It’s time to hunker down
The end may be near for the pestilence that has haunted the world this year. Good news is arriving on almost every front: treatments, vaccines, and our understanding of this coronavirus.
Pfizer and BioNTech have announced a stunning success rate in their early Phase 3 vaccine trials—if it holds up, it will be a game changer. Treatments have gotten better too. A monoclonal antibody drug—similar to what President Donald Trump and the former Governor Chris Christie received—just earned emergency-use authorization from the FDA. Dexamethasone—a cheap, generic corticosteroid—cut the death rate by a third for severe COVID-19 cases in a clinical trial.
Doctors and nurses have much more expertise in managing cases even in using nonmedical interventions like proning, which can improve patients’ breathing capacity simply by positioning them facedown. Health-care workers are also practicing fortified infection-control protocols, including universal masking in medical settings
Our testing capacity has greatly expanded, and people are getting their results much more quickly. We may soon get cheaper, saliva-based rapid tests that people can administer on their own, itself a potential game changer.
The Centers for Disease Control and Prevention has finally acknowledged that aerosol transmission happens and that ventilation is important. The initial bungled messaging and science around masks was unfortunate, but things have turned around; the CDC has even publicized how masks can help protect the wearer from infection, as well as lower the chances of onward transmission. The importance of clusters and super-spreading is more widely appreciated, maybe partly because of the highly publicized White House cluster, which is still simmering.
We have reasons to celebrate, but—and you knew there was a but—a devastating surge is now under way. And worse, we are entering this dreadful period without the kind of leadership or preparation we need, and with baseline numbers that will make it difficult to avoid a dramatic rise in hospitalizations, deaths, and potential long-term effects on survivors.
Almost every day, America is breaking new records in confirmed cases: They are up 40 percent from just one week ago. These cases are not confined to a region or a state; the whole nation is in the midst of a terrible surge. So too is much of Europe, where country after country is experiencing record numbers of cases.
This is not a “casedemic”—the false notion that we just have better testing and detection, without any real change in the underlying risk for illness and death. It’s true that we missed a lot of cases in the spring because we didn’t have enough tests, and that we are catching more of them now. But it’s not just confirmed cases that are on the rise. The United States is also experiencing a steep increase in hospitalizations, as well as about 1,500 reported deaths a day; those are the highest numbers since mid-May, and they are still rising sharply. Trevor Bedford, a scientist at the Fred Hutchinson Cancer Research Center, in Seattle, calculates that more than 2,000 deaths a day may already be baked in for early December, meaning that even if we stopped every new infection from now on, we’d still see that many people die per day in just a few weeks among those already infected. [Continue reading…]