The pandemic has gotten better. It’s still not over.

Sixteen months into the COVID-19 pandemic Wisconsin’s rates of infection, hospitalization and death are continuing to decline, half of the people in the state who are eligible have had at least one shot of the vaccine and increasingly the world is looking like it’s getting back to normal.

It isn’t.

COVID-19 hasn’t gone away — in Wisconsin, the country or the world, even if it might feel that way on our streets, in our stores or during a night on the town.

There’s one reason that conditions have improved so much and so relatively quickly, public health practitioners say: the COVID-19 vaccine, now available not just for adults but also for children 12 or older.

But the vaccine is also one reason that health officials continue to warn that the danger hasn’t passed. Vaccination rates vary widely across the state, from Dane County, where 69% of eligible people have gotten vaccinated, according to the state Department of Health Services (DHS), to Taylor, Clark and Rusk counties, where fewer than one in three people who qualify for the shot have gotten one.

But how active the disease is in each county varies widely as well.

To assess “disease activity,” DHS combines the rate of new cases and whether case levels are growing, shrinking or staying the same. As of June 30, COVID-19 activity remained “high” in four counties. It was “low” in 17 and “medium” in the remaining 51 counties.

Statewide new, confirmed cases of COVID-19 have fallen to, on average, 63 per day, DHS reported on Tuesday, less than 1% of the mid-November peak of more than 6,500 new cases per day on average.

“Much like the vaccine having a wide range in uptake from county to county, there’s also variability in cases from county to county,” says Ajay Sethi, an epidemiologist and faculty director of the Master of Public Health program at the University of Wisconsin School of Medicine and Public Health.

“But overall they’re low,” Sethi continues. “There’s no [case] count anywhere [in the state] that can’t be managed through testing, contact tracing and quarantine and isolation” for people exposed to or confirmed positive for the coronavirus.

He cautions: “But we want to keep it that way — and not exceed our ability to follow chains of transmission.”

Vaccinations: A lot, not enough

It’s the same story with vaccinations: Wisconsin is making progress, but it has a distance still to go. “We clearly haven’t vaccinated enough — but we’ve vaccinated a lot,” Sethi says.

But where vulnerable populations, such as people over 65, are still not as widely vaccinated in some parts of the state as others, there’s cause for concern, he adds.

Vaccine rates may help explain why some parts of the state have “low” COVID-19 activity — such as Door, Iowa or La Crosse counties, where a higher percentage of eligible people than in the state overall have gotten at least the first dose of a COVID-19 shot. Low vaccination rates could help explain why Rusk and Dunn counties have higher disease activity. 

Those patterns aren’t uniform, however; Taylor County, another “low” disease activity county, has the lowest vaccination rate in the state. Kenosha County, with “high” activity, has about the same vaccination rate (more than 45% of those eligible) as Vernon and Calumet counties, which both have “low” activity.

“Vaccinations offer our best protection against COVID-19, but high vaccination rates aren’t the only factor that drive infection rates in a community,” says DHS spokeswoman Jennifer Miller. “That’s why looking at trends is so important.”

At the same time, health officials are watching some non-COVID-related illness outbreaks that could complicate efforts to manage the pandemic.

A week ago, on June 28, DHS official Tom Haupt spoke with reporters about an “unusual increase in non-COVID viral respiratory illness” particularly in children under the age of 5.

“These viruses can spread very quickly if they are introduced into a congregate setting like a long term care facility or a daycare center,” said Haupt, a respiratory disease epidemiologist for the health department.

Because people with upper respiratory symptoms are likely to get a COVID-19 test — and should do so — if that test is negative, “additional testing by clinicians is needed to identify these viruses,” Haupt said. The additional pandemic precautions, including thorough hand-washing as well as covering coughs and sneezes and even wearing a mask in public, are helpful public health measures to reduce the spread of these other conditions, he added.

The vaccine and variants

Meanwhile, state health officials remain confident of the COVID-19 vaccines.

While there have been a little more than 1,500 COVID-19 cases in people who have completed the vaccination process, that number represents only about 1% of the total confirmed and probable cases of COVID-19 since Jan. 1, 2021, according to Miller. In the period from March 1 through June 24, she adds, 95% of COVID-19 deaths were of people who had not been fully vaccinated.

The vaccine has also demonstrated its effectiveness against the coronavirus variants that have been emerging, according to public health officials. One of the most recent mutations to draw concern is known as Delta, and like some of the other variants it appears to spread much more easily than the original coronavirus.

So far, according to the DHS figures, Delta hasn’t been widely found in Wisconsin. Identifying a variant requires additional examination of the sample. In most of the state, fewer than 1% of the cases that have undergone that additional testing have been linked to Delta; the exception is in the northeastern part of the state, where it has been found in nearly 2% of the tested samples.

DHS officials caution, however, that the number of variants may be much more than those that are identified, and they have warned against complacency as a result. So does Sethi of the UW.

“Whenever we’ve seen a new variant spread in the United States, Wisconsin isn’t always necessarily the first state to experience that,” he says. “That’s emblematic of the very complex dynamics that promote the spread of the virus.”

But even if the variant hasn’t shown up more prominently yet, “we should assume that it will,” he says. That will continue to happen until vaccination is so widespread that the virus can’t find a safe harbor in human hosts that allow it to mutate and spread.

“We never want to be reactionary,” Sethi adds. “We will always be under the threat of new variants as long as the virus keeps spreading in this world — which it will for some time to come because there’s such a disparity [in conditions] from country to country.”

Children under 12 “should wear masks, distance, and avoid other unvaccinated people” until they are eligible for vaccination, Sethi observed in a Twitter thread leading into the Fourth of July weekend. He hopes that will be soon.