States have arrived at a crossroads that will define the coronavirus pandemic in the United States as half of the country struggles to manage rising COVID-19 cases, health experts say.
Dr. Anthony Fauci, the top infectious disease expert at the National Institutes of Health, told Congress on Tuesday that the next two weeks will be "critical" in how the country addresses the surge in states like Florida, Texas and Arizona.
Experts say states that don’t manage their case counts risk overwhelming the health care system again and infecting neighboring states that have already flattened the curve. While summer travel is expected to decline 15% from last year, AAA still projects 683 million road trips from July to September, which could spread coronavirus.
All this could happen ahead of the fall, when the coronavirus may reappear in a second wave and likely be accompanied by the flu.
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Are lockdowns needed?
The U.S. on Wednesday saw its highest number of new coronavirus cases in months, with three of the nation's most populous states — California, Texas and Florida — reporting record-setting highs in daily new cases.
California reported 7,149 new cases Wednesday. Texas reported 5,551 new cases. And Florida reported 5,508 new cases.
Some say intermittent lockdowns are essential to control flare ups. Fauci, however, said it might not be necessary for states to issue a total lockdown, but instead roll back or pause reopening phases until cases are manageable.
Gov. Greg Abbott hit pause on Texas reopening plans on Thursday and suspended elective surgeries in the state’s largest counties. Phase 3 plans included increasing restaurant and business occupancy, and allow amusements parks and carnivals in counties with more than 1,000 cases to operate at half-capacity.
“We want to make sure everyone reinforces the best safe practices of wearing a mask, hand sanitation, maintaining safe distance, but importantly, because the spread is so rapid right now, there’s never a reason for you to have to leave your home unless you need to go out,” Abbott said earlier in the week. “The safest place for you is at your home.”
Texas still plans to reopen schools this fall, though the Texas Education Agency delayed releasing public health guidelines on how districts should safely do that.
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'People aren’t doing those most basic things'
It's not surprising based on how Texans have been acting that Houston is getting close to a crisis situation, said Catherine Troisi, an infectious disease epidemiologist at The University of Texas Health Science Center at Houston.
"In my opinion, we have not seen the worst of it and the next couple of weeks are going to be hard," she said. "The only way to get out of this, as we know, is physical distancing, mask wearing, washing your hands, staying away from other people – all the things public health folks have been saying all the time."
Statewide, the number of COVID-19 tests coming back positive jumped from 7% to 11% in just a week, showing that the increase in cases is real, Troisi said, not an artifact of extra testing.
In the county that includes Houston, people are now required to wear masks when they go inside businesses, but with the governor opposed to most public health measures, little else has been done to slow the spread, Troisi said.
"Ultimately, people spread the disease. Unless people start paying attention to these public health messages and doing them, I don’t think it looks good," she said. "Even if magically today, we shut down all transmission, we would continue to see for the next week or two or three increased cases and hospitalizations. And that’s scary."
The Universal of Washington’s Institute for Health Metrics and Evaluation released a model Wednesday that predicted a universal mask-wearing order could save the country as many as 33,000 lives.
But mask-wearing has become politicized, with anti-mask rallies held in Arizona even as Gov. Doug Ducey gave local communities the authority to require masks last week, and both Scottsdale Mayor Jim Lane and the Phoenix City Council issued mask mandates this week.
“We’re in this situation now because people aren’t doing those most basic things,” said Dr. Ron Waldman, professor of global health at George Washington University’s Milken Institute School of Public Health.
What states can do
Waldman believes the only sure way to prevent transmission is to close businesses and keep everyone home, but he understands that many state officials are unwilling to do that for the economy's sake.
“The more stringent measures are certainly the best way to turn the situation around,” he said. “If we cannot do that, then we have to at least institute a number of interventions that we know can have a serious beneficial impact on reducing transmission.”
He said states should be enforcing public health guidelines. For example, New York Gov. Andrew Cuomo signed an executive order in May that allowed businesses to deny entry to anyone not wearing a mask or face-covering.
The Texas Alcoholic Beverage Commission cracked down on bars not following social distancing protocols by suspending their alcohol licenses during an undercover investigation.
Arnold Monto, professor of epidemiology at the University of Michigan School for Public Health, says that in addition to enforcement, state officials must clearly communicate what's expected of residents and lead by example.
Some hospitals may reach capacity by July
Health officials have consistently reiterated that keeping the health care system functional was a main priority during the coronavirus pandemic.
“When we started the lockdown, the goal was to spare our health care system to make sure our hospitals weren’t being overrun,” Waldman said.
In Arizona, 88% of hospital ICU beds were filled with patients on Tuesday. Texas broke its record for hospitalizations for the 13th day in a row reporting 4,389 patients in hospitals Wednesday.
Interim Austin-Travis County Health Authority Dr. Mark Escott said that while 1,500 beds are available for COVID-19 patients across Central Texas hospitals, that may not be the case in the two to three weeks. At their current pace, hospitals may reach their capacity by mid-July, he said Wednesday.
"When hospitals are evaluating the anticipated future demands, you have to be thinking two to four weeks ahead," said Caitlin Rivers, epidemiologist at the Johns Hopkins Center for Health Security.
Texas Children's Hospital confirmed on Twitter Wednesday that it's already beginning to receive adult patients to create more capacity at other hospitals. In emailed statements to USA TODAY, Nicklaus Children's Hospital and Johns Hopkins All Children's Hospital in Florida both say they stand ready to help nearby hospitals if their areas experience a sudden surge in cases.
The American Health Care Association and National Center for Assisted Living, which represents more than 14,000 facilities, said the strain brought by the pandemic has put the nursing home industry on the "verge of collapse."
“It’s important to turn things around (now), what we don’t want is the outbreaks to be out of control and stress the health care system," Rivers said.
More than 40,600 residents and employees of long-term-care facilities had died of COVID-19 by early June, according to an analysis by USA TODAY. Containing the spread within nursing homes has come at a high price as facilities scramble to source protective equipment, secure testing and fill staffing shortages.
Second wave and the flu
Finally, experts are concerned that the mismanagement in coronavirus cases now will impact the country’s preparedness for the fall.
"We need to fix this and correct it fast," said Joseph Allen, director of the Healthy Buildings program at Harvard T.H. Chan School of Public Health. "If we don’t, we will be going into the fall with a high case count heading into the potential (second) wave with runaway cases in some areas."
The Centers for Disease Control and Prevention estimates that seasonal flu was associated with more than 490,000 hospitalizations and 34,000 deaths during the 2018-2019 influenza season.
Early CDC estimates predict there were 410,000-740,000 flu hospitalizations and 24,000-62,000 deaths from October 2019 through April 2020.
“If we’re seeing COVID-19 and flu at the same time then we have a double whammy," Monto said.
While many experts expect a second wave of COVID-19 cases in the fall when conditions for the coronavirus to transmit are more preferable and schools are in session, other experts like Rivers are quick to point out that nothing is certain.
“Exponential growth is a really powerful force," Rivers said. "The longer you let it unfold the harder it is to overcome."
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