For a fourth consecutive summer, COVID-19 is on the rise, though this year’s warm-weather wave appears milder than those in the emergency period of the pandemic.

COVID-19 indicators of hospital admissions, emergency department visits, test positivity, and wastewater levels have all been increasing in the past month, with a peak not yet clearly in sight, according to data-tracking by the Centers for Disease Control and Prevention. From June 10 to July 29, test positivity rose from 4.1 percent to 8.9 percent. For reference, the most recent winter wave had a peak test positivity of 10.6 percent on December 31, 2022.

On the brighter side, however, weekly COVID-19 hospital admissions and deaths continue to be at their lowest points since the start of the pandemic. For now, deaths do not appear to be rising, though there are lags in data reporting. Weekly new hospital admissions are ticking up only slightly—with admissions rising to about 8,000 in the week of July 22, up from around 6,300 the week of June 24.

Death counts for the most recent weeks with complete data show tallies of 500 to 400. And excess deaths—the number of deaths above expected baseline levels—are no longer being observed in CDC data. That is, the weekly number of deaths in the US from all causes is currently tracking with the pre-pandemic number of expected deaths.

The seemingly milder wave is likely due to a combination of factors, including immunity from vaccines and past infections and the fact that many people vulnerable to the virus died in previous waves. The cumulative US death toll of the COVID-19 pandemic stands at over 1.1 million.

Still, the virus is surging again this summer, raising questions of whether summer waves will be a fixed seasonal cycle for this virus. Many health experts see SARS-CoV-2 as predominately a cold-weather virus, much like other respiratory germs, such as the common cold and flu viruses that thrive and surge in the fall and winter. The Food and Drug Administration, for instance, has modeled its COVID-19 vaccine booster plans around those used for annual flu shots.

But SARS-CoV-2’s seasonality is still unclear, and researchers don’t know exactly what’s driving the summer waves, which often start in the southern part of the country. A leading hypothesis is that the upticks coincide with summer vacations, travel, and get-togethers.

Another potential factor for waves is newly emerging variants. Currently, a new omicron subvariant—EG.5, which is related to XBB.1.9.2—is gaining dominance in the US over the previously reigning variants, XBB.1.5 and XBB.1.16. However, monitoring for SARS-CoV-2 variants has declined so steeply that the CDC only has enough data to estimate variant prevalence for three of the country’s 10 health regions (the areas around California, New York, and the Southeast).

Based on an FDA advisory committee meeting in June, vaccine manufacturers will likely roll out updated COVID-19 booster shots this fall aimed at an XBB subvariant lineage, possibly XBB.1.5.

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A new omicron coronavirus subvariant dubbed XBB.1.5 now accounts for an estimated 40.5 percent of all US COVID-19 cases amid a winter wave that is driving up hospitalizations, particularly in places where XBB.1.5 is most prevalent.

Nationwide, new reported cases are hovering around 59,000 per day, which is still relatively low compared with previous waves. But case data has become murkier over the 3-year-old pandemic, with fewer testing sites available now and the results of common at-home tests going unreported. Additionally, data reporting generally lags around end-of-year holidays, meaning case reports may jump in the coming days as backlogged data rolls in.

Hospitalizations, however, are clearly rising, with an average of around 45,000 hospitalized per day, according to data tracking by The New York Times. National hospitalization rates now rival those from the peak over this past summer driven by bygone omicron subvariants, federal data shows. Some of the areas seeing the large upticks in hospitalizations are those where the new subvariant, XBB.1.5 is most prevalent. For instance, in the Northeast (federal health region 1), XBB.1.5 has the highest regional proportion, accounting for 75 percent of cases, and hospitalizations have risen 16 percent over the prior seven days, the largest region-specific rise, according to data from the Centers for Disease Control and Prevention.

Wave factors

This does not mean XBB.1.5 is causing more severe disease than previous variants. There is a variety of reasons why hospitalizations may be increasing as a yet more transmissible subvariant takes off. That includes waning immunity and the abysmal uptake of the bivalent booster, particularly among older adults, who are most vulnerable to severe disease. Currently, only 15 percent of Americans aged 5 and over have gotten their bivalent shot, and only 37.5 percent of people aged 65 and over have been boosted. In December, the CDC quietly expanded access to the bivalent vaccine to children aged 6 months to 5 years, but just 3 percent of that population has completed a primary series.

