New strain, family visits raise fears deadliest months of pandemic now ahead

The bright lights of the winter holidays are giving way to a dark winter of death and disease across the United States as a new variant of the coronavirus that has already killed more than 350,000 Americans begins to worry public health experts and officials.

Millions of Americans who traveled to see family over the Christmas and New Year’s holidays once again threaten to contribute to an already unprecedented spike in cases caused by family gatherings over the Thanksgiving holidays.

And the early optimism over vaccines created in record time is giving way to frustration and anger as distribution and administration fall substantially behind expectations.

The United States continues to lead the world in infections and deaths. More than 355,000 people have died from causes related to the coronavirus, according to data maintained by Johns Hopkins University’s Center for Systems Science and Engineering, a toll that is greater than the next two countries — Brazil and India, home to a combined 1.5 billion people — combined.

Fourteen of the 20 worst outbreaks in the world, measured by the number of residents per 100,000 infected, are American states. Arizona, California, Rhode Island and Tennessee have all recorded an average of more than 90 new cases a day per capita over the last week.

It is too early to tell whether the Christmas holiday will lead to a substantial spike in cases. Most states paused testing and reporting of new case data over at least a few days during the holiday week, muddling figures from the first several days of the new year.

But experts are worried by the new variant of the virus that broke out first in the United Kingdom. Early research suggests that variant is substantially more transmissible than previous strains. While experts say it does not appear that the strain causes more severe disease, the simple arithmetic of higher transmission is likely to lead to more death.

“Viruses don’t respect borders, so the identification of a strain in the U.K. that appears to transmit easier and faster than the previous strain is likely a harbinger of what we will see in the United States,” said Rich Besser, a former director of the Centers for Disease Control and Prevention who now runs the Robert Wood Johnson Foundation. “Just by transmitting easier, that will lead to increased numbers of cases, hospitalizations and deaths.”

Viruses are simple organisms that replicate billions or trillions of times in anyone infected, making mutations common. The coronavirus itself appears to mutate at about a quarter of the speed of HIV, and about half as rapidly as a typical influenza virus. 

It is unlikely that the new strain will have an impact on the effectiveness of the vaccines, two of which have been approved by American regulators and another produced by AstraZeneca and Oxford University that has been approved by British officials.

But the path to herd immunity — the point at which enough people have either generated immunity to the virus by recovering on their own or received one of the vaccines — is still miles away. Only about 4.6 million Americans, or about 1.5 percent of the nation’s population, has received a vaccine. Twenty million Americans have tested positive for the virus, though its true toll is probably substantially higher.

Experts estimate that at least 75 percent, and perhaps as much as 90 percent, of the population would need to be immune from the virus to stop its spread. Even those who recover will need a vaccine, some warned, because the vaccine conveys a higher degree of immunity than the body’s immune system creates itself.

“The vaccine offers a more robust immunity than previous infection,” said Eric Feigl-Ding, an epidemiologist and a senior fellow at the Federation of American Scientists. “In each of the trials early on they noticed the antibody levels and the neutralizing activity was lower in convalescent infection than the vaccine.”

The pace of vaccine administration has frustrated local, state and federal officials, though it has picked up in recent days. Some are concerned at the number of those eligible for the vaccine — including front-line health care workers who are most at risk of infection — who have declined to receive their shots.

“Vaccines only work if people get them, and if 40 to 50 percent of people who work in nursing homes are concerned about safety and decide not to get vaccinated and similar proportions of health care workers decide to wait to get vaccinated, it won’t have the kind of impact that it could,” Besser said. “As people start to know friends and relative who have been vaccinated and hear about their experience with the vaccine, I think that’s going to encourage more acceptance.”

The surge in cases even as the vaccine begins to roll out threatens the stability of the American health care system. Nationally, 77 percent of intensive care unit beds were occupied at the end of December. Hospitals in the hardest-hit areas have reported running low on oxygen, and many in Los Angeles County are declaring emergencies that will send ambulances elsewhere.

At the same time, while England and Scotland implement new lockdowns to combat the spread, the American appetite for strict containment measures is virtually nonexistent. 

“There’s so much excitement and enthusiasm around the vaccine and so much attention to the challenges that many states are seeing in distributing” it, Besser said. “We are losing sight of what will reduce disease impact this winter, and that is following the guidance of public health officials.”

The combination of a more transmissible new variant, an overtaxed health care system and a public that is letting down its guard has positioned the country that has proved worst in the world at containing the virus for the most deadly stretch of the pandemic.

“Previously, you were burning some wood, but now it’s burning wood with some starter fluid, some kerosene on top,” Feigl-Ding said. “It will just keep burning and burning, and this is why the tug of war becomes much harder to win.”