The more contagious Delta variant of Covid-19 now makes up 83% of sequenced samples in the United States, US Centers for Disease Control and Prevention Director Dr. Rochelle Walensky said Tuesday.
"This is a dramatic increase, up from 50% for the week of July 3," Walensky said in a Senate Committee on Health, Education, Labor, and Pensions hearing.
Health experts have said the Delta variant is more transmissible than any other identified variant so far. "We should think about the Delta variant as the 2020 version of Covid-19 on steroids," Andy Slavitt, a former senior adviser to Joe Biden's Covid Response Team, told CNN last week.
"It's twice as infectious," Slavitt said. "Fortunately, unlike 2020, we actually have a tool that stops the Delta variant in its tracks: It's called vaccine."
The most recent data from Israel evaluating effectiveness of the Pfizer/BionTech mRNA vaccine against the Delta variant found the vaccine to be 64% protective against infection, and that the vaccine is 93% effective in preventing severe disease and hospitalizations. Other studies indicate that the Moderna and Johnson & Johnson vaccines are also effective against the Delta variant.
But more than half of the US is not yet fully vaccinated, according to the CDC, an obstacle that has become increasingly worrisome to health experts as resistance to vaccination rises with the spread of misinformation. If many of those who are holding out do not get inoculated, Dr. Anthony Fauci said the US can expect a "smoldering" outbreak for "a considerable period of time."
Having been tricked by the virus before, the US Surgeon General says now is the time to be cautious.
"There have been multiple times when we have been fooled by Covid-19, when cases went down and we thought we were in the clear and then cases went up again," Dr. Vivek Murthy told CNN's Anderson Cooper. "It means we shouldn't let down our guard until cases not only come down but stay down, and right now cases are actually going up. Cases are going up, hospitalizations are going up, death rates are ticking up."
The average of new daily cases this week is up 66% from last week and 145% from two weeks ago, as cases surge in 44 states, according to data from Johns Hopkins University. In addition, hospitalizations are up 26% from last week.
And 99.5% of deaths are among the unvaccinated, Murthy told CNN's Dana Bash on "State of the Union" Sunday -- a figure cited by the US Centers for Disease Control and Prevention earlier in the month.
Already some hospitals are again being overwhelmed by Covid-19 patients, Murthy said.
"I am heartbroken to see just how hard (physicians are) working -- how exhausted they are," Murthy said. "Many of them are suffering with depression, anxiety, post-traumatic stress disorder, suicidal ideation, as a result of the stress that they have endured during this pandemic."
Murthy urged Americans to get vaccinated -- if not for themselves then for health care workers who need protection from burnout and children who are not yet eligible for the protection provided by the vaccine.
Even if parents are vaccinated, wearing a mask in areas of high transmission risk is "the right thing to do," he said. Murthy -- the father of two children, ages 3 and 4 -- said he takes such precautions because "I want to take every possible measure to protect my child."
"Our kids who cannot get vaccinated, they depend on us being vaccinated to protect them from the spread of the virus. We are their shields," Murthy said. "Even if you don't want to do it for yourself, consider getting vaccinated to protect the children in your community. They are depending on us."
Pediatrics association recommends masks in schools
In addition to protecting children from infection, many experts and officials have stressed the importance of getting them safely back into the classroom.
Most children are at a lower risk than adults for severe disease from Covid-19, and the benefits of learning in a classroom outweigh the risks, said Dr. Greta Massetti, a member of the U.S. Centers for Disease Control and Prevention's Covid-19 Emergency Response.
"However," she added, "for some families, particularly those with children or family members who are at increased risk of severe illness from COVID-19, or who cannot get vaccinated, those families might be more comfortable with a remote option this fall."
On Monday, the American Academy of Pediatrics released new guidance for schools that supports in-person learning and recommends universal masking in schools for everyone over the age of 2.
"The AAP believes that, at this point in the pandemic, given what we know about low rates of in-school transmission when proper prevention measures are used, together with the availability of effective vaccines for those age 12 years and up, that the benefits of in-person school outweigh the risks in all circumstances," the guidance said.
The guidance differs some from the CDC recommendations, which advise masks be worn indoors in schools by all individuals who are not fully vaccinated.
But Fauci said the CDC leaves flexibility for localities to make judgment calls based on their situation.
And when there is a high rate of virus spread in a community and a low proportion of vaccinated people, "you really want to go the extra step, the extra mile, to make sure that there's not a lot of transmission, even breakthrough infections among vaccinated individuals," Fauci said. "They just want to be extra safe."
There are some states, including Connecticut, Hawaii, New Mexico, New York, Virginia, and Washington, that follow the AAP guidance to require masks among K-thru-12 students regardless of their vaccination status.
But an updated CNN analysis has found that at least nine states -- Arkansas, Arizona, Georgia, Iowa, Oklahoma, South Carolina, Texas, Utah and Vermont -- have enacted legislation that prohibit districts from requiring masks in schools.
Local leaders urge residents to put masks back on
While some states are staying away from mask mandates, others are embracing a return to preventative measures.
As California reports a surge in cases to levels not seen since February -- when new cases were dropping after a winter surge -- about half of the state's population is once again under mask mandates and recommendations.
"This is inevitable," California Gov. Gavin Newsom said of the new requirements and recommendations. "If we want to end this pandemic once and for all, if we want to turn the page, we can get it done in a matter of weeks, not months. It's as simple as this: If you're not vaccinated, get vaccinated."
In Massachusetts, officials in Provincetown issued a public health advisory Monday, strongly advising the public to wear masks and get vaccinated if they haven't already. The public health advisory comes amid an increase in cases in Provincetown after the July 4 holiday weekend, according to the advisory.
The advisory also states that venues with "high density where social distancing is not achievable are strongly advised to enforce vaccine verification prior to admittance."
New Jersey is also seeing increasing rates, with a positivity rated increased to 2.5% and a 20% increase in unvaccinated patients in hospitals, state Health Commissioner Judy Persichili said. But the state will not go back to a mask mandate at this time.
"We continue to be comfortable where we are, but we watch this like a hawk. And our strong, strong preference is to not go back," Gov. Phil Murphy said.