In a long time, the most hopeful pandemic news came last week when Pfizer announced that its experimental COVID-19 vaccine appeared to be 90% effective at preventing infection.
The vaccine still needs further testing and outside review, in part to be more certain about safety. Still, the prevailing assumption has been that a COVID-19 vaccine would be a lot like the flu shot, which in most years is effective around half the time. If Pfizer’s vaccine and similar ones in development come even close to hitting 90%, the U.S. could be months away from getting the pandemic under control.
But months away is still … months away. And right now, the COVID-19 situation in the U.S. is as bleak as it’s been since the pandemic’s start. The case total is above 10 million. The death tally is approaching 250,000. And both numbers are climbing at an accelerating rate ― just as cold weather is pushing people indoors, where the virus spreads most efficiently, and the upcoming Thanksgiving holiday promises both more travel and large indoor gatherings.
It doesn’t have to be this way. We know a lot more about preventing the spread of COVID-19 than we did in the spring, just as we know a lot more about how to treat those who have it. And the two go hand in hand. The health care system can save many more people as long as it has the time and the resources, which depend on containing the spread, so providers don’t become overwhelmed.
But knowledge alone is not enough. Containing COVID-19 requires both collective will and political leadership, neither of which is in great supply right now ― the former because the entire country is so understandably tired of living this way, the latter because Donald Trump will still be president until Jan. 20. Many of his allies will remain in power afterward.
The Upper Midwest Is Now The Nation’s Worst Hot Spot
The part of the country’s hardest-hit right now is the Upper Midwest, where several governors have resisted taking the kind of aggressive public health action their counterparts in other parts of the country did.
Two Republican governors stand out in this regard; from the earliest stages of the pandemic, Govs. Kristi Noem of South Dakota and Kim Reynolds of Iowa ignored calls to require masks or limit public activity more strictly because their states’ wide-open spaces and spirit of rugged individualism dictated a different approach.
“South Dakota is not New York City,” Noem said in April.
The bit about the virus not spreading in airy, wide-open spaces at least had some scientific plausibility to it. And if every single person in Iowa and South Dakota were doing nothing all day but driving tractors, fishing, or skipping across the prairie, then stricter rules truly wouldn’t have made sense. But even in the Great Plains, people gather indoors sometimes ― at churches and on college campuses, not to mention in meatpacking plants and prisons.
Then, there was the motorcycle rally in Sturgis, South Dakota, which drew nearly half a million bikers from across the country in August. The bikers spent a lot of time outdoors, where perhaps the risk was low. They also spent a lot of time packed into bars, where the risk was almost certainly high. Mask wearing was sporadic. Experts agreed that the event likely led to thousands of cases, if not tens or even hundreds of thousands, as bikers returned home.
This really is the worst it’s been in our hospitals.
Dan Diekema, infectious disease division at the University of Iowa
South Dakota’s big surge started shortly after the rally, whether it was because of Sturgis or some other combination of factors. But Noem, who had used her August speech at the Republican National Convention to brag about her state’s defiance of public health experts, insisted the numbers were misleading even as the numbers climbed. “We’re doing really good,” she said, citing among other things the state’s low rates of hospitalization and death.
Epidemiologists predicted it was only a matter of time before hospitalizations and deaths spiked, too. They were right. The state’s current death rate, 165 per 100,000 residents, is among the country’s highest. On Saturday, the state reported 53 new deaths, a new record. The test positivity rate is sitting at an eye-popping 60%, which could mean there’s even more spread in the community, while hospital administrators struggle to find staffed beds for new patients.
Reynolds spurned calls in Iowa, including some from the White House’s own coronavirus task force ― to limit indoor bar and restaurant service more aggressively. In the last few days, Reynolds has relented a bit by issuing a limited mask order and urging residents to be vigilant by social distancing and avoiding activities that seem risky. But the mask order applies only to large gatherings and businesses such as barbershops.
“You can still go to a movie and work out at the gym — and in many states, you can’t do that,” Reynolds said in announcing the new measures. “Iowa is open for business, and we intend to keep it that way.”
Meanwhile, the state’s health care infrastructure is buckling, much as South Dakota’s is. “This really is the worst it’s been in our hospitals,” Daniel Diekema, director of the division of infectious diseases at the University of Iowa, told HuffPost this week.
