State of Affairs: Europe. Should we stop counting cases?

This is a bit different approach to my usual State of Affairs. While I present current cases, hospitalizations, deaths, and vaccinations, I still try and answer two pressing questions along the way:

  1. What is happening in Europe? Are vaccines not working?

  2. Should we still track cases?

What is happening in Europe?

Europe has become the epicenter of the SARS-CoV-2 pandemic. Selfishly, the States continue to watch because Europe has acted as an early warning sign throughout the pandemic. Almost every European country is increasing in cases; some at alarming rates.

But, I think a lot of Americans assume that all of Europe has very high rates of vaccination. And many do have much higher rates than the United States. But there are also countries with suboptimal coverage. So, believe it or not, we continue to see a beautiful correlation between country-level vaccination rates and case rates/deaths:

  • Countries with the lowest vaccination rates have the highest cases. For example, Czech Republic has a 43% unvaccination rate and a 7-day average of 499 cases per 100K.

  • And, countries with the highest vaccination rates have the lowest cases. For example, Portugal has a 12.4% unvaccination rate and a 7-day average of 67 cases per 100K.

There are outliers, like Germany. At 31% unvaccinated and a 7-day average of 438 cases per 100K, Germany is breaking case records. Hospitals have stopped elective surgeries. The German armed forces is preparing to mobilize 12,000 soldiers to assist overrun healthcare systems. This is an odd picture, as Germany has been a consistent success story throughout the pandemic.

The reason for the surge is, as always, complex but includes a change of leadership, politics, and restrictions lifted prematurely. It also includes a dangerous wave of vaccine skepticism and mis/disinformation campaigns. Sound familiar?

There’s certainly variation within Germany. Southeast Germany has the highest case rates per capita and they also have the highest populous of right-wing radical Alternative for Germany (AfD) party. In a recent poll by Forsa, 50% of unvaccinated identified as AfD.

German states follow the same correlation as European countries: States with the highest case rates have the lowest vaccination rates. And vise versa.

Across Germany, unvaccinated people are taking up the majority of hospital beds. Robert Koch Institute (RKI—Germany’s CDC) reported last week that 87% of adults under 60 receiving intensive care have not been vaccinated.

87% is not 100%. So, Germany has another problem: Eligible Germans are not getting boosted. Only 4% of eligible are boosted. Part of this has been due to confusing messaging causing dire consequence. As RKI reported: “In ICU’s one in three patients over 60 were vaccinated. The situation is also tense in nursing homes.” While people are rushing to now get boosters, it’s a bit too late for this wave.

Importantly German deaths are substantially lower than previous waves. I expect this will increase (deaths lag cases), but certainly not at a rate we saw back in December because we now have vaccines.

In the United States…

Cases have begun to increase. Would this be considered the 5th wave? Or an extension of the 4th wave? Nonetheless, it’s deflating, exhausting, and frustrating.

Alaska has finally receded as case leader. The baton has been passed to Minnesota with 67 cases per 100,000. New Mexico (64 per 100K), North Dakota (62 per 100K), and Alaska (59 per 100K) follow. Vermont is increasing in cases fastest (85%) followed by Rhode Island (55%).

Many have asked about Vermont, as they have the highest vaccination rate in the country after Puerto Rico: 72% are fully vaccinated in VT and 82% have at least one dose. First, this isn’t 100%. There are still ~100,000 people susceptible to disease. Second, vaccines aren’t perfect; some of these are breakthrough cases. Third, Vermont has an average of 1 COVID19 death per day. That’s something to celebrate, which isn’t captured by increasing case trends.

So, should we still track cases?

Many strong opinions are appearing in the media, Op Eds, Twitter, and my YLE inbox: Why continue to track cases? Why not just track hospitalizations and deaths? Why should we [vaccinated] still care about the pandemic?

Well, Vermont is not the norm. As a nation, 81,000 new cases per day is not an endemic state. High rates of transmission directly effect the vaccinated for 4 reasons:

  1. Mutations. High levels of transmission means faster rate of mutations. Period. We know Mu can escape our vaccine- and infection-induced immunity. Thankfully Mu can’t outperform Delta, but we are just a few sublineages away from Delta making the same changes.

  2. Ineligible. There is still a large chunk of our population that is susceptible. Believe it or not, people still use these numbers to make safe decisions for their families. This includes parents of 0-4 year olds, elderly who have higher chance of severe breakthrough cases, and a ton of frustrated and helpless immunocompromised. Also, only 3% of 5-11 year olds are partially vaccinated.

  3. Breakthrough cases. The more transmission, the more breakthrough cases. A physician, Dr. Leana Wen, gave a fantastic analogy during the Delta wave: Vaccines are like umbrellas. They protect very well against rain. But an umbrella during a hurricane won’t help much.

  4. Flying blind. We don’t know what our storm looks like right now. There is literally zero national data that is publicly available (or publicly communicated) on cases by vaccination status (no vaccine vs. fully vaccinated vs. boostered). The last time CDC updated their data was on September 4. We are flying blind.

I do think the vaccinated can now approach surges with far less anxiety and urgency. The sky is not falling because we have great protection. But please stay informed, make smart decisions, and understand that others around you may be very much still living in the pandemic.

The bigger question is: How do we use cases to inform policy? I have a strong opinion, but so does everyone else. In fact, “what offramp and when” is the most contentious debate among epidemiologists right now. As always, some strong public health leadership would be nice…

Love, YLE

“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, MPH PhD— an epidemiologist, biostatistician, professor, researcher, wife, and mom of two little girls. During the day she has a research lab and teaches graduate-level courses, but at night she writes this newsletter. Her main goal is to “translate” the ever-evolving public health science so that people will be well-equipped to make evidence-based decisions, rather than decisions based in fear. This newsletter is free thanks to the generous support of fellow YLE community members. To support the effort, please subscribe here: