The bad news is that death from COVID remains an option, even now. The good news is that, because the vaccines are so effective, we’ve reached the point where you basically have to choose that option. The virus can no longer choose it for you.

The terrible news is that a lot of people are going to choose it anyway.

Yesterday Rochelle Walensky announced that cases and hospitalizations in the United States continue to trend downward. Why’s she nudging people to keep getting vaccinated, then? Because she knows that what happens in the UK tends to happen here a month or so later and the trend in the UK at the moment isn’t great. Watch, then read on.

CDC Director Dr. Rochelle Walensky says that with vaccines widely available now, "nearly every death" due to COVID-19 is "entirely preventable." pic.twitter.com/Fe7HSFWK2S

— CBS Evening News (@CBSEveningNews) June 22, 2021

She’s worried about B.1.617, the Indian/Delta variant, which represents around 20 percent of all cases in the U.S. but upwards of 90 percent in the UK. Because of that, Britain just recorded its highest number of cases in nearly five months, a figure per capita equivalent to around 80,000 cases in the U.S. The Delta variant is freakishly contagious and might also produce more severe illness, although the jury remains out on that point for now. Israel is sufficiently worried, though, that the prime minister’s office has ordered anyone who tests positive for B.1.617 to quarantine even if they’ve been vaccinated. Vaccinated people aren’t supposed to be able to transmit the virus in most cases but some data suggests Delta is more capable of evading immunity than most other variants are. Israel’s taking no chances with average daily cases having now risen above 50 for the first time since early May.

The latest casualty of B.1.617 is Russia, where the variant represents 51 percent of all cases according to one analysis. Cases in Russia have nearly doubled in two weeks with Moscow setting a new record of 86 deaths per day and ICUs getting crowded. Partly that’s due to Delta and partly to Russia’s low rate of vaccination, with even many doctors telling the Daily Beast that they don’t trust the government’s assurances that Putin’s vaccine is effective.

That’s what Walensky’s worried about too, the vaccine holdouts. Vaccinated people do very well against B.1.617, a growing body of evidence suggests:

BREAKING NEWS ON DELTA VARIANT (except not really, preprint was posted PHE on June 14): Vaccine effectiveness against hospitalization with delta was similar to that seen with alpha – 94% after 1st dose, 96% after 2nd dose Pfizer. 71% after 1st dose with AZ; 92% after 2 doses pic.twitter.com/v7Ck059bwq

— Monica Gandhi MD, MPH (@MonicaGandhi9) June 23, 2021

Parts of the U.S. with high vaccination rates should be okay but the parts with low rates are iffy. One American genomics firm analyzed 20,000 samples across 700 U.S. counties and found, to no one’s surprise, that Delta was spreading more aggressively in places with fewer vaccinated people. States with lower vaccination rates are seeing some spread as well:

The 3 states–Missouri, Utah, Arkansas–with highest Delta variant prevalence are all increasing in cases, leading the country (still relatively low cases/capita rates), going in the opposite direction as most of the country /2 pic.twitter.com/rQEqQ6cg9a

— Eric Topol (@EricTopol) June 23, 2021

Arkansas, Missouri, and Utah rank in the bottom third of all U.S. states by share of the population that’s fully vaccinated. There’s no reason to think we won’t experience a surge in cases here among the unvaccinated just like the UK is experiencing.

But will we experience a surge in deaths? Here’s the trend in Britain:

Deaths are increasing there too, from 66 last week to 101 this week, but the daily average is down by something like 99 percent from the country’s winter peak. There’s no mystery why: Most older people are vaccinated now so the surge of cases is happening among younger healthier adults who are more likely to survive their bouts with COVID, even if they need to visit the ER at some point for treatment. We’ll never see a big spike in deaths again here, in all likelihood, barring the emergence of the variant from hell. But we may yet see deaths start ticking up again, especially now that we seem to have leveled off at around 300 per day as B.1.617 spreads. Like Walensky says, nearly all of those deaths were preventable. It’s a simple matter of making the choice to protect oneself.