Close to 10 million Americans have been diagnosed with Covid-19 in the past 10 months, and with the start of winter just a month away, and the public increasingly likely to spend more time cooped up inside, the virus shows few signs of slowing down.
Infections are setting sequential daily records and expected to soar further as cold weather grips northern US states, schools and businesses try to reopen, people move their daily activities inside and the holidays spur gatherings, health officials and experts said.
As of Sunday afternoon in New York, the U.S. had recorded 9.87 million infections since the start of the pandemic, accounting for roughly a fifth of the nearly 50 million cases world-wide.
While Democrat Joe Biden’s election victory is likely to lead to more aggressive steps to contain the virus from Washington policy makers, any changes will take time to have a noticeable effect on transmission levels after he is sworn in as president in January.
In the meantime, the virus is already blowing past the few speed bumps in its way. Vaccines that could make a difference are still in development, with no word yet on how many infections they may be able to thwart. And while a few medicines can help the hospitalized or severely ill, they don’t slow the spread of the virus.
“Our saving grace this summer was that we could be outside,” said Gregg Gonsalves, an epidemiologist at Yale School of Public Health and co-director of the Global Health Justice Partnership. “We have no respite this winter in large parts of the country. It’s going to be bad.”
From the very beginning of the coronavirus outbreak in the U.S., public health officials warned about an expected rising tide of cases during the Covid-19 pandemic’s first full winter. Governments urged individuals to embrace a handful of measures that could help dampen the danger.
Yet with limited national leadership on measures such as testing, masks and contact tracing, state and local governments have been left to corral the virus. After months of curtailed socializing and entertainment, fatigue has set in, making it even harder to follow through with the few existing protective measures.
Little Change Expected
Now, the skyrocketing rates mean that whoever is president three months from now may face continued record cases and the U.S. leading the world in infections and deaths, despite President Donald Trump’s campaign claims of the outbreak “rounding the corner.”
Even an aggressive campaign of testing, tracing and mask-wearing — as Biden has pledged to implement — may take weeks if not months to yield results, and could face continued political opposition. Meanwhile, little is expected to change before the Jan. 20 Inauguration day.
“We could have prepared for the winter in a much better way than we did,” Gonsalves said. “Now we are facing a tsunami of virus over the next few months. If I’m the virus, I’m looking for hosts, and we have plenty of them in the United States.”
The looming holiday season is also likely to worsen the situation, said Carrie Horn, chief medical officer at National Jewish Health, an academic medical center and respiratory hospital based in Denver.
“Most holiday events revolve around food, so you aren’t masking up,” she said. “Even if people do wear masks, they have to take them off to eat.”
The sheer number of infected people underscores how much more dangerous this winter will be, she said. When just one in 50 people were infected, small gatherings were less likely to include someone who might have been unknowingly infected. Lowering that to about one in 20 people significantly raises the risk, she said.
“As cases go up on a daily basis, you need fewer and fewer people to get together to have that transmission risk,” she said. “The other thing is that we are at a time when people are getting together more, and people are doing it indoors.”
State governors are using a combination of cajoling and threats to get a handle on rising infections. In Rhode Island, Democratic Governor Gina Raimondo put in place restrictions that include a voluntary stay-at-home order from 10 p.m. to 5 a.m. on weeknights after the state hit a record this week.
Take Medicine Later
“We have to take our medicine,” Raimondo said. “If we wait and try to outrun the virus, and take the medicine later, it’s going to be much harder.”
Further increases in cases might lead to “a shutdown order and that would be brutal,” she said.
Experts’ mathematical models project an unmerciful winter ahead. The Institute for Health Metrics and Evaluation at the University of Washington estimates that 372,030 Americans will have died by Inauguration day in the U.S. That number would be 50,000 lower if everyone in the country wore a mask, and 71,000 higher if the current mandates are relaxed further.
With more than 237,000 Americans dying from Covid-19 so far in 2020, the novel pathogen is already firmly entrenched as the U.S.’s third-leading cause of death, following heart disease and cancer, according to the Center for Disease Control and Prevention
Early in the outbreak, medical facilities that were overwhelmed could move patients to neighboring hospitals with more room. Now that the virus has hit every county in the country, including many rural areas with few hospital beds, options are limited.
“The challenge will be to keep those cases from falling on vulnerable people and putting our hospitals into crisis,” said Amesh Adalja, a senior scholar at Johns Hopkins Center for Health Security in Baltimore.
Hospitals may have to cut back on elective procedures again this winter, while others have likely started doing it on an informal basis already, he said. Areas that are hard-hit, like the Dakotas and El Paso, may not have other options.
It’s important for individuals to know that they do hold power in this outbreak, even if the steps needed to break it may be hard to follow after months of limiting social connections, Adalja said. Families may want to consider including high-risk relatives in their Thanksgiving plans via Zoom, and could get outside for a friendly game of football instead of watching one on television, Horn said.
If Americans don’t embrace safety changes, the virus may push the envelope of severity, Adalja said.
“It could slow down at any period of people change their behavior,” he said, “because it’s behavior that is influencing the cases.”
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