Meanwhile, people are traveling, gathering, and spending more time indoors amid holidays and cold weather—all things that can boost transmission. Some places where XBB.1.5 has yet to take off are also seeing rises in hospitalizations. For instance, in the South (health region 4), XBB.1.5 only accounts for about 19 percent of cases, with BQ.1.1 still accounting for 41.5 percent. Hospitalizations in the region have increased by nearly 14 percent over the past week’s data.

XBB.1.5 has a clear transmission advantage over other omicron subvariants and is expected to continue spreading throughout the country. The virus is a sublineage of omicron XBB, which is a combination of two BA.2-sublineages that merged: BJ.1 (BA.2.10.1.1) and BA.2.75. XBB.1.5 has three additional notable mutations compared with the original XBB.

Though early research has suggested that XBB.1.5 is even more immune-evasive than its predecessors, data published late last month in the New England Journal of Medicine offered some good news in regard to vaccine protection. The data indicated that people boosted with the BA.5-targeting bivalent vaccine used in the US had stronger neutralizing antibody activity against XBB than those who had only received the original booster.

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With national cases of COVID-19 dropping precipitously, the Centers for Disease Control and Prevention will soon release new guidance on how states and local governments can ease out of health restrictions, including indoor mask wearing. According to news reports citing unnamed officials, new guidance could come as early as next week.

The CDC’s guidance will arrive well after several states and local governments charged ahead with plans to pull back pandemic restrictions, particularly indoor masking. The moves have left some questioning whether the CDC is, once again, struggling to keep up with the pandemic’s shifting conditions.

In a press briefing last week, CDC Director Rochelle Walensky stood by the current guidance, noting that “our hospitalizations are still high, our death rates are still high.” While the agency was “encouraged” by current downward trends, “we are not there yet,” Dr. Walensky said of easing guidance.

At the time, 99.1 percent of US counties had high or substantial levels of virus transmission, which necessitates indoor masking, according to the CDC’s current guidance. Though cases continue to fall, transmission levels have changed little since then. Nationally, the average daily new cases is still around 140,000, which is not much lower than the peak average seen during the delta wave. Hospitalizations are still high, with a daily average around 85,000. And daily deaths are still higher than at any point during the delta wave, with the current daily average of around 2,300.

Eager to move on

But in a briefing Wednesday, Walensky acknowledged the reality “that everyone is anxious to move beyond this pandemic” as well as the health restrictions put in place over the last two years.

“As we see the omicron wave continue to wane, we know that you may have questions regarding what prevention strategies are really necessary for this moment, especially as people are so eager to remove them,” she said.

As such, the CDC is working on new metrics for determining when it’s safe to ease restrictions in specific areas. Though Walensky stopped short of explicitly saying what those metrics will be, she emphasized that the agency is focused on local levels of severe disease and hospital capacity rather than cases and transmission levels.

“As we consider future metrics, which will be updated soon, we recognize the importance of not just cases… but critically, medically severe disease that leads to hospitalizations,” she said. “We must consider hospital capacity as an additional important barometer. Our hospitals need to be able to take care of people with heart attacks and strokes. Our emergency departments can’t be so overwhelmed that patients with emergent issues have to wait in line.”

With the new metrics, Walensky said she hopes the updated guidance will be more flexible in terms of adapting to changing conditions. “We want to give people a break from things like mask-wearing, when these metrics are better, and then have the ability to reach for them again should things worsen,” she said.

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Despite being widely seen as mild, the omicron coronavirus variant has been brutal on children and adolescents—particularly babies and toddlers, who are still ineligible for vaccination.

According to a study published Tuesday by the Centers for Disease Control and Prevention, the peak rate of pediatric hospitalizations during the recent omicron surge was four times higher than the peak seen during delta’s wave last fall. And the largest increase was seen in children ages 0 to 4, who had a peak hospitalization rate five times higher than that seen amid delta’s wave.

The study authors, led by CDC emergency response team researcher Kristin Marks, were careful to note that incidental cases of COVID-19 in hospitalized children do not account for the jump in rates amid omicron. Marks and colleagues looked carefully at medical charts from hospitalized children during both the delta and omicron waves. They compared the proportions of children coming into hospitals who had COVID-19-related symptoms at admission and were marked as being admitted specifically for COVID-19. Between the two waves, they found no significant differences in those proportions.

Specifically, during the delta wave, about 88 percent of children entering the hospital had COVID-19-related symptoms, compared with 87 percent during the omicron wave. And about 81 percent of hospitalized children were admitted primarily for COVID-19, compared with about 82 percent during the omicron wave.

