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Coronavirus cases are on the rise in many states as the United States targets the winter months. And forecasters predict a staggering rise in infections and deaths if current trends continue.
This is exactly the scenario for which public health experts have long warned that it can prepare for the country if it does not aggressively suppress infections in the summer.
“We really hoped to crater the cases in preparation for a bad winter,” said Tara Smith, a professor of epidemiology at Kent State University. “We did the opposite in principle.”
After reaching an all-time record in July, cases did drop significantly, but the United States never reached a level where the public health system could really handle the outbreak.
Now the infections are increasing again.
The United States has an average of more than 52,000 new cases a day (the highest number since mid-August) caused by bubble outbreaks inland, especially in the Midwest, Great Plains and West
Contributing to this growth is the return of students to campus, resistance to mandates for social distancing and wearing masks, and more people spending time in restaurants and other indoor venues, Smith said.
Dr. Michael Mina, a professor at the Harvard School of Public Health TH Chan, compares the situation to a growing wildfire with small sparks in the United States that will only gain strength as the weather gets colder.
“We’re probably going to see massive explosions of cases and outbreaks that could potentially have made what we’ve seen so far not so much,” Mina said.
Nearly 400,000 deaths by February?
A forecast by one of the country’s leading coronavirus modeling groups estimates that more than 170,000 people could die from COVID-19 by February 1, resulting in a total of 390,000 victims of the pandemic.
“Unfortunately, the first wave of the outbreak is still in the United States,” said Ali Moqdad, a professor of health metrics at the Institute of 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 human behavior on outcomes. Worst of all, social distancing mandates continue to be revoked – and projects nearly 483,000 cumulative deaths by February 1st. The worst-case scenario assumes that communities restore such mandates when deaths reach a certain level per capita and that almost everyone wears masks. In this case, the cumulative deaths could still reach nearly 315,000.
The United States currently averages more than 700 deaths a day. The IHME predicts it could rise to more than 2,000 a day by mid-January, which will rival the most fatal days of spring.
So far, Moqdad says the data clearly shows that the United States is stuck in a jet cycle: when cases jump into their community, people change their behavior significantly – they stay home longer and wear masks, even in places where it is not required.
Once the situation improves, people return to their previous behavior.
“We’re like a train everywhere in the United States,” Moqdad said. “We take down cases, then we leave our guards. But it’s a deadly virus – you can’t give it a chance to circulate.”
And cold weather could play a role. In the southern hemisphere in recent cold months, countries have increased, even with a lot of social distancing and many people wearing masks, Moqdad said, indicating that “there is a seasonality factor” with COVID-19 that mimics pneumonia.
High levels of circulating virus
Even places that have already returned from devastating outbreaks remain vulnerable to winter resurgence, said Lauren Ansel Myers, a professor at the University of Texas at Austin who heads the COVID-19 Modeling Consortium at the University of Texas.
Myers notes that even in Texas – a state where the summer tide has helped accumulate a total of 17,000 victims – the virus is much more prevalent than in the spring. This is true in many parts of the country.
“Although things seem kind of flat in terms of where trends are going, the level at which we are flat is still an awful lot of virus circulating in our communities,” she says, although the hope is for these communities to be more responsive now to take precautions if cases jump.
Her group’s model currently predicts a cumulative 234,684 deaths by November 9, but looks no further.
“We understand so much about how this virus spreads,” Myers said. “What we don’t know is what the behavior will be and what decisions people will make in the coming months.”
This forecast is similar to that of researchers at the University of Massachusetts, Amherst at COVID-19 ForecastHub, an “ensemble model” that brings together about 30 different COVID models.
He predicts about 234,633 deaths by November 7th.
“There are some opposing forces that act according to what we can see,” said University of Massachusetts professor Amherst Nicholas Reich, whose lab leads the ensemble’s model.
“On the one hand, we know that people will spend more time inside, and that has the potential to increase transmission,” he said. “On the other hand, people are generally more careful.”
But Reich says there are too many uncertainties to predict in a month: “In my opinion, this is something like the limit of reliable predictability, “he said.
While the US outbreak can be described as a variety of “waves” – one in the spring, another in the summer, public health experts say it does not fully capture how the pandemic has washed away unevenly over the country throughout the year.
“The better way to think about it is a wave that has entered a pool and unraveled in that pool,” said Dr. Roger Shapiro, a professor at Harvard School of Public Health in Chan. “Where it hasn’t been yet, it will go, and the place where it already was can be returned.”
Estimates vary, but the majority of the U.S. population is not infected, meaning most communities are still at risk of large outbreaks, he said.
Strict adherence to wearing masks and reducing indoor gatherings can help avoid the worst winter scenarios of COVID-19. But it is not certain that community leaders have the political will to impose such restrictions.
Mina says she expects countries to continue to open up just as virus transmission increases and more people spend time inside, creating a “perfect storm.”
“Will we be able to close completely again?” Mina asks. “Or will we choose a lot of infections? If that’s the case, we still haven’t done a really good job of figuring out how to keep vulnerable people safe.”
But COVID-19 model Nicholas Reich notes that the terrible predictions are just that – our best guess. He says winter may look very different if Americans take precautions seriously.
“The optimism we can get from this is that human behavior can change that,” he said. “We can bend and straighten the curve.”