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Ohio has had an “unprecedented spike” in Covid-19 hospital admissions. ICU beds in Tulsa, Oklahoma, are full. North Dakota’s hospitals don’t have enough doctors and nurses. And hospital administrators in Iowa are warning that they are approaching their limits.

The U.S. is heading for a “dark winter,” a “Covid hell,” the “darkest days of the pandemic.” However you describe it, the next few months of the coronavirus pandemic will be unlike anything the nation has seen yet.

Even as drug manufacturers make progress on a vaccine and treatments, epidemiologists, scientists and public health officials are warning that the United States has yet to see the most difficult days of the outbreak. Those are projected to come over the next three to four months.

“What America has to understand is that we are about to enter Covid hell,” Dr. Michael Osterholm, director of the Center of Infectious Disease Research and Policy at the University of Minnesota, said in an interview with CNBC’s “Squawk Alley” on Monday, hours after Pfizer announced promising news about its vaccine. “It is happening.”
Osterholm, who was appointed to President-elect Joe Biden’s coronavirus advisory board, correctly predicted months ago that there would be an “astronomical” increase in new cases after Labor Day. He now says “this number is going to continue to increase substantially.”

“We have not even come close to the peak and, as such, our hospitals are now being overrun,” Osterholm said. “The next three to four months are going to be, by far, the darkest of the pandemic.”

The U.S. is now reporting an average of more than 120,000 new Covid-19 cases a day — a staggering number that sets a deadly tone heading into the holiday season, medical experts say. The sheer volume of new cases cannot be explained by increased testing alone, because daily new cases are outpacing the rise in testing, health officials acknowledge.

Cases are also rising at a faster pace, with a roughly 33% jump in the seven-day average over the past week, according to a CNBC analysis of data compiled by Johns Hopkins University. The number of people currently hospitalized across the U.S. also stands at record 61,964, according to the COVID Tracking Project, which is run by journalists at The Atlantic.

‘Worst days ahead’
The approaching holidays set the country up for a lethal winter and spring since hospitalizations and deaths lag newly diagnosed infections by a few weeks, said Dr. Isaac Bogoch, an infectious disease specialist at the University of Toronto.
“The upcoming holidays of Thanksgiving, Diwali, Christmas, Hanukkah and New Year’s the potential for innumerable super-spreading events across the country,” he said. “This has the potential to introduce and reintroduce the virus to new areas and to further exacerbate community transmission.”

More lives will be lost in December than the U.S. saw in March and April, said Ali Mokdad, a professor of global health at the Institute for Health Metrics and Evaluation at the University of Washington. The country was reporting around 20,000 to 30,000 new cases and more than 2,000 deaths a day this spring.
The Centers for Disease Control and Prevention is also warning that daily deaths are on the rise. It says “newly reported COVID-19 deaths will likely increase over the next four weeks, with 4,600 to 11,000 new deaths likely to be reported in the week ending” Nov. 28.

Based on current trends, Mokdad’s forecasting team, which has provided Covid-19 projections for the White House, estimates that the country will see more than 2,100 Covid deaths per day this winter. That figure could change if more restrictions are put in place to curb the spread of the virus or if state and local officials ease up.

‘Take over hospitals’
“Unfortunately, the worst days are ahead of us,” Mokdad said. “We are starting from a worse position, because we didn’t do a good job in the summer to bring it down and then we see right now a rapid rise in cases, so the surge of fall and winter has started. That’s why the worst days are ahead of us.”
To be sure, the U.S. has more tools to fight the virus than ever before. Pfizer and BioNTech released early data from their late-stage vaccine trial on Monday that indicated it was more than 90% effective. If authorized, the vaccine could be available to a limited number of people as early as December, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. Pfizer said it can make enough doses of its two-dose vaccine to immunize about 25 million out of roughly 331 million Americans before the end of the year.

Doctors also have an arsenal of treatments that weren’t available at the outset of the outbreak. Treatments like the antiviral drug remdesivir and the steroid dexamethasone have helped hasten recovery and save lives. But the outbreak today looks starkly different from what the U.S. was dealing with earlier in the pandemic. Cases are running so high that some hospitals are already operating at max capacity and setting up Covid-19 tents in Illinois, Texas and other parts of the country to handle the surge in patients.

“This virus is now spread across the entire United States. When the first surge came, it was localized to the Northeast in New England, New York, New Jersey. In the second wave, it was the South and Southwest,” said Dr. Megan Ranney, an emergency physician at Brown University. “But now we’re seeing it literally take over hospitals across the country.”
‘Bad in a different way’

In the spring and summer, the federal government marshaled scarce resources like personal protective equipment, ventilators and trained health workers to hard-hit areas New York, New Jersey, Florida and Texas. But now, with so many communities in dire straits, it won’t be easy to reallocate those resources, Ranney said.

The virus is quickly overwhelming parts of the country that weren’t hit all that hard this spring and summer, said Christine Petersen, an epidemiologist at the University of Iowa. In many rural states like Iowa, she said, hospitals and health workers aren’t equipped to handle a surge in Covid patients as large medical centers in bigger cities were earlier in the crisis.

While the medical community knows a lot more about how to effectively treat the disease than before, there’s still a steep learning curve for places that haven’t seen widespread outbreaks and don’t have a lot of experience treating the disease.
“That doesn’t mean that the doctor in northeastern Iowa has seen this disease. They’re seeing it now,” Petersen said.
She also said the outbreak is “going to be bad,” but in a different way than it was this spring in New York City.

“Instead of having these pictures of morgue trucks and densely populated areas with a lot of patients, this is going to be lots of smaller places,” she said. “So it’s going to be harder to see the obvious impact because it’s so spread out in these really small town hospitals, but they’re really going to be struggling.”

Exhaustion
New York City in the spring and Arizona in the summer got a lot of help from travel nurses and doctors who volunteered to treat patients in the hot spots. But with the virus surging everywhere across the country, there may not be a lot of idle medical workers ready to deploy to hard hit areas, said Dr. Lewis Kaplan, president of Society of Critical Care Medicine and a surgeon at the hospital of the University of Pennsylvania.

Health workers may be the next scarce resource in the pandemic, and many of the most experienced doctors and nurses are already exhausted, Kaplan said. He worries about whether they can keep up with the pace of the virus.

“We rely on having those seasoned individuals when we stand up novel ICUs again and have people who don’t normally work in the ICU work alongside them. The floor nurse is now going to provide critical care under the guidance of the seasoned ICU nurse,” he said. “What happens when that seasoned ICU nurse says, ‘I’ve had enough.’ That’s a potentially very scary future.”

Dr. Angela Hewlett, an infectious diseases specialist at the University of Nebraska Medical Center, said her hospital is “under a significant degree of stress” with beds filling up as fast as they are open. The hospital recently cleared an entire floor with 48 beds for Covid patients. That hit capacity in a matter of days, she said.

“This is not like a natural disaster where you can have this influx of health-care workers coming from all over to help manage this. Everyone is dealing with surges of patients with Covid-19, particularly here in the Midwest,” she said. “And so there’s not an emergency crew of health-care workers that will swoop down and come in and save us.”

 

*CNBC