“Consistent with national hospital surveillance data, the findings in this report indicate that the omicron-predominant period had higher rates of pediatric COVID-19 hospitalizations than the Delta-predominant period,” Marks and her colleagues concluded.

Not so mild

Marks et al. also noted that omicron produced severe disease in some children and has the potential to cause long-term symptoms. “Observed indicators of severe COVID-19 among children and adolescents, in addition to the potential for longer-term sequelae, highlight the importance of multicomponent strategies to reduce the incidence of COVID-19, including vaccination of eligible persons and other prevention measures,” such as masking, they wrote.

The study drew data from a hospital surveillance network that spans 99 counties across 14 states. The authors included medical records of children who tested positive for COVID-19 and were admitted to a network hospital between July 3, 2021, and January 22, 2022. The omicron wave was considered to span December 19 onward. The authors determined rates of cases based on pre-existing population data on the areas surrounding the hospitals.

During the two waves, pediatric weekly hospitalization rates peaked during the weeks ending on September 11, 2021 (amid delta) and on January 8, 2022 (amid omicron). During the omicron wave, weekly pediatric hospitalizations peaked at 7.1 per 100,000 children, which is about four times higher than delta’s peak rate of 1.8 per 100,000.

Peak hospitalization rates of children ages 0 to 4 years during the omicron wave were more than five times higher, with about 15.6 hospitalizations per 100,000 children, compared with delta’s peak in that age group of 2.9 per 100,000. Additionally, omicron hospitalization rates among children ages 5 to 11 and adolescents 12 to 17 were both around double their peaks during delta.

When the researchers looked at admission rates to intensive care units, they also found an increase during the omicron wave. Peak ICU admissions amid omicron were 1.4 times higher than during delta.

Vaccination appeared to strongly protect against pediatric hospitalizations, but vaccine availability was limited across the study. The only age group that was eligible for vaccination throughout the whole study was the 12- to 17-year-olds. Based on December data, hospitalization rates among unvaccinated adolescents were six times higher than among fully vaccinated adolescents in that same age group.

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US officials are comparing the ultra-transmissible omicron coronavirus variant to a natural disaster as the country continues to shatter records, logging over 1.4 million new COVID-19 cases Monday and seeing hospitalizations at all-time highs of over 140,000.

Officials are now bracing for the weeks ahead, which are expected to bring yet higher numbers of cases that will hamstring health care systems and other essential services nationwide.

“I think that we’re talking about a natural disaster,” Janet Woodcock, acting commissioner of the Food Drug Administration, said in a Senate Health Committee hearing Tuesday. “I think right now, we need to focus on continuity of operations for hospitals and other essential services as this variant sweeps through the population.”

It has been less than seven weeks since researchers first reported omicron and just 42 days since it was detected in the US. But the highly mutated variant now accounts for an estimated 98 percent of coronavirus infections, according to an analysis updated today by the Centers for Disease Control and Prevention.

The explosive spread has sent cases skyrocketing. The US reported 1,417,493 new COVID-19 cases Monday, according to data tracking by The New York Times. The daily tally breaks the country’s previous record of just over 1 million cases on January 3, and it also sets a new global record. The seven-day average of daily new cases is now over 737,000, a 203 percent jump from two weeks ago.

Hospitalizations have seen a relatively smaller spike but are now at the highest levels seen in the pandemic. On Sunday, the US reached its record of just over 142,000 hospitalizations, previously set in mid-January 2021. On Monday, the US reported over 140,000 hospitalizations, bringing the seven-day average to 135,559, an 83 percent increase in the past two weeks. Deaths are also rising. The US reported 1,673 deaths Monday, bringing the seven-day average to 1,653 per day, a 36 percent increase in the past two weeks.

Bracing for disaster

Some eastern states and areas hit by omicron early in its spread, such as New York and the District of Columbia, may be nearing or seeing peaks in cases. But some Midwestern states are still early in their peaks, meaning omicron’s surge through the US may not subside for several more weeks.

In the Senate hearing Tuesday, Dr. Woodcock and other health officials defended the federal response to the pandemic, particularly this latest and most devastating wave. Dr. Anthony Fauci, President Joe Biden’s chief medical adviser, called the omicron wave a “massive, unprecedented surge.”

