The D.C. region is rounding the corner on another pandemic fall season.

While life looks different now — schools have welcomed back students en masse, restaurants are seating diners at full capacity, and 60% of the region’s population is fully vaccinated — the delta variant has driven local COVID-19 case counts well beyond the levels recorded in fall 2020, back when entire industries remained shut down and vaccines were wishful thinking.

Across D.C., Maryland, and Virginia, the average number of daily new cases surpassed 5,000 in recent days, compared to roughly 1,500 average daily cases this time last year. The number of people dying or falling seriously ill with the virus also steadily increased this month; on Wednesday, 68 people in the three jurisdictions died of the virus. One year ago, the daily death count was 51.

And while the region’s daily death count and hospitalization levels remain below the numbers recorded during the devastating winter surge, an influx of patients — a majority of them unvaccinated — has overwhelmed hospitals.

“What we’re seeing is the shadow of the things that we were doing three weeks ago,” says Neil J. Sehgal, a public health professor at the University of Maryland. “We had a return to school, we had a return to universities, a return to work for people.”

Despite the current surge in cases driven by the delta variant, public health experts believe the D.C. region could turn a corner this fall and sustain a decline in cases through the colder months.

But there are a few necessary factors that would make that scenario a reality: With colder weather pushing social engagement indoors and holiday travel opening opportunities for exposure, Sehgal and other public health experts say the key to seeing a sustained decline in infections — and avoiding another wave — is moving the dial on the vaccination rate for adults in the D.C. area and expanding vaccination eligibility to young children.

As of Sept. 23, 81.3% of adults in D.C. are at least partially vaccinated, and in Maryland, 83% of the adult population is partially vaccinated. In Virginia, 79.8% of adults have at least one dose. (The commonwealth is reporting the highest average of daily new cases per 100,000 residents out of all jurisdictions.) Each jurisdiction boasts a higher partial vaccination rate for adults than the national average of 76.7%.

The relatively high vaccination rate compared to other parts of the U.S. is a small piece of good news, according to Anne Monroe, an associate research professor at George Washington University’s Milken Institute School of Public Health. Vaccines have prevented an even greater surge of death and serious illness — but the unvaccinated 40% of the population remains a threat to the pandemic’s trajectory.

“Hopefully with the large number of people who’ve already been infected, and a large number of people who are vaccinated, that if there is a surge [this winter,] it would not have the magnitude of last year’s,” Monroe says.

Both Monroe and Sehgal suggest that vaccine mandates are one way to move the needle on the stagnating vaccination numbers for eligible adults. The percentage of D.C.’s vaccinated workforce rose by 16% after Mayor Muriel Bowser announced a mandate, and earlier this week, she announced a new mandate for all school staff and childcare workers — with no option of testing out. 

Sehgal says that expanding vaccine requirements beyond places of employment to businesses like bars and restaurants, or events like sporting games, could be a nudge for anyone on the fence — especially if these requirements were enacted and enforced on a national scale.

“I sound like a heavy-handed public health guy, but mandates work,” Sehgal says. “One way to increase the number of people who are vaccinated is to require vaccines in more places.”

The effort to vaccinate teens — and to expand eligibility to kids below 12 — will be another crucial element of controlling spread this fall, according to experts. In Maryland, 70% of residents ages 12-17 have received at least one dose of the vaccine. In Virginia, 62.6% of kids ages 12-15 have received at least one dose, and 68.7% of teens ages 16-17 are at least partially vaccinated. In D.C., 57% of 12-15 year-olds are at least partially vaccinated, and 55.5% of 16-17 year olds are at least partially vaccinated.

Still, kids are getting sick. Montgomery County recently reported that roughly 30% of its new infections over the past month were in individuals 19 and younger, and earlier this month, Children’s National Hospital in D.C. reported an all-time peak in the number of children coming in with COVID-19.

On Monday, Pfizer announced that its vaccine was safe for use and produced a “robust” immune response in children ages 5-11, but the federal Food and Drug Administration will need to approve the data and authorize use of the vaccine. The FDA is expected to begin vetting and reviewing the data in the coming weeks. But Monroe says vaccine eligibility for younger children is just one step towards achieving a higher vaccination percentage in the region — it will ultimately come down to the rate at which they get their shots.

“The first big question in my mind is: How are we going to do with vaccinating kids ages five to 12?” Monroe says. “The more young kids get vaccinated, the better the case numbers look, but I don’t think that’s a sure thing.”

Monroe pointed to equity as an issue that may persist into the younger age groups’ vaccination campaign. Since vaccines became available to residents under 18, D.C. has reported the same gaps along racial and geographic lines as it did during the rollout for older individuals. In predominantly Black wards 7 and 8, 21% and 17% of children ages 17 and younger have received a vaccine, respectively, compared to 74% in Ward 2, and 66% in Ward 3.

“I would still love to see better vaccine uptake, more equitable vaccine uptake,” Monroe says. “I think if we can really get good uptake of the vaccine among these younger kids when it becomes available, that’s certainly going to help us get our case numbers lower as we move through the fall and winter.”

Even in Seghal’s best-case scenario, he predicts a number of outbreaks will occur this fall, many linked to K-12 schools, college campuses, or holiday gatherings.

But if more of the population is vaccinated, these outbreaks won’t result in a sustained increase in cases, or a significant increase in deaths and serious illness, he says. A higher number of vaccinated residents also decreases the likelihood of another, more contagious variant.

“The less transmission we have going on in the community, the less chance there is that we’ll have new variants,” says Monroe. “So, certainly, again, the message is just vaccinate, vaccinate, vaccinate.”

This story was updated to include the most recent vaccination rates for children under 18 in D.C.