The pace of new Covid-19 infections is accelerating at exactly the wrong moment in the United States, Europe, and elsewhere, alarming scientists who envision a winter of coronavirus carnage — physical, mental, and economic — unlike anything we’ve seen so far.
In America, daily new infections are surging, which could lead to an inevitable peak that will exceed the highs seen in the spring and summer, all exacerbated by the effects of colder weather.
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“We face rapidly accelerating increase in Covid-19 cases across much of Europe, the USA, and many other countries across the world,” according to an October 14 open letter published in The Lancet journal and signed initially by about 80 of the top infectious-disease experts in the United States and around the world, and hundreds more since. “It is critical to act decisively and urgently.”
Most frustrating for infectious-disease experts: It all could have been prevented. “We should have had this virus under control already,” says Michael Mina, MD, an assistant professor of epidemiology at Harvard T.H. Chan School of Public Health. “We have spectacularly continued to squander any effort in the time that we’ve had.”
“The great concern here is that we are once again at the tipping point of exponential growth of Covid-19 in the U.S. and this time coinciding with the predictable return of the flu season.”
Given that the coronavirus is airborne, scientists stress that every individual effort at mask-wearing and distancing helps keep the pandemic from getting even worse. But they say the outlook is grim for health and the economy if governments don’t quickly launch strong, well-funded efforts to control community spread.
Here are 10 signs Covid-19 is nearing a dire tipping point:
1. There’s a vast reservoir of infected people
Mina likens the current situation to fighting forest fires.
This spring, many states chose to lockdown even when there were only a few embers poised to flare up on the perimeters — in New York City and a handful of other cities. Now, with all states engulfed in outbreaks and documented new cases exceeding 50,000 each day and rising, there are sparks strewn throughout the entire forest, all ready to ignite.
“We’re likely to see massive explosions of cases and outbreaks that could potentially make what we’ve seen so far look like it hasn’t been that much,” Mina told a group of reporters recently. Other experts agree.
Epidemiologists worry when the rate of new infections ratchets up from linear to exponential, doubling every few days instead of every few weeks, explains Mark Cameron, PhD, an immunologist and medical researcher in the School of Medicine at Case Western Reserve University in Ohio.
That’s what happened in the spring and fall, with those tipping points leading to uncontrolled spread and new highs.
“The great concern here is that we are once again at the tipping point of exponential growth of Covid-19 in the U.S., this time starting from an infection level above our April peak, and this time coinciding with the predictable return of the flu season,” Cameron tells Elemental. “Not good.”
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2. The viral high season has just begun.
The high number of cases could not come at a worse time, with schools restarting, restaurants and bars reopening, and cooler weather forcing people indoors and potentially making the coronavirus itself more virulent. Scientists don’t know exactly what effect colder weather will have on the virus itself, but none expect it to calm down. “I think we are in a dangerous place,” Caitlin Rivers, an epidemiologist at Johns Hopkins University, told The New York Times.
3. Young people are being infected at unprecedented rates.
In the early stages, the pandemic swept through nursing homes and infected a disproportionate number of older people.
But since Memorial Day, the number of infections in young adults has soared, and now with in-person classes resuming, children are being infected more than ever — we don’t really know how many, because they often don’t have symptoms, but we do know they’re able to spread what they’ve caught.
Because younger people are less likely to die from Covid-19, the rate of deaths per infection has fallen (improved treatment has also helped lower the death rate). But that masks the fact that more than 700 Americans are dying from Covid every day — a plateau that has held steady for several weeks. Meantime, hospitalizations have already started to tick back up, and Covid-19 deaths were rising in 23 states as of October 16.
4. There are far more infections than we know.
While the official count of new daily infections is in the tens of thousands, the real count is in the hundreds of thousands, Mina says. Many of those who are infected do not know it and may never know, given a lack of symptoms or only mild symptoms.
A handful of these people create superspreading events like what occurred at the White House. Expect more of these if people don’t avoid crowds, maintain physical distance, and wear masks.
Everyone needs a break from all the social separation, sure.
But traveling to large family gatherings is a surefire way to worsen the pandemic, scientists say.
5. Everyone’s fed up.
Covid fatigue is widespread, fueled by sadness, stress, isolation, constant vigilance, and conflicting messages from political leaders that run counter to scientific advice. We all run the risk of letting our guard down, psychologists say.
