“You should be prepared for how bad it’s going to get.”
The words of Dr. William Haseltine, an internationally renowned infectious disease expert, summarized the resounding—and sobering—takeaway from several public health experts and epidemiologists who spoke to The Daily Beast on Saturday, hours after the U.S. smashed its previous record of new daily COVID-19 cases. The country hit 83,757 reported infections in one day on Friday, while hospitalizations rocketed across the nation by 40 percent.
The problem, experts say, isn’t Friday’s number. It’s the upward trajectory.
“It’s going to get a lot worse,” said Dr. Haseltine, who was at the heart of the U.S response to the HIV/AIDS and anthrax crises. “We’re looking at easily an excess of 100,000 infections a day and overwhelmed hospitals all over the country.”
Haseltine said that prediction was supported by several factors: The weather will only get colder, forcing people indoors. Flu season is approaching. The holidays will tempt people to gather in groups. There are no silver bullets coming. The smaller—but still devastating—peaks in the spring and the summer were largely contained to specific regions of the United States.
“Now it’s just about everywhere across the country,” said Haseltine, noting that cases are impacting more age groups, environments, and facilities. While many states saw clusters originating in meatpacking plants, prisons, and retirement facilities earlier in the year, they’re now being traced more often back to private family gatherings, religious services, bars, athletic events, colleges, high schools, and more.
That news might be shocking to anyone who believed President Trump’s declaration this week that the country is “rounding the corner” on the pandemic and that the virus is “going away.”
But Haseltine’s prediction that “we’re not even near the peak” of the latest surge was backed by other experts who spoke with The Daily Beast on Saturday.
“What we can hope for,” said Haseltine, “is that this will plateau at 100,000 [new cases per day], and that enough people will get enough scared and that enough hospitals will get overwhelmed” that it convinces the American public to wear masks, social distance, and exercise caution.
Dr. Jennifer Horney, founding director and professor in the University of Delaware’s epidemiology program, noted that Haseltine’s prediction was consistent with the latest published results from the forecasting team at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle. Its report on Friday in Nature estimated a cumulative total of 511,373 deaths across the United States by Feb. 28, 2021.
A Pervasive Myth
To be clear, more Americans are, every day, gaining increased access to quicker and effective tests, raising a question that Horney called a “pervasive” myth: Are dramatic COVID-19 case increases just a reflection of the fact that we’re testing more people?
In short: No.
Experts surveyed by The Daily Beast on Saturday pointed out that hospitalization and fatality rates are also increasing—robust indications of trends—and that positivity rates in several states are too high to be accurately reflecting a full picture of the number of infections.
“Hospitalizations don’t yet reflect what happened this week,” Haseltine said.
Even still, hospitals all over the country—from Amarillo, Texas to Salt Lake City, Utah, and Kansas City, Missouri and Milwaukee, Wisconsin—reported this week that they were overwhelmed and approaching capacity.
Dr. Irwin Redlener, founding director of the National Center for Disaster Preparedness and a senior research scholar at Columbia University’s Earth Institute, agreed with Haseltine’s prediction, saying he would “also remind people” that the number of confirmed cases is only “a fraction of the total.”
In June, Robert Redfield, the director of the Centers for Disease Control and Prevention, said the number of confirmed cases likely represented only 10 percent of true infections. That means on the days that the country saw 60,000 new cases, there were actually closer to 600,000. While Delaware’s Dr. Horney noted that such case representation has likely improved with access to testing, it hasn’t improved enough not to be reflecting a true rise in cases across the nation.
And, worryingly, none of the experts interviewed by The Daily Beast said there was any evidence of change at the institutional, state, local, or individual level that would curb the deadly virus’s worrying trend.
‘Failure of Leadership’
“There’s a failure of leadership, failure of governance and failure of social solidarity in the Western world,” said Haseltine. “The Chinese taught the world what to do. You can stop the infection without a vaccine, without a drug—and stop it forever. It’s not that they’re totalitarian, it’s that they did what public health officials told them to do. What is wrong with the rest of us?”
On that point, both Redlener and Horney agreed.
“The dearth of federal leadership has become so apparent and has had such a tragic impact,” said Horney. “The secret in all of these kinds of emergencies is to have strong guidance with enough flexibility to make it locally relevant.”
The Institute for Health Metrics and Evaluation’s projection published on Friday in Nature also found “that achieving universal mask use—95 percent mask use in public—could be sufficient to ameliorate the worst effects of epidemic resurgences in many states” and that such compliance “could save an additional 129,574 lives” through the end of February 2021. Even 85 percent mask compliance, said the forecast, could save an additional 95,814 lives.
“It’s not too late to talk about a national mask mandate, which is one of the few tools we have to deal with this since we don’t have a vaccine,” said Redlener, echoing a sentiment vocalized a day earlier by Dr. Anthony Fauci, the nation’s top infectious disease official.
But without a national mandate, state and local health departments are left to make their own ordinances, the result of which has been headline-grabbing in-fighting from Texas to Georgia.
In Illinois, the state’s public health director broke down in tears on Friday, begging the public to follow health guidelines.
“If you’re talking about COVID fatigue from having to keep wearing a mask, think about the COVID fatigue for health-care workers, respiratory therapists, who are going to have to go through this whole episode again of trying to fight for people’s lives, because we couldn’t figure out how to control this virus by doing some of the simple measures that have been prescribed,” Dr. Ngozi Ezike said.
Without a federal strategy, said infectious disease experts, pandemic-weary Americans have been left to make their own decisions in the public interest, to decipher mixed messages from departments and politicians, to understand that eating indoors at restaurants may be technically allowed, but not responsible. There will always be people who trust a corporation’s analysis that its product is safe—or who believe their individual liberty is more important than the public good.
“We are always emotional and sometimes rational, it’s just human nature,” said Haseltine. “Belief trumps facts every time.”
Horney’s advice to the public is to “double down” and make plans now. Whether you live in New York or South Dakota, in a city or rural environment, on a college campus or in a retirement community: “Get your flu shot. Wear your mask.” The more lax people are, the worse cases will get, and the worse off every community will be, she said.
“Be prepared—and not in this joking sort of way about running out of toilet paper—in the real way,” she continued. “If your kids are in school, be ready for them to pivot to remote learning.”
As Redlener said, the nation is in a “battle” between pandemic fatigue and pandemic fatalities.
“This virus is anything but slowing down,” Redlener warned, and if Americans don’t begin to take it much, much more seriously, he said, “We’re in trouble.”