The vaccines — the elixirs that will help drag this pandemic to a close — had finally arrived. There they were on Monday, being readied for health care workers in New York, Colorado, Ohio, Texas, and beyond, each rolled-up sleeve marking an initial step in curbing Covid-19.
And yet, even as the images of trucks, planes and unpacked boxes offered a triumphant respite for a public desperate for hope, the bad news kept knocking. The country crossed 300,000 official deaths from the coronavirus on Monday. It hit a record number of Covid-19 patients hospitalized — more than 110,000, according to the Covid Tracking Project. For the week that ended Monday, the average daily toll included more than 2,300 deaths and more than 210,000 infections, according to STAT’s Covid-19 Tracker.
It would have been a jarring split screen, if not for the fact that so much of the suffering from Covid-19 has seen people dying or mourning alone. While doctors and nurses administered vaccines in front of cameras as governors kept watch, the 1,300 people who died from the virus Monday largely did so isolated in hospital rooms.
It’s a strange moment in the pandemic, particularly in the U.S. The vials of vaccine rolling through supply chains embody real promise — a glimpse of a future that resembles life before masks, distancing, and holidays spent apart. But it will be months before enough people have been vaccinated to make a dent in the U.S. outbreak, let alone to wind down the pandemic. Meanwhile, millions of people will contract the SARS-CoV-2 virus, a portion of whom will get so sick they will eventually take over a hospital bed; be tended to by overstretched respiratory therapists, nurses, and physicians; and die. Vaccines won’t immediately change that.
“I feel like it’s a race between the virus and the vaccine, and that is not a good race,” said Krutika Kuppalli, an infectious disease physician at the Medical University of South Carolina.
Cases had already been soaring in the U.S., and now, experts say, health systems are facing an extra bump from Thanksgiving. Even as many people didn’t travel or avoided people outside their households, others certainly gathered. Those who contracted the virus over the holiday and who are becoming seriously ill likely only just showed up to hospitals in the past couple days; it would have taken them about five to seven days before they started feeling symptoms after the holidays, and then another week or so before their symptoms got bad enough they showed up at the emergency department. It could be another week or two before those who eventually die do so.
As providers face “a surge upon a surge” after Thanksgiving, as Kuppalli called it, they are also looking ahead to Christmas, when the pattern could repeat itself.
“We are seeing an unfolding disaster,” said Yonatan Grad, an infectious disease expert at Harvard’s T.H. Chan School of Public Health. “We are seeing incredibly high rates of transmission. We’re seeing increasing ICU bed occupancy, and in many places, they are running up against the limits of the resources they have available to care for people. I think it’s challenging in the extreme right now and it’s going to get worse.”
Because U.S. hospitals are so crowded, some people with Covid-19 now have to wait until they’re sicker to get care than they would have at other points in the pandemic. Overburdened hospitals also threaten the care of non-Covid patients who might show up after a heart attack or car crash. Some facilities have postponed what are deemed “elective” surgeries, but procedures like bypass operations have meaningful impacts on people’s lives.
As cases continue to rise in the Northeast and West, some places in the Midwest are seeing plateaus and even declines in new infections. But the outbreaks were so large that thousands will continue to contract the coronavirus even as transmission ebbs; their curves have to fall a long way to get to low numbers.
Experts have been trying to stress that, with vaccines on the horizon, this is a time for people to buckle down, commit to the public health measures that can keep people safe, and push through to the end of the pandemic — essentially, that we need to try to keep as many people healthy and alive as possible as the vaccine rollout progresses. They also say that in many places, the virus is so widespread that it will take policy changes limiting certain businesses and gatherings to result in any sort of quick turnaround, even as they acknowledge the economic consequences of such actions.
But they’re not getting much help from national leaders. President Trump has touted the arrival of the vaccines, but beyond that, has not addressed the fall’s spike in cases or tried to rally the public to take precautions, let alone rolled out any new initiatives to slow the virus.
Some state and local leaders are imposing new restrictions to try to get a handle on their rising cases. In California, Gov. Gavin Newsom tied regional stay-at-home orders to local hospital capacity. Boston and surrounding cities have reclosed gyms, museums, and theaters.
And in Pennsylvania, Gov. Tom Wolf has prohibited indoor dining — a move designed to ease the crush on health systems like the University of Pittsburgh Medical Center. Its hospitals have seven to eight times the number of Covid-19 patients as they did during the initial spring surge.
“This is not yet in the rear-view mirror, and people can still get sick,” Don Yealy, the chair of emergency medicine at UPMC, said Monday, as the first of his colleagues was getting vaccinated. “We have to applaud the good news but recognize we are not of the woods yet.”
Other states have been slower to impose restrictions or roll out new strategies, in part because Congress has failed to approve any new financial support for businesses and workers. Some governors don’t want to be seen closing businesses unless there’s something there to prop them up.
When Arizona experienced a summer surge, Gov. Doug Ducey eventually closed bars and gyms and allowed local communities to impose mask mandates. The actions helped the state bring the crisis under control — evidence that policy changes make a difference.
But Ducey hasn’t been willing to take similar steps in the face of another spike, even as it dwarfs what the state saw over the summer. Plus, because so much of the country is now flooded with Covid-19 patients, the state’s hospitals can’t rely on extra help like they could this summer when outbreaks were concentrated in a handful of states.
“We could import nurses from elsewhere, but now that’s much harder to do,” said Joshua LaBaer, who is coordinating Arizona State University’s Covid-19 research efforts.
LaBaer pointed to modeling data from ASU that showed the state’s ICUs could be completely overwhelmed by Covid-19 by the end of the month unless action was taken to drag down transmission.
“It’s spreading like crazy in the state, and there’s really nothing to suggest it’s slowing down right now,” he said.