“We could be surprised again”: an unpredictable pandemic wreaks terrible havoc


The Philippine Red Cross is distributing relief supplies to families affected by COVID-19 in Caloocan City on September 11, 2020. The distribution is in partnership with the People’s Republic of China and local barangay officials. Jonathan Cellona, ​​ABS-CBN News

It’s a staggering toll, nearly 200,000 people have died from the coronavirus in the United States, and nearly five times as many – nearly one million people – worldwide.

And the pandemic, which has driven cases up in many countries and then down after lockdowns, has reached a precarious point. Will countries like the United States see the virus continue to slow down in the months to come? Or is a new wave on the way?

“What’s going to happen, nobody knows,” said Catherine Troisi, infectious disease epidemiologist at the University of Texas Health Sciences Center at Houston. “This virus has surprised us on many fronts, and we may be surprised again.”

In the United States, fewer new cases of coronavirus have been detected week by week since the end of July, following heartbreaking outbreaks first in the northeast, then in the south and west.

But in recent days, the daily number of new cases in the country is rising again, fueling concerns of a resurgence of the virus as universities and schools reopen and colder weather pushes people indoors before that. that some epidemiologists fear it will be a devastating winter.

The coronavirus death toll in the United States is now roughly equal to the population of Akron, Ohio, nearly 2 1/2 times the number of U.S. servicemen who have died in combat in Vietnam and in wars of Korea combined, and about 800 still are. die daily.

Around the world, at least 73 countries are seeing an increase in newly detected cases, and concerns are growing rapidly.

In India, more than 90,000 new cases are now detected daily, adding 1 million cases since the start of the month and pushing the total number of cases in the country to past 5 million.

In Europe, after lockdowns helped quell the crisis in the spring, the virus is once again burning its way across the continent as people move on with their lives.

Israel, with nearly 1,200 deaths attributed to the virus, imposed a second lockdown last week, one of the few countries to have done so.

When the first wave of infections spread around the world, governments imposed drastic restrictions on travel: more than 4 billion people were under some sort of stay-at-home order at one point. But most countries are now desperately trying to avoid resorting to such intense measures again.

“We have a very serious situation unfolding before us,” said Hans Kluge, World Health Organization regional director for Europe, last week. “Weekly cases have now exceeded those reported when the pandemic first peaked in Europe in March.”

Across Latin America, the death toll stands at over 310,000. Two-thirds of the total comes from just two countries: Brazil with over 132,000 reported deaths and Mexico with 72,000. Dr Carissa F. Etienne, director of the Pan American Health Organization, warned that the threat persisted.

“Latin America has started to return to almost normal social and public life at a time when COVID-19 still requires major control interventions,” she said last week. “We need to be clear that opening too early gives this virus more room to spread and puts our populations at greater risk. Look no further than Europe. ”

Deaths in the United States from the coronavirus topped 199,300 on Sunday afternoon, leaving families across the country in mourning. Just four months ago, at the end of May, the nation’s death roll reached 100,000. Even the current tally may be a significant undercoverage in the US toll, analyzes suggest, but not including some. people who have died of COVID-19 as well as those who die from secondary causes also linked to the pandemic.

As the virus overtook the United States this spring, deaths have increased. By mid-April, more than 2,000 people were dying on average every day. Deaths rose again this summer as cases increased in the south and west. The pace has slowed down considerably since then.

Although the capacities of health care systems vary widely across the world, the early detection of infections, efforts to keep the virus out of nursing homes and away from the most vulnerable groups, and better treatments have meant that fewer people need to be ventilated and improved. results for those who become seriously ill.

Yet as the vaccine race continues, there is no cure for COVID-19.

Every day, about 800 people with the virus die on average in the United States. This is down from more than 1,200 deaths per day in early August. Yet even as some of the country’s most populous states report vast improvements and states in the Northeast have kept new infections low, deaths continue to rise in nine states and two territories.

Dr Tom Inglesby, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, said it was conceivable that the death toll in the United States could reach 300,000 if the public let their guard down.

“There are a lot of countries that we could think of as our economic peers, or that are much less developed in terms of economics or health care systems, that have much less mortality,” he said.

