Armed with booster shots, and pediatric vaccines, millions of Americans are expected to gather once again over the Thanksgiving holiday, which for many, will be the first major familial gathering since before the pandemic.
"If you're vaccinated, and hopefully you'll be boosted too, your family can enjoy a typical Thanksgiving holiday with your family. There's no reason not to do that," Dr. Anthony Fauci, the White House's chief medical adviser, said during an appearance on ABC's "This Week" on Sunday.
However, although there is hope for a return to pre-pandemic normalcy this holiday season, there are renewed concerns brewing among health experts that yet another coronavirus surge could be on the horizon, as coronavirus cases and hospitalizations increase again across the country.
Holidays have proven to be a catalyst of COVID-19 spread across the country. In the weeks following Thanksgiving of 2020, the U.S. experienced its most significant viral spread of the pandemic, with nearly 17 million infections, and more than 220,000 virus-related deaths reported between the months of November and January alone.
"While there is room for more optimism this Thanksgiving, this virus has consistently proved us wrong. It is clearly less than ideal to head into a major holiday at the starting point of a national surge in COVID cases," said John Brownstein, an epidemiologist at Boston Children's Hospital and an ABC News contributor.
Infection rates growing rapidly across the country
Infectious disease experts warn that there are implications of yet another difficult winter ahead, with their concerns stemming from the apparent beginnings of a surge across colder regions of the country.
Nationally, the U.S. is reporting more than 93,000 new COVID-19 cases each day, up by 46% since late October. 32 states -- nearly all of them in the north or mountain region -- have seen an uptick in daily cases of 10% or more in the last two weeks.
Michigan is currently reporting the nation's highest new infection, with the state now averaging more cases than at any other point in the pandemic, with health officials now warning that patients are being turned away or placed in hallways due to lack of beds and staffing.
"The reality is most hospitals throughout the state have more patients in their emergency departments than they do available rooms and staff to care for them. This results in long wait times, patients being placed in hallways or conference rooms, and diverting patients away from a hospital because there is no physical room or medical staff available to accept more patients," officials from the Michigan Hospital Association wrote in a statement on Monday. "We are extremely concerned because our best predictions are that COVID-19 patients will continue to increase during the weeks ahead as we enter the yearly flu season."
Given the surge, the Michigan Department of Health and Human Services issued a face mask advisory, ahead of the holidays, recommending that all individuals over the age of 2 wear a face mask at indoor gatherings, regardless of their vaccination status.
New York, which is set to welcome thousands of visitors to the streets of Manhattan for its annual Macy's Thanksgiving Day Parade, had maintained relatively low COVID-19 infection figures in recent months. However, now, the state is averaging its highest number of new cases since February.
In Illinois, daily cases are higher than at any point over the summer, and in Minnesota, federal medical staff have been sent in to help overwhelmed hospitals.
"Every day, our doctors and nurses are treating Minnesotans sick with COVID-19 or suffering other emergencies. But they are underwater, and they need all the help we can give them," Gov. Tim Walz wrote in a statement last week.
Even the states with the highest vaccination rates -- including Massachusetts, Connecticut and Vermont -- have all seen notable upsurgence since the early fall. In Maine, hospitalization totals have reached record levels.
The magnitude of the geographic area seeing a COVID-19 resurgence is growing, according to a recent forecast released by the PolicyLab at Children's Hospital of Philadelphia.
Although hospitalizations had remained flat throughout the fall, in areas of high vaccination coverage, large urban areas should "anticipate increases in case incidence, alongside an increase in hospital admissions," forecasters wrote.
This uptick could be further exacerbated, experts say, by the high number of Americans traveling, and with unvaccinated and vaccinated family members mingling indoors, particularly in states with colder climates.
A total of 53.4 million people are expected to travel for Thanksgiving, up 13% from 2020, according to estimates from AAA. In the last five days alone, the Transportation Security Administration reported it has already screened 10.5 million people through checkpoints.
Unvaccinated Americans driving national COVID-19 uptick
Although positive COVID-19 cases among the vaccinated do appear to be on the rise, due to waning immunity, health officials say the vast majority of infections and severe hospitalizations are among the unvaccinated.
"The thing we are concerned about is the people who are not vaccinated, because what they're doing is they're the major source of the dynamics of the infection in the community," Fauci said. "The higher the level of dynamics of infection, the more everyone is at risk."
On Monday, new data from the Centers for Disease Control and Prevention revealed that despite the emergence of the Delta variant, vaccines continue to dramatically reduce one's risk of getting infected by COVID-19, being hospitalized or dying from the disease.
In September, unvaccinated individuals had a 5.8 times greater risk of testing positive for COVID-19, and a 14 times greater risk of dying from it, as compared to vaccinated individuals.
At this time, more than 101 million Americans remain completely unvaccinated, 81 million of whom are currently over the age of 5, and thus are eligible to be vaccinated.
Public health experts continue to advise caution to minimize COVID-19 risk, beginning with getting primary vaccinations, if eligible, and receiving a booster shot before traveling for the holiday in order to increase protection against the virus.
“By working together, we can enjoy safer holidays, travel, and protect our own health as well as the health of our family and friends,” the CDC wrote.
If certain family members are unvaccinated, immunocompromised or elderly, and thus at increased risk for severe illness, CDC guidance recommends people take precautions by getting tested before the holiday, wearing masks and if possible, gathering outdoors, which is safer than indoors.
"Risk of transmission of gatherings is highly nuanced and dependent on a range of factors including group size, age and underlying health conditions of attendees, vaccination coverage as well as quality of ventilation," Brownstein said. "While there is no event that is 0 risk, at this point in the pandemic, everyone should be armed with enough information to help significantly reduce risk while still enjoying the holidays."