True sign of COVID-19 vaccine success: Hospital capacity is no longer threatened

Several months ago, President Biden announced an ambitious goal of vaccinating 70 percent of adult Americans with at least one dose of a COVID-19 vaccine by the Fourth of July. It is increasingly clear that we are not going to meet this goal — as the White House is expected to concede — but it is important to realize that the U.S. vaccination campaign has met its primary purpose and has been a success regardless of whether the president’s date goal is achieved.

COVID-19 became a public health emergency because it, unlike the four other coronaviruses that cause 25 percent of the cases of the common cold, was able to cause severe disease on such a scale (and speed) that it threatened hospital capacity in the United States. The goal of “flattening the curve” was to keep hospitalizations to a level manageable by the health care system (which is severely limited in its ability to rapidly expand capacity in a crisis). COVID-19 was never going to go zero, be eliminated or eradicated — its fate was to become more like ordinary respiratory viruses we deal with year in and year out.

As we’ve seen since the beginning of the pandemic, the risk of hospitalization with COVID-19 is not equal. Hospitalization risk clusters strongly with advanced age, which also carries a higher prevalence of other conditions such as diabetes, cardiovascular disease, and lung disease. We prioritized vaccine rollout to nursing home residents and those of advanced age living in the community to deny the virus the ability to harm these individuals who were extremely likely to require hospital-level care. 

Now that over 87 percent of this portion of the population has at least one shot of a COVID-19 vaccination (and over 77 percent fully vaccinated) there has been a decoupling of cases from hospitalizations and deaths in this country. This, to me, marks the end of the acute phase of the public health emergency in this country.  

Walking through a hospital this month is so different than it was in January 2021 for one reason: the vaccines. Now, most of what I and my colleagues working in emergency rooms or ICUs see is a spattering of unvaccinated individuals; we aren’t seeing enough severe cases to compromise our capacity or ability to care for patients. 

Looking at vaccination rates one may be struck by the fact that a proportion of Americans are not vaccinated. However, I would argue that is not the best metric to gauge where we are in the pandemic. Not only does that number omit significant natural immunity from prior infection, but it also undersells the initial goal of the vaccination campaign. Over three-quarters of those above the age of 65 — the high-risk hospitalization group — are fully vaccinated (and some proportion of the unvaccinated likely have natural immunity). Even in areas with low overall vaccination rates, a substantial proportion of those in the high-risk group are fully vaccinated. Such a situation has allowed the virus to be defanged and tamed to the point where it has lost the ability to ever threaten hospital capacity, in the manner it could just six months ago.

It is important to push vaccine rates as high as possible to increasingly make COVID-19, and its variants, unable to disrupt lives and cause illness, but this Fourth of July we should celebrate that the vaccines have dealt a devastating blow to this virus in the United States.

Amesh Adalja, M.D., is an infectious disease physician and a senior scholar at the Johns Hopkins Center for Health Security. Follow him on Twitter: @AmeshAA.