(NEW YORK) — State and local health officials are once again raising the alarm about the renewed threat of COVID-19 spread in communities across the country as people head indoors during the colder months and are set to gather for the holidays.

“Winter is coming,” California Gov. Gavin Newsom warned during a press conference on Tuesday. “COVID is not taking the winter off.”

For weeks throughout the early fall, the U.S. had seen steady declines in coronavirus infections and hospitalizations, offering hope that perhaps the pandemic was finally subsiding in the U.S. after a significant summer surge across the South and a renewed push for vaccinations.

However, the U.S. appears to be once again at an inflection point, with cold weather setting in across much of the North, COVID-19 restrictions relaxed and gatherings growing more frequent. On average, the U.S. is reporting approximately 75,000 new COVID-19 cases each day, according to federal data, still significantly lower than the country’s most recent surge over the summer, but higher than at any point last spring.

Since mid-October, the average number of new COVID-19 cases has risen by approximately 17%, marking the first consistent increase in national cases in nearly 10 weeks. While some health officials caution that case numbers may not be the best indicator of the prevalence of COVID-19, hospitalizations are also on the rise in a number of states.

Experts say a confluence of factors is likely driving the country’s recent uptick besides cold weather — largely the more than 107 million Americans who remain completely unvaccinated and continue to account for the majority of new infections and hospitalizations.

People who have not been fully vaccinated are 6.1 times more likely to test positive with the virus and 11.3 times more likely to die from it, compared with people who are vaccinated, according to federal data.

But there is also the factor of waning immunity for those who are fully inoculated, something that other countries have seen as well.

“Lowering temperatures, increased population mixing, reduced masking, fully open schools and the more contagious delta variant all contribute to the increases in cases and hospitalizations in many parts of the country. Despite widespread availability of the vaccine, we still have pockets of under-vaccinated communities that consistently provide opportunities for the virus to spread,” said John Brownstein, an epidemiologist at Boston Children’s Hospital and an ABC News contributor.

“While we should all be more optimistic than this time last year, we are not yet in a position to declare victory on the pandemic,” Brownstein said.

COVID-19 cases on the rise in nearly 2 dozen states

Over the last two weeks, 22 states — many of them with colder temperatures — have seen an uptick in daily cases of 10%.

Similarly, 14 states — Arizona, Colorado, Connecticut, Iowa, Kansas, Michigan, Minnesota, Missouri, New Hampshire, Rhode Island, South Dakota, Utah, Vermont and Wisconsin — have seen an increase of about 10% or more in hospital admissions over the last week.

And after nearly 10 weeks of declines, national hospitalizations have also begun to increase. Although hospitalizations have declined significantly from the country’s summer surge, when more than 104,000 patients were hospitalized at one time, 47,000 patients currently in the hospital with COVID-19 — an increase of 2,000 from last week.

“We need to stop talking as though covid is over,” Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, tweeted last week. “More than 40% of the country remains unvaccinated. That’s a lot of warm water for hurricane delta. I’m concerned about yet another surge beginning after Thanksgiving (just like last year).”

Jennifer Nuzzo, epidemiology lead at the Johns Hopkins University Coronavirus Resource Center, called the stall in the national decline “worrisome.”

“We’re stalling at a level of weekly case numbers that are still well above what we saw at the lower periods at the end of June and in early July,” Nuzzo said during a briefing last week. “There are a number of states where these increases have persisted for two or more weeks, and that’s usually the metric we look for to say a trend is happening. So there are some early signs that we’re headed in the wrong direction.”

Even states with high vaccination rates see upticks

Despite states across the Northeast boasting high vaccination rates, with several jurisdictions reporting full vaccination rates above 70%, several states are struggling through their worst surge yet.

In Maine, COVID-19 infections and hospitalizations have been steadily rising across the state, despite the fact more than 70% of the state’s total population fully inoculated.

Since the onset of the pandemic, LifeFlight of Maine, which provides critical care transport across the state, has not seen a decline in the steady stream of patients in need of urgent care.

“The number of COVID patients we’re transporting is remaining the same as it was for the last 19 months. We’re continuing to say the hospitals are full to capacity,” Thomas Judge, executive director of LifeFlight of Maine, told ABC News.

