The good news: The United States has a window of opportunity to beat back Covid-19 before things get much, much worse.
The bad news: That window is rapidly closing. And the country seems unwilling or unable to seize the moment.
Winter is coming. Winter means cold and flu season, which is all but sure to complicate the task of figuring out who is sick with Covid-19 and who is suffering from a less threatening respiratory tract infection. It also means that cherished outdoor freedoms that link us to pre-Covid life — pop-up restaurant patios, picnics in parks, trips to the beach — will soon be out of reach, at least in northern parts of the country.
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Unless Americans use the dwindling weeks between now and the onset of "indoor weather" to tamp down transmission in the country, this winter could be Dickensianly bleak, public health experts warn.
"I think November, December, January, February are going to be tough months in this country without a vaccine," said Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.
It is possible, of course, that some vaccines could be approved by then, thanks to historically rapid scientific work. But there is little prospect that vast numbers of Americans will be vaccinated in time to forestall the grim winter Osterholm and others foresee.
Human coronaviruses, the distant cold-causing cousins of the virus that causes Covid-19, circulate year-round. Now is typically the low season for transmission. But in this summer of America's failed Covid-19 response, the SARS-CoV-2 virus is widespread across the country, and pandemic-weary Americans seem more interested in resuming pre-Covid lifestyles than in suppressing the virus to the point where schools can be reopened, and stay open, and restaurants, movie theaters, and gyms can function with some restrictions.
"We should be aiming for no transmission before we open the schools and we put kids in harm's way — kids and teachers and their caregivers. And so, if that means no gym, no movie theaters, so be it," said Caroline Buckee, associate director of the Center for Communicable Disease Dynamics at Harvard's T.H. Chan School of Public Health.
"We seem to be choosing leisure activities now over children's safety in a month's time. And I cannot understand that tradeoff."
While many countries managed to suppress spread of SARS-CoV-2, the United States has failed miserably. Countries in Europe and Asia are worrying about a second wave. Here, the first wave rages on, engulfing rural as well as urban parts of the country. Though there's been a slight decline in cases in the past couple of weeks, more than 50,000 Americans a day are being diagnosed with Covid-19. And those are just the confirmed cases.
To put that in perspective, at this rate the U.S. is racking up more cases in a week than Britain has accumulated since the start of the pandemic.
Public health officials had hoped transmission of the virus would abate with the warm temperatures of summer and the tendency — heightened this year — of people to take their recreational activities outdoors. Experts do believe people are less likely to transmit the virus outside, especially if they are wearing face coverings and keeping a safe distance apart.
But in some places, people have been throwing Covid cautions to the wind, flouting public health orders in the process. Kristen Ehresmann, director of infectious disease epidemiology, prevention, and control for the Minnesota Department of Health, points to a large, three-day rodeo that was held recently in her state. Organizers knew they were supposed to limit the number of attendees to 250 but refused; thousands attended. In Sturgis, S.D., an estimated quarter of a million motorcyclists were expected to descend on the city this past weekend for an annual rally that spans 10 days.
Even on smaller scales, public health authorities know some people are letting down their guard. Others have never embraced the need to try to prevent spread of the virus. Ehresmann's father was recently invited to visit some friends; he went, she said, but wore his mask, elbow bumping instead of shaking proffered hands. "And the people kind of acted like, … 'Oh, you drank that Kool-Aid,' rather than, 'We all need to be doing this.'"
Ehresmann and others in public health are flummoxed by the phenomenon of people refusing to acknowledge the risk the virus poses.
"Just this idea of, 'I just don't want to believe it so therefore it's not going to be true' — honestly, I have not really dealt with that as it relates to disease before," she said.
Buckee, the Harvard expert, wonders if the magical thinking that seems to have infected swaths of the country is due to the fact many of the people who have died were elderly. For many Americans, she said, the disease has not yet touched their lives — but the movement restrictions and other response measures have.
"I think if children were dying, this would be … a different situation, quite honestly," she said.
Epidemiologist Michael Mina despairs that an important chance to wrestle the virus under control is being lost, as Americans ignore the realities of the pandemic in favor of trying to resume pre-Covid life.
"We just continue to squander every bit of opportunity we get with this epidemic to get it under control,'' said Mina, an assistant professor in Harvard's T.H. Chan School of Public Health and associate medical director of clinical microbiology at Boston's Brigham and Women's Hospital.
"The best time to squash a pandemic is when the environmental characteristics slow transmission. It's your one opportunity in the year, really, to leverage that extra assistance and get transmission under control," he said, his frustration audible.
Driving back transmission would require people to continue to make sacrifices, to accept the fact that life post-Covid cannot proceed as normal, not while so many people remain vulnerable to the virus. Instead, people are giddily throwing off the shackles of coronavirus suppression efforts, seemingly convinced that a few weeks of sacrifice during the spring was a one-time solution.
Osterholm has for months warned that people were being misled about how long the restrictions on daily life would need to be in place. He now thinks the time has come for another lockdown. "What we did before and more," he said.
The country has fallen into a dangerous pattern, Osterholm said, where a spike in cases in a location leads to some temporary restraint from people who eventually become alarmed enough to start to take precautions. But as soon as cases start to plateau or decline a little, victory over the virus is declared and people think it's safe to resume normal life.
"It's like an all or nothing phenomenon, right?" said Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases. "You all locked down or you get so discouraged with being lockdown that you decide you're going to be in crowded bars … you can have indoor parties with no masks. You can do all the things that are going to get you in trouble."
Osterholm said with the K-12 school year resuming in some parts of the country or set to start — along with universities — in a few weeks, transmission will take off and cases will start to climb again. He predicted the next peaks will "exceed by far the peak we have just experienced. Winter is only going to reinforce that. Indoor air," he said.
Buckee thinks that if the country doesn't alter the trajectory it is on, more shutdowns are inevitable. "I can't see a way that we're going to have restaurants and bars open in the winter, frankly. We'll have resurgence. Everything will get shut down again."
Fauci favors a reset of the reopening measures, with a strong messaging component aimed at explaining to people why driving down transmission now will pay off later. Young people in particular need to understand that even if they are less likely to die from Covid-19, statistically speaking, transmission among 20-somethings will eventually lead to infections among their parents and grandparents, where the risk of severe infections and fatal outcomes is higher. (Young people can also develop long-term health problems as a result of the virus.)
"It's not them alone in a vacuum," Fauci said. "They are spreading it to the people who are going to wind up in the hospital."
Everyone has to work together to get cases down to more manageable levels, if the country hopes to avoid "a disastrous winter," he said.
"I think we can get it under much better control, between now and the mid-to-late fall when we get influenza or we get whatever it is we get in the fall and the winter. I'm not giving up," said Fauci.
But without an all-in effort "the cases are not going to come down," he warned. "They're not. They're just not."