The contrast to other wealthy industrialized countries is stark, reflecting how the virus is still tearing parts of the United States apart. In one day last week, the United States reported 849 new deaths. On the same day, Italy, once the epicenter of the pandemic, had 13 dead. Canada and Germany reported seven deaths that day.

The virus took off later in the United States than in other places, but cases were never fully contained. Since the start of April, the country’s average daily case total has not fallen below 20,000, and a key question arose at the end of the summer: a general downward trend in reports The nation’s dailies on new cases and deaths since August continue – or was a recent increase in cases indicative of a worrying new trend?

Yvonne Maldonado, a pediatric infectious disease specialist at Stanford University, compared the country’s current situation to that of California weeks ago when a new wave of cases emerged.

“For those of us in California, we went through this time where we were really proud of the lockdown and our ability to really flatten the curve,” said Maldonado. “We ended up getting overconfident.”

The pandemic could be prolonged, she warned, like the influenza pandemic of a century ago. Then the deadly flu swept through the United States in three waves: one in the spring of 1918, another in the fall, and another in the winter and spring of 1919. In this influenza pandemic, approximately 675,000 Americans are dead.

New factors are adding to the uncertainties over the course of the coronavirus. Cold weather should test the risks of shared indoor air more than ever. The onset of flu season threatens to further stretch the health care system. And the success of efforts to stop the virus from spreading to newly restarted schools and college campuses remains uncertain.

Many of the country’s largest school districts start the year with distance education, but most states have at least some school districts, mostly in rural or suburban areas, that have open for in-person instruction.

Schools in states like Georgia and Indiana have already been open for a month, but experts say they cannot yet be sure of the effect on the transmission of the virus in communities.

Bill Hanage, associate professor of epidemiology at Harvard’s TH Chan School of Public Health, said that due to the huge variation in the way schools reopen – some schools strictly enforce social distancing and mask requirements and others are doing much less – to be broad enough in terms of consequences. ”

Already, a return to colleges and universities, with widespread testing on campuses, has resulted in an increase in known cases. More than 88,000 cases of coronavirus have been reported at more than 1,100 U.S. colleges during the pandemic, according to a New York Times investigation.

Campus transmission is expected to be less deadly among students, but experts fear these cases could lead to larger and more dangerous epidemics when young people interact with faculty, family members and others. neighbors.

And indeed, the metropolitan areas where the virus grew most rapidly included places where university outbreaks were significant: La Crosse, Wisconsin, home to the University of Wisconsin-La Crosse, the University of Viterbo and the Western. Technical College; State College, Pennsylvania, headquarters of the main campus of Pennsylvania State University; and Gainesville, Florida, home to the University of Florida. Other college towns have also reported skyrocketing increases, including Provo, Utah and Manhattan, Kansas.

“If this spike continues, it will put a strain on our systems,” wrote Andrew P. Manion, president of Edgewood College in Madison, Wisconsin, in a letter imploring students to follow social distancing rules following an increase in cases. . “The short term payoff of going to a party comes at the cost of making more people sick. If this trend continues, I will make the painful but necessary decision to end the semester via fully distance learning courses, and the residences and offices will close for the semester.

The initial months of the pandemic brought flooding of cases to urban and coastal areas across the United States, but the virus is spreading widely now, in rural communities and in places that had seen few or even cases of cases. none at first. States in the center of the country, including Wisconsin, Montana and North Dakota, have seen higher numbers of cases in recent days than ever.

The infection rate in North Dakota last week was double that of Texas and more than quadruple that of California, two earlier hot spots. The infection rate measures cases of the virus per 100,000 people, and North Dakota, which has reported more than 17,000 cases and 190 deaths during the pandemic, has only about 760,000 people.

Still, more than half of North Dakota’s cases have been reported since the start of August.

“At first it was a big city disease and we watched it on television,” said Sister Kathleen Atkinson, a Benedictine nun who is director of a ministry in Bismarck, the capital of North Dakota. “Now, there isn’t a single county that hasn’t had positive cases, and that’s part of everyone’s life.”

© The New York Times Company

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