This issue is not unique to Maine, Judge explained, adding that his colleagues across the country, and in the Northeast, are all still struggling.

“Because the hospitals can’t absorb all these patients, they’re just under such pressure for beds, especially the ICU beds,” Judge said.

Judge explained that they are frequently flying patients out of state, at times, as far away as Connecticut or New York, depending on bed availability.

“We’re taking patients across state lines routinely. Just because of these challenging beds, and we’re taking patients much further than we would normally take them which you can imagine,” Judge added. “The patients we’re seeing are primarily unvaccinated and the vast majority of patients in the ICU, and on ventilators are unvaccinated, and that continues to be the challenge.”

Vermont sees record surge in COVID-19 infections

In neighboring Vermont, which has the highest vaccination rate of any state with nearly 72% of the population fully vaccinated, COVID-19 cases increased by 50% over the last 14 days. According to a recent report by the Department of Financial Regulation, people who are not fully vaccinated continue to report infection rates 3.7 times higher, per capita, compared to people who are fully vaccinated.

Further, according to the report, 67% of hospitalizations, over the last seven days, are among the unvaccinated.

The patterns observed in communities with current spikes in infections and hospitalizations suggest that they are driven not only by those still unvaccinated, but also the decline of vaccine efficacy over time.

“Waning immunity likely is also contributing to increases in cases especially among those with increased vulnerability because of underlying conditions. Boosters can at least play a supporting role in averting a larger surge this winter,” Brownstein said.

Experts say the key to getting through the winter will ultimately be to get more Americans fully vaccinated and boosted when eligible.

“As we go into the winter months with the challenge of a respiratory infection being worse in the winter months, we can get through this if we really put a lot of effort into getting as many people vaccinated as we possibly can,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases said in an interview with NPR, this week.

Health experts also say that it will also be critical for people to get the flu vaccine, in addition to their COVID-19 shots, as both vaccines only protect against their respective diseases. According to the Centers for Disease Control and Prevention, it is safe to get the COVID and flu vaccines during the same visit.

At this time, booster shots are recommended for anyone over the age of 18 who has received the Johnson & Johnson vaccine. Moderna and Pfizer recipients are encouraged to get a booster shot six months after receiving their second dose, if they are over the age of 65, have an underlying medical condition or are at high risk for exposure. On Tuesday, Pfizer requested the Food and Drug Administration allow all Americans over 18 to be eligible for booster shots.

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(NEW YORK) — Experts agree climate change is exacting a hefty toll on human health — from increasing rates of asthma and heat stroke to depression and anxiety. But now, dermatologists are chiming in, too, saying climate change could also impact your skin.

“There are a lot of ways that the skin interacts with the environment,” said Dr. Misha Rosenbach, associate professor of dermatology at the University of Pennsylvania and co-founder of the American Academy of Dermatology’s climate change and environmental issues expert resource group.

Your skin is your body’s first line of defense against the outside world. Now, some dermatologists are seeing an uptick in some dermatological conditions linked to the burgeoning climate crisis. As the first barrier of protection against different climates, the skin must adjust to these changes, but it can be difficult to adjust to extreme environments.

“As temperatures rise, our skin’s ability to adapt to increasing temperatures has its limits,” said Dr. Sarah Coates, a pediatric dermatologist and assistant clinical professor of dermatology at the University of California, San Francisco.

Common skin conditions

Multiple common skin conditions have been linked to climate change. One of them is eczema, a skin condition that can happen at any age and often involves irritating, itchy rashes that can disrupt sleep and overall quality of life. Eczema can flare up due to multiple triggers, including air pollutants.

“It turns out eczema can be exacerbated by wildfire smoke,” Rosenbach said. A study published in JAMA Dermatology showed a link between an increase in eczema flares in California during the California Camp Fire in 2018.

Air pollution might also be causing flares in psoriasis and lupus, two different immune system medical conditions that can cause skin rashes.

The air pollution that triggers these flares could make it more difficult to treat these already persistent conditions, some dermatologists say.

Experts also say skin cancer is influenced by changes in climate and could happen more in the future because of it.

“It’s warmer in more areas, and so people are outside more, wearing less clothing for most of the year, and that’s more sun exposure,” Rosenbach explained.

