By Debbie Koenig
If it seems to you like the number of new cases of COVID-19 is speeding up, you’re right. Not long ago, things were slowing down -- while it took just over 2 weeks to get from 4 million to 5 million confirmed U.S. cases over the summer, the climb from 6 million to 7 million took most of September. But recently, the trend has reversed:
- In only 6 days last week, we leapt from 10 million to 11 million cases.
- The daily count of new cases has increased 77% from the average 2 weeks ago. We’re now adding around 160,000 confirmed cases every day.
- In almost every state, the transmission rate is on the rise.
- Hospitals in multiple states are straining to keep up with the caseload.
- The CDC forecasts that we’ll continue to see around a million new cases each week for the next month, and as many as 16,000 weekly deaths.
“We’re seeing exponential spread,” says Celine Gounder, MD, an infectious disease specialist at the NYU Grossman School of Medicine. “The full brunt of what’s brewing now still hasn’t hit hospitals, because there’s a delay from the time somebody is infected until they get sick enough to go to the hospital. The next couple weeks will be really bad in terms of what’s already been transmitted.”
National Problem, Local Responses
Without a federal response in the early days of the pandemic, state and local governments issued a patchwork of restrictions across the country. Many places have already rolled back the strictest of them. Unsurprisingly, states that have taken the fewest steps to contain the spread, like North Dakota, South Dakota, and Iowa, are now seeing the worst outbreaks. Eight months into the pandemic, the governors of North Dakota, Iowa, and Utah recently issued their first mask mandates.
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Even in areas that had a full lockdown in the spring, now that the weather has cooled and people are spending more time spent indoors, the virus is surging again. After the positivity rate hit 3% on Nov. 18, New York City closed down all its schools. With cases on the rise there, Rhode Island’s governor just announced a 2-week “pause” starting Nov. 30. Colleges and universities, offices, bars, recreational venues, and indoor sports facilities will all close completely, and other indoor activities will be severely limited.
Those restrictions follow the latest science. For instance, one recent study analyzed cellphone data for 98 million Americans. It found that indoor spaces where people tend to linger in larger numbers (like bars and recreational venues) present the highest risk.
“This really is an all-hands-on-deck situation,” said David Dowdy, MD, of the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, during a webcast on reversing the trends. “It’s important for us to come together as a country and figure out how we can reallocate resources from those places that have a slightly lower burden to those that are completely maxed out.”
Pandemic Fatigue and ‘Compassion Fade’
With confusing and even conflicting guidance coming from various levels of government, deciding whether to stay home or go out, or when to wear a mask, can be overwhelming.
“Pandemic fatigue is playing a big role,” says Syra Madad, DHSc, senior director of the System-wide Special Pathogens Program at New York City Health + Hospitals. “People are letting down their guard, mingling without masks. We’re seeing explosive growth from small gatherings. And people are angry at so many things. They're angry that we are in this pandemic, they’re angry that it's gotten this bad, they're angry that some states are not doing their part in helping prevent the spread of COVID-19.”
After so many months of dreary headlines, many of us are also having what Madad calls “compassion fade.” “People are becoming numb to what’s happening every day. They feel helpless, like there’s nothing they can do, so they just go with the flow,” she says.
“Never a Bad Time to Start Doing What Works”
With the potential for two effective vaccines on the horizon, it may be tempting to sit back and wait for herd immunity to save us. But we’re still months away from that point -- current estimates are that the vaccines won’t be widely available before April 2021. That’s more than 18 weeks away, which could mean another 18 million or more confirmed cases. And before the vaccines, we’ve got to get through the holidays as well as more time indoors thanks to winter weather.
Experts estimate that right now, we have more than 3 million active and infectious cases in the U.S. Because COVID takes time to progress from infection to serious illness, there’s no way to stop the rise in hospitalizations and deaths headed our way in the next 2 to 6 weeks. “Thanksgiving could be a superspreader event, and it could exacerbate what is already widespread community transmission,” says Gounder. “We already know we’ll see a big surge hitting hospitals soon, and then you’re going to have another surge on top of that. I’m very concerned about the health system’s capacity to absorb all that.”
But we can still stop the virus from spreading further. A concept known as the “Swiss cheese strategy” seems to work, says Madad. Picture each measure you can take -- wearing a mask, social distancing, hand-washing, staying home if you’re sick, and so on -- as a slice of Swiss cheese. Each one has holes, but when you stack them together, they form a solid block. “No one layer is 100%, but if you add additional layers, it reduces the risk,” she explains. “Picture a tiny little mouse eating away at the layers -- that’s disinformation and misinformation. If you believe it, you’re increasing your risk.”
The point, Madad stresses, is that every measure each of us takes brings us a step closer to where we want to be -- stopping the spread of the virus.
“There’s never a bad time to start doing what works,” she says. “We can start today.”
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