Angela Johnson circled the block around the New Mount Zion Missionary Baptist Church in Tampa. It was a balmy August morning, but she couldn’t bring herself to walk through the glass doors.
“Have you had anything to eat yet?” her brother asked over the phone. “You don’t know how you’re going to feel after, so you better eat now.”
Johnson’s brother had called to make sure she kept her vaccination appointment and said he’d stay on the line until she made it inside.
This was her fourth attempt, the 54-year-old Johnson said, after getting her first shot of the Pfizer vaccine. “I’d get ready, and each time, there’s something holding me back.”
Johnson spent nearly three weeks bedridden with COVID-19 last year. She knew she’d be protected from a second infection for some months, but the delta variant was spreading across the state, infecting more than 20,000 residents each day. Research shows her decision to get vaccinated will keep her safer through the holidays.
Florida’s summer delta wave is behind us — the positivity rate has been below 5 percent for seven weeks and cases have fallen to fewer than 1,600 per day. Around Tampa Bay, the positivity rate has hovered below 3 percent. But physicians and public health experts say the pandemic is far from over.
COVID-19 hot spots around the country indicate what could be coming back, said University of Florida epidemiologist Derek Cummings. Another outbreak could be driven by waning immunity, a busy holiday season and complacency.
“People seem to think they won’t get infected, but the virus is still out there,” Cummings said. “It’s generally good to have (population) immunity, but as an unvaccinated individual, you can’t rely on it.”
Even so, those who follow basic precautions can have the semblance of a normal holiday season, health experts said.
For Thanksgiving, Johnson planned to be with other vaccinated family members for the first time in nearly two years. She said she wanted to replicate her mother’s beloved stuffing and serve canned cranberry sauce, even though no one would touch it.
And before supper, Johnson and her family planned to gather around the dining table to say what they were thankful for.
At the top of her list? Seeing her loved ones in person.
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The goal of public health officials is to reach herd immunity, when a large enough share of the population is vaccinated or immune that viral spread is unlikely.
“Think of herd immunity like a brick wall,” said University of Florida epidemiologist Cindy Prins.
Each person who gets the vaccine or becomes infected with COVID-19 adds one more brick to that wall, she said. Eventually, the wall becomes high enough that the virus can’t spread, and cases start to drop.
But coronavirus cases were up in 34 states over the past two weeks, according to The New York Times’ COVID tracker.
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“The problem with the wall is that not all the bricks are built the same,” Prins said. Immunity gained through vaccination tends to be stronger and longer-lasting than immunity that comes after an infection, she said.
Unvaccinated people who had COVID-19 were five times more likely to get a subsequent infection than fully vaccinated people who didn’t have a prior infection, according to a recent study from the Centers for Disease Control and Prevention.
Typically, the immune response in an unvaccinated person lessens after three months, according to the CDC, and fades to almost nothing after six months.
Nearly 1 million Floridians were infected during a COVID-19 surge between June 18 and Oct. 3, according to state data. Neither the state nor the CDC will report how many of them were vaccinated, but those who weren’t will start to lose their immunity this holiday season.
Protection from vaccines also wanes over time. After six months, the Pfizer and Moderna vaccines have lost nearly one-third of their protective power, according to the CDC. Concerns over that flagging effectiveness prompted U.S. health officials last week to open COVID-19 vaccine boosters to all adults.
The degree of waning immunity could determine whether Florida sees another surge in cases this winter, said University of Washington epidemiologist Ali Mokdad.
Mokdad uses mathematical models to predict the spread of COVID-19. In models without waning immunity, he said, Florida wouldn’t see a surge this winter.
“However, if we add waning immunity, then there is a possible surge in Florida,” he said,” but not at the levels that we’ve seen before.”
The CDC recommends that all eligible people get vaccinated, even if they’ve had COVID-19.
As of last week, 64 percent of Florida’s population was at least partially vaccinated against the coronavirus, according to state data. That puts Florida slightly above the national average.
The other 36 percent of Floridians include the immunocompromised and children under 5.
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St. Petersburg residents Pat Vosburgh, 63, and her husband, Chuck, 56, are among the 7 million Floridians who haven’t been vaccinated.
They both have chronic Lyme disease, and their physician suggested they forgo the jab. Health experts disagree on whether having Lyme disease should prohibit one from being vaccinated, but the Vosburghs are following their physician’s advice.
The couple had been careful. As Realtors, they were in and out of homes all day, but they wore masks and gloves. They evaded COVID-19 infection during Florida’s first two waves, but on July 30, that changed. While out on a house viewing, Pat started to feel off.