Infectious skin diseases

Climate change can also spur infectious disease. Data shows climate change has been contributing to a rise of infections that affect the skin, not only globally but in the United States, which experts say could worsen as the environment changes. This is the result of various factors, including weather changes that affect the vectors that transmit diseases to humans, such as mosquitos and ticks.

Experts say some infectious skin diseases have been occurring during unseasonable times in the U.S., including Lyme disease, according to the U.S. Environmental Protection Agency.

Lyme disease first shows up as a “bull’s-eye” rash, but the infection can later manifest into other skin changes.

According to the EPA, new cases of Lyme disease have nearly doubled since 1991, which they label as an indicator of climate change.

Experts say these changes in infectious skin disease patterns are occurring nationwide. The multiple manifestations of climate change — from air pollution to flooding — all contribute to skin and overall health across the entire country. Flooding, such as that recently seen in the Southeast and Northwest, can carry pathogens that can damage the skin, Coates said.

“I think you would be very hard pressed to find someplace in the country that is completely unaffected,” Rosenbach added.

How to help protect your skin

Experts say there are various things you can do if you experience skin conditions or if they seem to worsen during different weather events.

Seeing a board-certified dermatologist is key for proper diagnosis and management of the condition, especially during different climates.

“It really depends on the condition that you’re talking about,” Coates said. “If you have atopic dermatitis (eczema), and you know that wildfire season is approaching, you can be more liberal with your use of moisturizers and emollients that protect your skin barrier from some of the harmful pollutants that can penetrate the skin barrier.”

For infectious skin diseases, it depends on the disease and what causes it, but experts say there are still extra measures you can take.

“It’s important, when you’re hiking outside, to wear long sleeves and to protect yourself from the elements, including mosquitoes and ticks,” Coates said, also adding that it’s good to stay indoors when it’s hot outside.

At COP26, the ongoing U.N. Climate Change Conference in Glasgow, experts are urging nations to take steps to reduce human impact on the environment. They also say everyday people can also make a difference by taking the train rather than flying, buying a hybrid or electric car, or by committing to eating less meat and dairy.

“Climate change is happening to our health,” Rosenbach said. “Now we know what we have to do. But it’s not just about doing it, it’s about how fast we do it.”

Alexis E. Carrington, M.D. is an ABC News Medical Unit Associate Producer and a rising dermatology resident at George Washington University.

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(ATLANTA) — Vermont is one of the most vaccinated states in the country and has served as a model for its COVID-19 response throughout the pandemic. But now, the state is experiencing its worst COVID-19 surge yet, with several factors — including its own success — to blame, officials said.

In Vermont, nearly 72% of residents are fully vaccinated against COVID-19 — more than any other state, according to U.S. Centers for Disease Control and Prevention data. At the same time, it has the 12th-highest rate of new COVID-19 cases over the last week, state data released Tuesday shows.

Vermont has seen a “significant” increase in COVID-19 cases in the past week, Mike Pieciak, commissioner of the state’s Department of Financial Regulation, said during a press briefing Tuesday.

The seven-day average for COVID-19 cases rose 42% as of Tuesday, according to state data. Vermont does more testing than nearly any other state, though testing only increased 9% during the same period. The statewide positivity rate also increased 30%, with the seven-day average positivity rate just under 4%. The number of new cases increased by nearly 700 in the past week, state officials said Tuesday.

“We just haven’t [previously] seen an increase in terms of that raw number of cases during the pandemic,” said Pieciak, noting there were just over 2,100 cases reported for the week in Vermont, one of the least-populated states in the country.

Case rates in Vermont residents who are not fully vaccinated are nearly four times higher than in fully vaccinated residents, according to state data. Essex County, the least-vaccinated county in the state, is reporting the highest case rates of any county in Vermont, with 1,022 cases per 100,000 people reported from Nov. 2 to 8. In Grand Isle County, which has the highest vaccination rate in the state, that number was 160.

Statewide, those driving the surge include people in their 20s, who are the least vaccinated among Vermont adults, as well as children ages 5 to 11, who are just now eligible to get vaccinated, Dr. Mark Levine, Vermont’s health commissioner, said Tuesday.

There’s no “one simple answer” behind the surge, according to Levine. Though one major factor is the delta variant, experts said.

