Students walk across N.C. State’s campus. Photo by Jade Wilson. 

Those watching the numbers knew it was going to be a bad week.

After months of keeping the spread of COVID-19 mostly at bay through an aggressive vaccination campaign, restrictions eased this summer just as a new threat emerged: an even more contagious strain of the virus known as the Delta variant. 

New cases of the virus and hospitalizations—nearly all among the 40 percent of North Carolinians who remain unvaccinated—began to uptick, at first moving slowly from the low hundreds to just over a thousand by mid-July. Then, just from Monday to Tuesday last week, the number of cases doubled—to more than 3,000. By Friday, 10 percent of COVID-19 tests were coming back positive, the worst rate since February. 

Dr. Cameron Wolfe, an infectious disease specialist at Duke Hospital, expects the number of cases to only increase more in the coming weeks.

“It is baked into the system that that number is going to go up for at least a couple of weeks … all of those people who were exposed yesterday for example are not likely to get sick for a couple of days,” Wolfe said during a media briefing last week. “With the Delta variant, the timeline is condensed a little bit. You’re in fact more infectious more quickly with this, so we’re seeing a hospitalization impact more quickly.”

What we can’t know yet is how bad things could get, or how quickly. While the Centers for Disease Control and Prevention updated its guidance last week to urge even the vaccinated to wear masks indoors to prevent the spread of the virus,

Governor Roy Cooper has yet to reinstate any restrictions locally. Cooper did announce Thursday that state employees would be required to receive the vaccine and urged other employers to follow suit. And some local governments, such as Wake County and the Cities of Raleigh and Durham, have required masks in public buildings once again. But with no current mask mandate at the state level, and all gathering restrictions lifted, counties throughout North Carolina have seen a surge in cases.

Schewel said he will meet this week with public health officials and scientists at Duke Health to discuss Durham’s response to the variant.

“Just a month ago, we had less than five cases per day,” Schewel wrote in a text message. “Now we are up to 40 cases a day. This is a very serious increase, and we have to respond accordingly.”

Mandy Cohen, North Carolina’s Secretary of Health and Human Services, echoed Schewel’s concerns more broadly.

“Our trends are accelerating at an alarmingly fast rate and the highest rates of viral spread are happening in areas with low vaccination rates and among those who are not fully vaccinated,” Cohen said.

The state has administered almost 10 million doses of the vaccine and as of Friday, 57 percent of adults are fully vaccinated and 61 percent have received their first dose. The problem has been convincing the remaining population to get the shot.

According to Wolfe, oftentimes the state’s anti-vaxxers don’t change their minds until they end up on a hospital gurney.

“It does change people’s opinion. There’s no question about that,” Wolfe said. “There’s nothing fun about being hypoxic in a hospital. It’s an awful situation to face.”

A series of million-dollar government-sponsored lottery drawings barely moved the needle. While vaccinations surged in April after becoming available to the general population, the rate began to bottom out in late May and has continued to decline. Fewer than 100,000 new doses are now being administered per week.

As evidenced by the uptick in cases, the current vaccination rate isn’t fast enough to curb the spread of the Delta variant, which is not only more contagious but also has been shown to make people sicker faster, and sometimes more severely, Wolfe says. 

Part of the reason is that viruses mutate each time they are transmitted from person to person, says Duke Professor David Montefiori, who leads the Laboratory for AIDS Vaccine Research and Development. This means the longer the pandemic rages on, the more new strains are likely to emerge.

“The more we can shut this pandemic down and slow down the spread of the virus, the less opportunities it’s going to have to mutate and change and become more contagious,” Montefiori said. “The mutation rate is dependent on the transmission rate, how many times the virus has transmitted from one person to another [and] how long it’s been continuing to replicate in the human population. That’s what drives mutations and allows the accumulation of multiple mutations to occur.”

Although the Delta variant is evolving quickly, vaccines are still effective against it. Booster shots will likely be necessary for the future to strengthen immunity to new and emerging variants. 

If vaccination rates don’t increase, the Triangle, especially, could be in for a surge next month when students from Duke, UNC-Chapel Hill, and North Carolina State University return from summer vacation. Last year, in-person classes were abruptly canceled and moved online after outbreaks were reported within days of students’ return to campus. While Duke is requiring all staff, students, and faculty members to be vaccinated, the UNC System schools will not, instead relying on once-a-week testing and students’ self-reporting their vaccination status. 

The endgame is simple: either increase the rate of vaccination or wait for herd immunity—which won’t occur without significant fatalities. For Cohen, the latter is not an option.

“There is only one way out of this pandemic and that is vaccination,” Cohen said. “If you are already vaccinated, I call on you to urge your unvaccinated family and friends to get their shot now. It is not an understatement to say that you will save lives by doing so.” 

Support independent local journalism. Join the INDY Press Club to help us keep fearless watchdog reporting and essential arts and culture coverage viable in the Triangle. 

Follow Senior Staff Writer Leigh Tauss on Twitter or send an email to