“This is an extraordinary virus, the likes of which we have not seen even close to in well over 100 years,” he said. “We’re doing the best we possibly can,” he added.

Sen. Mike Braun (R-IN) specifically asked Woodcock if it was time to dramatically change and “decentralize” the country’s approach to handling the virus, noting that health precautions and vaccine mandates didn’t appear to avert the current omicron wave.

“You can fire a board of directors because your factory was devastated by a hurricane, a tornado, or a wildfire, but I don’t know whether that would improve the situation,” Woodcock said (at 2:41:51).

“Prior approaches” aren’t responsible for the omicron wave, Woodcock added. She then tried to redirect the discussion away from politics, giving a sobering outlook of the next few weeks.

“I think it’s hard to process what’s actually happening right now, which is [that] most people are gonna get COVID,” Woodcock said. “And what we need to do is make sure that the hospitals can still function [and that] transportation [and] other essential services are not disrupted while this happens. I think after that will be a good time to reassess how we’re approaching this pandemic.”

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Hospitals nationwide are once again buckling under the strain of COVID-19 cases as the ultratransmissible omicron wave crashes into health care systems that are already critically short-staffed and exhausted from previous waves of the pandemic.

The current situation is forcing states and hospitals to declare emergencies, deploy the National Guard, delay or cancel elective procedures, institute crisis standards of care, and allow health providers to stay at work even if they themselves are positive for COVID-19 because there is no one available to take their place. Together, the situation has some doctors openly worrying that the omicron wave will cause some systems to collapse in the coming weeks.

“The comforting news that this variant generally causes milder disease overlooks the unfolding tragedy happening on the front lines,” Craig Spencer, an emergency medicine physician and director of global health in emergency medicine at NewYork-Presbyterian/Columbia University Irving Medical Center, wrote in a New York Times opinion piece Monday.

Spencer noted that, unlike this time last year, there are effective COVID-19 treatment plans, therapeutics, and vaccines. “Yet these tools are still not enough to slow the rapid influx of patients we’re now seeing from omicron, and the situation is bleak for health workers and hospitals.”

Numbers and projections

Currently, the seven-day average of daily COVID-19 cases is nearing 700,000—an all-time high in the pandemic. Meanwhile, daily hospitalizations are averaging over 132,000, up 83 percent in the course of two weeks. The number of hospitalizations is quickly nearing the all-time record of around 137,000 hospitalizations per day in the pandemic, which was set in mid-January last year.

According to date reported by the Department of Health and Human Services, 77 percent of hospital beds in the country are occupied and 78 percent of beds in intensive care units are full. But the department’s data can have lags, reflecting hospital usages that may be one to two weeks behind. For instance, physicians and researchers tracking hospital capacity suggest Maryland’s hospitals may now be hitting capacity, based on a projection of lagging HHS hospital data that suggests hospital beds are only 79 percent full.

In his online bulletin, Inside Medicine, Harvard emergency physician Jeremy Faust on Monday quoted a Maryland physician colleague as backing up the projection, saying:

I can attest the situation in Maryland is [expletive] horrendous. The state has been maxed out for about 2 weeks. Multiple hospitals are operating under crisis standard of care. EMS [i.e. ambulances] is now so taxed that Baltimore county started transporting people in fire trucks last week. This is absolutely unheard of and absurd. Reports of people waiting over 1-2 hours on scene with fire fighters before an EMS unit gets there. Then when they get to the hospital they wait literally hours for a bed. Transfer centers now just laugh when you call the system is so back logged. It’s mind boggling to me how none of this has been national news.

Strained systems

Though a smaller proportion of people infected with omicron appears to develop severe COVID-19, there’s still a crush of patients, and some of them are suffering the worst of the disease. Last Friday, for instance, a hospital in Kansas ran out of ventilators amid a surge in COVID-19 case, spurring the county board to issue a local emergency. In addition, omicron is reaching vulnerable populations that end up needing hospital care after omicron exacerbates a previous condition, such as diabetes. Meanwhile, seasonal flu and other conditions bringing people to hospitals are also at high levels.

The surge of patients is coming at a time when overstretched hospitals are already critically understaffed and providers are facing extreme burnout.

On Monday, Virginia Gov. Ralph Northam issued a limited 30-day state of emergency to try to ease the strain on overburdened hospitals after the state saw record numbers of hospitalizations last week. The order allows hospitals to increase their bed capacity and increase staffing through a number of technical changes, such as adding flexibility for active out-of-state providers to practice in the state and expanding the ability of physician assistants to provide care.

