US Tops 10 Million Cases Amid COVID-19 Surge

Brenda Goodman, MA

November 09, 2020

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

The U.S. began another dark chapter in its COVID-19 epidemic, cresting 10 million cases and approaching nearly a quarter of a million deaths from the virus.

Many Asian countries that were hit hard early on have now controlled their outbreaks with tried-and-true measures, like wearing face masks, social distancing, and quarantines.

But in America, where the public health response to the new coronavirus has collided with deep political and social divisions, the outbreak has simmered along barely checked as public trust in science and government has foundered.

Now, as temperatures drop and people are spending more time indoors, where risk of catching the virus is greatest, the public is struggling with pandemic fatigue. Health care workers who have been on the front lines for months are burning out.

Experts are warning weary Americans that as bad as the current situation is, it will almost certainly get worse over the coming winter months.

"It will get worse if we don't pull it together, if we don't realize this is us against the virus and not people against people," says Viviana Martinez-Bianchi, MD, director for health equity at the Duke Department of Family Medicine and Community Health.

Already, the U.S. is setting records for cases almost daily, logging close to 100,000 cases a day over the last week. Internal reports from the White House Coronavirus Task Force, obtained by the Center for Public Integrity, currently show 38 states in the red zone for cases. The "red zone" means the state has crossed a threshold of at least 101 new cases for every 100,000 people.

Cases are so high in the U.S. that we are now recording more cases each day than China and Japan have had in total since the beginning of the pandemic.

"This is an unimaginable tragedy. I mean if you had said to anybody in January, this is where we will be, I don't think anybody would have believed you," says Heidi Tworek, PhD, a professor of international history and a specialist in science communications at the University of British Columbia in Vancouver. "It's an extraordinary tragedy," she says, "a tragedy that was preventable with strong public health."

Cases Explode in Midwestern States

In Colorado, where COVID hospitalizations and cases have recently reached all-time highs, Gov. Jared Polis urged residents to take precautions.

"Colorado, I love you, but this in an intervention," he said in a news release. With one out of 100 people living in the Denver area contagious with COVID-19, he urged everyone to stop mingling with anyone outside their own families. "Each of us needs to do better. We need to see less people, as difficult as that might be for the next month," he said in a recorded statement.

In Wisconsin, where internal White House Coronavirus Task Force documents flagged an "unrelenting rise in cases" and an "ongoing public health emergency," Lt. Gov. Mandela Barnes told journalist Don Lemon on CNN, "We are in a crisis right now in the state of Wisconsin, and it's scary." Ninety percent of Intensive Care Unit beds in Wisconsin are filled. Eighty-five percent of counties in the state have seen high levels of community transmission, according to the White House report.

On Nov. 5, Gov. Tony Evers pleaded with Wisconsinites to stay home. "Folks, this pandemic isn't happening someplace else or to somebody else," he said. "Wisconsinites in every corner of our state know firsthand the tragedy and loss of this virus." Currently, one out of every three people tested in Wisconsin are positive for COVID.

So far, seven states have walked back some reopening measures, trying to once again control their outbreaks.

One of the biggest reasons the U.S. has reached 10 million cases, experts say, is that states have largely been left on their own to fight the virus.

"We got here because we really have not had a national strategy. We really never did the things that needed to be done to decrease transmission," says Carlos Del Rio, MD, a distinguished professor of medicine in the Division of Infectious Diseases at Emory University School of Medicine in Atlanta.

"When you have a virus, which is easily transmissible with people with person-to-person contact, and you only shut down for a short period of time and then you rapidly open, and you didn't put in place mitigation strategies that were necessary to put in place, the result you get is exactly what we're getting. I mean this is not surprising," he says.

Dire Predictions Bear Out

In early July, the University of Washington's Institute for Health Metrics and Evaluation predicted we'd have more than 208,000 deaths by Nov. 1 if the U.S. followed its current trajectory. Instead, we hit 226,000 deaths that day, according to data collected by the Johns Hopkins Coronavirus Resource Center.

The higher count likely reflects about 65% of the American public consistently wearing masks, instead of the more ideal 95%. People on average are also far more mobile than they were in the spring. In March, during the nationwide lockdown, cellphone data showed the U.S. at about 50% of its normal activity. Currently, we're at about 80% of normal, according to data from the institute.

Along with a relaxing of COVID-19 restrictions, people have also lacked clear, consistent, truthful communication from the federal government.

With the nation facing record-high unemployment rates after the lockdown, President Donald Trump cast public health measures against the virus as harmful to the U.S. economy, pitting the nation's health against its pocketbooks.

