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The U.S. Centers for Disease Control and Prevention, as of July 27, is recommending Americans in places with “substantial” or “high” COVID-19 transmission resume wearing face masks indoors — even if they’re vaccinated.

The updated guidance applies to three Western Tidewater Health District localities: Isle of Wight County and the cities of Suffolk and Franklin.

According to CDC data, the nationwide 7-day moving average of new coronavirus cases rose 346% from July 1 through July 27 — a surge the federal agency attributes to lagging vaccination rates coupled with the spread of a more contagious version of the disease now known as the delta variant, which began spreading through India late last year.

The CDC reports delta has become the predominant variant throughout much of the nation, making up an estimated 83% of recent U.S. cases. In fact, variants now account for all cases in the United States. The original strain is no longer being detected.

The CDC looks at two metrics when designating localities as having “substantial” or “high” transmission: their number of new cases per 100,000 residents and their percentage of positive COVID-19 tests over a one-week period.

According to CDC data, just under half of all U.S. localities fall into the high category, indicating 100 or more cases per 100,000 residents or a positivity rate of 10% or higher.

Another 16% of localities are in the substantial category, indicating 50 to 99 new cases per 100,000, or an 8-9% positivity rate.

Isle of Wight and Suffolk both fall into the high category, according to the CDC’s online map. The city of Franklin, while not listed on the CDC’s map, also meets the criteria, according to VDH data.

While delta has yet to be detected in any of the four localities comprising Virginia’s Western Tidewater Health District, VDH data indicates 92% of the district’s recent cases have been identified as the alpha variant, also known as B.1.1.7, which was first detected in the United Kingdom last fall. The alpha variant, according to the National Institutes of Health, is not only more contagious than the original coronavirus strain but also carries an increased risk of severe illness and death.

According to VDH data, Isle of Wight and Suffolk have both been trending upward in cases for more than a month. Isle of Wight, in fact, is reporting a worse resurgence than Suffolk, despite having less than half the city’s population.

The data shows Isle of Wight averaging 97.4 cases per 100,000 and a 9.9% positivity over the past week. Suffolk is averaging 85.5 new cases per 100,000 for the same time period and Franklin, the smallest of the four Western Tidewater localities, is averaging 124.8. Though Isle of Wight’s and Suffolk’s data would seem to warrant only a “substantial” classification, the CDC’s recommendation is the same: keep your mask on when inside a public building regardless of your vaccination status.

Dr. Todd Wagner, when asked about the discrepancies between the state and federal data, pointed to a disclaimer on the CDC’s website stating the federal data may differ from what’s reported on state and local websites due to differences in how that data was collected.

Southampton County is the only Western Tidewater locality showing a downward trend in new cases and percent positivity, though the decrease has been occurring for less than two weeks and as such is described as “fluctuating” on the VDH pandemic metrics website. As of July 29, VDH data for Southampton showed 17.1 new cases per 100,000 and a 3.2% positivity over the past week, putting the county in the CDC’s “moderate” transmission category.

“As a rural county with a low population, there could be a few explanations for this,” Wagner said. “A few more cases reported could increase the 7-day moving average substantially due to the low population. As a corollary to this, as a rural county there are fewer places within a reasonable distance to pursue testing for COVID-19. Also, as a rural county, there is more physical distancing as there are fewer areas for large crowds to gather. These are all possibilities.”

The CDC defines moderate transmission as 10 to 49 new cases per 100,000 or 5-7% positivity over a one-week period. Surry County, which is in the Crater Health District, is also in the moderate category with 46.3 cases per 100,000 and a 1.3% positivity.

However, new cases in Surry have been trending upward over the past two weeks, and two new outbreaks were reported in the county during July, according to the VDH. Prior to July, Surry had been outbreak-free since May of last year.

​​As of July 23, the Crater Health District, which spans west from Surry to Petersburg and south all the way to Emporia, had 13 confirmed delta cases, but Tara Rose, the district’s COVID-19 public information officer, couldn’t say how many, if any, were in Surry County, nor would she speculate as to why Surry had lower rates of transmission than Isle of Wight.

“What is important is that vaccination remains the best way to fight the surge in COVID-19 cases, especially those caused by the highly contagious Delta variant,” she said. “To protect yourself and others, get vaccinated for COVID-19. Until you are fully vaccinated, continue wearing a mask correctly, stay at least six feet from others outside of your household, avoid crowds and poorly ventilated spaces, and wash your hands often.”

‘A pandemic of the unvaccinated’

CDC Director Dr. Rochelle Walensky, in mid-July, referred to the coronavirus resurgence as “a pandemic of the unvaccinated,” a sentiment Gov. Ralph Northam echoed on Twitter following the updated CDC mask guidance.

“We know the vaccines work — since January, over 98% of #COVID-19 hospitalizations and deaths have been among unvaccinated Virginians,” Northam wrote on his @GovernorVA account July 29. “Masks are effective at preventing the spread of #COVID-19, but getting vaccinated is the surest way we can bring this pandemic to an end. All three vaccines are safe, effective and free.”

The Moderna and Pfizer-BioNTech vaccines each require two injections, the second given roughly a month after the first. The Johnson & Johnson shot is a single-dose vaccine. The New York Times reports that so far, data suggests all three vaccines provide good protection against delta, especially against severe outcomes, hospitalizations and deaths.

Vaccinations peaked in Virginia during the first week of April, with around 110,000 shots per day going into arms. By May, the number of vaccinations started to decline and, as of July, have now slowed to 11,000 to 12,000 doses per day, Wagner said.

“It is likely a mix of hesitancy and some misinformation,” including that people may not know the vaccine is free, Wagner said of the slowdown.

Those who remain unvaccinated might not know where to find more information or where to get the vaccine, he suggested. People can visit vaccines.gov to find a place near them.

According to CDC data, 66.8% of the nation’s population ages 12 and up has received at least one vaccine dose, and 57.6% are fully vaccinated.

Locally, “we cannot give a definitive percentage breakdown of cases between vaccinated and unvaccinated individuals,” Wagner said, but “the vast majority of cases are in unvaccinated individuals.”

As of July 29, according to VDH data, around 53% of Isle of Wight County’s total population had received at least one dose, and around 47% were fully vaccinated. Counting only the county’s adult population, percentages were slightly higher: roughly 63% had received at least one dose, and 57% were fully vaccinated.

By that same date, 46% of Suffolk’s total population had received at least one dose and 41% were fully vaccinated. Counting only Suffolk’s adults, the breakdown was roughly 57% had received at least one dose and 51% were fully vaccinated.

In Franklin, just under half of the city’s total population had received one dose and about 42% had been fully vaccinated. Counting only Franklin’s adults, 64% had received at least one dose and around 55% were fully vaccinated.

In Southampton, only 43% of the county’s total population has received one dose and only 37% has been fully vaccinated. Counting only Southampton’s adult population, just over half have received one dose and just under 45% have been fully vaccinated.

In Surry, around 51% of the county’s total population had received one dose and around 46% had been fully vaccinated. Counting only Surry’s adults, around 58% have received one dose and around 53% are fully vaccinated.