“This has been so emotionally taxing, and we can only take so much,” says Neda Gould, PhD, a clinical psychologist and assistant professor of psychiatry at Johns Hopkins Medicine. “People are feeling exhausted and burned-out from having to do certain things a certain way, and then not do so many things.”
Scientists fear some people might stop masking up or give in to the temptation of large or even small gatherings. The coronavirus will take full advantage of any lapse, they warn.
6. The holidays will only make it worse.
Everyone needs a break from all the social separation, sure. But traveling to large family gatherings is a surefire way to worsen the pandemic, scientists say.
Already, “small household gatherings” are contributing to the rising rate of infections, Robert Redfield, director of the U.S. Centers for Disease Control and Prevention, said on a call with governors October 13.
“This does not surprise me given people’s Covid-19 fatigue,” says Krutika Kuppalli, MD, a clinical professor of infectious diseases at Stanford University School of Medicine. “And it makes me increasingly concerned as we head into the holiday season with Thanksgiving, Christmas, Hanukkah, and other religious festivals that we will see more small gatherings leading to an increase of cases.”
7. The people who are most likely to spread the virus are least able to stay home.
Those most affected by the pandemic are overrepresented in crucial jobs like frontline health care, transportation, and the service industry, and many of them don’t have the privilege of working from home to stay safe and help avoid spread.
This has been a problem throughout the pandemic, but with restaurants and other businesses opening back up, and schools restarting, the risk of exposure for everyone grows. Recently, it was revealed that 123 frontline workers on Capitol Hill, including police and contractors, have tested positive for Covid-19.
8. A widespread vaccine is at least months away.
Even if a safe vaccine is cleared for production tomorrow (which nobody expects), it will be months before most people have access to it. Maybe April, says Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
But given the politicization of the effort and the breakneck speed of development, we might end up with multiple vaccines and people won’t know which one works best — some may not work well. Expect lots of confusion as scientists and politicians wrangle over who gets the first doses. Meanwhile, an increasing number of Americans say they’re unwilling to get the vaccine, according to the latest Gallup Poll.
Regardless, even a wildly successful vaccine won’t dent the pandemic in 2020.
“We need to have a national plan to get control of this virus. It’s not out of our reach. And this is why I’m so frustrated at the federal response.”
9. We’re nowhere near natural “herd immunity”
From early on in the pandemic, a handful of scientists and politicians have proposed we let the coronavirus run wild, eventually creating natural “herd immunity,” whereby enough people will have been infected and presumably protected that the virus finds few new hosts and dies out.
The latest version, the so-called Great Barrington Declaration, has been promoted within the White House by three scientists who claim the virus is not that deadly. They suggest protecting only the most vulnerable people and letting the virus run its course among younger people and others.
“This is a dangerous fallacy unsupported by scientific evidence,” the infectious-disease experts argue in The Lancet letter. “Uncontrolled transmission in younger people risks significant morbidity and mortality across the whole population. In addition to the human cost, this would impact the workforce as a whole and overwhelm the ability of health-care systems to provide acute and routine care.”
Somewhere between 40% to 70% of a population would have to be infected to see a significant impact of natural herd immunity, infectious-disease experts say. In the United States, some 10% or fewer have caught Covid-19 so far.
Achieving natural herd immunity here would cause at least 1 million deaths, the scientists say.
10. The economy is being prioritized over health.
Scientists are well aware that lockdowns are economically painful. They argue, however, that the economy can’t be healthy if the people aren’t healthy.
“We need to have a national plan to get control of this virus,” Mina says. “It’s not out of our reach. And this is why I’m so frustrated at the federal response.” Full-on lockdowns may become inevitable if hospitals fill up, but he says we don’t need to get to that point. “We have the tools, and the wherewithal, and the ability, if we actually worked as one.”
Imagine, Mina muses, if the president were to change his tone and say the following: ”My fellow Americans, today we’re turning over a new leaf. We are going to take control of this virus. All we have to do is everyone wear a mask, and everyone social distance as much as possible within reason. But wear a mask, and be responsible.”
“Those few words coming from this president, combined with all of the people who are doing that already, could really make all the difference in the world to our ability to control this virus,” Mina says. “And then we could safely open the economy.”
