Skyrocketing

Covid cases are skyrocketing again. States have no new plans.

Strategies for managing 130,000 new daily Covid cases are largely the same as they were for managing 30,000 new daily cases four months ago.

By MEGAN MESSERLY, KRISTA MAHR and ADAM CANCRYN

State health officials are out of ideas.

They’ve told people to wear masks, socially distance and avoid crowds. They’ve reminded people about the availability of life-saving therapeutics. They’ve pleaded with people to get vaccinated and boosted.

As the latest and most transmissible Covid-19 variant has sent case numbers skyward, with hospitalizations and deaths also rising, the response from state officials has been largely muted, a concession to the reality that their messages rarely resonate and that most people — even, and sometimes especially, politicians — are ready to move on.

“When you’ve said the same thing over and over about being vaccinated, being boosted, that if you’re vulnerable and you’re indoors with people who are not part of your household and you can’t distance, you need to wear a mask — I mean, the message hasn’t changed since the very beginning,” Louisiana Gov. John Bel Edwards, a Democrat, told POLITICO. “But the receptivity to the messaging, I mean, there’s only so much of that people are going to consume, and it becomes a diminishing return at some point, too.”

There are no new plans or bold initiatives on the horizon, officials in 10 states told POLITICO, even as much of the South remains unvaccinated and vaccination uptake among children nationwide is well below what state and federal officials would like. Instead, state and federal strategies for managing 130,000 new daily Covid cases in the U.S. are largely the same as they were for managing 30,000 new daily cases four months ago.

The fear, expressed in both red and blue states, is that if state officials sound the alarm on this Covid surge too early, the public won’t listen later if hospital capacity becomes strained, or the number of daily deaths starts to rapidly increase. Louisiana, for instance, has the second highest case count in the country per capita but is only seeing a quarter of the new daily hospital admissions it did during the Omicron wave and about 15 percent of the deaths.

“If you’re doing a full court press 100 percent of the time regardless of what your numbers look like, then people are going to tune you out faster,” Edwards said. “Whereas, if you wait until there is a clearly worsening problem, especially affecting hospital capacity, I think your messaging will actually do a better job.”

Rather than hitting the panic button, governors are hewing closely to their long-term Covid response plans announced this spring and, in some cases, continuing to step down their pandemic response.

Last week, Illinois Democratic Gov. JB Pritzker, who tested positive for Covid this week, announced that he was loosening testing and vaccination requirements for workers in certain industries even as case daily counts climbed 30 percent. Health officials in Hawaii said they were dropping their statewide school mask mandate, the last in the nation, beginning in August. And in New York, where cases have climbed more than 70 percent in the last two weeks, Gov. Kathy Hochul, a Democrat, said she has no plans to change her administration’s approach to Covid-19.

“We’re on top of it. We’re not changing our policies at this time — always reserving the right to do so,” Hochul said. “Right now, we just want to have people be smart and would recommend in various settings — including transportation — we still want everyone to wear a mask.”

While BA.5, which is now responsible for at least 78 percent of U.S. infections, is the most contagious and most immune-evading strain of Covid-19 to date, doctors have not yet seen an uptick in serious illness caused by the disease. Hospitalizations — now hovering around 40,000 in the U.S., according to the New York Times’ tracker — have been steadily increasing, not exponentially spiking, as they did with Omicron in the winter, and there hasn’t been a dramatic increase in people requiring ICU care or ventilators.

The number of daily deaths from Covid is over 400, up 25 percent from one month ago, but there’s a growing recognition there is little more to be done — even if, as previous waves of the virus have shown, a more transmissible variant means more cases, more cases means more hospitalizations, and more hospitalizations mean more deaths.

“Every one of those people … has a family, has co-workers, has friends. There’s an empty seat at the dinner table for those folks,” David Scrase, cabinet secretary for the New Mexico Department of Health and Human Services, told reporters last week. “I think no death is acceptable, and I would prefer that the target be zero. But there also is a dynamic in society between freedom and public health.”

Official case counts are still below the peak of the Delta surge last summer and well below Omicron’s winter wave but current numbers are widely recognized to be undercounted due to the proliferation of at-home testing, for those who test at all.

