A third and formidable wave of the coronavirus pandemic is crashing in the Bay Area, and it is possibly the most demanding test yet of the regional resolution that has never tamed the virus, but has until ‘now prevented much of the most dreaded deadly devastation.
Coronavirus cases are increasing at a faster rate than ever before, even during the summer wave that halted attempts to reopen California. Meanwhile, conditions to fight the virus are poor: the cold, rainy season that will bring everyone indoors is just beginning, and the winter holidays will almost certainly bring people together despite calls. repeated not to do so. Thanksgiving, which could prove to be the most difficult challenge of a pandemic day, is just days away.
State and local public health officials are applying increasingly aggressive measures to slow the spread of the current and prevent another complete shutdown. As of Saturday, nearly 95% of the state’s residents were under a month-long curfew imposed by Governor Gavin Newsom. San Francisco public health officials said on Friday that they plan to fall under this curfew soon and that another shelter-in-place order was possible.
However, healthcare providers and public health experts are preparing. And they ask themselves a crucial question: Is the Bay Area determined to flatten the curve again, or will it be the surge that overwhelms hospitals and causes hundreds of preventable deaths?
“It will be the worst wave yet. And I don’t think we’ve realized or internalized this yet, ”said Dr Andra Blomkalns, director of the department of emergency medicine at Stanford. “I compare it to hurricanes: you see it coming, you know it’s coming, but you might think that it won’t hit you directly, and maybe the winds won’t be as bad as it is. we say so.
“We need to prepare for a Category 5 hurricane,” she said. “Preparing for anything less than this makes no sense.”
The difference between a hurricane and a pandemic wave, she said, is that human behavior can change the course of that storm. And it all depends on Thanksgiving: Whether people can squat and skip one of America’s most popular vacations may decide how fast and how high this wave is, and how long its peak is.
If people follow calls from public health officials and avoid gatherings of family and friends, the Bay Area and the state can roll back cases, or at least keep them stable. If they ignore the advice, if they sit down for a long family meal this Thursday with nieces and nephews and grandparents and cousins, the repercussions could continue until the end of the year.
“It will depend on the choices people make,” said Dr. Michael Vollmer, infectious disease expert and co-chair of the Kaiser Permanente regional infection control committee. “This will affect the height of this outbreak, the number of people infected and the duration of this increase.”
This third wave of coronavirus has raged across almost the entire country over the past month, pushing the total reported cases to over 12 million on Saturday. For a while, it looked like California could escape relatively unscathed. But as the country reported record highs day after day – over a million cases per week and nearly 200,000 as of Friday alone – it became clear that California was not so safe after all.
Average daily cases nearly doubled in November from the previous month, both for the state as a whole and in the Bay Area. The total number of cases for the seven days ending Nov. 20 is up 50% from the previous week in the state and 25% for the region.
The state has already passed the peak of the summer surge, and the Bay Area is also approaching its summer highs. This third wave, Newsom said on Monday, when he pulled the “emergency brake” on plans to reopen the state, “is simply unprecedented in the history of the California pandemic.
The difference between the current rate of increase and what has been reported in previous waves “is mind-boggling,” said Dr Peter Chin-Hong, an infectious disease expert at UCSF. “It’s like you’re on the biggest roller coaster in Six Flags this time around rather than one of the children’s roller coasters.”
Hospitals are feeling the strain. More than 500 people are hospitalized with COVID-19 in the Bay Area and the number is steadily increasing. Nearly 5,000 people are hospitalized statewide – more than double the number a month ago.
Deaths have yet to start climbing, but public health experts say it is inevitable, even if the state manages to temper the latest torrent. About 18,700 people have died from COVID-19 in California, including about 1,900 in the Bay Area. Models suggest that in the best-case scenario, fewer than 2,000 more Californians will die by the end of the year. The worst-case scenario is an additional 7,000 deaths.
“California is on the rise. We’re still better than the rest of the country, but we might be right behind them. They can foreshadow where we are heading, ”said Dr Ori Tzvieli, deputy director of health for Contra Costa County. “We still have the ability to take measures that interrupt transmission. We started this wave in a better place than the rest of the country, which saved us a bit of time. But this time flies. “
Thanksgiving is most important as California and the Bay Area seek to contain the current spread. But that’s not the only challenge. Cold weather will make outdoor events less appealing in the coming weeks, leading to some indoor gatherings, where the virus is more easily spread.
Cold and flu season, although it may be alleviated this year by the same behaviors intended to reduce the spread of the coronavirus, could stress health care resources, including testing supplies and room beds. emergency. Healthcare staffing could also be an issue if providers fall ill with normal seasonal respiratory viruses.
Public health experts said the global nature of the national boom presented a unique resource problem. Previous outbreaks have been isolated in one or two corners of the country. Now, the need for personal protective equipment and ventilators – even nurses and doctors – is consistently high and states are unable to support each other.
“The first two waves were mainly regional. When an area was booming, we were able to move resources, ”Chin-Hong said. “Now the whole country is on fire. What are you doing then? Who will help us? Canada?”
Chin-Hong echoed other public health experts who are also concerned about President Trump’s turbulent transition of power to President-elect Joe Biden, which is compounding what has already been a chaotic national response to the pandemic. The Trump administration has refused to work with the Biden coronavirus preparedness team.
The complications resulting from this lack of cooperation “cannot be overstated,” Chin-Hong said.
Public health experts are also concerned about pandemic fatigue, which has led even the most docile Californians to relax their behaviors. With more viruses in the community now, that leaves even less room for error.
“People are not careful and they are tired, and I understand that,” said Dr Yvonne Maldonado, infectious disease specialist at Stanford. “It’s just that the risk has increased. When you start saving money here and there, and the virus begins to infiltrate different parts of the country, your risk is simply higher. “
She and Blomkalns said they spoke to infected patients after meeting in small groups – a couple of children at a sleepover or a reunion with two households who moved inside. They are not necessarily weddings or birthdays.
“People will say, ‘But I’ve been so good for so long. I was perfect, ”said Blomkalns.
The next month and a half will likely be one of the darkest weeks in the pandemic. If Thanksgiving dinners produce a wave of new cases, as feared by so many infectious disease experts, those cases will result in an influx of hospital patients around mid-December and an increase in deaths over Christmas and New Years Day. ‘Year. And it is possible that this surge will not only be the worst, but it will persist much longer than the others.
Still, there is cause for hope.
“If I can get the vaccine for Christmas, I’ll be really excited,” Chin-Hong said with a laugh.
It is not an unreasonable expectation. Pharmaceutical companies have shown two vaccines to be highly effective in clinical trials and could gain federal approval in late November or early December. The first doses, many for healthcare providers, could be released before the end of the year.
These vaccines and others likely won’t be widely available until spring or summer, according to federal public health experts. But that does mean that the end of this pandemic, while still distant, is at least in sight. People who can keep tabs on this award over the next few weeks can feel their resolve hardening. The altered vacations and cold weather, loneliness and all-pervading pandemic fatigue, could be easier to bear.
“We’ve never had a light at the end of the tunnel before,” said Blomkalns. “It will be a good six months before everyone can get vaccinated, but the light is here.”