The country moves into a difficult phase of the pandemic as fall slides into winter with no national mandates and no vaccine.
Nine months into a global pandemic, more than 9.2 million positive cases of Covid-19 have been recorded and 230000 Americans have died. After the virus stormed through New York City and environs this past spring, it turned its fury to the South and sickened many in Florida, Georgia, North Carolina and other warm states. The Midwest currently bears the brunt of the virus, but—as predicted—cases are increasing nationally now that colder weather is here and people move their socializing indoors.
A recent briefing held by the Infectious Diseases Society of America (IDSA) aimed to shed light on what the next six months will look like as the US and the rest of the world try to get control of this virus and return to some semblance of normalcy. Not surprisingly, speakers highlighted the need for decisive action to prevent transmission of the virus, whether in the form of governmental orders or a more careful citizenry.
European countries that imposed mandates in the form of lockdowns or mandatory mask wearing have gotten control of the virus much faster, Ali Mokdad, PhD, Professor of Health Metrics Sciences at the Institute for Health Metrics and Evaluation and Chief Strategy Officer for Population Health, University of Washington, both in Seattle, noted. “We need the public to be more vigilant,” he said. “The holidays are upon us. We cannot afford to overrun our hospitals.”
The Institute for Health Metrics and Evaluation revised its projection from 385000 deaths in the US by February 1, 2021 to 399000 if the country continues following the guidelines currently in place. If universal masking were put into effect, the death projection would drop to 337600. Should mask mandates ease, deaths would be expected to rise to at least 513000. Worldwide, deaths are projected to double from the 1245000 that have already occurred to 2.5 million if countries continue along the paths they’re on.
The question of the U.S. changing course on COVID-19 is a highly charged one, given that the nation is in the process of choosing between two presidential candidates who have very different outlooks on pandemic management. President Donald Trump, the incumbent candidate, has had a distinctly laissez-faire attitude, tasking individual states and cities with their own testing, tracing, and masking protocols and floating the idea of herd immunity, a strategy Mokdad said could result in global deaths of up to 15 million and which he referred to as “criminal.”
Would things be better if the U.S. implemented a nationalized response to the viral outbreak? “I think it would make a world of difference,” Amesh Adalja, MD, FIDSA, an IDSA fellow and senior scholar at Johns Hopkins University Center for Health Security in Baltimore, said. “You don’t get a hodgepodge of policies.” With a nationalized response, he said, the U.S. Centers for Disease Control and Prevention (CDC) would work with each state to make sure testing is uniform instead of having certain states get test results in 2 days and others in 8 days. “If we can’t answer the question of who is infected and not infected, who is contagious and not contagious, it’s very hard to move forward,” he added.
Dr. Mokdad agreed. “The most important part in a national response is you need to come up with a consistent message to the public,” he said. “A national mandate for masks would save a lot of lives.” Instead, he noted, not only is a state like Florida doing things differently from other states when it comes to mask mandates and the opening of bars and restaurants, policies aren’t even uniform within the state itself. Also crucially important is contact tracing, which the speakers noted has not been optimized in the U.S.
The news is better when it comes to treating rather than preventing Covid-19. Therapies such as dexamethasone and remdesivir have demonstrated success in helping patients recover, and healthcare workers have learned more about using oxygen therapies to ease breathing. While virus case numbers may continue to grow over the next 6 months, more patients’ lives likely will be saved thanks to existing and emerging therapies and a better understanding of how to employ them.
Of course, the world has been waiting for a vaccine for Covid-19, and multiple clinical trials show encouraging results. However, experts are in agreement that a vaccine will not magically terminate the virus and prevent people from getting sick. “[There will be] roving hot spots with seesawing levels of control,” Mokdad said. “Risk perception will change when we have a vaccine.” So while people may be tempted to toss their masks to the wind, it’s important to recognize that a vaccine should help prevent severe disease and hospitalization but do a more modest job preventing infection in the first place.
Once a vaccine is approved for use, it must be manufactured and distributed to all who want it, which may mean it will not be immediately available. Another issue is whether enough people will, in fact, want it: Current surveys show that 44% of Americans may not be willing to take it, which may affect its ability to hinder transmission in a meaningful way.
But even when the pandemic does get under control, the US healthcare system will continue to suffer the aftershocks of the government’s mismanagement for years and perhaps a decade, Adalja predicted. “Healthcare systems are stressed—all aspects of them,” he said. “As a clinician, it’s almost like groundhog day every day. It does seem sometimes never ending. We are going to have healthcare worker burnout.”