination rates.
• Most of the increase in cases is associated with the delta variant.
• Experts say more people need to be vaccinated, and mask mandates need to be reinstated to reduce cases again.

A “runaway train” and a “raging forest fire that will continue to grow in size and strength.”

That’s how public health researchers are describing the current COVID-19 surge in Arkansas.

The latest forecast from officials at the University of Arkansas for Medical Sciences Fay W. Boozman College of Public Health projects an average of 1,039 new cases per day in the state over the next week.

They also predict an average of 169 new cases per day in children under the age of 17.

The researchers warn that those numbers may already be out of date because the coronavirus is moving so rapidly in this region of the country.

Why? The researchers point to Arkansas’ vaccination rate of 35 percent, one of the lowest in the country.

Arkansas has one of the highest rates of new COVID-19 cases per capita, but it has plenty of company amid this latest nationwide surge.

In overall numbers, the Centers for Disease and Control and Prevention (CDC) reports that Florida had the most new cases the past week. Florida also had the most COVID-19 deaths the past week.

“It’s more heartbreaking than surprising,” Dr. Rajiv Bahl, an emergency medicine physician in central Florida, told Healthline. “If we could get more people vaccinated, we could start to see the numbers plateau, even decrease.”

Outbreaks in unexpected places

A preprint study reports that the viral load in the delta variant is more than 1,000 times higher than that of the original coronavirus variant.

That makes it much easier to be transmitted from person to person.

Driven by the delta variant, even states such as California are seeing a spike in new cases and hospitalizations. That comes despite the fact the number of fully vaccinated people in the state is 61 percent.

The rise is most dramatic in Los Angeles County, the largest U.S. county with a population of 11 million.

On June 15, when the state reopened, Los Angeles County reported 210 cases. This past Sunday, the caseload was 1,635. It was the 10th straight day of more than 1,000 new cases.

“What’s happening is that there are just not enough people vaccinated there,” Dr. George Rutherford III, a professor of epidemiology at the University of California, San Francisco, told Healthline.

“When you look at a map of the county, there are large swaths where vaccination rates are low and there wasn’t enough natural acquired immunity, especially in the face of the delta variant,” he said.

There are reports of positive test results in people who are fully vaccinated. A White House staff member and a senior aide to House Speaker Nancy Pelosi both tested positive, but they reportedly have only mild symptoms.

Experts say that shows the vaccines are working.

“Those who are getting COVID-19 despite the vaccine are only experiencing very mild symptoms,” Bahl said. “The point of the vaccine was to prevent severe and life threatening illness. That’s exactly what it’s doing even with the delta variant.”

What’s the outlook?

One expert said combining a highly transmissible virus variant with low vaccination rates and doing away with COVID-19 restrictions is a recipe for trouble.

“Pretending the pandemic is over is going to cost lives,” said Dr. Gregory Poland, a professor of medicine and infectious diseases at the Mayo Clinic in Minnesota, and director of the Mayo Vaccine research group.

“We are going to see these so-called hot spots, no question about it,” he told Heathline. “We will see outbreaks and a major surge in the later part of the summer and fall, particularly as kids go back to school. That wasn’t an issue with the original virus but will be a major issue with the delta variant.”

“The message has to be vaccines and masks, not one or the other,” Poland said. “Get the vaccine, and when you’re in a crowd, when you’re indoors, wear a mask. That’s what I do, what my medical colleagues do. It’s the safest course if we want to beat this thing back. Otherwise, we’re going to be in a cycle and people will needlessly die.”

Los Angeles County has already put its indoor mask mandate back in place. Other California counties are strongly urging people to wear a mask indoors but aren’t requiring it.

Chicago announced it was putting travel restrictions back in place. Unvaccinated travelers from Arkansas and Missouri, two states considered hot spots, will have to either quarantine for 10 days or present a negative COVID-19 test result.

Amid the resurgence of cases, officials at Apple Inc. are reportedly pushing back the date for workers to return to the office until at least October. The company has also recommended that workers in its retail stores wear masks.

