It was avoidable. Its harms can be lessened. Fall’s Covid surge is under way.

covidmapoct-300x201As the weather has turned crisper, and autumn leaves have begun to fall, in sadly predictable fashion, coronavirus cases are rising once again coast-to-coast.

More than 8 million Americans have been infected — roughly equivalent to the population of New York and far exceeding the number of people who live in metropolitan Washington, D.C.

The nation is racing toward 220,00 Covid-19 deaths, with that number rising inexorably and likely an understatement of the disease’s terrible toll. The coronavirus now has claimed as many lives as the population of cities such as Des Moines, Iowa, Salt Lake City, Utah, or Modesto, Calif.

As the Atlantic magazine reported, based on the coronavirus data collection it has undertaken along with other news organizations:

“The third surge of the Covid-19 pandemic in the United States is under way. Outbreaks have been worsening in many states for more than a month, and new Covid-19 cases jumped 18% this week, bringing the seven-day average to more than 51,000 cases a day. Though testing rose by 8% nationally, that’s not enough of an increase to explain the steep rise in cases. Meanwhile, Covid-19 hospitalizations, which had previously been creeping upward slowly, jumped more than 14% from a week earlier.”

The New York Times reported this:

“Case numbers in the United States are rising rapidly as states in the Midwest and Rocky Mountains struggle to control major outbreaks, and as new hotspots emerge elsewhere in the country. The national trajectory is only worsening. Wisconsin has opened a field hospital. North Dakota, which not long ago had relatively few cases, now has the most per capita in the country. And across the rural West, states like Alaska, Wyoming and Montana that had long escaped the worst of the pandemic have seen case numbers soar to alarming new records. Deaths, though still well below their peak spring levels, averaged around 700 per day by mid-October, far more than were reported in early July.”

USA Today quoted the nation’s leading and currently most listened to infectious disease expert on the glum indicators about the pandemic:

“Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said the share of positive coronavirus tests is increasing in the Northwest, Midwest and other northern states.  The share of tests that detect the virus is a key indicator of whether the coronavirus is spreading or under control in a community. Public health officials want to see less than 3% of all tests return positive. An ideal rate is less than 1%, Fauci said Tuesday during a College of American Pathologists meeting. ‘We’re starting to see a number of states well above that, which is often, and in fact invariably, highly predictive of a resurgence of cases,’ Fauci said. A rise in the share of positive cases ‘we know leads to an increase in hospitalizations and then ultimately an increase in deaths.’”

CNN offered a succinct explanation of the dreaded seasonal surge, which authorities had hoped the nation would avoid:

“The fall Covid-19 surge is here, fueled by colder weather, reopened schools and pandemic fatigue. The flu season could make the coronavirus pandemic even worse. For the next several months, new Covid-19 infections, hospitalizations and deaths are expected to keep rising as the temperatures keep dropping.”

Although a flailing President Trump and the White House may be undercutting the evidence-based best guidance for how Americans best can safeguard themselves, the steps remain simple and clear:

  • keep up high hygiene, especially with vigorous hand washing
  • cover your face, including both the mouth and nose (and eyes if you can)
  • maintain distance from others, avoid closed spaces and close contact, especially for prolonged periods
  • get a flu shot and keep up the recommended vaccinations for grownups and kids
  • try to keep your spirits up and avoid infection fatigue

Public health officials worry that the respite Americans have found by avoiding the aggressive transmission of the coronavirus aerosol transmission by staying at distance and outdoors may give way now to confined indoor spaces. The holidays also are racing toward us, with some experts arguing that kids may be able to trick-or-treat for Halloween with caution, while others urging friends and families to think hard about Thanksgiving feasts.

The reckless optimism about medical interventions to deal with the pandemic seems to have subsided a bit, especially as rigorous clinical trials for a coronavirus therapy (with monoclonal antibodies) has been paused for safety reasons, as have studies of prospective virus-fighting vaccines. A large-scale scrutiny of the much-promoted drug remdesivir also has produced key knowledge about the anti-viral medication. Though it has been flogged as a way to shorten the duration of infections, researchers say it does not show evidence of preventing patient deaths.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.

It is a tragic and frustrating part of the pandemic that the presidential race and a shambolic federal response to the coronavirus by the Trump Administration has fostered unhelpful confusion and counter-factual misinformation about dealing with Covid-19, likely contributing to yet another surge of the disease as the nation is experiencing. How can it be that our contemporary handling of a pandemic can be so unchanged as to be easily compared to how Europeans, notably in Florence, Italy, dealt centuries ago with the plague?

The Kaiser Family Foundation and the sports site the Undefeated have released results of their polling of African Americans, finding significant skepticism about a prospective coronavirus vaccine, whether black men, women, and children ought to take it, and whether the historic abuse and neglect of black patients has changed, particularly during a pandemic that has taken a disproportionate toll on blacks, Latinos, and native peoples. A perspective article in the New England Journal of Medicine offers a concurrence of sorts, arguing that the challenges in getting a coronavirus vaccine into wide acceptance also underscores how the U.S. health system owes itself to its patients, especially African Americans, to prove anew its trustworthiness and credibility.

We’ve all got to hunker down and do a lot of work in the cold, gray, winter days to battle the coronavirus and to see that our country and its health care system move to a far better place than it is now in the days ahead.

Map: New York Times illustration of states with high, rising, and steady coronavirus cases.
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