What restrictions were in place the last time COVID cases were so high

Kent Nishimura / Los Angeles Times via Getty Images

(NEW YORK) — Despite widespread vaccination and several available treatments, the U.S. is recording as many COVID-19 cases now at the tail end of the omicron peak as it was last summer during the delta surge.

On Wednesday, the latest date for which data is available, 181,000 new infections were reported, according to the Centers for Disease Control and Prevention.

Over the last seven days, the country has recorded a total of 766,949 cases of the virus, although the true caseload is likely much higher.

This is on par with late August 2021, when the U.S. was recording between 182,000 and 187,000 new infections every day.

However, mitigation measures in the U.S. looked very different at the time. Although there were no lockdowns, several indoor venues mandated masks, vaccine passports were in effect in many large cities and one state even required proof of vaccination or a negative test to enter.

After the omicron wave that swept the country this past winter, an estimated 60% of Americans has been left infected since the start of the pandemic, many with much milder cases — even though studies suggest omicron is more infectious than delta — so communities started loosening restrictions.

Although the latest omicron subvariants appear to be even more transmissible than the original variant, a combination of vaccination, boosters and effective and readily available therapeutics appear to have muted the impact of severe disease.

Masking indoors

“When we think about summer 2021, we were in a different place in many ways,” Dr. Stuart Ray, a professor of medicine at Johns Hopkins University, told ABC News. “We’d had vaccines for only about six months … The delta variant became the predominant variant in the U.S. mid-summer.”

The delta variant was first identified in March 2021 and quickly took over as the dominant variant, accounting for most U.S. cases during the summer. Before that, the country had been seeing encouraging declines in infections.

By late July 2021, the CDC was urging all Americans in COVID hot spots regardless of vaccination status to wear masks indoors.

At the time, states with high transmissions were mostly in the Southeast, Midwest and Southwest, including Alabama, Florida, Louisiana, Missouri and Texas.

Through summer and fall 2021, some states were still imposing face coverings indoors including schools and even for the vaccinated; however, masks were also still required on public transportation, including in airports and on planes — a measure that has since been lifted.

Amid increasing COVID-19 cases in recent weeks, some school districts have reimposed mask mandates including in Philadelphia; Brookline, Massachusetts; and Providence, Rhode Island as well as universities such as the University of Delaware and the University of Hawaii, though the vast majority have not.

“Each district and each local health department is going to have to look at their own metrics and decide what the trigger is for bringing back mask mandates,” Dr. Michael Smith, a professor of pediatrics and medical director of the pediatric antimicrobial stewardship program at Duke University School of Medicine, told ABC News. “I wish we never had to do it, but they work.”

Vaccine passports

Starting in August 2021, New York City became the first city in the U.S. to require venues — including restaurants, gyms and movie theaters — to check for proof of vaccination.

Several cities followed suit including Boston, Chicago, Los Angeles, Minneapolis and St. Paul, New Orleans, Philadelphia and San Francisco.

Currently, no cities have vaccine mandates in place restricting indoor activities and some states have banned requiring vaccination proof altogether.

Florida was the first state to do so in April 2021 and several GOP-led states followed including Arizona, Georgia, Montana and Wyoming.

Ray said even with COVID-19 cases rising, he doesn’t see vaccine passports making a return.

“I don’t think it’s likely that vaccine passports are going to become a widespread measure, in part because they’re hard to implement,” he said.

He added that people can get around the passport requirement by showing forged vaccination cards and that there is not standardized electronic system to prevent it from happening.

Ray continued, “You would think that we could, but we don’t have an electronic system where people could display a QR code on their phone that shows that they have a verifiable vaccine history. Without technology like that, the system is not really in place logistically.”

Hawaii’s COVID-19 travel restrictions

Long after states had dropped their COVID-19 measures for domestic travelers in 2020, Hawaii kept its restrictions in place.

American visitors to the islands needed to show either proof of vaccination or a negative COVID-19 test taken one to three days before their departure.

Those who didn’t have either were subject to a mandatory 10-day quarantine.

Gov. David Ige announced the state would drop its so-called Safe Travels Program for domestic travelers on March 26 due to lower cases and hospitalizations but keep rules in place for international travelers.

Dr. Vandana Madhavan, clinical director of pediatric infectious diseases at Massachusetts General Hospital, said that even though increasing COVID infections may lead to the return of mask mandates, not all restrictions will need to return because the country has learned how to better treat and prevent the virus over the last two years.

“We’re at a very different point with other preventative measures,” she told ABC News. “More people are eligible to get vaccinated and a number of populations are eligible for boosters.”

She continued. “Also, we have a number of different options for therapeutics. We have oral and IV options, and options for both people who are at high risk before they get to the hospital and once, they get to the hospital.”

Madhavan added that COVID restrictions can be viewed as a “dimmer” that gets “dialed up” when cases rise and “dialed down” once cases fall.

“I view it not as an on and off switch at this point but a dimmer dial,” she said. “And so, we may have to dial up for a while, make sure that we’re not at the point where we’re stressing resources and then we can dial back.”

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