OVERLAND PARK, Kan. — A summer that began with plunging caseloads and real hope that the worst of Covid-19 had passed is ending with soaring death counts, full hospitals and a bitter realization that the coronavirus is going to remain a fact of American life for the foreseeable future.
Vaccination rates are ticking upward, and reports of new infections are starting to fall in some hard-hit Southern states. But Labor Day weekend bears little resemblance to Memorial Day, when the country was averaging fewer than 25,000 cases daily, or to the Fourth of July, when President Biden spoke about nearing independence from the virus.
Instead, with more than 160,000 new cases a day and about 100,000 Covid patients hospitalized nationwide, this holiday feels more like a flashback to 2020. In Kansas, many state employees were sent home to work remotely again. In Arizona, where school mask mandates are banned, thousands of students and teachers have had to go into quarantine. In Hawaii, the governor has issued a plea to tourists: Don’t visit.
“The irony is that things got so good in May and most of June that all of us, including me, were talking about the end game,” said Dr. John Swartzberg, an infectious disease specialist at the University of California, Berkeley. “We started to enjoy life again. Within a very few weeks, it all came crashing down.”
The resurgence has left the country exhausted, nervous and less certain than ever about when normalcy might return.
More than 1,500 Americans are dying most days, worse than when cases surged last summer but far lower than the winter peak. Though the rate of case growth nationally has slowed in recent days and incremental progress has been made in Southern states, other regions are in the midst of growing outbreaks. And with millions of schoolchildren now returning to classrooms — some for the first time since March 2020 — public health experts say that more coronavirus clusters in schools are inevitable.
“No one’s wanting to go back to fight-Covid mode,” said Andrew Warlen, the director of the Health Department in Cass County, Mo., who said some parents had resisted quarantining their students even after they were exposed to someone with the virus.
Vaccines are effective in preventing severe disease and death, but 47 percent of Americans are not fully vaccinated, allowing the highly infectious Delta variant more than enough opportunity to inflict suffering and disrupt daily life. Health officials say that most of the patients who are being hospitalized and dying are not vaccinated, and that it is those unvaccinated people who are driving the current surge and burdening the health care system.
“I know a lot of people are feeling this whiplash — you could see the light at the end of the tunnel, and then it was snatched away again,” said Kate Franzman, 36, a director of a nonprofit group who lives in Indianapolis and has started wearing a mask in public once again.
The summer surge has played out in a fatigued, politically divided country with no unified vision for how to navigate the pandemic. During previous upticks, the promise of vaccines led many to think that a return to ordinary life was perhaps just months away and that masking up or staying home was a short-term investment toward that goal. But the virus’s mutations and the refusal of millions of Americans to take the shots have dimmed that hope.
In much of the South, intensive care units are overflowing, and in the Midwest and Mid-Atlantic regions, where cases are still rising, governors are bracing for worse days in the coming weeks.
“People ask us sometimes, ‘What’s the end goal here? You’re not going to conquer Covid, and it’s not going to go away forever,’” said Elizabeth Groenweghe, the chief epidemiologist for the public health department in Kansas City, Kan. “And I think that really it’s to get to a point where the level of community transmission is at least sustainable and not impacting our daily lives so negatively.”
The question, increasingly, is not how to eradicate Covid, but how to manage it. In contrast to the early months of the pandemic, businesses are open, children are returning to classrooms, and sports stadiums are full. Across most of the country, government-ordered vaccine mandates and new lockdowns have been political nonstarters.
A small but growing list of Democratic governors in states including Illinois, Louisiana and New Mexico have required facial coverings in indoor public settings, but most governors from both parties have not. Several Republican-led states have blocked local officials from imposing their own mask mandates.
Gov. Laura Kelly of Kansas, a Democrat whose state has experienced rising case levels since early July, expressed no appetite for requiring masks or imposing other statewide restrictions. “I want to avoid that at all costs,” she said during a news conference at a children’s hospital that was facing nursing shortages and record Covid admissions.
Gov. Eric Holcomb of Indiana, a Republican, also pointed to inoculations, not mask mandates, as the best response to the current surge. Daily reports of new cases in his state have quadrupled since the start of August.
“I’m trying to do everything I can to get people to see the answer to the problem — and the answer to the problem is getting vaccinated,” Mr. Holcomb said. “I hated that people had to learn that cold, hard fact through death and hospitalization.”
Signs of Delta’s toll abound. Colleges in Virginia and Texas have moved classes online after outbreaks. A hospital in Kansas transferred a patient to Wisconsin because there were no staffed beds nearby. Exhausted hospital employees in North Dakota have been asked to cover extra shifts.
“It’s as if you finish a battle, and before you truly get rested and really thinking about your personal well-being and recovery, you’re thrust back in,” said Dr. Michael LeBeau, the president and chief executive for the Bismarck, N.D., region for Sanford Health, a hospital system in the Upper Midwest where coronavirus hospitalizations increased 339 percent over four weeks in August.
Epidemiologists described the country’s current state in the pandemic as fragile, and examples from other countries offer few concrete answers about the path forward. Infection levels in India and Britain fell sharply after Delta-fueled surges, but cases in Britain have since started to rebound. In Israel, Delta has led to a major uptick in cases this summer despite a strong vaccination rate.