The main shortage right now isn’t rooms or equipment, Diekema said. It’s personnel because many workers end up sick or in quarantine ― frequently because of the inevitable exposures outside the hospital, where they are in the community.
Hospitals can adjust by reducing non-COVID-19, non-essential procedures, and bringing in personnel from different specialties or out of retirement. But, Diekema said, rural hospitals were already struggling financially. They might not survive without the revenue from elective procedures ― many of which, such as biopsies for possible cancer, are not really that elective and could lead to serious health consequences if delayed. Retired health care workers are usually older, putting them at greater risk for severe COVID-19 complications, while workers shifted from other departments don’t have the same level of specialized experience.
If it sounds a lot like the dire situation that some cities faced when the pandemic first hit, Diekema said, that’s because his state and those around him are approaching that point with no immediate relief in sight.
“It could get to the point where the health system is just overwhelmed, similar to what was happening in Italy or New York City, where you’re running out of protective gear again, having to ration care, keeping people home or sending them home even though they should be in the hospital,” he said. “It could definitely get that bad.”
Public Gatherings Are Spreading The Disease Everywhere
It could get that bad in other places, too. Pretty much every state now has rising COVID-19 cases, and many have desperate front-line workers sounding alarms as they confront a mentally and physically draining onslaught of patients.
Geographic spread from the Midwest is part of the story here. In Michigan, a state that had the outbreak mostly under control during the summer and early fall, the third wave started with the virus coming across the Wisconsin border to the Upper Peninsula and from Indiana into the state’s southwest corner.
But regional spread alone doesn’t explain what’s happening in Michigan or other states now seeing more COVID-19. A gradual loosening of guidelines and a growing ambivalence about social distancing among individuals are also big factors, sparking new outbreaks in areas where COVID-19 had receded but not disappeared altogether.
“We most definitely had an uptick in the Upper Peninsula that was directly related to travel to Wisconsin or people who work in one state and live in the other,” said Emily Martin, an epidemiologist at the University of Michigan. “However, what we see now is not so much a spread pattern as it is a breakdown in prevention happening in multiple areas of the state at once. … The reality is that Michigan and the west side of Michigan especially never got close enough to containment over the summer. So every region still had enough embers around to restart a fire as soon as behavior changed.”
Maybe the most vivid example of how public gatherings seed outbreaks is the now-infamous superspreader event in Maine, whose record at controlling the virus was otherwise as good as any states.
The event was a wedding attended by 55 people at an inn in Millinocket, a previously COVID-19-free town of about 5,000 people. The wedding party and guests, many of whom came from out of state, got tested before attending and took temperature checks on the day of the event. But the room was slightly overcapacity, and, according to a subsequent investigation by state health inspectors, many guests “did not comply” with a posted requirement to wear masks.
A few days later, a resident who attended as a guest developed COVID-19 symptoms. It’s not clear how this “index patient” got it, but soon several other people at the wedding also got sick, including inn staff members. In turn, they spread it to the community, infecting, among others, a worker at a local long-term care facility, who then infected some patients.
Over the span of 38 days, 176 people became ill, and seven died. None of the seven had been at the wedding.
National Leadership Continues To Fail
Among the other superspreader events in the news lately were those involving Trump, starting with the late September Rose Garden ceremony celebrating the nomination of Supreme Court Justice Amy Coney Barrett and followed more recently by the election-night soiree at the White House. Administration officials keep getting sick, as Trump himself did a month ago. This week brought news that at least 30 members of his personal protection detail in the Secret Service tested positive as well.
None of this has affected the administration’s outlook, which is (notwithstanding official denials) to embrace a “herd immunity” strategy of letting the virus run rampant while supposedly protecting the elderly and the vulnerable. By now, this strategy’s flaws are well known: Isolating and protecting the vulnerable isn’t really feasible since community spread inevitably gets into long-term care facilities, and a huge number of vulnerable people are younger and not in such facilities anyway.
Nor can the economy survive when the virus runs rampant because, with or without official restrictions, most people aren’t going to shop and socialize at normal levels when they are afraid of a deadly illness. The best proof of this comes from Sweden, which tried a version of this strategy. Its economy didn’t perform markedly better than that of other nations. But it did have a high number of deaths, especially relative to its immediate neighbors in Scandinavia.