“Health care workers and hospitals are exhausted, and they are again facing increasing numbers of patients, affecting their ability to provide care,” Gov. Northam said in a statement. “These steps will help ease the strain, giving medical professionals more flexibility to care for people. Ultimately, the best thing everyone can do for our hospitals and their staff is to get vaccinated.”

Easing the strain

Neighboring Maryland issued a similar 30-day state of emergency last week to buttress the state’s health care facilities amid record-high COVID-19 hospitalizations.

“The truth is that the next four to six weeks will be the most challenging of the entire pandemic,” Maryland Gov. Larry Hogan said in a statement last week. “All of the emergency actions we are taking today are to keep our hospitals from overflowing, to keep our kids in school, and to keep Maryland open for business, and we will continue to take whatever actions are necessary in the very difficult days and weeks ahead.”

Gov. Hogan’s order mobilized 1,000 members of the Maryland National Guard to assist state and local health officials. At least 10 states have called up National Guard members, spanning Oregon to New York, to help respond to the tidal wave of omicron cases and hospitalizations. For instance, Massachusetts deployed National Guard members in late December to hospitals deluged by COVID-19 patients. One of those facilities is UMass Memorial Medical Center, the main hospital in central Massachusetts, which is currently operating at 115 percent, according to a January 9 report by CNN.

“It’s just the perfect storm for a nightmare here in the emergency department,” Dr. Eric Dickson, CEO of the hospital and an emergency physician, told the outlet.

The staffing crisis also has some hospitals, such as some in Rhode Island and Arizona, allowing medical providers to stay at work, even if they themselves are infected with COVID-19.

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More states are activating crisis standards of care, and at least two have expanded access to COVID-19 vaccine booster doses as the delta wave continues to wash across the country.

While cases and hospitalizations have subsided in previous southeastern hotspots such as Florida and Alabama, the wave has headed north and west. Nationally, new cases of COVID-19 have plateaued at a high level of more than 70,000 per day, down from September peaks of upwards of 160,000.

North Dakota, Colorado, Minnesota, Alaska, and Vermont currently have the top-five highest case rates per 100,000 people, according to tracking by The New York Times. New Mexico, which ranks seventh for the highest daily case rates, is seeing a surge in hospitalizations, and more facilities are moving to crisis standards of care.

Effective Thursday, the two largest healthcare systems in Albuquerque—the University of New Mexico Health System and Presbyterian Healthcare Services—announced that they are activating crisis standards.

“Currently at UNM today, we’re operating at about 140% of our normal operating capacity, and I’ve had moments where we’ve approached 150%. This really is an unsustainable and unprecedented level of activity that we’ve been able to create,” Dr. Michael Richards, senior vice president for clinical affairs at UNM Health System, said at a press conference Thursday.

According to reporting by ABC News, “multiple” other health systems in the state are also considering implementing crisis standards.

Crises and boosters

“Our hospital teams are really stretched thin, and we are seeing way more patients than they thought possible,” Dr. David Scrase, acting cabinet secretary of the state’s Department of Health, said during the press briefing on Wednesday, according to ABC News. “What it means is if one of the people watching this press conference has a heart attack right now, there’s a good chance that we won’t have an intensive care unit bed for that person here in New Mexico.”

Earlier this week, Colorado also reactivated its crisis standards for care given the surge of COVID-19 cases. To try to turn the tide, Colorado Governor Jared Poli announced on Thursday that the state would open up COVID-19 booster doses to all adults. Currently, the Centers for Disease Control and Prevention only recommends boosters for certain groups.

“We want to ensure that Coloradans have every tool they need to protect themselves from this deadly virus and to help reduce the stress on our hospitals and health care workers. Every Coloradan is now eligible to get the booster so they can protect themselves and their families,” Governor Polis said in a statement. “I was relieved to get the booster two weeks ago and strongly encourage you to get it, too.”

And Poli is not alone. California is also providing more leeway for adults to get booster shots, regardless of whether they fall neatly into the CDC’s approved groups. In a press conference Wednesday, California’s secretary of health and human services, Dr. Mark Ghaly, noted evidence of waning protection from initial doses amid high levels of transmission in various parts of the country. “If you’re interested in getting a booster, go ahead and get one,” he said.

