The number of Americans being diagnosed with COVID-19 is higher than ever—on Wednesday, there were more than 100,000 new cases reported in this country for the first time during the pandemic. There’s a delay between case spikes and death spikes, which means there may be more deaths in the coming weeks. The Center for Disease Control and Prevention is predicting total mortality counts at 250,000 to 266,000 by the end of November. This is happening while it’s still relatively warm in many parts of the country and socializing and dining outside is feasible. We have not yet started gathering for the holidays, which experts fear will bring groups of people from multiple generations together, doing one of the most dangerous things you can do indoors (eating). Winter is already “prime season for respiratory viruses,” says Saskia Popscu, an infectious disease epidemiologist in Arizona. “Hospitals are already busy this time of year.” And they’re likely to get busier. Joe Biden is on track to win the presidency, but no matter how the election shakes out, we are still in Trump’s pandemic for the next two and half months.
“What we’re really seeing now is that we never recovered from the first wave, we never recovered from the second wave, we’re kind of stair stepping,” says Rachel Bender Ignacio, an infectious disease specialist at the University of Washington Medical Center. The “third wave” of the virus isn’t as much a wave as it’s much a new level of national COVID-19-hell.
Compounding the effects of cold weather is the fact that we are all very tired of dealing with the virus. “It feels like cases are rising and hospitalizations are rising but we’re not acting with the same vigilance,” says Jeremy Faust, an emergency medicine physician in Boston, and Slate contributor. One issue with vigilance, and one reason why people’s resolve may be waning, is that you don’t get any sort of prize for being vigilant, for months on end, except maybe not getting sick. “When prevention works, nothing happens. All you have is a normal healthy day” says Howard Koh, a professor of public health leadership at Harvard. And sometimes—often!—when you ignore vigilance, what happens is also nothing. You still have a normal healthy day. “If you [take a risk] one time and nothing happens, does that encourage you to keep taking risks?” says Popescu. We have been at this for so long that it’s possible that what many people have internalized is a false sense of security, combined with numbness. “We seem to have accepted the thing that I feared the most, which is a steady stream of death,” says Faust.
The individualized nature of America’s response to the virus is part of the problem. Prevention can’t happen “by hoping that every person or every business, or every establishment is going to make the right choice,” says Ignacio. Since the start of the pandemic, “fundamentally, nothing has changed, really on a policy level,” says Ignacio. Trump has spent the entire pandemic outright mocking people who take it seriously. He hasn’t been taking steps to make sure Americans have access to up-to-date health advice, or adequate support to follow it. Resources that existed earlier in the pandemic, like additional unemployment benefits that allowed workers to afford to stay home, have not been renewed. New York’s overwhelmed hospitals were framed as a blue-state problem. Now, hospitals across the country are being overwhelmed: Milwaukee is running a field hospital, Salt Lake Hospitals are preparing to ration care, a town in Idaho was sending kids to a hospital two hours away in Boise (until the Boise pediatric unit became full as well), a county in Texas shut down non-essential businesses and now has four “mobile morgues,” meaning refrigerators with bodies in a parking lot.
There’s one reason why we are in a slightly better spot than March: Doctors have gotten better at this. Compared to earlier escalations of cases, “our hospitals in some ways are more prepared,” says Ignacio. “We have some way of mitigating severe disease.” Steroids, for example, can reduce mortality among very sick patients. There’s more evidence that flipping patients over—proning—can help with breathing and either delay or eliminate the need to go on a ventilator, which helps free up resources. Still, the ability to treat COVID now compared to March is just “incrementally” better, as Faust quantifies it. The public’s focus right now should be on prevention, not putting hope in treatments, says Ignacio. Though deaths rates as a percentage of infections have gone down (at least, in cases where hospitals are not overburdened), what we really need is more research, a vaccine, and in the meantime, hopefully, better leadership.
What can we do, now that voting, the one clear somewhat meaningful outlet for systemic change, is over? We mitigate the damage that gathering and celebrating indoors could bring. We can admit that it will be hard. “We want people to enjoy the holidays,” says Koh, “but it just can’t be anything close to what we’ve done in previous years.” This is a common appeal among experts: as human beings with loved ones, they get it, because everyone wants to see family right now. But they are still imploring you: please don’t gather with more than a few carefully-chosen people. “I really discourage people from traveling for the holidays,” says Popescu. “I’m not going to travel. My husband and I are going to bubble with my brother and sister in law.” One more time: “I’m really encouraging people to focus on the basics–masks, keeping gatherings small,” says Ignacio. “Having people get together around the same table for a holiday meal is one of the most risky things we can do.” Holiday travel is especially concerning given that it can involve several generations of people hanging out together, says Ignacio. With a three-to-five week delay between new cases, and deaths, Thanksgiving get-togethers could lead to terrible December holidays.
In the background of this, we will still have at least a couple months of a president who is vindictive and abusive—and may become all the more so if he loses reelection. “I do worry that the Trump administration is just going to be like, ‘screw it,’” says Popescu. How could the Trump administration’s response to COVID possibly get worse? “I ask myself that every day and then it does,” says Popescu. “I think we’re all worried about a scorched earth approach,” she explained, in which the Trump administration disables all support for the pandemic, and further fuels conspiracy theories. After we talked, Trump suggested he might fire Anthony Fauci following the election. No matter what happens tonight, or tomorrow (or maybe the days after!), Trump will be in power for two more months. We are stuck watching a crash—stuck continuing to watch a crash that has been happening all year. Even if we have a new president soon, it will be too late.
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