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COVID-19 infection rates are down. COVID-19 vaccination rates are up. Employers are plotting ways to bring workers back to the office, and educators are undergoing similar planning for schools this fall.

Yes, this is very good news. The national vaccination effort continues getting jabs into arms, and Americans are seeing the positive results. As masks come off and crowds gather again at sporting events, music performances and the like, one Duke expert says there’s still work to do to keep the data trending in the right direction.

Mark McClellan, MD, the former commissioner of the federal Food and Drug Administration and current head of the Duke-Margolis Center for Health Policy, said Wednesday efforts now shift to finding those who are not yet vaccinated and provide the necessary resources for them to make an informed decision.

McClellan took questions from reporters during a virtual media briefing. (Watch on )

Here are excerpts:

On whether reopening is too fast

“We don’t yet have very, very high rates of vaccinations. We’re still having lots of COVID cases and hospitalizations, and deaths every day. On the other hand, the numbers continue to get better and better, especially as we head into summer. So what we saw, especially after the CDC relaxed its mask mandate, was not an increase in cases, but rather a bump-up in the number of people getting vaccinated.”

“And that, along with the other trends we’re seeing – people getting out more, spending less time close together, and for the most part still paying close attention to social distancing and other steps that have helped to contain the pandemic, have led to the case numbers continuing to decline.”

“I do have some concerns that if we don’t keep vaccinating well over a million people a day … if we see more variants emerge, if we see outbreaks occur in some places that have lower vaccination rates – and the rates are varying a lot now in places across the country -- that could lead to some additional outbreaks. But so far the overall numbers are continuing to trend down. It’s a reminder that when people see there are consequences to getting vaccinated – like being able to do what they want to do with more confidence, and being more confident they aren’t going to spread infections, like getting back to travel and spending time with others, that’s added a boost to our vaccination rates. That in turn is helping to keep the decline in cases continuing for now at least.”

On ways to get back to in-person work effectively

“Coming back to the office is going to be coming back to a different office. We’re seeing most employers re-thinking how often people need to be back in the office.”

“Continuing testing. We have tests available now, very conveniently, that can be done quickly. There have been some concerns about those tests, called antigen tests, that they don’t pick up every case. That’s less critical now because we are seeing fewer cases and less transmission.”

“We’ve also seen changes in office design with more spacing. Very importantly, a recognition that air flow and air cleaning are critical steps, not just for preventing further cases of COVID if COVID is circulating, but also changing our expectations about if you’re going to get the flu or some other respiratory infection if you come into the office.”

“On top of that, the most important thing about preventing spread is getting the rates down in your community. As a result of all the vaccinations, all the people in the U.S. who have developed immunity – at least for now because they were infected -- the number of cases in the U.S. have fallen to the lowest levels we’ve seen since we started tracking nationally last spring. Well under 10 cases per 100,000 people. Those very low rates of cases, that makes it much more safe and secure to reopen workplaces.”

On the current situation in North Carolina

“North Carolina, we’re now at a point where about half adults, maybe more, have gotten at least one shot. We also have a number of people who have recovered from COVID and for now at least are immune, though the vaccine immunity seems to last much longer and work better than the typical immunity from infection.”

“Overall we’re seeing the trends in N.C. look like the trends in most of the rest of the United States. Continued downward trend in cases, downward trend in hospitalizations. If we really want to continue those trends though, the best way to do it is to continue the activities to get vaccinations to people. There are a lot of North Carolinians who say they want to get vaccinated but haven’t been able to do it yet.”

“We need to keep up those efforts.”

On what could still go wrong?

“In the short term, the most important thing to watch is the vaccination numbers. Are those continuing to rise, or does it look like we’re really hitting a plateau? Part of the reason cases are going down now is because we’re vaccinating more people (and) there are fewer and fewer places for the virus to go.”

“As you’ve seen around the country and around the world, with so many cases of COVID still happening in huge outbreaks outside the United States … we’re seeing more concerning variants emerge. Fortunately, none of these that have been tracked … are very resistant to the vaccines. The vaccines still work. But they are easier to transmit and some of them may cause more serious consequences.”

“As we go forward, more people coming back to the office, more people doing travel, more people maybe going back to the way they were before, it’ll be important to watch the case trends. If they start to go up … that is a cause for concern especially as we head into the fall and winter when more people may be back, closer together, spending more time indoors.”

On whether loosening of restrictions was too early

“Is it leading to a worsening of trends in the pandemic? The answer so far seems to be no. We’re still seeing cases declining.”

“What all the evidence tells us … is that life is much safer if you’ve been vaccinated. This is a reflection of that. The people who the CDC made clear should have concerns are especially those who haven’t been vaccinated.”

“If you have symptoms and you haven’t been vaccinated – especially if you have some risks  of bad outcomes from COVID – you can get access to a treatment called monoclonal antibodies that has been proven to be very effective when given early. It’s a drug that needs to be infused within a few days, ideally, of when you get infected.”

On whether people should still wear masks

“It is pretty easy to do, especially in indoor settings. I think what the governor found though, when he made his announcement he pointed out he’s trying to follow the public health expert guidance. That guidance has evolved as we’ve learned more about the virus. What we didn’t know three or four months ago is when you get vaccinated, not only do you have a very low risk of having a serious complication from COVID – hospitalization or worse -- you’re also much, much less likely to get infected, let alone transmit COVID to someone around you. It was that public health evidence that was behind the changes in guidance. And so far, that’s playing out in the number of cases continuing to decline even after this change.”

On what happens if infections spike again

“I don’t think we’re ever going to go back to any kind of broad lockdown unless something really different happens with the pandemic. The biggest concerns out there for the long term are, number 1, more people getting vaccinated with effective vaccines, and 2, making sure that’s happening everywhere and not just in the United States.”

“Short of that, we now have an opportunity to really get on top of any new outbreaks that occur. They’d probably happen in communities or places within a community with fewer people vaccinated. If you look at the hospitalizations and deaths happening now, the vast majority are among people who are unvaccinated. Very, very low rates among people who are vaccinated.”

On in-person schools this fall, even for kids too young for vaccines

“I think and I hope all kids can get back to school this fall. It’s such a better learning environment and we know how to make it safe. Even before we had widespread availability of vaccines, we were seeing in schools that were following good protocols – some distancing and some use of masks – we saw very low rates of infection occurring.”

“Most if not all teachers in a school will be vaccinated. All the adult staff there. A lot of the adolescent children in older grades will be vaccinated. Because of all of this, the case rates in our communities will be much, much lower.”

Meet the expert:

Mark McClellan, M.D.
, M.D., is a medical economist who directs the , where he works on strategies and policy reform to improve health care. He was commissioner of the U.S. Food and Drug Administration and administrator of the Centers for Medicare & Medicaid Services. McClellan serves on the boards of Johnson & Johnson and Cigna (each company is involved in aspects of the COVID-19 response).