Still, the surge has alarmed Biden health officials, who have spent recent weeks trying to determine how much more BA.5 could drive up hospitalizations.

“There is concern, and I think that’s universal,” one senior administration official said of the mood inside the administration’s Covid response operation.

The White House Covid team is exploring whether to permit Americans under 50 to get a second booster shot to provide extra protection over the next few months, two people with knowledge of the matter said.

But they haven’t taken action, with officials still debating whether it’s worth rolling out the shots just weeks ahead of a fall campaign to offer revamped vaccines they hope will better target the current strain.

Nor has there been much renewed interest in mask mandates, though the Centers for Disease Control and Prevention’s community-level map now shows more than a third of counties are experiencing a “high” level of Covid-19 transmission, meaning the agency advises people to wear a mask indoors in public. While many state and local health departments are individually recommending mask wearing, few have entertained a return to mandates, as Los Angeles County is considering.

An Axios/Ipsos poll released on Tuesday and taken over the weekend found that only 13 percent of Americans believe the government should be increasing mask mandates and vaccine requirements, down from 21 percent in February.

“Policymakers, politicians are highly attuned to public opinion. And right now the public opinion is that we’re kind of done with this,” said Marcus Plescia, chief medical officer for the Association of State and Territorial Health Officials. “It would take a pretty courageous politician or policymaker to go against that, and there’s not a whole lot of reason to do that right now.”

The White House has instead tried a lower-key approach in recent weeks aimed at targeting individual communities most at risk from the virus. Covid coordinator Ashish Jha has made several media appearances emphasizing the need for older people to get their boosters and for everyone to consider masking in high-transmission areas.

But public health officials say recommendations just don’t seem to carry the same weight as mask mandates, even in blue states where acceptance of mask wearing is higher. Paul Cieslak, senior health adviser and medical director for communicable diseases and immunizations at the Oregon Health Authority, said few people have returned to masking in Portland even though Multnomah County has been strongly encouraging people to do so.

“Frankly, mask wearing hasn’t changed much since April,” Cieslak said.

Beyond encouraging more vaccines and boosters, White House aides argue there’s little more they can, or should, do at this point. The White House’s Covid funding has been stretched thin by Congress’ monthslong refusal to allocate more money, administration officials say. And like state health officials, Biden’s team acknowledges there’s limited value in trying to convince people to treat every new variant as a national emergency.

“Trying to find that right balance between protecting people from this ugly disease and making sure that the other aspects of their health are also not impacted is hard,” said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association. “I’m not sure that anybody feels they know exactly the right strategy.”

Hospitals say they aren’t overwhelmed but are monitoring BA.5’s course. Though Covid-19 admissions are rising, both ICU occupancy and ventilator use are down dramatically from the Omicron surge earlier this year. Now about 6 percent of ICU beds are in use for Covid-19 among the 5,406 hospitals that report that data to HHS.

Hospitals count both patients who are admitted because of Covid-19 and those admitted for other reasons who test positive for Covid-19 when reporting their tallies. Hospital administrators say it can be tricky to untangle the two groups, and that, practically speaking, once a patient tests positive for Covid-19 in a hospital, they require the same monitoring as a Covid-19 admission.

In parts of the country where fewer people are vaccinated, hospitals are taking more precautions, stocking up on PPE for staff and making sure they have more Covid-19 treatments like Paxlovid for patients.

“Where we have high levels of vaccination, health care provider organizations, especially hospitals, are a little more confident that they won’t be overwhelmed by patients,” Foster said. “Where we have lower levels of vaccination, there’s greater concern.”

And while they may not be overwhelmed with Covid-19 cases, hospitals are strained by persistent staffing shortages across all positions, due to a combination of pandemic burnout and staff getting sick with Covid during spikes.

Some working in large hospital systems would like to see a much stronger message coming from public health officials on masking while transmission is high, and for officials to strongly encourage boosters.

“Even if it’s into an echo chamber,” said David Wohl, the infectious diseases expert leading the Covid-19 response at UNC Health in North Carolina, where cases are up by 26 percent over two weeks ago.

Instead, he said, public health officials have let the push to get people to protect themselves — and others — fade into the background. “It’s like they’re saying, ‘We’re out of this fight.’”