An epidemic of mental health problems has followed the pandemic, with 62% of Americans saying they feel more anxious than they did at the same time last year, according to a recent poll by the American Psychiatric Association. Studies show alcohol use has spiked, as isolation and stress take a toll.

"We cannot let the cure be worse than the problem itself," Trump wrote in a March 22 Tweet.

In reality, countries that have controlled their outbreaks promptly have reopened their economies more quickly.

The Trump administration also muzzled the CDC, the very agency that had developed a play-by-play response plan for a pandemic virus. The last CDC news briefing, held in late October, was the agency's first in 2 months.

News briefings on the pandemic from the White House Coronavirus Task Force and the Department of Health and Human Services have also been infrequent.

"Instead of seeing the pandemic as an important public health issue, the president and many of his advisers saw the pandemic as a political public relations issue, where their goal was to provide messages to the public that would portray the president positively," says Gary Kreps, PhD, director of the Center for Health and Risk Communication at George Mason University in Fairfax, VA.

As a result, a steady stream of false messages were communicated to the public, he says, downplaying the virus and discouraging public health practices, including claims that there were minimal risks, the pandemic would go away, things were getting better, there was no need to follow prevention guidelines, and that it was safe to reopen, Kreps says.

"Worse," he says, "the president suggested that following prevention guidelines, such as social distancing and wearing masks, were un-American and the guidelines were violating individual rights. He violated guidelines regularly himself, providing a very bad role model for Americans."

After failing to follow public health guidelines, Trump caught COVID, as did his wife and son and some two dozen others who worked in the White House or attended meetings there, according to reporting by The New York Times.

To rein in the virus, Kreps says we need "clear, accurate and consistent information about how to curtail the spread of the virus." Previous false messages have to be corrected, and public figures have to demonstrate their firm commitment to strictly following these guidelines.

Still Possible to Flatten the Curve

As the U.S. continues to see increases in its COVID cases and deaths, industries struggle, and millions of students are stuck home as their schools stay closed, countries in Asia are cautiously opening up again. In late October, Taiwan marked its 200th day without a locally transmitted COVID case. New Zealand, which eradicated local transmission of COVID in April, has seen only sporadic cases crop up since. Australia was preparing to reopen closed borders as cases transmission died down there.

"This is great news for families, especially in the lead-up to Christmas," South Australian Premier Steven Marshall said at a news briefing.

Experts say 10 million doesn't have to turn into 20 million in the U.S. Our fate as a nation has not been sealed. There is still time to stop the spread of the virus while we wait for an effective and safe vaccine by following tried and true public health measures such as washing your hands frequently, wearing a mask, and social distancing.

Testing is more widely available than it was in the spring, with shorter wait times for results. If proven effective, experts believe a vaccine could be authorized for use by the end of the year and more widely available in the spring.

"I hope it gives a humility to recognize that this was a preventable tragedy and that everything must be done to ensure that a) we can try to get out of this as quickly as possible and b) structures must be fundamentally changed to ensure that something like this never happens again," says Tworek, the University of British Columbia professor.


Viviana Martinez-Bianchi, MD, director for health equity, Department of Family Medicine and Community Health, Duke University, Durham, NC.

Heidi Tworek, PhD, associate professor of history and public policy, University of British Columbia, Vancouver.

Carlos Del Rio, MD, distinguished professor of medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta.

Gary Kreps, PhD, director, Center for Health and Risk Communication, George Mason University, Fairfax, VA.

Johns Hopkins Coronavirus Resource Center, Accessed Nov. 6, 2020.

News release, Institute for Health Metrics and Evaluation, July 7, 2020.

Institute for Health Metrics and Evaluation: "COVID-19 Projections," Nov. 6, 2020.

Wisconsin Department of Health Services: "COVID-19: Wisconsin Summary Data," Nov. 6, 2020.

News release, Colorado Gov. Jared Polis, Nov. 5, 2020.

BBC News: "Dr. Fauci: Covid vaccine result could come by end of 2020."

American Psychiatric Association: "New APA Poll Shows Surge in Anxiety Among Americans Top Causes Are Safety, COVID-19, Health, Gun Violence, and the Upcoming Election."

Yahoo! News: "Australia has one local COVID-19 case as two New Zealand health workers test positive."

The bmj opinion: "Bill Boland: How has New Zealand been so successful in managing covid-19?"

The New York Times: "Tracking the White House Coronavirus Outbreak."


Journal of the American Medical Association: "Changes in Adult Alcohol Use and Consequences During the COVID-19 Pandemic in the US."

Twitter: @realDonaldTrump, March 22, 2020.