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Coronavirus cases are rising rapidly in many states as the United States enters the winter months. And predictors predict staggering growth in infections and deaths if current trends continue.
This is exactly the kind of scenario that public health experts have long warned is in store for the country if it does not aggressively crack down on infections over the summer.
“We were really hoping to crater the cases in preparation for a bad winter,” said Tara Smith, a professor of epidemiology at Kent State University. “We’ve pretty much done the opposite.”
After reaching a record high in July, cases dropped markedly, but the United States never reached a level where the public health system could really control the outbreak.
Now infections are on the rise again.
The United States has, on average, more than 52,000 new cases a day (the highest it has been since mid-August), driven by balloon eruptions across the country’s interior, particularly in the Midwest, Great Plains and West.
Contributing to this increase is students’ return to campus, opposition to mandates of social distance and masking, and more people spending time in restaurants and other indoor settings, Smith says.
Dr. Michael Mina, a professor at the Harvard TH Chan School of Public Health, compares the situation to a growing forest fire with small sparks across the United States that only gains strength when the weather gets colder.
“We’re likely to see massive explosions of cases and eruptions that could potentially make what we’ve seen so far look like it hasn’t been that much,” Mina says.
Nearly 400,000 deaths in February?
A forecast from one of the country’s leading coronavirus modeling groups projects that more than 170,000 people could die from COVID-19 by February 1, bringing the total death toll from the pandemic to nearly 390,000.
“Unfortunately, in the United States, it is still the first wave of the outbreak,” said Ali Mokdad, a professor of health measurement science at the Institute for Health Metrics and Evaluation at the University of Washington, who developed the model.
The model predicts three different scenarios to reflect the potential impact of policies and people’s behaviors on outcomes. The worst assumes that the mandates for social distancing will continue to be rolled back – and projects nearly 483,000 cumulative deaths by February 1st. The brightest scenario assumes that societies reintroduce such mandates when deaths reach a certain level per. Inhabitant, and that almost everyone wears masks. In that case, cumulative deaths could still reach nearly 315,000.
Currently, the United States averages over 700 deaths a day. IHME projects that it could rise to more than 2,000 a day in mid-January and compete with the deadliest days of spring.
So far, Mokdad says the data clearly shows that the United States is stuck in a reactive cycle: As cases increase in their society, people change their behavior significantly – they become more at home and wear masks, even in places where it is not necessary.
As the situation improves, people return to their past behaviors.
“We ride like a roller coaster all over the United States,” Mokdad says. “We bring cases down, then we fail our guard. But this is a deadly virus – you can not give it a chance to circulate.”
And cold weather could play a role. In the southern hemisphere, countries have seen an increase in cases in recent cold months, even with a lot of social distance and many people wearing masks, says Mokdad, indicating that “there is a seasonal factor” with COVID-19 mimicking pneumonia.
High levels of circulating virus
Even places that have already recovered from devastating outbreaks remain vulnerable to a winter flare-up, says Lauren Ancel Meyers, a professor at the University of Texas at Austin who heads the University of Texas COVID-19 Modeling Consortium.
Meyers notes that the virus is much more prevalent than during the spring, even in Texas – a condition in which a summer rise helped bring the cumulative death toll to more than 17,000. This is true in many parts of the country.
“Even though things look flat from the perspective of which trends are going, the level at which we are flat is still an awful lot of viruses circulating in our society,” she says, though the hope is that these societies may be more responsive now to take precautions if cases increase.
Her group’s model currently projects a cumulative 234,684 deaths by November 9, but looks no further.
“We understand so much about how this virus spreads,” Meyers says. “What we do not know is what behavior will be and what decisions people will make in the coming months.”
This projection is similar to what researchers at the University of Massachusetts, Amherst, predict in COVID-19 ForecastHub, an “ensemble model” that merges about 30 different COVID models.
It predicts about 234,633 total deaths by November 7th.
“There are kind of opposing forces acting on what we might see,” says University of Massachusetts Amherst professor Nicholas Reich, whose laboratory operates the ensemble model.
“On the one hand, we know that people will spend more time inside, and that has the potential to increase transmission,” he says. “On the flip side, people are generally more cautious.”
But Reich says there are too many uncertainties to predict beyond a month: “In my opinion, it is a kind of limit for reliable predictability, ”he says.
While the U.S. outbreak can be described as various “waves” – one in the spring, another in the summer – public health experts say it does not fully capture how the pandemic has washed unevenly across the country.
“A better way of thinking about it is a wave that went into a pool and in that pool it hit around,” says Dr. Roger Shapiro, professor at Harvard TH Chan School of Public Health. “Wherever it has not been yet, it will go, and where it has already been, it may go back.”
Estimates vary, but the vast majority of the U.S. population has not been infected, meaning most communities are still at risk of major outbreaks, he says.
Strict adherence to wearing a mask and shrinking indoor joints can help ward off the worst COVID-19 scenarios in the winter. But it is not certain that community leaders have the political will to impose such restrictions.
Mina says he expects states to continue to open up, just as the virus’ transmissibility increases, and more people spend time inside, creating “a perfect storm.”
“Will it be that we close completely again?” Asks Mina. “Or will it be that we pick a lot of infections? If that’s the case, we still have not done a really good job of figuring out how to protect vulnerable people.”
But COVID-19 model Nicholas Reich notes that the gloomy predictions are just that – our best guess. He says winter can look very different if Americans take precautions seriously.
“The optimism we can take from this is that human behavior can change this,” he says. “We can bend and flatten the basket.”