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A woman adjusts her face mask while sitting in front of a microphone.
Enlarge / Rochelle Walensky, director of the US Centers for Disease Control and Prevention (CDC), adjusts her protective mask during a Senate Health, Education, Labor, and Pensions Committee hearing in Washington, DC.

Highly effective COVID-19 vaccines are simply too slow to stop surges like the one underway in Michigan, Rochelle Walensky, director of the Centers for Disease Control and Prevention, said Monday.

Dr. Walensky’s explanation during the White House COVID-19 press briefing comes amid mounting requests and calls for federal authorities to flood Michigan with vaccine supply. The state has seen a 400 percent spike in cases since March 5, when state officials eased restrictions on residential gatherings and occupancy limits for bars, restaurants, venues, and stores. Since then, the highly transmissible B.1.1.7 coronavirus variant has also increased in prevalence. Now, the state’s seven-day average for new daily cases is over 7,377, and hospitals are filling up.

On March 30, when the surge was already in full swing, Michigan Gov. Gretchen Whitmer appealed to the White House for additional vaccine shipments. However, the White House declined, opting to stick to its largely population-based strategy for dolling out vaccine supply to each state and jurisdiction.

Experts quickly decried the move, saying that an increase in vaccine doses could help bring an end to the surge in cases. In an interview on CBS’s Face The Nation Sunday April 11, former Food and Drug Administration commissioner and Pfizer board member Dr. Scott Gottlieb echoed his calls for the White House to boost Michigan’s vaccine allotment. “It’s a request that’s been made for weeks now, and I think we should have done it weeks ago,” he said. “We need to get in the habit of trying to surge resources into those hotspots to put out those fires of spread.”

But Walensky pushed back on that idea Monday, noting that it takes weeks for people to build up protective immune responses from vaccines. With the mRNA vaccines made by Pfizer-BioNTech and Moderna—the two most common vaccines used in the US right now—people don’t reach full protection until two weeks after their second dose, which occurs three and four weeks after their first, respectively.

Reality check

“We know that if vaccines go in arms today, we will not see an effect of those vaccines, depending on the vaccine, for somewhere between two to six weeks,” Walensky said. She continued:

So when you have an acute situation, [an] extraordinary number of cases like we have in Michigan, the answer is not necessarily to give vaccine. In fact, we know that the vaccine will have a delayed response. The answer to that is to really close things down, to go back to our basics, to go back to where we were last spring, last summer and to shut things down, to flatten the curve.

Walensky emphasized the use of lockdowns, social distancing measures, testing, and contact tracing as the primary responses to surges like Michigan’s. As before, she noted that the CDC has surged other resources to Michigan, including teams to help deal with specific outbreaks and hasten the use of the vaccine doses already distributed to the state.

Meanwhile, the B.1.1.7 variant is continuing to spreading in states across the country, Andy Slavitt, a senior White House adviser on the pandemic, said during the press briefing. It is now the predominant lineage of the virus nationwide. The White House doesn’t want to prioritize Michigan, potentially compromising vaccination campaigns in others states, Slavitt explained. The current strategy provides the “ability to vaccinate people quickly in each of those states,” Slavitt said, “rather than taking vaccines and shifting it to play whack-a-mole, [which] isn’t the strategy that public health leaders and scientists have laid out.”

The points were largely echoed in a press briefing by the World Health Organization also on Monday, which emphasized that globally, the pandemic is growing exponentially. There have now been seven consecutive weeks with increases in cases and four weeks of increasing deaths. Several concerning variants are driving outbreaks in various regions. “This is not the situation we want to be in 16 months into a pandemic, where we have proven control measures,” WHO technical lead Maria Van Kerkhove said in the briefing.

Vaccinations are underway, she noted, but their full impact is not yet in effect. For now, she and the WHO director-general echoed Walensky, imploring people to get back to the basics of physical distancing, mask-wearing, ventilation, hand hygiene, and avoiding crowds—until vaccination efforts are farther along.

“We need headlines around the tools that we have right now that can prevent infections and save lives,” Van Kerkhove said. “We are in a critical point… It is time right now where everyone has to take stock and have a reality check about what we need to be doing.”

An A frame sign tells diners in a downtown patio how to behave.
Enlarge / A sign requiring protective face masks in Detroit, Michigan, on Sunday, March 21, 2021.

Even as the pace of vaccination in the US nears a heartening 3 million per day, the country hovers on the brink of a fourth surge, with current cases lingering at a “disturbingly high level,” according to top infectious disease expert Anthony Fauci.

The current seven-day average of new daily cases is now over 63,000—levels seen at the base of the record winter surge. “When you’re at that level, there is the risk of getting a surge back up,” Fauci said in an interview with CNN.

Adding to the precarious situation is the highly transmissible B.1.1.7 coronavirus variant, first identified in the UK. It is now the predominant strain of SARS-CoV-2 in the US, Rochelle Walensky (director of the Centers for Disease Control and Prevention) said in a White House Press Briefing Wednesday.

“These trends are pointing to two clear truths,” Walensky said. “One, the virus still has hold on us—infecting people and putting them in harm’s way—and we need to remain vigilant. And, two, we need to continue to accelerate our vaccination efforts.”

Now, many experts are eyeing Michigan as a potential bellwether for the fate of the rest of the country. As the variant spreads there, the state is seeing a spike in cases, hospitalization, and deaths, rivaling numbers seen in the winter peak. The B.1.1.7 variant has been detected in 46 of the state’s 83 counties.

Michigan’s case rates are up 375 percent since its previous low on February 19, the Michigan Department of Health and Human Services said in a recent data update. According to the CDC, the state has a seven-day case rate of 492 per 100,000 people, the highest case rate in the country. Next is New Jersey, with a seven-day-case rate of 328 per 100,000.

Michigan has seen nearly 50,000 cases in the last seven days, also the highest in the country. It currently has a seven-day rolling average of around 7,000 new cases a day, an 89 percent increase from a week ago, according to tracking by The New York Times.

Surge plans

Hospitalizations are above 3,000 in the state, a 124 percent increase from two weeks ago, and the number of patients filling intensive care units has increased 41 percent just in the last week, according to the MDHHS. State projections estimate that ICU use will exceed that seen in the winter peak by Monday, March 12. MDHHS Director Elizabeth Hertel told reporters Wednesday that hospitals are now looking into implementing their surge plans.

Deaths are also rising now, with an average daily deaths around 36. Since a low on March 9, deaths have increased 75 percent in the state.

The CDC has deployed teams of its public health workers to help with the statewide surge. “We are working closely with the state of Michigan and the state health officials there,” Walensky said Wednesday. The CDC is helping to investigate outbreaks in correctional facilities and youth sports teams. It’s also working to monitor the spread of B.1.1.7 and shift the state’s vaccine supply to the hardest hit areas.

Some experts have questioned whether the Biden administration should send a surge supply of vaccines to the state to try to head off the variant and the spike in cases. Currently, the federal government largely doles out doses based on each state and jurisdiction’s population. But last month, Michigan Gov. Gretchen Whitmer had asked for a boost in supply to avert the state’s surge. The White House declined the request, however, according to The Washington Post.

In the press conference Wednesday, Andy Slavitt, a senior White House advisor on the pandemic, told reporters that, for now, the administration is largely sticking to its population-based distribution plan.

“We have a long way to go today to get the country to a place where each of our states has reached the number of vaccinations that the population can handle,” Slavitt said. “Clearly, we will get to a place where targeted strategies will work. But right now, I would commit to you that we’re doing both.”