While the pace of the growth of COVID-19 has slowed across the country — it’s rising at less than half the rate it was seven weeks ago — the confirmed U.S. case count has reached 29,258,941 — about 25% of the world’s total.

Similarly, though total cases number 529,527 to date, the pace of daily deaths from the disease is now about half what it was in mid-January.

As another measure of improvement, hospitalizations across the country have dropped below 50,000 for the first time in four months.

Yet, worries remain, and one of the most recent voices of concern came from the White House, through Rochelle Wolensky, M.D., just appointed by President Biden as director of the Centers for Disease Control and Prevention (CDC). These are some things that concern her.

Things may be improving, but not enough

Dr. Walensky expresses worry that, although COVID-19 statistics had improved sharply, the trend hasn’t gone far enough. “The latest data suggest these declines may be stalling, potentially leveling off at a very high number,” she says. “We at CDC consider this a very concerning shift in the trajectory.” Comments by Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases and the chief medical advisor to President Biden, support that view.

What is the trend?

A look at charts and graphs recording the rates of COVID-19 cases and deaths nationwide show an initial spike, mostly in the Northeast and New York City, in March and April. Another spike developed in mid-summer, across much of the South, Texas, and Arizona. Another one developed late in the year in the Dakotas. The worst spike of all was the “post holiday spike of December and January.” Despite declines in the past few weeks, the figures have flattened, which is the primary reason for concern.

Variants could cause another surge

The CDC has tracked numerous variants of the coronavirus, the most prominent of which have entered the United States via Brazil, South Africa, and the United Kingdom. The agency reports on them to the public via its U.S. COVID-19 Cases Caused by Variants report. The data show that variants have spread to 48 states. This is one reason that Walensky is worried.

Among the unknowns about variants is how quickly they spread, whether they are more deadly than the version of the disease that has been dominant in the country since January of last year and whether current vaccines can treat them. If there is another surge, as the CDC worries there will be, variants may be the cause.

Vaccination rates are better than expected

One favorable trend that should mitigate worry is the pace of vaccinations. In December, the Trump administration indicated that much of the American population would be vaccinated early in 2021. That turned out not to be the case. The Biden administration has ordered a large number of new doses but does not expect another 200 million to be delivered entirely until July.

Currently, about 17% of American adults have received at least one dose, and 9% have been given two shots. This state has done the worst at giving two vaccine doses.

Not enough people have been vaccinated yet

In raw numbers, 116,355,405 doses have been distributed and 87,912,323 shots have thus far been administered. However, there are about 255 million people ages 18+ in America, so the vaccination rate has a very long way to go. These are the states that have done the best in rolling out vaccines.

We’re not sure when we’ll achieve herd immunity

Definitions of herd immunity vary. Most often, the term means that when 70% to 80% of a population has been either infected or vaccinated, the spread of the disease and the pace of fatalities will slow substantially. At least one expert believes the U.S. will reach herd immunity soon.

Not everyone is so sure. Among the unknowns is exactly how many people in the United States have been infected. While the official number is less than 30 million, some epidemiologists put the figure at double that. Poor testing and the presence of asymptomatic cases have been blamed for the difference.

Carelessness is a concern

Despite the rollout of the vaccines and declining case numbers and death rates, the United States has reached an inflection point. The good news in the fight against COVID-19 might encourage people to let down their guard, and forget precautions of mask-wearing, social distancing, and avoiding closed spaces. This carelessness seems to worry Dr. Walensky the most.

Click here to read COVID-19: This Is America’s Worst Hotspot

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