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In U.S., New Trends Fuel Coronavirus Resurgence

As the United States reports record-high case totals, patterns in viral spread are emerging.



Across the country, states are reporting record increases in daily coronavirus case totals. (Map by Direct Relief)
As coronavirus cases surge across the United States, officials scramble to roll back reopening measures in a renewed effort to contain the spread of Covid-19. The reverse course comes as record-breaking case totals threaten to overwhelm hospital systems in several states, including Texas, Florida, Arizona, and California. While the United States managed to “flatten the curve” in May through nearly universal stay at home orders, case totals plateaued at a relatively high level. Now, as preventative measures, such as mask wearing, are being met with controversy, leveling the curve may be more difficult. “I think we’re in a much more challenging environment now in terms of compliance with these orders,” says Direct Relief’s head of Research and Analytics Andrew Schroeder. “So, that’s going to make it so that the tools that are in our toolkit are potentially more limited than they were the first time around.” On this episode of the podcast, we speak with Schroeder about the trends behind the recent outbreak and what we can expect as the pandemic progresses, from reopening economies to rolling out mass vaccination campaigns. Interview Transcript: AMARICA RAFANELLI: Based on what we’ve observed over the last three months, in terms of infection rates and hospitalizations, where are we at today in the pandemic? ANDREW SCHROEDER: I think we’re at a somewhat worse position than we were at the peak of New York’s epidemic. We’re seeing places like Phoenix, Arizona, and Houston, Texas, which are basically at new York’s rates of case increase and hospitalization and with similar threats to health systems being overwhelmed because we’re basically out of hospital beds and things like this. These are very high population states and you’re seeing a much larger area being impacted, including many areas that are more rural and have much lower resource levels, than what we were seeing when you had epidemics that were concentrated in large cities, more or less exclusively in the first phase around New York, New Jersey, Boston, et cetera. That’s very concerning. I think the thing that’s kind of linked to that is that this outbreak phase happened after we’ve already gone through a lot of these debates around the political will to maintain social distancing and to maintain non-pharmaceutical interventions like mask wearing, and where there’s been this kind of eruption of controversy throughout the areas principally that are being affected right now. Whereas in March and April this was a much newer set of events and we had a willingness for a good, at least six-week period in many places, to lock down, have enforced stay at home orders of various kinds and to begin rolling out recommendations around mask wearing and things like this. I think we’re in a much more challenging environment now in terms of compliance with these orders. So, that’s going to make it so that the tools that are in our toolkit are potentially more limited than they were the first time around. So, the risk factors question is really, really important to factor in right now. In Texas and Florida, you have a disproportionate number of cases that are being reported that are outside of the principle risk group. You’re talking about high numbers of people in their twenties, thirties, and forties that are being reported now. The good news about that is that they’re less likely to die as a result of the disease. So, even if they’re hospitalized, they’re more likely to recover. You know, the CDC estimates that that’s probably just the tip of the iceberg in terms of total cases, though. The estimates that they’re putting out publicly is that it’s probably 10 times beyond in terms of cases that are detected versus cases that are not detected. There’s 10 not detected for every one detected. So you’re talking about a large number of people that are either asymptomatic or are in a low risk group that are testing positive. These people are all potentially passing the virus over time to people that are in higher risk groups, as you get higher numbers of contacts. And the areas where you see the outbreaks occurring now are the areas that, without question, have the greatest preexisting health vulnerabilities in the entire country. Throughout the South, there are the highest rates of diabetes, hypertension, heart disease, obesity. You name it, you name the problem, and it’s worse in the South. Also just many disproportionately older communities. These are Sunbelt communities that have a high number of retirees, rural communities that trend disproportionately older, just because you’ve had younger people that have moved to cities. RAFANELLI: So, what explains these trends in terms of the spread of the virus and these recent, uh, surges in cases in these places like Florida and Texas.