“It started as a migraine, but I knew something was wrong,” she said.
The headache evolved into chills and body aches. Her husband drove her home wrapped in a sweater and shivering in the July heat. Three days later, she tested positive.
Chuck caught the virus the next week. Both recovered without a trip to the hospital. But that was nearly five months ago, and the Vosburghs are likely nearing the end of their natural immunity, according to CDC standards.
Neither plans to be vaccinated, and decided their Thanksgiving celebration would be starkly different.
For 10 years before the pandemic, the family held what Pat calls an “open” Thanksgiving.
“Everyone is welcome at our table,” she said, “whether they’re a friend or family or a complete stranger.” Even people they hadn’t met before from their Volkswagen enthusiasts club had attended.
But this year, the couple planned to host a meal for only her immediate family, some in their 70s.
“I believe in faith over fear,” she said, “but that doesn’t mean you should act irresponsibly.”
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Waning immunity can’t fully explain the rise and fall of infections during the pandemic, Cummings said. Taking protective measures, as the Vosburghs did, is essential for preventing future waves.
“A lot of it is driven by people’s behaviors,” Cummings said. “We’ve seen this time and again. When people responded — masks, social distancing, closing the schools — cases went down.”
Vaccines protect against illness, but vaccinated individuals can still spread the virus. And when people start socializing again, it’s only a matter of time before vulnerable individuals are exposed.
“Another complication is that vaccinated people aren’t distributed evenly among the population,” Cummings said. The virus is more likely to spread when vaccinated and unvaccinated individuals are concentrated into separate groups, he said. If two-thirds of the population is vaccinated, it doesn’t help if the other third only associates with each other.
“It’s like they’re moving around outside the wall,” Cummings said. “There’s no protection there.”
Epidemiologists worry that concentrations of unvaccinated populations may lead to more outbreaks within those communities.
Miami-Dade, Monroe and Broward counties have vaccinated more than 70 percent of residents. Hillsborough has vaccinated 63 percent of residents, and Pinellas has vaccinated 65 percent.
Meanwhile, less than 60 percent of residents are vaccinated in 39 Florida counties, including Hernando and Citrus. Since the start of the last coronavirus wave, those two counties have had higher case rates than the rest of Tampa Bay.
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Holiday social gatherings can contribute to the spread of coronavirus, but those who choose to travel or gather can take precautions to make it safer, public health experts said.
“Most of the advice hasn’t changed in the past 20 months,” Cummings said. The best defense is getting vaccinated, masking and social distancing in crowded indoor settings, he said.
“We should also be taking advantage of this beautiful Florida weather,” Cummings said. “If you can, why not move your gathering outside?”
One underutilized tool is the rapid at-home coronavirus test, experts said.
“If you think you’ve been exposed, if you’re not feeling great, if you’ve been in a crowded setting, you can easily test to see if you’ve been exposed,” Cummings said.
If they test positive, unvaccinated people should quarantine for two weeks, or seven days with a negative COVID-19 test, according to CDC guidance. Vaccinated people should quarantine for 10 days or until they stop experiencing symptoms.
We also can make better use of data, said Tampa General Hospital physician Jason Wilson.
“In a world where case positivity is below 5 percent and hospitalizations aren’t increasing,” he said, “a group of people who are all vaccinated can gather and feel pretty good about that choice.”
Florida’s positivity rate was 2.5 percent as of Nov. 19, but experts warn families to take precautions with out-of-state visitors, especially those from areas with higher infection rates.
Much of the responsibility for precaution now falls on individuals. Florida is among the states that have pushed back against federal vaccine mandates. Last week, Gov. Ron DeSantis signed into law bills reining in the ability of businesses to mandate vaccines and banning mask requirements in Florida schools.
Health experts recognize that taking precautions isn’t always easy. But it can save lives.
“If you get grandma sick over the holiday, think of how you’re going to feel,” Cummings said. “So why not wear a mask? Why not be outside? Why not take a test?”
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How to get vaccinated
The COVID-19 vaccine for ages 5 and up, and booster shots for eligible recipients are being administered at doctors’ offices, clinics, pharmacies, grocery stores and public vaccination sites. Many allow appointments to be booked online. Here’s how to find a site near you:
Find a site: Visit vaccines.gov to find vaccination sites in your ZIP code.
More help: Call the National COVID-19 Vaccination Assistance Hotline.
Phone: 800-232-0233. Help is available in English, Spanish and other languages.
Disability Information and Access Line: Call 888-677-1199 or email DIAL@n4a.org.