The next Covid-19 superspreading event: Thanksgiving

Volunteers distribute turkeys for Thanksgiving dinner baskets in Porter Ranch, California on November 16. | Brian van der Brug/Los Angeles Times via Getty Images

America’s coronavirus epidemic is already bad. The holidays could make it worse.

America’s Covid-19 epidemic is at the worst point it’s been since the spring. And experts say it looks poised to get much worse this Thanksgiving and the rest of the holiday season, with a vaccine likely still months away.

The US hit an all-time record for coronavirus cases in a single day on Friday, November 13: more than 181,000. That came just nine days after the country hit more than 100,000 cases in a single day on November 4. The weekly average of daily new cases stood above 155,000 as of November 16 — nearly triple what it was a month ago.

While testing can help explain why the US is recording more cases now than it did during the spring surge, it can’t explain the recent increase in Covid-19 cases. Between October 16 and November 16, the total number of tests in the US, based on the Covid Tracking Project, increased by 35 percent. In that time, the number of Covid-19 cases nationwide increased by 176 percent — a fivefold difference.

The number of people hospitalized with Covid-19 has also hit record highs: More than 73,000 people were hospitalized with the disease as of November 16, up nearly double from October 16. Covid-19 deaths are increasing too: With more than 1,100 coronavirus deaths a day on average as of November 16, deaths are up nearly 66 percent compared to the same day last month.

Unlike the spring, this surge is a truly national phenomenon. Every state now has more than four daily new coronavirus cases per 100,000 people, a standard for controlling Covid-19. The vast majority of states completely surpass that. Nine states now report more than 100 daily new cases per 100,000 — which was unthinkable in even one state just months ago.

Kumi Smith, an epidemiologist at the University of Minnesota, gave me a frank assessment: “Things are looking pretty bad.”

Even these numbers may not represent how dire it really is. With the coronavirus, it takes some time — days, maybe weeks — for someone to go from getting infected to actually getting tested. Then it can take days or weeks for that person to end up at a hospital with serious symptoms. Deaths can take even longer, if treatment fails. All this data is like light from another galaxy that takes time to travel to our eyes: It’s reflective of infections that happened weeks ago, not today or yesterday.

Some experts now say that the US will inevitably record at least 2,000 deaths in a day in the coming weeks, a threshold the country hasn’t seen since the spring. That daily death toll is, at this point, “essentially baked in,” Brown University School of Public Health dean Ashish Jha told me.

It likely gets worse from here. The holiday season, starting with Thanksgiving and continuing into Christmas and New Year’s, will bring friends and family together — sometimes from across the country — in large gatherings. With winter coming, the colder weather in much of the country will push people indoors, where the virus has an easier time spreading due to poor ventilation.

The flip side is a vaccine is closer than ever, with recent reports suggesting at least two Covid-19 vaccines undergoing trials may be more than 90 percent effective. The problem is widespread vaccination is still likely months away; the remaining steps of research and development, manufacturing, and distribution mean the medicine likely won’t be in reach for most Americans until spring 2021 or later. Before then, the country has to remain vigilant — arguably more so, given the current rate of spread — to make sure as many people as possible make it across the finish line.

“I have become far more pessimistic about the next two months, and far more optimistic about what happens after that,” Jha said. “I’m starting to feel better about where we’ll be in February. The rest of November, December, and a good chunk of January are just going to be the hardest months of the pandemic.”

To put it another way: A vaccine may save us in a few months. But before then, things are likely to get much worse.

The holidays will likely cause Covid-19 to spread more

America may be only in the beginning of its third Covid-19 surge.

The recent increase appears to be largely reflective of a mix of pandemic fatigue and broader reopenings. Since the spring and summer, the country has eased the initial stay-at-home orders to open up all sorts of public spaces and businesses, from parks and beaches to schools to bars and restaurants. At the same time, people have become exhausted with combating the virus — leading them to not only venture back out into risky indoor spaces like bars and restaurants but also to host house parties and gatherings with friends and family. That’s led to more interactions between more people who don’t live together and, subsequently, more infections.

Consider New York. The state managed to suppress the virus after its massive outbreak in the spring. But as it’s reopened more and more — with indoor dining starting again in New York City in September — cases have spiked from a weekly average of 800 a day to more than 4,500.

And that’s with the state’s mask mandate and social distancing guidelines still in place. Less careful and more lax states, like South Dakota, are seeing much larger spikes and outbreaks.

The holiday season will likely lead friends and family to come together even more. These kinds of gatherings are tremendously risky: People will gather close together for potentially hours or days; take off masks, if they had them on at all; and then talk, shout, laugh, and sing while maskless, spewing potentially coronavirus-carrying particles all over each other.

So while many people may expect a good time with friends and family this Thanksgiving, experts have a much grimmer outlook: “We’re going to see much more transmission as a result of that,” Saskia Popescu, an infectious disease epidemiologist, told me. That means likely more Covid-19 cases, hospitalizations, and deaths in the weeks to follow.

