As the country prepares for its next big spike in COVID-19, many are asking themselves—are we already in it?
New York Magazine tacked the beginning of this wave to President Trump’s diagnosis at the beginning of October. Numbers of cases across the country are rising, particularly in the midwest and rural regions. Two of the most populous counties in North Dakota, where there is no mandate to wear a mask, have become hotspots. The Daily Beast noted that rising cases there have become so bad that a candidate running for a seat in the state’s house of representatives, has passed away but will still be on the election ballot.
The country as a whole now has more than 8 million known cases, according to The New York Times. North Dakota, South Dakota, Montana, and Wisconsin have all reached troubling new case rates: over 300 cases per 100,000 people. But the general upward trend extends beyond those states. In total, 45 states are seeing increased cases numbers.
Meanwhile, Europe is facing a new spate of shutdowns. The World Health Organization noted in a press briefing last week that Europe’s case numbers grew by a million in the short span of 10 days, bringing the total number of reported cases to 7 million.
Even though the organization anticipates more cases and more burden to hospitals during this spike than in April, there was a bright spot in the report.
“Although we record two to three times more cases per day compared to the April peak, we still observe five times fewer deaths,” said, Dr. Hans Henri P. Kluge, WHO Regional Director for Europe. He cuffs the higher infection to more testing capacity, especially among young people, and higher transmission among young people. That also explains the lower death rate.
“These figures say that the epidemiological curve rebound is so far higher, but the slope is lower and less fatal for now,” he said. “But it has the realistic potential to worsen drastically if the disease spreads back into older age cohorts after more indoor social contacts across generations.”
A much larger number of people could die in this upcoming season of COVID-19 than did in April, Kluge said.
The key to preventing contagion is sticking to the very protocols that helped curb transmission in the first place. Kluge said widespread mask wearing and limits on social gatherings could save up to 281,000 lives in Europe. Already, Britain is imposing new restrictions in certain areas against spending time indoors at other people’s houses and is asking people to limit their use of public transit. France, where there are 30,000 new cases, is instituting stronger guidelines for restaurant dining and gathering in public. In parts of the country with particularly high rates of disease, people will not be allowed to leave their homes without some sort of certification that they need to travel.
In Europe, politicians are strategically locking down hotspots as opposed to whole cities. New York City has taken a similar approach, shutting down businesses, schools, and houses of worship in areas where virus numbers are climbing. While New York has seen a growth in cases, Columbia University’s Wafaa El-Sadr says it’s too early to say that New York is in its winter wave.
“It is a bit premature to describe the spike in cases in NYC as a major surge,” says El-Sadr, who serves as the director of Columbia’s public health institute ICAP. “The next few weeks will show whether the spike now in some neighborhoods in NYC will be quenched by the measures put in place or whether there will spread of the virus to other neighborhoods in NYC.”
Her comment hits on the truly local nature of infection waves. Even though cases are rising nationally, even internationally, it’s not reflective of what’s happening in individual counties, cities, or neighborhoods. This may make it hard to know whether you as an individual are in the trough or peak of a wave. It also doesn’t tell you anything about how high the wave you’re in will reach when it ultimately crests. All that depends on local tactics.
Americans face scattershot policies on containing the virus, with some states embracing strict new rules around gatherings and mask wearing and other states forgoing these measures all together. Only 34 states require citizens to wear a mask in public.
There’s good reason to believe that the virus could spread beyond the small areas where cases are rising now. But how far they spread will ultimately rest on what policies are put in place by public officials and whether the public abides those policies. In the U.S. in particular, public health efforts have been undermined by politics. President Trump has frequently downplayed the health ramifications of COVID-19. State policies have proven to be extremely politically charged and do not always reflect the advice of scientists and public health officials. People who live in absence of cogent public health policy concerning COVID-19 are undoubtedly at higher risk.
Wisconsin’s governor tried to limit indoor gatherings at venues to 25% of their normal capacity only to be sued by a local trade association and blocked by the courts while the case plays out. South Dakota has no mask requirement or other restrictions, leaving its citizens to make decisions for themselves about how they want to respond to information about the virus. Montana, on the other hand, has been requiring masks since July. It has also restricted gatherings to no more than 50 people. On Tuesday, the governor asked people to stay socially distant and instituted new rules in Yellow Stone County in particular, preventing gatherings over 25 people. Governor Steve Bullock, who has been continuously committed to reopening the state and allowing businesses to continue operating, says he wants to get cases below 40 per 100,000. But his efforts seem to be hampered by counties that don’t want to participate in these restrictions, per reporting from The Montana Free Press.
Restrictions on gathering have also drained the common public psyche. Even New York, whose residents have largely complied with restrictions, is having a crisis of faith. Houses of worship are rioting and filing lawsuits over closures brought on by new restrictions aimed at stopping the spread of a new crop of COVID-19 cases.
Still, El-Sadr says, if people can keep up mask wearing, physical distancing, and avoid crowds, it will go very far towards preventing spread. She also says it’s crucial people get a flu vaccine. There is a lot of overlap between flu and COVID-19 symptoms and she’s concerned that people will show up to the hospital thinking they have COVID-19 when really they have the flu. Reducing flu cases will lower the strain on hospitals.
“I understand the frustration that the public has, since my husband and I have been essentially locked down since end of February since he is high risk,” says Steffanie Strathdee, associate dean of global health at University of California San Diego and author of The Perfect Predator.
“The next time you are tempted to go indoor dining or to a party, ask yourself if it’s really worth putting you or your family at risk of being on the ventilator,” she says. “My husband was in the ICU fighting a superbug infection prior to the COVID-19 pandemic for months. Every time I think of what hell he and our family went through, I realize nothing is worth taking that kind of risk.”