“Across the United States and in Vermont, we’re seeing the impact of the highly contagious delta variant,” Dr. Jan Carney, associate dean for public health and health policy at the University of Vermont’s Larner College of Medicine, told ABC News. “It really is so contagious, it seeks out pretty much every unvaccinated person.”

The delta surge in Vermont mirrors rising cases in the region, as northern parts of the country that were largely spared over the summer are now seeing increases during colder weather. Vermont is one of 22 states, many of them with colder temperatures, that has seen an uptick in daily cases of 10% or more in the last two weeks, according to an ABC News analysis of CDC and Health and Human Services data.

Vermont is also one of 14 states that have seen an increase of about 10% or more in hospital admissions over the last week, the ABC News analysis found. About two-thirds of hospitalized COVID-19 patients in Vermont are unvaccinated, with those in the intensive care unit also largely unvaccinated, state officials said this week. COVID-19 patients make up between 10-15% of ICU patients; if that number increases to around 25%, “then the system could be in jeopardy,” Levine said.

Regarding the recent case surge, Vermont may also be a “victim of our success,” Levine said Tuesday, pointing to a lack of natural COVID-19 immunity among unvaccinated residents “because we kept the virus at such low levels throughout the entire pandemic.” Vermont has one of the lowest levels nationwide of people who have developed natural immunity to the virus, CDC data shows.

By the same token, waning immunity among residents who were “efficiently and effectively” vaccinated early on is also likely contributing to rising cases, Levine said. Breakthrough cases among vaccinated residents are up 31% over the past week, according to state data.

The COVID-19 vaccines have proven to be highly effective at preventing serious illness, hospitalization and death. No vaccine is 100% effective, and the waning immunity among residents, especially those who may not have mounted a robust immune response, may be tested by high community spread, experts say.

“You still have pockets of unvaccinated people, even in a highly vaccinated state,” said Dr. John Brownstein, an epidemiologist at Boston Children’s Hospital and ABC News contributor. “Unvaccinated individuals are the primary host by which the virus will spread and continue to allow for transmission to take place in the community and ultimately create challenges for those that are vaccinated.”

Changes in behavior, including more travel and indoor gatherings, and Halloween festivities have also helped fuel the surge, state officials said. At Saint Michael’s College in Colchester, Halloween parties were blamed for causing an outbreak on campus that led school officials to briefly move classes online and suspend in-person social gatherings through Thanksgiving. Post-Halloween, 87 students have tested positive for the virus, compared to just 11 between Aug. 27 and Oct. 22, according to school data.

“We were doing really well as a community up to the point where there were numerous Halloween parties where students were unmasked and in close contact,” the college’s president, Lorraine Sterritt, said in a letter to students earlier this week.

Statewide, COVID-19 cases are not expected to decrease over the next four weeks, state modeling shows, as hospitalizations are on the rise. Vermont has among the lowest COVID-19 hospitalization rates in the country “thanks to vaccines doing their jobs,” Gov. Phil Scott told reporters Tuesday. But ICU capacity is the “biggest concern at this point” as hospitals are currently “under stress from an increase in patient care for health issues that are not related to COVID,” he said.

Health officials are stressing vaccination and urging residents to get booster shots and vaccinate newly eligible children. Nearly 50% of Vermonters aged 65 and older have gotten a booster dose, while over 30% of children between the ages of 5 and 11 have made an appointment to get vaccinated or already started the process, state officials said Tuesday.

Reaching the remaining unvaccinated adults will also be key, Carney said.

“If there are people who have not yet decided to get vaccinated, I strongly urge them to talk to whoever they seek for their health care and have a conversation,” she said. “Vaccinating as many people as we can who are eligible for the vaccine will help us — in the short-term and in the long-term.”

Maintaining high levels of testing will also help, Brownstein said. “Testing is such an important way for us to identify those who have been exposed and infected and to limit transmission,” he said.

Scott said he isn’t reissuing a mask mandate amid the increase in cases, saying he feels it would be an “abuse of power,” but encouraged residents to “take a few extra precautions,” including wearing masks indoors while in public and getting tested before gatherings.

“If we make smart decisions in the coming weeks, and make an extra effort to protect the vulnerable, we can help reduce hospitalizations,” Scott said. “But it takes all of us committing to these smart, practical choices, starting with getting vaccinated.”

“None of us wants to step backwards,” he added.

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