Winter could hasten spread further. The colder weather in particular could push activities back inside, where close spaces, prolonged interactions, and poor ventilation make it easier for the coronavirus to travel from one host to another.

Then, as hospitalizations due to Covid-19 rise, another virus — the flu — could join the fray, further straining health care facilities and workers. The gains doctors and nurses have made to treat the coronavirus could disappear if many patients are left in waiting rooms, without treatment, as there simply aren’t enough medical staff and hospital beds to care for them.

And if the outbreak is truly national, as is the case so far, there will be less ability for other states to send in reinforcements of health care workers to help save the day, as happened in New York this spring. Doctors, nurses, and technicians will be dealing with their own crises at home.

Unlike countries in Asia, Europe, and Oceania, America never managed to truly suppress the virus, and it has circulated in different parts of the country in some form since the spring. That’s left a lot of coronavirus out in the US, able to spread the moment that people go out and interact with each other again.

The power of exponential spread makes the high levels of virus already in the community particularly calamitous. Like many pathogens, the coronavirus can spread quicker and quicker as an outbreak goes on — to the point that cases can double every few days or weeks. But it’s obviously worse for 100,000 daily new cases to double than 10.

We’ve already seen the effects of this in the past month. The country went from a weekly average of 100,000 cases a day to 150,000 more than three times as fast as it went from 50,000 to 100,000 daily new cases. And that’s before holiday travel and winter.

So the milestones of 200,000, 300,000, or worse may be even closer than they appear. As bad as it looks, the country’s Covid-19 outbreak stands to get worse — quickly.

A vaccine is still months away. We need action in the meantime.

The past few weeks have brought surprisingly good news on vaccine development. Based on press releases from Pfizer and Moderna about early data from their respective trials, their vaccines may be at least 90 percent effective. That number dramatically exceeds expectations — a week before Pfizer’s announcement, experts said they expected 50 or 60 percent efficacy, 70 percent if we were really lucky.

The bad news is widespread vaccine distribution is still months away. The clinical trials still have to finish, or the companies need to get the necessary approvals from the Food and Drug Administration to distribute the vaccines early. Even after approvals, it will take time, money, and a whole lot of planning to produce and ship the vaccine, and administer it to hundreds of millions of Americans. Realistically, experts said, the earliest most of us could expect to see a vaccine is next spring.

That makes it all the worse that America may now face the worst of the coronavirus, since illnesses or deaths now could be avoided by suppressing cases for just a few months more. It makes efforts to stop the spread of the virus all the more important.

That may require America to close down again. The research suggests that lockdowns did reduce cases in the spring. Other countries that have faced resurgences of Covid-19, from Israel to European nations, have also seen success with widespread closures (often after milder, more targeted measures failed).

A chart of Israel’s Covid-19 cases, which plummeted following a lockdown. Our World in Data

While physical distancing, testing, tracing, and masking all have solid evidence behind them, they may only be able to keep cases down when they’re already low (not true for the US), at least for a time, and only if they’re universal (also not true) and sustained (nope).

Take contact tracing. The idea is “disease detectives” can contact people who are positive for the coronavirus to get them to isolate, find out their close contacts, and get those close contacts to quarantine. But that is simply much harder when there are more than 100,000 new cases a day — it requires much more staff, time, and resources. Even the best teams may not be able to keep up with exponential spread.

Crystal Watson, a senior scholar at the Johns Hopkins Center for Health Security, estimated that contact tracing becomes difficult at 10 daily new cases per 100,000 people. The US is now at more than four times that, and several states are now past 10 or even 15 times that threshold.

So some experts believe widespread closures are now likely needed: People should stay home as much as possible — only going out for basic needs like food and medicines — and not socialize with others from different households. Large gatherings, including in private, should be banned and avoided. In-person, indoor services at nonessential businesses, like bars and restaurants, should shut down.

That begins with Thanksgiving and other holidays. As great as it would be to spend time with family and friends after such a rough year, experts argue that now is still not the time.

Different levels of government could mandate all of this, while offering economic relief to those affected. A few places, including some states, are already moving in this direction. But short of that, individuals could try to act on their own, voluntarily choosing to stay at home or close businesses until Covid-19 subsides.

Still, with the outbreak so widespread, the actions of a few individuals or states just won’t do. It will require a truly national effort. President Donald Trump and his administration so far have shown no signs of changing their approach, and President-elect Joe Biden won’t take office until January 20, 2021. That may leave it to the states and general public to deal with the worst of Covid-19 yet — and both seem, as of now, highly resistant to more drastic measures.

“I don’t think people realize this is the worst it’s gotten,” Popescu said.

So the US could see mounting Covid-19 deaths, on top of the more than 248,000 that it’s already seen, right as the country needed to hold off just a few more months to ensure that more people made it across the finish line.

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