 

Why Some Experts Think Nasal Sprays Are the Best Approach for COVID-19 Vaccines

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Experts say a nasal spray would attack the novel coronavirus at the point it enters the body. Petri Oeschger/Getty Images

• Researchers say a nasal spray vaccine against COVID-19 might be the most effective way to fight the novel coronavirus.
• That’s because the virus usually enters the human body in the nasal passage, and a spray would attack the invader there.
• Right now, 7 of the 100 COVID-19 vaccines in clinical trials are nasal sprays.

SARS-CoV-2 is a respiratory virus, which means its favorite place to enter the body is through the nose. That’s why testing for the novel coronavirus involves nasal swabs.

If that’s the case, though, why do we vaccinate people against COVID-19, the disease caused by an infection with the coronavirus, with a shot in the arm and not a nasal spray?

Indeed, nasal sprays can be used to vaccinate against COVID-19, and several such vaccines are now being developed.

“One of the big selling points would be that intranasal vaccines are needle-free, and there is a big population of people who are freaked out by getting a needle stick,” Dr. Troy Randall, an inflammation, immunology, and immunotherapeutics researcher at the University of Alabama at Birmingham, told Healthline.

“Given that [the novel coronavirus] is a respiratory virus, having an antibody response in the nose is probably a better model,” he added.

Randall co-authored an article that was published today in Science magazine with fellow researcher Frances Lund on the potential benefits of an intranasal COVID-19 vaccine.

A different type of immune response

Delivering vaccines via a nasal spray is not a new idea.

FluMist, a nasal influenza vaccine, has been on the market since 2003.

Of the approximately 100 COVID-19 vaccines currently undergoing clinical trials, however, only seven are nasal sprays. And all COVID-19 vaccines currently approved for use are delivered via intramuscular injection.

Immunology researchers have learned in recent decades that the immune response to infections occurs not just throughout the body but also locally, such as in the mucous membranes in the nose and throat.

“To get that specialized response, you need to put the vaccine at the infection site,” Randall said.

The idea is to defeat the coronavirus while it’s still in the nose before it has the chance to invade the body further.

“You prevent the virus from getting a foothold,” he said. “A nasal infection won’t kill you, but you want to prevent an inflammatory immune response in the lungs that could.”

Vaccine shots, whether they use the cutting edge mRNA technology or a form of neutralized coronavirus, provide an immune response throughout the body, Randall noted, but only a relatively weak response in the mucosal lining of the nose, where most SARS-CoV-2 infections first take root.

Conversely, intranasal vaccines are potent at the site of administration but perhaps less so systemically, he said.

“From a public health perspective, it might make sense for everyone gets the shot in the arm initially and that the booster shot be the internasal one” so that a strong immune response is generated both locally and systemically, Randall suggested.

A vaccine that activates the immunoglobulin A and resident memory B and T cells in the nasal passages and upper airways not only would provide a barrier to infection but also reduce transmission of the coronavirus by immunized people who have a mild case of COVID-19.

Obstacles to the nasal spray approach

Randall said that making effective COVID-19 nasal vaccines is complicated.

The most effective COVID-19 vaccines now being administered are based on cutting edge mRNA technology and include only bits of surface protein from the target SARS-CoV-2 virus, not an intact live or dead virus itself.

FluMist, however, delivers a dose of live attenuated (or weakened) influenza virus. That’s because “for it to work, it has to infect cells,” said Randall.

The COVID-19 nasal vaccines now being developed mostly work the same way.

Using live attenuated virus is an older method of vaccination and carries some risk of causing infection and illness in some cases.

The effectiveness of such vaccines can also be limited if the recipient has previously had the flu, since previously acquired immunity can destroy the vaccine before it can be recognized as a new strain of the disease.

Randall said that a nasally delivered mRNA-based vaccine is possible, but it likely would require tweaks to the coronavirus spike protein nanoparticles currently used in injectable COVID-19 vaccines.

“It needs to be formulated so that nasal epithelial cells will take it up and cause an immune response,” he said.