Northwestern Feinberg School of Medicine | Buehler Center for Health Policy and Economics The Global SARS-CoV-2 Surveillance Project (GASSP)

Figure 1. North America’s SARS-CoV-2019 Outbreak on October 15, 2021

SARS-CoV-2 Vaccinations: Lessons from California.

As a country, the United States has been in an outbreak, defined by the CDC as >10 new daily cases of SARS-CoV-2 transmissions per 100,000 population, throughout most of the pandemic. The most recent spike of cases, fueled by a combination of the Delta variant and low vaccination rates, began mid-June, turning into an outbreak on July 19, 2021. The US states remained in an outbreak until this past weekend when something amazing happened. California was the first state to pull out of the outbreak even though surrounding states had significant outbreaks. Oregon rate was more than 3X the daily rate of new cases compared to California; Nevada was 2.63X; Arizona was 3.6X the rate of California. COVID-19 does not respect state borders so how is it that California managed to pull out in the middle of a hot mess when America is divided on whether to vaccinate? The answer to that is policy. Los Angeles put policies in place that it made life nearly impossible without being vaccinated. For example, Los Angeles residents must show evidence of COVID-19 vaccine to eat, drink, shop, attend a sporting event or a gym, making it difficult to live without a vaccine. What’s more, LA’s policies are becoming more restrictive. Without a vaccination, you cannot get a haircut. San Francisco’s policies are similar. In-N-Out, a popular fast-food chain, was forced to close its doors by the city because they refused to enforce vaccination mandates.

Figure 2. SARS-CoV-2 American Trends throughout the Pandemic

The orange trend lines in Figure 2 predict pending outbreaks, the red trend lines signal America is already in an outbreak and blue lines indicate the pandemic is cycling downwards or stable. The largest peak was fueled by the Thanksgiving, Christmas, and New Year’s holiday celebration. From January 11 to June 18, 2021, novel cases of COVID-19 dropped dramatically pulling America out of the pandemic. This drop in cases coincided with vaccinations. As availability of vaccines increased, rates of COVID-19 dropped. As the number of American’s getting their vaccine leveled off, the novel variant Delta breached American boundaries and created an epidemic among the unvaccinated. On average, so many states are in an outbreak that the US remains in an outbreak. Since last weekend, two more states followed California’s lead and pulled out of the SARS-CoV-2 outbreak.

Table 1. The American COVID-19 Pandemic by State on 10/17/21

Table 1 lists all US States rank ordered by their outbreak rate from best to worst. Every state in an outbreak is colored red. The daily speed is the rate of the pandemic on any given day. Speed is measured as the number of new cases per day per 100,000 population based on a 7 day moving average. Two days after California exited the COVID-19 outbreak, Hawaii and Connecticut followed. Louisiana, Florida, and Mississippi are close behind. Alaska ranks dead last at 90.5 daily new cases of COVID-19 per 100,000 but then again, Alaska is flanked by massive outbreaks in Canadian Provinces and Territories.

Lessons from California. California demonstrates that vaccines and policies are effective at combating COVID-19. Short of knocking on doors and forcing Americans to get the jab, making life impossible without a vaccine is just as effective while not violating individual rights. So sure, Americans have the right not to be vaccinated but they don’t have the right to infect others. States must protect their residents from anti-vaxxers. Policies that prevent the unvaccinated from engaging in daily life protect the public health while driving transmission rates down. California accomplished this while flanked by states with outbreaks similar to Alaska’s COVID-19 hot mess. Alaska should give California a shout.