We know what’s coming the next few weeks. But how long it continues and how bad it gets, that really depends on our actions today.
Nahid Bhadelia, Boston Medical Center Special Pathogens Unit
Europe has its own surge now, which is a reminder that attentive leadership is necessary for containing the virus but not a sufficient one. Experts put much of the blame on everyday Europeans who, feeling the same sort of fatigue as everyday Americans, flouted social distancing rules during August vacations. But rates remain dramatically lower in countries such as Germany, which throughout the pandemic has been among those successful both at containing the virus and supporting its citizens during the inevitable economic slowdown.
This was actually the part of the pandemic response that the U.S. handled reasonably well for much of 2020. A series of relief measures — most important among them the CARES Act — propped up businesses and individuals, especially low-income people.
But that money has run out, and Congress hasn’t found its way to agreement on a renewal. House Speaker Nancy Pelosi (D-Calif.) wants a major package that, among other things, will help financially depleted local and state governments. Senate Majority Leader Mitch McConnell (R-Ky.) insists a relatively small bill is enough, given that the economy has held up reasonably well so far.
It’s Not Too Late To Avoid the Worst For The Winter
Indeed, the economy has not deteriorated as much as experts once predicted. But more than 20 million Americans remain out of work; extra benefits are expiring; and the new spike in the virus is sure to deter economic growth as the majority of people, scared of contracting or spreading the virus, reduce their activity. (Some rescue for bars and restaurants, in particular, could save those businesses and help save lives, too, by making it easier for those venues to scale down operations until it is safe to serve people indoors again.)
How much economic assistance the country needs and for how long it will ultimately depend on the duration of the pandemic ― which, in turn, depends not only on whether the vaccines really work but also on whether they can get to the population quickly and efficiently.
That is no small thing. For example, the Pfizer vaccine requires two doses and storage in subfreezing conditions because it is sensitive to heat. Smaller rural hospitals will have trouble getting the equipment to handle the vaccine, and there are reports that dry ice, which is necessary for shipment, is in short supply.
The Trump administration said that it has distribution under control and that 20 million doses could be administered before the end of the year, which is a perfectly reasonable boast — except that Trump administration boasts along those lines rarely turn out to be true.
There’s good reason to think the Biden administration will be better prepared, starting with this week’s announcement that the White House chief of staff will be Ronald Klain, whose long resume of highly relevant experience includes coordinating President Barack Obama’s Ebola response, an effort considered now to be a model. Other advisers include Ezekiel Emanuel, an Obama administration veteran, who co-wrote a paper with Topher Spiro of the Center for American Progress with a detailed plan for managing vaccine production and distribution.
That report included some detailed benchmarks to hit, such as securing an adequate supply of vials and plungers and getting enough freezers for the vaccine. At this point, it’s impossible to know whether the Trump administration has met such goals: It is not sharing information that it is supposed to during the presidential transition because Trump still won’t allow that to happen.
For the next two months, the crisis response from Washington may amount to nothing ― or worse than nothing, which happened last week when congressional leaders from both parties inexplicably decided to host indoor dinners for incoming members Congress. At a time when public health experts beg families to stay home and avoid large gatherings over the holidays, the Republican and Democratic leaders of Congress apparently decided it would be a fine time to have some. (Democrats subsequently canceled their dinner; it’s not clear whether Republicans did.)
The mixed messaging couldn’t come at a worse time. Hospitalizations and deaths are sure to increase over the next month because they lag a few weeks behind the infection rate. But things could improve afterward if the public takes the COVID-19 threat seriously, and the infection rate falls.
“That’s why you hear the desperation in the voices of so many of us,” Nahid Bhadelia, medical director at the Boston Medical Center Special Pathogens Unit, told HuffPost. “We know what’s coming for the next few weeks. But how long it continues and how bad it gets, that really depends on our actions today.”
Some officials are paying attention. On Sunday, Democratic Gov. Gretchen Whitmer announced a wave of new restrictions, following the lead of Democratic governors in New Mexico and Oregon. But there’s only so much they can do without federal help.
That help may come on Jan. 20. And eventually, science will stop this plague. But until those things happen, Americans may have to save themselves.