Tuesday marks the end of most state-mandated COVID-19 restrictions in Michigan, including capacity restrictions on indoor and outdoor gatherings and an end to mask mandates. Orders for protecting vulnerable populations in prisons, long-term care facilities and in agricultural facilities remain in place. But no more mandated capacity limits in bars and restaurants. You can have as many friends over for a gathering as you like. And the mask can stay at home in most situations.

So, the pandemic’s over for the U.S. then?

Not exactly, said Dr. Elvin H. Geng, MD, MPH, a professor of medicine at Washington University of St. Louis and a specialist in infectious diseases.

“I don’t think it’s over everywhere for everyone,” Dr. Geng told Detour. “Certainly we are making progress towards vaccination. And I would say that even with all the variants, if we’re able to get almost everybody vaccinated, we will be in good shape.”

That’s because evidence indicates that people are getting more colds. “We’ve seen a rise in a whole bunch of other respiratory viruses which the Centers for Disease Control tracks, and the fact that those are going up means people are interacting, but COVID isn’t exploding, and that is a very good sign,” Geng said.

Of course, the pandemic is still very much alive in places like Brazil and Argentina, with 35 and 46 cases per 100,000, respectively. And the vaccine is not yet widespread in many places.

And in the United States, areas with low vaccination rates —  which includes the city of Detroit —  populations remain vulnerable.

“If people are highly vaccinated, then we are in a situation where we’re sort of back to normal;  or at least back to normal-ish,” said Geng. “But places right now where 20-30% of people are vaccinated — that’s not a place we should think about as being the pandemic over.”

While slightly more than 51% of Michiganders ages 12 and up are fully vaccinated (with more than 60% with at least one dose), Detroit’s vaccination rate stands at 30.3%. Full vaccination rates for ages 12 and up in the suburbs are also higher: 50.7% in Macomb County, 60.7% in Oakland and 56.7% in outer Wayne. 

Poll results released last week show that nearly one-third of unvaccinated Black Americans and one-fifth of unvaccinated Native Americans who expressed some degree of vaccine hesitancy say the discrimination their communities have faced within the healthcare system makes it hard to trust COVID-19 vaccines are safe and effective.

“On the one hand it’s important to honor and acknowledge the justifiable distrust that Black communities have of the medical establishment. So that’s definitely real,” Geng said. “But on the other hand as a physician, I feel strongly confident that a vaccination is good for your health. I think it’s the job of public health and the job of physicians to keep that conversation going, and to try to steer people towards the decisions that we know, in medicine, are good for your health —  the vaccine being one of those things.

But for Detroiters, the story may go deeper than simple vaccine hesitancy–despite the city’s efforts to publicize mass vaccine sites like Ford Field, information and transportation barriers are hard to scale. The city recently began a new initiative to go out into communities to vaccinate homebound residents, targeting an estimated 40,000 residents and anyone unvaccinated in their households.

So what will it take to get more Detroiters vaccinated?

Geng is not a proponent of heavy-handed ways of getting people vaccinated, and believes it’s important to respect people’s autonomy. 

“From a public health perspective, the first 60% is relatively easy to get people to do some health intervention or activity,” said Geng. “But the amount of effort, time, energy and money you will have to spend on the last 30% is going to be far bigger.”

Poll results also showed that one out of three Americans who expressed some hesitancy to getting a COVID-19 vaccine would prefer to hear from their doctor. And half of Americans who expressed some hesitancy about COVID-19 vaccination say the prospect of opening businesses and schools makes them more likely to get vaccinated. That may mean that as life gets closer to normal, and more people hear directly from their doctors, the vaccination rate will rise.

Whether it will be enough to stem another surge in the fall as the more-transmissible Delta variant becomes predominant in the United States, people head back indoors and kids head back to school, is not yet clear.

“I think schools have done remarkably well during the pandemic in terms of not having a massive transmission,” Geng said. “COVID seems to have a particular predilection not to spread among children, particularly younger children, and that is reassuring. Now, whether or not that remains true with the Delta variant remains to be seen.”