After surpassing another grim milestone — 200,000 confirmed coronavirus deaths — the U.S. is bracing for an increase in lives lost this fall and winter as the pandemic collides with flu season.
Temperatures are beginning to dip across the country and case counts are subsequently starting to rise again, putting the country on the wrong path as colder weather approaches.
Anthony Fauci, the nation’s top infectious diseases expert, had hoped daily new cases would be around 10,000 by the fall, but the seven-day average is 42,000 and heading upward.
“It’s incredibly high levels of transmission, which puts us in a very difficult situation going into the winter,” said Joshua Michaud, an infectious disease epidemiologist and associate director for global health policy at the Kaiser Family Foundation.
“That’s because if we haven’t been able to reduce transmission to much lower levels than we have right now, it provides the seeds for further transmission as winter sets in.”
Respiratory viruses like the flu and common cold tend to spread more easily in colder, dryer climates, leading experts to believe it will be the same for COVID-19. That’s why experts say it’s especially important this year to get vaccinated for the flu, to prevent hospitals from being overwhelmed by flu and coronavirus patients at the same time.
Fauci has warned that if the U.S. does not bring case numbers down this month, it will become much harder to control COVID-19 when winter forces people back indoors, aiding the virus’s spread.
And while he has often said “outside is better than inside” when it comes to socializing during a pandemic, that motto becomes harder to live by when temperatures drop and people begin to spend more time indoors.
“We already know, even in the warm weather months, that indoor facilities and small rooms with poor ventilation and close contact between people, those are the things that mediate the greatest amount of COVID-19 spread,” said Andrew Pekosz, a virologist, professor and vice chair of the Department of Molecular Microbiology and Immunology at Johns Hopkins University.
“As we go into the winter, we naturally move inside. We spend more time in smaller rooms, we spend more time in confined spaces. And so there absolutely becomes an increase in the number of times a person enters an environment where COVID-19 spread can be optimized,” he added.
The current projections are grim. One of the models that has proved to be the most accurate so far, by data scientist Youyang Gu, projects a total of 223,000 deaths in the U.S. by Nov. 1. He doesn’t offer estimates past that date, but a model from the University of Washington puts the death toll at 378,000 by Jan. 1.
“I think that’s not at all unfathomable given the progression of this pandemic,” said Jeanne Marrazzo, director of the division of infectious diseases at the University of Alabama at Birmingham, noting that the U.S. is closing in on 7 million confirmed cases of COVID-19.
“The bottom line is that it doesn’t matter what side of the aisle you’re on politically. The numbers are the numbers, you can’t argue with them, and they are not going in the right direction. That’s really the bottom line,” she said.
The recent case increases have largely occurred in the Midwest and Great Plains states like Oklahoma and North Dakota, which had yet to be hit very hard by COVID-19. The spikes are likely tied to colleges reopening, the lifting of coronavirus restrictions and little adherence to social distancing guidelines.
Over the past week, there have been an average of 41,400 new cases per day, a 13 percent increase from two weeks earlier, according to a New York Times tracker.
That puts the U.S. back to where it was in June, when cases started climbing in the South before peaking at about 74,000 new cases per day in late July.
Still, other parts of the country — particularly the Northeast, which was hit hard in the early days of the pandemic — have done well in recent months, keeping their test positivity rates below 1 percent.
The World Health Organization says test positivity rates of 5 percent or lower indicate an area has control of the virus.
“Parts of the country are doing well. We should make them be the models. But there are others where you’re starting to see an uptick in test positivity. We know from historical observation, retrospectively, that when that happens, you’re going to have a surge,” Fauci said in an interview with The Atlantic on Tuesday.
Thirty states have test positivity rates higher than 5 percent, according to figures tracked by Johns Hopkins University.
That’s not where a state or the country wants to be heading into the cold weather months, Fauci said.
“We’re looking at 40,000 new cases per day. That’s unacceptable. That’s what we’ve got to get down before we get into the more problematic winter,” he said.
Even states that have the virus under control now could see increases in cases in the winter, said Stephen Kissler, a research fellow in the Department of Immunology and Infectious Diseases at Harvard University’s T.H. Chan School of Public Health, referring to the dynamics of the 2009 flu pandemic.
“I think that the possibility of a rise in cases is possible just about everywhere,” he said.
Meanwhile, the U.S. is still facing shortages of personal protective equipment for health care workers, slow turnaround times for tests and subpar contact tracing, experts say.
“I don’t think that there is evidence we have built up our basic public health interventions to a degree that allows us to address the potential surge in cases in the fall and winter,” said Michaud.
“We’re already struggling to do enough testing … and for the most part, contact tracing efforts are overwhelmed, meaning they’re having a hard time doing tracing of all of the cases in the context we have already.”
Experts say the U.S. has learned a lot about COVID-19 in the past six months that will help it prepare for the fall and winter — how the virus spreads, how to treat the disease, who is most at risk for serious illness and death, how to slow spread by using masks and social distancing and what settings are most conducive for transmission, like indoor venues with poor ventilation.
But what matters most is getting people to heed public health advice, which has proved challenging so far.
“We actually, I think, have the tools to deal with [winter], said Marrazzo of the University of Alabama at Birmingham.
“The question is: Do we have the social, political and economic will to do it? I think we have the medical will, we have the public health will, it’s just a question of, can we mobilize the community to continue to exercise the kinds of caution we need?”