On Tuesday, Pfizer and BioNTech submitted a request to the Food and Drug Administration to make booster doses of their vaccine available to people ages 18 and up nationwide. The FDA is expected to grant the request, but the timing is not yet clear.

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Health officials in Idaho are reporting dire circumstances as hospitals around the state continue to crumble under the delta-fueled surge of COVID-19 cases.

“We continue to set record highs,” Dave Jeppesen, director of the Idaho Department of Health and Welfare, said in a press briefing Tuesday. With the latest data through September 18, the state saw a new record high of 686 hospitalized COVID-19 patients, a record high of 180 COVID-19 patients in intensive care units, and a record high of 112 COVID-19 patients on ventilators. The number of ventilated COVID-19 patients is nearly double what was seen in the last surge of COVID-19 cases in December.

“These numbers continue to increase, and we expect them to continue to increase,” Jeppesen added.

Currently, the daily average of new cases is around 1,200, an increase of 25 percent in the past two weeks, according to data tracking by The New York Times. Hospitalizations are up 34 percent, and the current average of deaths each day is 22, an increase of 223 percent.

Last Thursday, the health department expanded the use of crisis standards of care to cover the entire state. The health department had previously only activated the standards—which allow for suboptimal care and rationing of resources, like ventilators—for 10 hospitals in the hard-hit northern region of the Gem State. Now, hospitals statewide are facing a crush of patients, staff shortages, and a lack of beds.

“Bottom line: Our in-patient facilities are progressively becoming COVID hospitals and that’s the same story for the rest of the state,” said James P. Souza, chief physician executive for St. Luke’s Health System.

Lost time

Dr. Souza gave a grim rundown of what health care providers are now facing in Idaho’s hospitals. In the St. Luke system—which includes several hospitals across the state—COVID-19 patients accounted for just 8 percent of adult hospitalizations in July, but they now account for 67 percent. “That’s an unprecedented event in modern medicine,” he said. In the system’s intensive care units, the percentage of COVID-19 patients went from 17 percent to a current high of 70 percent.

As for the patients themselves, they’re skewing younger and sicker than those seen in the previous surge, Souza said. Of 51 COVID-19 patients in system’s ICUs, 36 are under the age of 55 and 13 are under the age of 40. The hospital system is also using more invasive treatments than before. Souza attributed this to the younger ages of the patients, who are attempting to use every method possible to try to survive their infections. “If we’re honest about it, 40-year-olds have not contemplated death before,” he said.

The system is also seeing more complications for severe COVID-19 infections, including clotting disorders and kidney damage. The average length of stay in the ICU has also increased from about six days to eight. Souza estimated that 30 percent of patients will have long-term recoveries.

Patients are also dying more. In previous surges, the mortality rate among COVID-19 patients in the ICU was about 28 percent, Souza said. But in the current surge, it’s 43 percent. There have been 80 COVID-19 deaths in the system since the beginning of September—four every day—with 35 in the last week. Calculating the estimated years of life lost from the people who died just in September—assuming they would have had average life spans otherwise—it amounts to more than 1,100 life years lost.

Crisis care

“For the people who say ‘we all die sometime:’ Yes we do,” Souza said. “But these people didn’t need to die now, and they didn’t need to die like this.”

Of the patients hospitalized with COVID-19, 90 percent are unvaccinated, as are 98 percent of ICU patients. Of the sliver of COVID-19 patients who are vaccinated, many have compromised immune systems, such as organ-transplant patients and people who are actively being treated for cancers.

The unvaccinated are far from the only ones suffering in this crushing surge. Health department director Jeppesen noted in an emotional appeal that his mother suffered a stroke and a fall on Thursday, just as crisis standards went into effect statewide. His mother went to an emergency department, where she saw people being treated in the waiting room. She had to wait longer than normal for care and was treated in a “nontraditional” area of the hospital. Though the hospital would have normally kept his mother overnight for observation, she was instead discharged the same day. Though he reported that his mother appears to be recovering well, the stroke was more stressful than it would have normally been.

“We are so lucky to have such talented health care professionals in Idaho,” Jeppesen said, his voice cracking with emotion. “And those same health care professionals need our help. They need the unvaccinated to please consider getting vaccinated.”

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The US reached a milestone of having 200 million people vaccinated with at least one dose of a COVID-19 vaccine on Friday. And for two days in a row now, over one million people rolled up their sleeves for a shot. Those are daily highs not seen in nearly seven weeks.

