As Cases Jump, Are We Better Prepared for COVID?

Jay Croft

July 02, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

People are hitting the beaches. Stores and restaurants are reopening. Baseball is back (at least spring training).

Yet just as life seems to be returning to something more normal, there's also worrisome news.

There are record numbers of COVID-19 cases in the U.S., with several states in the South and West driving the resurgence. Texas has closed its bars, California has closed its restaurants in some counties, and some beaches in Florida are closed.

 

Officials of all political stripes are encouraging people to wear masks, if not mandating it.

Has the country made progress in containing this disease?

"As we see new cases rising ― and we're tracking them very carefully ― there may be a tendency among the American people to think that we are back to that place that we were 2 months ago, that we're in a time of great losses and great hardship on the American people," Vice President Mike Pence said last week at the first briefing in 2 months of the White House task force on the pandemic. "The reality is we're in a much better place."

Richard Besser, MD, president and CEO of the Robert Wood Johnson Foundation and a former CDC acting director, says there's been improvement in some crucial areas.

For example, more hospitals have personal protective equipment (PPE) for front-line employees, he says, although many hospitals say they're still woefully short. More testing is available. Doctors understand more about the virus and treatment.

But, on the whole, "We're in worse shape than we were 2 to 3 months ago," Besser says.

Many health experts agree, and some governors have paused or rolled back their state's efforts to reopen the economy. As more of their residents get sick, states are again trying to keep them at home more, knowing that business restrictions could bring political heat from constituents eager to work and resume other normal activities.

"We are not even beginning to be over this," says Anne Schuchat, MD, the CDC's principal deputy director, offering a summary of expert opinion.

So where exactly do we stand? Here's a look at new case numbers, death rates, hospitalizations, and more.

On Death Rates, Hospitals, and Medication

The number of people dying each day has slowed, Pence said. People are getting diagnosed earlier, hospitals are sharing treatment information, and some drugs are helping recovery.

"We can still take some comfort in the fact that fatalities are declining," Pence said, pointing out that last week, there were 2 days when fewer than 300 Americans died, down from a peak of more than 2,500.

We can still take some comfort in the fact that fatalities are declining. Vice President Mike Pence

But death rates typically lag behind diagnoses, experts say, so an increase in deaths could be coming soon. More younger people have begun testing positive. Their death rate is lower, but they are able to infect others, including more vulnerable people with whom they come in contact.

Hospitals might be, in some ways, better prepared ― certainly, at least, now experienced ― in dealing with the coronavirus than they were a few months ago.

But many report they're at or approaching a crisis point with COVID-19 patients and available ICU beds. On June 29, 33 states were at 80% or greater capacity of their ICUs and beds, according to CovidExitStrategy.org. That's up from 23 on May 28.

In Los Angeles, health officials say the city's hospital beds could reach capacity in a few weeks.

And experts say contact tracing and testing capacity still lag.

Medication is helping somewhat. A trial sponsored by the National Institutes of Health found that the drug remdesivir cut recovery time by an average of 4 days. It did not improve the death rate. In the United Kingdom, a trial found that dexamethasone ― a cheap, common steroid ― can save the lives of people seriously ill with COVID-19.

The cost of remdesivir will be more than $3,000 per treatment course for Americans who have private insurance, and about $2,300 for those who have government-sponsored insurance, its manufacturer, Gilead Sciences, and the U.S. Department of Health and Human Services say.

Results Are "Tip of the Iceberg," Former CDC Chief Says

More Americans are being tested than in April, and public health officials say that's a good thing.

"To one extent or another, the volume of new cases coming in is a reflection of a great success in expanding testing across the country," Pence said.

The numbers you're seeing are just a tip of the iceberg of even more spread. Tom Frieden, MD, former CDC director

But it's not so simple, according to statistics and health experts.

"As a doctor, a scientist, an epidemiologist, I can tell you with 100% certainty that in most states where you're seeing an increase, it is a real increase," says Tom Frieden, MD, a former CDC director. "It is not more tests. It is more spread of the virus. ... The numbers you're seeing are just a tip of the iceberg of even more spread."

Some states are seeing higher percentages of positive tests, not just higher numbers of positive tests. "That's explosive spread of coronavirus," Frieden says.

Anthony Fauci, MD, the country's top expert on infectious diseases, told a Senate hearing June 30 that the country could go from "now having 40-plus thousand new cases a day … to up to 100,000 a day if this does not turn around."

The CDC now says the number of Americans who have been infected could be 10 times higher than those revealed by testing ― because relatively few people have been tested at all.

"The window is closing" for the country to control the pandemic, the administration's top health official, Health and Human Services Secretary Alex Azar, said 2 days after Pence's comments.

"This is a very, very serious situation," he said.

What Slowing the "Reopenings" Means

New cases hit a record June 26, breaking the mark set just the day before, numbers from Johns Hopkins University reveal. The country's daily average of new cases was also higher than ever. And more than 30 states saw their own numbers rising, as well.

That caused states including California, Arizona, Texas, and Florida to halt or lessen their efforts to reopen the economy. It again brought into sharp focus the struggle to balance economic freedom with public health, a problem faced by governments at all levels, health care experts, business leaders, and ordinary Americans. After the devastating effects of the initial shutdowns ― lost businesses, high unemployment, lower consumer spending, and more ― the country saw economic improvement as more people returned to work

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Los Angeles officials were not prepared for the surge in cases. Mayor Eric Garcetti said after Pence’s comments that the next 2 weeks would be a "second big test" to see if the state can "keep people living and to keep livelihoods."

Other examples of governors forced to reinstate restrictions on business, knowing they would face political backlash from some businesses, voters, and local governments desperate for revenue:

  • In Texas, bars are closed.

  • So are some Florida beaches, ahead of the Independence Day holiday.

  • Arizona closed bars, gyms, theaters, and more, with the governor citing "brutal" case numbers that he expects to continue to rise.

  • New York, New Jersey, and Connecticut are requiring visitors from 16 states with rising coronavirus case numbers to quarantine for 2 weeks before they’re allowed to visit.

"These increases (in new cases) are in many places," Schuchat says. "It’s so many geographic areas. We're clearly not at a point where there's so little virus being spread that it's going to be easy to snuff out."

The Way Forward

Besser says that at first, the country had a shared sense of purpose and a belief that individual actions can have an effect on the pandemic. But since then, political pressure and a desire to get back to working and socializing have clouded the mission.

Pretending that the virus is going away is not a very successful strategy. Richard Besser, MD, president and CEO, Robert Wood Johnson Foundation

"We’re seeing consequences of that now," he says, also noting that Black people, Hispanics, and many "essential" workers are still suffering and dying disproportionately.

"Pretending that the virus is going away is not a very successful strategy," Besser says, calling for continued commitment to masks, hand-washing, and social distancing, plus testing, tracing, and isolating patients.

"To sustainably reopen the economy, we need to follow the path being laid out by public health," he says. That means, among other things, seeing 2-week declines in cases and hospitalizations, and ensuring hospitals can handle COVID-19 needs as well as non-pandemic care.

"We can successfully contain and control this," Besser says. "The big question is will we."

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