With low vaccination rates, paired with hot and humid weather, Southern states may experience a surge of COVID-19 cases this summer but with a smaller increase in hospitalizations and deaths.
Most seniors have been vaccinated even in the states with the slowest vaccination rollouts, meaning any summer surge will not be as severe as 2020. Yet, there are still populations who are vulnerable because they have not received a vaccine.
“Based on what we experienced last year, I think it is perfectly reasonable for all of us to expect an uptick in cases in the South,” said Angela Clendenin, instructional assistant professor at the Texas A&M School of Public Health.
In the summer of 2020, most states running from Virginia down to Florida and then west to Texas saw COVID-19 cases rise from June until late July or early August. Some, such as Kentucky and Arkansas, saw rather modest increases, while others in Texas and Florida saw steep jumps. Only Virginia did not experience a surge.
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Alabama, Arkansas, and Texas have each experienced small increases in COVID-19 cases over the last week, according to data from Johns Hopkins University. However, those increases came on the heels of some of the lowest case numbers since the pandemic began. Whether it is a warning sign or just a temporary increase remains to be seen.
One reason the South could experience a surge this summer is that its vaccination rates tend to be lower than other states.
“As long as a virus has somewhere to go, it will,” said Susan Hassig, an epidemiology professor at the Tulane University School of Public Health and Tropical Medicine. “And the South tends to be less vaccinated.”
Just under 52% of the United States population has received at least one dose of the COVID-19 vaccine. Among Southern states, Virginia exceeds that at 56%, and Florida is close behind at 50%. But all other southern states are below 50%, and eight are below 45%. Mississippi has the lowest at 34%, with Alabama and Louisiana both at 36%.
Vaccination rates have not been uniform within Southern states, varying greatly from county to county. That will affect where a surge could occur.
“If you look at the community and county level, there are larger concentrations of people who are unvaccinated,” said Dr. Harry Heiman, a clinical associate professor in the Division of Health Management and Policy at the School of Public Health at Georgia State University. “The possibility of surges in those communities or counties are very present.”
Generally, larger metropolitan areas have higher vaccination rates in the South, while rural counties often lag.
The weather in the South may also play a role, as summer temperatures routinely move into the mid-to-high 90s and humidity often exceeds 90%. As a result, people in those states will likely congregate indoors with air conditioning.
“That will put people in close proximity, and we know that this virus loves to spread among people in close proximity indoors,” said Dr. Marissa Levine, a former state health commissioner in Virginia and current director at the Center for Leadership in Public Health Practice at the University of South Florida. “These are risky environments where a lot of young people will congregate. Younger folks tend to be less vaccinated.”
Jill Roberts, a professor of molecular epidemiology at the University of South Florida College of Public Health, is concerned about the impact tourism in Florida will have on the spread of the coronavirus.
“We get a lot of travelers this time of year, not just from the U.S. but also from other countries. So we can have variants of the virus come into the state as well as from other countries, and we can also spread variants from here to other places,” Roberts said. “We don’t see as much of a problem with people inside here, but rather with people crowding in theme parks and beaches during the summer.”
The fact a substantial portion of the population has been vaccinated means a surge in the South is unlikely to be as widespread as it was in 2020. As a result, hospitals probably won’t be strained, as they were last year.
Since much of the older population has been vaccinated, any surge would likely occur among younger people who are less likely to be hospitalized with severe COVID-19. But, that doesn’t mean there are no vulnerable populations at risk.
“Even in Florida, where we’ve vaccinated over 80% of those age 65 and older, if you look at the numbers, that’s still 1 million people over 65 who have not been vaccinated,” Levine said. “I suspect there are similar numbers throughout the South. If those people become more mobile during the summer, you could see hospitalizations and deaths increase.”
Furthermore, many Southern states have high numbers of people with multiple comorbidities, a condition that creates a high risk for severe COVID-19. A study from 2020 in the journal Plos One found that of the 10 states with the highest rates of comorbidities, five were in the South: Arkansas, Alabama, Kentucky, Louisiana, and Mississippi.
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“Southern states tend to have worse health outcomes overall and more profound health disparities, so there are populations at greater risk if they become infected,” said Heiman. “To the extent some of those same populations may choose not to get vaccinated, that’s a problem.”