Of those one million vaccinations each day, approximately 562,000 and 534,000 shots went to people receiving their first dose, according to White House COVID-19 Data Director, Cyrus Shahpar. Earlier this week, the seven-day average of new first doses nationwide has been hovering around 400,000, according to the Centers for Disease Control and Prevention.

The boost in vaccinations comes amid a devastating wave of COVID-19 cases, hospitalizations, and deaths driven by the hypertransmissible delta variant, which now accounts for nearly all cases in the US. The surge stands to rival the country’s worst wave of the pandemic, which peaked in January 2021 with average daily new cases around 200,000. The country is now averaging over 130,000 cases a day, and that figure is still climbing.

Hospitalizations and deaths are also on the rise. In the past two weeks, hospitalizations have increased 53 percent and deaths have increased 108 percent, according to data tracking by the New York Times. Hospitals in several states are reaching capacity and, in some cases, running out of beds in intensive care units. The country recorded around 1,000 deaths each day in the last two days. With highly effective vaccines widely available for free to all people over the age of 12, nearly all deaths are entirely preventable.

The surge in disease appears to be boosting vaccination in some places. As White House COVID-⁠19 Response Coordinator Jeff Zients noted last week, some of the states with the highest case rates are seeing some of the biggest gains in vaccination. In the past month, the average number of doses administered each day has tripled in Arkansas and quadrupled in Louisiana, Alabama, and Mississippi.

Generally, the more people protected by vaccines the better, however, the jump in shots is unlikely to spare the country from the worst of the current surge. It takes five to six weeks for vaccination to provide full protection. Other mitigation efforts—such as the tried and true measures of mask wearing, crowd avoidance, and good ventilation—can drag down the current trend. That said, health experts say that the extra protection from vaccinations now will help as we head into fall, a new school year, and colder weather, all of which can spur increases in transmission.

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As the hypertransmissible delta coronavirus variant continues its rampage through the unvaccinated, several states continue to set new COVID-19 cases records and many hospitals are hitting their limits.

At least five states have exceeded their previous peaks of seven-day averages for new daily cases—Florida, Louisiana, Hawaii, Oregon, and Mississippi. Seven states have exceeded their most recent peaks in hospitalizations—Arkansas, Florida, Hawaii, Louisiana, Mississippi, Oregon, and Washington.

Florida in particular has been ablaze with COVID-19. The Sunshine State exceeded its previous record average of around 16,000 new daily cases, which was set in January. The state is now averaging just under 22,000, according to data reported by the Centers for Disease Control and Prevention. As for daily hospitalization tallies, Florida is currently at its all-time record of around 15,000, exceeding its previous highest peak of around 12,000 last July.

Federal health officials noted last week that shipments to Florida containing COVID-19 treatments, including monoclonal antibodies, increased eightfold over the past month. On Tuesday, the Florida Hospital Association reported that it soon expects 75 percent of hospitals in the state to reach critical staffing shortages.

Grim outlook

“There can be no question that many Florida hospitals are stretched to their absolute limits,” Mary Mayhew, FHA president and CEO, said in a statement. “While hospitalizations continue to increase, three out of four Florida hospitals expect to face critical staff shortages in the next seven days, an increase of nearly ten percent since last week, and half of our hospitals will no longer accept transfer patients from other facilities.”

Nationwide, current US daily case are up 64 percent over the past two weeks. The current numbers rival those seen in early February when the country was coming down from its highest COVID peak in early January. About 75 percent of the country’s hospital and ICU beds are filled, according to data reported by the Department of Health and Human Services. And about one in five ICUs nationwide has reached or exceeded 95 percent occupancy.

Hospitalizations, severe disease, and death from COVID-19 continue to occur almost entirely among people who are unable or unwilling to get vaccinated. Currently, only 51 percent of the US is fully vaccinated. With filling hospitals, health experts warn that quality of care can decrease, leading to delayed treatments, worse outcomes for patients, and higher overall mortality rates.

Health experts expect that things will only get worse into the autumn as the hypertransmissible delta variant continues to spread. Delta is already estimated to account for more than 90 percent of infections nationwide. Meanwhile, we’re heading into a new school year and colder weather, both of which can increase transmission of COVID-19, as well as other seasonal plagues.

The current high transmission, delta’s dominance, and a grim-looking fall likely all contributed to the reported decision by the Biden administration to soon begin offering booster shots. However, as CDC experts laid out last week, the most effective way to curb transmission is to get more shots into unvaccinated arms.

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