Peak of third COVID-19 wave still weeks away

The skyrocketing number of new coronavirus infections in the United States is likely to climb further over the next several weeks, even in the hardest-hit areas where soaring case loads are starting to overwhelm hospitals and medical facilities.

New cases appear to be reaching a peak in the Dakotas and Iowa, where infections are at their highest levels since the pandemic began. But most states experiencing a COVID-19 surge are weeks behind those epicenters as tens of thousands of people test positive every week.

“It’s starting to plateau in relatively few locations, but it’s giving us a sense that many areas could continue to experience this into January,” said David Rubin, a physician who runs the PolicyLab at the Children’s Hospital of Philadelphia. “This is a hard period.”

A January peak would put the height of the coronavirus pandemic around the time of President-elect Joe Biden’s inauguration on Jan. 20.

Forty-three states and the District of Columbia recorded more cases last week than the week prior. More than 1 percent of North Dakota’s population tested positive for the coronavirus this week, as did nearly 1 in 100 residents in Wyoming.

Twenty-seven states now have higher per capita infection rates than did Arizona during its summer surge. More than 83,000 people are in U.S. hospitals with COVID-19, the highest figure during the pandemic. And more than 80 percent of intensive care unit beds are occupied in 16 states.

The case surge has been most acute in rural communities, where health care options are fewer. Many small hospitals are full to overflowing, and patients can wait six to eight hours for a transfer to a larger medical center that can admit them — if those larger facilities aren’t already overrun. 

“We’re full,” said Rob Davidson, an emergency room physician in a western Michigan hospital that has 25 beds. “The only time you get a bed is if someone dies.”

Still, millions of Americans are resuming everyday activities, fatigued by the strains of a pandemic that has dragged on for eight months. Davidson’s hospital is 15 miles from a restaurant where patrons rallied against Michigan’s coronavirus restrictions and dined indoors, without masks.

The region saw an uptick in cases in the weeks after President Trump held last-minute rallies in Muskegon and Grand Rapids. While the statewide positivity rate in Michigan is around 11 percent, it is closer to 20 percent in western Michigan. 

The normal trajectory of a coronavirus infection hints at a situation that will only devolve in the coming weeks, potentially worsened by the Thanksgiving holiday that public health experts have warned could become a nationwide superspreading event. Hospitalizations typically occur a week or two after a confirmed case. Recovery or death lags another week behind hospitalization.

States “are likely to have a long tail and face real significant pressure from hospitalizations for a few weeks here,” Rubin said.

Health facilities are already experiencing a substantial staffing shortage as more patients demand more care. Early in the pandemic, doctors and nurses traveled to New York City to aid the surge of patients, and then from New York City to other hot spots around the country to handle local conflagrations.

But now that the virus is spreading so rapidly in so many places, there are no more traveling doctors or nurses.

“There’s nobody who’s willing to give up staff or move people around, because they’re either in it or anticipate being in it in the next few weeks,” Davidson said.

Hospitals in half the states are experiencing a critical shortage of nurses and doctors, according to a survey conducted by STAT News.

The Centers for Disease Control and Prevention (CDC) has warned against traveling during the Thanksgiving holiday, though there are signs that Americans are resuming some of normal life. The Transportation Security Administration reported screening more passengers at the nation’s airports on Sunday than on any day since the beginning of the pandemic.

“Better a Zoom Thanksgiving than an ICU Christmas,” wrote Tom Frieden, who led the CDC during the Obama administration and now runs the global health nonprofit Resolve to Save Lives.

The hopeful signs of a vaccine — the pharmaceutical company AstraZeneca said Monday its COVID-19 vaccine candidate appears to be highly effective, the third such candidate to show promising signs in recent weeks — are a light at the end of the tunnel, health experts said. But they caution that there is still more tunnel to get through before then.

“The public should be wildly enthusiastic about the early success of these numbers,” Rubin said. “The night is darkest right before the dawn.”