Less than three months ago, the U.S. reached 700,000 COVID-19 deaths, and public health experts mused over whether the toll would reach a once-unthinkable 1 million.
Now the nation has surpassed 800,000 coronavirus deaths as 1,200 Americans die from the coronavirus every day, the delta variant drives an infections spike and the ominous omicron variant races around the world.
“There is no question that we will reach 1 million deaths sooner rather than later,” Robert Glatter, an emergency medicine physician at Lenox Hill Hospital in New York City, told USA TODAY in an interview. “At the current trajectory we may reach it much sooner than expected, with cases, hospitalizations and deaths significantly increasing in the past two months.”
Such a death toll may be inevitable, but “we can still do a lot within our means to prevent that from happening,” said Ogbonnaya Omenka, an assistant professor and director of diversity at the Butler University College of Pharmacy and Health Sciences.
Glatter and Omenka emphasized a recurring theme: Vaccination is the key to curbing the trajectory. But other mitigations will be required.
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Experts cringe at what winter could bring. The flu is already spreading through some communities. The coronavirus causes about 100,000 new COVID-19 cases a day in the U.S. The delta surge hasn’t peaked, and here comes omicron.
Masking indoors and even at large outdoor events, vaccinations and booster shots, and testing if sick or exposed may be the only hope for avoiding the looming triple threat of the flu, the variants – and the holidays.
“The potential for a catastrophic surge of deaths looms large this winter,” Glatter said. “The outlook … looks bleak at best.”
Authorities are paying attention. Tighter U.S. travel restrictions kicked in this month. New York Mayor Bill de Blasio unveiled a vaccine mandate requiring 184,000 businesses across the city to have all of their workers vaccinated starting Dec. 27.
“Even before omicron, we were worried about the cold-weather months and the holiday gatherings,” de Blasio said. “Before we heard the word ‘omicron,’ we saw the troubling trendlines.”
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Omicron, the latest “variant of concern” as described by the World Health Organization, is drawing a lot of attention. There are signs that vaccinated people have some protection. Pfizer announced that lab tests indicate a third dose of its vaccine provides neutralizing antibodies against omicron similar to the level observed after two doses against the original coronavirus and other variants.
Glatter said that, as omicron poses an increasing threat, Americans need to receive all three doses to prevent transmission, breakthrough infections, severe disease and hospitalizations.
Even that conditional good news comes with a warning.
“The variant is circulating in vaccinated persons and could adapt in the future to ‘outsmart’ the vaccine’s antigen cocktail,” said Melissa Nolan, an assistant professor of epidemiology and biostatistics at the University of South Carolina Arnold School of Public Health. That could make the “omicron variant in February 2022 more infectious in vaccinated persons than today.”
Atul Nakhasi, a primary care physician at Martin Luther King Jr. Outpatient Center in South Los Angeles, said the goal in the fight against COVID-19 is the same as every fight in health science: to alleviate human suffering.
Historical advances have been made toward detecting early cancers, decreasing preventable heart attacks and treating HIV to the point where people can live a normal and full life. COVID-19 is the latest in a long line of similar targets that medical science must vanquish or neutralize, Nakhasi said.
“That is the remarkable feat of science, and I have no doubt science will and can do the same now for the pandemic,” Nakhasi told USA TODAY. “Our goal is to turn deadly COVID into the COVID cold. I think we can do it.”
Help could be on the way. Until recently, the only available treatment was monoclonal antibodies, which must be delivered through a shot or infusion. Health care providers may soon get another treatment option – a federal advisory committee recommended that the FDA authorize the first antiviral oral pills to treat COVID-19, called molnupiravir from Merck and Ridgeback Biotherapeutics.
“Just as with the flu, vaccines prevent sickness, hospitalization, death and transmission,” Nakhasi said. “Yet we also have Tamiflu for treatment, too. Similarly, it is great news to have effective pill treatments potentially soon available.”
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More and better treatment options for unvaccinated, high-risk people are being developed every day, Nolan said.
Collectively, these give promise to lower overall mortality risk – and lower the risk of more dangerous variants. When an unvaccinated, immunosuppressed person is infected with SARS-CoV-2, the virus mutates more quickly.
Treatments such as the Merck pill not only lower the chance of death but also lower the chance of variants, Nolan said.
The nation must proceed with “cautious optimism,” regardless of the experimental results, until treatments prove successful against the disease, Omenka said. The clinical approach alone – vaccines and medications – won’t be enough to combat an infectious disease, he said.
A hybrid approach of clinical and of public health practices such as hand washing and face covering remains the most viable method, he said.
“It’s understandable, the eagerness to identify a sort of ‘golden bullet’ for the disease,” Omenka said. “However, the drugs are aimed at mitigating the severity of the disease, not preventing or curing it.”
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Nolan said clinicians and public health officials look beyond the numbers and are devastated by every death. Hoping to avoid the 1 million milestone, they are “saddened” to see low vaccination rates among some groups and in some areas – rates helping to drive the toll ever higher, she said.
“We hope to gain these groups’ trust for future vaccination interventions,” she said.
Who are the people in these groups? An encouraging study by researchers from Carnegie Mellon University and the University of Pittsburgh found that vaccine hesitancy decreased among U.S. adults by one-third from January to May. The largest decrease in hesitancy during the period, by education group, was in those with a high school education or less. Vaccine hesitancy decreased across virtually all racial groups, most markedly among Black Americans.
People in counties with higher support of Donald Trump in the 2020 presidential election showed higher hesitancy. Other studies indicate that since May, people in Trump-dominated counties have been nearly three times as likely to die from COVID-19 as those who live in areas that went for Joe Biden as president.
Such findings highlight “the politicization of public health recommendations,” said Wendy King, associate professor of epidemiology in Pitt’s Graduate School of Public Health and a co-author of the Pitt-CMU study.
Nakhasi said most scientists and physicians believe the world must co-exist with COVID-19. It’s an infection our children, grandchildren and great grandchildren will need to be protected from – and vaccinated against, he says.
The scourge won’t end with omicron. Viruses are designed to “outsmart our immune system and vaccines,” Nolan said. More vaccinated people are needed to slow the mutation rate of variants, she added.
“There will be more variants in the future,” Nolan said.
Glatter said new variants could shift the pandemic to an even more dangerous phase.
“As long as we don’t aggressively vaccinate the global community, we are looking at several more years of pain and suffering,” he said. “Not to mention the economic effects imposed by travel bans as well as supply chain disruptions. It’s in everyone’s best interest to get vaccinated and boosted.”
Nolan said that every day, the nation grows closer to a form of normalcy. She said she hopes that by summer, Americans will be able to freely travel and mingle, maskless, with friends and family.
Experts said winning the battle against vaccine hesitancy is crucial to whatever “normal” becomes. Now more than ever, being fully vaccinated means having three doses of the mRNA vaccines or two doses of the single-shot Johnson & Johnson vaccine, Glatter said.
How long will the boosters last? Will Americans be urged to get the shots forever?
“If I could look into the crystal ball, I would anticipate another round of boosters would be needed before next summer,” Nolan said. “Within the next year, I believe we will be to a point of annual, once-a-year boosters.”
Nakhasi said it’s crucial for everyone to have “the conversation” with loved ones, family members and friends who are not vaccinated. Including eligible children and adults, he estimated that more than 75 million Americans remain unvaccinated.
“You never know when a conversation could save someone’s life. Let’s have 75 million conversations this holiday season,” he said. “In the hospital right now, taking care of several COVID-19 patients, that’d be my one Christmas wish for our country.”