SCHROEDER Well, to be quite honest, I think the main thing that explains it is reopening the economy. Most of these places did have a period of social distancing that happened in March and April early May. By early May the will to maintain those distancing orders really kind of dissipated and you had a fairly rapid shift in most places towards reopening areas of the economy that meant reopening bars and restaurants, reopening public spaces, having more people going back into offices, on and on and on. And so there’s a time lag in a lot of these phenomenon. We were warning at the time when this happened that there’s a certain amount of time that’s required for contacts to happen. And then a certain amount of time for viral contact to turn into symptoms. And then another time lag between symptoms and potentially serious health consequences, including hospitalization. Right now we’re in the window where we’re seeing the accumulation of the consequences of a series of reopening actions that have been taken throughout much of the Southern United States. I think one of the things that explains it potentially is a reverse winter effect in really hot parts of the country. We’ve been told that maybe summer would be better than winter because people can be outside and viral contacts are lower outside, but in places like Arizona, it’s extraordinarily hot right now. And people that have gone back to work or in bars and restaurants, et cetera, are really inside air-conditioned spaces and those air-conditioned spaces are really challenging for viral spread. You know, it’s recycled air. It’s all the kinds of things you would be worried about in the winter, only in this case, it’s just very hot and they’re in air conditioning. That probably plays some role in this. RAFANELLI: Does that mean that reopening the economy and containing the spread of the virus are mutually exclusive? SCHROEDER: No. The problem, honestly, is that we have done a poor job of following the lead of what other countries have done well. So, there’s a formula to this, and we’ve been saying this literally for months now, and I don’t think the message has changed much. It’s test, trace, isolate and you can reopen the economy. So, you have to test a lot of people. The virus is good at hiding and finding a reservoir population and having people that are passing the virus based upon asymptomatic context. The only way you find that is through a widespread testing program. When you test people that are positive, then you need to have contact tracing that follows their contacts and then identifies whether or not they have passed the virus to others. And if you find those people, then you need to isolate them and make sure that they are able to go through their quarantine period and not pass the virus to anybody else. And then on top of that, add in things like mask wearing, which has been shown to reduce the likelihood of passing the virus by 60 to 70%. So that’s just arithmetic, right? You have everyone wear masks, you reduce the contacts by 60, 70%. That takes a huge percentage out right off the top. And then through test, trace and isolate, you can get very specific about who is able to be in a public space and that combination has simply not been followed in the United States, especially in the South, or it has been followed in parts of the United States, but not unilaterally, and the South has been the worst. This is the thing that people have gotten totally backwards to: The economic consequences, in many ways, lagged the virus, so people are not avoiding economies because of the shutdown orders, they’re avoiding it because of the virus. So the more the virus now goes out of control under conditions where people are being told, ‘Yes, go back out in public, et cetera and don’t worry about the shutdown orders,’ the more you’re going to create worse economic problems down the road because people will have no choice, but to lock down even harder in the future. Given that the only other choice to that is mass hospitalization and death. Period. RAFANELLI: So given this surge in cases, does the United States still face supply problems in terms of PPE and hospital capacity issues? SCHRODER: I think that’s a really good question, actually. And I think it’s an interesting point that so far we have not seen this same concern over PPE shortages and ICU supply shortages or ventilator shortages, things like that, that we saw it back in March in April and early May. Why? I’m not totally sure. Maybe it just hasn’t surfaced enough yet. We’re just now starting to really read about the threat to the hospital system in Texas. So, maybe we’ll get there within about a week. It’s also possible that we’re in a different set of conditions than we were when we had gone through the earlier supply shortages. For instance, China, back in March, was still in lockdown. China is still where most of the PPE is manufactured. So that changed the conditions for accessing PPE back in March and April, just taking Chinese manufacturing offline in this way. That’s just not the case anymore. So, the ability to manufacture PPE is at a higher level now than it was in March. I’m sure that affects some of these supply questions. RAFANELLI: Looking way ahead, when the vaccine arrives, do you think that the United States is going to have the ability to widely distribute it? SCHROEDER: The United States has a pretty effective vaccination system now. As long as people follow through with getting vaccinated. So, if you compare it to like something like measles vaccination, or flu vaccination, the reason why we have variances in vaccination rates in the United States is generally not because we don’t have the capacity to store, transmit and or transport and administer the vaccine, it’s because people choose not to get vaccinated for whatever reason. I think the other question could be cost. So, if the COVID vaccine is expensive and it’s not being covered by insurance, or it’s only partially being covered by insurance, you could see gaps in vaccination purely due to the economics of healthcare. There’s a scenario where none of that happens and where the vaccine is basically given away for free and we have a kind of widespread mass vaccination program throughout the country. I kind of don’t see that scenario panning out under the current circumstances, but who knows. The vaccination campaigns would probably start earliest about 12 to 18 months from now. The earliest, anyone is saying that a vaccine would be developed is by end of this year, beginning of next year, and then it still has to go through safety trials. So, before you’re talking about actually getting a mass vaccination campaign of American citizens going, yeah, you’re still quite a ways out. This transcript has been edited for clarity and concision.

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