In much of the United States, schools are just beginning to open up, though children under 12 remain ineligible for vaccines, and mask usage is uneven. Vaccination rates are inching upward as more employers require shots, but 36 percent of adults are still not fully vaccinated. And breakthrough infections in vaccinated people are becoming more frequent, suggesting that vaccines are losing some efficacy, though they remain highly protective against severe outcomes.
Understand Vaccine and Mask Mandates in the U.S.
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- Vaccine rules. On Aug. 23, the Food and Drug Administration granted full approval to Pfizer-BioNTech’s coronavirus vaccine for people 16 and up, paving the way for an increase in mandates in both the public and private sectors. Private companies have been increasingly mandating vaccines for employees. Such mandates are legally allowed and have been upheld in court challenges.
- Mask rules. The Centers for Disease Control and Prevention in July recommended that all Americans, regardless of vaccination status, wear masks in indoor public places within areas experiencing outbreaks, a reversal of the guidance it offered in May. See where the C.D.C. guidance would apply, and where states have instituted their own mask policies. The battle over masks has become contentious in some states, with some local leaders defying state bans.
- College and universities. More than 400 colleges and universities are requiring students to be vaccinated against Covid-19. Almost all are in states that voted for President Biden.
- Schools. Both California and New York City have introduced vaccine mandates for education staff. A survey released in August found that many American parents of school-age children are opposed to mandated vaccines for students, but were more supportive of mask mandates for students, teachers and staff members who do not have their shots.
- Hospitals and medical centers. Many hospitals and major health systems are requiring employees to get a Covid-19 vaccine, citing rising caseloads fueled by the Delta variant and stubbornly low vaccination rates in their communities, even within their work force.
- New York City. Proof of vaccination is required of workers and customers for indoor dining, gyms, performances and other indoor situations, although enforcement does not begin until Sept. 13. Teachers and other education workers in the city’s vast school system will need to have at least one vaccine dose by Sept. 27, without the option of weekly testing. City hospital workers must also get a vaccine or be subjected to weekly testing. Similar rules are in place for New York State employees.
- At the federal level. The Pentagon announced that it would seek to make coronavirus vaccinations mandatory for the country’s 1.3 million active-duty troops “no later” than the middle of September. President Biden announced that all civilian federal employees would have to be vaccinated against the coronavirus or submit to regular testing, social distancing, mask requirements and restrictions on most travel.
“What worries me the most is not where we’re at, although that’s bad enough, but where we’re headed,” said Andrew Noymer, an associate professor of public health at the University of California, Irvine. “I think the U.S. is still in for a doozy of a next six months. We haven’t seen the effects yet of school reopening.”
Interviews with people across the country revealed a swirl of angst, frustration and resignation over the current state of the pandemic. Some Americans said that, once vaccinated, they were determined to return to the activities they had treasured before the pandemic. Others said they felt stuck in an interminable state of Covid, concerned about the Delta variant and newly cognizant of how much time they were spending in public.
“We’re still living like we’re unvaccinated,” said Stacey Hopkins, 58, a community organizer in Atlanta who is vaccinated. “If we go to a restaurant, we see if we can eat outside, or take out.”
Chantheada No, 18, of Aberdeen, Wash., said she had recently been denied access to a restaurant because she was not vaccinated. She said she had been saddened by the uptick in cases and had adjusted her routine as a result.
“I take a lot of precautions,” Ms. No said. “I wash my hands extra, and I don’t go out as much as I used to.”
But the return of restrictions and mandates has also led to frustration, notably among some vaccinated Americans who questioned why they were facing new rules when so many others had not gotten their shots. Though fully vaccinated people are far less likely to get Covid or to require hospitalization, federal officials have warned that they can still transmit the virus to others if they become infected.
“I hate wearing a mask,” said Sabastien Pavese, 23, a transportation coordinator in Portland, Ore., where the governor has ordered that face coverings be worn at public gatherings, including outdoors. “I think people should be able to walk around without a mask if they feel like it. I’m vaccinated, and I’m doing just fine.”
Justin Reid, a structural engineer in Meadowbrook, Ala., has been frustrated by the possibility of a mask requirement in his 4-year-old daughter’s preschool — so much so that he has decided to keep her home if necessary.
“I’m not subjecting her to that when I don’t have to,” said Mr. Reid, who said he had been vaccinated.
There will be no immediate fix for the pandemic, experts said, and no promise that the current surge will be the final one.
“I think we’re definitely at risk for being in a very unsatisfying, muddling-though kind of state for a while,” said Dr. Joshua Sharfstein, a vice dean at the Johns Hopkins Bloomberg School of Public Health.
Still, there remains the prospect, as more city councils vote to require face coverings and more people decide to get shots, that the pandemic’s course will eventually feel more upbeat, more like it did when summer started.
“I’m hoping March of next year that we’re having a very different conversation, that we’ve gotten through it,” said Cory Mason, the mayor of Racine, Wis., where masks are once again mandatory. “I think that’s the one thing that everybody agrees on: Can we just get back to a place where Covid isn’t dominating so much of our time and our lives?”
Mitch Smith reported from Overland Park, and Julie Bosman from Chicago. Reporting was contributed by Sarah Bahr in Indianapolis; Sydney Cromwell in Birmingham, Ala.; Grace Gorenflo in Aberdeen, Wash.; Daniel Heyman in Charleston, W.Va.; Timothy Pratt in Atlanta; and Emily Shetler in Portland, Ore.
